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Sagar, G. Vidya-MCQs in Pharmacology-New Age International (P) LTD (2008) PDF
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Copyright © 2008, New Age International (P) Ltd., Publishers
Published by New Age International (P) Ltd., Publishers
Very useful book for students preparing for GATE & USMLE. Recommended reading.
Dr. Sanjay Pai
Al-Ameen college of Pharmacy
Bangalore.
This book will be of good use for students appearing for Competitive exams.
Presentation of the matter is good.
Prof. Y. Madhusudhan Rao
Univ. College of Pharmaceutical Sciences
Kakatiya University, Warangal.
FOREWORD
Medical & Pharmacy are fast growing professions with a wide range of opportunities open to the students after a basic
degree. These professions play a vital role in health care management.
This book will be of immense value for students to develop themselves as the meritorious & motivated candidates for
admission to post graduate courses like M.D., M.S. & M.Pharm.
I compliment the author for his pains-taking efforts in mobilizing a very large number of good MCQs from a vast
subject like Pharmacology. Adequate coverage of all topics is done.
I feel that this book will be a very useful companion for professional PG entrance examinations. I strongly recom-
mend this book to college library collection
I acknowledge the help rendered by the following well wishers during the preparation of the manuscript.
• Dr. Ananta Naik Nagappa
Professor, Pharmacy practice, Manipal College of Pharm. Sciences, Manipal, Karnataka.
• Dr. K. R. Mahadik
Principal, Bharati Vidyapeeth Deemed University’s College of Pharmacy, Pune.
• Prof. Vijay Raghunath Patil
Principal, Tapi Valley Education Society’s College of Pharmacy
Faizpur, Maharashtra.
• Dr. Havigiray R. Chitme
Professor of Pharmacology, Oman medical College, Oman
• Dr. Chandrakant S. Magdum
Vice Principal, Shri Appasaheb Birnale College of Pharmacy,
Sangli, Maharashtra.
• Dr. B. P. Nagori
Director, Lachchoo Memorial College of Pharmacy,
Jodhpur.
My sincere thanks are due to Mr. Ojas M. Suroo, Lecturer, Computer Science of my institute for his meticulous
typing the manuscript and the final format of the book.
Finally, I would like to place on record the generous help rendered by New age International (P) Limited,
Publishers in bringing out this book.
Preface (xi)
CHAPTER 1 1
General Pharmacology
CHAPTER 2 29
Drugs Acting on Central Nervous System
CHAPTER 3 85
Drugs Acting on Autonomous Nervous System
CHAPTER 4 103
Vitamins & Minerals
CHAPTER 5 107
Analgesics & Antipyretics
CHAPTER 6 121
Cardiovascular Drugs
CHAPTER 7 135
Drugs Used in Respiratory Disorders
CHAPTER 8 143
Antibiotics
CHAPTER 9 157
Drugs Used in Gastrointestinal Tract Disorders
CHAPTER 10 165
Oxytocics & Uterine Muscle Relaxants
CHAPTER 11 167
Chemotherapy
xiv
CHAPTER 12 193
Drugs used in Endocrine disorders (Hormones)
CHAPTER 13 207
ANTIDIABETICS
CHAPTER 14 211
Anticoagulants
CHAPTER 15 215
Antihyperlipedemic agents
CHAPTER 16 217
Antacids
CHAPTER 17 221
Antiemetics
CHAPTER 18 223
Match the Following
CHAPTER 1
GENERAL PHARMACOLOGY
1. All of the following are general (e) Distribution of a drug out of the bloodstream
mechanisms of drug permeation Except terminates the drug’s effect
(a) Aqueous diffusion 4. Distribution of drugs to specific tissues
(b) Aqueous hydrolysis
(a) Is independent of blood flow to the organ
(c) Lipid diffusion
(b) Is independent of the solubility of the drug in
(d) Pinocytosis or endocytosis that tissue
(e) Special carrier transport (c) Depends on the unbound drug concentration
2. If the plasma concentration of a drug gradient between blood and tissue
declines with “first-order kinetics”, this (d) Is increased for drugs that are strongly bound
means that to plasma proteins
(a) There is only one metabolic path for drug (e) Has no effect on the half-life of the drug
disposition
5. A physical process by which a weak acid
(b) The half-life is the same regardless of the becomes less water-soluble and more
plasma concentration lipid-soluble at low pH is
(c) The drug is largely metabolized in the liver
(a) Distribution (b) Elimination
after oral administration and has low
bioavailability elimination (c) First-pass effect (d) Permeation
(d) The rate of climination is proportionate to (e) Protonation
the rate of administration at all times 6. Dose-response curves are used for drug
(e) The drug is not distributed outside the evaluation in the animal laboratory and
vascular system in the clinic, Quantal dose-response
curves are often
3. Regarding termination of drug action
(a) Used for determining the therapeutic index
(a) Drug must be exerted from the body to
terminate their action of a drug
(b) Metabolism of drugs always increases their (b) Used for determining the maximal efficacy
water solubility of a drug
(c) Metabolism of drugs always abolishes their (c) Invalid in the presence of inhibitors of the
pharmacologic activity drug being studied
(d) Hepatic metabolism and renal excretion are (d) Obtained from the study of intact subject but
the two most important mechanisms involved not from isolated tissue preparations
2 MCQs IN PHARMACOLOGY
(a) Extends over a time period of at least 3 years (c) Physostigmine (d) Pilocarpine
in order to discover late toxicities (e) Neostigmine
(b) Requires the use of at least two primate 22. Phenylephrine causes
species, eg. Monkey and baboon
(a) Constriction of vessels in the nasal mucosa
(c) Requires the submission of histopathologic
(b) Increased gastric secretion and motility
slides and specimens to the FDA for
government evaluation (c) Increased skin temperature
(d) Has good predictability for drug allergy-type (d) Miosis
reactions (e) All of the above
(e) May be abbreviated in the case of some very 23. Pretreatment with propranolol will block
toxic agents used in cancer which one of the following ?
17. The “dominant lethal” test involves the (a) Methacholine-induced tachycardia
treatment of a male adult animal with a (b) Nicotine-induced hypertension
chemical before mating; the pregnant (c) Norepinephrine-induced bradycardia
female is later examined for fetal death (d) Phenylephrine-induced mydriasis
and abnormalities. The dominant lethal
24. Most drug receptors are
test therefore is a test of
(a) Small molecules with a molecular weight
(a) Teratogenicity between 100 and 1000
(b) Mutagenicity (b) Lipids arranged in a bilayer configuration
(c) Carcinogenicity (c) Proteins located on cell membranes or in the
(d) All of the above cytosol
(e) None of the above (d) DNA molecules
(e) RNA molecules
18. The Ames test is a method for detecting
25. With regard to distribution of a drug from
(a) Carcinogenesis in rodents
the blood into tissues
(b) Carcinogenesis in primates
(a) Blood flow to the tissue is an important
(c) Teratogenesis in any mammalian species
determinant
(d) Teratogenesis in primates
(b) Solubility of the drug in the tissue is an
(e) Mutagenesis in bacteria
important determinant
19. “Nicotinic” sites include all of the (c) Concentration of the drug in the blood is an
following except important determinant
(a) Bronchial smooth muscle (d) Size (volume) of the tissue is an important
(b) Adrenal medullary cells determinant
(c) Parasympathetic ganglia (e) All of the above are important determinants
(d) Skeletal muscle
26. The pH value is calculated mathematically
(e) Sympathetic ganglia
as the
20. A good example of chemical antagonism (a)
–
Log of the hydroxyl ion (OH ) concentration
(a) Heparin & Protamine (b)
–
Negative log of the OH concentration
(b) Protamine & Zinc (c)
+
Log of the hydrogen ion (H ) concentration
(c) Heparin & Prothrombin +
(d) Negative log of the H concentration
(d) All the above + –
(e) Ratio of H /OH concentration
21. Which of the following agents is a pro-
drug that is much less toxic in mammals 27. Which property is classified as colligative?
than in insects ? (a) Solubility of a solute
(a) Acetylcholine (b) Bethanechol (b) Osmotic pressure
4 MCQs IN PHARMACOLOGY
(c) Fraction of drug excreted unchanged in the urine 68. The principle of superposition in designing
(d) Apparent volume of distribution (VD) and multiple-dose regimens assumes that
desired drug concentration in plasma (a) Each dose affects the next subsequent dose
(e) Area under the plasma drug concentration causing nonlinear elimination
versus time curve (AUC) (b) Each dose of drug is eliminated by zero-order
63. The renal clearance of insulin is used as elimination
a measurement of (c) Steady-state plasma drug concentration are
(a) Effective renal blood flow reached at approximately 10 half-lives
(b) Rate of renal drug excretion
(d) Early doses of drug do not affect subsequent
(c) Intrinsic enzyme activity
doses
(d) Active renal secretion
(e) The fraction of drug absorbed is equal to
(e) Glomerular filtration rate (GFR) the fraction of drug eliminated
64. All of the following statements about 69. Which equation is true for a zero-order
plasma protein binding of a drug are true reaction rate of drug ?
except
(a) dA/dt = - k (b) t½= 0.693/k
(a) Displacement of a drug from plasma protein
binding sites results in a transient increased (c) A = A0e -kt
volume of distribution (VD) 70. Which of the following functional groups
(b) Displacement of a drug from plasma protein is most susceptible to hydrolysis ?
binding sites makes more free drug available
(a) R – CO – R (b) R – COOR
for glomerular filtration
(c) R – O - R (d) R – NH- CH3
(c) Displacement of a potent drug that is normally
more than 95% bound may cause toxicity (e) R – COOH
(d) Albumin is the major protein involved in 71. Monomer units of proteins are known as
protein binding of drugs
(a) Monosaccharides (b) Prosthetic groups
(e) Drugs that are highly bound to plasma
(c) Amino acids (d) Purines
proteins generally have a greater V D
compared with drugs that are highly bound (e) Nucleosides
to tissue proteins 72. Glucose is a carbohydrate that cannot be
65. _______ is expressed in both the intestinal hydrolyzed into a simpler substance. It is
epithelium and the kidney. best described as
(a) CYP2D6 (b) CYP1A1/2 (a) A sugar (b) A monosaccharide
(c) CYP3A4 (d) CYP2E1 (c) A disaccharide (d) A polysaccharide
(e) An oligosaccharide
66. The initial distribution of a drug into tissue
is determined chiefly by the 73. All of the following carbohydrates are
(a) Rate of blood flow to tissue considered to be polysaccharides except
(b) Glomerular filtration rate (GFR) (a) Heparin (b) Starch
(c) Stomach emptying time (c) Glycogen (d) Maltose
(d) Affinity of the drug for tissue (e) Cellulose
(e) Plasma protein binding of the drug
74. Which of the following compounds are
67. Which tissue has the greatest capacity to considered the building blocks of nucleic
bio-transform drugs? acids ?
(a) Brain (b) Kidney (a) Nucleotides (b) Nucleosides
(c) Liver (d) Lung (c) Monosaccharides (d) Purines
(e) Skin (e) Amino acids
8 MCQs IN PHARMACOLOGY
75. Which of the following terms best 83. Which class of antibody has the longest
describes a co-factor that is firmly bound serum half-life and opsonizes antigens for
to an apoenzyme? phagocytosis through two different
(a) Holoenzyme (b) Prosthetic group pathways?
(c) Coenzyme (d) Transferase (a) Immunoglobulin G (IgG)
(e) Heteropolysaccharide (b) Immunoglobulin M(IgM)
76. Enzymes that uncouple peptide linkages (c) Immunoglobulin A (IgA)
are best classified as (d) Immunoglobulin E (IgE)
(a) Hydrolases (b) Ligases 84. Urticaria that appears rapidly after the
(c) Oxidoreductases (d) Transferases ingestion of food usually indicates which
(e) Isomaerases type of hypersensitivity reaction?
77. The sugar that is inherent in the nucleic (a) Type I (b) Type II
acids RNA and DNA is (c) Type III (d) Type IV
(a) Glucose (b) Sucrose 85. A patient receives long-term, high-dose
(c) Ribose (d) Digitoxose therapy with a sulfonamide. After
(e) Maltose approximately 3 weeks of therapy, the
patient has a low-grade fever, rash, and
78. N-oxidation will be involved with the muscle and joint pain. Which type of
metabolism of following drugs, except hypersensitivity accounts for these
(a) Dapsone (b) Meperidine symptoms?
(c) Phenytoin (d) Chlorpheniramine (a) Type I (b) Type II
79. Which of the following statements (c) Type III (d) Type IV
describes plasmids? They
86. CD4+T cells specifically recognize antigens
(a) Are single – stranded DNA molecules in which form?
(b) Carry optional gene(s) (a) Bound to major histocompatibility (MHC)
(c) Carry genes essential for growth class I molecules on the surface of any body
(d) Are always found in linear form cell
80. Bacteria that grow at temperatures as (b) In free, soluble form in extracellular fluids
high as 550C are known as (c) Bound to MHC class II molecules on the
surface of special antigen-presenting cells
(a) Psychrophiles (b) Thermophiles
(APCs)
(c) Mesophiles (d) Auxotrophs
87. Which of the following statements
81. Which of the following organisms can use
concerning a drug receptor is true?
only molecular oxygen as the final
acceptor? (a) It mediates the nonspecific action of volatile
anesthetics
(a) Obligate anaerobes
(b) Facultative anaerobes (b) Its expression is induced only by exogenously
added drugs
(c) Obligate aerobes
(c) It can bind endogenous ligand to produce
(d) Strict anaerobes
physiological activity
82. A declining growth rate occurs during (d) It mediates the cathartic activity of
which of the following phases of bacterial magnesium citrate
cell growth? (e) Down-regulation of receptor level can lead
(a) Lag phase (b) Exponential phase to sensitization of the target cell to the
(c) Stationary phase (d) Death phase receptor agonist.
GENERAL PHARMACOLOGY 9
88. Which of the following acids has the (c) All drugs are excreted more rapidly in an
highest degree of ionization in an alkaline urine.
aqueous solution?
94. Which of the following drugs is
(a) Aspirin pKa = 3.5 considered to be the agent of choice for
(b) Indomethacin pKa = 4.5 anaphylactic reactions?
(c) Warfarin pKa = 5.1 (a) Edrophonium (b) Ipratropium
(d) Ibuprofen pKa = 5.2 (c) Ambenonium (d) Propantheline
(e) Phenobarbital pKa = 7.4 (e) Homatropine
89. Which of the following salts forms an 95. Which of the following drugs is considred
aqueous solution that is alkaline to to be the agent of choice for anaphylactic
litmus? reactions?
(a) Sodium chloride (a) Clonidine (b) Isoproterenol
(b) Benzalkonium chloride (c) Epinephrine (d) Phenylephrine
(c) Meperidine hydrochloride (e) Terbutaline
(d) Cefazolin sodium
96. Which of the following emissions from the
(e) Chlordiazepoxide hydrochloride decay of radionuclides is most commonly
90. Hydrolysis reaction are involved with the used in nuclear medicine imaging?
metabolism of following drugs, except (a) X-ray (b) Beta
(a) Procaine (b) Diazepam (c) Alpha (d) Gamma
(c) Aspirin (d) Lidocaine (e) Positron
91. Flurazepam has pKa of 8.2. What 97. Which of the following radionuclides is
percentage of flurazepam will be ionized mot commonly used in nuclear pharmacy
at a urine pH of 5.2? practice?
92. Precipitation may occur when mixing 98. Which of the following radionuclides is
aqueous solutions of meperidine hydro- generator produced?
chloride with which of the following (a) 99m
TC (b) 201
TI
solutions? (c) 67
GA (d) 133
Xe
(a) Sodium bicarbonate injection (e) 123
I
(b) Atropine sulfate injection 99. Abrasives, ingredients in dentifrices, are
(c) Sodium chloride injection noted for which of the following actions?
93. The excretion of a weakly acidic drug (a) Providing flavor
generally is more rapid in alkaline urine (b) Cleansing via a foaming detergent action
than in acidic urine. This process occurs (c) Removing plaque and debris
because (d) Preventing dental caries
(a) A weak acid in alkaline media will exist (e) Adding thickness to the product
primarily in its ionized form, which cannot
be reabsorbed easily 100. The appropriate pH range for ophthalmic
products is
(b) A weak acid in alkaline media will exist in
its lipophilic form, which cannot be (a) 2.0 – 3.0 (b) 4.0 – 6.0
reabsorbed easily. (c) 6.0 – 8.0 (d) 8.0 – 10.0
10 MCQs IN PHARMACOLOGY
101. Which type of contact lens can most easily (a) Renal insufficiency
be ruined by the absorption of chemicals? (b) Hirschsprung’s disease
(a) Hard lenses (b) Soft lenses (c) Anorectal malformations
(c) Gas-permeable lenses (d) Children between the ages of 6 and 12 years
102. All of the following desensitizing agents 107. Which of the following factors is as-
are recommended for sensitive teeth sociated with an increased risk of non-
except compliance in the elderly?
(a) 10% carbamide peroxide (a) Polypharmacy
(b) 5% potassium nitrate (b) Hypertension
(c) Dibasic sodium citrate (c) Male gender
(d) 10% strontium chloride hexahydrate (d) Living with a spouse in an isolated environment
(e) Expensive medications
103. Carbamide peroxide appears to soften
earwax by 108. The principal difference between compet-
(a) Causing oxygen to be released, which itive and non-competitive inhibition is
loosens the wax (a) Extent of receptor site blocking
(b) Stimulating fluid secretion in the ear canal (b) Whether inhibition occurs
(c) Actually dissolving the ear wax (c) Extent of enzyme inhibition
(d) Decreasing lipid content of the wax (d) Degree of agonism
(e) None of the above (e) None of the above
104. A common oral problem caused by 109. Drug administrated through which of the
herpes simplex type I virus (HSV-1) is following routes is mot likely to be
(a) Aphthous ulcers subjected to first-pass metabolism:
(b) Canker sores (a) Oral (b) Sublingual
(c) Aphthous stomatitis (c) Subcutaneous (d) Rectal
(d) Fever blisters
110. Many receptors use distinct hetero
(e) Thrush _________ GTPä-binding regulatory
105. The definition of a sur factant (an proteins
ingredient in toothpaste) can best be (a) Tetrameric (b) Trimeric
described by which of the following (c) Dimeric (d) Monomeric
statements? Surfactant
111. Alkalinization of urine hastens the
(a) Prevents drying of the preparation
excretion of
(b) Removes debris by its detergent action and
(a) Weakly basic drugs
causes foaming, which is usually desired by
the patient (b) Weakly acidic drugs
(c) Physically removes plaque and debris (c) Strong electrolytes
(d) Determines the texture, dispersiveness, and (d) Nonpolar drugs
appearance of the product 112. Majority of drugs cross biological
(e) Adds flavor to the preparation which makes membranes primarily by
it more appealing to the patient
(a) Weakly basic drugs
106. Which is not a risk factor for hyper- (b) Weakly acidic drugs
phosphatemia and death from sodium (c) Strong electrolytes
phosphate enemas when used in
(d) Nonpolar drugs
children?
GENERAL PHARMACOLOGY 11
113. The most important factor which governs (a) Are bound primarily to a1 acid glycoprotein
diffusion of drugs across capillaries other in plasma
than those in the brain is (b) Are excreted faster in alkaline urine
(a) Blood flow through the capillary (c) Are highly ionized in the gastric juice
(b) Lipid solubility of the drug (d) Do not cross blood—brain barrier
(c) pKa value of the drug 120. High plasma protein binding
(d) pH of the medium (a) Increases the volume of distribution of the
114. Active transport of a substance across drug
biological membrane has the following (b) Facilitates glomerular filtrtion of the drug
characteristics except (c) Minimizes drug interactions
(a) It is specific (d) Generally makes the drug long acting
(b) It is pH dependent 121. Biotransformation of drugs is primarily
(c) It is saturable directed to
(d) It requires metabolic energy (a) Activate the drug
115. Bioavailability differences among oral (b) Inactivate the drug
formulations of a drug are most likely to (c) Convert lipid soluble drugs into nonlipid
occur if the drug soluble metabolites
(d) Convert nonlipid soluble drugs into lipid
(a) Is freely water soluble
soluble metabolites
(b) Is completely absorbed
(c) Is incompletely absorbed 122. A prodrg is
(d) Undergoes little first-pass metabolism (a) The prototype member of a class of drugs
(b) The oldest member of a class of drugs
116. Bioavailability of drug refers to
(c) An inactive drug that is transformed in the
(a) Perecentage of administered dose that body to an active metabolite
reaches systemic circulation in the (d) A drug that is stored in body tissues and is
unchanged form then gradually released in the circulation
(b) Rario of oral to parental dose
123. Which of the following cytochrome P450
(c) Ratio of orally administered drug to that
isoenzymes is involved in the metabolism
excreted in the faeces
of a large number of drugs in human
(d) Ratio of drug excreted unchanged in urine beings and has been implicated in some
to that excreted as metabolites dangerous drug interactions:
117. The most important factor governing (a) CYP 3A4 (b) CYP 2C9
absorption of a drug from intact skin is (c) CYP 2E1 (d) CYP 1A2
(a) Molecular weight of the drug 124. The most commonly occurring conjugation
(b) Site of application reaction for drugs and their metabolites is
(c) Lipid solubility of the drug (a) Glucuronidation
(d) Nature of the base used in the formulation (b) Acetylation
118. Redistribution is a feature of (c) Methylation
(d) Glutathione conjugation
(a) Highly plasma protein bound drugs
(b) Depot preparations 125. G-protein coupled receptors span the
(c) Poorly lipid soluble drugs plasma membrane as a bundle of _____
alpha helices
(d) Highly lipid soluble drugs
(a) One (b) Three
119. Weakly acidic drugs
(c) Seven (d) Ten
12 MCQs IN PHARMACOLOGY
126. Which of the following drug metabolizing (a) A constant amount of the drug will be
reactions is entirely nonmicrosomal eliminated per unit time
(a) Glucuronide conjugation (b) Its clearance value will remain constant
(b) Acetylation (c) Its elimination half-life will increase with dose
(c) Oxidation (d) It will be completely eliminated from the body
(d) Reduction in 2 x half-life period
127. Induction of drug metabolizing enzymes 133. If a drug has a constant bio-availability
involves and first order elimination, its main-
tainance dose rate will be directly
(a) A conformational change in the enzyme proportional to its
protein to favor binding of substrate
molecules (a) Volume of distribution
(b) Expression of enzyme molecules on the (b) Plasma protein binding
surface of hepatocytes (c) Lipid solubility
(c) Enhanced transport of substrate molecules (d) Total body clearance
into hepatocytes
134. The following dose of a drug is governed
(d) Increased synthesis of enzyme protein by its
128. Drugs which undergo high degree of first- (a) Aqueous diffusion
pass metabolism in liver (b) Aqueous hydrolysis
(a) Have oral bioavailability (c) Lipid diffusion
(b) Are excreted primarily in bile (d) Pinocytosis or endocytosis
(c) Are contraindicated in liver disease
135. Monitoring plasma drug concentration is
(d) Exhibit zero order kinetics of elimination useful while using
129. Glomerular filtration of a drug is affected (a) Antihypertensive drugs
by its (b) Levodopa
(a) Lipid solubility (c) Lithium carbonate
(b) Plasma protein binding (d) MAO inhibitors
(c) Degree of ionization
136. Microsomal enzyme induction has one of
(d) Rate of tubular secretion the following features
130. If a drug undergoes net tubular secretion, (a) Takes about one week to develop
its renal clearance will be (b) Results in increased affinity of the enzyme
(a) More than the glomerular filtration rate for the substrate
(b) Equal to the glomerular filtration rate (c) It is irreversible
(c) Less than the glomerular filtration rate (d) Can be used to treat acute drug poisonings
(d) Equal to the rate of urine formation 137. Which of the following is a competitive
131. Which of the following is not a primary/ type of enzyme inhibitor
fundamental, but a derived pharmaco- (a) Acetazolamide (b) Disulfiram
kinetic parameter (c) Physostigmine (d) Theophyline
(a) Bio-availability
138. What is true in relation to drug receptors
(b) Volume of distribution
(a) All drugs act through specific receptors
(c) Clearance
(b) All drug receptors are located on the surface
(d) Plasma half life
of the target cells
132. If a drug is eliminated by first order (c) Agonists induce a conformational change in
kinetics the receptor
GENERAL PHARMACOLOGY 13
(d) Partial agonists have low affinity for the 145. Placebo effects result presumably from
receptor the
139. A partial agonist can antagonize the (a) Physician-patient relationship
effects of a full agonist because it has (b) Mental set up imparted by the therapeutic
(a) High affinity but low intrinsic activity settings
(b) Low affinity but high intrinsic activity (c) Mental set up imparted by the physician
(c) No affinity and low intrinsic activity (d) All of the above
(d) High affinity but no intrinsic activity 146. All of the following subserve as
140. Receptor agonists possess intracellular second messengers in
receptor mediated signal transduction
(a) Result in increased smooth endoplasmic except
reticulum
(a) Cyclic AMP
(b) Result in increased rough endoplasmic reticulum
(b) Inositol trisphosphate
(c) Result in decreased enzymes in the soluble
cytoplasmic fraction (c) Diacyl glycerols
(d) Require 3–4 months to reach completion (d) G protein
141. Agonists affect the receptor molecule in 147. A receptor which itself has enzymatic
the following manner property is
(a) Alter its amino acid sequence (a) Insulin receptor
(b) Denature the receptor protein (b) Progesterone receptor
(c) Alter its folding or alignment of subunits (c) Thyroxine receptor
(d) Induce covalent bond formation (d) Glucagon receptor
142. Receptors perform the following function/ 148. Down regulation of receptors can occur
functions as a consequence of
(a) Ligand recognition (a) Continuous use of agonists
(b) Signal transduction (b) Continuous use of antagonists
(c) Both ligand recognition and signal (c) Chronic use of CNS depressants
transduction (d) Denervation
(d) Disposal of agonists and antagonists
149. When therapeutic effects decline both
143. Which of the following receptor types has below and above a narrow range of
7 helical membrane, spanning amino acid doses, a drug is said to exhibit
segments with 3 extracellular and 3
(a) Ceiling effect
intracellular loops
(b) Desensitization
(a) Tyrosine protein kinase receptor
(c) Therapeutic window phenomenon
(b) Gene expression regulating receptor
(d) Nonreceptor mediated action
(c) Intrinsic ion channel containing receptor
(d) G protein coupled receptor 150. ‘Drug efficacy’ refers to
144. Which of the following is a G protein (a) The range of diseases in which the drug is
coupled receptor beneficial
(b) The maximal intensity of response that can
(a) Muscarinic cholinergic receptor
be produced by the drug
(b) Nicotinic cholinergic receptor
(c) The therapeutic dose range of the drug
(c) Glucocorticoid receptor
(d) The therapeutic index of the drug
(d) Insulin receptor
14 MCQs IN PHARMACOLOGY
151. If the dose-response curves of a drug for 158. A fixed dose combination preparation
producing different actions are widely meant for internal use must not contain
separated on the dose axis, the drug is the following class of drug
(a) Highly potent (b) Highly efficacious (a) Thiazide diuretic
(c) Highly toxic (d) Highly selective (b) Fluoroquinolone antimicrobial
152. The therapeutic index of a drug is a (c) Corticosteroid
measure of its (d) H2 blocker
(a) Safety (b) Potency 159. Interindividual variations in equieffective
(c) Efficacy (d) Dose variability doses of a drug are most marked if it is
153. If the effect of combination of two drugs disposed by
is equal to the sum of their individual (a) glomerular filtration
effects, the two drugs are exhibiting (b) Tubular secretion
(a) Potentiation (b) Synergism (c) Both (a) and (b)
(c) Cross tolerance (d) Antagonism (d) Hepatic metabolism
154. The antagonism between adrenaline and 160. The pharmacokinetics of drugs in the
histamine is called ‘Physiological anta- neonate differs from that in adults,
gonism’ because because their
(a) Both are physiologically present in the body (a) Intestinal transit is fast
(b) They act on physiological receptors (b) Glomerular filtration rate is high
(c) Both affect many physiological processes (c) Tubular transport mechanisms are not well
(d) They have opposite physiological effects developed
155. A drug ‘R’ producing no response by itself (d) Drug metabolizing enzymes are overactive
causes the log dose-response curve of
161. Pharmacodynamic tolerance may involve
another drug ‘S’ to shift to the right in a
changes in _____of drug receptors
parallel manner without decreasing the
maximal response : Drug ‘R’ is a (a) Number (b) Affinity
(a) Partial agonist (c) Function (d) All the above
(b) Inverse agonist 162. Drug metabolism can be induced by the
(c) Competitive antagonist following factors except
(d) Noncompetitive antagonist (a) Cigarette smoking
156. A drug which does not produce any (b) Acute alcohol ingestion
action by itself but decreases the slope (c) Exposure to insecticides
of the log dose-response curve and
(d) Consumption of characoal boiled meat
suppresses the maximal response to
another drug is a 163. Which of the following is true of placebos
(a) Physiological antagonist (a) Placebo is a dummy medication
(b) Competitive antagonist (b) Placebo is the inert material added to the
(c) Noncompetitive antagonist drug for making tablets
(d) Partial agonist (c) Placebos do not produce any effect
157. A drug which is generally administered (d) All patients respond to placebos
in standard doses without the need for 164. In patients of hepatic cirrhosis
dose individualization is
(a) The extent of change in pharmacokinetics of
(a) Insulin (b) Mebendazole drugs can be predicted from the values of
(c) Prednisolone (d) Digoxin liver function tests
GENERAL PHARMACOLOGY 15
(b) High doses of furosemide can be safely used (a) Chloroquine (b) Warfarin sodium
(c) Metformin is the preferred oral hypoglycaemic (c) Dicyclomine (d) Methyldopa
(d) Disposition of atenolol is not significantly
171. Select the drug which has been found to
affected
be a strong human teratogen
165. An undersireable effect of a drug that (a) Isoniazid (b) Isotretinoin
occurs at therapeutic doses and can be (c) Hydralazine (d) Propylthiouracil
predicted from its pharmacological
actions is called 172. Oral route
(a) Side effect (b) Toxic effect (a) Yields better absorption than parenteral
(c) Allergic reaction (d) Idiosyncrasy administration for majority of drugs
(b) Should be avoided in the recumbent position
166. Which of the following is a type II
(c) Has no demerit
(unpredictable) adverse drug reaction
(d) Produces quick onset of action
(a) Side effect
(b) Toxic effect 173. Intramuscular route
(c) Idiosyncrasy (a) Always produces faster absorption than oral
(d) Physical dependence route
(b) Can be used to inject mild irritants
167. A ‘toxic effect’ differs from a ‘side effect’
(c) In a child is made into the gluteus maximus
in that
muscle
(a) It is not a pharmacological effect of the drug (d) Can be used to inject a volume of 15 ml
(b) It is a more intense pharmacological effect
that occurs at high dose or after prolonged 174. Advantage of sublingual route include the
medication following except
(c) It must involve drug induced cellular injury (a) It has a rapid onset of action
(d) It involves host defence mechanisms (b) Spitting out the tablet can terminate its action
(c) Its usefulness is limited to treat local conditions
168. Which of the following statements is true
in relation to ‘drug toxicity’ and ‘poisoning’ (d) It avoids first pass hepatic metabolism
(a) The two terms are synonymous 175. First pass metabolism
(b) When a toxic effect requires specific (a) Can increase the oral bio-availability of the
treatment, it is called poisoning drug
(c) A toxic effect which endangers life by (b) Occurs only in the liver
markedly affecting vital functions is called (c) Is higher on intravenous administration
poisoning
(d) Necessitates high oral dose for certain drugs
(d) Toxicity is caused by drugs while poisoning
is caused by other harmful chemicals 176. Bio-transformation
169. The most vulnerable period of pregnancy (a) Renders the drug more lipid soluble
for the causation of foetal malformations (b) Can be altered by drugs
due to drugs is (c) Is necessary for all drugs for their elimination
(a) 18–55 days of gestation (d) Takes place only in the liver
(b) 56–84 days of gestation 177. Entry of a drug in the central nervous
(c) Second trimester system is enhanced if the drug is
(d) 36 weeks onwards (a) Ionized
170. Which of the following is a proven human (b) More lipid soluble
teratogen (c) Given intravenously
(d) Highly plasma protein bound
16 MCQs IN PHARMACOLOGY
181. What is the best criterian for judging the (a) The percentage of drug released from a
therapeutic superiority of a drug over its formulation that becomes available for
congeners? biological effect
(b) The percentage of drug that is ionized from
(a) Potency
a formulation
(b) Wide range of activity
(c) The net amount of actual therapeutic agent
(c) Efficacy present in the formulation
(d) Variability (d) The dose of a drug by which 50% animals
182. pKa of a compound show signs of toxicity
(a) Is the pH of solution at which the compound 188. The absorption time of a drug can be
is 50% ionized reduced by
(b) Is the pH of compound at which it is 50% (a) Making a more soluble salt – for oral
ionized (b) By using hyaluronidase – for injection
(c) Is the time in which the compound is ionized (c) By using vesoconstrictor substances
(d) Is the time in which total compound is ionized (d) By giving combination of drugs
183. Pharmacokinetics is 189. Reduction of heavy metal toxicity by
(a) The study of absorption, distribution, dimercaprol is an exmple of
metabolism and excretion of drugs (a) Chemical antagonist
(b) The study of biological and therapeutic effects (b) Physiological antagonist
of the drugs (c) Pharmacokinetic antagonist
(c) The method of development of new (d) Antagonism by receptor block
pharmacological agent
190. Which of the following drugs is primarily
(d) The study of carcinogenic activity of a new
stored in the natural fat of the body
drug
(a) Primaquine (b) Acetyl salicylic acid
184. In which form the drug is absorbed more
(c) Thiopentone (d) Vitamin C
rapidly?
GENERAL PHARMACOLOGY 17
191. Bio-transformation of the drugs is to 198. The receptor concept was first introduced
render them by
(a) Less lipid soluble (a) J.N. Langley in 1878
(b) More protein bound (b) Paul Ehrlich in 1926
(c) Less ionized (c) Somonis in 1964
(d) Less protein bound (d) Wakesman in 1826
192. Drug metabolism occurs chiefly in 199. True tolerance develops because of
(a) Liver (b) Brain (a) Diminition in absorption
(c) Spleen (d) Kidneys (b) Rapid excretion of the drug
193. For renal excretion the factors important (c) Both of the above
are (d) None of the above
(a) Extent of plasma protein binding of drugs 200. Two drugs binding to the same receptors
(b) Glomerular filtration rate is
(c) Active renal tubular reabsorption (a) Chemical antagonism
(d) All of the above (b) Pharmacokinetic antagonism
194. If tubular urine is made more acid (c) Competitive antagonism
(d) Non-competitive antagonism
(a) Excretion of weak acid is reduced
(b) Excretion of weak acid is increased 201. Tachyphylaxis is
(c) Excretion of weak base is increased (a) A drug interaction between two similar types
(d) Excretion of weak base is reduced of drugs
(b) Rapidly developing tolerance
195. Simultaneous administration of two
drugs may – (select the false statement) (c) A synergism between two types of drugs
(a) Show an additive effect (d) None of the above
(b) Produce synergism 202. Drug A in a dose of 10 mg produces same
(c) Result in antagonism response as with 100 mg of drug B
(d) Produce any of above phenomena (a) Drug A is 10 times more potent than drug B
196. The advantages of bio-assay over (b) Drug B is 10 times more potent than drug A
chemical assay include – (select false (c) Drug A is 10 times more efficacious than
statement) drug B
(a) It is cheaper (d) Both are equally potent
(b) The active principal does not have to be (e) Both are equally efficacious
known 203. Teratogenicity is
(c) The active principal does not have to be in a
(a) The acute reaction to drugs
pure state
(b) Intolerance to drugs
(d) The sensitivity may be greater
(c) Tumour forming action of the drugs
197. In presence of competitive antagonist (d) Malformation of the foetus
(a) The maximum response of agonist can never
204. The chances of foetal malformation with
be achieved
a teratogenic drug is maximum
(b) The maximum can be achieved by increasing
the concentration activity (a) During first trimester of pregnancy
(c) Maximum can be achieved only if the (b) During second trimester of pregnancy
antagonist is having intrinsic activity (c) During third trimester of pregnancy
(d) None of the above (d) When given just prior to the labor
18 MCQs IN PHARMACOLOGY
205. Phocomelia is a known teratogenic effect 212. Which one of the following is an example
of of physical or chemical interaction?
(a) Anticancer drugs (a) Warfarin plus salicylates–prolongation of
(b) Antiviral drugs anticoagulant effect and bleeding tendency
(c) Antiepileptic drugs (b) Methotrexate plus sulfonamides–pancytopenia
(d) Thalidomide (c) Heparin plus protamine–reversal of heparin
effect
206. Which of the following drugs are known
(d) Sulfonamides plus salicylate–sulfa toxicity
to cause toxic cataract?
(a) Chloroquine (b) Ergot 213. First order kinetics of the drugs is called
when
(c) Phenothiazine (d) Naphthalene
(e) All of the above (a) A constant fraction of the drug is removed in
per unit time
207. The passage of drugs into the foetus from (b) A constant amount of the drug is removed in
placenta per unit time
(a) Is by active transport (c) Total amount of the drug is removed in one
(b) Is by passive diffusion hour
(c) Is by carrier mediated transport (d) Total amount of the drug is removed in first
(d) By any of the above methods passage through the kidneys
208. Idiosyncrasy reaction of a drug is 214. For the drugs which follow first order
kinetics, after 4 half life the elimination
(a) A type of hypersensitivity reaction
will be approximately
(b) A type of drug antagonism
(a) 40% (b) 94%
(c) Unpredictable, inherent, qualitatively
abnormal reaction of a drug (c) 25% (d) 4%
(d) Quantitatively exaggerated response 215. Passive diffusion of a drug across cell
209. Two drugs having similar effects are membrane is low when its molecular
termed as mass is greater than
218. pH difference between extracellular and 227. The hepatic enzyme inducer naringenin
intracellular fluid is is present in
(a) Nil (b) 0.2 (a) Tobacco smoke (b) Grape juice
(c) 0.4 (d) 0.8 (c) Alcohol (d) Apple Juice
219. Which type of drugs penetrate CNS better 228. In gene tranfer which metal particle is
(a) Lipid soluble (b) Weak acids often used
(c) Weak bases (d) All equally (a) Iron (b) Gold
220. Acidic drugs mostly bind to plasma (c) Platinum (d) Mobybdenum
(a) Albumin (b) Globulin 229. Slow reacting substance of anaphylaxis
(c) Glycoprotein (d) None of the above refers to
221. The number of P 450 gene families (a) LTC4 (b) LTD4
identified in human being is (c) Both of the above (d) None of the above
(a) 4 (b) 8 230. Drugs producing allergic reaction
(c) 12 (d) 16 generally act as
222. The majority of drug biotransformation (a) Complete antigens
occurs by which cytochrome family (b) Haptens
(a) CYP1 (b) CYP2 (c) Antibodies
(c) CYP3 (d) None of the above (d) Mediators
223. Nonlinearity in pharmacokinetics of a 231. An addicting drug which produces little
drug is due to saturation of or no physical dependence is
(a) Protein binding (a) Amphetamine (b) Methadone
(b) Hepatic metabolism (c) Phenobarbitone (d) Diazepam
(c) Active renal transport
(d) All of the above 232. Which of the following statements
regarding therapeutic window is correct ?
224. Which of the following disease is due to
(a) The ratio of LD50 to the ED50
G protein receptor malfunction
(b) The Dosage range between the minimum
(a) Precocious puberty effective therapeutic concentration and the
(b) Retinitis pigmentosa minimum toxic concentration
(c) Malignant hyperthyroidism (c) Both the above
(d) All of the above (d) None of the above
225. The pharmacokinetic alternations in 233. Which of the following statements
elderly are due to
regarding acid –base balance is not
(a) Reduction in lean body mass and total body correct ?
water
(a) it is an essential balance between the amount
(b) Increase in percentage of body fat of carbonic acid and biocarbonate in blood.
(c) Reduced cytochrome P450 enzymes
(b) It must be kept constant so that the hydrogen
(d) All of the above in concentration in the blood plasma is in
226. The effect of enzyme induction is greatest turn kept constant
when the drug is given (c) Any deviation in the balance can have a
(a) Digoxin (b) Furosemide profound effect on physiological function
(c) Enalapril (d) Amrinone (d) All the above
(e) None of the above
20 MCQs IN PHARMACOLOGY
258. Which one of the following statements structure of drugs and the effects that
regarding glucuronide conjugation is not they produce
correct (a) Paracelsus (b) William Harvey
(a) The most frequently occurring reactions (c) James Blake (d) Rudolf Buccheim
(b) The conjugating agent is glucuronic acid, (e) None of the above
C6H10O6
264. The great scientist who explained the
(c) The glucuronide are rapidly eliminated in the
circulation of the blood to the world which
urine
signaled of the beginning of the scientific
(d) The glucuronides are also secreted in the bile, study of the medical sciences was
but this does not always lead to their
elimination in the feces (a) Paracelsus (b) William Harvey
(e) All the above (c) James Blake (d) Rudolf Buccheim
(e) None of the above
(f) None of the above
265. All the below mentioned drugs cause
259. Which of the following therapeutic sys-
enzyme inhibition in man except one
tems provides continuous, unattended,
controlled drug input for a long period (a) Acetazolamide (b) Allopurinol
without gastrointestinal or hepatic drug (c) Meprobamate (d) Disulfiram
inactivation prior to systemic circulation ? (e) Selegiline
(a) Parenteral (b) Oral 266. All the below mentioned drugs cause
(c) Transdermal (d) All the above enzyme induction in man except one
(c) None of the above (a) Phenytoin (b) Phenobarbitone
260. The translocation of a solute from one (c) Griseofulvine (d) Enalapril
side of a biologic barrier to the other side (e) Rifampicin
and the transferred solute appearing in
the same form on both side of the 267. Cimetidine potentiates the action of
biological barrier is known as propranol, theophylline, warfarin and
phenytoin because
(a) Bioavailability (b) Biotransport
(a) It causes deficiency of G - 6–PD
(c) Bioequivalence (d) None of the
(b) It blocks the H2 – histaminergic receptors
261. Guanine nucleotides bind to the ______ (c) It is an inhibitor of microsomal P–450
subunit of G-proteins
(d) None of the above
(a) α (b) β
268. The incidence of adverse drug reaction
(c) γ (d) All the above
rises with age in the adult, especially after
262. Pharmacodynamics include 65 years because of
(a) The biological effects produced by chemicals (a) The increasing number of drugs they need
(b) The site/s and mechanism by which the to take because they tend to have multiple
biological effects are produced diseases
(c) The factors that effect the safety and (b) Poor compliance with dosing regimens
effectiveness of the agent (c) Bodily changes of aging that require
(d) All the above modification of dosage regimens
(e) None of the above (d) All the above
(e) None of the above
263. The person who set forth the principles
that drugs are effective only after 269. Agranulocytosis is
reaching a responsive tissue and that (a) Virtual absence from the blood of white cells
there is a relationship between the known as neutrophils
GENERAL PHARMACOLOGY 23
(b) It is a life-threatening conditions that results (b) Drugs with low safety margin
from toxic damage to the bone-marrow by (c) Drugs activated in the body
some drugs (d) Hit and run drugs
(c) Can be treated with antibiotics and
sometimes transfusion of white blood cells 275. During competitive equilibrium type of
antagonism
(d) All the above
(a) Equilibrium constant (Km) is unchanged, but
270. Characteristically following oral admin- total number of binding sites (Vmax) is reduced
istration to a man, drugs (b) Equilibrium constant (Km) is increased and
(a) Are absorbed readily when in the unionized total number of binding sites (Vmax) is reduced
rather than in the ionized form (c) Equilibrium constant (Km) is increased and
(b) Are absorbed primarily in the intestine total number of binding sited (Vmax) remain
(c) Cross membranes mainly by simple diffusion unchanged
(d) With high lipid solubility readily penetrate (d) None of the above
into CNS 276. Addition of oxygen or negatively charged
(e) All the above radical and removal of hydrogen or
positively charged radical is known as
271. Competitive antagonists
(a) Reduction (b) Oxidation
(a) Dissociate from receptors faster than their
(c) Acetylation (d) Hydrolysis
respective agonists
(e) None of the above
(b) Alter the shape of the log dose response
curve of an agonist 277. Pharmacopoeia includes list of esta-
(c) According to the rate theory have low blished drugs and medicinal preparation
dissociation rate constants with the description of their
(d) Initiate the opposite cellular response to (a) Physical properties
receptor occupancy to that obtained by the (b) Identification test
agonist (c) Purification test
(e) All the above (d) Potency test
272. A non-competitive antagonist (e) All the above
(a) Alters the mechanism of action of an agonist 278. Claude Bernard is known as
(b) Alters the potency of an agonist (a) Father of Medicine
(c) Shifts the dose-response curve of an agonist (b) Father of Pharmacognosy
to the right (c) Father of Polypharmacy
(d) Decreases the maximum response to an (d) Father of Pharmacology
agonist
(e) Father of Experimental Medicine
(e) None of the above
279. Oswald Schmiedeberg is known as
273. Repeated administration of a drug may
(a) Father of Medicine
(a) Increase its own metabolism
(b) Father of Pharmacognosy
(b) Increase the metabolism of other drugs (c) Father of Polypharmacy
(c) Increase the metabolism of endogenous (d) Father of Pharmacology
compounds
(e) Father of Experimental Medicine
(d) All the above
(e) None of the above 280. Catalytic conversion of GTP to GDP is
carried out by _____ subunit of G-proteins
274. Plasma concentration is useful for
(a) α (b) β
(a) Drugs with high safety margin (c) γ (d) All the above
24 MCQs IN PHARMACOLOGY
ANSWERS
1. b 2. b 3. d 4. c 5. e 6. a
7. a 8. b 9. d 10. a 11. e 12. c
13. a 14. a 15. a 16. a 17. b 18. e
19. a 20. a 21. a 22. a 23. a 24. c
25. e 26. d 27. b 28. c 29. b 30. c
31. c 32. e 33. a 34. c 35. a 36. d
37. b 38. a 39. b 40. c 41. a 42. a
43. a 44. a 45. c 46. a 47. c
48. 1. a, 2. d, 3. b, 4. a 49. 1. a, 2. d, 3. c 50. 1. b, 2. e, 3. c, 4. a
51. b 52. b 53. c 54. d 55. d 56. b
57. d 58. b 59. b 60. a 61. b 62. d
63. e 64. e 65. c 66. a 67. c 68. d
69. a 70. b 71. c 72. b 73. d 74. a
75. b 76. a 77. c 78. c 79. b 80. b
81. c 82. d 83. a 84. a 85. c 86. c
87. c 88. a 89. d 90. b 91. e 92. a
93. a 94. b 95. c 96. d 97. c 98. a
99. c 100. c 101. b 102. a 103. a 104. d
105. b 106. d 107. a 108. c 109. a 110. b
111. b 112. a 113. a 114. b 115. c 116. a
117. c 118. d 119. b 120. d 121. c 122. c
123. a 124. a 125. c 126. b 127. d 128. a
GENERAL PHARMACOLOGY 27
7. a because of enhanced disassociation weak acids 180. a Spare receptors are generally found whenever
are excreted faster in basic (not acidic) urine. a receptor acts catalytically and not
20. a Chemical antagonism does not involve any stoichiometrically. Hence, they are generally
receptors. Protamine is a positively charged found among drugs, which elicit smooth muscle
protein at physiological pH and thus contraction.
antagonizes the effects of Heparin which is 189. a Dimercaprol interacts directly with heavy metals
negatively charged at physiological pH. in blood and tissue fluids and prevents binding
35. a Facilitated diffusion differs from active transport of heavy metals to cellular constituents.
in that it does not require energy source and it Dimercaprol forms an inactive complex with
carries the transport in the direction of heavy metals.
electrochemical gradient. 200. c Two drugs binding to the same receptor is an
52. a Glycoprotein binds to basic drugs and albumin example of competitive antagonism and effect
binds to many acidic drugs and a small number of one drug can be decreased by increasing
of basic drugs. the concentration of other drug.
65. c CYP3A4 is involved in the metabolism of 217. d Receptors for steroid hormones are intracellular
majority of drugs and is also expressed DNA – binding proteins, which regulate gene
extrahepatically. In fact, poor bioavailability of transcription.
many drugs is attributed to the drug metabolism 240. a Receptors linked directly to ion channels are
by CYP3A4 in gastrointestinal tract. involved in the fast synaptic transmission e.g.
78. c N-oxidation is involved in the metabolism of nicotinic acetylcholine receptor. This receptor is
dapsone, meperidine and chloramphenicol. a pentamer i.e. it is made up of five poly-peptide
Metabolism of phenytoin involves oxidative N- subunits.
dealkylation. 261. a In G-protein coupled receptors, agonist-receptor
110. b Many receptors use heterotrimeric GTP-binding complex enhances GTP binding to the α subunit,
regulatory proteins. The subunits are designated mainly by dissociating already bound GDP.
as β, α and α and their classification is based 280. a The termination of agonist-receptor coupling in
on á subunits. a G-protein-coupled receptor is because of
125. c G-protein coupled receptors are hydrophobic conversion of GTP to GDP by a GTPase that is
proteins and span the plasma membrane in intrinsic to α subunit.
seven á-helical segments. 290. a Therapeutic index is the range between minimal
145. d Placebo effect is a desired response to a therapy and maximal concentration required to elicit
without drug. Placebo effect is mainly because desired response.
of various psychological reasons e.g. physician- 295. c intracellular fluid comprises 35%, whereas
patient relationship, mental set up affected by contribution of other compartments is far less
surroundings and positive mental set up because e.g. plasma – 5%; interstitial fluid – 16%; fat –
of known and trusted physician. 20% and transcellular fluid – 2%.
161. d Pharmacodynamic tolerance involves multiple 310. d Receptors for steroids, vitamin D, retinoids and
mechanism such as number, affinity and function also thyroid hormones are DNA-binding
of receptors. proteins, which regulate transcription of genes.
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 29
CHAPTER 2
DRUGS ACTING ON CENTRAL
NERVOUS SYSTEM
(a) Alprostadil (b) Aspirin (a) Direct stimulation of cardiac contractile force
(c) Ibuprofen (d) LTC4 (b) Tachycardia
(e) Zafirlukast (c) Increased gastric acid secretion
5. A molecule that stimulates nitric oxide (d) Postural hypotension
synthase, especially the eNOS isoform, is (e) Throbbing headache
30 MCQs IN PHARMACOLOGY
10. Which one of the following chemicals 16. Suramin is an antagonists of ________
does not satisfy the criteria for a receptors
neurotransmitter role in the CNS? (a) Purine (b) Somatostanin
(a) Acetylcholine (b) Dopamine (c) Neuropeptide Y (d) Neurotensin
(c) Glycine (d) Nitric Oxide
17. Which one of the following statements
(e) Substance P
best describes the mechanism of action
11. Neurotransmitters may of benzodiazepines?
(a) Increase chloride conductance to cause (a) Benzodiazepines activate GABAB receptors
inhibition in the spinal cord
(b) Increase potassium conductance to cause (b) Their inhibition of GABA transminase leads
excitation to increased levels of GABA
(c) Increse sodium conductance to cause (c) Benzodiazepines block glutamate receptors
inhibition in hierarchical neuronal pathways in the
(d) Increase calcium conductance to cause brain
inhibition (d) They increase the frequency of opening of
(e) Exert all of the above actions chloride ion channels that are coupled to
GABAA receptors
12. Which of the following chemicals is most (e) They are direct-acting GABA receptor
likely to function as a neurotransmitter agonists in the CNS
in hierarchical systems?
18. Which one of the following statements
(a) Dopamine (b) Glutamate
about the use of triazolam in this elderly
(c) Metenkephalin (d) Norepinephrine patient is accurate?
(e) Serotonin
(a) Ambulatory dysfunction does not occur in
13. Activation of metabotropic receptors elderly patients taking one-half of the
located presynaptically causes inhibition conventional adult dose
by decreasing the inward flux of (b) Hypertension is a common adverse effects
(a) Calcium (b) Chloride of benzodiazepines in patients over 70 years
of age
(c) Potassium (d) Sodium
(c) Over-the-counter cold medications may
(e) None of the above
antagonize the hypnotic effects of the drug
14. This compound decrease the functional
activities of several CNS neurotransmit- (d) She may experience amnesia, especially if
ters, including dopamine, norepineph- she also drinks alcoholic beverages
rine, and serotonin. At high doses it may (e) Triazolam is distinctive in that it does not
cause parkinsonism-like extrapyramidal cause rebound insomnia on abrupt
system dysfunction. discontinuance
(a) Amphetamine (b) Baclofen
19. The most likely explanation for the
(c) Diazepam (d) Ketamine increased sensitivity of elderly patients
(e) Reserpine to a single dose of triazolam and other
sedative-hypnotic drugs is
15. This amine neurotransmitter is found in
high concentration in cell bodies in the (a) Changes in brain function that accompany
pons and brain stem; at some sites, the aging process
release of transmitter is autoregulated via (b) Decreased renal function
presynaptic inhibition. (c) Increased cerebral blood flow
(a) Acetylcholine (b) Dopamine (d) Decreased hepatic metabolism of lipid-
(c) Glutamate (d) Norepinephrine soluble drugs
(e) Substance P (e) Changes in plasma protein binding
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 31
(d) Induces liver drug-metabolizing enzymes 36. Withdrawal of antiseizure drugs can
(e) Inhibits renal clearance of acetaminophen cause increased seizure frequency and
severity. Withdrawal is least likely to be
31. The activity of this enzyme is specifically a problem with
decreased in the Wernicke-Korsakoff
syndrome (a) Clonazepam (b) Diazepam
(c) Ethosuximide (d) Phenobarbital
(a) Alcohol dehydrogenase
(e) Phenytoin
(b) Cytochrome P450
(c) L-Aromatic amino acid decarboxylase 37. A young femal patient who suffers from
(d) NADH dehydrogenase bipolar affective disorder (BAD) has been
(e) Pyruvate dehydrogenase managed with lithium. If she becomes
pregnant, which one of the following
32. Following is glycine antagonists drugs is likely to be effective in bipolar
(a) Quisqualate (b) Taurine affective disorder with minimal risk of
(c) Strychnine (d) â-alanine teratogenicity?
(a) Carbamazepine (b) Clonazepam
33. Which one of the following statements
concerning the pharmacokinetics of (c) Phenytoin (d) Valproic acid
antiseizure drugs is accurate? (e) None of the above
(a) At high doses, phenytoin elimination follows 38. The most likely mechanism involved in
first-order kinetics the antiseizure activity of carbamazepine
(b) Valporic acid may increase the activity of is
hepatic ALA synthase and the synthesis of (a) Block of sodium ion channels
porphyrins
(b) Block of calcium ion channels
(c) The administration of phenytoin to patients
in methadone maintenance programs has led (c) Facilitation of GABA actions on chloride ion
to symptoms of opioid overdose, including channels
respiratory depression (d) Glutamate receptor antagonism
(d) Although ethosuximide has a half-life of (e) Inhibition of GABA transaminase
approximately 40 hours, the drug is usually
39. Which one of the following statements
taken twice a day
about phenytoin is accurate?
(e) Treatment with vigabatrin may reduce the
effectiveness of oral contraceptives (a) Displaces sulfonamides from plasma proteins
(b) Drug of choice in myoclonic seizures
34. With chronic use in seizure states, the
(c) Half-life is increased if used with pheno-
adverse effects of this drug include
barbital
coarsening of facial features, hirsutism,
gingival hyperplasia, and osteomalacia. (d) Isoniazid (INH) decreases steady state blood
levels of phenytoin
(a) Carbamazepine (b) Ethosuximide
(e) Toxicity may occur with only small increments
(c) Gabapentin (d) Phenytoin
in dose
(e) Valproic acid
40. Which one of the following statements
35. Which one of the following statements concerning nitrous oxide is accurate?
about vigabatrin is accurate?
(a) It continues to be a useful component of
(a) Blocks neuronal reuptake of GABA anesthesia protocols because of its lack of
(b) Drug of choice in absence seizures cardiovascular depression
(c) Is established to be teratogenic in humans (b) Megaloblastic anemia is a common adverse
(d) Life-threatening skin disorders may occur effect in patients exposed to nitrous oxide
(e) Visual field defects occur in up to one-third for periods longer than 2 hours
of patients (c) It is the most potent of the inhaled
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 33
46. Use of this agent is associated with a high (a) Serious cardiovascular reactions are more likely
incidence of disorientation, sensory and to occur with tetracaine than with bupivacaine
perceptual illusions, and vivid dreams (b) Cyanosis may occur following injection of
during recovery from anesthesia large doses of lidocaine, especially in
patients with pulmonary disease
(a) Diazepam (b) Fentanyl
(c) Intravenous injection of local anaesthetics may
(c) Ketamine (d) Midazolam
stimulate ectopic cardiac pacemaker activity
(e) Thiopental
(d) In overdosage, hyper ventilation (with
47. Postoperative vomiting is uncommon oxygen) is helpful to correct acidosis and
with this intravenous agent; patients are lower extracellular potassium
able to ambulate sooner than those who (e) Most local anaesthetics cause vasoconstriction
34 MCQs IN PHARMACOLOGY
57. Which one of the following is most (a) Taking the drug in divided doses will
effective in the management of malignant decrease nausea and vomiting
hyperthermia? (b) He should be careful when he stands up
because he may get dizzy
(a) Baclofen (b) Dantrolene
(c) Uncontrollable muscle jerks may occur
(c) Haloperidol (d) Succinylcholine
(d) A net-like reddish to blue discoloration of
(e) Vecuronium the skin is a likely side effect of the medication
58. Following is a G-protein coupled receptor (e) The drug will probably improve his symptoms
for a period of time but not indefinitely
(a) AMPA (b) Kainate
(c) NMDA (d) Metabotropic 65. As the physician who is prescribing
levodopa, you will note that the drug
59. Which one of the following drugs is most
often associated with hypotension caused (a) Causes less severe behavioral side effects if
by histamine release? given with carbidopa
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 35
(b) Fluctuates in its effectiveness with increasing (c) The primar y therapeutic benefit of
frequency as treatment continues antimuscarinic drugs in parkinsonism is their
(c) Prevents extrapyramidal adverse effects of ability to reliever bradykinesia
antipsychotic drugs (d) Dopamine receptor against should not be
(d) Protects against cancer in patients with used in Parkinson’s disease prior to a trial of
melanoma levodopa
(e) Has toxic effects that include pulmonary (e) The concomitant use of selegiline may
infiltrates increase the peripheral adverse effects of
levodopa
66. The major reason why carbidopa is of
value in parkinsonism is that the 70. A previously healthy 50-year-old woman
compound begins to suffer from slowed mentation
(a) Crosses the blood-brain barrier and develops writhing movement of her
tongue and hands. In addition, she has
(b) Inhibits monoamine oxidase type A
delusions of being persecuted. The
(c) Inhibits aromatic L-amino acid decarboxylase woman has no past history of psychiatric
(d) Is converted to the false neurotransmitter or neurologic disorders. The most
carbidopamine appropriate drug for treatment is
(e) Inhibits monoamine oxidase type B
(a) Amantadine (b) Bromocriptine
67. Which one of the following statements (c) Haloperidol (d) Levodopa
about bromocriptine is accurate? (e) Trihexyphenidyl
(a) It should not be administered to patients
71. Great caution must be exercised in the
taking antimuscarinic drugs
use of this drug (or drugs from the same
(b) Effectiveness in Parkinson’s disease requires class) in parkinsonian patients who have
its metabolic conversion to an active prostatic hypertrophy or obstructive
metabolite gastrointestinal disease
(c) The drug is contraindicated in patients with
(a) Benztropine (b) Carbidopa
a history of psychosis
(c) Levodopa (d) Ropinirole
(d) The drug should not be administered to
patients already taking levodopa (e) Selegiline
(e) Mental disturbances occur more commonly 72. Which of the following statements about
with levodopa than with bromocriptine pramipexole is accurate?
68. A 72-year-old patient with parkinsonism (a) Activates dopamine D2 receptors
presents with swollen feet. They are red, (b) Commonly a first-line therapy for Parkinson’s
tender, and very painful. You could clear disease
up these symptoms within a few days if (c) May cause postural hypotension
you told the patient to stop taking
(d) Not an ergot derivative
(a) Amantadine (b) Benztropine
(e) All of the above
(c) Bromocriptine (d) Levodopa
(e) Selegiline 73. Tolcapone may be of value in patient
being treated with levodopa–carbidopa
69. Concerning the drugs used in because it
parkinsonism, which of the following
(a) Activates catechol – O – methyltransferease
statements is accurate?
(b) Decreases formation of 3 – O – methyldopa
(a) Levodopa causes mydriasis and can
(c) Inhibits monoamine oxidase type B
precipitate an attack of acute glaucoma
(d) Inhibits dopamine reuptake
(b) Useful therapeutic effects of amantadine
continue for several years (e) Releases dopamine from nerve endings
36 MCQs IN PHARMACOLOGY
74. Concerning hypotheses for the patho- (c) Give oral diphenydramine
physiologic basis of schizophrenia, which (d) Switch the patient to fluphenazine
one of the following statements is accu-
(e) Inject benztropine
rate?
(a) Positron emission tomography has shown 78. Which one of the following statements
decreased dopamine receptors in the brains about the action of phenothiazines is
of both untreated and drug-treated accurate?
schizophrenics (a) They activate muscarinic receptors
(b) Drugs that block dopamine receptors are (b) They are antiemetic
useful for alleviating psychotic symptoms in (c) They decrease serum prolactin levels
parkinsoniam patients
(d) They elevate the seizure threshold
(c) The clinical potency of many antipsychotic
(e) They raise blood pressure
drugs correlates well with their beta
adrenoceptor-blocking actions 79. Within days of starting haloperidol treat-
(d) Drug-induced psychosis can occur without ment for a psychatric disorder, a young
activation of brain dopamine receptors male patient developed severe general-
(e) All effective antipsychotic drugs have high ized muscle rigidity and a high fever. In
affinity for dopamine D2 receptors the emergency room he was incoherent,
with increased heart rate, hypotension,
75. Choose the correct statement from the and diaphoresis, Laboratory studies in-
following? dicated acidosis, leukocytosis, and in-
(a) Muscimol is GABAB selective creased creatine kinase. The most likely
(b) Bicuculline is GABAA agonist reason for these symptoms is that the pa-
(c) Picrotoxin blocks chloride channels tient was suffering from
associated with GABAA receptors (a) Agranulocytosis
(d) Baclofen is GABAA agonist (b) A severe bacterial infection
76. A 30-year-old male patient is on drug (c) Neuroleptic malignant syndrome
therapy for a psychiatric problem. He (d) Spastic retrocollis
complains that he feels “flat” and that (e) Tardive dyskinesia
he gets confused at times. He has been
gaining weight and has lost his sex drive. 80. Following is the main inhibitor y
As he moves his had, you notice a slight transmitter in the brain
tremor. He tells you that since he has been (a) Dopamine (b) Norepinephrine
on medication he is always thirsty and (c) Glycine (d) GABA
frequently has to urinate. The drug he is
most likely to be taking is 81. Concerning the proposed mechanisms of
(a) Clonazepam (b) Clozapine action of antidepressant drugs, which one
of the following statements is accurate?
(c) Haloperidol (d) Lithium
(e) Trifluoperazine (a) Bupropion is an effective inhibitor of NE and
5-HT transporters
77. A young male patient diagnosed as (b) Chronic treatment with an antidepressant often
schizophrenic develops severe muscle leads to the up-regulation of adrenoceptors
cramps with torticollis a short time after
(c) Elevation in amine metabolites in cere-
drug therapy is intiated with haloperidol.
brospinal fluid is characteristic of most
The best course of action would be to
depressed patients prior to drug therapy
(a) Add clozapine to the drug regimen
(d) MAO inhibitors used as antidepressants
(b) Discontinue haloperidol and observe the selectively decrease the metabolism of
patient norepinephrine
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 37
(e) The acute effect of most tricyclics is to block 87. Established clinical uses of this drug
the neuronal reuptake of both norepinephrine include enuresis and chronic pain
and serotonin in the CNS (a) Bupropion (b) Fluvoxamine
82. Which one of the following effects is (c) Imipramine (d) Phenelzine
unlikely to occur during treatment with (e) Selegiline
amitriptyline?
88. Which one of the following drugs is most
(a) Alpha adrenoceptor blockade likely to increase plasma levels of
(b) Elevation of the seizure threshold alprazolam, the ophyline, and warfarin
(c) Mydriasis (a) Desipramine (b) Fluvoxamine
(d) Sedation (c) Imipramine (d) Nefazodone
(e) Urinary retention (e) Venlafaxine
83. A 54-year-old male patient was using 89. Which one of the following actions of
fluoxetine for depression but decided to opioid analgesics is mediated via
stop taking the drug. When questioned, activation of kappa receptors?
he said that it affected his sexual
(a) Cerebral Vascular dilation
performance and that “he wasn’t getting
(b) Decreased uterine tone
any younger.” You notice that he is a used
of tobacco products. If you decide to (c) Euphoria
reinstitute drug therapy in this patient, (d) Sedation
the best choice would be (e) Psychologic dependence
(a) Amoxapine (b) Bupropion 90. ______ antagonists are known to
(c) Imipramine (d) Sertraline attenuate some of the actions of alcohol.
(e) Venlafaxine (a) GABAA (b) GABAB
84. Regarding maprotiline, which one of the (c) NMDA (d) Glycine
following statements is accurate?
91. Which one of the following statements
(a) Blocks serotonin reuptake selectively about propoxyphene is accurate?
(b) Cause hypertension (a) Analgesia equivalent to oxycodone
(c) Raises the seizure threshold (b) Antagonist at mu receptors
(d) Sedation occurs commonly (c) Causes dose-limiting diarrhea
(e) Has a tricyclic structure (d) Highly effective cough suppressant
85. Which one of the following drugs is most (e) Seizures have occurred in overdose
likely to be of value in obsessive 92. A young male patient is brought to the
compulsive disorders (OCD)? emergency room of a hospital suffering
(a) Amitriptyline (b) Bupropion from an overdose of cocaine following
(c) Clomipramine (d) Desipramine intravenous administration. His symp-
toms are unlikely to include
(e) Mirtazapine
(a) Agitation (b) Bradycardia
86. Compared with other antidepressant
(c) Hyperthermia (d) Myocardial infarct
drugs, mirtazapine has the distinctive
(e) Seizures
ability to act as an antagonist of
(a) Alpha2 adrenoceptors 93. Which one of the following statements
(b) Beta adrenoceptors about hallucinogens is accurate?
(c) D2 receptors (a) Mescaline and related hallucinogens are
thought to exert their CNS actions through
(d) NE transporters
dopaminergic systems in the brain
(e) 5-HT transporters
38 MCQs IN PHARMACOLOGY
of St. John’s wort in terms of proposed 109. Recreational use of drugs sometimes
mechanism of action? leads to dependence. Which of the
(a) Alprazolam (b) Fluoxetine following is least likely to cause physical
dependence?
(c) Levodopa (d) Methylphenidate
(e) Selegine (a) Alcohol is excitatory in nature
(b) Alcohol has a direct stimulatory effect on
103. The primary site of action of tyramine is sexual responsiveness
(a) Ganglionic receptors (c) Alcohol is teratogenic
(b) Gut and liver catechol–O–methyltransferase (d) Alcohol increases ADA production
(c) Postganglionic sympathetic nerve terminals
110. This agent is currently a first-choice drug
(d) Preganglionic sympathetic nerve terminals in the management of absence seizures
(e) Vascular smooth muscle cell receptors as well as partial, primary generalized,
and tonic-clonic seizures.
104. Which one of the following drugs has
been used in ophthalmology, but causes (a) Carbamazepine (b) Clonazepam
mydriasis and cycloplegia lasting more (c) Ethosuximide (d) Phenytoin
than 24 hours? (e) Valproic acid
(a) Atropine (b) Echothiophate 111. If one patient is taking amitriptyline and
(c) Edrophonium (d) Ephedrine another patient is taking chlorpromazine,
(e) Tropicamide they are both likely to experience
105. The antihypertensive drug most likely to (a) Excessive salivation
aggravate angina pectoris is (b) Extrapyramidal dysfunction
(a) Clonidine (b) Guanethidine (c) Gynecomastia
(c) Hydralazine (d) Methyldopa (d) Increased gastrointestinal motility
(e) Propranolol (e) Postural hypotension
106. After an intravenous bolus injection of 112. The phenothiazines have a variety of
lidocaine, the major factors determining actions at different receptor types.
the initial plasma concentration are However, they do not appear to interact
with receptors for
(a) Dose and clearance
(a) Dopammine (b) Histamine
(b) Dose and apparent volume of distribution
(c) Nicotine (d) Norepinephrine
(c) Apparent volume of distribution and
(e) Muscarine
clearance
(d) Clearance and half-life 113. A psychiatric patient taking medications
(e) Half-life and dose develops a tremor, thyroid enlargement,
and leukocytosis. The drug he is taking
107. Diuretics that increase the delivery of is most likely to be
poorly absorbed solute to the thick
(a) Clomipramine (b) Haloperidol
ascending limb of the nephron include
(c) Imipramine (d) Lithium
(a) Furosemide (b) Indapamide
(e) Sertraline
(c) Mannitol (d) Spironolactone
(e) All of the above 114. The mechanism of action of benzodiaz-
epines is
108. Following is used in methanol poisoning (a) Activation of GABAB receptors
(a) Disulfiram (b) Naltrexone (b) Antagonism of glycine receptors in the spinal
(c) Ethanol (d) None of the above cord
40 MCQs IN PHARMACOLOGY
(c) Blockade of the action of glutamic acid 120. the consumption of shellfish harvested
(d) Increased GABA mediated chloride ion during a “red tide” (due to a large
conductance population of a dinoflagellate species) is
(e) Inhibition of GABA aminotranferase not recommended. This is because the
shellfish are likely to contain
115. A drug that is used in the treatment of
(a) Arsenic (b) Botulinum toxins
parkinsonism and will also attenuate
(c) Cyanide (d) Saxitoxin
reversible extrapyramidal side effects of
neuroleptics is (e) Tetrodotoxin
(a) Amantadine (b) Levodopa 121. A 35-year-old female who has never
(c) Pergolide (d) Selegiline been pregnant suffers each month from
(e) Trihexyphenidyl pain, discomfort, and mood depression
at the time of menses. She may benefit
116. The characteristics of one-daily dosing from the use of this selective inhibitor of
with aminoglycosides compared with the reuptake of serotonin.
conventional dosing protocols (every 6-12
(a) Amitriptyline (b) Bupropion
hours) include
(c) Mirtazapine (d) Paroxetine
(a) Decreased drug uptake into the renal cortex
(e) Trazodone
(b) Higher peak serum drug levels to MIC ratios
(c) Postantibiotic actions 122. Which of the following is a common effect
of muscarinic stimulant drugs?
(d) All of the above
(e) None of the above (a) Decreased peristalsis
(b) Decreased secretion by salivary glands
117. A young mother is breast-feeding her 2-
(c) Hypertension
month-old infant. Which one of the
(d) Inhibition of sweat glands
following drug situations involving the
mother is most likely to be safe for the (e) Miosis
nursing infant? 123. Four stages of general anesthesia are
(a) Doxycycline, for Lyme disease distinctly seen with the use of
(b) Metronidazole, for trichomoniasis (a) Halothane (b) Diethyl ether
(c) Nystatin, for a yeast infection (c) Nitrous oxide (d) Enflurane
(d) Phentermine, used for weight reduction
124 Infusion of phenotolamine into the
(e) Triazolam, used as a sleeping pill
cerebrospinal fluid of an experimental
118. Cocaine intoxication has become a animal will prevent the bood pressure –
common problem in hospital emergency lowering action of
rooms. Which one of the following drugs (a) Clonidine (b) Enalapril
is not likely to be of any value in the (c) Guanethidine (d) Reserpine
management of cocaine overdose?
(e) Trimethaphan
(a) Dantrolene (b) Diazepam
125. A drug suitable for producing a brief (5
(c) Lidocaine (d) Naltrexone
to 15 minute) increase in cardiac vagal
(e) Nitroprusside
tone is
119. Which one of the following agents used (a) Digoxin (b) Edrophonium
in hypertension is a prodrug that is (c) Ergotamine (d) Pralidoxime
converted to its active form in the brain?
(e) Pyridostigmine
(a) Clonidine (b) Doxazosin
126. Propranolol and hydralazine have which
(c) Methyldopa (d) Nitroprusside
of the following effects in common?
(e) Verapamil
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 41
147. Which of the following drugs is a volatile 152. Which of the following agents would not
substance that is administered by be an alternative to Phenobarbital in the
inhalation? treatment of partial seizures?
(a) Thiopental (b) Halothane (a) Trimethadione (b) Gabapentin
(c) Alprazolam (d) Buspirone (c) Felbamate (d) Lamotrigine
(e) Phenytoin (e) None of the above
148. The brief duration of action of an ultra- 153. A 32-year-old forklift operator with a
short acting barbiturate is due to a past history of cardiac arrhythmias is
suffering from seasonal rhinitis. Which of
(a) Slow rate of metabolism in the liver
the following choices is the best recom-
(b) Low lipid solubility, resulting in a minimal mendation for this patient?
concentration in the brain
(a) Diphenhydramine (b) Meclizine
(c) High degree of binding to plasma proteins
(c) Astemizole (d) Fexofenadine
(d) Rapid rate of redistribution from the brain
due to its high liposolubility (e) Famotidine
(e) Slow rate of excretion by the kidneys 154. Which of the following diuretics is most
similar in chemical structure to the
149. Which of the following mechanisms of antihypertensive agent diazoxide?
action most likely contributes to the
treatment of parkinsonism? (a) Furosemide (b) Spironolactone
(c) Mannitol (d) Acetazolamide
(a) The direct-acting dopaminergic agonist
amantadine mimics the activity of striatal (e) Chlorothiazide
dopamine 155. Following is an example of ideal anesthetic
(b) The antimuscarinic activity of dophen-
(a) Ether (b) Halothane
hydramine contributes to the restoration of
(c) Thiopental (d) None of the above
striatal dopaminergic-cholinergic neuro-
transmitter balance 156. An action common to most general
(c) Striatal H1 – receptors are blocked by the anesthetic
antihistaminic trihexyphenidyl (a) Increase in the cellular threshold of firing
(d) The ergoline bromocriptine stimulates the (b) Potentiation of spontaneous and evoked
release of striatal dopamine from intact activity of neurons
terminals. (c) Inhibition of effects of glutamate
(e) One of the above (d) None of the abvoe
150. All of the following adverse effects are 157. An unconscious patient is brought to the
associated with the use of levodopa emergency department with a history of
except an unknown drug overdose. Which of the
(a) Sialorrhea following actions should the physician
(b) Orthostatic hypotension perform?
(c) Delusions, confusion, and depression (a) Administer 50ml of 50% dextrose, thiamine
(d) Dyskinesia and dystonia 100 mg IV push, and naloxone 0.8 mg IV
push, and naloxone 0.8 mg IV push
(e) Livedo reticularis
(b) Protect the patient’s airway and ensure that
151. The activity of which of the following vital signs are stable
drugs is dependent on a p-phenyl – N – (c) Perform gastric lavage
alkylpiperidine moiety?
(d) Order the following laboratory tests: CBC,
(a) Phenobarbital (b) Chlorpromazine electrolytes, and a toxicology screen
(c) Diazepam (d) Imipramine (e) All of the above
(e) Meperidine
44 MCQs IN PHARMACOLOGY
169. Match the adverse effects with the 173. Which anticonvulsant drug requires
antihypertensive agent that is most likely therapeutic monitoring of Phenobarbital
to cause them. serum levels as well as it’s own serum
(a) Trandolapril (b) Methyldopa levels?
(c) Nitroprusside (d) Terazosin (a) Phenytoin (b) Primidone
(e) Propranolol (c) Clonazepam (d) Ethotoin
(1) Thiocyanate intoxication, hypotension, (e) Carbamazepine
and convulsions 174. Zolpidem belongs to following class of
(2) Bradycardia, bronchospasm, and drugs
cardiac decompensation
(a) Benzodiazepines
(3) Postural, hypotension, fever, and a
(b) Carbamates
positive Coombs’ test
(c) Imidazopyridines
(4) First–dose syncope, postural hypo-
tension, and palpitations (d) None of the above
170. Match each description of a β -blocker 175. What are the most common adverse
with the most appropriate β -adrener- effects of anticonvulsive drugs?
gicblocking agent. (a) headache and dizziness
(a) Esmolol (b) Labetalol (b) Gastrointestinal symptoms
(c) Bisoprolol (d) Nadolol (c) Alternation of cognition and mentation
(e) Pindolol (d) Adverse effects on appetite and body weight
(1) A β-blocker with intrinsic sympathomi- (e) All of the above
metic activity 176. What are the important elements in
(2) A β-blocker that also blocks a-adrenergic considering treatment strategies for
receptors Parkinson’s patients?
(3) A β-blocker with an ultrashort duration (a) Age
of action
(b) Clinical presentation of disease
(4) A β-blocker with a long duration of
(c) Sex
action and nonselective blocking activity
(d) Etiology of the disease
(5) A b-blokcer with relative cardioselective
blocking activity (e) All of the above
171. Phenytoin is effective for the treatment 177. Which of the following have liver failure in
of all of the following types of seizures their side effect profile and how often the
except liver function tests should be monitored?
(a) Ropinirole
(a) Generalized tonic-clonic
(b) Pramipexole
(b) Simple partial
(c) Levodopa/carbidopa
(c) Complex partial
(d) Tolcapone
(d) Absence
(e) Both (a) and (b)
(e) Grand mal
178. Which of the following agents should not
172. Which of the following anticonvulsants
be used concurrently with levodopa?
is contraindicated in patients with a
history of hypersensitivity to tricyclic (a) Diphenhydramine
antidepressants? (b) Benztropine
(a) Phenytoin (b) Ethosuximide (c) Amantadine
(c) Acetazolamide (d) Carbamazepine (d) Monoamine oxidase (MAO) inhibitors
(e) Phenobarbital (e) Carbidopa
46 MCQs IN PHARMACOLOGY
(d) It is considerably less expensive (c) It has additional direct agonistic action on
(e) It is more effective nicotinc receptors at the muscle end plate
(d) It penetrates blood-brain barrier
230. In an anaesthetized dog, repeated
intravenous injection of ephedrine shows 237. The mechanism by which neostigmine
the phenomenon of improves contraction of myasthenic
(a) Anaphylaxis (b) Tachyphylaxis muscle involves
(c) Idiosyncrasy (d) Drug resistance (a) Repetitive binding of the acetylcholine
231. The cotransmitter may ser ve the molecules to the same receptors at the muscle
following function/functions end plate
(a) Regulate the release of the primary transmitter (b) Diffusion of acetylcholine released from
from the nerve ending motor ner ve endings to a wider area
activating neighbouring receptors
(b) Alter postjunctional action of the primary
transmitter (c) Activation of motor end-plate receptors by
(c) Itself act as an alternative transmitter neostigmine molecules themselves
(d) All of the above (d) All of the above
232. Pseudocholinesterase differs from the 238. Symptoms of schizophrenia are produced
cholinesterase in that by following agents, except
(a) It does not hydrolyse acetylcholine (a) Amphetamine (b) Apomorphine
(b) It hydrolyses acetylcholine at a slower rate (c) Bromocriptine (d) Reserpine
(c) It is more susceptible to inhibition by
239. Select the anticholinesterase drug that is
physostigmine
being used to afford symptomatic
(d) It is the only form of circulating cholinesterase improvement in Alzheimer’s disease
233. Acetylcholine has no therapeutic appli- (a) Echothiophate (b) Tacrine
cation because
(c) Demecarium (d) Ambenonium
(a) None of its actions are beneficial in any
condition 240. Pilocarpine reduces intraocular tension in
open angle glaucoma by
(b) Its effects are transient
(c) It produces wide spread actions affecting (a) Contracting sphincter pupillae
many organs (b) Increasing tone of ciliary muscle
(d) Both ‘B’ and ‘C’ are correct (c) Reducing aqueous formation
234. Pilocarpine is used in (d) Enhancing u/veo-scleral outflow
(a) Glaucoma (b) Paralytic ileus 241. Timolol eye drops are preferred over
(c) Urinary retention (d) All of the above pilocarpine eye drops by many glaucoma
patients because
235. Which of the following inhibitors binds
only to the anionic site of the choline- (a) Timolol is more effective than pilocarpine
sterase enzyme ? (b) Timolol acts by enhancing uveo-scleral
(a) Neostigmine (b) Physostigmine outflow
(c) Edrophonium (d) Dyflos (c) Timolol produces less ocular side effects
(d) There are no contraindications to timolol
236. Neostigmine is preferred over physostig-
mine for treating myasthenia gravis be- 242. Select the longer acting ocular beta
cause blocker
(a) It is better absorbed orally (a) Timolol (b) Betaxolol
(b) It has longer duration of action (c) Cartilol (d) Levobunolol
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 51
243. Which of the following is a prodrug of 250. Local anaesthetics block nerve conduction
adrenaline used topically in glaucoma ? by
(a) Phenylephrine (a) Blocking all cation channels in the neuronal
(b) Dipivefrine membrane
(c) Phenylpropanolamine (b) Hyperpolarizing the neuronal membrane
(d) Dorzolamide (c) Interfering with depolarization of the
neuronal membrane
244. Which of the following diuretics is most (d) Both (b) and (c)
effective in acute congestive glaucoma ?
251. Sensitivity of a nerve fibre to blockade
(a) Indapamide (b) Amiloride by lidocaine depends on
(c) Mannitol (d) Furosemide
(a) Whether the fibre is sensory or motor
245. Neostigmine is beneficial in cobra en- (b) Whether the fibre is myelinated or
venomation because nonmyelinated
(a) It binds to and inactivates cobra toxin (c) Internodal distances in the fibre
(b) It reverses coma due to cobra toxin (d) Both (b) and (c)
(c) It counteracts the cardio-depressant action 252. Which sensation is blocked first by low
of cobra toxin concentrations of a local anaesthetic ?
(d) It antagonizes the paralyzing action of cobra (a) Temperature (b) Pain
toxin
(c) Touch (d) Deep pressure
246. Which is the most important drug in the 253. Following are the MAO-inhibitors, except
treatment of organophosphate poisoning ?
(a) Tranylcypromine (b) Nomifensine
(a) Atropine sulfate (b) Pralidoxime
(c) Moclobemide (d) Isocarboxid
(c) Diazepam (d) Adrenaline
254. The local anaethetic with the longest
247. Which of the following diseases is wors- duration of action is
ened by propranolol ?
(a) Procaine (b) Chloroproacine
(a) Glaucoma (c) Lidocaine (d) Dibucaine
(b) Raynaud’s disease
255. Which of the following is a poor surface
(c) Benign prostatic hypertrophy
anaesthetic ?
(d) Parkinsonism
(a) Procaine (b) Lidocaine
248. Diazepam is used as a muscle relaxant for (c) Tetracaine (d) Benoxinate
(a) Deep intra-abdominal operation
256. The local anaesthetic having high car-
(b) Trachial intubation diotoxic and arrhythmogenic potential is
(c) Tetanus (a) Lidocaine (b) Procaine
(d) Diagonosis of myasthenia gravis (c) Bupivacine (d) Chloroprocaine
249. The local anaesthetics having amide 257. Low concentration of bupivacaine is
linkage differ from those having ester preferred for spinal/epidural obstetric
linkage in that the amide linked local analgesia because
anaesthetics
(a) It has a longer duration of action
(a) Are not surface anaesthetics (b) It can produce sensory blockade without
(b) Have a shorter duration of action paralyzing abdominal muscles
(c) Are degraded in the plasma (c) It distributes more in maternal tissues so that
(d) Do not show cross-sensitivity with ester linked less reaches the foetus
local anaesthetics (d) All of the above are correct
52 MCQs IN PHARMACOLOGY
258. Which of the following local anaesthetics 264. The calcium channel blocker used for
is poorly water soluble PABA derivative prophylaxis of migraine but not for
and primarily used for anorectal lesions, angina pectoris is
wounds and ulcers ? (a) Verapamil (b) Diltiazem
(a) Benzocaine (b) Dibucaine (c) Flunarizine (d) Amlodipine
(c) Procaine (d) Benoxinate
265. Select the nonapeptide which can be
259. Oxethazaine is used for anaesthetizing generated from plasma globulin by
gastric mucosa because snake venom enzymes and causes fall in
BP and intense pain when applied to
(a) It is not absorbed from the gastrointestinal
blister base
tract
(b) It remains largely unionized in acidic medium (a) Kallidin (b) Bradykinin
(c) It is highly ionized in acidic medium (c) Angiotensin II (d) Angiotensin III
(d) It produces no systemic effects even at high 266. Captopril produces greater fall in blood
doses pressure in
260. In which of the following techiniques the (a) Diuretic treated patients
concentration of the local anaesthetic (b) Patients having low plasma rennin activity
required is the lowest ? (c) Sodium replete normotensive individuals
(a) Infiltration anaesthesia (d) Untreated CHF patients
(b) Field block anaesthesia
267. Enalapril differs from captopril in that
(c) Nerve block anaesthesia
(a) It blocks angiotensin II receptors
(d) Spinal anaesthesia
(b) It does not produce cough as a side effect
261. The segmental level of spinal anaesthesia (c) It is less liable to cause abrupt first dose
depends on hypotension
(a) Volume of the local anaesthetic injected (d) It has a shorter duration of action
(b) Specific gravity of the local anaesthetic 268. Which of the following drugs increases
solution cardiac output in congestive heart failure
(c) Posture of the patient without having any direct myocardial
(d) All of the above action ?
262. Spinal anaesthesia is not suitable for (a) Digoxin (b) Captopril
(c) Amrinone (d) Dobutamine
(a) Vaginal delivery
(b) Lower segment caesarian section 269. Which of the following statements most
(c) Prostatectomy closely describes the current status of
(d) Operations on mentally ill patients angiotensin converting enzyme inhibitors
in congestive heart failure ?
263. Epidural anaesthesia differs from spinal (a) They are the first choice drugs unless
anaesthesia in that contraindicated
(a) Epidural anaesthesia produces less (b) They are used when diuretics alone fail
cardiovascular complications (c) They are a substitute for digitalis
(b) Headache is more common after epidural (d) They are to be used as adjuncts only in
anaesthesia resistant cases
(c) Blood concentrations of the local anaesthetic
are lower after epidural anaesthesia 270. Following is a MAO-inhibitor and also has
anit-tubercular activity
(d) Greater separation between sensory and
motor blockade can be obtained with (a) Iproniazid (b) Phenelzine
epidural anaesthesia (c) Moclobemide (d) Isocarboxid
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 53
(c) Sensitization of heart to adrenaline 291. Which of the following drugs has been
(d) No postoperative residual CNS depression found to reduce alcohol craving and
chances of resumed heavy drinking by
285. Dissociative anaesthesia is produced by alcoholics after they have undergone a
(a) Ketamine detoxification programme
(b) Fentanyl + droperidol (a) Chlordiazepoxide (b) Chlorpromazine
(c) Propofol (c) Methadone (d) Naltrexone
(d) Both (a) and (b)
292. Following agent potentiates actions of
286. Use of morphine in preanaesthetic GABA
medication (a) Volatile anaesthetics
(a) Is routine except in the presence of (b) Barbiturates
contraindications (c) Propofol
(b) Is restricted to patients being anaesthetized (d) All of the above
with ether
293. Ethanol is used in methanol poisoning
(c) Should be made only in combination with
because it
atropine
(d) Is restricted mostly to patients in pain (a) Antagonises the actions of methanol
preoperatively (b) Stimulates the metabolism of methanol and
reduces its blood level
287. Which of the following drugs is routinely
(c) Inhibits the metabolism of methanol and
used in preanaesthetic medication for
generation of toxic metabolite
prolonged operations
(d) Replenishes the folate stores depleted by
(a) Atropine (b) Morphine methanol
(c) Promethazine (d) Ranitidine
294. The mechanism of action of barbiturates
288. Patients treated with the following drugs differs from that of benzodiazepines in
should be cautioned not to consume that they
alcoholic beverages (a) Do not affect the GABA–benzodiazepine
(a) Mebendazole (b) Metronidazole receptor–chloride channel complex
(c) Methimazole (d) Metamizol (b) Act as inverse agonists at the benzodiaze-
pine receptor
289. Consumption of alcoholic beverages,
even in moderate amounts, is contrain- (c) Increase the frequency of chloride channel
dicated for the following category of opening without affecting its life time
subjects except (d) Have both GABA–facilitatory as well as
GABA–mimetic actions
(a) Epileptics
(b) Patients with history of myocardial infarction 295. Which one of the following processes
(c) Gastroesophageal reflux patients plays the major role in terminating the
action of phenobarbitone
(d) Pregnant women
(a) Billary excretion
290. What is considered to be the safe limit of (b) Renal excretion
daily alcohol consumption by an adult
(c) Hepatic metabolism
man in the absence of contraindications
and interacting drugs (d) Redistribution
297. Hypnotic benzodiazepines increase the (a) Selective inhibition of high frequency
period of time spent in the following stage neuronal discharges
of sleep (b) Selective inhibition of epileptic focus
(a) Stage II (b) Stage III (c) Selective inhibition T-type Ca2+ current in
brain cells
(c) Stage IV (d) REM stage
(d) Selective enhancement of inhibitor y
298. The primary mechanism of action of transmission in the brain
benzodiazepines is
305. The characterstics feature of phenytoin
(a) Dopamine antagonism
pharmacokinetics is
(b) Adenosine antagonism
(a) High first pass metabolism
(c) Opening of neuronal chloride channels
(b) Nonsaturation kinetics of metabolism
(d) Facilitation of GABA–mediated chloride
influx (c) Capacity limited metabolism saturating at
higher therapeutic concentration range
299. At a single hypnotic dose, the pharma- (d) Extrahepatic metabolism
cokinetics of diazepam is characterized
by 306. Which of the following drugs displaces
plasma protein bound phenytion as well
(a) Slow elimination and little redistribution
as decreases its metabolism
(b) Slow elimination with marked redistribution
(a) Carbamazepine (b) Sodium valproate
(c) Rapid elimination and marked redistribution
(c) Cimetidine (d) Chloramphenicol
(d) Ultra rapid elimination
307. The following antiepileptic drug is also
300. The following drug is used to reverse the
CNS depression produced by diazepam effective in manic-depressive illness
301. Which of the following is not a CNS 308. The drug of choice for trigeminal neuralgia
depressant but increases the tendency to is
fall asleep at night ? (a) Aspirin (b) Imipramine
(a) Pyridoxine (b) Methaqualone (c) Carbamazepine (d) Valproic acid
(c) Melatonin (d) Ethanol 309. Which of the following is a narrow
302. The barbiturate having higher anticonvul- spectrum antiepileptic drug effective only
sant sedative activity ratio is in absence seizures
(a) Pentobarbitone (b) Phenobarbitone (a) Phenacemide (b) Ethosuccimide
(c) Bultabarbitone (d) Thiopentone (c) Sodium valproate (d) Primidone
303. The most probable mechanism of 310. Sodium valproate has been shown to
anticonvulsant action of phenytoin is (a) Prolong neuronal Na+ channel inactivation
(a) Facilitation of GABA ergic inhibitory (b) Attenuate ‘T’ type Ca2+ current in neurones
transmission (c) Inhibit degradation of GABA by GABA –
(b) Hyperpolarization of neurones transaminase
(c) Interaction with Ca2+ channels to rpmote Ca2+ (d) All of the above
influx
311. Sodium valproate should be used with
(d) Prolongation of voltage sensitive neuronal
caution in young children because they
Na+ channel inactivation
56 MCQs IN PHARMACOLOGY
are particularly at risk of developing the 319. Which of the following is the most suitable
following adverse effect drug for a 6-year-old girl suffering from
(a) Hepatitis (b) Loss of hair absence seizures with occasional
generalized tonic-clonic seizures ?
(c) Anorexia (d) Tremor
(a) Ethosuccimide (b) Sodium valproate
312. 2-bromo-2-chloro-1,1,1 trifluroethane is
(c) Carbamazepine (d) Phenytoin
(a) Halothane (b) Enflurane
320. The preferred drug for status spilepticus
(c) Isoflurane (d) Desflurane
is
313. Clobazam is a benzodiazepine used as (a) Intravenous diazepam
(a) Hypnotic (b) Muscle relaxant (b) Intravenous phenytoin sodium
(c) Anxiolytic (d) Antiepileptic (c) Intramuscular phenobarbitone
314. Which of the following is a recently (d) Rectal paraldehyde
developed antiepileptic drug used mainly 321. The most effective single drug in parkin-
as add-on therapy of refractory partial sonism is
seizures ?
(a) Bromocriptine (b) Selegiline
(a) Viloxazine (b) Lamotrigine
(c) Levodopa (d) Biperiden
(c) Bupropion (d) Clozapine
322. The dopamine D2 receptor has the fol-
315. Gabapentin acts lowing feature.
(a) As GABAA agonist (a) It is excitatory in nature
(b) As precursor of GABA (b) It is negatively coupled to adenlyl cyclase
(c) By enhancing GABA release (c) It is selectively blocked by chlorpromazine
(d) By GABA independent mechanism (d) It is not blocked by metoclopramide
316. Which of the following is a GABA – 323. The usual cardiovascular effect of
transaminase inhibitor ? levodopa is
(a) Gabapentin (b) Vigabatrin (a) Bradycardia due to increased vagal tone
(c) Lamotrigine (d) Clobazam (b) Rise in blood pressure due to increased
317. Which of the following factors indicates noradrenaline content of adrenergic nerve
that withdrawal of the successfully used endings
antiepileptic medication is likely to result (c) Fall in blood pressure due to decrease in
in recurrence of seizures ? sympathetic tone
(a) Childhood epilepsy (d) Both (a) and (b)
(b) Partial seizures 324. Which of the following adverse effects of
(c) Treatment started soon aftrer seizure onset levodopa has a delayed onset and
(d) Absence of EEG abnormality increases in severity with continued
therapy ?
318. An epileptic woman controlled by pheny-
(a) Nausea and vomiting
toin therapy conceives. Which of the fol-
lowing measures is most appropriate ? (b) Postural hypotension
(c) Cardiac arrhythmia
(a) Mecal termination of pregnancy
(d) Abnormal movements
(b) Withdraw phenytoin therapy
(c) Gradually reduce phenytoin dose to the 325. The drug which abolishes the therapeu-
lowest effective level tic effect of levodopa in parkinsonism, but
(d) Stubstitute phenytoin with a combination of not that of levodopacarbidopa combina-
carbamazepine and sodium valproate tion is
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 57
(a) Metoclopramide (b) Pyridoxine 332. Which of the following drugs is added to
(c) Chlorpromazine (d) Isoniazid levodopa therapy of parkinsonism to
attenuate wearing off effect ?
326. Use of carbidopa along with levodopa in
(a) Selegiline (b) Trihexiphenidyl
the treatment of parkinsonism
(c) Amantadine (d) Any of the above
(a) Inhibits development of involuntar y
movements 333. The following drug is effective in
(b) Minimises ‘on–off’ effect chlorpromazine induced parkinsonism.
(c) Inhibits occurrence of behavioral abnormal (a) Trihexyphenidyl
ities (b) Selegiline
(d) Accentuates nausea and vomiting (c) Bromocriptine
327. Which of the following adverse effects of (d) Levodopa + carbidopa
levodopa is not minimized by combining 334. For majority of patients of parkinsonism
it with carbidopa the standard drug therapy is
(a) Involuntary movements (a) Levodopa
(b) Nausea and vomiting (b) Levodopa + carbidopa
(c) Cardiac arrhythmia (c) Levodopa + trihexiphenidyl
(d) ‘On–off ‘ effect (d) Bromocriptine
328. Though bromocriptine acts directly on 335. Compared to other antipsychotic drugs,
dopamine receptors, it is used in the distinctive feature of penfluridol is
parkinsonism only as a supplement to
levodopa because (a) Very long duration of action
(b) Weak dopamine D2 blocking activity
(a) It has low efficacy
(c) Lack of extrapyramidal side effects
(b) It produces ‘first dose hypotension’
(d) Additional 5–HT2 receptor blocking activity
(c) Used alone, its effective doses produce
intolerable side effects 336. Which of the following adverse effects of
(d) Its therapeutic effect takes long time to develop neuroleptic drugs is positively correlated
to the antipsychotic potency of the
329. Nitrous oxide is different compounds ?
(a) Non-flammable (a) Sedation
(b) Non-irritant (b) Extrapyramidal motor distubances
(c) Potent analgesis (c) Postural hypotension
(d) All of the above (d) Lowering of seizure threshold
330. The antiparkinsonian drug which acts by 337. Chlorpromazine therapy increases the
inhibiting the degradation of dopamine secretion of the following hormone.
in the brain is
(a) Prolactin (b) Gonadotropin
(a) Carbidopa (b) Amantadine
(c) Corticotropin (d) Antidiuretic hormone
(c) Selegiline (d) Bromocriptine
338. What is true of risperidone ?
331. Tolerance to the antiparkinsonian action
develops most rapidly in the case of (a) It is an atypical neuroleptic which produces
few extrapyramidal side effects
(a) Levodopa
(b) It has combined dopamine D2 and 5-HT2
(b) Levodopa + carbidopa receptor blocking activity
(c) Amantadine (c) It is highly sedative
(d) Bromocriptine (d) Both (a) and (b)
58 MCQs IN PHARMACOLOGY
339. Which of the following is a high potency 346. The most important reason for the
antipsychotic drug having minimal unpopularity of nonselective MAO
sedative and autonomic effects and no inhibitors as antidepressants is their
propensity to cause weight gain ?
(a) Low antidepressant efficacy
(a) Chlorpromazine (b) Triflupromazine (b) Organ toxicity
(c) Haloperidol (d) Reserpine (c) Potential to interact with many foods and
340. The psychotic symptoms most benefited drugs
by neuroleptic drugs are (d) Propensity to precipitate hypomania in
(a) Judgement and memory impairment depressed patients
(b) Loss of insight and voltion 347. The antidepressant which selectively
(c) Hallucinations, delusions and aggressive blocks 5-hydroxytryptamine uptake is
(d) Apathy and social withdrawl (a) Desipramine (b) Amoxapine
341. A manic patient has been brought to the (c) Fluoxetine (d) Dothiepin
hospital with nonstop talking, singing, 348. Adaptive changes in brain monoamine
uncontrollable behavior and apparent turnover due to blockade of noradre-
loss of contact with reality. Which of the naline/5-HT reuptake is credited with the
following is the most appropriate drug following effect.
for rapid control of his symptoms ?
(a) Antipsychotic (b) Antianxiety
(a) Lithium carbonate (b) Diazepam
(c) Antiparkinsonian (d) Antidepressant
(c) Haloperidol (d) Chloral hydrate
349. A 65-year-old man was brought to the
342. The drug which should not be used to hospital with complaints of pain in lower
treat neurotic anxiety and tension abdomen and not having passed urine
syndromes despite having antianxiety for 16 hours. The bladder was found to
action is be full. His son informed that he was
(a) Buspirone (b) Chlorpromazine depressed for the last 2 years and only
(c) Diazepam (d) Alprazolam the day before a doctor had given him
some medicine. Which of the following
343. Which of the following is a nonsedative drugs is he most likely to have received ?
anxiolytic ?
(a) Alprazolam (b) Haloperidol
(a) Meprobamate (b) Buspirone (c) Imipramine (d) Trazodone
(c) Hydroxyzine (d) Alprazolam
350. Following analgesics are frequently
344. Which of the following statements in employed as supplemental drugs during
correct about buspirone ? general anesthesia.
(a) It interacts with benzodiazepine receptor as (a) Meperidine (b) Fentanyl
an inverse agonist (c) Alfentanil (d) All of the above
(b) It is a rapidly acting anxiolytic, good for
panic states 351. Prolonged painful erection of penis has
(c) It produces physical dependence and been noted particularly as a side effect
suppresses barbiturate withdrawl syndrome of
(d) It has anxiolytic but no anticonvulsant or (a) Doxepin (b) Trimipramine
muscle relaxant propery (c) Mianserin (d) Trazodone
345. Which of the following selective MAO–B 352. A 30-year old woman suffering from
inhibitor ? endogenous depression improved after
(a) Selegiline (b) Chlorgiline one month of treatment with amitripty-
line. How long the drug should be
(c) Moclobemide (d) Tranylcypromine
continued
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 59
(a) Selegiline (b) Chlorgiline 360. The drug of choice for hyperkinetic children
(c) Moclobemide (d) Tranylcypromine is
353. Which of the following statements about (a) Methylphenidate (b) Nikethamide
lithum is not correct (c) Caffeine (d) Clonazepam
(a) It has a sedative action in normal individuals 361. The neurotransmitter system in the brain
(b) It controls mania, but takes 1–2 weeks to most affected in Alzheimer’s disease is
produce the effect (a) Glutaminergic (b) Gabaergic
(c) It has prophylactic effect in recurrent unipolar (c) Dopaminergic (d) Cholinergic
depression
(d) It can be combined with tricyclic antidepres- 362. Which of the following drugs is claimed
sants for refractory cases of major depres- to have a therapeutic effect in senile
sion dementia and has adrenergic blocking
activity
354. For therapeutic effect in manic depressive
(a) Digoxin (b) Furosemide
illness, stady-state serum lithium concen-
tration should be maintained between (c) Enalapril (d) Amrinone
(a) 0.2–0.4 mEq/L (b) 0.5–0.8 mEq/L 363. Which of the following drugs improves
(c) 1.0–1.3 mEq/L (d) 1.5–2.5 mEq/L some symptoms in Alzheimer’s dementia
by increasing brain acelylcholine levels
355. Renal excretion of lithium is enhanced by
(a) Pemoline (b) Tacrine
(a) Furosemide (b) Mannitol (c) Nicergoline (d) Piribedil
(c) Indomethacin (d) Both (a) and (b)
364. Pyritinol (pyrithioxine) is used as
356. Which of the following drugs can be used
(a) Analeptic drug (b) Cerebroactive drug
as an alternative to lithium in mania and
bipolar illness (c) Antiepileptic drug (d) Antidepressant drug
(a) Diethyl carbamazine 365. Extract of the following plant has platelet
(b) Haloperidol activating factor antagonistic activity and
is claimed to benefit congnitive disorders
(c) Clomipramine
due to cerebral ischaemia
(d) Carbamazepine
(a) Ginkgo biloba (b) Claviceps purpurea
357. The constellation of side effects consist-
(c) Amanita muscaria (d) Artemisia annua
ing of thirst, polyuria, looseness of stools
and fine tremors is characteristically as- 366. Digitalis increases the force of contraction
sociated with the following psychotropic of ventricles by
drug (a) Increasing the duration of systole
(a) Amitriptyline (b) Buspirone (b) Increasing the rate of contraction without
(c) Lorazepam (d) Lithium carbonate affecting the duration of systole
358. Prolonged lithium therapy can cause (c) Increasing the rate of contraction, but
reducing the duration of systole
(a) Diabetes mellitus (b) Goiter
(d) Increasing both the rate of contraction as
(c) Parkinsonism (d) Gout well as the duration of systole
359. Strychnine produces convulsions by 367. Digitalis induced increase in refractory
(a) Stimulating NMDA receptors period of myocardial fibres is most
(b) Facilitating the excitatory transmitter glutamate consistent and pronounced in the
(c) Blocking the inhibitory transmitter GABA (a) Atria (b) Ventricles
(d) Blocking the inhibitory transmitter glycine (c) A-V node (d) Purkinje fibres
60 MCQs IN PHARMACOLOGY
381. Select the drug which is an ‘inodilator’ (a) It has selective antihypertensive action at
beneficial in refractory congestive heart doses which cause little diuresis
failure (b) It is a more efficacious antihypertensive
(a) Astemizole (b) Amiodarone (c) Its antihypertensive action develops more
(c) Amrinone (d) Amiloride rapidly
(d) All of the above
382. The principal action common to all class I
antiarrhythmic drugs is 389. In the treatment of hypertension the beta
adrenergic blockers have the following
(a) Na+ channel blockade
advantage
(b) K+ channel openine
(a) They have minimal effect on work capacity,
(c) Depression of impulse conduction
sleep quality and libido
(d) Prolongation of effective refractory period
(b) They do not cause postural hypotension
383. Following is an amide linked local anaesthetic (c) Used alone, they have high ceiling
(a) Bupivacaine (b) Procaine antihypertensive efficacy
(c) Tetracaine (d) Proparacaine (d) They can be used in combination with any
other antihypertensive drug
384. Persistent dry cough may occur as a side
effect of the following antihypertensive 390. The following antihypertensive drug has
drug a favourable effect on plasma lipid profile
(a) Enalapril (b) Atenolol (a) Prazosin
(c) Diltiazem (d) Methyldopa (b) Propranolol
(c) Hydrochlorothiazide
385. Loss of taste sensation can be a side effect
(d) Furosemide
of the following antihypertensive drug
(a) Clonidine (b) Captopril 391. The following drug has been found to
improve urine flow in elderly males with
(c) Verapamil (d) Prazosin
benign prostatic hypertrophy
386. Furosemide is to be preferred over (a) Nifedipine (b) Prazosin
hydrochlorothiazide when hypertension
(c) Disopyramide (d) Imipramine
is accompanied by
392. Following is an ester linked local anaesthetic
(a) Asthma
(b) Hyperuricaemia (a) Mepivacaine (b) Ropivacaine
(c) Benzocaine (d) Prilocaine
(c) Diabetes
(d) Congestive heart failure 393. The following antihypertensive is used
topically to treat alopacia areata
387. Thiazide diuretics are the preferred first
(a) Hydralazine (b) Prazosin
line antihypertensives from the following
category of patients (c) Minoxidil (d) Guanethidine
(c) Its response increases steeply over a narrow 412. A patient of congestive heart failure was
dose range being treated with furosemide and
(d) All of the above digoxin. He developed urinary tract
infection. Which of the following
+
407. Thiazide diuretics enhance K elimination antimicrobials should not be prescribed
in urine primarily by (a) Ampicillin (b) Gentamicin
+
(a) Inhibiting proximal tubular K reabsorption (c) Norfloxacin (d) Cotrimoxazole
–
(b) Inhibiting Na+ K+–2C1 cotransport in the
413. Which of the following has a ‘self limiting
ascending limb of of loop of Henle
diuretic’ (action of the drug itself causing
(c) Increasing the availability of Na+ in the distal changes which limit further diuresis)
tubular fluid to exchange with interstitial K+ action ?
(d) Potentiating the action of aldosterone (a) Indapamide (b) Spironolactone
408. The primary site of action of thiazide (c) Theophylline (d) Acetazolamide
diuretics is
414. The most important therapeutic indication
(a) Proximal tubule of acetazolamide is
(b) Ascending limb of loop of Henle (a) Congestive heart failure
(c) Cortical diluting segment (b) Renal insufficiency
(d) Collecting ducts (c) Cirrhosis of liver
409. The most important reason for the (d) Glaucoma
thiazides being only moderately effica- 415. Aldosterone increases Na+ reabsorption
cious diuretics is and K+ excretion in the renal collecting
(a) FSH + LH obtained from urine of menstruating duct cells by
women (a) Inducing synthesis of Na+ K+ ATP ase
(b) LH obtained from urine of pregnant women (b) Inducing synthesis of amiloride sensitive Na+
(c) FSH + LH obtained from urine of menopausal channels
women (c) Translocating Na+ channels from cytosolic
(d) LH obtained from serum of pregnant mare site to luminal membrane
(d) All of the above
410. Combined tablets of thiazide or high
ceiling duretics with potassium chloride 416. Select the diuretic that can cause gynae-
are not recommended because comastia, hirsutism and menstrual distur-
bance as a side effect on long-term use.
(a) Potassium absorbed while diuresis is
occurring is largely excreted out (a) Amiloride (b) Spironolactone
(b) Potassium administered concurrently (c) Metolazone (d) Acetazolamide
diminishes the diuretic action 417. Which of the following is a potassium
(c) Potassium chloride in tablet formulation is retaining diuretic ?
likely to cause gut ulceration (a) Trimethoprim (b) Triamterene
(d) Both (a) and (c) (c) Trimethaphan (d) Trimethadione
411. _______ technique relies on using the 418. Triam
vasculature to bring the local anesthetic
solution to the nerve trunks and endings (a) It has greater natriuretic action
(b) Its K+ retaining action is not dependent on
(a) Spinal anesthesia
presence of aldosterone
(b) Nerve block anesthesia
(c) It acts from the luminal membrane side of
(c) Intravenous regional anesthesia the distal tubular cells
(d) All of the above (d) Both (b) and (c)
64 MCQs IN PHARMACOLOGY
419. Potassium sparing diuretics should not be (b) Produces reflex tachycardia
coadministered with (c) Is contraindicated in patients with renal
(a) Furosemide insufficiency
(b) Hydrochlorothiazide (d) Decreases plasma renin activity
(c) Captopril 426. Diazoxide
(d) Verapamil
(a) Causes marked sodium and water retention
420. The primar y mechanism by which (b) Can be used in hypertensive emergencies
antidiuretic hormone reduces urine
(c) Can produce alopecia
volume is
(d) Lowers blood sugar levels
(a) Decrease in glomerular filtration rate
(b) Decreased renal blood flow 427. Hydroxyethyl starches
(c) Decreased water permeability of descending (a) Are allergenic
limb of loop of Henle (b) Do not cause coagulation disturbances
(d) Increased water permeability of collecting (c) Can precipitate renal failure
duct cells (d) Are hydrolysed by amylase
421. Which of the following tissues is most
428. Normal saline
sensitive to vasopressin ?
(a) Has a long duration of action
(a) Vascular smooth muscle
(b) Is commonly used as a vehicle for
(b) Intestinal smooth muscle
noradrenaline drip
(c) Renal collecting ducts
(c) Is 5% sodium chloride
(d) Uterus
(d) Is a commonly used agent to raise effective
422. Which of the following drugs reduces blood volume in emergencies
urine volume in both pituitary origin as
well as renal diabetes insipidus and is 429. The sympathomimetic amine preferred in
orally active ? shock due to myocardial infarction is
436. The anti-cholinesterase with the shortest (a) Phenelzine (b) Selegiline
duration of action is (c) Isocarboxazid (d) Pargyline
(a) Neostigmine (b) Physostigmine 446. Nitrous oxide
(c) Edrophonium (d) Ambenonium
(a) Provides slow induction
437. The agent that produces cycloplegia for (b) Produces adequate muscle relaxation
a short time is (c) By itself is not a potent anaesthetic
(a) Cyclopentolate (b) Homatropine (d) Is a poor analogesic
(c) Tropicamide (d) Atropine
447. Propofol
438. The drug of choice in the treatment of
(a) Enhances the neuromuscular blockade of d-
organophosphorus poisoning is
tubocurarine
(a) Neostigmine (b) Atropine (b) Causes marked postoperative confusion
(c) Pralidoxime (d) Acetylcholine
(c) Can produce involuntary movements during
439. The average rate of ethanol metabolism its use
in one hour in normal adults is between (d) Has a delayed recovery after induction
(a) 1 to 2 ml (b) 8 to 12 ml 448. Neurolept analgesia
(c) 30 to 50 ml (d) 100 to 150 ml
(a) Is used in patients with Parkinson’s disease
440. Following barbiturate is significantly (b) Precludes the use of succinylcholine
excreted as unchanged drug (c) Induces unconsciousness
(a) Phenobarbital (b) Pentobarbital (d) Is useful for minor surgical procedures
(c) Secobarbital (d) All of the above 449. The local anaesthetic with a short dura-
441. Acute opium poisoning is treated by tion of action is
intravenous administration of (a) Lignocaine (b) Procaine
(a) Naloxone (b) Pethidine (c) Tetracaine (d) Mepivacaine
(c) Nalbuphine (d) Noscapine 450. The local anaesthetic with significant
442. Ultrashort duration of effct of thiopentone vasoconstriction effect is
sodium given intravenously is due to (a) Cocaine (b) Procaine
(c) Bupivacaine (d) Tetracaine
66 MCQs IN PHARMACOLOGY
451. The local anaesthetic recommended as an (c) They are strong bases and are highly ionized
antiarrhythmic is at gastric pH
(a) Lignocaine (b) Procaine (d) They are weak acids and are ionized at
(c) Medivacuene (d) Tetracaine gastric pH
464. Regarding the eardiac and therapeutic 469. Hemicholinium modifies Ach metabolism
effect of phenytoin, which of the following by
is true? (a) Interfering with destruction of Ach
(a) It increases the action potential duration in (b) Interfering with relese of Ach
purkinje fibres (c) Interfering with synthesis of Ach
(b) It has a brief duration of action because (d) Promoting release of Ach
of t½ of 2 hours
(c) It is probably the drug of choice in the 470. Action of acetylcholine is terminated by
treatmet of arrhythmias caused by digitalis (a) Diffusion away from the site of action
intoxication (b) Deamination
(d) The drug markedly depresses conduction (c) Hydrolysis
velocity in the A-v node and intraventricular
(d) Temporary adsorption on plasma proteins
conduction system
471. Norepinephrine in the synaptic cleft can
465. Phenytoin
activate presynaptic alpha 2 receptors
(a) Is useful only in the treatment of epilepsy which results in
(b) Has an antiarrhythmic action that is quite (a) Increased release of exocytotic norepinephrine
different from that of quinidine
(b) Displacement of norepinephrine from the
(c) Has antiarrhythmic action against many types storage site
of arrhythmias
(c) Further inhibition of exocytotic release of
(d) Increases excitability of atrial or ventricular norepinephrine
muscle
(d) Increased synthesis of norephinephrine
466. The drug of choice in the treatment of
472. Which of the following barbiturates is
hypertensive emergency is
preferred as sedative agent in a patient
(a) Guanethidine (b) Reserpine having liver disease ?
(c) Diazoxide (d) Furosemide (a) Allobarbitone (b) Cyclobarbitone
467. Which of the following statements (c) Phenobarbitone (d) Pentobarbitone
concerning hypertension is true?
473. One of the way to classify regions of the
(a) It is easier to obtain salt depletion in cortex is
hypertensive patients with thiazide diuretics
(a) By the modality of information processed
than by limitation of salt intake
(b) By the physiological position
(b) I.V. guanethidine is very useful in controlling
hypertensive emergencies (c) By the chemical relationship between cell
types in the major cortical layers
(c) In essential hypertension the excretion of
catecholamine in the urine is abnormally high (d) All of the above
(d) Aldosterone stimulates the secretion of 474. Peak serum level of orally administered
angiotensin leading to certain types of lithium is usually achieved in
hypertension (a) 5 to 10 min (b) 1 to 2 days
468. The duration of action of methacholine is (c) 2 to 4 hours (d) 8 to 12 hours
longer than that of acetylcholine because
475. For induction of anaesthesia nitrous oxide
(a) Acetylcholine is inactivated by active is superior to ether because
transport into schwan cell
(a) Nitrous oxide is not explosive, while ether
(b) Acetylcholine is inactivated by active vapours are flammable in air
transport into nerve cell
(b) Iuduction with nitrous oxide is very rapid
(c) Acetylcholine is metabolized more rapidly while with ether it is slow and unplea sant to
(d) Acetylcholine is excreted more rapidly patient
68 MCQs IN PHARMACOLOGY
(c) Ether is irritant to respiratory tract and may 482. Which of the following neuromuscular
lead to coughing, laryngeal spasm and blocking agent has short duration of
increased mucus secretion while nitrous oxide action
does not (a) Atracurium (b) Mivacurium
(d) All of the above (c) Pancuronium (d) Doxacurium
476. Succinylcholine is preferred over d- 483. Botulinium toxin causes muscle palsy by
tubocurarine for endotrachial intubation, blocking
because of the following reasons except
(a) Nerve action potential
(a) With succinylcholine total paralysis lasts upto (b) Acetylcholine release
4 min. with 50% recovery at about 10 min
(c) Permeability to sodium and potassium
(b) Allergic reactions due to release of histamine
(d) Muscle action potential
are not seen with succinylcholine
(c) In addition to neuromuscular blocking effect 484. Dopamine is preferred over nore-
succinylcholine blocks autonomic ganglia pinephrine in cardiogenic and hypo-
volemic shock because
(d) Bronchospasm is less common with
succinylcholine (a) Better cardiac stimulation
(b) Potent renal vasodilator
477. The difference between autonomic and
somatic nerves are all except (c) Potent cerebral vasodilation
(d) All of the above
(a) Somatic nerves do not contain peripheral
ganglia unlike autonomic nerves 485. What is the mechanism of action of
(b) Motor nerves to skeletal muscles are clonidine
myelinated while postganglionic autonomic (a) α1 antagonist (b) α2 agonist
nerves are unmyelinated (c) α1 agonist (d) β1 agonist
(c) The presynaptic transmitted in both the cases
is different 486. What is true of methylphenidate
(d) None of the above (a) Mild CNS stimulant
(b) Abuse potential as of amphetamine
478. In endothelium nitric oxide is synthezised
(c) Effective in narcolepsy and attention deficit-
from
disorder
(a) Arginine (b) Valine (d) All of the above
(c) Tyrosine (d) All of the above
487. The longest half-life is of which of the
479. Ipratropium bromide is principally following betablockers
effective in (a) Esmolol (b) Nadolol
(a) Asthma (b) Bronchitis (c) Pindolol (d) Acebutolol
(c) COPD (d) All of the above
488. Which of the following is both alpha and
480. What are obidoxine and pralidoxime beta blocker
(a) Acetylcholine reactivators (a) Propranolol (b) Labetalol
(b) Choline esterase reactivators (c) Esmolol (d) Metoprolol
(c) Choline esterase inhibitors 489. The rate limiting enzyme in synthesis of
(d) Cellular poisons melatonin and serotonin is
481. Which of the following cholinergic drugs (a) Tryptophan hydroxylase
is used in Alzheimer’s disese (b) 5 HT N-acetylase
(a) Neostigmine (b) Pyridostigmine (c) Aldehyde dehydrogenase
(c) Tacrine (d) None of the above (d) Aldehyde reductase
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 69
507. Which of the following is the most trouble 516. Chemically the phenothiazines have
shooter in spinal anaesthesia (a) One ring (b) Two rings
(a) Sympathetic block (c) Three rings (d) Five rings
(b) Parasympathetic block
517. Following are examples of generalized
(c) Contracted intestines seizures, except
(d) Paralysed intercostals muscles
(a) Tonic-clonic seizures
508. A local anaesthetic in its lowest concen- (b) Infantile spasms
tration will block (c) Simple partial seizures
(a) Somatic motor (d) Atonic seizures
(b) Somatic sensory
518. The D3 receptors are preferentially
(c) Preganglionic sympathetic present in
(d) All of the above
(a) Negative inotropy
509. Benzodiazepines act on which receptors (b) QT prolongation
(a) GABAA (b) GABAB (c) P-R prolongation
(c) Both of the above (d) None of the above (d) ST depression
(e) All of the above
510. Which of the following benzodiazepines
has shortest half-life 519. What is rabit syndrome
(a) Alprazolam (b) Oxazepam (a) Tardive dyskinesia
(c) Clonazepam (d) Midazolam (b) Akathisia
(c) Perioral tremor
511. Which of the following barbiturate has
(d) None of the above
shortest half-life
(a) Secobarbital (b) Pentobarbital 520. The maximum daily dose of Alprazolam is
(c) Methohexital (d) Amobarbital (a) Anxiolytic (b) Sedative
(c) Antidepressant (d) All of the above
512. Barbiturate induced enzyme induction
facilitates metabolism of 521. Atypical antidepressant is
(a) Steroid (b) Ethanol (a) Selegiline (b) Trazodone
(c) Vit K and D (d) All of the above (c) Desipramine (d) Doxeptan
513. Most barbiturates loose biological action 522. Setraline belongs to which class of com-
after oxidation of radicals at position pounds
(a) Digoxin (b) Furosemide (a) MAO inhibitor
(c) Enalapril (d) Amrinone (b) Serotonin reuptake inhibitor
514. The metabolism of ethanol is directly (c) Nor epinephrine reuptake inhibitor
proportional to (d) None of the above
(a) Digoxin (b) Furosemide 523. Following is an irreversible inhibitor of
(c) Enalapril (d) Amrinone GABA amino transferase
(a) Pyrimidine (b) Vigabatrin
515. Disulfiram–ethanol interaction often
produces hypertension due to (c) Lamotrigine (d) Gabapentin
(a) Increased concentration of ethanol 524. Lithium has also been used for which of
(b) Inhibition of sympathetic tone the following
(c) Inhibition of dopamine hydroxylase (a) Gout (b) Salt substitute
(d) None of the above (c) Anticonvulsant (d) All of the above
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 71
525. Which lithium salt is used for manic- 534. Which of the following is 5 HT receptor
depressive disorders antagonist
(a) Carbonate (b) Chloride (a) Methysergide (b) Plzotifen
(c) Bromide (d) All of the above (c) Minaserin (d) All of the above
526. MAO inhibitors in general raise the brain 535. Fenton reaction refers to the formation of
level of
(a) Free radical (b) Hydrogen peroxide
(a) Dopamine (b) Serotonin
(c) Nitric oxide (d) None of the above
(c) Nor adrenaline (d) All of the above
536. How many types of dopamine receptors
527. Which of the following is not MAO-A are present in brain
inhibitor
(a) 3 (b) 5
(a) Selegiline (b) Brofaromine
(c) 7 (d) 9
(c) Clorgyline (d) Moclobemide
537. The term endorphin refers to which of the
528. Which of the recently introduced
following
antiepileptics is useful in absence seizure
(a) Encephalins (b) Dynorphins
(a) Absence attack
(b) Partial seizure (simple) (c) b endrophin (d) All of the above
(c) Clonic tonic seizure 538. How many types of opioid receptor are
(d) Complex partial seizure present in brain
562. Which of the following drugs is not 569. Huntington’s chorea is hereditary
effective in acute congestive glaucoma disorder where there is
(a) Acetazolamide (b) Pilocarpine (a) Loss of GABA neurons in corpus striatum
(c) Timolol (d) Mannitol (b) An over-activity in dopaminergic nigro-striatal
pathway
563. The anticholinergic used only as prean-
(c) Loss of some cholinergic neurons in the
aesthetic medication is
corpus striatum
(a) Atropine (b) Glycopyrrolate (d) All the above
(c) Isopropamide (d) Dicyclomine (e) None of the above
564. Ephedrine is similar to adrenaline in 570. Which of the following MAO inhibitors
respect to prevents the 1-methyl 4-Phenyl 1,2,3,6
(a) Duration of action tetrahydropyridine’s (MPTP) selective
(b) Potency action in destroying the dopaminergic
(c) Penetration of blood brain barrier nigro-striatal neurons
(d) Both α and β adrenergic effects2106. (a) Tranylcypromine
(b) Phenelzine
565. The neurotransmitter released at the end
of the sympathetic nerve fibre is (c) Selegiline
(d) All of the above
(a) Epinephrine (b) Furosemide
(e) None of the above
(c) Enalapril (d) Amrinone
571. Concurrent use ow which of the following
566. Valproic acid is shown to be effective
drugs may reverse the antiparkinsonian
against
effect of levodopa
(a) Absence seizures
(a) Carbidopa (b) Selegiline
(b) Partial seizures
(c) Bromocriptine (d) Pyridoxine
(c) Generalized seizures
(e) All of the above (f) None of the above
(d) All of the above
572. Selegiline is a
567. In which of the following conditions
centrally acting anticholinergic drugs (a) MAO – A inhibitor
cannot be used for treatment (b) MAO – B inhibitor
(a) Parkinsonian disease (c) Drug that releases dopamine
(b) Akathisia (d) All of the above
(c) Tardive dyskinesia (e) None of the above
(d) All the above 573. Schizophrenia has following clinical
(e) None of the above feature
575. Which of the following drugs used in 582. Droperidol, a neuroleptic, belongs to
Parkinson’s disease is a peripherally following class of drugs.
acting dopa decarboxylase inhibitor ?
(a) Phenothiazines
(a) Levodopa (b) Carbidopa (b) Thioxanthines
(c) Bromocriptine (d) Selegiline (c) Butyrophenone
(e) Amantadine (f) All of the above (d) Benzamides
(g) None of the above
583. Which of the following opioid analgesics
576. Which of the following opioid antagonists is used as a preferred and rational
is used as an adjunct to prevent relapse antitussive agent ?
in addicts following detoxification
because of its long half-life ? (a) Morphine (b) Codeine
(c) Meperidine (d) Methadone
(a) Nalorphine (b) Naloxone
(c) Naltrexone (d) All of the above 584. Which of the following opioid analgesics
(e) None of the above has very low protein binding ?
(a) Morphine (b) Codeine
577. Which of the following opioid antagonists
is not a derivative of oxymorphone ? (c) Meperidine (d) Methadone
(e) Propoxyphene (f) All of the above
(a) Nalorphine (b) Naloxone
(c) Naltrexone (d) All of the above (g) None of the above
(e) None of the above 585. Which of the following group of analgesic
drugs act on the CNS ?
578. Which of the following opioid antagonists
is a competitive antagonist of all the (a) Morphine – like drugs
effects of morphine at opioid receptor in (b) NSAIDS (Aspirin and related drugs)
a low dose and in higher dose mimics (c) Local Anaesthetic
effects of morphine (such as analgesic
(d) All of the above
effect) ?
(e) None of the above
(a) Nalorphine (b) Naloxone
(c) Naltrexone (d) All of the above 586. Which of the following statements
(e) None of the above regarding lithium is not correct ?
(a) It is a monovalent cation
579. Morphine administration leads to
(b) Salts of lithium share some chemical
(a) Physical dependence characteristics with salts or sodium and
(b) Psychological dependence potassium
(c) Physical as well as Psychological dependence (c) The half life of lithium is more in adult and
(d) None of the above adolescent patient of bipolar as compared
to an elderly patient of bipolar disorder
580. Naloxone and naltrexone are
(d) Chances of neonatal goiter and congenital
(a) Opioid agonists cardiovascular malformation if administered
(b) Opioid agonists/antagonists to a pregnant women
(c) Opioid antagonists (e) All of the above
(d) None of the above (f) None of the above
581. Opioid analgesics inhibit the release of 587. Which of the following anticonvulsant
which of the following hormones. drugs is used for prophylactic treatment
(a) Anti-diuretic hormone of mood swings (i.e. manic-depression
(b) Luteinizing hormone illness) in patients unresponsive to lithium
carbonate ?
(c) Prolactin
(d) Somatotropin (a) Phenobarbitone (b) Phenytoin
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 75
601. Phenelzine and tranylcypromine belong 607. Which of the following barbiturates is a
to which one of the following group long acting barbiturate (i.e. has a longer
(class) of antidepressants onset and duration of action)
(a) Tricyclic antidepressants (a) Phenobarbital (b) Amobarbital
(b) MAO inhibitors (c) Secobarbital (d) All the above
(c) 5-HT uptake inhibitors (e) None of the above
(d) Atypical antidepressant drugs 608. The half life of ethosuximide in adult is
(e) None of the above
(a) 10–20 hours (b) 30–40 hours
602. Which one of the following drugs is not (c) 50–60 hours (d) 60–70 hours
5-HT uptake inhibitor but used as an (e) None of the above
antidepressant ?
609. Concurrent use of carbamazepine and
(a) Fluoxetine (b) Maprotiline
phenyton will lead to
(c) Paroxetine (d) Sertraline
(a) Increased metabolism of phenyton
(e) All of the above (f) None of the above
(b) Decreased metabolism of phenytoin
603. Following endogenous opioid peptide is (c) No change in the metabolism of phenytoin
a pentapeptide
610. Zolpidem is used as
(a) Enkephalin (b) Dynorphin A
(a) Anticonvulsant drug
(c) Endorphin (d) Dynorphin B
(b) Anti-anxiety drug
604. Concurrent use of which of the following (c) Sedative and hypnotic drug
may lead to similar effects seen in
(d) myorelaxant drug
patients who are administered disulfiram
after the ingestion of alcohol (e) All the above
(f) None of the above
(a) Oral hypoglycemic drug
(b) Coumarin type antigoagulants 611. Which of the benzodiazepines is used
(c) Salicylates only as a sedative and hypnotic
(d) All of the above (a) Chlordiazepoxide (b) Clorazepam
(e) None of the abvoe (c) Diazepam (d) Flurazepam
(e) All of the above (f) None of the above
605. Wernicke’s encephalopathy and Korsa-
koff’s psychosis occur often in alcoholic’s 612. Which of the following benzodiazepines
due to is not in active form and behaves as a
(a) Malnutrition prodrug or drug prercursor
(b) Vitamin deficiencies (a) Chlordiazepoxide (b) Diazepam
(c) Faulty gastrointestinal deficiencies (c) Parzepam (d) Clorazepate
(d) All of the above (e) All of the above (f) None of the above
(e) None of the above 613. The dynorphins are endogenous ligands
606. Phenobarbitone is beneficial in the for
treatment of which of the following (a) µ (b) δ
generalized seizures (c) κ (d) σ
DRUGS ACTING ON CENTRAL NERVOUS SYSTEM 77
614. A drug that produces a mild degree of (e) All of the above (f) None of the above
nonselective depression of the central
620. In small intestine, morphine particularly
nervous system by decreasing the
affects
response of an individual to all sensory
modalities is known as (a) Duodenum
(b) Ileum
(a) Sedative (b) Hypnotic
(c) Both (a) and (b)
(c) None of the above
(d) Does not affect small intestine
615. Lidocaine is used as
621. Local anaesthetics affect membrane
(a) Mucosal local anaesthetic excitability by inhibiting
(b) Parenteral local anaesthetic agent (a) Sodium (Na+) Channel inactivation
(c) Mucosal as well as parenteral local anaesthetic (b) Increased (Na+) conductance
agent
(c) Increased potassium (K+) conductance
(d) None of the above (d) All of the above
616. Prilocaine, a local anaesthetic is used as (e) None of the above
(a) Dental anaesthesia 622. The order of loss of sensory function
(b) Low spinal anaesthesia for vaginal delivery when a local anaesthetic is used is
(c) Abdominal surgical anaesthesia (a) Temperature, pain, touch and deep pressure
(d) Caudal anaesthesia (b) Pain, touch, deep pressure and termperture
(e) All the above (c) Pain, temperature, touch and deep pressure
(f) None of the above (d) None of the above
617. Which of the following statements 623. Ester type local anaesthetics are hydrolyzed
regarding procaine, a local anaesthetic by
agent is not correct. (a) True cholinesterase
(a) It has a very low lipid solubility at pH 7.4 (b) Pseudo cholinesterase
(b) It is least protein bound (c) Liver microsomal enzymes
(c) it has a short duration of action (d) All of the above
(d) It is an amide – type local anaesthetic (e) None of the above
(e) All of the above 624. When an amide is acted upon by an
amidase
618. Which of the following parenteral local
anaesthetics has a very high protein (a) Alcohol and acid is formed
binding and may produce analgesia for (b) Amine and acid is formed
more than 10 hours via its nerve block (c) Alcohol and amine is formed
action (d) None of the above
(a) Chloroprocaine (b) Bupivacaine 625. Which one of the following is not an ester
(c) Lidocaine (d) Prilocaine local anaesthetic ?
(e) All of the above (f) None of the above (a) Cocaine (b) Procaine
(c) Lidocaine (d) Benzocaine
619. Which of the following parenteral local
(e) All of the above (f) None of the above
anaesthetics has a short duration of
action (i.e. between 30 to 60 minutes) 626. Which of the following local anaesthetics
cause arteriolar vasoconstriction ?
(a) Chloroprocaine (b) Bupivacaine
(c) Lidocaine (d) Prilocaine (a) Lidocaine (b) Procaine
(c) Cocaine (d) Prilocaine
78 MCQs IN PHARMACOLOGY
640. Which of the following inhalation general (a) Excitatory causing decrease in potassium
anaesthetic is not a volatile liquid conductance
(a) Enflurane (b) Methoxyflurane (b) Inhibitory causing decrease in potassium
(c) Ether (d) Isoflurane conductance
(e) Nitrous oxide (f) All of the above (c) Excitor y causing increase in cation
conductance
(g) None of the above
(d) All of the above
641. Which of the following general anaesthetics (e) None of the above
is not administered intravenously
646. Which of the following CNS Neurotrans-
(a) Thiopental (b) Diazepam
mitters is excitatory on the individual
(c) Ketamine (d) Halothane neurons and causes decrease in potassi-
(e) All of the above um conductance
642. The use of nitrous oxide to relieve the (a) Dopamine (b) Acetylcholine
pain of surgery (c) GABA (d) Glycine
(a) Horace Wells (b) Humphry Davy (d) All of the above (e) None of the above
(c) William Morton (d) None of the above 647. Which of the following amino acids is an
643. Which of the following is designated as inhibitory transmitter and increases the
“The Vital Node” membrane permeability to chloride ions,
and thus causing inhibitory post synaptic
(a) Mid brain potential (IPSP) in the CNS
(b) Pons
(a) Glycine (b) Glutamate
(c) Medulla oblongata
(c) Aspartate (d) All of the above
(d) All of the above
(e) None of the above
(e) None of the above
648. Which of the following is a neurotrans-
644. CNS stimulant agents belong to
mitter in the central nervous system (CNS)
(a) Respiratory stimulants
(a) Acetylcholine
(b) Psychomotor stimulants
(b) Noradrenaline
(c) Psychomimetic agents
(c) Dopamine
(d) All of the above
(d) 5–Hydroxytryptamine
645. Acetylcholine action at the nicotinic (e) All of the above
receptor in the motoneuron – Renshaw
cell synapse is
ANSWERS
1. d 2. a 3. a 4. e 5. a 6. c
7. e 8. b 9. b 10. d 11. a 12. b
13. a 14. e 15. d 16. a 17. d 18. d
19. a 20. c 21. b 22. c 23. c 24. e
25. a 26. e 27. a 28. a 29. c 30. d
31. e 32. c 33. d 34. d 35. e 36. c
37. b 38. a 39. e 40. a 41. b 42. b
43. e 44. d 45. d 46. c 47. d 48. d
80 MCQs IN PHARMACOLOGY
108. c As ethanol competes for alcohol dehydroge- 270. a Iproniazid is an antitubercular agent, an
nase, a 10% ethanol solution is generally used inhibitor of MAO and has antidepressant effect.
in methanol poisoning. 280. d The major factors, which affect elimination of a
109. c Alcohol is teratogenic and is associated with general anesthetic are, pulmonary ventilation,
fetal alcohol syndrome. blood flow and solubility in blood and tissues.
123. b Diethyl ether has high solubility in blood and 292. b Barbiturates bind to GABA receptors (GABAA)
has slow onset of central action and hence all but on a different site than benzodiazepines and
the four stages of general anesthesia can be enhance the action of GABA.
observed with this drug. 312. a Chemical name of halothane is 2-bromo-2-
141. d Metabolism is not an important route of chloro-1,1,1-trifluoroethane.
elimination of inhalational anaesthetics. However, 329. d Nitric oxide is a colorless gas without significant
except nitrous oxide, other anaesthetics such as odor or taste and is non-flammable, non-irritant
halothane, ether and isoflurane do undergo some and potent analgesic.
degree of metabolism.
350. d Surgical pain is often severe and hence opioid
155. d An ideal anesthetic should possess wide margin
analgesics such as meperidine, fentanyl,
of safety with no adverse effect. But no single
alfentanil, sufentanil and morphine are generally
anaesthetic can achieve all the desirable effects
used as supplemental agents during general
of general anaesthetics without some adverse
anaesthesia.
effects.
368. a Propofol is an intravenous anesthetic agent. It
156. a An action common to most general anaesthetics
is an oil at room temperature and is supplied as
is to increase the cellular threshold of firing and
1% emulsion.
thus decreasing neuronal activity.
379. b Local anaesthetics produce stimulation of CNS,
168. b β-Carbolines are inverse agonists of
restlessness and tremors, which may proceed
benzodiazepines.
to convulsions. Selective depression of inhibitory
174. c Zolpidem is a nonbenzodiazepine sedative- neurons is responsible for the CNS excitation.
hypnotic agent and belongs to imidazopyridine
class of drugs. 383. a Bupivacaine is an amide-linked local anaesthetic.
Procaine, tetracaine and proparacaine have ester
193. b Ethinamate is a sedative-hypnotic agent and is
linkage in their structure.
a urethane derivative. Ethinamate has rapid
onset and short duration of action. 392. c Benzocaine has ester linkage in its structure.
Mepivacaine, ropivacaine and priocaine have
200. d For substance to be classified as neuro-transmitter,
amide linkage in their structure.
it has to fulfill all the criteria as stated in A, B and
C. 397. a In infiltration anesthesia, local anaesthetic is
directly injected into tissue without taking into
213. c Phencyclidine, also called as angel-dust, is a
consideration the course of cutaneous nerves.
non-competitive antagonist of NMDA receptors
and it produces various psychotic symptoms e.g. 411. c Intravenous regional anesthesia or Bier’s block
hallucinations, thought disorders etc. relies on using the vasculature to bring the local
anaesthetic to the nerve trunks and endings.
219. a Fluoxetine is a serotonin transport blocker and
it is an antidepressant agent. 424. b Fetal alcohol syndrome is characterized by
225. c Neuronal death in response to high glutamate cluster of facial abnormalities viz. short nose,
concentration is mediated by excessive hypoplastic upper lip and short palpebral
activation of NMDA receptors and is associated fissures. In addition, it is associated with CNS
with influx of calcium. dysfunction and slow growth.
238. d Drugs that increases dopaminergic activity in 440. a Except Phenobarbital, only insignificant
CNS can produce or aggravate symptoms of quantities of the barbiturates are excreted
schizophrenia unchanged.
253. b Tranylcypromine, moclobemide and isocarboxid 458. a Zolpidem is a nonbenzodiazepine sedative-
are MAO inhibitors. Nomifensine is a dopamine hypnotic that interacts with benzodiazepine BZ1
transport blocker. receptors to produce its effects.
84 MCQs IN PHARMACOLOGY
473. a Regions of the cortex can be classified in three characterized by disordered thinking, delusions,
different ways: auditory hallucinations and emotional
(i) By the modality of the information processed. withdrawal.
(ii) By the cytoarchitectonic classification i.e. the 582. c Droperidol like haloperidol belongs to
geometrical relationship between cell types in butyrophenone neuroleptic class of drug.
the major cortical layers. 593. c MAO is a flavin-containing enzyme, which is
(iii) By the anatomical position. localized in mitochondrial membranes in nerve
496. d The rate at which inhalational anaesthetics terminals, liver and other organs.
passes into tissues depends on various factors; 600. b Pergolide, an ergot derivative, is a dopamine
tissue-blood partition coefficient i.e. solubility agonist and it interacts with both D1 and D2
of anaesthetics in tissues and blood, the rate of receptors.
delivery of anesthetic to the tissue. 603. a Enkephalin is a pentapeptide i.e. it has 5 amino
517. c Generalized seizure can be of various types – acids in its structure.
tonic- clonic seizures, absence seizures, tonic 613. c Dynorphin, specifically dynorphin A, is the
seizures, atonic seizures, clonic and myoclonic
endogenous ligand for ê1 receptors that are
seizures and infantile spasms.
responsible for spinal analgesia.
523. b Vigabatrin is an irreversible inhibitor of GABA
620. a In small intestine, morphine particularly affects
aminotransferase, the enzyme responsible for
upper part of small intestine, especially the
the degradation of GABA and thus increases
duodenum compared to ileum.
GABA at synaptic sites.
637. d Opioid analgesics provide symptomatic relief
540. a Carbamazepine is a derivative of iminostilbene
of pain, cough and diarrhea but the disease
and is chemically related to tricyclic
antidepressants. remains unaffected.
566. d Although valproic acid has been widely used 638. c All the opioid receptors are coupled to pertussis
for the treatment of absence seizures, it is also toxin-sensitive GTP binding proteins. These
effective against wide variety of partial and receptors produce opening of potassium
generalized seizures. channels and inactivation of calcium channels.
573. d Schizophrenia is an idiopathic psychoses 644. d CNS stimulants belong to all three categories.
DRUGS ACTING ON AUTONOMOUS NERVOUS SYSTEM 85
CHAPTER 3
DRUGS ACTING ON
AUTONOMOUS NERVOUS SYSTEM
8. Atropine overdose may cause which one 14. A 7-years-old boy has a significant bed-
of the following wetting problem. A long-acting indirect
(a) Gastrointestinal smooth muscle crampine sympathomimetic agent sometimes used
(b) Increased cardiac rate by the oral route for this and other
indications is
(c) Increased gastric secretion
(d) Pupillary constriction (a) Dobutamine (b) Ephedrine
(e) Urinary frequency (c) Epinephrine (d) Isoproterenol
(e) Phenylephrine
9. The synaptic pre-ganglionic neurons have
their cell bodies in the lateral horn of the 15. When pupillary dilation-but not cyclo-
grey matter of the plegia-is desired, a good choice is
(a) Thoracic segment only (a) Homatropine (b) Isoproterenol
(b) Lumbar segment only (c) Phenylephrine (d) Pilocarpine
(c) Both (a) and (b) (e) Tropicamide
(d) None of the above
16. ‘Fight or flight’ state can be described as
10. Which one of the following can be
(a) Sympathetic active; para-sympathetic
blocked by atropine?
quiescent
(a) Decreased blood pressure caused by (b) Sympathetic active; para-sympathetic active
hexamethonium
(c) Sympathetic quiescent; para-sympathetic
(b) Increased blood pressure caused by nicotine
active
(c) Increased skeleton muscle strength caused
by neostigmine 17. Your patient is to receive a selective β2
(d) Tachycardia caused by exercise stimulant drug β2 selective stimulant are
often effective in
(e) Tachycardia caused by infusion of acetylcholine
(a) Angina due to coronary insufficiency
11. Which of the following best describes the
(b) Asthma
mechanism of action of scopolamine ?
(c) Chronic heart failure
(a) Irreversible antagonist at nicotinic receptors
(d) Delayed or insufficiently strong labor
(b) Irreversible antagonist at muscarinic
receptors (e) All of the above
(c) Physiologic antagonist at muscarinic receptors 18. Which of the following drugs is the drug
(d) Reversible antagonist at muscarinic receptors of choice in anaphylaxis associated with
(e) Reversible antagonist at nicotinic receptors bronchospasm and hypotension ?
12. Accepted therapeutic indications for the (a) Cortisone (b) Epinephrine
use of antimuscarinic drugs include all of (c) Isoproterenol (d) Norepinephrine
the following except (e) Phenylephrine
(a) Hypertension
19. Which of the following effects of epineph-
(b) Motion sickness rine would be blocked by phentolamine
(c) Parkinson’s disease but not by metoprolol ?
(d) Postoperative bladder spasm (a) Cardiac stimulation
(e) Traveler’s diarrhea (b) Contractionof radial smooth muscle in the iris
13. In male sex organs _______ system is (c) Increase of camp in fat
responsible for erection. (d) Relaxation of bronchial smooth muscle
(a) Sympathetic (b) Parasympathetic (e) Relaxation of the uterus
(c) Norepinephrine (d) None of the above
DRUGS ACTING ON AUTONOMOUS NERVOUS SYSTEM 87
20. Propranolol is useful in all of the following (d) β1 – selective receptor blockers
except (e) Nonselective β - blockers
(a) Angina 25. A visitor from another city comes to your
(b) Familial tremor office complaining of incessant cough. He
(c) Hypertension has diabetes and hypertension and has
(d) Idiopathic hypertrophic subaortic cardiomy- recently started taking a different
opathy antihypertensive medication. The most
likely cause of his cough is
(e) Partial atrioverntricular heart block
(a) Enalapril (b) Losartan
21. ‘Rest and digest’ state can be described
(c) Minoxidil (d) Propranolol
as
(e) Verapamil
(a) Sympathetic active; para-sympathetic
quiescent 26. Reserprine, an alkaloid derived from the
(b) Sympathetic active; para-sympathetic active root of Rauwolfia serpentina
(c) Sympathetic quiescent; para-sympathetic (a) Can be used to control hyperglycemia
active (b) Can cause severe depression of mood
(c) Can decrease gastrointestinal secretion and
22. A friend has very severe hypertension and
motility
asks about a drug her doctor wishes to
prescribe. Her physician has explained that (d) Has no cardiac effects
this drug is associated with tachycardia (e) A spare receptor agonist
and fluid retention (which may be marked)
27. Nitroglycerin, either directly or through
and increased hair growth. Which of the
reflexes, results in which one of the
following is most likely to produce the
following effects
effects that your friend has described?
(a) Decreased heart rate
(a) Captopril (b) Guanethidine
(b) Decreased venous capacitance
(c) Minoxidil (d) Prazosin
(c) Increased afterload
(e) Propranolol
(d) Increased cardiac force
23. Which one of the following is character- (e) Increased diastolic intramyocardial fiber
istic of captopril and enalapril ? tension
(a) Competitively blocks angiotensim II at its 28. The antianginal effect of propranolol may
receptor be attributed to which one of the following
(b) Decreases angiotensin II concentration in the
(a) Block of exercise – induced tachycardia
blood
(b) Decreased end – diastolic ventricular volume
(c) Decreases rennin concentration in the blood
(c) Dilation of consticted coronary vessels
(d) Increases sodium and decreases potassium
(d) Increased cardiac force
in the blood
(e) Increased resting heart rate
(e) Decreases sodium and increases potassium
in the urine 29. The major common determinant of myo-
cardial oxygen consumption is
24. Postural hypotension is a common ad-
verse effect of which one of the follow- (a) Blood volume
ing types of drugs ? (b) Cardiac output
(a) ACE inhibitors (c) Diastolic blood pressure
(b) Alpha-receptor blockers (d) Heart rate
(c) Arteriolar dilators (e) Myocardial fiber tension
88 MCQs IN PHARMACOLOGY
30. Choose the incorrect statement from the (b) An increase in ATP synthesis
following (c) A modification of the actin molecule
(a) Sympathetic system increases rate of SA node (d) An increase in systolic intracellular calcium
(b) Sympathetic system causes constriction of levels
coronary arteries (e) A block of sodium/calcium exchange
(c) Sympathetic system causes increased motility
36. A patient has been taking digoxin for
of GIT smooth muscles
several years for chronic heart failure is
(d) Sympathetic system causes constriction of about to receive atropine for another
sphincter in GIT condition. A common effect of digoxin (at
31. Denervation super-sensitivity includes therapeutic blood levels) that can be
almost entirely blocked by atropine is
(a) Proliferation of receptors
(a) Decreased appetite
(b) Loss of mechanism for transmitter removal
(b) Increased atrial contractility
(c) Increased post-junctional responsiveness
(c) Increased PR interval on the ECG
(d) All of the above
(d) Headaches
32. Which of the following is approved for (e) Tachycardia
the treatment of hemorrhagic stroke ?
37. In a patient given a cardiac glycoside,
(a) Amyl nitrite
important effects of the drug on the heart
(b) Hydralazine include which of the following?
(c) Isosorbide moninitrate
(a) Decreased atrioventricular conduction
(d) Nifedipine velocity
(e) Nimodipine (b) Decreased ejection time
33. Which of the following drugs used for the (c) Increased ectopic automaticity
treatment of angina by inhalation has a (d) Increased ectopic automaticity
very rapid onset and a brief duration of (e) All of the above
effect ?
38. Which of the following situations consti-
(a) Amyl nitrite
tutes an added risk of digoxin toxicity ?
(b) Hydralazine
(a) Starting administration of captopril
(c) Isosorbide mononitrate
(b) Starting administration of quinidine
(d) Nifedipine
(c) Hyperkalemia
(e) Nimodipine
(d) Hypermagnesemia
34. Which of the following is a vasodilator (e) Hypocalcemia
drug used for hypertension that lacks a
direct effect on autonomic receptors but 39. At rest, the interior of the typical
may provoke anginal attacks? mammalian neuronal axon potential is
approximately ________ mV
(a) Amyl nitrite
(b) Hydralazine (a) 0 (b) –70
(c) Isosorbide mononitrate (c) –100 (d) –20
(d) Nifedipine 40. Following enzyme is involved in the
(e) Nimodipine synthesis of actylcholine
41. Which of the following has been shown (a) Adenosine (b) Amiodarone
to prolong life in patient with chronic (c) Disopyramide (d) Esmolol
congestive failure but has a negative (e) Mexiletine
inotropic effect on cardiac contractility?
(a) Carvedilol (b) Digitoxin 48. Which of the following has the longest
half-life of all antiarrhythmic drugs?
(c) Digoxin (d) Dobutamine
(e) Enalapril (a) Adenosine (b) Amiodarone
(c) Disopyramide (d) Esmolol
42. Which of the following is the drug of
(e) Flecainide
choice in treating suicidal overdose of
digitoxin ? 49. Which of the following diuretics would
(a) Digoxin antibodies be most useful in a patient with cerebral
edema?
(b) Lidocaine
(c) Magnesium (a) Acetazolamide (b) Amiloride
(d) Potassium (c) Ethacrynic acid (d) Furosemide
(e) Quinidine (e) Mannitol
43. When used as an antiarrhythmic drug, 50. Which of the following therapies would
Lidocaine typically be most useful in the management of
severe hypercalcemia?
(a) Increases action potential duration
(b) Increases contractility (a) Amiloride plus saline infusion
(c) Increses PR interval (b) Furosemide plus saline infusion
(d) Reduces abnormal automaticity (c) Hydrochlorothiazide plus saline infusion
(e) Reduces resting potential (d) Mannitol plus saline infusion
(e) Spironolactone plus saline infusion
44. A 16-year-old-girl is found to have
paroxysmal attacks of rapid heart rate. 51. A 55-year-old patient with severe post-
The antiarrhythmic of choice in most cases hepatitis cirrhosis is started on a diuretic
of acute AV nodal tachycardia is for another condition. Two days later
(a) Adenosine (b) Amiodarone he is found in a coma. The drug most
likely to cause coma in a patient with
(c) Flecainide (d) Propranolol
cirrhosis is
(e) Quinidine
(a) Acetazolamide
45. Recognized adverse effects of quinidine (b) Amiloride
include which one of the following?
(c) Furosemide
(a) Cinchonism (d) Hydrochlorothiazide
(b) Constipation (e) Spironolactone
(c) Lupus erythematosus
(d) Increase in digoxin clearance 52. Oxytremorine is a selective agonist of
muscarinic _______ receptors
(e) Precipitation of hyperthyroidism
(a) M1 (b) M2
46. Following is an antagonist of ganglion
(c) M3 (d) M4
type nicotinic receptors
(a) Tubercurarine (b) α-bungarotoxin 53. A drug that is useful in glaucoma and
high-altitude sickness is
(c) Trimethaphan (d) All of the above
(a) Acetazolamide (b) Amiloride
47. Which of the following is an orally active
(c) Demeclocycline (d) Desmopressin
drug that blocks sodium channels and
decreases action potential duration? (e) Ethacrynic acid
90 MCQs IN PHARMACOLOGY
54. Cromolyn has as its major action (a) Chronic renal failure
(a) Block of calcium channels in lymphocytes (b) Hyperparathyroidism
(b) Block of mediator release from mast cells (c) Intestinal osteodystrophy
(c) Block of phosphodiesterase in mast cells and (d) Nutritional rickets
basophils (e) Osteoporosis
(d) Smooth muscle relaxation in the bronchi 60. Which one of the following drugs, when
(e) Stimulation of cortisol release by the adrenals used chronically, is associated with the
development of bone pain and mineral-
55. Following events occur in the cytoplasm
ization defects such as osteomalacia?
and not inside storage vesicles, except
(a) Calcitonin
(a) Conversion of tyrosine to dopa
(b) Dihydrotachysterol
(b) Conversion of dopa to dopamine
(c) Ergocalciferol
(c) Conversion of dopamine to norepinephrine
(d) Etidronate
(d) Conversion of dopamine to 3,4 dihydroxy
phenyl acetic acid (e) Norgestrel
56. Which one of the following is lest likely 61. A 70-year-old man has severe urinary
to be useful in the therapy of hyper- hesitancy associated with benign
calcemia? prostatic hyperplasia. He has tried alpha
blockers with little relief. His physician
(a) Calcitonin recommends a drug that blocks 5α α -
(b) Glucocorticoids reductase in the prostate and writes a
(c) Plicamycin prescription for
(d) Parenteral infusion of phosphate (a) Atropine (b) Clonidine
(e) Thiazide diuretics (c) Hydralazine (d) Neostigmine
57. Characteristics of Vitamin D and its (e) Propranolol
metabolites include which one of the 62. Action of norepinephrine and epinephrine
following? are terminated by
(a) Act to decrease serum levels of calcium (a) Reuptake into nerve terminal
(b) Activation of their Vitamin D receptors (b) Dilution by diffusion and uptake at extra-
increases cellular CAMP neuronal site
(c) Calcitriol is the major derivative responsible (c) Metabolic transformation
for increasing intestinal absorption of
(d) All of the above
phosphate
(d) Metabolites of Vitamin D increase renal 63. Typical results of beta-receptor activation
excretion of calcium include which one of the following?
(e) Vitamin D deficiency results in Pager’s (a) Hypoglycemia
disease (b) Lipolysis
58. Which of the following conditions is an (c) Glycogen synthesis
indication for the use of calcitonin? (d) Decreased skeletal muscle tremor
(a) Chronic renal failure (e) Decreased rennin secretion
(b) Hypoparathyroidism 64. A patient is admitted to the emergency
(c) Intestinal osteodystrophy room with orthostatic hypotension and
(d) Pager’s disease evidence of marked GI bleeding. Which
of the following most accurately describes
(e) Rickets
the probable autonomic response to this
59. Clinical uses of Vitamin D do not include bleeding?
DRUGS ACTING ON AUTONOMOUS NERVOUS SYSTEM 91
(a) Slow heart rate, dilated pupils, damp skin (a) Intestinal (b) Ureteric
(b) Rapid heart rate, dilated pupils, damp skin (c) Bronchial (d) Layngeal
(c) Slow heart rate, dry skin, increased bowel 71. α 1 – receptors are coupled with _______
sounds G protein.
(d) Rapid heart rate, constricted pupils,
(a) Gs (b) Gi
increased bowel sounds
(c) Gq (d) Go
(e) Rapid heart rate, constricted pupils, warm
skin 72. Hyoscine differs from atropine in that it
65. Drugs that block the α receptor on effector (a) Exerts depressant effects on the CNS at
cells at adrenergic nerve endings relatively low doses
(b) Exerts more potent effects on the heart than
(a) Antagonize the effects of isoproterenol on
on the eye
the heart rate
(c) Is longer acting
(b) Antagonize some of the effects of
epinephrine on the blood pressure (d) Has weaker antimotion sickness activity
(c) Antagonize the effects of epinephrine on 73. Which of the following anticholinergic
adenylyl cyclase drugs is primarily used in preanaesthetic
(d) Cause mydriasis medication and during surgery
(e) Decreases blood glucose levels (a) Glycopyrrolate
(b) Pipenzolate methyl bromide
66. Yohimbine is an antagonist of ______
receptors. (c) Isopropamide
(d) Dicyclomine
(a) α1 (b) α2
(c) both (a) and (b) (d) None of the above 74. Glycopyrrolate is the preferred antimus-
cannic drug for use before and during
67. Which of the following organs is surgery because
innervated only by parasympathetic
(a) It is potent and fast acting
nerves ?
(b) It has no central action
(a) Iris muscles (b) Ciliary muscle
(c) It has antisecretory and vagolytic actions
(c) Sweat glands (d) Splenic capsule
(d) All of the above
68. Muscarinic cholinergic receptors
75. Which of the following mydriatics has the
(a) Are located only on parasympathetically fastest and briefest action ?
innervated effector cells (a) Atropine (b) Homatropine
(b) Mediate responses by opening an instrinsic (c) Tropicamide (d) Cyclopentolate
Na+ ion channel
(c) Are present on vascular endothelium which 76. The most suitable mydratic for a patient
has no cholinergic nerve supply of corneal ulcer is
(d) Predominate in the autonomic ganglia (a) Atropine sulfate (b) Homatropine
(c) Cyclopentolate (d) Tropicamide
69. The cardiac muscarinic receptors
(a) Are of the M1 subtype 77. The most effective antidote for belladon-
na poisoning is
(b) Are of the M2 subtype
(a) Neostigmine (b) Physostigmine
(c) Are selectively blocked by pirenzepine
(c) Pilocarpine (d) Methacholine
(d) Function through the PIP 2 → IP 3/DAG
pathway 78. Atropine is contraindicated in
70. Atropine does not exert relaxant/ antis- (a) Cyclic AMP (b) Inositol trisphosphate
pasmodic effect on the following muscle (c) Diacyl glycerols (d) G protein
92 MCQs IN PHARMACOLOGY
79. Select the correct statement from the 86. Adrenaline raises blood glucose level by
following about α1 – adrenergic receptor the following actions except
agonists (a) Inducing hepatic glycogenolysis
(a) Isoproterenol > epinephrine ≥ norepinephrine (b) Inhibiting insulin secretion from pancreatic
(b) Epinephrine > isoproterenol > norepinephrine β cells
(c) Isoproterenol = epinephrine ≥ norepinephrine (c) Augmenting glucagons secretion from
pancreatic α cells
(d) Epinephrine ≥ norepinephrine > isoproterenol
(d) Inhibiting peripheral glucose utilization
80. The most efficacious inhibitor of cate-
cholamine synthesis in the body is 87. Noradrenaline is administered by
84. Low doses of adrenaline dilate the 91. While undergoing a surgical procedure
following vascular bed a patient develops hypotension. Which
of the following drugs can be injected
(a) Cutaneous (b) Mucosal intramuscularly to raise his BP
(c) Renal (d) Skeletal muscle
(a) Noradrenaline (b) Isoprenaline
85. α 2–adrenergic receptors are associated (c) Mephentermine (d) Isoxsuprine
with following except
92. Vasoconstrictors should not be used in
(a) Increase in phospholipase C activity
(a) Neurogenic shock
(b) Increase in potassium channel conductance
(b) Haemorrhagic shock
(c) Decrease in calcium channel conductance (c) Secondary shock
(d) Increase in adenylyl cyclase activity (d) Hypotension due to spinal anaesthesia
DRUGS ACTING ON AUTONOMOUS NERVOUS SYSTEM 93
111. Following drug enhances the evoked 118. Ergotamine relieves migraine by
release of acetylcholine (a) Blocking vascular a adrenergic receptors
(a) 4-aminopyridine (b) Vesamicol (b) Blocking vascular 5-HT2 receptors
(c) Magnesium ion (d) None of the above (c) Dilating cranial arterio-venous shunt channels
(d) Constricting cranial vessels and reducing
112. Which of the following muscle relaxants
perivascular neurogenic inflammation
can be used to control spasticity associated
with upper motor neurone paralysis ? 119. Which of the following drugs is most com-
(a) d-tubocurarine (b) Succinylcholine monly used for prophylaxis of migraine ?
(c) Mephenesin (d) Baclofen (a) Ergotamine (b) Propranolol
(c) Methysergide (d) Sumatripitan
113. Following muscarinic agonist is suscepti-
ble to hydrolysis by cholinesterase 120. Stimulation of exocrine glands by
(a) Carbachol (b) Methacholine muscarinic agonist leads to
(c) Bethanechol (d) Muscarine (a) Sweating
(b) Salivation
114. Dihydroergotamine differs from ergota-
(c) Bronchial secretions
mine in the following respect
(d) All of the abvoe
DRUGS ACTING ON AUTONOMOUS NERVOUS SYSTEM 95
121. Datura stramonium (thorn apple) 129. The drug that produces neuromuscular
mainly contains following muscarinic blockade by persistent depolarization is
antagonist (a) D-tubocurarine (b) Gallamine
(a) Atropine (b) Hyoscine (c) Pancuronium (d) Decamethonium
(c) Homatropine (d) Dicyclomine
130. Agents that block neuromuscular
122. β-blockers are contraindicated in transmission of acetyl choline acts via
(a) Prophylaxis of anxiety states (a) Inhibiting acetyl choline synthesis
(b) Hyperthyroidism (b) Inhibiting acetyl choline release
(c) Hypertrophic obstructive cardiomyopathy (c) Inhibiting post-synaptic action of acetyl
(d) Peripheral vascular disease choline
(d) All of the above
123. β-blockers are better avoided in
(a) Bronchial astham 131. The skeletal muscle relaxant causing
significant release of histamine is
(b) Pheochromocytoma
(c) Myocardial infarction (a) Pancuronium (b) Atracurium
(d) Migraine (c) Gallamine (d) D-tubocurarine
124. Preferential beta1 adrenergic blocking 132. The antibiotic that may accentuate the
agent is neuromuscular blockade produced by d-
tubocurarine is
(a) Propranolol (b) Atenolol
(a) Pencillin G (b) Erythromycin
(c) Penbutolol (d) Oxprenolol
(c) Streptomycin (d) Chloramphenicol
125. Prazosin
133. Centrally acting skeletal muscle relaxant
(a) Produces preferential alpha1 adrenergic is
receptor blockade
(a) Carisoprodol (b) Dantrolene
(b) Has a half-life of 24 hours
(c) Gallamine (d) Succinylcholine
(c) Can worsen lipid profile in hypertensive
patients 134. β-blockers
(d) Does not depress the baroreceptor function (a) Relieve symptoms of thyrotoxicosis
126. The organ extremely sensitive to the (b) Should not be used along with carbimiazole
action of atropine is (c) Reduce the synthesis of hormones in the gland
(a) Gastric glands (d) Should not be given before thyroid surgery
(b) Salivary glands 135. Which of the following alpha adrenocep-
(c) Urinary bladder muscle tor blockers is powerful and also has
(d) Heart longer duration of action ?
127. The antimuscarinic agent preferred in the (a) Tolazoline (b) Phenoxybenzamine
management of motion sickness is (c) Phentolamine (d) Chlorpromazine
(a) Atropine methonitrate 136. Heart has beta as sympathetic and va-
(b) Scopolamine gus as parasympathetic drive. If simul-
(c) Homatropine methyl bromide taneously both are blocked by beta
blocker and stropine, the heart will
(d) Ipratropium bromide
(a) Stop
128. Belladonna poisoning is best treated with
(b) Beat with very slow rate
(a) Neostigmine (b) Physostigmine (c) Beat with very fast rate
(c) Acetylcholine (d) Adrenaline (d) Beat at its intrinsic rate, about 100/min
96 MCQs IN PHARMACOLOGY
(b) Bronchial asthma (e) All of the above (f) None of the above
(c) Insulin – treated diabetes
161. Following agent reduces the transmitter
(d) All of the above release by blocking nerve terminal
(e) None of the above calcium channels
154. Which of the following adrenoreceptor (a) Botulinum toxin (b) β-bungarotoxin
antagonists has partial agonist activity (c) ω-conotoxin (d) All of the above
and also membrane stabilizing activity
162. Atropine in doses of 2.0mg to 5.0mg may
(a) Propanolol (b) Atenolol cause
(c) Oxprenolol (d) Metoprolol
(a) Increased heart rate
(e) All of the above (f) None of the above
(b) dryness of mouth
155. Which of the following indirectly acting (c) Dilated pupils
sympathomimetics is an uptake-1 (d) Difficulty in micturition
inhibitor ? (e) Reduced intestinal peristalsis
(a) Tyramine (b) Amphetamine (f) All of the above
(c) Ephedrine (d) All of the above (g) None of the above
(e) None of the above
163. Chemically following anti-cholinesterase
156. Which of the following drugs is used in is an alcohol
cardiogenic shock ? (a) Ambenonium (b) Edrophonium
(a) Noradrenaline (b) Adrenaline (c) Ecothiophate (d) None of the above
(c) Isoprealine (d) Dobutamine
164. Which of the following â-adrenoceptor
(e) Salbutamol
blockers has the minimal hepatic
157. Pseudo-cholinesterase is present in biotransformation ?
(a) Membrane (b) Vesicles (a) Atenolol (b) Labetalol
(c) Synaptic cleft (d) Plasma and tissue (c) Metoprolol (d) Propranolol
(e) Sotalol
158. Which of the following drugs is used as
inhalation as a bronchodilator and may 165. Which of the following β –adrenoceptor
be used when cough is a pronounced blockers is the drug of choice for
symptom in asthmatic patient ? treatment of essential tremors ?
(a) Atropine (b) Homtropine (a) Propranolol (b) Nadolol
(c) Ipratropium (d) Tropicamide (c) Timolol (d) Atenolol
(e) All of the above (f) None of the above (e) All of the above (f) None of the above
159. Activation of sympathetic system leads 166. Which of the following â-adrenoceptor
to _________ except blockers is used as anti-glaucoma agent
(a) Contraction of bronchial smooth muscles (a) Propranolol (b) Nadolol
(b) Gluconeogenesis (c) Timolol (d) Atenolol
(c) Glycogenolysis (e) All of the above (f) None of the above
(d) Contraction of radial smooth muscle of iris
167. Concurrent use of atropine will interfere
160. Which of the following antimuscarinic with the anti-glaucoma action of
drugs is short acting mydriatic ? (a) Pilocarpine (b) Physostigmine
(a) Atropine (b) Homatropine (c) Carbachol (d) All of the above
(c) Ipratropium (d) Tropicamide (e) None of the above
98 MCQs IN PHARMACOLOGY
168. To reduce the muscarinic side effects of (c) Without membrane stabilizing effect and
oral forms of cholinesterase inhibitors without partial agonist effect
they should be administered (d) With membrane stabilizing effect, partial
(a) On empty stomach agonist effect and direct vasodilator activity
(b) With food 175. Phenylephrine is useful as
(c) With milk (a) Mydriatic to facilitate examination of retina
(d) One hour after food (b) Decongestant for minor allergic hyperemia
(e) With food or milk of conjunctival membranes
169. Which of the following cholinesterase (c) A drug in localizing the lesion in Horner’s
inhibitors is said to produce more severe Syndrome
muscarinic side effects (d) All of the above
(a) Pyridostigmine (b) Neostigmine (e) None of the above
(c) Ambenonium (d) All of the above 176. d-Amphetamine is not used in
(e) None of the above (a) Narcolepsy
170. Which of the following cholinesterase (b) Hyperkinetic child (specilly attention deficit
inhibitors is preferred in patients disorder)
hypersensitive to the bromide ion ? (c) Migraine
(a) Pyridostigmine (b) Neostigmine (d) Child appetite suppressant
(c) Ambenonium (d) All of the above 177. Following is a tertiary amine anti-mus-
(e) None of the above carinic drug used for Parkinson’s disease
ANSWERS
1. d 2. c 3. c 4. b 5. a 6. d
7. c 8. b 9. c 10. e 11. d 12. a
13. b 14. b 15. c 16. a 17. b 18. b
19. b 20. e 21. c 22. c 23. b 24. b
25. a 26. b 27. d 28. a 29. e 30. c
31. d 32. e 33. a 34. b 35. d 36. c
37. e 38. b 39. b 40. a 41. a 42. a
43. d 44. a 45. a 46. c 47. e 48. b
49. e 50. b 51. a 52. a 53. a 54. b
55. c 56. e 57. c 58. d 59. b 60. d
61. b 62. d 63. b 64. b 65. b 66. b
67. b 68. c 69. b 70. d 71. c 72. a
73. a 74. d 75. c 76. a 77. b 78. d
79. a 80. a 81. c 82. c 83. d 84. d
85. d 86. d 87. c 88. a 89. d 90. d
91. c 92. c 93. c 94. b 95. c 96. c
97. c 98. c 99. d 100. a 101. d 102. d
103. d 104. c 105. d 106. d 107. b 108. c
109. c 110. b 111. a 112. d 113. b 114. d
115. c 116. a 117. c 118. d 119. b 120. d
121. b 122. d 123. a 124. b 125. a 126. b
127. b 128. b 129. d 130. d 131. d 132. c
133. a 134. a 135. b 136. d 137. a 138. a
139. c 140. b 141. c 142. a 143. a 144. b
145. e 146. a 147. a 148. b 149. c 150. d
151. d 152. b 153. d 154. c 155. b 156. d
157. d 158. c 159. a 160. d 161. c 162. f
163. b 164. a 165. a 166. c 167. d 168. e
169. b 170. c 171. c 172. b 173. b 174. c
175. d 176. c 177. a 178. d 179. a 180. d
100 MCQs IN PHARMACOLOGY
CHAPTER 4
VITAMINS & MINERALS
11. Physiologically carnitine plays following 18. The gut controls the entry of ingested iron
role in the body of
(a) Important for oxidation of fatty acids (a) Regulating the availability of apoferritin
(b) Decreases aerobic metabolism of carbohy- which acts as the carrier of iron across the
drates mucosal cell
(c) Decreases rate of oxidative phosphorylation (b) Regulating the turnover of apoferritin-ferritin
(d) All of the above interconversion in the mucosal cell
(c) Complexing excess iron to form ferritin which
12. Patients receiving iron therapy should be remains stored in the mucosal cell and is shed
warned about
off
(a) Dizziness (d) Regulating the number of transferring
(b) Ringing in the ears receptors on the mucosal cell
(c) Danger of sunlight
19. The percentage of elemental iron
(d) Blackening of the stool hydrated ferrous sulfate is
(e) Paresthesia
(a) 5% (b) 10%
13. Therapeutically vitamin B1 has been (c) 20% (d) 33%
employed most successfully in the
treatment of 20. In isolated fibroblast or epithelial cells,
retinoids enhance the synthesis of
(a) Microcytic anemia
following protein
(b) Pellagra
(a) Fibronectin
(c) Scurvy
(b) Collagenase
(d) Beriberi
(c) Certain species of keratin
(e) Macrocytic anemia
(d) All of the above
14. Magnesium ion is necessary in
21. The side effect which primarily limits
(a) Stimulating enzyme systems acceptability of oral iron therapy is
(b) Muscular contraction
(a) Epigastric pain and bowel upset
(c) Nerve conduction
(b) Black stools
(d) All of the above
(c) Staining of teeth
(e) None of the above
(d) Metallic taste
15. The following derivatives of retinal shows
the greatest biological potency than 22. Iron sorbitol-citric acid differs from iron
others dextran in that
(a) 9-Cis-retinoic acid (b) All-trans-retinoic acid (a) It cannot be injected i.v.
(c) All-trans-retinol (d) 11-Cis-retinal (b) It is not excreted in urine
(c) It is not bound to transferritin in plasma
16. The drug used for controlling tetany is
(d) It produces fewer side effects
(a) Intravenous diazepam
23. Which of the following is true about iron
(b) Intramuscular vitamin D
therapy ?
(c) Intravenous calcium gluconate
(a) Haemoglobin response to intramuscular iron
(d) Intravenous calcitonin
is faster than with oral iron therapy
17. Absorption of oral iron preparations can (b) Iron must be given orally except in pernicious
be facilitated by coadministering anaemia
(a) Antacids (b) Tetracyclines (c) Prophylactic iron therapy must be given
(c) Phosphates (d) Ascorbic acid during pregnancy
VITAMINS & MINERALS 105
(d) Infants on breast feeding do not require (c) Conversion of homocysteine to methionine
medicinal iron (d) All of the above
24. Concentrations of retinal in plasma in 31. Vitamin K is indicated for the treatment
excess of _____ µ g/dl usually are
of bleeding occurring in patients
diagnostic of hypervitaminosis A
(a) Being treated with heparin
(a) 10 (b) 50
(b) Being treated with streptokinase
(c) 100 (d) 200
(c) Of obstructive jaundice
25. Megaloblastic anaemia occurs in
(d) Of peptic ulcer
(a) Vitamin B12 but not folic acid deficiency
32. Menadione (Vitamin K3)
(b) Folic acid but not Vitamin B12 deficiency
(c) Either Vitamin B12 or folic acid deficiency (a) Can cause hemolysis in patients with G-6-PD
(d) Only combined Vitamin B12 + folic acid deficiency
deficiency (b) Is given in large doses in patients with severe
liver disease
26. The daily dietary requirement of Vitamin
B12 by an adult is (c) Is useful to prevent haemorrhagic disease of
the newborn
(a) 1–3 µg (b) 50–100 µg
(d) Is the preparation of choice to antagonize
(c) 0.1–0.5 µg (d) 1–3 µg
the effect of warfarin overdose
27. Which of the following factor(s) is/are
33. Vitamin K promotes the hepatic biosynthesis
required for the absorption of Vitamin B12
ingested in physiological amounts ? of following blood clotting factor
Answer
1. c 2. a 3. a 4. c 5. a 6. d
7. c 8. a 9. b 10. c 11. a 12. d
13. d 14. d 15. c 16. c 17. d 18. c
19. c 20. a 21. a 22. a 23. c 24. c
25. c 26. a 27. d 28. d 29. b 30. d
31. c 32. a 33. b 34. c 35. a 36. b
CHAPTER 5
ANALGESICS & ANTIPYRETICS
20. A drug that decreases blood pressure and (a) Oxidation of the ester
has analgesic and spasmolytic effects (b) Reduction of the carboxylic acid
when given intrathecally is (c) Hydrolysis of the ester
(a) Atenolol (b) Clonidine 27. Diamprit is an agonist of ______ receptors,
(c) Morphine (d) Nitroprusside except
(e) Prazosin (a) H1 (b) H2
21. Cyclooxygenase-1 and –2 are responsible (c) H3 (d) All of the above
for 28. Which of the following enzymes is
(a) The synthesis of prostaglandins from ultimately responsible for the production
arachidonate of prostaglandins associated with
(b) The synthesis of leukotrienes from arachidonate inflammatory reactions?
(c) The conversion of ATP to cAMP (a) Phospholipase
(d) The metabolic degradation of cAMP (b) Lipoxygenase
(e) The conversion of GTP to cGMP (c) Cyclooxygenase-I
(d) Cyclooxygenase II
22. Following agent is generally used in (e) Xanthine oxidase
allergic rhinitis
29. Which of the following prostaglandin
(a) Beclomethasone (b) Fluticasone
analogs is used specifically for the
(c) Triamcinolone (d) All of the above treatment of NSAID induced
gastrointestinal ulcertation?
23. The primary objective for designing drugs
that selectively inhibit COX – 2 is to (a) Alprostadil (b) Misoprostol
(a) Decrease the risk of nephrotoxicity (c) Carboprost (d) Dinoprostone
(e) Epoprostenol
(b) Improve anti-inflammatory effectiveness
(c) Lower the risk of gastrointestinal toxicity 30. Which of the following compounds is
(d) Reduce the cost of treatment of rheumatoid most likely to lower circulating levels of
arthritis leukotrienes?
(e) Selectively decrease thromboxane A2 without (a) Zileuton (b) Montelukast
effects on other eicosanoids (c) Carprofen (d) Aspirin
(e) Allopurinol
24. A newborn was diagnosed as having a
congenital abnormality that resulted in 31. The action of aspirin that results in its
transposition of her great arteries. While greater efficacy as an antithrombotic
preparing the infant for surgery, the (anti-platelet) drug is its ability to
medical team needed to keep the ductus (a) Inhibit lipoxygenase as well as cyclooxygenase
arteriosus open. They did this by infusing (b) Selectively inhibit cyclooxygenase I
(a) Cortisol (b) Indomethacin (c) Inhibit leukocyte migration
(c) Ketorolac (d) Misoprostol (d) Promote uric acid excretion
(e) Tacrolimus (e) Acetylate cyclooxygenase
25. Acetyl salicylic acid is soluble in 32. Which of the following drugs may be
effective in the treatment of gouty
(a) An aqueous base (b) Water
arthritis by acting by two separate and
(c) An aqueous acid distinct mechanisms?
26. Decomposition of the acetyl salicylic acid (a) Allopurinol (b) Probenecid
at room temperature most likely would (c) Colchicine (d) Indomethacin
occur by (e) Sulfinpyrazone
110 MCQs IN PHARMACOLOGY
33. Acute or chronic colchicine toxicity may (a) Contraction of gastrointestinal muscles
be identified by which of the following (b) Decreased muscle tone
signs/symptoms? (c) Decreased peristalsis
(a) Alopecia (d) All of the above
(b) Blood dyscrasias
39. A FDA – approved ingr edient for
(c) Severe gastrointestinal upset protection against painful sensitivity of
(d) All of the above the teeth due to cold, heat, acids, sweets
(e) None of the above or contact is
(a) Acetaminophen (4) Aspirin may slow this drug’s rate of excretion
(b) Nonsteroidal anti-inflammatory drugs (5) Vision should be monitored every 3–6
(c) Warfarin months
(d) Lithium 48. All of the following statements concerning
(e) Aspirin an acute gouty arthritis attack are correct
except
45. Which of the following statements best
describes the usual course of rheumatoid (a) The diagonosis of gout is assured by a good
arthritis? therapeutic response to colchicines because
no other form of arthritis responds to this drug
(a) It is an acute exacerbation of joint pain treated
(b) To be assured of the diagnosis, monosodium
with short-term anti-inflammatory therapy
urate crystals must be identified in the
(b) It is a chronic disease characterized by acute synovial fluid of the affected joint
changes within nonsynovial joints
(c) Attacks frequently occur in the middle of the
(c) It is an acute disease that is characterized by night
rapid synovial changes due to inflammation
(d) An untreated attack may last up to 2 weeks
(d) It is a chronic disease characterized by acute (e) The first attack usually involves only one joint,
exacerbations followed by remissions with most frequently the big toe (first metatar-
consequences associated with chronic sophalangeal joint)
inflammatory changes
(e) It is a joint disease characterized by a αis an example of eicosanoids
49. TNF-α
marked loss of calcium from the bones and (a) Interleukins
a resultant thinning of the bones (b) Cytotoxic factors
46. Match the drug characteristic with the (c) Interferons
appropriate agent. (d) Colony stimulating factors
(a) Corticosteroids (1) Persistent platelet 50. Potential adverse effects associated with
function effect aspirin include all of the following except
(b) Lbuprofen (2) Oral form of gold (a) Gastrointestinal ulceration
(c) Aspirin (3) Given on an empty (b) Renal dysfunction
stomach
(c) Enhanced methotrexate toxicity
(d) Aurancfin (4) May be used intra-
(d) Cardiac arrhythmias
articularly
(e) Hypersensitivity asthma
(e) Penicillamine (5) May cause drowsiness
51. All of the following facts are true about
47. Match the phrase below with the appro-
non-steroidal anti-inflammatory drugs
priate agent used to treat rheumatoid
(NSAIDs) except
arthritis.
(a) They are antipyretic
(a) Indomethacin
(b) There is a celling effect to their analgesia
(b) Aspirin
(c) They can cause tolerance
(c) Hydroxychloroquine
(d) They do not cause dependence
(d) Methotrexate
(e) They are anti-inflammatory
(e) Cyclophosphamide
(1) May cause hemorrhagic cystitis 52. Which of the following narcotics has the
longest duration of effect?
(2) May cause more severe central nervous
system (CNS)adverse effects than other (a) Methadone
nonsteroidal anti-inflammatory drugs (b) Controlled-release morphine
(NSAIDS) (c) Levorphanol
(3) Enteric – coated form may be useful in (d) Transdermal fentanyl
treating some patients (e) Dihydromorphone
112 MCQs IN PHARMACOLOGY
53. Cylcoocygenase-II specific inhibitors block 60. Eicosanoids are a group of _____ carbon
the following unsaturated fatty acids
(a) Production of cytoprotective prostaglandins (a) 20 (b) 10
(b) Tumor necrosis factor - α (c) 25 (d) 35
(c) Production of prostaglandins responsible for
61. Which of the following durgs is a
pain and inflammation
monamine oxidase inhibitor, but is used
54. The emetic action of morphine is due to to treat hypertension?
(a) Irritation of gastrointestinal tract (a) Tranylcypromine (Parnate)
(b) Stimulation of cerebral cortex (b) Reserpine
(c) Stimulation of medullary vomiting center (c) Propranolol (Inderal)
(d) Stimulation of emetic chemoreceptor trigger (d) Pargyline (Eutonyl)
zone (e) Imipramine (Tofranil)
(e) None of the above
62. Autacoids differ from hormones in that
55. Colchicine is used mainly to treat (a) Autacoids are involved only in the causation
(a) Gout (b) Arthiritis of pathological states
(c) Diabetes (d) Carcinomas (b) Autacoids do not have a specific cell/ tissue
(e) High blood pressure of origin
(c) Autacoids generally act locally at the site of
56. Which type of patient is most likely to generation and release
hypersensitive to aspirin?
(d) Both (b) and (c)
(a) Intrinsic asthamatic
63. Which of the following eicosanoids is
(b) Extrinsic asthamatic
generated through the lipozygenase
(c) Chronic bronchitic pathway ?
(d) Patient with viral injection
(a) Prostaglandin E2 (b) Thromboxane A2
(e) Both (c) and (d)
(c) Prostacyclin (d) Leukotriene C4
57. Codeine acts as a cough sedative by
64. The cyclooxygenase isoenzymes COX-1
(a) Producing mild nausea and COX-2 differ from each other in that
(b) Depressing bronchiolar secretions (a) They catalyse different pathways in prostanoid
(c) Depressing pulmonary action biosynthesis
(d) Depressing cough center (b) COX–1 is inhibited by aspirin but not COX–2
(e) Paralyzing sensory nerves of bronchi (c) COX–2 is inhibited by ibuprofen but not
COX–1
58. The greatest threat from morphine
poisoning is (d) COX–1 is constitutive while COX–2 is
inducible
(a) Renal shutdown
(b) Paralysis of spinal cord 65. Which of the following is an irreversible
(c) Respiratory depression inhibitor of cyclooxygenase ?
(d) Cardiovascular collapse (a) Aspirin (b) Phenylbutazone
(e) None of the above (c) Indomethacin (d) Piroxicam
59. A very common side effect of morphine 66. The prostanoid that consistently constricts
is blood vessels is
(a) Allergic response (b) Blood dyscrasias (a) Prostaglandin E2 (b) Prostaglandin F2a
(c) Constipation (d) Liver damage (c) Thromboxane A2 (d) Prostacyclin
(e) Visceral pain
ANALGESICS & ANTIPYRETICS 113
110. The distinctive feature of nimesulide is 116. Sulfasalazine is used in the following
disease(s)
(a) It does not inhibit prostaglandin synthesis
(b) It does not cause gastric irritation (a) Bacillary dysentery
(c) It is well tolerated by aspirin intolerant (b) Ulcerative colitis
asthama patients (c) Rheumatoid arthritis
(d) It is not bound to plasma proteins (d) Both (b) and (c)
114. Which of the following anti-inflammatory 120. Select the drug which is neither analgesic,
analgesics has been cleared for pediatric nor antiinflammatroy nor uricosuric, but
use is highly efficacious in acute gout
(a) Indomethacin (b) Ibuprofen (a) Prednisolone (b) Colchicine
(c) Ketorolac (d) Piroxicam (c) Naproxen (d) Sulfinpyrazone
115. Which of the following statements is 121. The most important dose-limiting adverse
effect of colchicines is
correct about gold therapy of rheumatoid
arthiritis (a) Sedation (b) Kidney damage
(a) It is indicated only in rapidly progressing (c) Diarrhoea (d) Muscle paralysis
disease, not controlled by nonsteroidal anti- 122. Probenecid has the following action(s)
inflammatory drugs
(a) Uricosuric (b) Analgesic
(b) It is indicated only in severe cases after both
(c) Antiinflammatory (d) Both (a) and (c)
nonsteroidal anti-inflammatory drugs and
corticosteroids have failed 123. Vasodilation mediated by 5-HT1 re-
(c) When gold therapy is started, nonsteroidal ceptors involve following mechanism
anti-inflammator y drugs should be (a) Direct relaxant effect on smooth muscle
discontinued (b) Inhibition of norepinephrine
(d) Intramuscular gold is the most rapidly acting (c) Nitric oxide release from endothelial cells
drug in severe rheumatoid arthritis (d) All of the above
ANALGESICS & ANTIPYRETICS 117
ANSWERS
1. b 2. d 3. b 4. c 5. c 6. d
7. e 8. e 9. b 10. d 11. d 12. b
13. b 14. b 15. d 16. b 17. d 18. c
19. c 20. b 21. a 22. d 23. c 24. d
25. a 26. c 27. a 28. d 29. b 30. a
31. e 32. d 33. d 34. a 35. e 36. d
37. d 38. a 39. c 40. c 41. a 42. b
43. b 44. a 45. d
46. 1.c, 2.d, 3.c, 4.a, 5.b 47.1.e, 2.a, 3.b, 4.d, 5.c 48. a 49. b
50. e 51. c 52. d 53. c 54. d 55. a
56. a 57. d 58. c 59. c 60. a 61. d
62. d 63. d 64. d 65. a 66. c 67. d
68. b 69. c 70. c 71. c 72. b 73. a
74. b 75. a 76. c 77. b 78. d 79. b
80. b 81. b 82. a 83. d 84. d 85. b
86. b 87. d 88. a 89. b 90. a 91. b
92. c 93. c 94. d 95. c 96. b 97. d
98. d 99. c 100. d 101. d 102. d 103. b
104. b 105. c 106. a 107. c 108. b 109. a
110. c 111. b 112. d 113. c 114. d 115. a
116. d 117. a 118. d 119. d 120. b 121. c
122. a 123. d 124. c 125. d 126. a 127. d
128. c 129. b 130. a 131. c 132. b 133. e
134. d 135. e 136. c 137. c 138. d 139. d
140. a
ANALGESICS & ANTIPYRETICS 119
10. A hypertensive patient has been using 16. Activation of endothelin receptor ETA,
nifedipine for some time without unto- leads to
ward effects. If he experiences a rapidly (a) Vasoconstriction
developing enhancement of the antihyper- (b) Bronchoconstriction
tensive effect of the drug, it is probably
(c) Aldosterone release
due to
(d) All of the above
(a) Concomitant use of antacids
(b) Fods containing tyramine 17. Methylxanthine drugs such as aminophyl-
(c) Grapefruit juice line cause which one of the following?
(d) Induction of drug metabolism (a) Vasoconstriction in many vascular beds
(e) Over – the – counter decongestants (b) Decrease in the amount of cAMP in mast
cells
11. A drug lacking vasodilator properties that
(c) Bronchodilation
is useful in angina is
(d) Activation of the enzyme phosphodiesterase
(a) Isosorbide dinitrate
(e) Sedation
(b) Metoprolol
(c) NIfedipine 18. Drugs used in asthma that often cause
(d) Nitroglycerin tachycardia and tremor include
(e) Verapamil (a) Beclomethasone (b) Cromolyn sodium
(c) Ipratropium (d) Metaproterenol
12. Aldosterone release is stimulated by
(e) All of the above
(a) Angiotensin I (b) Angiotensin
(c) Angiotensin III (d) Both (b) and (c) 19. Following potassium sparing diuretic
inhibits action of aldosterone
13. Which one of the following drugs is used
in the treatment of male impotence and (a) Amiloride (b) Triamterene
activates prostaglandin E1 receptors? (c) Spironolactone (d) All of the above
CARDIO–VASCULAR DRUGS 123
20. In patients with chronic granulomatous (d) Slows the depolarization phase of the action
disease which of the following agents potential in AV nodal cells
increases the synthesis of tumor necrosis (e) Used in management of supraventricular
factor, leading to activation of phagocy- tachycardias
tosis?
26. What drug is used to prevent embolism in
(a) Aldesleukin (b) Cyclosporine
the lung and during myocardial infarction?
(c) Filgrastim (d) Infliximab
(a) Alteplase
(e) Interferon gamma
(b) Human growth hormone
21. The mechanism of action of cyclosporine (c) Granulocyte–macrophage colony – stimulating
involves factor (GM–CSF)
(a) Activation of calcineurin (d) EPOGEN (EPO)
(b) Binding to cyclophilin to cause inhibition of (e) None of the above
a cytoplasmic phosphatase
27. Which of the following cardiovascular
(c) Blockade of interleukin – 2- receptors
agents is classified chemically as a gly-
(d) Inhibition of phospholipase A2 coside?
(e) Suppression of bone marrow progenitors
(a) Nifedipine (b) Digoxin
22. Which one of the following drugs predictably (c) Flecainide (d) Cholestyramine
prolongs the PR interval and increases (e) Warfarin
cardiac contractility?
28. Inhibition of carbonic anhydrase results in
(a) Digoxin (b) Lidocaine
(a) Abolition of NaHCO 3 reabsorption in
(c) Propranolol (d) Quinidine
proximal tubule
(e) Verapamil
(b) Enhanced of NaHCO3 reabsorption in
23. Which of the following is the drug of proximal tubule
choice for management of cardiac (c) Enhanced NAHCO3 secretion in distal tubule
arrhythmias that occur in digitalis (d) None of the above
toxicity?
29. Which of the following cyclotron produced
(a) Amiodarone (b) Lidocaine
radiopharmaceuticals is used for assessing
(c) Propranolol (d) Sotalol
regional myocardial perfusion as part of
(e) Prazosin an exercise stress test?
24. A 54-year-old woman with severe (a) Thallous chloride 201TI USP
hypercholesterolemia is to be treated (b) Sodium iodide 123I
with a combination of niacin and (c) Gallium citrate 67Ga USP
atorvastatin. With this drug combination,
(d) Indium 111In pentetate
it is important that the patient be
monitored closely for signs of (e) Cobalt 57Co cyanocobalamin
(a) Agranulocytosis (b) Gallstones 30. Mary has a family history of heart disease
(c) Lactic acidosis (d) Myopathy and wonders if garlic would be beneficial
to her. Which of the following statements
(e) Thyrotoxicosis
is correct about garlic?
25. Regarding verapamil, which one of the (a) Enteric-coated tablets release their contents
following statements is false? in the stomach
(a) Angina pectoris is an important indication (b) Side effects include heartburn, flatulence, and
for the use of verapamil sweating
(b) Contraindicated in the asthmatic patient (c) The safety of garlic in pregnancy is unknown
(c) Relaxes vascular smooth muscle (d) Garlic does not interact with warfarin
124 MCQs IN PHARMACOLOGY
68. In heart, potassium channels determine (c) They preferentially dilate autoregulatory
(a) Pacemaker function arterioles without affecting the larger arteries
(b) Resting potential (d) They increase subepicardial blood flow
without affecting subendocardial blood flow
(c) Action potential duration
(d) All of the above 75. Organic nitrates relax vascular smooth
muscle by
69. Lidocaine is the preferred antiarrhythmic
(a) Increasing intracellular cyclic AMP
for emergency control of cardiac arrhyth-
mias following acute myocardial infarction (b) Increasing intracellular cyclic GMP
because (c) Decreasing intracellular cyclic AMP
(a) It has a rapidly developing and titratable (d) Both (b) and (c)
antiarrhythmic action 76. Select the organic nitrate which undergoes
(b) It casues little myocardial depression and minimal first-pass metabolism in the liver
hypotension (a) Glyceryl trinitrate
(c) It has broad spectrum antiarrhythmic efficacy (b) Isosorbide dinitrate
in atrial as well as ventricular arrhythmias
(c) Isosorbide mononitrate
(d) Both (a) and (b)
(d) Erythrityl tetranitrate
70. Hypothyroidism is a possible consequence
77. The primary mechanism of beneficial
of prolonged therapy with
effect of glyceryl trinitrate in classical
(a) Procainamide (b) Mexiletine angina pectoris is
(c) Sotalol (d) Amiodarone (a) Increase in total coronary blood flow
71. Which of the following drugs is preferred (b) Redistribution of coronary blood flow
for termination of paroxysmal supraven- (c) Reduction of cardiac preload
tricular tachycardia (d) Reduction of cardiac after load
(a) Digoxin (b) Quinidine 78. Enhanced automaticity in cardiac cells
(c) Propranolol (d) Verapamil may occur because of
72. The following drug is used to reduce the (a) β-adrenergic stimulation
frequency of angina pectoris as well as (b) Hypokalemia
to terminate an acute attack (c) Mechanical stretch of cardiac muscles
(a) Digoxin (b) Furosemide (d) All of the above
(c) Enalapril (d) Amrinone
79. Glyceryl trinitrate is administratered by
73. Antianginal drugs afford the following all of the following routes except
benefit/benefits (a) Oral (b) Sublingual
(a) Terminate anginal attacks (c) Intramuscular (d) Intravenous
(b) Decrease the frequency of anginal attacks 80. A patient of acute myocardial infarction
(c) Retard the progression of coronary artery being treated in intensive care unit
disease developed left ventricular failure with raised
(d) Both (a) and (b) central venous pressure. It was decided to
use glyceryl trinitrate. Which route/method
74. Choose the correct statement about the of administration would be most suitable.
action of nitrates on coronary vessels
(a) Sublingual
(a) They mitigate angina pectoris by increasing
(b) Oral
total coronary flow
(c) Intravenous bolus injection
(b) They preferentially dilate conducting arteries
without affecting resistance arterioles (d) Slow intravenous infusion
128 MCQs IN PHARMACOLOGY
81. A patient suffers from spisodic pain 88. Which of the following drugs is a potassium
diffusely localized over the chest and upper channel opener ?
abdomen, which is relieved by sublingual (a) Pinacidil (b) Hydralazine
glyceryl trinitrate. He could be suffering
(c) Glibenclamide (d) Amiloride
from
(a) Angina pectoris 89. Though nitrates and calcium channel
blockers are both vasodilators, they are
(b) Biliary colic
used concurrently in angina pectoris
(c) Esophageal spasm
because
(d) All of the above
(a) They antagonize each other’s side effects
82. The dihydropyridines block the following (b) Nitrates primarily reduce preload while
type of calcium channels. calcium channel blockers primarily reduce
(a) L-type voltage sensitive channels after load
(b) T-type voltage sensitive channels (c) Nitrates increase coronary flow while
(c) N-type voltage sensitive channels calcium
(d) Receptor operated calcium channels (d) Both (b) and (c)
83. Which of the following drugs is most 90. ‘Coronary steal phenomenon’ has been
likely to accentuate varient (Prinzmetal) noted most frequently with
angina ? (a) Glyceryl trinitrate (b) Dipyridamole
(a) Digoxin (b) Furosemide (c) Propranolol (d) Diltiazem
(c) Enalapril (d) Amrinone 91. Which of the following drugs is believed
84. In cardiac cells, adenosine to improve microcirculation in peripheral
vascular diseases by promoting RBC
(a) Causes shortening of action potential duration flexibility ?
(b) Depolarization
(a) Cyclandelate (b) Theophyline
(c) Increase in normal automaticity
(c) Pentoxiphyline (d) Nicotinic acid
(d) All of the above
92. Higher incidence of myocardial infarc-
85. Which of the following antianginal drugs tion and increased mortality has been
is most likely to produce tachycardia as noted with the use of the following anti-
a side effect ? hypertensive drug
(a) Amlodipine (b) Nifedipine (a) Nifedipine (b) Verapamil
(c) Diltiazem (d) Verapamil (c) Diltiazem (d) Lisinopril
86. Which of the following is not an attribute 93. Cardiac glycosides are obtained from
of amlodipine ? following plant source.
(a) High and consistent oral bioavailability (a) Rauwolfia serpentina
(b) Large volume of distribution (b) Strophanthus gratus
(c) Generation of an active metabolite (c) Ricinus commounts.
(d) Long elimination half-life (d) Atropa belladonna
87. Propranolol should not be prescribed for 94. Therapeutic dose of digoxin in a normal
a patient of angina pectoris who is already individual has the following effects, except
receiving
(a) Increase in the speed of myocardial contractility
(a) Nifedipine
(b) No significant change in cardiac output
(b) Felodipine
(c) Relaxation of peripheral vascular bed
(c) Verapamil
(d) Increase in the force of myocardial
(d) Isosorbide mononitrate contractility
CARDIO–VASCULAR DRUGS 129
95. Digoxin given for cardiac failure is 102. Digitalis was discovered by
extremely valuable in patients of (a) William Withering
(a) Thyrotoxicosis (b) Beriberi (b) Ottolewi
(c) Cor pulmonale (d) Atrial fibrillation (c) Walksman
96. The agent given sublingually in an acute (d) Dale
attack of angina pectoris is 103. The cardiac slowing by digitalis in atrial
(a) Glyceryl trinitrate fibrillation and congestive failure
(b) Amyl nitrite (a) Is due partly to increased vagal activity
(c) Erythrital tetranitrate (b) Is due partly to decreased sympathetic
(d) Pentaerythritol tetranitrate activity
(c) Is due partly to depression of S.A. Node
97. Following statement is true about lidocaine
(d) May be partly related to a vagal mediated
(a) Reduce the slope of Phase 4
increse in atrial frequency
(b) Threshold excitability is not altered
(c) Action potential is not affected 104. After oral administration peak concentra-
tion of digoxin is reached in
(d) All of the above
(a) 1 to 2 mins (b) 30 to 60 mins
98. Aspirin in small doses (50 to 150 mg per
(c) 5 to 10 mins (d) 4 to 6 hours
day)
(a) Is of benefit in patients of unstable angina 105. The normal therapeutic plasma con-
centration of digitalis is
(b) Has thrombolytic action
(c) PREFerentially inhibits prostacyclin synthetase (a) 0.5 to 1.5 ng/ml and toxicity appears above
enzyme 3 mg/ml
(d) MAY Alleviate need for Verapamil in variant (b) 1 to 5 ng/µl and toxicity appears above 50
angina mg/ml
(c) 0.1 to 0.5 αg mg/ml and toxicity appears
99. Major beneficial effect of nitrates in above 5
classical angina is due to
(d) 0.5 to 1.5 αg mg/ml and toxicity appears
(a) Dilation of veins more than arteries above 5 αg mg/ml
(b) Increase in total coronary blood flow
106. Drug of choice for digitalis induced
(c) An increase in the end diastolic size of the arrhythmia is
heart
(a) Propranolol (b) Phenytoin
(d) An increase in the heart rate
(c) Xylocaine (d) Phenylephrine
100. Major lipid class present in chylomicrons
is 107. In which of the following conditions,
digitalis is most likely to be beneficial?
(a) Endogenous triglycerides
(a) Heart failure from valvular lesions
(b) Cholesterol esters
(b) Furosemide
(c) Dietary triglycerides
(c) Heart disease with anaemia
(d) All of the above
(d) Heart failure from thyrotoxicosis
101. Polymorphic ventricular tachycardia can
occur when terfenadine 108. Nicotinic acid
109. Which of the following would least likely (a) Probably be unrelated to drug administration
benefit a patient in acute pulmonary (b) Be the desired response of the drug
edema due to congestive heart failure?
(c) Probably be the result of drug-induced heart
(a) Intravenous morphine block
(b) Digoxin (d) Be an indication for increasing the drug dose.
(c) Oxygen
115. Digoxin differs from digitoxin in that
(d) Rotating tourniquets
digoxin
110. Monoamine oxidase inhibitors (a) Has a longer half life
(a) Do not cause postural hypotension (b) Is completely absorbed from the GI tract
(b) Are known to reduce blood pressure by (c) Is bound extensively to plasma proteins
depleting catecholamines
(d) Its half-life is more dependent on the
(c) Have a prompt hypotensive action adequacy of renal function
(d) Generally do not cause tachycardia
116. Diazoxide is administered by slow IV-
111. Digitalis is given before quinidine in the injection in emergency treatment of
treatment of atrial fibrillation, because hypertension because
digitalis increase A-V conduction and
counteracts (a) The drug is rapidly biotransformed by hepatic
microsomal enzymes
(a) The “Vagotonic” effect of quinidine and
(b) The drug is highly lipid-soluble and quickly
prevents “paradoxic” tachycardia
deposited in natural fat
(b) The “Vagolytic” effect of quinidine and
prevents “paradoxic” bradycardia (c) This measure is necessary to prevent severe
hyperglycemia
(c) The “Vagotonic” effect of quinidine and
prevents paradoxic bradycardia (d) The drug is quickly inactivated by serum
protein binding
(d) The “Vagolytic” effect of quinidine and
prevents paradoxic tachycardia 117. Glyceryl trinitrate is generally taken by
112. The earliest toxic symptom of chronic (a) Oral route (b) Intravenous route
digitalis administration is (c) Sublingual route (d) Subcutaneous route
(a) Altered color vision
118. Which of the following is longest acting
(b) Psychic symptoms nitrate?
(c) Anorexia, nausea, vomiting
(a) Glyceryl trinitrate
(d) Retrosternal pain
(b) Ethyt tetranitrate
113. In normal condition sequence of con- (c) Octyl nitrite
duction of cardiac action potential is
(d) Pentaerythritol tetranitrate
(a) SA node to AV node to bundle of His to atrium
119. Methaemoglobinaemia can occur with
(b) SA node to atrium to AV node to bundle of
high doses of
His
(c) SA node to atrium to bundle of His to AV (a) Digitalis (b) Nitrites
node (c) Propranolol (d) All of the above
(d) SA node to AV node to atrium to bundle of
120. Cardiac glycoside consists of
His
(a) Aminoacids and sugar
114. While treating a CHF patient with cardiac
(b) A steroid combined with sugar residue
glycoside, one notices that the patient’s
resting heart rate, which previously had (c) A polypeptide and sugar
been 86/min is now 40/min. This would (d) None of the above
CARDIO–VASCULAR DRUGS 131
ANSWERS
1. a 2. d 3. d 4. d 5. d 6. c
7. a 8. d 9. d 10. c 11. b 12. d
13. a 14. e 15. d 16. d 17. c 18. d
19. c 20. e 21. b 22. a 23. b 24. d
25. b 26. a 27. b 28. a 29. a 30. b
31. c 32. e 33. b 34. b 35. d 36. c
37. c 38. e 39. c 40. c 41. b 42. c
43. b 44. b 45. d 46.b 47.a 48. b
49. b 50. c 51. a 52. d 53. a 54. a
55. a 56. e 57. a 58. a 59. e 60. b
61. e 62. b 63. a 64. c 65. c 66. d
67. d 68. d 69. d 70. d 71. d 72. a
73. d 74. b 75. b 76. c 77. c 78. d
79. c 80. d 81. d 82. a 83. a 84. a
85. b 86. c 87. c 88. a 89. b 90. b
91. c 92. a 93. b 94. c 95. d 96. a
97. a 98. a 99. a 100. c 101. c 102. a
103. a 104. d 105. a 106. b 107. a 108. b
109. d 110. d 111. d 112. c 113. b 114. c
115. d 116. d 117. c 118. d 119. b 120. b
121. d 122. a 123. b 124. d 125. a 126. a
127. b 128. b 129. d 130. b 131. d 132. a
133. d 134. a 135. a 136. b 137. b 138. a
139. a 140. c 141. a
CARDIO–VASCULAR DRUGS 133
1. a Arterial blood pressure is directly proportional other phosphodiesterase isoforms are as follows:
to the blood flow, i.e., cardiac output and Phosphodiesterase I : Vinopocetine
peripheral vascular resistance. This relationship
Phosphodiesterase II : Not available
is correctly represented by equation in ‘A’
Phosphodiesterase IV : Rolipram
7. d Moxonidine acts mainly on imidazline I 1
57. a Phase 2 of action potential, also known as
receptors and produces antihypertensive effect.
‘plateau phase’ involves inward calcium current,
Dexmedetomidine is a α2-adrenergic receptor which has a slower inactivation. This inward
agonist. calcium current is balanced by outward delayed
Tizanidine is a spasmolytic agent. rectifier potassium current.
12. d Both angiotensin II and III promote aldosterone 68. d Potassium channels play an important role in
release. Aldosterone promotes the reabsorption various aspects of action potential in the heart
of sodium by distal renal tubules and this may viz. pacemaker function, resting potential and
increase the plasma volume and hypertension. action potential duration.
Angiotensin I is inactive. 78. d β-Adrenergic stimulation, hypokalemia and
16. d Activation of ETA receptors leads to vasocon- mechanical stretch produce increase in phase
striction, bronchoconstriction and stimulation of 4 slope, leading to acceleration of pacemaker
aldosterone release. rate, which results in enhanced automaticity.
Affinity of various endothelins for ETA receptor 84. a In cardiac cells, adenosine acts on its specific
is ET1 = ET2 > ET3. membrane receptors and activates acetylcholine-
19. c Spironolactone binds with cytoplasmic sensitive potassium current, specifically in atrium,
mineralocorticoid receptors. It also decreases sinus and AV node. This results in shortening of
the interacellular formation of active metabolites action potential duration. Activation of potassium
of aldosterone. current also results in hyperpolarization and
Triamterene and amiloride directly interfere with slowing of automaticity.
sodium entry. 97. a Lidocaine blocks both open and inactivated
28. a Carbonic anhydrase inhibitors inhibit both the cardiac sodium channels. It decreases
membrane and cytoplasmic forms of carbonic automaticity mainly by reducing the slope of
anhydrase and thus completely inhibit phase 4 and alters the threshold for cardiac
reabsorption of sodium bicarbonate in the excitability.
proximal tuble. Lidocaine may shorten the duration of action
34. b Both glycerin and isosorbide are orally active potential because of blockade of sodium
osmotic diuretics and hence show good oral channels, which get inactivated late during
absorption. action potential,
Mannitol shows negligible absorption. 100. c Chylomicrons contain dietary triglycerides as
39. c Ethacrynic acid is a phenoxy acetic acid the major lipid class.
derivative. Furosemide and bumetanide contain VLDL contains endogenous triglycerides and IDL,
sulfonamide moiety in their structure. LDL and HDL contain cholesterol esters as major
40. c Spironolactone is an aldosterone antagonist. lipid class.
Aldosterone is a mineralocorticoid and miner- 108. d Nicotinic acid produces decrease in LDL levels
alcorticoid receptors are present in epithelial because of decreased VLDL production and
cells of late distal tubule and collecting duct. enhanced clearance of LDL precursors in liver.
50. c Milrinone is an inhibitor of phosphodiesterase VLDL levels are decreased because of decreased
III and it produces positive inotropism via delivery of free fatty acids to liver, decrease in
inhibition of cGMP. Examples of inhibitors of triglyceride synthesis and decrease in VLDL-
134 MCQs IN PHARMACOLOGY
CHAPTER 7
DRUGS USED IN RESPIRATORY
DISORDERS
1. Which of the following terms best (d) Decreased calcium influx into the mast cells
describes the antagonism of leukotriene’s (e) Decreased prostaglandin production
bronchoconstrictor effect (mediated at
leukotriene receptors) by terbutaline 4. Which of the following will result from
(acting α adrenoceptors) in a patient with blockade of H2 receptors?
asthma?
(a) Decreased camp in cardiac muscle
(a) Pharmacologic antagonist (b) Increased camp in cardiac muscle
(b) Partial agonist (c) Decreased IP3 in gastric mucosa
(c) Physiologic antagonist
(d) Increased IP3 in gastric mucosa
(d) Chemical antagonist
(e) Increased IP3 in smooth muscle
(e) Noncompetitive antagonist
5. Toxicities of H2 antihistamines include
2. If therapy with multiple drugs causes
which one of the following?
induction of drug metabolism in your
asthma patient, it will (a) Blurred vision
(a) Result in increased smooth endoplasmic (b) Diarrhea
reticulum (c) Orthostatic hypotension
(b) Result in increased rough endoplasmic (d) P450 inhibition
reticulum (e) Sleepiness
(c) Result in decreased enzymes in the soluble
cytoplasmic fraction 6. A patient undergoing cancer chemo-
(d) Require 3-4 months to reach completion therapy is vomiting frequently. A drug that
(e) Be irreversible might help in this situation is
(a) Bromocriptine (b) Cimetidine
3. The Symptoms of allergen-mediated
asthma result from which of the (c) Ketanserin (d) Loratadine
following? (e) Ondansetron
(a) Increased release of mediators from mast 7. Which of the following is most useful in
cells the treatment of hyperprolactinemia ?
(b) Increased adrenergic responsiveness of the
airways (a) Bromocriptine (b) Cimetidine
(c) Increased vascular permeability of bronchial (c) Ergotamine (d) Ketanserin
tissue (e) LSD
136 MCQs IN PHARMACOLOGY
8. Drugs that can dilate bronchi during an 15. Which one of the following drugs is most
acute asthmatic attack include all of the suitable for management of essential
following except tremor in a patient who has pulmonary
(a) Epinephrine (b) Terbutaline disease?
(c) Nedocromil (d) Theophyline (a) Diazepam (b) Levodopa
(e) Ipratropium (c) Metoprolol (d) Propranolol
(e) Terbutaline
9. Which of the following is a nonselective but
very potent and efficacious bonchodilator 16. A drug useful in the treatment of asthma
that is not active by the oral route? but lacking bronchodilator action, is
(a) Aminophyline (b) Cromolyn (a) Cromolyn (b) Ephedrine
(c) Epinephrine (d) Ipratropium (c) Isoproterenol (d) Metaproterenol
(e) Metaproterenol (e) Metoprolol
10. Which of the following is a prophylactic 17. Relative to fexofenadine, diphenhy-
agent that appears to stabilize mast cells? dramine is more likely to
(a) Aminophyline (b) Cromolyn (a) Be used for treatment of asthma
(c) Epinephrine (d) Ipratropium (b) Be used for treatment of gastroesophageal
(e) Metaproterenol reflux disease
(c) Cause cardiac arrhythmias in overdose
11. Which of the following is a direct bron-
(d) Have efficacy in the prevention of motion
chodilator that is most often used in
sickness
asthma by the oral route?
(e) Increase the serum concentration of warfarin
(a) Aminophyline (b) Cromolyn
(c) Epinephrine (d) Ipratropium 18. Bacteria that make either a fementative
(e) Metaproterenol or respiratory set of enzymes are known
as
12. Acute exacerbations of asthma can be
(a) Obligate anacerobes
triggered by all of the following except
(b) Obligate aerobes
(a) Bacterial of viral pneumonia
(c) Microacerophiles
(b) Hypertsensitivity reaction to penicillin
(d) Facultative organisms
(c) Discontinuation of asthma medication
(d) Hot, dry weather 19. The symptoms of allergen-mediated asthma
result from which of the following?
(e) Stressful emotional events
(a) Increased release of mediators from mast
13. Which of the following has overdose cells
toxicity that includes insomnia, arrhy-
(b) Increased adrenergic responsiveness of the
thmias, and convulsions?
airways
(a) Aminophyline (b) Cromolyn (c) Inceased vascular permeability of bronchial
(c) Epinephrine (d) Ipratropium tissue
(e) Metaproterenol (d) Decreased calcium influx into the mast cell
14. Which of the following is a very long- (e) Decreased prostaglandin production
acting β2 – selective agonist that is used 20. Acute exacerbations of asthma can be
for asthma prophylaxis? triggered by all of the following except
(a) Aminophyline (b) Cromolyn (a) Bacterial or viral pneumonia
(c) Epinephrine (d) Ipratropium (b) Hypersensitivity reaction to penicillin
(e) Salmeterol (c) Discontinuation of asthma medication
DRUGS USED IN RESPIRATORY DISORDERS 137
(d) Hot, dry weather 26. Terbutaline has a preference for stimulation
(e) Stressful emotional events of which of the following receptors?
(a) Alpha (b) Gamma
21. In the emergency department, the preferred
first-line therapy for asthma exacerbation (c) Beta 1 (d) Beta 2
is (e) Dopaminergic
(a) Theophyline (b) A β-agonist 27. The National Institutes of Health (NIH)
(c) A corticosteroid (d) Cromolyn sodium guidelines for the treatment of asthma
(e) An antihistamine recommended institution of routine
inhaled corticosteroids when patients are
22. Which of the following tests is used at home classified as having greater than or equal
to assess therapy and determine if a patient to which type of asthma?
with asthma should seek emergency care?
(a) Mild intermittent
(a) Forced expiratory volume in one second (b) Mild persistent
(FEV1)
(c) Moderate persistent
(b) Forced vital capacity (FVC)
(d) Severe persistent
(c) Total lung capacity (TLC)
(d) Peak expiratory flow rate (PEFR) 28. Isoxuprine is used to treat
(e) Residual volume (RV) (a) Asthma (b) Severe hypotension
(c) Nasal congestion (d) Premature labor
23. Which of the following agents and
dosage regimens is the best choice of (e) Hypertension
treatment for an asthma patient with 29. The most likely complication of prolonged
rheumatoid arthritis who is considered use of nasal decongestant drops is
sensitive to aspirin (experiences bron-
(a) Atrophic rhinitis
chospasm with use)?
(b) Hypertrophy of nasal mucosa
(a) Lbuprofen, 800 mg three times daily
(c) Naso-pharyngeal moniliasis
(b) Acetaminophen, 650 mg every 4 hours
(d) Blockage of Eustachian tubes
(c) Gold injections, 25 mg intramuscularly once
a week 30. Which of the following is a selective H1
(d) Azathioprine, 75 mg daily receptor agoinist ?
(e) Cyclophosphamide, 100 mg daily (a) 4-methyl histamine
(b) Impromidine
24. A drug administered by inhalation of
(c) 2-Thiazolyl ethylamine
powder as a prophylactic for asthma is
(d) Mepyramine
(a) Ephedrine (b) Disodium cromolyn
(c) Isoproterenol (d) Ocytriphylline 31. Fall in blood pressure caused by larger
(e) Epinephrine doses of histamine is blocked by
(a) H1 antihistaminics alone
25. Which of the following may precipitate
(b) H2 ANTAgonists alone
an asthma attack?
(c) Combination of H1 and H2 antagonists
(a) Respiratory acidosis
(d) None of the above
(b) Viran and bacterial infections
(c) Respiratory alkalosis 32. Histamine is involved as a mediator in
the following pathological conditon
(d) Cranberry jiuce
(e) Chocolate or Coca Cola (a) Cocaine (b) Dibucaine
(c) Lidocaine (d) Procaine
138 MCQs IN PHARMACOLOGY
33. In the emergency department, the 40. The action of 5-Hydroxy tryptamine
preferred first-line therapy for asthma mediated by the 5-HT3 receptor is
exacerbation is (a) Vasoconstriction (b) Bradycardia
(a) Theophylline (b) A β-agonist (c) EDRF release (d) Platelet aggregation
(c) A corticosteroid (d) Cromolyn sodium
41. Tachyphylaxis to many actions on
(e) An antihistamine
repeated injection is a feature of the
34. The capacity of an antihistaminic to produce following autocoid
sedation depends on the following except (a) Histamine (b) 5-Hydroxytryptamine
(a) Relative affinity for central versus peripheral (c) Bradykinin (d) Angiotensin
H1 receptors
42. The smooth muscle stimulating action of
(b) Ability to penetrate blood-brain barrier
5-HT is most marked in the
(c) Individual susceptibility
(a) Bronchi (b) Intestines
(d) Ratio of H1 : H2 blockade produced by the drug
(c) Ureter (d) Billary tract
35. While prescribing the conventional H1
43. The 5-HT antagonist that has anti-
antihistaminics the patient should be
hypertensive property is
advised to avoid
(a) Methysergide (b) Cyproheptadine
(a) Driving motor vehicles
(c) Ketanserin (d) Ondansetron
(b) Consuming processed cheese
(c) Strenuous physical exertion 44. The most important receptor involved in
(d) All of the above cytotoxic drug induced vomiting is
(a) Histamine H1 receptor
36. The antihistaminc which has calcium
channel blocking and labyrinthine (b) Serotonin 5-HT3 receptor
suppressant property is (c) Dopamine D2 receptor
(a) Cyproheptadine (b) Cinnarizine (d) Opioid µ receptor
(c) Clemastine (d) Cetirizine 45. Which of the following expectorants acts
both directly on the airway mucosa as
37. Erythromycin should not be given to patient
well as reflexly ?
being treated with terfenadine because
(a) Potassium iodide (b) Guaiphenesin
(a) Erythromycin induces the metabolism of
terfenadine (c) Terpin hydrate (d) Bromhexine
(b) Dangerous ventricular arrhythmias can occur 46. Bromhexine acts by
(c) Terfenadine inhibits metabolism of erythromycin (a) Inhibiting cough center
(d) Terfenadine antagonizes the antimicrobal (b) Irritating gastric mucosa and reflexly
action of erythromycin increasing bronchial secretion
38. Select the H1 antihistaminic which is used (c) Depolymerizing mucopolysaccharides present
topically in the nose for allergic rhinitis (d) Desensitizing stretch receptors in the lungs
(a) Deep intra-abdominal operation 47. The primary goals of asthma therapy
(b) Trachial intubation include all of the following except
(c) Tetanus (a) maintain normal activity levels
(d) Diagonosis of myasthenia gravis (b) maintain control of symptoms
39. H1 antihistaminics are beneficial in (c) avoid adverse effects of asthma medications
(a) All types of allergic disorders (d) prevent acute exacerbations and chronic
symptoms
(b) Certain type I allergic reactions only
(e) prevent destruction of lung tissue
(c) Anaphylactic shock(d) Bronchial asthma
DRUGS USED IN RESPIRATORY DISORDERS 139
49. Which of the following antitussive is 55. Caffeine is more powerful than theophylline
present in opium but has no analgesic or in exerting the following action
addicting properties ? (a) Bronchodilatation
(a) Noscapine (b) Codeine (b) Cardiac stimulation
(c) Pholcodeine (d) Ethylmorphine (c) Diuresis
(d) Augmentation of skeletal muscle contractility
50. Bronchodilators are useful in cough
(a) Only when cough is non-productive 56. Methylxanthines exert the following
(b) Only when cough is associated with thick action (s) at cellular/molecular level
sticky secretions (a) Intracellular release of Ca2+
(c) Only when reflex bronchoconstriction is (b) Antagonism of adenosine
associated (c) Inhibition of phosphodiesterase
(d) Irrespective of nature of cough or associated (d) All of the above
features
57. Relatively higher dose of theophylline is
51 The common and dose related side effect required to attain therapeutics plasma
of salbutamol is concentration in
(a) Rise in blood pressure (a) Smokers
(b) Muscle tremor (b) Congestive heart failure patients
(c) Hyperglycaemia
(c) Those receiving erythromycin
(d) Central nervous system stimulation
(d) Those receiving cimetidine
52. Which of the following tests is used at home
58. The antiasthma drug which cannot be
to assess therapy and determine if a patient
administered by inhalation is
with asthma should seek emergency care?
(a) Theophylline (b) Ipratropium bromide
(a) Forced expiratory volume in one second (FEV1)
(c) Budesonide (d) Terbutaline
(b) Forced vital capacity (FVC)
(c) Total lung capacity (TLC) 59. A 10 year old child suffers from exercise
(d) Peak expiratory flow rate (PEFR) induced asthma: Which is the most suit-
(e) Residual volume (RV) able first line drug for regular prophy-
lactic therapy ?
53. In a patient of bronchial asthma, inhaled
(a) Oral salbutamol
salbutamol produces the following
effect(s). (b) Oral theophylline
(c) Inhaled sodium cromoglycate
(a) Inhibits antigen-antibody reaction in the lungs
(d) Inhaled beclomethasone dipropionate
(b) Causes bronchodilatation
(c) Reduces bronchial hyperreactivity 60. Which of the following drugs is neither
(d) Both (b) and (c) bronchodilator nor anti-inflammatory,
but has antihistaminic and mast cell
54. Select the correct statement about salmeterol. stabilizing activity ?
(a) It is a long acting selective β2 agonist bron- (a) Sodium cromoglycate
chodilator
(b) Ketotifen
140 MCQs IN PHARMACOLOGY
ANSWERS
1. c 2. a 3. a 4. a 5. d 6. e
7. a 8. c 9. c 10. b 11. a 12. d
13. a 14. e 15. c 16. a 17. d 18. d
19. a 20. d 21. b 22. d 23. c 24. b
25. b 26. d 27. b 28. d 29. a 30. c
31. c 32. b 33. b 34. d 35. a 36. b
37. b 38. d 39. b 40. b 41. b 42. b
43. c 44. b 45. a 46. c 47. e 48. d
49. a 50. c 51. b 52. d 53. b 54. a
55. d 56. d 57. a 58. a 59. c 60. b
61. d 62. c 63. b 64. c 65. c 66. b
67. d 68. c 69. b 70. c 71. b 72. b
73. b
6. Which of the following statements about (a) Methylation of binding sites on the 50S
vancomycin is accurate? ribosomal subunit
(a) It is bacteriostatic (b) Formation of esterases that hydrolyze the
lactone ring
(b) It binds to PBPs
(c) Increased activity of efflux mechanisms
(c) It is not susceptible to penicillinase
(d) Formation of drug-inactivating acetyltran-
(d) It has the advantage of oral bioavailability
ferases
(e) Staphylococcal enterocolitis occurs
(e) Decreased drug permeability of the
commonly with its use
cytoplasmic membrane
7. Which one of the following statements
11. The appearance of markedly vacuolated,
about ampicillin is false?
nucleated red cells in the marrow, anemia,
(a) Its activity is enhanced by sulbactam and reticulocytopenia are characteristic
(b) It causes maculopapular rashes dose-dependent side effects of
(c) It is the drug of choice for Listeria mono- (a) Azithromycin (b) Chloramphenicol
cytogenes infection (c) Clindamycin (d) Doxycycline
(d) It eradicates most strains of MRSA (e) Linezolid
(e) Pseudomembranous colitis may occur with
its use 12. In a patient with culture-positive entero-
coccal endocarditis who has failed to
8. The mechanism of antibacterial action of respond to vancomycin because of
tetracycline involves resistance, the treatment most likely to
(a) Binding to a component of the 50S ribosomal be effective is
subunit (a) Clarithromycin (b) Erythromycin
(b) Inhibition of translocase activity (c) Linezolid (d) Minocycline
(c) Blockade of binding of aminoacyl – tRNA to (e) Ticarcillin
bacterial ribosomes
13. All of the following factors may increase
(d) Selective inhibition of ribosomal peptidyl the risk of nephrotoxicity from gentamicin
transferases therapy except
(e) Inhibition of DNA–dependent RNA
(a) age over 70 years
polymerase
(b) prolonged courses of gentamicin therapy
9. Clarithromycin and erythromycin have very (c) concurrent amphotericin B therapy
similar spectrums of antimicrobial activity. (d) trough gentamicin levels below 2 mg/ml
The major advantage of clarithromytcin is
(e) concurrent cisplatin therapy
that it
14. Which one of the following antibiotics is
(a) Eradicates mycoplasmal infections in a single
likely to be most effective agent in the
dose
treatment of an infection due to enterococci
(b) Is active against strains of streptococci that if used in conjuction with penicillin G?
are resistant to erythromycin
(a) Amikacin (b) Gentamicin
(c) Is more active against Mycobacterium avium
(c) Netilmicin (d) Streptomycin
complex
(e) Tobramycin
(d) Does not inhibit live drug-metabolizing enzymes
(e) Acts on methicillin-resistant strains of 15. Regarding the antibacterial action of
staphylococci gentamicin, which one of the following
statements is most accurate?
10. The primary mechanism underlying the
(a) Efficacy is directly proportionate to the time
resistance of gram-positive organisms to that the plasma level of the drug is greater
macrolide antibiotics is than the minimal inhibitory concentration
ANTIBIOTICS 145
(b) The antibacterial action of gentamicin is not (d) It is often less toxic than conventional
concentration - dependent (multiple)dosing regimens
(c) Gentamicin continues to exert antibacterial (e) Under-dosing is less of a problem
effects even after plasma levels decrease
below detectable levels 21. Regarding the recently introduced lipid
formulation of amphotericin B, which one
(d) Antibacterial activity is often reduced by the
of the following statements is accurate?
presence of an inhibitor of cell wall synthesis
(e) The antibacterial action of gentamicin is time (a) Affinity of amphotericin B for these lipids is
– dependent greater than affinity for ergosterol
(b) They are less expensive to use than conventional
16. Which one of the following drugs is most amphotericin B
likely to be effective against multidrug –
(c) They are more effective in fungal infections
resistant strains of M tuberculosis,
because they increase tissue uptake of
including those resistant to streptomycin?
amphotericin B
(a) Amikacin (b) Clarithromycin
(d) They may decrease nephrotoxicity of
(c) Gentamicin (d) Meropenem amphotericin B
(e) Spectinomycin (e) They have wider spectrums of antifungal
17. Sterptomycin has no useful activity in the activity than conventional formulations of
treatment of amphotericin B
(a) Bubonic plague (b) Brucellosis 22. Which one of the following antimicrobial
(c) Lyme disease (d) Tuberculosis drugs does not require supplementation
(e) Tularemia of dosage following hemodialysis?
(a) Ampicillin (b) Cefazolin
18. Your 23-year-old female patient is
pregnant and has gonorrhea. The past (c) Ganciclovir (d) Tobramycin
medical history includes anaphylaxis (e) Vancomycin
following exposure to amoxicillin. 23. The persistent suppression of bacterial
Worried about compliance, you would like
growth that may occur following limited
to treat this patient with a singly dose, so
exposure to some antimicrobial drugs is
you chose
called
(a) Cefixime (b) Ceftriaxone
(a) Time-dependent killing
(c) Ciprofloxacin (d) Spectinomycin
(b) The post antibiotic effect
(e) Tetracycline
(c) Clinical synergy
19. In the empiric treatment of severe bacterial (d) Concentration – dependent killing
infections of unidentified entiology, this (e) Sequential blockade
drug, often used in combination with an
aminoglycoside, provides coverage against 24. In which of the following groups do all four
many staphylococci drugs warrant careful monitoring for drug-
related seizures in high-risk patients?
(a) Amoxicillin (b) Clavulanic acid
(c) Erythromycin (d) Nafcillin (a) Penicillin G, imipenem, amphotericin B,
(e) Tetracycline metronidazol
(b) Penicillin G, chlormphenicol, tetracycline,
20. Which one of the following statements vancomycin
about “one daily” dosing with aminogly-
(c) Imipenem, tetracycline, vancomycin,
cosides is false ?
sulfadiazine
(a) It is convenient for outpatient therapy (d) Cycloserine, metronidazole, vancomycin,
(b) Adjustment of dosage is less important in sulfadiazine
renal insufficiency (e) Metronidazole, imipenem, doxycycline,
(c) Less nursing time is required erythromycin
146 MCQs IN PHARMACOLOGY
25. Which one of the following antibiotics is a and a Gram stain reveals many white
potent inducer of hepatic drug-metabolizing cells but no organisms. Since this patient
enzymes? appears to have atypical pneumonia. You
(a) Ciprofloxacin (b) Cyclosporine should initiate treatment with
(c) Erythromycin (d) Rifampin (a) Cefazolin (b) Clindamycin
(e) Tetracycline (c) Erythromycin (d) Gentamicin
(e) Trovafloxacin
26. Beta – lactamase production by strains
of Haemophilus influenzae, Moraxella 30. Chloramphenicol is particularly effective
catarrhalis, and Neissera gonorrhoeae in the treatment of
confers resistance against penicillin G. (a) Diphtheria (b) Tuberculosis
which one of the following antibiotics is (c) Emphysema (d) Rickettsial diseases
most likely to be effective against all (e) Streptomyces pyogenes infections
strains of each of the above organisms?
31. An advantage of bleomycin over most
(a) Ampicillin (b) Ceftriaxone
antineoplastic drugs is its
(c) Clindamycin (d) Gentamicin
(a) Rapid onset of action
(e) Piperacillin
(b) Lack of toxicity to all normal cells
27. A 19-year-old woman with recurrent (c) Relative lack of bone marrow toxicity
sinusitis has been treated with different (d) Very broad spectrum of activity
antibiotics on several occasions. During
(e) Both (a) and (b)
the course of one such treatment she
developed a severe diarrhea and was 32. The drug of choice for scarlet fever is
hospitalized. Sigmoidoscopy revealed (a) Tetracycline (b) Sulfonamides
colitis, and pseudomembranes, were (c) Penicillin (d) Chloromycetin
confirmed histologically. Which of the
(e) Novobiocin
following drugs, administered orally, is
most likely to be effective in the treatment 33. An advantge of betamethasone acetate
of colitis due to C difficile? over betamethasone sodium phosphate
is
(a) Ampicillin (b) Cefazolin
(c) Clindamycin (d) Metonidazole (a) Fewer allergic reactions
(e) Tetracycline (b) Prompter action
(c) More sustained action
28. Bleomycin is used in most effective drug
(d) Greater solubility
combination regiment for the chemother-
(e) There is no advantage
apy of testicular carcinoma. Which one
of the following statements about the 34. Cyclosporine is used for
drug is accurate? (a) Allergies
(a) Acts mainly in the M phase of the cell cycle (b) Angina
(b) Derived from the bark of yew trees (c) Prevention of transplant rejection
(c) Myelosuppression is dose-limiting (d) Steroid deficiency
(d) Peripheral neuropathy occurs in more than (e) Treating led poisoning
50% of patients
35. The plasma half life of pencillin-G is
(e) Pulmonary infiltrates and fibrosis may occur longer in the new born because their
29. A high school student presents with head- (a) Plasma protein level is low
ache, fever, and cough of 2 day’s dura- (b) Drug metabolizing enzymes are immature
tion. Sputum is scant and nonpurulent
ANTIBIOTICS 147
47. What is break point concentration of an 52. Adverse effects of ciprofloxacin are
antibiotic ? referable primarily to the following except
(a) Concentration at which the antibiotic lyses the (a) Gastrointestinal tract
bacteria (b) Kidney
(b) Concentration of the antibiotic which demarks (c) Skin
between sensitive and resistant bacteria (d) Nervous system
(c) Concentration of the antibiotic which 53. A single oral dose of the following drug
overcomes bacterial resistance can cure most cases of uncomplicated
(d) Concentration at which a bacteriostatic antibiotic gonorrhoea
becomes bactericidal (a) Ciprofloxacin (b) Cotrimoxazole
48. Which type of antimicrobial drug (c) Spectinomycin (d) Doxycycline
combination is most likely to exhibit 54. Which fluoroquinolone has markedly
antagonism ? enhanced activity against gram positive
(a) Bactericidal + Bactericidal bacteria and anaerobes ?
(b) Bactericidal + Bacteriostatic for a highly (a) Pefloxacin (b) Ciprofloxacin
sensitive organism (c) Sparfloxacin (d) Norfloxacin
(c) Bactericidal + Bacteriostatic for a marginally
55. A woman has an upper respiratory in-
sensitive organism fection. Six years ago, she experienced
(d) Bacteriostatic + Bacteriostatic an episode of bronchospasm follwing
penicillin V therapy. The cultures now
49. Indicate the sulfonamide whose sodium
reveal a strain of streptococcus pneumo-
salt yields a nearly neutral solution which
niae that is sensitive to all of the follow-
is suitable for topical use in the eye ing drugs. Which of these drugs would
(a) Sulfadiazine (b) Sulfacetamide be the best choice for this patient?
(c) Sulfamerazine (d) Sulfamethizole (a) Amoxicillin/clavulanate
(b) Erythromycin
50. Sulfamethoxypyridazine and other
related long acting sulfonamides have (c) Ampicillin
now gone into disuse because (d) cefaclor
(e) Cyclacillin
(a) They have produced serious cutaneous
reactions 56. Important microbiological features of
(b) They have produced high incidence of ciprofloxacin include the following except
crystalluria (a) Long postantibiotic effect
(c) They interact with many drugs (b) Marked suppression of intestinal anaerobes
(d) They do not penetrate blood-brain barrier (c) MBC values close to MIC values
(d) Slow development of resistance
51. Which of the following is not true of
sulfonamides ? 57. Currently the drug of choice for emperic
(a) They are primarily metabolized by acetylation treatment of typhoid fever is
(b) They are more likely to produce crystalluria (a) Chloramphenicol (b) Cotrimoxaxole
in alkaline urine in which they are less soluble (c) Ciprofloxacin (d) Ampicillin
(c) They may exert bactericidal action in the 58. In the treatment of typhoid fever, ciprof-
urinary tract loxacin has the following advantage(s)
(d) Used alone, they have become therapeutically (a) It is effective in nearly all cases
unreliable for serious infections (b) Early abetment of fever and other symptoms
ANTIBIOTICS 149
(c) Development of carrier state is less likely (d) All natural and semisynthetic penicillins are
(d) All of the above contraindicated for him
59. Penicillins interfere with bacterial cell wall 64. The most important reason for highly
synthesis by restricted use of penicillin G injections in
present day therapeutics is its
(a) Inhibiting synthesis of N-acetyl muramic acid
pentapeptide (a) Narrow spectrum of activity
(b) Inhibiting conjugation between N-acetyl (b) Potential to cause hypersensitivity reaction
muramic acid and N-acetyl glucosamine (c) Short duration of action
(c) Inhibiting transpeptidases and carboxy (d) Neurotoxicity
peptidases which cross link the peptidoglycan
65. Benzathine penicillin injected once every
residues
4 weeks for 5 years or more is the drug
(d) Counterfeiting for D-alanine in the bacterial of choice for
cell wall
(a) Agranulocytosis patients
60. All of the following drugs are suitable oral (b) Prophylaxis of bacterial endocarditis in
therapy for a lower urinary tract infection patients with valvular defects
due to Pseudomonas aeruginosa except (c) Prophylaxis of rheumatic fever
(a) Norfloxacin (d) Treatment of anthrax
(b) Trimethoprim-sulfamethxazole
66. Which of the following is not a semisyn-
(c) Ciprofloxacin
thetic penicillin ?
(d) Carbenicillin
(a) Procaine penicillin(b) Ampicillin
(e) Methenamine mandelate
(c) Cloxacillin (d) Carbenicillin
61. Gram negative organisms are largely
insensitive to benzyl penicillin because 67. Cloxacillin is indicated in infections
caused by the following organism(s)
(a) They produce large quantities of penicillinase
(a) Staphylococci (b) Streptococci
(b) They do not utilize D-alanine whose
(c) Gonococci (d) All of the above
incorporation in the cell wall is inhibited by
benzyl penicillin 68. The most frequent side effect of oral
(c) Benzyl penicillin is not able to penetrate ampicillin is
deeper into the lipoprotein-peptidoglycan (a) Nausea and vomiting
multiplayer cell wall of gram-negative
(b) Loose motions
bacteria
(c) Constipation
(d) Both (a) and (b)
(d) Urticaria
62. The penicillin G preparation with the
longest duration of action is 69. Amoxicillin is inferior to ampicillin for the
treatment of the following infection
(a) Benzathine penicillin
(a) Typhoid
(b) Sodium penicillin
(b) Shigella enteritis
(c) Potassium penicillin
(c) Subacute bacterial endocarditis
(d) Procaine penicillin
(d) Gonorrhoea
63. If a patient gives history of urticaria, itching
and swelling of lips following injection of 70. Piperacillin differs from carbenicillin in the
penicillin G, then following respect(s)
(a) He will develop similar reaction whenever (a) It is more active against pseudomonas
aeruginosa
penicillin is injected
(b) It is active against Klebsiella also
(b) He can be given ampicillin safely
(c) It is acid resistant
(c) He can be given oral phenoxymethyl
penicillin safely (d) Both (a) and (b)
150 MCQs IN PHARMACOLOGY
71. Clavulanic acid is combined with (c) They bind to 50S ribosomes and interfere
amoxicillin because with translocation of the growing peptide
chain in the bacteria
(a) It kills bacteria that are not killed by-moxicillin
(d) They interfere with DNA mediated RNA
(b) It reduces renal clearance of amoxicillin
synthesis in bacteria
(c) It counteracts the adverse effects of
amoxicillin 77. Select the most potent tetracycline
(d) It inhibits beta lactamases that destroy antibiotic
amoxicillin (a) Demeclocycline (b) Methacycline
72. Amoxicillin + Clavulanic acid is active (c) Minocycline (d) Doxycycline
against the following organism except 78. An 8-year-old child presented with
(a) Methicillin resistant Staph. aureus brownish discoloured and deformed
(b) Penicillinase producing Staph. aureus anterior teeth. History of having received
an antibiotic about 4 years earlier was
(c) Penicillinase producing n. gonorrhoeae
obtained. Which antibiotic could be
(d) β-lactamase producing E. coli responsible for the condition ?
73. A woman’s neglected hangnail has (a) Chloramphenicol (b) Tetracycline
developed into a mild staphylococcal (c) Erythromycin (d) Genetamicin
cellulites. Which of the following regimens
would be appropriate oral therapy? 79. The most suitable tetracycline for use in
a patient with impaired renal function is
(a) Dicloxacillin 125 mg q6h
(a) Chlortetracycline (b) Demeclocycline
(b) Vancomycin 250 mg q6h
(c) oxytetracycine (d) Doxycycline
(c) Methicillin 500 mg q6h
(d) Cefazolin 1 g q8h 80. Compared to older tetracyclines, doxycycline
produces a lower incidence of superinfection
(e) Penicillin V 500 mg q6h
diarrhoea because
74. Cefotaxime has the following properties (a) It is completely absorbed in the small
except intestines so that drug concentration in the
(a) It is highly active against aerobic gram colonic contents is low
negative bacteria (b) It is inactivated by the gut microflora
(b) It is the most active cephalosporin against (c) It is not active against the microbes of the
Pseudomonas aeruginosa normal gut flora
(c) It produces an active metabolite (d) It is a potent tetracycline and inhibits the
(d) It has achieved high cure rates in serious superinfection causing microbes as well
hospital acquired infections 81. Tetracyclines are still the first choice drugs
75. Select the fourth generation cephalospor- for the following disease.
in among the following (a) Granuloma linguinale
(a) Cefpirome (b) Ceftizoxime (b) Chancroid
(c) Ceftazidime (d) Cefuroxime (c) Syphilis
(d) Gonorrhoea in patients allergic to penicillin
76. The most important mechanism by which
tetracycline antibiotics exert antiimicrobial 82. Chloramphenicol is more active than
action is tetracyclines against
(a) They chelate Ca2+ ions and alter permeability (a) Bateroides fragilis
of bacterial cell membrane (b) Treponema pallidum
(b) They bind to 30S ribosomes and inhibit (c) Streptococci
bacterial protein synthesis (d) Staphylococci
ANTIBIOTICS 151
83. Which out of the following antibiotics 89. The most important mechanism of bacterial
penetrates blood-CSF barrier the best resistance to an aminoglycoside antibiotic
(a) Erythromycin (b) Gentamicin is
(c) Tetracycline (d) Chloramphenicol (a) Plasmid mediated acquisition of aminogly-
coside conjugating enzyme
84. The most important mechanism by which
gram negative bacilli acquire chloram- (b) Mutational acquisition of aminoglycoside
phenicol resistance is hydrolyzing enzyme
(a) Decreased permeability into the bacterial cell (c) Mutation reducing affinity of ribosomal
protein for the antibiotic
(b) Acquisition of a plasmid encoded for
chloramphenicol acetyl transferase (d) Mutational loss of porin channels
(c) Lowered affinity of the bacterial ribosome 90. Which toxic effect of aminoglycoside
for chloramphenicol antibiotics is most irreversible in nature ?
(d) Switching over from ribosomal to
(a) Vestibular damage
mitochondrial protein synthesis
(b) Hearing loss
85. What is the most important reason for
(c) Neuromuscular blockade
restricted clinical use of chloramphenicol ?
(d) Kidney damage
(a) Its narrow spectrum of activity
(b) Emergence of chloramphenicol resistance 91. Streptomycin sulfate is not absorbed
(c) Its potential to cause bone marrow depression orally because it is
(d) Its potential to cause superinfections (a) Degraded by gastrointestinal enzymes
(b) Destroyed by gastric acid
86. Aminoglycoside antibiotics have the
following common property (c) Highly ionized at a wide range of pH values
(a) They are primarily active against gram- (d) Insoluble in water
negative bacilli 92. The aminoglycoside antibiotic which is
(b) They are more active in acidic medium distinguished by its resistance to bacterial
(c) They readily enter cells and are distributed aminoglycoside inactivating enzymes is
in total body water
(a) Kanamycin (b) Sisomicin
(d) They are nearly completely metabolized in
(c) Amikacin (d) Tobramycin
liver
93. An aminoglycoside antibiotic should not
87. Which aminoglycoside antibiotic causes
be used concurrently with the following
more hearing loss than vestibular
disturabance as toxic effect ? drug
88. Which of the following drugs has 94. All of the following statements regarding
demonstrated in vitro activity against pentamidine isethionate are true except
Mycobacterium avium-intracellular (a) it is indicated for treatment or prophylaxis of
(MAI)? infection due to Pneumocystis carinii
(a) Vancomycin (b) it may be administered intramuscularly,
(b) Clarithromycin intravenously or by inhalation
(c) Erythromycin base (c) it has no clinically significant effect on serum
(d) Troleandomycin glucose
(e) Erythromycin estolate (d) it is effective in the treatment of leishmaniasis
152 MCQs IN PHARMACOLOGY
95. Prolonged oral therapy with the following (b) M.avium complex infection in AIDS patient
antibiotic can damage intestinal villi (c) M.tuberculosis infection in a patient who
resulting in statorrhoea and loose motions develops jaundice due to first line
(a) Ampicillin (b) Tetracycline antitubercular drugs
(c) Neomycin (d) Nystatin (d) Both (a) and (b)
96. Hepatitits with cholestatic jaundice occurs 103. A 23-year-old male with a history of
most frequently as an adverse reaction to influenza A infection. An outbreak of
the following preparation of erythromycin influenza A has just been reported in
his community and he is exhibiting
(a) Erythromycin base initial symptoms of influenza A. Which
(b) Erythromycin stearate agent would be the most useful to treat
(c) Erythromycin estolate him?
(d) Erythromycin ethylsuccinate (a) Cidofovir (b) Famciclovir
97. The following antibiotic is a first line drug (c) Rimantidine (d) Foscarnet
for treatment of Mycobacterium avium (e) Ribavirin
complex infection in AIDS patients 104. Addition of clavulanic acid to amoxicillin
(a) Clindamycin (b) Clarithromycin is to
(c) Roxithromycin (d) Erythromycin (a) Decrease the renal excretion of amoxicillin
98. Roxithromycin has the following (b) Enhance the anti-bacterial activity of
advantages over erythromycin except amoxicillin
(c) Decrease the biotransformation of amoxicillin
(a) It is more effective in whooping cough
(d) To increase oral absorption of amoxicillin
(b) It causes less gastric irritation
(c) It has longer plasma half-life 105. The aminoglycoside that can be used in
(d) It is unlikely to precipitate theophylline toxicity amoebiasis is
(a) Paromomycin (b) Framycetin
99. Highest incidence of antibiotic associated
(c) Amikacin (d) Netilmicin
pseudo membranous enterocolitis has
been noted with the use of 106. Tetracyclines are avoided in pregnancy
(a) Ampicillin (b) Chloramphenicol because they can
(c) Vancomycin (d) Clindamycin (a) Cause abortions
(b) Cause excessive postpartum hemorrhage
100. The drug of choice for treatment of
(c) Affect the bones and teeth of the fetus
methicillin resistant Staphylococcus
aureus infection is (d) Cause excessive vomiting in the mother
(a) Cloxacillin (b) Vancomycin 107. Ciprofloxacin inhibits the bacterial enzyme
(c) Erythromycin (d) Amikacin (a) Transpeptidase
101. ‘Red man syndrome’ has been associated (b) DNA gyrase
with rapid intravenous injection of the (c) DNA dependent RNA polymerase
following antibiotic (d) Dihydrofolate reductase
(a) Vancomycin (b) Clindamycin 108. Erythromycin is the drug of choice in
(c) Cefoperazone (d) Piperacillin (a) Pertussis
102. Clarithromycin is used for the following (b) Gonococcal urethritis
(a) Multidrug resistant M.tuberculosis infection (c) Prophylaxis of bacterial endocarditis
(d) Chlamydial infections
ANTIBIOTICS 153
123. Drugs usually active against penicillinase 130. Penicillin was first used clinically for
producing Staphylococcus aureus include systemic infections in the year
which of the following?
(a) 1926 (b) 1935
I. Timentin (ticarcillin-clavulanate) (c) 1941 (d) 1957
II. Augmentin (amoxicillin-clavulanate)
III. Oxacillin 131. Antiviral agents that are active against
cytomegalovirus (CMV) include which of
(a) Only I is correct
the following?
(b) Only III is correct
I. Ganciclovir
(c) I and II are correct
(d) II and III are correct II. Foscarnet
(e) I, II and III are correct III. Acyclovir
(a) Only I is correct
124. Cephalosporins
(b) Only III is correct
(a) Are more vulnerable to beta–lactamase (c) I and II are correct
enzyme
(d) II and III are correct
(b) Are less vulnerable to beta–lactamase
enzyme (e) I, II and III are correct
(c) Do not possess beta lactam ring 132. Which of the following is a steroidal
(d) Have multiple beta lactam rings antibiotic
125. Which of the following antibiotics possess (a) Nalidixic acid (b) Fusidic acid
neuromuscular blocking action (c) Spectinomycin (d) Nitrofurantoin
(a) Ampicillin (b) Streptomycin 133. The antibiotic that enters brain freely is
(c) Chloramphenicol (d) Sulphonamides
(a) Tetracycline (b) Erythromycin
126. Oral neomycin and streptomycin are used (c) Chloramphenicol (d) Gentamicin
for sterlization of bowel and for dysen-
tery because 134. The tetracycline safe in renal failure is
(a) They are least absorbed from oral route (a) Digoxin (b) Furosemide
(b) The peak concentration in blood is achieved (c) Enalapril (d) Amrinone
quickly
135. The semisynthetic penicillin which is
(c) They are least toxic to G.I.T destroyed by acid is
(d) None of the above
(a) Phenoxymethyl penicillin
127. Chloramphenicol is the drug of choice in (b) Ampicillin
(a) Staphylococcal infection (c) Carbenicillin
(b) Salmonella infection (d) Coxacillin
(c) Viral infection
136. Why benzyl penicillin is ineffective in
(d) Amoebic dysentry gram negative infections ?
128. Drug of choice for ringworm infection is (a) Is destroyed by penicillinase of gram negative
(a) Griseofulvin (b) Amphotericin B organisms
(c) Nystatin (d) Neomycin (b) Gram negative organisms donot utilize D-
alanine whose incorporation is inhibited by
129. In renal failure safest tetracycline is benzyl penicillin
(a) Oxytetracycline (c) The lipoprotein – peptidoglycan cell wall of
(b) Chlortetracycline gram negative organisms prevents entry of
(c) Doxycycline penicillin
(d) Demethyl chlortetracycline (d) All of the above
ANTIBIOTICS 155
ANSWERS
1. a 2. b 3. e 4. e 5. d 6. c
7. d 8. c 9. c 10. a 11. b 12. c
13. d 14. d 15. c 16. a 17. c 18. d
19. d 20. b 21. d 22. e 23. b 24. a
25. d 26. b 27. d 28. e 29. c 30. d
31. c 32. c 33. c 34. c 35. d 36. b
37. c 38. c 39. d 40. c 41. b 42. c
43. d 44. d 45. c 46. a 47. b 48. b
49. b 50. a 51. b 52. b 53. a 54. c
55. b 56. b 57. c 58. d 59. c 60. b
61. c 62. a 63. d 64. b 65. c 66. a
67. a 68. b 69. b 70. d 71. d 72. a
73. a 74. b 75. a 76. b 77. c 78. b
79. d 80. a 81. a 82. a 83. d 84. b
85. c 86. a 87. c 88. b 89. a 90. b
91. c 92. c 93. b 94. c 95. c 96. c
97. b 98. a 99. d 100. b 101. a 102. b
103. c 104. b 105. a 106. c 107. b 108. a
109. b 110. d 111. d 112. c 113. c 114. c
115. d 116. b 117. d 118. d 119. a 120. a
121. b 122. a 123. e 124. b 125. b 126. a
127. b 128. a 129. c 130. c 131. c 132. b
133. c 134. b 135. c 136. c
is now considered very low, most clinicians 94. c Pentamidine isethionate is indicated for both
avoid the use of these agents in patients with treatment and prophylaxis of infection due to
histories of type I hypersensitivity reactions (e.g., Pneumocystis carinii. It can be administered
anaphylaxis, bronchospasm, giant hives) intramuscularly, intravenously or by inhalation.
60. b Norfloxacin, ciprofloxacin, carbenicillin and Inhalation may produce bronchospasm. Blood
methenamine mandelate achieve urine glucose should be carefully monitored because
concentrations high enough to treat urinary tract pentamidine may produce either hyperglycemia
infections due to Pseudomonas aeruginosa. or hypoglycemia.
Trimethoprim-sulfamethoxazole is not useful for 103. c Cidofovir, famciclovir and foscarnet have little
treating infections due to this organism, although or no in vivo activity agains influenza A.
the combination is useful for treating certain Ribavirin has some activity but is a second line
other urinary tract infections. agent for influenza A and is mainly indicated
73. a Although vancomycin, methicillin and cefazolin for treatment of RSV. Rimantidine is a derivative
have excellent activity against staphylococci, of amantidine with excellent activity against
they are not effective orally for systemic influenza A. it is indicated for the prophylaxis
infections. Vancomycin is prescribed orally for and treatment of influenza A viral infections.
infections limited to the gastrointestinal tract, but 117. d All are protease inhibitors, but only nelfinavir
because it is poorly absorbed orally, it is not has been shown to cross the blood-brain barrier,
effective for systemic infections. Most hospital a known reservoid for HIV viruses.
and community acquired staphylococci are 123. e Timentin and augmentin each include a β-
currently resistant to penicillinV. Thus, of the lactamase inhibitor, combined with ticarcillin
drugs listed in the question, the most appropriate and amoxicillin respectively. These combinations
drug for oral therapy of staphylococcai cellulites offer activity against Staphylococcus aureus
is dicloxacillin. similar to that of the penicillinase-resistant
88. b Clarithromycin, an alternative to erythromycin, penicillins, such as oxacillin.
has demonstrated in vitro activity against 131. c Only ganciclovir and foscarnet are active
Mycobacterium avium-intracellulare (MAI). against cytomegalovirus (CMV) infections. These
Clarithromycin is also used against Toxoplasma agents are virustatic and arrest DNA synthesis
gondii and Cryptosporidium species, and it is by inhibiting viral DNA polymerase. Although
more active than erythromycin against ganciclovir in the treatment of CMV infections
staphylococci and streptococci. Vancomycin is in the CNs has not been successful. Foscarnet
used to treat staphylococci and streptococci, but is a broad-spectrum antiviral agent and is used
has no demonstrated activity versus MAI. in patients with ganciclovir resistance. Acyclovir
Troleandomycin is similar to erythromycin but is not clinically useful for the treatment of CMV
is generally less active against these organisms. infections because CMV is relatively resistant to
acyclovir in vitro.
DRUGS USED IN GASTRO INTESTINAL TRACT DISORDERS 157
CHAPTER 9
DRUGS USED IN GASTROINTESTINAL
TRACT DISORDERS
12. Metronidazole is least likely to be effective 16. A 55-year-old woman with insulin-
in the treatment of dependent diabetes of 40 years’ duration
complains of severe bloating and abdominal
(a) Amebiasis (b) Giardiasis distress, especially after meals. Evaluation
(c) Pneumocystosis (d) Psudomembranous is consistent with diabetic gastroparesis. The
colitis drug you would be most likely to
(e) Trichomoniasis recommend is
13. Which of the following statements about (a) Docusate (b) Dopamine
non-drug therapies for acute diarrhea is (c) Loperamide (d) Metoclopramide
not correct? (e) Sucralfate
(a) Breast feeding should be continued as normal 17. A patient who must take verapamil for
(b) Even if the patient is not vomiting, food should hypertension and angina has become
be withheld for 6–12 hours severely constipated. Which of the
(c) Fluids can be given to patients who following drugs would be most suitable
experience vomiting, but small amounts of as a cathartic?
fluid should be used. (a) Aluminum hydroxide
(d) Replacement fluids mainly consist of water, (b) Diphenoxylate
sugar, potassium, sodium and bicarbonates (c) Magnesium hydroxide
14. A 2-year-old child was brought to the (d) Metoclopramide
emergency room 1 hour after ingestion of (e) Mineral oil
tablets he had managed to obtain from a
18. Your cousin is planning a three-week trip
bottle on top of the refrigerator. His
overseas and asks your advice regarding
symptoms included marked gastro-
medications for traveler’s diarrhea. A drug
intestinal distress, vomiting (with hemate-
suitable for noninfectious diarrhea is
DRUGS USED IN GASTRO INTESTINAL TRACT DISORDERS 159
20. A drug associated with the long QT 25. Which one of the following drugs has
syndrome and cardiac arrhythmias is resulted in severe hematotoxicity when
(a) Aluminum hydroxide administered to a patient being treated
with azathioprine?
(b) Cisapride
(c) Granisetron (a) Allopurinol (b) Cholestyramine
(d) Loperamide (c) Digoxin (d) Lithium
(e) Metromidazole (e) Theophyline
21. On your way to an examination you 26. Which one of the following antibodies has
experience that vulnerable feeling that the longest half-life?
an attack of diarrhea is imminent. If you (a) Black widow spider antivenin
stopped at a drugstore, you could buy (b) Botulinum antitoxin
this antidiarrheal drug without a
(c) Diphtheria antitoxin
prescription even though it is related
chemically to the strong opioid – analgesic (d) Hepatitits B immune globulin
meperidine (e) Snake bite antivenin
(a) Aluminum hydroxide 27. Hepatitis B vaccine is least likely to be
(b) Diphenoxylate recommended for prophylactic use in
(c) Loperamide (a) Dialysis patients
(d) Magnesium hydroxide (b) Intravenous drug abusers
(e) Metoclopramide (c) Newborns
22. This antibiotic is not appropriate for use (d) Raw oyster eaters
as an oral agent in the treatment of (e) Surgeons
recurrent peptic ulcer associated with
Helicobacter pylori 28. Which of the following statements
concerning traveler’s diarrhea (TD) is
(a) Amoxicillin (b) Clarithromycin
true?
(c) Metronidazole (d) Tetracycline
(a) TD can usually be avoided by not eating raw
(e) Vancomycin
vegetables, seafood or eggs when traveling
23. Which of the following statements about to third-world countries
adsorbant drugs used for diarrhea is (b) TD can be prevented by taking one dose of
true? antibiotic 1 day before a trip
160 MCQs IN PHARMACOLOGY
(c) A specific of Helicobacter pylori is the of bloating and sour bleaching after
primary pathogen responsible for TD meals. On several occasions, vomiting
(d) Phillip’s milk of magnesia is used to prevent/ has occurred after a meal. Evaluation
treat TD reveals delayed emptying of the stomach,
and you diagnose diabetic gastro paresis.
29. Dietary supplementation with DHEA is Which of the following drugs would be
best documented to have therapeutic most useful in this patient?
value in the treatment of
(a) Famotidine (b) Metoclopramide
(a) Acne (c) Misoprostol (d) Omeprazole
(b) Diabetes insipidus (e) Ondansetron
(c) Hirsutism in female patient
34. Which one of the following agents is least
(d) Postmenopausal osteoporosis
likely to protect the upper gastrointestinal
(e) Systemic lupus erythematosus tract from ulcer formation?
30. Which one of the following compounds has (a) Antacids (b) Celecoxib
been shown to have value in managing (c) Cimetidine (d) Misoprostol
symptoms of jet lag? (e) Sucralfate
(a) DHEA (b) Garlic
35. This agent is the drug of choice in severe
(c) Ginseng (d) Melatonin amebic disease and for hepatic abscess.
(e) Sassfras It is activated to toxic intermediates by
the pyruvate – ferredoxin oxidoreductase
31. A patient with Zollinger–Ellison syndrome
enzyme system present in the parasite.
has been receiving high doses of
cimetidine for 7 weeks. A frequent (a) Diloxanide furoate
adverse effect of cimetidine is (b) Emetine
(a) Agranulocytosis (c) Iodoquinol
(b) Systemic lupus erythematosus (d) Metronidazole
(c) Inhibition of hepatic metabolism of other (e) Paromomycin
drugs
36. All of the following agents are considered
(d) Antiestrogenic effects close to ideal laxatives except
(e) Hypertension (a) emollient laxatives
32. Most weak acid drugs as well as weak (b) bulk-forming laxatives
base drugs are absorbed primarily from (c) fiber
the small intestine after oral administration (d) stimulant laxatives
because
37. Which solution is used as an astringent?
(a) Both types are more ionized in the small
intestine (a) Strong iodine solution USP
(b) Bothe types are less ionized in the small (b) Aluminum acetate topical solution USP
intestine (c) Acetic acid NE
(c) The blood flow is greater in the small intestine (d) Aromatic ammonia spirit USP
than that of other parts of the gut (e) Benzalkonium chloride
(d) The surface area of the small intestine is
38. Mechanistically, which of the following
greater than other parts of the gut
drugs will decrease stomach acid secretion
(e) The small intestine has nonspecific carriers by blockade of H2 histaminic receptors?
for most drugs
(a) Pyrilamine (b) Hydroxyzine
33. A patient with a 30-year history of type (c) Cisapride (d) Omeprazole
1 diabetes comes to you with a complaint (e) Ranitidine
DRUGS USED IN GASTRO INTESTINAL TRACT DISORDERS 161
39. Lansoprazole would be effective in the 44. Which of the following statements
treatment of concerning traveler’s diarrhea (TD) is
(a) Gastroesophageal reflux disease true?
(b) Peptic ulcer disease (a) TD can usually be avoided by not eating raw
(c) Zollinger-Ellison syndrome vegetables, seafood, or eggs when traveling
to third-world countries.
(d) All of the above
(b) TD can be prevented by taking one dose of
(e) None of the above
antibiotic one day before a trip
40. All of the following statements about (c) A specie of Helicobacter pylori is the primary
stool softners are true except pathogen responsible for TD
(a) There is minimal systemic absorption (d) Phillip’s Milk of Magnesia is used to prevent
(b) the onset of action is usually 1–2 days / treat TD
(c) they are useful in patients with constipation 45. All of the following statements about
who have experienced an acute myocardial stool softeners are true except
infractioon
(a) There is minimal systemic absorption
(d) they can be taken with little or no water
(b) The onset of action is usually 1–2 days
41. All of the following statements adequately (c) They are useful in patients with constipation
describe bulk-forming laxatives except who have experienced an acute myocardial
(a) they produce a much more complete infarction
evacuation of constipation than stimulant (d) They can be taken with little or no water
products
(b) they can cause constipation if not taken with 46. Which of the following is an appropriate
water non-pharmacologic recommendation for
patients with gastroesophageal reflux
(c) they are derived from polysaccharides and
disease (GERD)?
resemble fiber (bran)in the mechanism of
action (a) Eat larger but fewer meals
(d) the onset of action is 24–72 hours (b) Avoid meals high in protein
(c) Eat evening meals at least 3 hours before
42. Which of the following statements
bed
adequately describes bulk-forming
laxatives? (d) Prop a patient’s head up with 2 pillows at
night
(a) Can cause diarrhea if not taken with water
(b) Are derived from polysaccharides and 47. Which of the following organisms has
resemble fiber (bran)in mechanism of action been implicated as a possible cause of
(c) Onset of action is in 4–8 hours chronic gastritis and peptic ulcer disease?
(d) Produce much more complete evacuation of (a) Campylobacter jejuni
constipation than stimulant products (b) Escherichia coli
43. Which of the following statements about (c) Helicobacter pylori
adsorbent drugs used for diarrhea is (d) Calymmatobacterium granulomatis
true? (e) Giardia lamblia
(a) Useful for treatment of severe diarrhea 48. A patient suffering from acute infectious
(b) Very safe because not absorbed systemically diarrhea caused by Shigella can be
(c) In general, small doses are needed to relieve managed in all of the following ways
diarrhea except
(d) Kaolin and pectin are considered to be very (a) no treatement because signs and symptoms
effective (category I)adsorbents usually resolve in 48 hours
162 MCQs IN PHARMACOLOGY
(b) use of glucose solutions (e.g., soda, apple (4) May cause dry mouth
juice)to settle the stomach and decrease the (5) Can be alternated with an antacid
number of stools mixture to control diarrhea
(c) avoiding food for at least 6 hours, then slowly
52. Aluminum hydroxide is used to treat
increasing fluid intake.
hyperphosphatemia associated with
(d) using antibiotics (e.g. Bactrim, doxycycline)
renal failure. Chronic use of aluminum
for 7 days
hydroxide may cause all of the following
49. As part of a comprehensive management conditions except
strategy to treat peptic ulcer disease, (a) Phosphate depletion
patients should be encouraged to do all (b) Calcium resorption and bone demineralization
of the following except
(c) Anorexia and constipation
(a) Decrease caffeine ingestion (d) Fluid retention
(b) Eat only bland foods
53. Which local anesthetic should be used to
(c) Stop smoking
treat symptoms of pain, itching, burning
(d) Avoid alcohol
and discomfort in patients with an
(e) Avoid the use of milk as a treatment modality established lidocaine allergy?
50. A gastric ulcer patient requires close (a) Tetracaine (b) Dibucaine
follow-up to document complete ulcer (c) Pramoxine (d) Benzocaine
healing because
54. Which of the following agents in most
(a) Perforation into the intestine is common
useful for carcinoma of the liver?
(b) Spontaneous healing of the ulcer may occur
(a) Vinblastine (b) Floxuridine (FUDR)
in 30% – 50% of cases
(c) Vincristine (d) Cytarabine (Cytosar)
(c) There is the risk of the ulcer being cancerous
(e) Mercaptopurine
(d) Symptoms tend to be chronic and recur
(e) Weight loss may be severe in gastric ulcer 55. All of the following vasoconstrictors are
patients deemed safe and effective for the temporary
relief of itching and swelling except
51. For each effect, select the agent that is
most likely associated with it (a) ephedrine 0.1% – 1.25%
(b) epinephrine 0.005% – 0.01%
(a) Sodium bicarbonate
(c) phenylpropanolamine 1% – 10%
(b) Aluminum hydroxide
(d) phenylephrine 0.25%
(c) Calcium carbonate
(d) Magnesium hydroxide 56. Bisacodyl frequently can cause
(e) Propantheline (a) Abdominal cramps
(1) May cause diarrhea (b) Constipation
(2) Cannot be used by patients with heart (c) Skin rashes
failure (d) Dizziness
(3) Use with milk and an alkaline substance (e) Nauseas
can cause milk-alkali syndrome
DRUGS USED IN GASTRO INTESTINAL TRACT DISORDERS 163
ANSWERS
1. c 2. c 3. b 4. b 5. e 6. d
7. a 8. d 9. e 10. b 11. d 12. c
13. b 14. d 15. d 16. d 17. c 18. b
19. b 20. b 21. c 22. e 23. d 24. c
25. a 26. d 27. d 28. a 29. e 30. d
31. c 32. d 33. b 34. b 35. d 36. d
37. b 38. e 39. d 40. d 41. a 42. b
43. b 44. a 45. d 46. c 47. c 48. b
49. b 50. c 51. 1.d, 2.a, 3.c, 4.e, 5.b 52. d 53. c
54. b 55. c 56. a
36. d The ideal laxative is natural and produces stool motility and increase water absorption into the
on a regular basis. The product produces stool bowel. However, patients must drink plenty of
quickly without adverse effects such as water to facilitate the absorption of water into
abdominal cramping or the formation of a hard the bowel, or they may become more constipated.
stool, which may be difficult to pass. Products 48. b Giving highly osmotic solutions of glucose can
such as fiber or bulk-forming agents produce a
result in more water absorbed into the intestinal
stool similar to a bolus of food, without adverse
tract and, thus further diarrhea. Many cases of
effects. Emollient laxatives produce soft stools
diarrhea resolve within 48 hours without treatment.
without difficult defecation. Stimulants produce
People with diarrhea can avoid food for atleast 6
a stool quickly, but patients often experience
hours, then increase their fluid intake slowly. Severe
severe abdominal cramping and hard stools.
cases of infectious diarrhea can be treated with
40. d Stool softeners are safe and do not produce
antibiotic or antiprotozoals, depending on the
any adverse systemic effects. Because stool
organism that caused the episode.
softners work as surfactants, they allow
absorption of water into the stool, which makes 53. c Due to its chemically distinct structure, promoxine
stool softer and easier to pass. These products exhibits less cross-sensitivity when compared to
are useful in patients who should avoid. the other anesthetics and should be used in
41. a Stimulant products result in a quicker, more patients with a lidocaine allergy.
complete and often more violent evacuation of 55. c Vasoconstrictors deemed safe and effective by
the bowel than do the bulk-forming agents are the FDA are ephedrine HCl 0.1% – 1.25%,
developed from complex sugars, similar to fiber, epinephrine HCl 0.005% – 0.01% and
that provide bulk to increase gastrointestinal phenylephrine HCl 0.25%.
OXYTOCICS & UTERINE MUSCLE RELAXANTS 165
CHAPTER 10
OXYTOCICS & UTERINE MUSCLE
RELAXANTS
1. A 29-year-old woman who was in her chemical analysis of the cancer reveals
41st week of gestation had been in labor the presence of estrogen and progester-
for 12 hours. Although her uterine one receptors. After this procedure, she
contractions had been strong and regular will probably receive
initially, they had diminished in force (a) Danazol (b) Flutamide
during the past hour. Which of the (c) Leuprolide (d) Mifepristone
following drugs would be administered (e) Tamoxifen
to facilitate this woman’s labor and
delivery? 5. A young woman complains of severe
abdominal pain at the time of menstruation.
(a) Dopamine (b) Leuprolide
Careful evaluation indicates the presence
(c) Oxytocin (d) Prolactin of significant endometrial deposits on the
(e) Vasopressin pelvic peritoneum. The most appropriate
therapy for this patient would be
2. Which one of the following agents is not
used in oral or implantable contraceptives? (a) Fultamide, orally
(b) Medroxyprogesterone acetate by intramuscular
(a) Clomiphene
injection
(b) Ethinyl estradiol (c) Norgestreal as an implant
(c) Mestranol (d) Oxandrolone by intramuscular injection
(d) Norethindrone (e) Raloxifene orally
(e) Norgestrel
6. Diethylstilbestrol should never be used in
3. All of the following are recognized effects pregnant women because it is associated
of combined oral contraceptives except with
(a) Breakthrough bleeding (a) Development of deep vein thrombosis in the
(b) Decreased risk of endometrial cancer pregnant woman
(c) Increased risk of ischemic stroke (b) Feminization of the external genitalia of male
offspring
(d) Increased risk of ovarian cancer
(c) Infertility and development of vaginal cancer
(e) Nausea in female offspring
4. A 50-year-old woman with a positive (d) Miscarriage
mammogram undergoes lumpectomy (e) Virilization of the external genitalia of female
and a small carcinoma is removed. Bio- offspring
166 MCQs IN PHARMACOLOGY
ANSWERS
1. c 2. a 3. d 4. e 5. b 6. c
7. e 8. d 9. c 10. b 11. b 12. d
OXYTOCICS & UTERINE MUSCLE RELAXANTS 167
CHAPTER 11
CHEMOTHERAPY
1. Twenty months after finishing her chemo- 4. A 31-year-old man has gonorrhea. He has
therapy, the woman had a relapse of breast no drug allergies, but he recalls that a few
cancer. The cancer was now unresponsive years ago while in Africa he had acute
to standard doses of chemotherapy. The hemolysis following use of an antimalarial
decision was made to treat the patient with drug. The physician is concerned that the
high-dose chemotherapy followed by au- patient has an accompanying urethritis
tologous stem cell transplantation. Which due to C trachomatis, though no cultures
or enzyme tests have been performed.
of the following drugs is most likely to be
Which of the following drugs is most likely
used to mobilize the peripheral blood stem
to be effective against gonococci and to
cells for the patient’s autologous stem cell
eradicate C trachomatis in this patient?
transplantation?
(a) Cefixime (b) Ciprofloxacin
(a) Erythropoietin (b) G – CSF
(c) Ofloxacin (d) Spectinomycin
(c) Interleukin - 11 (d) Intrinsic factor
(e) Sulfamethoxazole
(e) Thrombopoietin
5. The mechanism by which sulfasalazine
2. The combination of trimethoprim and exerts its primary action in ulcerative
sulfamethoxazole is effective against colitis is inhibition of
which one of the following opportunistic
(a) Folic acid synthesis
infections in the AIDS patient?
(b) The formation of leukotrienes and prostaglandins
(a) Disseminated herpes simplex (c) Phospholipase C
(b) Cryptococcal meningitis (d) Proton pump activity
(c) Toxoplasmosis (e) The formation of interleukind
(d) Oral cnadidiasis
6. Which one of the following adverse effects
(e) Tuberculosis
is most likely to occur with sulfonamides?
3. The top four most commonly diagnosed (a) Neurologic effects, including headache,
cancers include all of the following except dizziness, and lethargy
(a) Lung (b) Prostate (b) Hematuria
(c) Colon and rectum (d) Thyroid (c) Fanconi’s aminoaciduria syndrome
(e) Breast (d) Kernicterus in the newborn
(e) Skin reaction
168 MCQs IN PHARMACOLOGY
7. This drug is the preferred agent for teat- 12. A patient with AIDS and a CD4 cell count
ment of nocardiosis and, in combination of 100/µµL has persistent fever and weight
with pyrimethamine, is prophylactic loss associated with invasive pulmonary
against preumocystis carinii infections in disease that is due to M avium complex.
AIDS patiens. Optimal management of this patient is
(a) Ampicillin (b) Clindamycin to
(c) Norfloxacin (d) Sulfadiazine (a) Treat with rifabutin, since it prevents the
(e) Trimethoprim development of MAC bacteremia
(b) Select an antibiotic regimen based on drug
8. Supplementary folinic acid may prevent susceptibility of the cultured organism
anemia in folate-deficient persons who
(c) Start treatment with INH and pyrazinamide
use this drug; it is a weak base, and
achieves tissue levels similar to those in (d) Treat the patient with clarithromycin,
plasma ethambutol, and rifabutin
(a) Ciprofloxacin (b) Norfloxacin (e) Treat with trimethoprim – sulfamethoxazole
(c) Sulfacetamide (d) Trimethoprim 13. This drug has been used prophylactically
(e) Trovafloxacin in contacts of children with infection due to
Haemophilus influenzae type B. It is also
9. It is now recommended that trovafloxacin prophylactic in meningococcal and
be reserved for treatment of life-threatening staphylococcal carrier states. While the
infections because drug eliminates a majority of meningococci
(a) Bacterial resistance to the drug is very common from carriers, highly resistant strains may
(b) Complete liver failure has occured be selected out during treatment
(c) It is very expensive (a) Ciprofloxacin (b) Clofazimine
(d) Its use is associated with torsade de pointes (c) Dapsone (d) Rifampin
(e) Nephrotoxicity is dose-limiting (e) Streptomycin
10. The primary reason for the use of drug 14. Once–weekly administration of this
combinations in the treatment of tuberculosis antibiotic has prophylactic activity against
is to bacteremia due to M avium complex in
(a) Ensure patient compliance with the drug AIDS patients.
regimen (a) Azithromycin (b) Clarithromycin
(b) Reduce the incidence of adverse effects (c) Isoniazid (d) Kanamycin
(c) Enhance activity against metabolically (e) Rifabutin
inactive mycobacteria
(d) Delay or prevent the emergence of resistance 15. Which one of the following drugs is most
likely to cause loss of equilibrium and
(e) Provide prophylaxis against other bacterial
auditory damage?
infections
(a) Amikacin
11. The mechanism of high – level INH
(b) Ethambutol
resistance of M tuberculosis is
(c) Isonazid
(a) Formation of drug-inactivating N-acetyltrans-
(d) Para-aminosalicylic acid
ferase
(e) Rifabutin
(b) Reduced expression of the katG gene
(c) Decreased intracellular accumulation of INH 16. Chemical interactions between this drug
(d) Mutation in the inhA gene and cell membrane components can
result in the formation of pores lined by
(e) Change in the pathway of mucolic acid
hydrophilic groups present in the drug
synthesis
molecule.
CHEMOTHERAPY 169
(a) Dactinomycin (b) Griseofluvin (d) Increased activity of host cell phosphodi-
(c) Fluconazole (d) Nystatin esterases that degrade tRNA is one of the
(e) Terbinafine antiviral actions of interferons
(e) Foscarnet has no requirement for activation
17. Which one of the following statements by phosphorylation
about fluconazole is most accurate?
22. Which of the following drugs is most like-
(a) It is highly effective in treatment of aspergillosis ly to cause additive anemia and neutro-
(b) It does not penetrate the blood – brain barrier penia if administered to an AIDS patient
(c) Its oral bioavailability is less than that of taking zidovudine?
ketoconazole (a) Acyclovir (b) Amantadine
(d) It inhibits demethylation of lanosterol (c) Ganciclovir (d) Pentamidine
(e) It is potent inhibitor of hepatic drug– (e) Stavudine
metabolizing enzymes
23. The antiviral actions of this drug include
18. Which one of the following drugs is least inhibition of both RNA and DNA synthe-
likely to be effective in the treatment of sis. The drug is used for the treatment of
esophageal candidiasis, it is used by the severe respiratory syncytial virus infec-
oral route? tions in neonates.
(a) Amphotericin B (b) Clotrimazole (a) Amantadine (b) Amprenavir
(c) Fluconazole (d) Griseofulvin (c) Foscarnet (d) Ribavirin
(e) Ketoconazole (e) Ritonavir
19. Which one of the following statements 24. Regarding interferon alpha, which one
about flucytosine is accurate? of the following statements is least
(a) It is bioactivated by fungal cytosine deaminase accurate?
(b) It does not cross the blood–brain barrier (a) At the start of treatment, most patients
(c) It inhibits cytochrome P450 experience flu-like symptoms
(d) It is useful in esophageal candidiasis (b) Indications include treatment of genital warts
(e) It has a wide spectrum of antifungal activity (c) It is used in the management of hepatitis C
(d) Lamivudine interferes with its activity against
20. Which one of the following drugs is most hepatitis B
appropriate for oral use in vaginal
(e) Toxicity includes bone marrow suppression
candidiasis?
(a) Clotrimazole (b) Griseofluvin 25. Over 90% of this drug is excreted in the
urine in intact form. Because its urinary
(c) Fluconazole (d) Flucytosine
solubility is low, patients should be well
(e) Nystatin hydrated to prevent nephrotoxicity
21. Which one of the following statements (a) Acyclovir (b) Amantadine
about the mechanisms of action of (c) Indinavir (d) Zanamivir
antiviral drugs is least accurate? (e) Zidovudine
(a) The initial step in activation of famciclovir in
26. Used in the prophylaxis and treatment of
HSV-infected cells is its phosphorylation by
infection due to influenza viruses, this drug
viral thymidine kinase
facilitates clumping of mature virions and
(b) The reverse transcriptase of HIV is 30–50 their adhesion to infected cells.
times more sensitive to inhibition by indinavir
than host cell DNA polymerases (a) Amantadine (b) Efavirenz
(c) Gancicolvir inhibits viral DNA polymerase (c) Oseltamivir (d) Rimantadine
but does not cause chain termination (e) Saquinavir
170 MCQs IN PHARMACOLOGY
27. Which statement regarding phase-specific 32. A patient with AIDS has an extremely
chemotherapic agents is correct ? They high viral RNA titer. While blood is being
(a) Are most effective in one phase of the cell drawn from this patient, the syringe is
cycle accidentally dropped, contaminating the
floor, which is made of porous material.
(b) Effective in all phases of the cell cycle
The best way to deal with this is to
(c) Are only effective in G0 phase
(a) Completely replace the contaminated part
(d) Include the alkylating agents
of the floor
(e) Include the antituber antibiotics
(b) Clean the floor with soap and water
28. Infections due to gram–negative bacilli (c) Seal the room and decontaminate with
have occurred when this agent has been ethylene oxide
used as a skin antiseptic (d) Clean the floor with a 10% solution of
(a) Acetic acid household bleach
(b) Benzalkonium chloride (e) Neutralize the spill with a solution of
(c) Hexachlorophene potassium permanganate
(d) Merbromin 33. Certain anaerobic protozoan parasites
(e) Thimerosal lack mitochondria and generate energy–
rich compounds, such as acetyl–CoA, by
29. Which one of the following compounds means of enzymes present in organelles
is used topically to treat scabies and called hydrogenosomes. An important
pediculosis? enzyme involved in this process is
(a) Lindane (a) Cytochrome P450
(b) Mupirocin (b) Glycerol – 3 – phosphate oxidase
(c) Nitrofurazone (c) Hypoxanthine – guanine phosphoribosyltran-
(d) Polymyxin B ferase
(e) Silver sulfadiazine (d) Pyruvate – ferredoxin oxidoreductase
30. Methenamine salts are used as urinary (e) Thymidylate synthase
antiseptics. The reason why they lack
34. Which of the following compounds is a
systemic antibacterial action is that they
good substrate for hypoxanthine–
are
guanine phosphoribosyltransferase in
(a) Not absorbed into the systemic circulation trypanosomes (but not mammals) and is
following oral ingestion eventually converted into metabolites that
(b) Rapidly metabolized by liver drug– metabolizing are incorporated into RNA?
enzymes (a) Allopurinol
(c) Converted to formaldehyde only at low urinary (b) Alpha - difluoromethylornithine
pH (c) Glycerol
(d) Substrates for active tubular secretion (d) Mebendazole
(e) Over 90% bound to plasma proteins (e) Salicylhydroxamic acid
31. Which one of the following antiseptics 35. One chemotherapeutic strategy used to
promotes wound healing? eradicate the blood-stream form of
(a) Cetylpyridium African trypanosomes is based on the
(b) Chlorhexidine absolute dependence of the organism on
(c) Hexachlorophene (a) Cytochrome – dependent electron transfer
(d) Iodine (b) Dihydropteroate synthesis
(e) None of the above (c) Glycolysis
CHEMOTHERAPY 171
antibody that binds to TNF - a and inhibits 60. Which of the following drugs or drug
its action? groups is not useful in the prevention of
nausea and vomiting included by cancer
(a) Etanercept
chemotherapy ?
(b) Infliximab
(a) Dexamethasone (b) Dronabinol
(c) Muromonab – CD3
(c) Ketaserin (d) Ondansetron
(d) Sirolimus
(e) Phenothiazines
(e) Thalidomide
61. Passive immunization involves
56. Which one of the following agents is able
(a) Live immunogens
to suppress both B and T lymphocytes via
its inhibition of de novo synthesis of (b) Polysaccharide vaccines
purines? (c) Stimulation of antibody formation
(a) Cyclophosphamide (d) Use of antigens
(e) Use of preformed antibodies
(b) Methotrexate
(c) Mycophenolate mofetil 62. A businessman intends to travel abroad
(d) Prednisone in a geographical region where several
diseases are endemic. He would not be
(e) Tacrolimus
able to be vaccinated against
57. Which one of the following agents increases (a) Cholera
phagocytosis by macrophages in patients (b) Malaria
with chronic granulomatous disease?
(c) Meningococcal infection
(a) Aldesleukin (d) Typhoid fever
(b) Interferon - γ (e) Yellow fever
(c) Lymphocyte immune globulin
63. Which of the following is used in active
(d) Prednisone immunization of children and combines
(e) Trastuzumab bacterial toxoids with a bacterial
antigen?
58. A young woman employed as a dental
laboratory technician complains of (a) BCG (b) BSA
conjunctivitis, skin irritation, and hair loss. (c) DTP (d) ISG
On examination, she has perforation of (e) Rho(D)
the nasal septum and a “milk and roses”
64. Which of the following is a polysaccharide
complexion. These signs and symptoms
used for active immunization in patients
are most likely to be due to
with chronic cardiorespiratory ailments?
(a) Acute mercury poisoning (a) Antilymphocyte immune serum
(b) Chronic inorganic arsenic poisoning (b) BCG vaccine
(c) Chronic mercury poisoning (c) Mumps virus vaccine
(d) Excessive use of supplementary iron tablets (d) Pertussis immune globulin
(e) Lead poisoning (e) Pneumococcal vaccine
59. In the treatment of acute inorganic ar- 65. A needlestick injury is sustained by a
senic poisoning, the most likely drug to health care worker, and the blood is
be used is known to contain HBV surface antigens.
(a) Deferoxamine (b) Dimercaprol The health care worker should be given
(c) EDTA (d) Penicillamine (a) Nothing
(e) Succimer (b) Immune globulin
(c) Hepatitis B immune globulin
174 MCQs IN PHARMACOLOGY
(d) Hepatitis B vaccine 71. This agent, which is used in the chemo-
(e) Hepatitis B vaccine and hepatitis B immune therapy of Hodgkin’s lymphoma, is po-
globulin tentially leukemogenic
66. Which one of the following compounds (a) Dacarbazine (b) Doxorubicin
enhances immune function in vitro and (c) Prednisone (d) Procarbazine
in clinical trials decreases the symptoms (e) Vinblastine
of the common cold?
(a) Echinacea 72. A 54-year-old farmer has a 5-year
history of frequent, recurrent, and very
(b) Feverfew
painful kidney stones. Appropriate
(c) Garlic
chronic therapy for this man is
(d) Melatonin
(a) Furosemide
(e) Milk Thistle
(b) Hydrochlorothiazide
67. An important therapeutic or toxic effect
(c) Morphine
of loop diuretics is
(d) Spironolactone
(a) Decreased blood volume
(e) Triamterene
(b) Decreased heart rate
(c) Increased serum sodium 73. A 55-year-old executive has cardiomy-
(d) Increased total body potassium opathy and congestive heart failure. He
(e) Metabolic acidosis is being treated with diuretics. The mech-
anism of action of furosemide is best de-
68. The most appropriate drug for reversing scribed as
myasthenic crisis in a patient who is
experiencing diplopia, dysarthria, and (a) Interference with H+/HCO3 exchange
difficulty swallowing is (b) Blockade of a Na+/K+/2Cl- transporter
(a) Neostigmine (b) Pilocarpine (c) Blockade of a Na+/Cl- cotransporter
(c) Pralidoxime (d) Succinylcholine (d) Blockade of carbonic anhydrase
(e) Tubocurarine (e) Inhibition of genetic expression of DNA in
the kidney
69. In the management of patients with AIDS,
the sulfonamides are often used in 74. Which one of the following peptides is
combination with inhibitors of folate not a vasodilator?
reductase. However, such combinations
(a) Atrial natriuretic factor (ANF)
have minimal activity against
(b) Calcitonin gene-related peptide
(a) Escherichia coli
(c) Endothelin
(b) Nocardia species
(d) Substance P
(c) Pneumocystis carinii
(e) Vasoactive intestinal peptide
(d) Toxoplasma gondi
(e) Treponema pallidum 75. A young female patient using an oral
contraceptive is to be treated for pulmo-
70. Chemoprophylaxis for travelers to
geographic regions where chloroquine– nary tuberculosis. She is advised to use
resistant P falciparum is endemic is best an additional method of contraception
provided by since the efficacy of the oral agents is
commonly decreased if her drug regimen
(a) Atovaquone
includes
(b) Mefloquine
(a) Amikacin (b) Ethambutol
(c) Primaquine
(d) Pyrimethamine plus sulfadoxine (c) Isoniazid (d) Pyrazinamide
(e) Quinine (e) Rifampin
CHEMOTHERAPY 175
76. Which one of the following drugs is most (c) Increased likelihood of causing exophthalmo
likely to be effective in the treatment of during the first week of treatment
gonorrhea in this patient and safe to use? (d) Increased risk of fetal toxicity
(a) Amoxicillin - clavulanate (e) More sustained antithyroid activity when used
(b) Ceftriaxone continuously for several months
(c) Clarithromycin 82. In antiviral immunity, what directly
(d) Ofloxacin recognized and kills viral-infected cells?
(e) Tetracycline (a) Cytotoxic T cells (CTLs)
77. The rationale for combination chemother- (b) Antiviral antibodies
apy includes all of the following except (c) Interferons
(a) Biochemical enhancement of effect 83. An organ donor who is human leukocyte
(b) rescue of normal cells antigen (HLA)- matched with the recipient
(c) overcoming or preventing resistance of a graft is sought. Which individual is
(d) biochemical nullification of effect at least somewhat likely to provide a total
HLA match?
(e) cytotoxic to both resting and dividing cells
(a) A sibling of the graft recipient
78. This compound reduces the need for
(b) A parent of the graft recipient
platelet transfusions in patients undergoing
cancer chemotherapy (c) A cadaver
90. An enzyme that cleaves deoxyribonucleic 96. The efficacy rates for nonprescription
acid (DNA) at a specific site is called antifungal agents for vaginal yeast
(a) Restrictive endonuclease infections is
(b) Restrictive ribonuclease (a) 50% (b) 60%
(c) Trypsin (c) 70% (d) 80%
(d) None of the above 97. The best product to treat vulvar pruritus
91. An example of a cytokine is in a woman with a vaginal yeast infection
is
(a) Interleukin
(a) External miconazole (Monistat)
(b) Insulin
(b) External miconazole and intravaginal
(c) Gonadotropin
miconazole (Monistat-7 combination pack)
(d) Thyroxine
(c) Intravaginal tioconazole (Vagistat 1)
(e) None of the above
(d) Intravaginal butoconazole (Femstat 3)
92. A common storage condition for most
98. Which of the following patients complain-
biotechnology products after reconstitution
ing of vaginal yeast infection symptoms
is
should be referred to a physician?
(a) Room temperature
(a) If there is a history of recurrent vaginal yeast
(b) Cool place infection
(c) Warm place (b) If she is pregnant
(d) No excessive heat (c) If she is less than age 12
(e) Freezer (d) All of the above
93. What base is found in deoxyribonucleic 99. Which of the following herbs is known
acid (DNA)? to cause cancer?
(a) Cytosine
CHEMOTHERAPY 177
(a) Chaparral (b) Comfrey 104. Cisapride should not be used in combination
(c) Ma huang (d) Licorice with either fluconazole or indinavir because
(e) St. John’s wort of increased potential for
114. Procarbazine (Matulane) is used primarily 121. Which of the following is contraindicated
to treat in the presence of active tuberculosis?
CHEMOTHERAPY 179
134. The drug of choice for prophylaxis of 140. Indicate the drug which attain therapeutic
meningococcal meningitis during an antibacterial concentration in the urinary
epidemic is tract but not in other tissues
(a) Phenoxymethyl penicillin (a) Sulfasomidine (b) Piperacillin
(b) Tetracycline (c) Nitrofurantoin (d) Both (b) and (c)
(c) Rifampin
141. Acidic urine augments the antibacterial
(d) Ciprofloxacin action of the following drug
135. Trimethoprim inhibits bacteria without (a) Sulfadiazine (b) Cotrimoxazole
affecting mammalian cells because (c) Gentamicin (d) Nitrofurantoin
(a) It does not penetrate mammalian cells
142. Which of the following is not a first line
(b) It has high affinity for bacterial but low affinity
antitubercular drug ?
for mammalian dihydrofolate reductase
enzyme (a) Ciprofloxacin (b) Streptomycin
(c) It inhibits bacterial folate synthetase as well (c) Pyrazinamide (d) Ethambutol
as dihydrofolate reductase enzymes
143. The intermittently multiplying (spurter)
(d) All of the above tubercle bacilli present within caseous
136. Trimethoprim is combined with sulf- material having low oxygen tension are
amethoxazole in a ration of 1:5 to yield most susceptible to
a steady state plasma concentration ratio (a) Ethambutol (b) Rifampin
of (c) Streptomycin (d) Pyrazinamide
(a) Trimethoprin 1:Sulfamethoxazole 5
144. Occurrence of the following adverse
(b) Trimethoprin 1:Sulfamethoxazole 10 reaction absolutely contraindicates
(c) Trimethoprin 1:Sulfamethoxazole 20 further use of rifampin in the treatment
(d) Trimethoprin 1:Sulfamethoxazole 1 of tuberculosis
137. Indicate the condition in which neither (a) Respiratory syndrome
trimethoprim nor sulfamethoxazole alone (b) Cutaneous syndrome
are effective, but their combination (c) Flu syndrome
cotrimoxazole is (d) Abdominal syndrome
(a) Prostatitis
145. Which of the following chemotherapy
(b) Lymphogranuloma venereum
agents acts by intercalation?
(c) Pneumocystis carinii pneumonia
(a) Vincristine
(d) Bacillary dysentery
(b) Paclitaxel
138. Select the antimicrobial drug which is (c) Doxorubicin
used orally only for urinary tract infection
(d) Vincristine and paclitaxel
for bacterial diarrhoeas
(e) Topotecan
(a) Pefloxacin
(b) Azithromycin 146. Ethambutol is not used in children below
6 years of age because
(c) Bacampicillin
(d) Nalidixic acid (a) Young children are intolerant to ethambutol
(b) Ethambutol causes growth retardation in
139. Nalidixic acid is primarily active against
young children
(a) Cocci (c) It is difficult to detect ethambutol induced
(b) Bacilli visual impairment in young children
(c) Gram-positive bacteria (d) In young children visual toxicity of ethambutol
(d) Gram-negative bacteria is irreversible
CHEMOTHERAPY 181
147. In a patient of pulmonary tuberculosis, (d) Isoniazid + Rifampin for 6 months with
pyrazinamide is most active on the additional Pyrazinamide during the initial 2
following subpopulation of tubercle bacilli months
(a) Rapidly multiplying bacilli located on cavity
152. Corticosteroids are absolutely contrain-
walls
dicated in which of the following types
(b) Slow growing bacilli within macrophages
of tuberculosis
and at sites showing inflammatory response
(c) Intermittently multiplying bacilli within (a) Miliary (b) Meningeal
caseous material (c) Intestinal (d) Renal
(d) Dormant bacilli
153. Multi Drug Resistant (MDR) tuberculosis
148. The most important reason for using a is defined as resistance to
combination of chemotherapeutic agents
(a) Any two or more antitubercular drugs
in the treatment of tuberculosis is
(b) Isoniazid + any other antitubercular drug
(a) To obtain bactericidl effect
(c) Isoniazid + Rifampin ± any one or more
(b) To prevent developmet of resistance to the
antitubercular drugs
drugs
(c) To broaden the spectrum of activity (d) All five first line antitubercular drugs
(d) To reduce adverse effects of the drugs 154. Mycobat tuberculosis infection in a HI V
infected patient is treated with
149. Addition of pyrazinamide and ethambutol
for the first two months to the isoniazid + (a) The same antitubercular regimen as HIV
rifampin therapy of tuberculosis serves the negative patient
following purpose(s) (b) Four first line antitubercular drugs for 2
(a) Reduces the total duration of therapy to 6 months followed by a longer continuation
months phase of 7 months with rifampin + isoniazid
(b) Produces more rapid sputum conversion (c) All five first line antitubercular drugs for nine
(c) Permits reduction of rifampin dose months
(d) Both (a) and (b) (d) Clarithromycin + Ciprofloxacin + Rifabutin
150. What is true of short course DOTS(WHO) for 12 months
stategy for treatment of tuberculosis ? 155. The most important dose dependent
(a) It consists of an initial intensive phase and a toxicity of dapsone is
later continuation phase
(a) Methemoglobinemia
(b) The dose of antitubercular drugs is reduced
(b) Haemolysis
after clinical response occurs
(c) The patient himself is made responsible for (c) Hepatitis
administering antitubercular drugs (d) Dermatitis
(d) All of the above 156. The tetracycline with highest antileprotic
151. According to the currect WHO guidelines activity is
new (untreated) sputum smear positive (a) Minocylcine (b) Docycycline
cases of pulmonary tuberculosis are to
be treated with the following regimen (c) Methacycline (d) Oxytetracycline
(a) Isoniazid + Rifampin + Pyrazinamide for 6 157. Multidrug therapy with dapsone,
months rifampin and clofazimine is the treatment
(b) Isoniazid + Thiacetazone + Rifampin for 2 of choice of
months followed by isoniazid + thiacetazone (a) Multibacillary leprosy
for 6 months
(b) Paucibacillary leprosy
(c) Isoniazid + Rifampin for 6 months with
additional Pyrazinamide + Ethambutol/ (c) Dapsone resistant leprosy
Streptomycin during the initial 2 months (d) All forms of leprosy
182 MCQs IN PHARMACOLOGY
161. Choose the azole antifungal drug which 168. How do antimetabolites exert their cytotoxic
is used only topically effect?
(a) Ketoconazole (b) Fluconazole (a) Inhibiting DNA synthesis by sliding between
(c) Itraconazole (d) Econazole DNA base pairs
(b) Inhibiting RNA synthesis by sliding between
162. Fluconazole differs from ketoconazole in RNA base pairs
that
(c) Acting as false metabolites in the microtubules
(a) It is not active by the oral route (d) Acting as false substitutions in the production
(b) It is a more potent inhibitor of drug metabolizm of nucleic acids
(c) It is not effective in cryptococcal meningitis (e) Promoting microtubule assembly and
(d) It is unlikely to produce anti-androgenic side stabilization
effects
169. Antiretroviral therapy is not recommend-
163. The only antifungal drug which has some ed in asymptomatic HIV infected subjects
activity against moulds like Mucor and because of the following reason(s).
Aspergillus is
(a) All antiretroviral drugs lose efficacy after
(a) Itraconazole (b) Fluconazole some time
(c) Miconazole (d) Ketoconazole (b) Adverse effects of antiretroviral drugs
164. Iodoxuridine is indicated in compromise the quality of life of
asymptomatic subjects
(a) Herpes simplex keratitis
(c) The treated subjects may produce and
(b) Herpes zoster transmit drug resistant virus
(c) Chicken pox (d) All of the above
(d) All of the above
170. Choose the correct statement about aman-
165. Which of the following viruses is most tadine
susceptible to acyclovir ?
(a) It is an antimetabolite used for viral infections
(a) Herpes simplex type I virus
(b) It prevents penetration of the virus into the
(b) Herpes simplex type II virus host cell
CHEMOTHERAPY 183
182. The drug of choice for cerebral malaria (a) Pyrimethamine (b) Artemisinin
due to P. falciparum is (c) Primaquine (d) Mefloquine
(a) Quinine
189. All of the following chemotherapy agents
(b) Mefloquine work through affecting microtubule
(c) Chloroguanide function except
(d) Pyrimethamine + Sulfadoxine (a) Docotaxel (b) Vinblastine
183. Intravenous injection of quinine produces (c) Mitoxantrone (d) Vincristine
(a) Rise in blood pressure (e) Vinorelbine
(b) Neuromuscular block 190. Choose the correct statement(s) about
(c) Hyperglycaemia metronidazole
(d) Hypoglycaemia (a) It is a drug of choice for amoebic dysentery
184. The following is true of quinine as well as amoebic liver abscess
(b) It affords the most rapid symptom relief in
(a) It has a longer elimination half-life than
amoebi dysentery
chloroquine
(c) It is the most effective drug in eradicating
(b) It is not to be used for prophylaxis of malaria
amoebic cysts from the colon
(c) It is not active against P. vivax
(d) All of the above
(d) It should not be used along with sulfapy-
rimethamine 191. Metronidazole is used for
185. The fastest acting schizontocidal drug (a) Round worm infestation
among the following is (b) Hook worm infestation
(a) Artemether (c) Kala-azar
(b) Melfoquine (d) Giardiasis
(c) Chloroquine 192. In addition to having antiamoebic activity,
(d) Pyrimethamine tinidazole inhibits
186. Pyrimethamine + sulfadoxine should be (a) Anaerobic bacillin
used as a (b) Aerobic bacilli
(a) Clinical curative in areas with chloroquine (c) Gram-positive cocci
resistance (d) Gram-negative cocci
(b) Clinical curative in areas without chloroquine
193. Tinidazole differs from metronidazole in
resistance
that
(c) Prophylactic in areas with or without
chloroquine resistance (a) It is not active against anaerobic bacteria
(d) All of the above (b) It has a broader spectrum of activity
(c) It has a longer elimination half life
187. Which of the following antimalarial drugs
(d) It has better oral absorption
is more active against pre-and exoeryth-
rocytic stages of the malarial parasite 194. Emetine is now used only as a reserve
than against the erythrocytic stage ? drug for amoebiasis because
(a) Chloroguanide (b) Primaquine (a) It is less effective than metronidazole
(c) Pyrimethamine (d) Quinine (b) It produces a slower response than
metronidazole
188. Use of the following antimalarial drug
carrys high risk of adverse effect in (c) It has cardiotoxic potential
subjects with G-6-PD deficiency. (d) It does not clear stools of amoebic cysts
CHEMOTHERAPY 185
195. Choose the most effective drug for mild 202. Albendazole is less effective than
intestinal amoebiasis and asymptomatic mebendazole in the following helminthic
cyst passers infestation
(a) Metronidazole (b) Emetine (a) Hydatid disease (b) Trichuriasis
(c) Quiniodochlor (d) Diloxanide furoate (c) Strongyloidosis (d) Ascariasis
196. The following antiamoebic drug should 203. The following helminthic disease can be
not be used in children because of risk of treated by albendazole but not by
causing blindness mebendazole
(a) Quinidochlor (b) Diloxanide furoate (a) Hook worm infestation
(c) Tinidazole (d) Secnidazole (b) Thread worm infestation
(c) Trichuriasis
197. After treating intestinal amoebiasis with
metronidazole, a course of diloxanide (d) Neurocysticercosis
furoate is often advised to 204. Piperazine antagonizes the anthelmintic
(a) Cure any subclinical hepatic involvement action of the following drug
(b) Suppress the symbiotic intestinal flora (a) Pyrantel pamoate (b) Mebendazole
(c) Eradicate luminal cyst forming trophozoites (c) Albendazole (d) Niclosamide
(d) Both (b) and (c)
205. The following anthelmintic has been
198. The following drug is used for oral treatment found to be safe during pregnancy
of trichomonas vaginitis (a) Thialbendazole (b) Piperazine
(a) Diiodohydroxyquin (c) Albendazole (d) Pyrantel pamoate
(b) Tinidazole
206. A child has been brought with intestinal
(c) Clotrimazole
obstruction due to clumping of round
(d) Natamycin worms. Which of the following anthelm-
199. The drug of choice for Kala Azar is intics administered by intragastic tube can
relax the ascarids and relieve the obstruc-
(a) Pentamidine tion
(b) Amphotericin B
(a) Levamisole (b) Mebendazole
(c) Sodium stibogluconate
(c) Pyrantel pamoate (d) Piperazine
(d) Ketoconazole
207. Thialbendazole is rarely used now be-
200. Pentamidine + contrimoxazole is the cause
treatment of choice for the following
disease (a) It is not active against round worm and hook
worm
(a) Toxoplasmosis
(b) It produces lower cure rates in intestinal
(b) Pneumocystis carnii pneumonia helminthiasis than mebendazole or
(c) Actinomycosis albendazole
(d) Schistosomiasis (c) It needs pretreatment fasting and post
treatment purgative
201. Leishmania donovani is susceptible to
certain antifungal drugs because both (d) It frequently produces incapacitating side
fungi and Leishmania effects
(a) Utilize purine salvage pathway 208. Select the drug used in the treatment of
(b) Utilize similar glycolytic mechanisms filariasis
(c) Have similar topoisomerase II enzyme (a) Diethyl carbamazine citrate
(d) Have ergosterol in their cell membranes (b) Thialbendazole
186 MCQs IN PHARMACOLOGY
242. Which of the following are the principal 248. Sulphonamide given in late pregnancy or
organisms in superinfection? to new born can result in kernicterous
because
(a) Salmonella, shigella
(a) It stimulates synthesis of bilirubin
(b) Candida, albicans, proteus and staphylococci
(b) It displaces bilirubin from plasma protein and
(c) E. Coli, Mycobacterium tuberculosis
and results in high free bilirubin concentration
(d) None of the above
(c) It prevents the metabolism of bilirubin
243. In tuberculosis combination of antimicro- (d) It is metabolized in bilirubin
bials is used
249. Concentration of sulphonamides in C.S.F.
(a) To delay the development of drug resistance is about 40 to 80% of that in blood
(b) To reduce severity of adverse reactions because
CHEMOTHERAPY 189
(a) In C.S.F. there is no protein to bind the drug (c) Interfering with plasmodium mitochondria
(b) C.S.F. has higher protein content than the (d) By all of the above mechanisms
blood
257. Drug resistance develops
(c) C.S.F has low protein content than the blood
(a) More readily to pyrimethamine than chloroquin
(d) In C.S.F sulphonamides are quickely
destroyed (b) More readily to chloroquin than pyrimethamine
(c) In both cases resistance does not develop
250. Sulphonamides are primarily metabolized
(d) In both cases resistance develops readily
by
(a) Acetylation 258. For suppressive prophylaxis of malaria
the drug used is
(b) Glucuronidation
(c) Etheral sulphate formation (a) Pyrimethamine 25 mg. once a week
(d) None of the above (b) Pyrimethamine 250 mg. once a week
(c) Primaquine 15 mg daily for 2 days
251. In an alkaline urine sulphonamides are
(d) All of the above drug can be used
(a) Less soluble
259. For radical cure of malaria the drug of
(b) More soluble
choice is
(c) Not at all soluble
(a) Primaquine 25 mg bd. × 7 days
(d) No effect of pH on stability of sulphonamides
(b) Primaquine 15 mg once daily × 14 days
252. The risk of crystallurea by suylphonamides (c) Chloroquine 400 mg. once is a month
can be reduced by
(d) None of the above
(a) Giving more soluble sulphonamides
260. Which of the following statements
(b) Making urine alkaline
describe hemorrhagic cystitis? It
(c) Ensuring urinary volume at least 2 liters a
day (a) Is caused by excretion of tumor cell
(d) All of the above breakdown products
(b) Is associated with iforfamide or cyclophos-
253. Sulphamethizole is principally used for phamide administration
(a) Topical application (c) Is caused by the administration of mesna
(b) Systemic infection (d) Can be prevented or treated with acrolein
(c) Occular infection (e) Can be treated with G-CSF
(d) Urinary infection
261. The less common causative organism in
254. Stomatitis is characterized by all of the urinary tract infection is
following signs and symptoms except (a) E. Coli (b) Pseudomonas
(a) headache (b) erythema (c) Tubercular bacilli (d) Proteus
(c) bleeding (d) ulcerations
262. In an acute U.T.I. with alkaline urine and
(e) dryness of mouth unidentified organism, the treatment
255 In co-trimoxazole, sulphamethoxazole should begin with
and trimethoprim are in ratio of (a) Co-trimoxazole (b) Sulphonamide
(a) 2 : 1 (b) 1 : 5 (c) Nitrofurantoin (d) Mendallic acid
(c) 1 : 1 (d) 5 : 1 263. Nitrofurantion is useful only in urinary
256. Pyrimethamine and progunil act by tract infection because
(a) Interfering with parasite’s ability to digest Hb (a) It is rapidly excreted and concentrated in
urine
(b) Inhibiting dihydrofolate reductase which
converts folic acid to folinic acid (b) It is rapidly metabolized in liver which
prevents effective plasma concentration
190 MCQs IN PHARMACOLOGY
(c) It’s concentration in renal tissue is high (c) It potentiates the antitubercular effect of other
because of renal tubular reabsorption drugs
(d) It is effective against common organisms of (d) It has reduced the duration of antitubercular
U.T.I e.g. proteins, and E. Coli therapy
(e) All above reasons
270. In cell targeted suicide mode of gene
264. Hexamine mandelate is only effective in therapy for cancer the prodrug used is
U.T.I. and not in systemic infection (a) Gancyclovir (b) Acyclovir
because (c) Ara c/m (d) All of the above
(a) It is only concentrated in urine
271. Drug of choice for guinea worm infestation
(b) In urine at pH less than 5.5, it liberates active
is
antibacterials
(a) Digoxin (b) Furosemide
(c) For systemic infection dose required is too
high which is toxic (c) Enalapril (d) Amrinone
(d) Organisms in systemic infection are not 272. Which of the following can not be treated
sensitive to it with danzol ?
265. All of the following chemotherapy agents (a) Endometriosis
are vesicants except (b) Menorrhagia
(a) Doxorubicin (b) Mechlorethamine (c) Fibrocystic disease
(c) Vincristine (d) Methotrexate (d) Hirsutism
(e) Idarubicin 273. Melphalan is the drug of choice in
266. Which of the following is most effective (a) Leukemia
antitubercular drug? (b) Multiple myeloma
(a) INH (b) Thioactazone (c) Hodgkin’s disease
(c) PAS (d) Pyrazinamide (d) Osteosarcoma
267. Which of the following drugs is effective 274. Prolonged chlorpromazine therapy
against intracellular organism of tuber- results in
culosis?
(a) Osteomalacta
(a) INH (b) Streptomycin (b) Photosensitivity
(c) PAS (d) Ethambutol (c) Yellowish discolouration
268. Isoniazid may cause peripheral (d) Altered renal function
neuropathy and anaemia as its side
275. Drug of choice for actionomycosis is
effects because
(a) Penicillin (b) Tetracycline
(a) It is toxic to nerves and to R.B.C
(c) Sulfonamide (d) Dapsone
(b) It interferes with pyridoxin metabolism and
induces its defeciency 276. Match each of the following toxicities to
(c) It prevents absorption of iron and ascorbic acid the agent most likely to cause the toxicity
(d) It is a type of hypersensitivity reaction (a) Cardiotixicity (1) Vincristine
269. Rifampicin has gained significance in (b) Hypersensitivity (2) Irinotecan
antitubercular therapy because (c) Diarrhea (3) Doxorubicin
(a) It is the cheapest and effective drug (d) Pulmonary toxicity (4) Paclitaxel
(b) It is least toxic, so suitable for chronic use (e) Constipation (5) Bleomycin
CHEMOTHERAPY 191
ANSWERS
1. d 2. c 3. b 4. c 5. b 6. e
7. d 8. d 9. b 10. d 11. b 12. d
13. d 14. a 15. a 16. d 17. d 18. d
19. a 20. c 21. b 22. c 23. d 24. d
25. a 26. c 27. a 28. b 29. a 30. c
31. e 32. d 33. d 34. a 35. c 36. b
37. a 38. b 39. d 40. b 41. d 42. b
43. e 44. b 45. b 46. d 47. b 48. c
49. e 50. e 51. d 52. d 53. b 54. d
55. b 56. c 57. b 58. b 59. b 60. c
61. e 62. b 63. c 64. e 65. e 66. a
67. a 68. a 69. e 70. b 71. d 72. b
73. b 74. c 75. e 76. d 77. d 78. c
79. c 80. c 81. e 82. a 83. a 84. c
85. a 86. c 87. c 88. c 89. a 90. a
91. a 92. b 93. e 94. c 95. e 96. d
97. b 98. d 99. b 100. a 101. b 102. c
103. a 104. d 105. a 106. b 107. d 108. e
109. c 110. d 111. c 112. c 113. c 114. e
115. e 116. d 117. c 118. e 119. e 120. d
121. a 122. c 123. b 124. e 125. c 126. d
127. b 128. c 129. b 130. a 131. d 132. d
133. b 134. c 135. b 136. c 137. c 138. d
139. d 140. c 141. d 142. a 143. b 144. a
145. c 146. c 147. b 148. b 149. d 150. a
151. c 152. c 153. c 154. b 155. b 156. a
157. d 158. a 159. b 160. b 161. d 162. d
163. a 164. a 165. a 166. c 167. b 168. d
169. d 170. d 171. b 172. d 173. d 174. c
175. b 176. c 177. d 178. b 179. b 180. d
181. d 182. a 183. d 184. b 185. a 186. a
187. b 188. c 189. c 190. a 191. d 192. a
193. c 194. c 195. b 196. a 197. c 198. b
199. c 200. b 201. d 202. b 203. d 204. a
205. b 206. d 207. d 208. a 209. d 210. e
211. c 212. b 213. d 214. d 215. b 216. b
217. d 218. d 219. b 220. d 221. c 222. b
223. d 224. a 225. d 226. d 227. d 228. a
229. a 230. c 231. d 232. b 233. c 234. b
235. c 236. a 237. a 238. c 239. b 240. a
241. c 242. b 243. a 244. d 245. d 246. a
192 MCQs IN PHARMACOLOGY
Chapter 12
DRUGS USED IN ENDOCRINE
DISORDERS (HORMONES)
10. Effects of iodide salts given in large doses 15. Glucocorticoids have not been proved to
do not include be effective in the treatment of
(a) Decreased size of the thyroid gland (a) Acute lymphocytic leukemia
(b) Decreased vascularity of the thyroid gland (b) Addison’s disease
(c) Decreased hormone release (c) Asthma
(d) Decreased iodination of tyrosine (d) Chemotherapy-inhduced vomiting
(e) Increased 131I uptake (e) Osteoporosis
11. Synptoms of hypothyroidism (myxedema) 16. For patients who have been on long-term
do not include therapy with a glucocorticoid and who
now wish to discontinue the drug,
(a) Dry, puffy skin gradual tapering of the glucocorticoid is
(b) Increased appetite needed to allow recovery of
(c) Large tongue and drooping of the eyelids
(a) Depressed release of insulin from pancreatic
(d) Lethargy, sleepiness B cells
(e) Slow heart rate (b) Hematopoiesis in the bone marrow
12. When initiating thyroxine therapy for an (c) Normal osteoblast function
elderly patient with long-standing (d) The control by vasopressin of water excretion
hypothyroidism, it is important to begin (e) The hypothalamic-pituitary-adrenal system
with small doses to avoid
17. A 24-year-old woman with type 1 diabetes
(a) A flare of exophthalmos wishes to try tight control of her diabetes to
(b) Acute renal failure improve her long-term prognosis. Which of
(c) Hemolysis the following regimens is most appropriate?
(d) Overstimulation of the heart (a) Morning injections of mixed lente and
(e) Seizures ultralente insulins
13. A 46-year-old male patient has Cushing’s (b) Evening injections of mixed regular and lente
syndrome that is due to the presence of insulin
DRUGS USED IN ENDOCRINE DISORDERS (HORMONES) 195
(c) Morning and evening injections of regular (b) Has a longer half-life
insulin, supplemented by small amounts of (c) Has higher affinity for thyroid hormone
insulin at mealtimes receptors
(d) Morning injections of ultralente insulin, (d) Is faster acting
supplemented by small amounts of insulin (e) Is more likely to improve a patient’s mood
lispro at mealtimes
(e) Morning injection of semilente insulin and 23. A young woman seeks advice because she
evening injection of lente insulin had unprotected sexual intercourse 12
hours earlier. Based on her menstrual cycle,
18. Which of the following substances when she believes that conception is possible.
present in urine is the most likely positive Which of the following drugs should she
sign of pregnancy? use as a postcoital contraceptive?
(a) Thyroid-stimulating hormone (TSH) (a) Clompihene
(b) Corticotropin (b) Diethylstilbestrol plus raloxifene
(c) Human chronic gonadotropin (HCG) (c) Ethinyl estradiol combined with norethindrone
(d) Interstitial cell-stimulating hormone (ICSH) (d) Flutamide
(e) Protamine zinc insulin (PZI) (e) Letrozole plus finasteride
19. A 54-year-old obese patient with type 2 24. All of the following hormonal drugs
diabetes and a history of alcoholism possess a steroidal nucleus except
probably should not receive metformin
because it can increase his risk of (a) Ethinyl estradiol
(b) Nonethindrone
(a) A disulfiram-like reaction
(c) Liothyronine
(b) Excessive weight gain
(d) Prednisolone
(c) Hypoglycemia
(e) Fluoxymesterone
(d) Lactic acidosis
(e) Serious hepatotoxicity 25. Which one of the following statements
about hormone replacement therapy (HRT)
20. Which of the following drugs is taken regimens in menopause is accurate?
during the first part of a meal for the
purpose of delaying the absorption of (a) It commonly includes a progestin to reduce
dietary carbohydrates? the risk of endometrial cancer
(b) It has been shown in clinical trials to reduce
(a) Acarbose (b) Colestipol
migraine attacks
(c) Glipizide (d) Pioglitazone
(c) It includes steroids that induce cytochrome
(e) Repaglinide
P450
21. Which of the following drugs is most (d) It should be avoided in women with a history
likely to cause hypoglycemia when used of diabetes
as monotherapy in the treatment of type (e) It uses the same effective doses of steroids
2 diabetes? as those combined oral contraceptives
(a) Acarbose (b) Glyburide
26. Hypercoagulability and dermal vascular
(c) Metformin (d) Miglitol necrosis due to protein C deficiency is known
(e) Rosiglitazone to be an early–appearing adverse effect of
treatment with
22. In the treatment of hypothyroidism,
thyroxine is preferred over liothyronine (a) Aspirin (b) Clopidogrel
because thyroxine (c) Heparin (d) Streptokinase
(a) Can be made more easily by recombinant (e) Warfarin
DNA technology
196 MCQs IN PHARMACOLOGY
27. A 42-year-old woman requires treatment (c) Protamine zinc insulin (PZi)
for diabetes insipidus following surgical (d) Semilente insulin
removal of part of her pituitary gland. (e) Ultralente insulin
The advantage of treating this patient
with desmopressin instead of vasopressin 33. Which of the following classes of
is that desmopressin compounds stimulates the release of
(a) Causes less formation of factor VIII insulin from pancreatic β -cells?
(b) Causes less hypernatremia (a) Progestins
(c) Causes less hyperprolactinemia (b) Biguanides
(d) Is more selective for the V2 receptor subtype (c) α-Glucosidase inhibitors
(e) Provides greater relief of the excessive thirst (d) Thiourylenes
the patient experiencing (e) Sulfonylureas
28. All of the following substances are 34. Insulin preparations that contain a
endogenous tropic hormones secreted by modifying protein include
the pituitary gland except
(a) Lente insulin
(a) Somatotropin (b) Regular insulin
(b) Human Chorionic Gonadotropin (HCG) (c) Isophane insulin (NPH)
(c) Follicle-timulating hormone (FSH)
(d) Thyroid-stimulating hormone (TSH) 35. Metabolic reactions likely to be affected
by a protein–deficient diet include
(e) Corticotropin (ACTH)
(a) Glycine conjugation
29. Which of the following substances when
(b) Hydrolysis
present in urine is the most likely positive
sign of pregnancy? (c) Glucuronidation
(a) Thyroid–stimulating hormone (TSH) 36. What is the correct formula to use for
(b) Corticotropin (ACTH) calculating the free thyroxine index (FTI)?
(c) Human chorionic gonadotropin (HCG) (a) T4 × RT3 U/mean serum RT3 U
(d) Interstital cell-stimulating hormone (ICSH) (b) T3 × T3/mean serum RT3U
(e) Protamine zinc insulin (PZl) (c) T3 × RT3U/mean serum RT3U
(d) T4 × RT3U × mean serum RT3U
30. Which of the following glucocorticoids
produces the least sodium retention? (e) T3 × RT3U × mean serum RT3U
(a) Corticosone 37. Which of the following insulins can be
(b) Hydrocorticosone administered intravenously?
(c) Prednisolone (a) Regular insulin
(d) Dextramethasone (b) Isophane insulin (NPH)
(e) Fludrocortisone (c) Protamine zinc insulin (PZI)
31. Which of the following glucocorticoids (d) Semilente insulin
produces the least sodium retention? (e) Ultralente insulin
(a) Cortisone (b) Hydrocortisone 38. All of the following conditions are causes
(c) Prednisolone (d) Dexamethasone of hyperthyroidism except
(e) Fludrocortisone (a) Graves’ disease
32. Which of the following insulins can be (b) Hashimoto’s thyroiditis
administered intravenously? (c) Toxic multinodular goiter
(a) Regular insulin (d) Triiodothyronine tocicosis
(b) Isophane insulin (NPH) (e) Plummer’s disease
DRUGS USED IN ENDOCRINE DISORDERS (HORMONES) 197
(a) Thyrotropin-releasing hormone (TRH) 46. What laboratory tests are currently
(b) Thyrotropin (thyroid-stimulating hormone) recommended by the Thyroid association
to diagnose thyroid disease?
(c) Diiodothyronine (DIT)
(a) Resin triiodothyronine uptake (RT3U) and total
(d) Thyroglobulin
thyroxine (TT4)
(e) Thyroxine (T4)
(b) Thyrotropin (TSH)and free thyroxine index
41. All of the following conditions are causes (FTI)
of hypothyroidism except (c) Total thyroxine (TT4)and sensitive TSG assay
(a) Endemic goiter (d) Free T4 and sensitive TSH assay
(b) Surgical excision (e) Free T4 and RT3U
(c) Hashimoto’s thyroiditis 47. What patient population should be
(d) Goitrin-induced iodine deficiency screened for thyroid disease?
(e) Graves’s disease (a) Hospitalized patients
(b) Elderly patients with chronic disease
42. Common tests to monitor patients receiving
(c) Elderly hospitalized patients
replacement therapy for hypothyroidism
include all of the following except (d) College students
(e) Women over 20 years old
(a) Thyrotropin (TSH)stimulation test
(b) Sensitive TSH assay 48. What is the average replacement dose
of levothyroxine for an otherwise healthy
(c) Free thyroxine index (FTI)
adult?
(d) Resin triiodothyronine uptake (RT3U)
(a) 25–50 µg/day
(e) Total thyroxine (TT4)
(b) 50–100 µg/day
43. Which of the following pairs of prepara- (c) 75–150 µg/day
tions has been studies for bioequiva- (d) 100–200 µg/day
lence? (e) 200–400 µg/day
(a) Levoxyl–Thyrolar
49. In comparing levothyroxine to liothyro-
(b) Thyroglobulin - Proloid nine, which of the following statements
(c) Levothroid - Synthroid is not correct?
(d) Cytomel - Synthroid (a) Both levothyroxine and liothyronine are
(e) Desiccated thyroid–Armour thyroid naturally occurring thyroid hormones
(b) Liothyronine can be converted in the
44. The inhibition of pituitary thyrotropin
peripheral circulation to levothyroxine.
secretion iscontrolled by which of the
(c) Liothyronine is more potent than levothyroxine
following?
(d) The plasma concentration of liothyronine is
(a) Free thyroxine (T4) less than that of levothyroxine.
(b) Thyroid–releasing hormone (TRH) (e) Liothyronine has a shorter duration of action
(c) Free thyroxine index (FTI) than levothyroxine.
198 MCQs IN PHARMACOLOGY
50. Which of the values represents the lower (a) Muscle dystonia caused by triflupromazine
level of detection for the fourth generation (b) Insomnia after taking pentobarbitone
sensitive TSH assay as established by the (c) Precipitation of asthma by morphine
Thyroid Association?
(d) Gum hyperplasia caused by phenytoin
(a) 0.5–5 mlU/L
56. An immunologically mediated reaction to
(b) 1–2 mlU/L
a drug producing stereotyped symptoms
(c) 0.01–0.02 mlU/L unrelated to its pharmacodynamic actions
(d) 0.0001–0.002 mlU/L is
(e) 0.0001–0.0002 mlU/L (a) Hypersensitivity (b) Supersensitivity
51. In which of the following clinical (c) Intolerance (d) Idiosyncrasy
presentations should the sensitive TSH 57. Drugs producing allergic reactions
assay be used? generally act as
(a) Population screening for thyroid disease (a) Complete antigens
(b) Screening hospitalized patients (b) Haptenes
(c) Patients receiving thyroid replacement after (c) Antibodies
6 to 8 weeks of therapy (d) Mediators
(d) Patients who are human immunodeficiency
virus (HIV) positive 58. Which of the following allergic drug reaction
is caused by circulating antibodies ?
(e) Screening patients with psychiatric illness
(a) Serum sickness
52. Which of the following classes of com-
(b) Anaphylactic shock
pounds stimulates the release of insulin
(c) Systemic lupus erythematosus
from pancreatic β-cells?
(d) Angioedema
(a) Progestins
(b) Biguanides 59. The essential feature in drug addiction is
(c) α-Glucosides inhibitors (a) Physical dependence
(d) Thiourylenes (b) Psychological dependence
(e) Sulfonylureas (c) Both (a) and (b)
(d) Psychiatric abnormality
53. Which of the following is not an estrogenic
substance? 60. Adaptive neurophysiological changes
(a) Estradiol produced by repeated administration of
a drug, which result in the appearance
(b) Premarin
of characteristic withdrawal syndrome on
(c) Theelin discontinuation of the drug is called
(d) Follicle-stimulating hormone (a) Drug addiction
(e) Stilbesterol (b) Drug abuse
54. Propylthiouracil is useful in the treatment (c) Psychological dependence
of (d) Physical dependence
(a) Derangement toxicosis 61. What constitutes ‘drug abuse’?
(b) Hypothyroidism
(a) Physician prescribed use of penicillin G for
(c) Hypoparathyroidism the cure of viral fever
(d) Hyperthyroidism (b) Self administration of aspirin to relieve headache
(e) Thyroidits (c) Repeated self administration of morphine to
derive euphoria
55. Which of the following is an idiosyncratic
adverse drug reaction ? (d) All of the above
DRUGS USED IN ENDOCRINE DISORDERS (HORMONES) 199
62. Under physiological conditions the rate (a) Flutamide: Competitively blocks the binding
limiting enzyme in the generation of of androgens to their receptor
angiotensin II is (b) Finasteride: Inhibits 5α-reductase
(a) Renin (c) Miglitol: Inhibits α-glucosidase
(b) Angiotensin converting enzyme (d) Pioglitazone: Competitively blocks the
(c) Aminopeptidase binding of estrogens to their receptor
(d) Angiotensinase (e) Anastrazole: Inhibits aromatase
63. Angiotensin II causes rise in blood pressure 70. The most prominent action of bromocriptine
by is
(a) Direct vasoconstriction (a) Dopamine D2 agonism
(b) Releasing adrenaline from adrenal medulla (b) Dopamine D2 antagonism
(c) Increasing central sympathetic tone (c) Dopamine D1 antagonism
(d) All of the above (d) α adrenergic antagonism
64. Which of the following is a pressor peptide 71. Gynaecomastia can be treated with
that can be generated both in circulation
(a) Chlorpromazine
as well as locally in certain tissues ?
(b) Cimetidine
(a) Bradykinin (b) Angiotensin
(c) Bromocriptine
(c) Kallidin (d) Plasmin
(d) Metoclopramide
65. Angiotensin II palys a key role in the
72. Menotropins is a preparation of
following risk factor for ischaemic heart
disease (a) FSH + LH obtained from urine of menstruating
women
(a) Hypercholesterolemia
(b) LH obtained from urine of pregnant women
(b) Ventricular hypertrophy
(c) FSH + LH obtained from urine of menopausal
(c) Carbohydrate intolerance
women
(d) Cardiac arrhythmia
(d) LH obtained from serum of pregnant mare
66. Several actions of growth hormone are
exerted through the elaboration of 73. Serum TSH levels are high in most cases
of
(a) Cyclic AMP
(a) Myxoedema
(b) Cyclic GMP
(b) Grave’s disease
(c) Somatostatin
(c) Carcinoma thyroid
(d) Insulin like growth factor – 1
(d) Toxic nodular goiter
67. Somatostatin inhibits the release of
74. Adrenocorticotropic hormone is primarily
(a) Growth hormone (b) Insulin used for
(c) Thyrotropin (d) All of the above
(a) Treatment of Addison’s disease
68. For therapeutic use, growth hormone is (b) Treatment of congenital adrenal hyperplasia
obtained from (c) Treatment of autoimmune disease
(a) Recombinant DNA technique (d) Diagnosis of pituitary-adrenal axis disorders
(b) Human cadaver pituitaries
75. Which of the following compounds is
(c) Porcine pituitaries
incorrectly matched with one of its
(d) Chemical synthesis therapeutic uses?
69. Which of the following compounds is (a) Raloxifene: Advanced breast cancer
incorrectly matched with its mechanism (b) Metformin: Non-insulin dependent diabetes
of action? mellitus (NIDDM)
200 MCQs IN PHARMACOLOGY
(c) Finasteride : Benign prostatic hyperplasia I – resume carbimazole after 1 week for 2 –
(d) Propylthiouracil: Hyperthyroidism 3 months
(e) Tamoxifen : Estrogen-dependent breast (d) Propranolol + Lugol’s iodine for 2 weeks –
cancer
131
I – continue Lugol’s iodine for 2 – 3 months
76. Metabolic rate of the following organ is 82. The thyroid inhibitor which produces the
not significantly affected by thyroxine fastest response is
ANSWERS
1. a 2. b 3. c 4. a 5. d 6. e
7. b 8. d 9. b 10. e 11. b 12. d
13. d 14. e 15. e 16. e 17. d 18. c
19. d 20. a 21. b 22. b 23. c 24. c
25. a 26. e 27. d 28. b 29. c 30. d
31. d 32. a 33. e 34. c 35. a 36. a
37. a 38. b 39. d 40. e 41. e 42. a
43. c 44. a 45. b 46. d 47. e 48. c
49. b 50. d 51. c 52. e 53. d 54. d
55. b 56. a 57. b 58. a 59. b 60. d
61. c 62. a 63. d 64. b 65. b 66. d
67. d 68. a 69. d 70. a 71. c 72. c
73. a 74. d 75. a 76. a 77. c 78. d
79. b 80. d 81. c 82. b 83. d 84. c
85. c 86. b 87. b 88. c 89.d 90. c
91. d 92. a 93. a 94. b 95. d 96. a
97. d 98. d 99. d 100. b 101. a 102. a
103. b 104. c 105. c 106. b 107. b 108. d
109. c 110. c 111. b 112. b 113. b 114. c
115. b 116. a 117. a 118. d 119. b 120. c
121. d 122. b 123. b 124. b 125. d 126. c
127. d 128. a 129. c 130. a 131. b 132. a
133. b 134. a 135. a 136. a 137. d 138. d
139. d 140. e
CHAPTER 13
ANTIDIABETICS
1. Current criteria used in the diagnosis of patients neglect in rotating the insulin
diabetes mellitus (DM) include all of the injection site. This is known as
following symptoms except
(a) Lipoatrophy
(a) Fasting hyperglycemia
(b) Hypertrophic degenerative adiposity
(b) Polyuria
(c) Lipohypertrophy
(c) Polydipsia
(d) Atrophic skin lesion
(d) Tinnitus
(e) Weight loss (e) Dermatitis
2. The most useful glucose test used in moni- 5. Sulfonylureas are a primary mode of
toring diabetes mellitus (DM) therapy is therapy in the treatment of
(a) Urine monitoring (a) Insulin–dependent (type 1) diabetes mellitus
(b) Blood monitoring (DDM) patients
(c) Renal function monitoring (b) Diabetic patients experiencing severe hepatic
(d) Cardiovascular monitoring or renal dysfunction
(e) Vascular monitoring (c) Diabetic pregnant women
(d) Patient with diabetic ketoacidosis
3. Which of the following statements
concerning insulin replacement therapy (e) Non-insulin-dependent (type 2) DM patients
is most accurate?
6. Patients taking chlorpropamide should
(a) Most commercial insulin products vary little avoid products containing
with respect to time, course, and duration of
hypoglycemic activity (a) Acetaminophen (b) Ethanol
(b) Regular insulins cannot be mixed with NPH (c) Vitamin A (d) Penicillins
(isophane insulin suspension) (e) Milk products
(c) Regular insulin cannot be given intravenously
7. The standard recommended dose of gly-
(d) Counting or regulating carbohydrate con- buride is
sumption is a necessity for all diabetic pa-
tients (a) 0.5–2 mg/day
(e) Insulin therapy does not have to be monitored (b) 1.25–20mg/day
closely (c) 50–100 mg/day
4. A mass of adipose tissue that develops (d) 200 mg/day
at the injection site is usually due to the (e) 200–1000 mg/day
208 MCQs IN PHARMACOLOGY
8. Which of the following may increase the 16. The insulin preparation of choice in
insulin need of diabetics? diabetic ketoacidosis is
(a) Isoniazid (a) Regular insulin
(b) Penicillin (b) Lente insulin
(c) Glyceryl guaiacolate (c) Isophane insulin
(d) Aspirin (d) Monocomponent insulin
(e) Prednisone
17. Insulin resistance can be overcome by the
9. Excessive use of tolbutamide will lead to use of
(a) Diarrhea (a) Corticosteroids
(b) Prolonged hypoglycemia (b) Tolbutamide
(c) Tolerance to alcohol (c) Protamine
(d) Acidosis (d) Monocomponent insulin preparations
(e) Glycosuria 18. Human insulins are obtained by the
10. The insulin receptor is a following sources/methods except
(a) Ion channel regulating receptor (a) Cadaver pancreas
(b) Tyrosine protein kinase receptor (b) Proinsulin recombinant bacterial
(c) G-protein coupled receptor (c) Precursor yeast recombinant
(d) None of these (d) Enzyme modification of prok insulin
11. The duration of action of insulin–zinc 19. Compared to pork/beef insulins, the
suspension (lente insulin) is human insulins
(a) 2–4 hours (b) 8–10 hours (a) Are more potent
(c) 20–24 hours (d) 30–36 hours (b) Have a faster kinetics of absorption and
elimation
12. The most common adverse reaction to (c) Have longer biological action half-life
insulin is (d) Penetrated blood-brain barrier more
(a) Hypoglycaemia (b) Lipodystrophy efficiently
(c) Urticaria (d) Angioedema 20. The second generation sulfonylurea
13. Which of the following is a neuroglucopenic hypoglycaemics differ from the first
symptom of hypoglycaemia ? generation one in that they
(a) Sweating (b) Palpitation (a) Are more potent
(c) Tremor (d) Abnormal behavior (b) Are longer acting
(c) Do not lower blood sugar in nondiabetics
14. There is no alternative to insulin therapy subject
for
(d) Are less prone to cause hypoglycaemic
(a) All insulin dependent diabetes mellitus reaction
(IDDM) patients
(b) All noninsulin dependent diabetes mellitus 21. Metformin is preferred over phenformin
(NIDDM) patients because
(c) NIDDM patients not controlled by a (a) It is more potent
sulfonylurea drug (b) It is less liable to cause lactic acidosis
(d) NIDDM patients not controlled by a (c) It does not interfere with vitamin B 12
biguanide drug absorption
(d) It is not contraindicated in patients with
15. In a patient of diabetes mellitus maintained
kidney disease
on insulin therapy, administration of the
following drug can vitiate glycaemia 22. Sulfonylureas do not lower blood sugar
control. level in
(a) Prednisolone (b) Prazosin (a) Nondiabetics
(c) Paracetamol (d) Phenytoin (b) Noninsulin dependent diabetics
ANTIDIABETICS 209
37. The sulfonylurea with a relatively longer 43. A diabetic on oral hypoglycaemic drug
duration of action is chlorpropamide, suffered from enteric
fever and was prescribed chloramphenicol.
(a) Chlorpropamide (b) Tolbutamide
He developed severe hypoglycaemia. This
(c) Glibenclamide (d) Glipizide is because
38. Insulin (a) Chloramphenicol itself has mild hypoglycaemic
effect
(a) Release is enhance by somatostatin
(b) Chloramphenicol increases the absorption
(b) Has an identical chemical structure in all the
of chlorpropamide
species
(c) Chloramphenicol causes release of insulin
(c) Release from the pancreas occurs only in the
postprandial state (d) Chloramphenicol inhibits the metabolism of
chlorpropamide
(d) Promotes synthesis of triglycerides
44. For increasing the excretion of weakly
39. Metformin acidic drugs, urine should be made
(a) Does not cause hypoglycemia even in large (a) Alkaline
doses (b) At neutral pH
(b) Should not be combined with glipizide (c) Acidic
(c) Is contraindicated in obese NIDDM patients (d) pH does not effect the urinary excretion of
(d) Causes release of insulin from the pancreas acidic drugs
40. The agent with neglible mineralocorticold 45. Longest acting insulin is
effect is (a) Insulin zinc suspension
(a) Prednisone (b) Betamethasone (b) Isophane insulin
(c) Fludrocortisone (d) Cortisol (c) Globin zinc insulin
41. Preferred route of insulin is (d) protamine zinc insulin
ANSWERS
1. d 2. b 3. d 4. c 5. e 6. b
7. b 8. e 9. b 10. b 11. c 12. a
13. d 14. a 15. a 16. a 17. d 18. a
19. b 20. a 21. b 22. c 23. d 24. a
25. a 26. d 27. b 28. c 29. b 30. b
31. d 32. c 33. a 34. b 35. d 36. a
37. a 38. d 39. a 40. b 41. b 42. a
43. d 44. a 45. d 46. a 47. a
ANTICOAGULANTS 211
CHAPTER 14
ANTICOAGULANTS
1. Which preparation of Vitamin K should (c) They are metabolized slowly and have longer
not be injected in the new born ? duration of action
(a) Phytonadione (d) All of the above
(b) Menadione 6. Initiation of unfractionated heparin
(c) Menadione sod.diphosphate therapy for the patient in question 1
(d) Both (b) and (c) would best be achieved with
2. Unfractionated heparin binds to anti- (a) 5000-unit loading dose followed by 1000
thrombin III and inactivates clotting units/hr
factor(s). (b) 5000-unit loading dose followed by 1800
(a) Xa (b) Ixa units/hr
(c) Iia (d) All of the above (c) 8000-unit loading dose followed by 1800
(e) None of these units/hr
(d) 8000-unit loading dose followed by 1000
3. Low concentrations of heparin selectively units/hr
interfere with the following coagulation
patheay(s) 7. Which of the following can be used to
(a) Intrinsic pathway antagonize the action of heparin in case
of overdose ?
(b) Extrinsic pathway
(c) Common pathway (a) Heparin sulfate (b) Dextran sulfate
(d) Both (a) and (c) (c) Protamine sulfate (d) Ancrod
ANSWERS
1. d 2. b 3. a 4. b 5. d 6. a
7. c 8. a 9. d 10. b 11. a 12. c
13. a 14. b 15. b 16. d 17. a 18. a
19. d 20. b 21. b 22. c 23. b
effect of warfarin by eliminating bacterial flora and surgery or invasive procedures will always
thereby, producing vitamin – K deficiency. hasten the urgency of warfarin reversal. In the
23. e Pharmacists may be called on to offer advice setting of active bleeding, its clinical significance
regarding reversal of warfarin therapy or may must be demonstrated by consultation with the
be empowered using Pharmacy and patient’s physician. If the international
Therapeutics Committee or Medical Board normalized ration is >20 and the patient has
approved protocols to reverse warfarin’s effect. active bleeding that is clinically significant, the
In all instances, the pharmacist must critically pharmacist must hold drug therapy, consider the
and clinically evaluate the situations and most appropriate dose and route of vitamin-K
communicate with the physician regarding delivery and administer fresh frozen plasma to
management issue. A need for immediate replete the vitamin-Kdependent clotting factors.
ANTIHYPERLIPEDEMIC AGENTS 215
Chapter 15
ANTIHYPERLIPEDEMIC AGENTS
(a) Risk factors for coronary artery disease (a) It markedly lowers plasma triglyceride with
little effect on cholesterol level
(b) prosthetic heart valves
(b) It is used as an adjuvant to gemfibrozil for
(c) Chronic arteriovenous shunts for repeated type III hyperlipoproteinemia
haemodialysis
(c) It is not effective in diabetes associated
(d) Both (b) and (c) hypercholesterolemia
4. Select the hypocholesterolemic drug which (d) It is a competitive inhibitor of the rate limiting
interferes with intestinal absorption of bile step in cholesterol synthesis
salts and cholesterol, and secondarily 8. Select the drug which reduces cholesterol
increases cholesterol turnover in the liver synthesis in liver, increases expression of
216 MCQs IN PHARMACOLOGY
ANSWERS
1. d 2. b 3. d 4. b 5. a 6. b
7. d 8. a 9. a 10. c 11. b 12. c
13. c 14. a 15. d 16. c 17. a 18. a
19. d
ANTACIDS 217
Chapter 16
ANTACIDS
1. For healing duodenal ulcer the usual 5. Antacid combinations of magnesium and
duration of H2 blocker therapy is aluminium salts are superior to single
(a) 4 weeks component preparations because
(b) 6 weeks (a) They have rapid as well as sustained acid
(c) 8 weeks neutralizing action
(d) 12 weeks (b) They are less likely to affect gastric emptying
(c) They are less likely to alter bowel movement
2. What is true of acid control therapy with (d) All of the above
H2 blockers ?
(a) It generally heals duodenal ulcers faster than 6. In peptic ulcer, antacids are now primarily
gastric ulcers used for
(b) It checks bleeding in case of bleeding peptic (a) Prompt pain relief
ulcer (b) Ulcer healing
(c) It prevents gastroesophageal reflux (c) Preventing ulcer relapse
(d) Both (a) and (b) (d) Control of bleeding from the ulcer
3. The ‘acid neutralizing capacity’ of an 7. The following is a noncompetitive anta-
antacid is governed by gonist at the gastric jparietal cell H2
(a) The equivalent weight of the antacid receptor.
(b) The pH of 1N solution of the antacid (a) Cimetidine (b) Loxatidine
(c) The rate at which the antacid reacts with HCl (c) Roxatidine (d) Rantidine
(d) Both (a) and (c) 8. Gynaecomastia can occur as a side effect
4. An antacid with the following property of
would be desirable in the treatment of (a) Bromocriptine (b) Levodopa
peptic ulcer. (c) Famotidine (d) Cimetidine
(a) Which raises gastric pH to 4.0
9. Which histamine H2 blocker has maximum
(b) Which raises gastric pH to 7.0 inhibitory effect on microsomal cytochrome
(c) Which increases gastric motility and hastens P-450 enzyme ?
gastic emptying
(a) Cimetidine (b) Ranitidine
(d) Both (b) and (c)
(c) Roxatidine (d) Famotidine
218 MCQs IN PHARMACOLOGY
12. Ranitidine differs from cimetidine in the 18. The most efficacious drug for inhibiting
following manner. round the clock gastric acid output is
13. Eradication of H pylori along with gastric (a) Inhibition of gastric secretion
antisecretory drugs affords the following (b) Augmentation of bicarbonate buffered mucus
benefit(s). layer covering gastroduodenal mucosa
(a) Faster relief of ulcer pain (c) Increased bicarbonate secretion in gastric
juice
(b) Faster ulcer healing
(d) Increased turnover of gastric mucosal cell
(c) Reduced chance of ulcer relapse
(d) Both (b) and (c) 20. Which of the following statements is true
about misoprostol ?
14. The drugs employed for anti H pylori
therapy include the following except (a) It relieves peptic ulcer pain, but does not
promote ulcer healing
(a) Ciprofloxacin (b) Clarithromycin
(b) It heals nonsteroidal anti-inflammatory drug
(c) Tinidazole (d) Amoxicillin induced gastric ulcer not responding to H2
15. The following class of gastric antisecretory blockers
drug have primary effect on juice volume, (c) It produces fewer side effects than H2 blockers
with less marked effects on acid and (d) It is the most effective drug for preventing
pepsin content, and also reduce gastric ulcer relapse
motility
21. Sucralfate promotes healing of duodenal
(a) Histamine H2 blockers ulcer by
(b) Anticholinergics
(a) Enhancing gastric mucus and bicarbonate
(c) Proton pump inhibitors secretion
(d) Prostaglandins (b) Coating the ulcer and preventing the action
16. The following drug is an inhibitor of of acid-pepsin on ulcer base
gastric mucosal proton pump.
ANTACIDS 219
24. The preferred regimen for preventing 31. The success of oral rehydration therapy
duodenal ulcer relapse is of diarrhoea depends upon the following
process in the intestinal mucosa.
(a) Maintenance antacid regimen
(b) Maintenance H2 blocker regimen (a) Sodium pump mediated Na+ absorption
(c) On demand intermittent H2 blocker regimen (b) Glucose coupled Na+ absorption
(d) Mintenance sucralfate regimen (c) Bicarbonate coupled Na+ absorption
(d) Passive Na+ diffusion secondary to nutrient
25. Used as a laxative, liquid paraffin has absorption
the following drawbacks except
32. Saline laxatives containing magnesium
(a) It interferes with absorption of fat soluble
vitamins (a) Reduce the secretion of cholecystokinin
(b) It is unpleasant to swallow (b) Are more effective when administered on an
(c) It causes gripping empty stomach
(d) It may produce foreignbody granulomas (c) Are commonly used in the treatment in
functional constipation
26. Which of the following purgatives (d) Are safe in patients with impaired renal function
undergoes enterohepatic circulation to
produce prolonged action ? 33. Antimotility drugs are contraindicated in
(a) Docusates (b) Phenolphthalein (a) Mild traveler’s diarrhoea
(c) Castor oil (d) Lactulose (b) Acute infective diarrhoeas
(c) Ileostomy patients
27. The following laxative lowers blood
(d) Patients after anal surgery
ammonia level in hepatic encephalopathy.
(a) Bisacodyl (b) Liquid paraffin 34. Octreotide
(c) Lactulose (d) Magnesium sulfate (a) Has a short half-life of 2 minutes
(b) Is given orally three times in a day
28. Select the purgative that should not be
taken at bed time. (c) Is useful in carcinoid syndrome
(d) Increases intestinal smooth muscle
(a) Ispaghula (b) Bisacodyl
contractility
220 MCQs IN PHARMACOLOGY
ANSWERS
1. c 2. a 3. d 4. a 5. d 6. a
7. b 8. d 9. a 10. c 11. b 12. c
13. d 14. a 15. b 16. d 17. d 18. a
19. b 20. b 21. b 22. c 23. d 24. b
25. c 26. b 27. c 28. d 29. d 30. a
31. b 32. b 33. b 34. c 35. a 36. a
37. c 38. b 39. c 40. c 41. a
ANTIEMETICS 221
Chapter 17
ANTIEMETICS
(c) Blocking serotonin 5-HT3 receptor (d) Three times the molar concentration of Na+
(d) Blocking dopamine D2 receptor
16. The concentration of sodium ions in WHO
10. The most effective antiemetic for oral rehydration solution is
controlling cisplatin induced vomiting is (a) 40 m moles/L (b) 60 m moles/L
(a) Prochlorperazine (b) Ondansetron (c) 90 m moles/L (d) 110 m moles/L
(c) Metoclopramide (d) Promethazine
17. The electrolyte composition of WHO oral
11. Ondansetron is a rehydration solution is based upon that of
(a) Second generation antihistaminic (a) Enterotoxigenic E. coli diarrhea stools
(b) Drug for peptic ulcer (b) Cholera stools in adults
(c) New antiarrhythmic (c) Cholera stools in children
(d) Antiemetic for cancer chemotherapy (d) Rotavirus diarrhea stools
12. Ondansetron blocks emetogenic impulses 18. A case of acute diarrhea presents with
at the following site(s). abdominal pain, fever, mucus and blood
(a) Vagal afferents in intestines in stools and is suspected to be suffering
(b) Nucleus tractus solitarius from Shigella enteritis. What antimicrobial
(c) Chemoreceptor trigger zone treatment would be most appropriate.
(d) All of the above (a) No antimicrobial treatment
(b) Metronidazole
13. Cancer chemotherapy induced vomiting
that is not controlled by metoclopramide (c) Norfloxacin
alone can be suppressed by combining it (d) Chloramphenicol
with
19. Ordansetron
(a) Amphetamine (b) Dexamethasone
(a) Can cause extrapyramidal side effects
(c) Hyoscine (d) Cyclizine
(b) Is not effective in control of acute emesis
14. Irrespective of the type, all laxatives exert (c) Can prevent emesis due to radiation
the following action. (d) Is not absorbed orally
(a) Increase the content of solids in the faeces
20. The prokinetic effects of metoclopramide
(b) Increase the water content of faeces
can be abolished by
(c) Reduce absorption of nutrients
(a) Vagotomy (b) Atropine
(d) Increase intestinal motility
(c) Bethanechol (d) Acetylcholine
15. For optimum rehydration, the molar
concentration of glucose in ORS should be 21. The most potent drug for prevention of
motion sickness is
(a) Equal to the molar concentration of Na+
(b) Somewhat lower than molar concentration (a) Dimenhydrinate (b) Tripelenamine
of Na+ (c) Scopolamine (d) Hydroxygene
(c) Somewhat higher than the molar
concentration of Na+
ANSWERS
1. c 2. d 3. b 4. d 5. a 6. c
7. c 8. c 9. a 10. b 11. d 12. d
13. b 14. b 15. c 16. c 17. c 18. c
19. c 20. b 21. c
MATCH THE FOLLOWING 223
CHAPTER 18
MATCH THE FOLLOWING
1. Match the correct mechanism of action for (4) Sheep plasma (d) Human antihaemophyllic
the diuretic agents mentioned below: fraction
(1) Acetazolamide (a) Increases serum K+ level 4. The drug A to E are used as diuretics.
(2) Chlorthiazide (b) Competitively antagonizes Match them to their classes.
aldodsterone
(1) Osmotic diuretic (a) Spiranolactone
(3) Spiranolactone (c) Inhibits active Na+ secretion,
(2) Loop diuretic (b) Isosorbide
decreasing K+ excretion in the
distal nephron (3) Potassium sparing (c) Merasalyl theophylline
diuretic (d) Furosemide
(4) Triamterene (d) Inhibits carbonic anhydrase
(4) Organomercurial (e) Probenecid
(e) Inhibits electrolyte reabsorp-
diuretic
tion in the distal portion of the
ascending limb of the loop of 5. Pharmacologicla activity of certain well
Henle known plant drugs are listed A to E.
2. Listed are some of the commonly used Match them.
drugs. Their pharmacological actions are (1) Papaverin (a) Weak analeptic
listed in A to E, match them. (2) Camphor (b) Vasodilator
(1) Aspirin (a) Rises body temperature (3) Veratrum alkaloids (c) Antineoplastic
(2) Acetaminophen (b) Non–analgesic anti-inflam- (4) Vincristine (d) Central vasoconstrictor
matory (e) Anxiolytic
(3) Phenylbutazone (c) Non–anti-inflammator y an-
6. Listed are drugs 1 to 4. Their appropriate
algesic
antihypertensive mechanisms are given
(4) Probenacid (d) Increases of depth of res-
piration
in A to F match them.
(e) Increases fluid retention (1) Pindalol (a) Vadoilator
(2) Minoxidil (b) Angiotiensin coverting en-
3. The following are the test animals or zyme inhibitor
substances used for the biological assay (3) Captopril (c) Diuretic
of preparations listed in A to E. Match (4) Amiloride (d) Beta–blocker
them correctly.
(e) Centrally acting alpha
(1) Mice (a) Vasopressin adrenoceptor agonist
(2) Albino rats (b) Diphtheria antitoxin f) Potassium induction
(3) Guinea pigs (c) Insulin
224 MCQs IN PHARMACOLOGY
7. Symptoms for the following diseases are (4) Antitussive (d) Diphenoxylate
indicated from A to E . Match them. (e) Codeine
(1) Cushing’s syndrome (a) Hyperthyroidism 13. Match the following antiarrhythmic drugs
(2) Addison’s disease (b) Inflammatory bowel to the respective categories A to E:
(3) Grave’s disease (c) Decreased production of cortisol
(1) Acebutalol (a) Calcium channel blocker
(4) Crohn’s disease (d) Decreased production of cortisol
(2) Verapamil (b) Potassium channel blocker
(e) Increased production of cortisol
(3) Kromakalem (c) Sodium channel blocker
8. The undersirable effects of the antibiotics (4) Phenytoin (d) Beta adrenoceptor blocker
are listed in A to E. Match them. (e) Chloride channel blocker
(1) Tetracycline (a) Gray–baby syndrome 14. Match the following categories of
(2) Streptomycin (b) Discolouration of teeth antibiotics with their respective examples
(3) Chloramphenicol (c) Jaundice A to E:
(4) Rifampicin (d) Obesity (1) Narrow spectrum (a) Neomycin
9. Match the following terms with their (2) Broad - spectrum (b) Cephalsporins
respective definitions A to E: (3) Acting on cell (c) Streptomycin
membrane
(1) Achyliagestrica (a) Decrease in alkali contents
(4) Inhibiting protein (d) Cycloserine
(2) Acidosis (b) Absence of hydrochloric acid
synthesis
(3) Actinomycosis (c) A deficient disorder of adrenal
contex with anaemia, weakness, 15. Match the following penicillins with their
dyspepsia, hypotension respective categories A to E:
(4) Addision’s disease (d) A fungal disease caused by (1) Penicillin G (a) Broad spectrum
Actinomyces
(2) Penicillin V (b) Penicillinase resistant
(e) A state of psychic and physical
(3) Methicillin (c) Natural
drug dependence
(4) Ampicillin (d) Semi–synthetic
10. Match the following categories of (e) Anti–pseudomonas
Adrenocorticosteroids with their
respective examples A to E: 16. Match the following categories of
anticancer hormones with their respective
(1) Glucocorticoids (a) Aldosterone, Fludrocortisone
examples A to E:
(2) Mineral corticoids (b) Ketokonazole, Metyapone
(1) Androgens (a) Methoxyestradiol
(3) Receptor (c) Cholesterol, β-Sitosterol
(2) Gonadotropin- (b) Prednisolone
(4) Synthetic Inhibitors (d) Cortisol, Triamcinolone
releasing
(e) Mifepristone, Spironolactone
(3) Estrogens (c) Testosterone
11. Match the following anaesthetics with (4) Adrenocortrocoids (d) Goserelin
their respective nature A to E: (e) Diethylstilbestrol
(1) Coacine (a) Other anaesthetic
17. Match the following antidepressant drugs
(2) Lignocaine (b) Synthetic non-nitrogenous with their respective categories A to E:
compound
(1) Amitriptyline (a) Non-specific
(3) Propanediol (c) Inhaled anaesthetic
(2) Nizoxetin (b) Tricyclic first generation
(4) Chlorpromazine (d) Synthetic nitrogenous com-
pound (3) Caffeine (c) Tricyclic second generation
(e) Natural alkaloid (4) Isoniazid (d) Psychomotor stimulant
(e) Heterocyclic
12. Match the following antiemetic drugs with
their respective categories A to E: 18. Match the following antidiabetic drugs
with their respective categories A to E
(1) Weak agonist (a) Pentazocine
(2) Strong agonist (b) Propoxyphene (1) Phenformin (a) Long acting
(3) Antidiarrhea (c) Heroin (2) Tolbutamide (b) Rapid acting
MATCH THE FOLLOWING 225
(3) NPH Insulin (c) Intermediate acting 24. Match the following antiasthamtic drugs
(4) Protamine zinc (d) Beguanide suspension with their respective categories A to E:
insulin
(1) Ephedrine (a) Purine base bronchodilator
(e) Sulphonylurea
(2) Theophyline (b) Symathomimetic bronchodi-
19. Match the following categories of lator
antifungal drugs with their respective (3) Ipratropium bromide (c) Polypetide
examples A to E: (4) Disodium (d) Anticholinergics bronchodilator
(1) For superficial (a) Amphotericin B cromoglycate
infection (e) Anti - inflammatory
(2) Topical (b) Nystatin
(3) For systemic (c) Undercylenic acid 25. Match the following terms with their
mycoses respective meaning A to E:
(4) For vaginal (d) Grisefulvin (1) Bradicardia (a) Irritation of the mucous
candidiasis meanings membrane
(e) Nystatin
(2) Bronchitis (b) Feeble state produced by a
20. Match the following antihyperlipidemic serious disease
drugs with their respective categories A (3) Chachexia (c) Inflammation of mucous
to E: membrane
(1) Cholesteryl amine (a) Fibric acid derivative (4) Catarrh (d) Glowness of the heart beat
(2) Clofibrate (b) Bile acid sesquestrant (e) Narrowing of the bronchi
(3) Lovastation (c) VLDL secreting inhibitor
26. Match the following drugs with therir
(4) Niacin (d) Antioxidant
respective mechanisms A to E:
(e) HMGCO – A reductase
(1) Methotrexate (a) Nucleic acid derivative
21. Match the following categories of binding to viral enzymes
antimalarial drugs with their respective (2) PAS (b) Inhibitor of dihydrofolate
examples A to E: reductase
(1) Acridine dyes (a) Biguanide (3) Acyclovir (c) Competitive inhibition of PABA
(2) Cinchona alkaloid (b) Primaquine uptake
(3) Aminoquinoline (c) Quinacrine (4) Rifumpicin (d) Reversible inhibition of protein
(4) Diaminopyrimidine (d) Quinine synthesis
(e) Mepacrine (e) Inhibition of DNA dependent
RNA polymerase
22. Match the following antiseptic drugs with
their respective categories A to E: 27. Match the following cholinoceptor acting
(1) Halazone (a) Dye drugs their categories A to E:
(2) Thimerosol (b) Anionic surfactant (1) Pilocarpine (a) Nicotinic blockers
(3) Delqualinium (c) Halogen containing (2) Physostigmine (b) Cholinesterase regenerator
(4) Proflavin (d) Heavy metals
(3) Pirenzepine (c) Direct acting agonist
(e) Cationic surfactant
(4) Pralidoxine (d) Indirect acting carbamate
23. Match the following terms with their (e) Muscarinic blocker
respective meaning A to E:
28. Match the following diseases with their
(1) Aphrodisiac (a) Pain in joint
respective diagnostic tests A to E:
(2) Arrhythmia (b) Loss of power of governing
(3) Arthralgia (c) Absence of spermatozoa in the (1) Leprosy (a) Shick test
sperm (2) Scarlet Fever (b) Lepromin Test
(4) Ataxia (d) Exciting sexual desire (3) Syphilis (c) Dick test
(e) Variation from the normal (4) Typhoid (d) VDRL and Widal test
regular rhythm of the heart (e) Widal test
beat
226 MCQs IN PHARMACOLOGY
29. Match the following drugs with their (1) Astemizole (a) 500 mg
respective mechanisms of action from (2) Captopril (b) 200 mg
A to E: (3) Ascorbic acid (c) 2g
(1) Local anaesthetics (a) Blocks calcium channels (4) Cephalothin (d) 10 mg
(2) Minoxidil (b) Prevents synthesis of prothrombin (e) 100 mg
(3) Proserpine (c) Blocks neuronal sodium 35. Match the following psychoactive drugs
channels with their respective categories A to E:
(4) Warfarin (d) Vasodilation by blocking
(1) Haloperidol (a) Leukotriene
potassium channels
(2) Meprobamate (b) Antipsychotic
(e) Depletes the catecholamine
store in neurons (3) Imipramine (c) Anti - anxiety
(4) LSD (d) Anti - depressant
30. Match the following drugs of abuse with (e) Psychotogenic
their respective categories A to E:
36. Match the following sympathomimetic
(1) Scopolamine (a) Inhalant
drugs with their respective categories A
(2) Nitrous oxide (b) Marijuana
to E:
(3) Hashish (c) Hallucinogen
(1) Amphetamine (a) Dopamine
(4) Cocaine (d) Sedative hyponotic
(2) Phenylephrine (b) Indirect releaser
(e) Stimulant
(3) Dobutamine (c) Alpha–1 selective
31. Match the following enzymes inhibited by (4) Albuterol (d) Beta–1 selective
the corresponding agents A to E: (e) Beta–2 selective
(1) Acetylcholine (a) Acetazolamide
37. Given below are the ailments and the
esterase
drugs used. Match them correctly.
(2) Carbonic anhydrase (b) Methotrexate
(1) Parkinson’s disease (a) Probenecid
(3) Dihydrofoleate (c) Trimethoprim
reducatase in human (2) Glaucoma (b) Ampicillin
(4) Dihydrofoleate (d) Physostigmine (3) Gout (c) Nitroglycerin
reducatase in microbes (4) Angina (d) Pilocarpine
(e) Primethamine (e) Levo dopa
32. Match the following neurotransmitters with 38. Given below are the drugs and their
their respective localizations A to E: antagonists. Match them correctly.
(1) GABA (a) Neuromuscular junction (1) 5–HT (a) Bemegride
(2) L - Glutamate (b) Hypothalamus (2) Codeine (b) Atropine
(3) Neuropeptide (c) Substantia nigra and striatum (3) Phenobarbitone (c) Cyproheptadine
(4) Dopamine (d) Cerebral cortex (4) Muscarine (d) Naloxone
(e) Cerebral nerve (e) Pyridoxine
33. Match the following drugs used in 39. Choose the most appropriate from the
Parkinsonism with their respective group below to match drugs:
categories A to E: (1) Cocaine (a) Central stimulant
(1) Levodopa (a) Dopa decarboxylase inhibitor (2) Codeine (b) Acetylcholine estrase inhibitor
(2) Carbidopa (b) MAU inhibitor (3) Physostigmine (c) Cardiotonic
(3) Biperiden (c) Used in Wilson’s disease (4) Atropine (d) Relief of mild pain
(4) Penicillamine (d) Dopamine prodrug (e) Mydriatic
(e) Used in Tremor 40. Given below are some of the drugs and
their mode of action in A to E. Match them
34. Match the following drugs with their
correctly.
respective usual doses A to E:
MATCH THE FOLLOWING 227
(1) Hydralazine (a) Vasodilator by direct action (2) Streptomycin (b) An antibiotic cotaining nitro
(2) Phenothiazine (b) Inhibits the vasconstrictor and group which binds to 50 S
pressor effects of 5-HT ribosomal subunit
(3) Methysergide (c) Antagonist to HT receptor of (3) Chloramphenicol (c) A dimeric indole alkaloid which
Histamine binds avidily to tubulin, a class
(4) Tolazamide (d) Stimulate the islet tissue to of protein that forms the miotic
secrete insulin spindle
(e) Inhibiting the enzyme carbonic (4) Rifampicin (d) A quinoline alkalid which inhibits
anhydrase the growth of Plasmodium vivax
41. Givern below are the hypotensive agents. (e) A naphthalene antibiotic which
Match their modes of action: inhibits cell wall synthesis
(1) Minoxidil (a) Alpha adereno receptor 46. For the following drugs, specific mechanism
antagonist of action is given in A to D. Match them:
(2) Parazosin (b) Beta adereno receptor
antagonist (1) Spironolactone (a) Non-competitively inhibit the
enzyme carbonic anhydrase
(3) Alpha – methyl dopa (c) From alpha methyl norepi-
nepherine (2) Acetazolamide (b) Inhibit the cotransport of Na+
(4) Clonidine (d) Direct action on blood vessel and Cl- in loop of Henle
(e) Decreases sympathetic activity (c) Competitive inhibitor of
through brain aldosterone at the receptors in
the distal tubule
42. Given below are the drugs and their (d) Direct inhibition of Na+ and Cl-
enzymes inhibited by them. Match them reabsorption
correctly.
(1) Physostigmine (a) COMT 47. Match the following terms with their
(2) Imipramine (b) Acetaldehyde dehydrogenase respective definitions A to E:
(3) Pyrogallol (c) Carbonic anhydrase (1) Drug allergy (a) Excessive pharmacological
(4) Disulfiram (d) Cholinesterase action of the drug due to
(e) MAO overdosage or prolonged use
(2) Toxic effect (b) Characteristic toxic effects of
43. Choose the most appropriate drug for the a drug in an individual at
following: therapeutic doses
(1) Potassium sparing (a) Spironolactone (3) Idiosyncrasy (c) An immunologically mediated
diuretic reaction producing sterotype
(2) Loop diuretic (b) Mannitol symptoms
(3) Osmotic diuretic (c) Furosemide (4) Intolerance (d) Abnormal reactivity to a
(4) Carbonic anhydrase (d) Acetazolamide inhibitor chemical
(e) Aldosterone (e) Alteration of mood and feelings
44. Match the following regions in GIT with 48. Match the following terms with their
the pH levels indicated from A to E: respective meanings A to E:
(1) Mouth (a) = 5.0–6.0 (1) Carcinogenicity (a) Drugs causing genetic defects
(2) Stomach (b) = 6.8–7.5
(2) Mutagenicity (b) Drugs causing foetal absor-
(3) Deodenum (c) = 6.8–7.0 malities
(4) Large intestine (d) = 3.0–5.0 (3) Teratogenicity (c) Drugs capable of altering
(e) = 1.5–3.0 mood and feelings
45. For the drugs listed 1 to 4, mechanism of (4) Drug dependence (d) Drugs causing functional
action is indicated from A to E. Match them: disturbances which persist,
even after the offending drug
(1) Vincristine (a) Macrolide antibiotic which
inhibits DNA dependent RNA (e) Drug causing cancer
polymerase
228 MCQs IN PHARMACOLOGY
49. Match the following teratogenic drugs and (1) Aminoglycosides (a) Polymyxin–B Colistin, Bacitracin
their respective produced abnormalies (2) Macrolide (b) Streptomycin, Gentamycin,
A to D: antibiotics Neomycin
(1) Aspirin (a) Nose, eye and hand defects, (3) Polypeptide (c) Erythromycin, Oleandomycin,
growth retardation antibiotics Roxi-thromycin
(2) Antithyroid drugs (b) Hypoplastic phalanges, cleft (4) Nitrofuran (d) Vancomycin, Lincomycin,
lip, micro-cephaly derivatives Viomycin
(3) Phenytoin (c) Premature closure of ductus (e) Nitrofurantoin, Furazolidone
arteriosus
55. Match the following categories of anti-
(4) Warfarin (d) Foetal goiter and hypothyroidism
microbial agents with their respective
50. Match the following drugs and their examples A to E:
respective resulted diseases A to E: (1) Antibacterial (a) Chloroquine, Metronidazole,
(1) Isoniazid (a) Peptic ulcers Diloxanide
(2) Phenothiazines (b) Hepatitis (2) Antifungal (b) Sodium fusidate, Thiacetazone
(3) Salicylates (c) Parkinsonism (3) Antiviral (c) (Acyclovir), Amantadine,
Idoxuridine, Zidovudin
(4) Tetracyclines (d) Phocomelia, multiple defects
(4) Antiprotozoal (d) Amphotericin B, Griseofulvin,
(e) Discoloured and deformed teeth, Ketoconazole
retarded bone growth
(e) Aminoglycosides, Erythromy-
51. Match the following oral hypoglycaemic cin, Penicillins
drugs with their respective features A to 56. Match the following categories of
E laxatives/purgati es with their respective
(1) Tolbutamide (a) Potent examples A to E:
(2) Penicillin V (b) Penicillinase resistant (1) Bulk forming (a) Docusates
(3) Methicillin (c) Natural (2) Stimulant (b) Magnesium and sodium salts
(4) Ampicillin (d) Semi–synthetic (3) Osmotic (c) Bisacodyl, Senna, Castor Oil
(e) Anti–pseudomonas (4) Stool sofener (d) Dietar y fibre, Psyllium
Methylcellulose
52. Match the following sulfonamides with (e) Liquid paraffin
their duration of actions from A to E
(1) Sulphadiazine (a) Long acting
57. Match the following categories of antiulcer
drugs with their respective examples A to E:
(2) Sulfadimethoxine (b) Toxic
(3) Sulfaphenazole (c) Short acting (1) Ulcer heating drugs (a) Sodium bicarbonate, sodium
citrate
(4) Succinyl (d) Intermediate acting
(2) Ulcer protective (b) Carbenoxolone sodium,
sulfathiazole
Deglycyrrhi-zinized liquorice
(e) Poorly absorbed
(3) H2 antihistamines (c) Sucralfate, colloidal bismuth
53. Match the following modes of action with subctirate
their respective antimicrobial drugs A to E (4) Anticholinergics (d) Atropine Pirenzepine Trimi-
pramine
(1) Interfere with (a) Rifampicin, Norfloxacin,
(e) Cimetidine, Ranitiding,
intermediary meta- Metronidazole Roxatidine
bolism
(2) Interfere with DNA (b) Penicillins, Cephalosporins, 58. Match the following fat-soluble vitamins
synthesis Vancomycin Bactracin with their respective chemical constituents
(3) Intefere with DNA (c) Idoxuridine, Acylovir, Zidovudin A to E:
(4) Inhibit cell wall (d) Sulfonamides, PAS, Ethambutol (1) Vitamin A (a) Pyridoxine
synthesis (2) Vitamin D (b) Methyl Phytyl naphthaquinone
(e) Polymyxins, Colistins, Bacitracin (3) Vitamin E (c) Alpha tocopherol
(4) Vitamin K (d) Calciferol
54. Match the following categories with their
(e) Retinol
respective antimicrobial drugs A to E:
MATCH THE FOLLOWING 229
ANSWERS
1. 1-d, 2-e, 3-b, 4-c 2. 1-d, 2-c, 3-b, 4-e 3. 1-c, 2-d, 3-a, 4-c
4. 1-b, 2-d, 3-a, 4-c 5. 1- b, 2-a, 3-b, 4-c 6. 1-d, 2-a, 3-b, 4c
7. 1- e, 2-c, 3-a, 4-b 8. 1-b, 2-e, 3-a, 4-c 9. 1-b, 2-a, 3-d, 4-c
10. 1-d, 2-a, 3-e, 4-b 11. 1-c, 2-e, 3-d, 4-b 12. 1-b, 2-c, 3-d, 4-e
13. 1-d, 2-c, 3-e, 4-a 14. 1-d, 2-a, 3-b, 4-c 15. 1-c, 2-d, 3-b, 4-a
16. 1-c, 2-d, 3-e, 4-b 17. 1-b, 2-c, 3-d, 4-a 18. 1-d, 2-e, 3-c, 4-a
19. 1-d, 2-e, 3-a, 4-b 20. 1-b, 2-a, 3-e, 4-c 21. 1-e, 2-d, 3-b, 4-c
22. 1-c, 2-d, 3-e, 4-a 23. 1-d, 2-e, 3-a, 4-b 24. 1-b, 2-a, 3-d, 4-e
25. 1-d, 2-c, 3- b, 4- a 26. 1-b, 2-c, 3-a, 4-e 27. 1-c, 2-d, 3-e, 4-b
28. 1-b, 2-c, 3-d, 4-e 29. 1-c, 2-d, 3-e, 4-b 30. 1-c, 2-a, 3-b, 4-e
31. 1-d, 2-a, 3-b, 4-c 32. 1-e, 2-d, 3-b, 4-c 33. 1-d, 2-a, 3-b, 4-c
34. 1-d, 2-e, 3-a, 4-c 35. 1-b, 2-c, 3-d, 4-e 36. 1-b, 2-c, 3-d, 4-e
37. 1-e, 2-d, 3-a, 4-c 38. 1-c, 2-d, 3-a, 4-b 39. 1-a, 2-d, 3-b, 4-e
40. 1-a, 2-a, 3-a, 4-a 41. 1-b, 2-a, 3-a, 4-e 42. 1-e, 2-d, 3-b, 4-c
43. 1-a, 2-c, 3-b, 4-d 44. 1-b, 2-e, 3-d, 4-c 45. 1-c, 2-d, 3-b, 4-a
46. 1-X, 2-X, 3-X, 4-X 47. 1-c, 2-a, 3-d, 4-b 48. 1-e, 2-a, 3-b, 4-c
49. 1-c, 2-a, 3-b, 4-a 50. 1-b, 2-c, 3-a, 4-e 51. 1-e, 2-c, 3-b, 4-a
52. 1-c, 2-a, 3-d, 4-e 53. 1-d, 2-c, 3-a, 4-b 54. 1-b, 2-c, 3-a, 4-e
55. 1-e, 2-d, 3-c, 4-a 56. 1-d, 2-a, 3-b, 4-a 57. 1-b, 2-c, 3-e, 4-d
58. 1-e, 2-d, 3-c, 4-b