CAGAYAN STATE UNIVERSITY College Of Medicine & Surgery PHARMACOLOGY- Shifting Examination NSAIDs, OMARDs, Drugs For Gout, Drugs For Blood Disorders + Directions: Each of the Numbered Items or Incomplete Statements is followed by Answers or By ANSWERS or COMPLETIONS of the Statements. Select the ONE Lettered Ans- ‘wer or Completion that is Best in each case. On the ANSWER SHEET, completely Blacken the BOX corresponding to the Letter of your Answer. No Erasures - Or Alterations Allowed 1A child takes what comes close to being a lethal dose of ACETAMINOPHEN; Which of the following is the most likely pathology involved in this drug overdose 7 ‘Acute Nephropathy (D~ Status Asthmaticus api for sever wees tower apn TONEY Selon, Weg eon paent has been taking igh doses of ASP yin? 10-4 ‘would be mos indicative of the sal i pos these ssn mp. A Constipation c wn cae Cc —_ J a ‘C-Hypertension , 3 en vgs hast dese effects reduced or eliminate By ASN iftaken together en % ( probenecid, D-Indomethacin 5 a = Colchicine or ~ C- Acetaminophen © si i ‘is the slopment of which of the \yw 412 The main reason for avoiding Colchicine, even with avery shor oral course, is the develop : c following effects ? ~ tone marrow pression O-Weptos . bronchospasm ts Tolerance Coch dstres thats severe 113: Which ofthe following isthe most likely mechanism by which ETANERCEP or INFLIXIMAB suppresses the signs, symptoms or unde thophyslology of Rheumpataid Arthritis ? + Neutralizes cl 1 necrosis factor {alpha TNF) ‘Phospholipase A-2 -Intubits leukocyte migration by blocking microtubular formation D- Selectively and effectively inhibits COX-2 - Stimulates collagen and mucopolysaccharide synthesis in the joints t wing, Except ‘AC Reversal of int destruction in heumatoid arthritis . a - Reduction of fever D- Analgesic action in headache E- Reduction of thromboxane synthesis in platelets i p 15- Drugs that are useful in dysmenortheal include all ofthe following, Except D- Naproxen B Colchicine E-Piroxicam 16-Drugs tat ate useful inthe wreatment of gout incude al ofthe folowing, Except C Ratopuinot indomethacin 8: Cokhcine Probenecid oo, GF 17-Salicylate imorication is characterized by all ofthe following, Except A. Metabolic Acidosis E- Hypoprothrombinemia B- Respiratory Alkalosis D- Hypothermia, ——— DB Whien of te folowing vier FE megaloblastic anemia but does not protect th fe a tect the neurological ‘manitestations of pernicious anemia ? 2 D-Vitamin D B- Folic Acid E-Thiamine teeter eet ot meimpar te opt Ae Folic Acid cid 8 Vitamin 6-12 & Vion s Pyridoxine ~2-20-Vitamin K promotes the Hepatic Biosynthesis of A. Factors xa D- Factors |, tt, X, Xi 1 x E- Factors Vill, Vi.IN, IC a Aspirin in the following conditions, Except in : viral infection D- Patients with diabetes insipidus e vo a ow dou, the ebminatin of Aspirin by Fodor Bnet, wth apa at x 1D 10to 22 hs 5s Pawism © “Toe Ws. 29- The Half-life of Naproxen and Piroxicarm Is = A-5to6 hrs. 0-30 to 36hrs. 10 hes, E- None of the above c12t028 30: Which of the following drugs '5 2 canbe administered orally? ‘A: Auranofin Methotre e 431. Which statement regarding Acetaminophen ' Incorrect? igesic inhibitor in peripheral tgsues Ce nrmneggineme as Dale abrorbed when given oraly and metabolized nthe Wes1) _36-Apotent inhibitor of cyclooxygenase; used to accelerate A 12 Stara mips tho St SSeS 38 — A drug that has antt-lnflammatory effects only in gout, ‘g 39 An antimalarial agent witha slow, disease ~modifying. £20" Sowacing enineumae dug that epione td fa sheumatoid joints; also used in leukernia areas sere. ‘A~ALLOPURI B~ SULFASALAZINE C-ACETAMINOPHER™ D~ PHENACETIN E COLCHICINE” 41- A drug that may be metabolized to a hepatotoxic product; the antidote is acer 42- A drug that is metabolized to a product that inhibits the enzyme that produced it 43; Ahighly selective inhibitor of microtubule assembly 44. Acompound of a sulfonamide with 5-aminosalicylic acid 45- A drug that is metabolized to acetaminophen; it has a high incidence of renal damage SeTC A-FOUCACID 1B—IRON DEXTRAN (C= DEFEROXAMINE, D-CYANOCOBALAMIN E~ DEFERASIROX P 46. Essential for the therapy of neurologic defects in 47 Used parenterally in severe iron deficiency and iron malabsorption syndromes 448 — Used in emergency treatment of acute iron intoxication: given by IV 49 — Necessary for the synthesis of purines and for te formation of Thymidyic acid DG] c S0- Used ora as ron chelator.saret Sesr V a seTD A~FOUC ACID B-HEMOSIDERIN, (C— TRANSFERRIN D-SARGRAMOSTIN: E-ERYTHROPOIETIN, B 2 51 -cren increased in tissues of patients with hemochromatons Se aod owt © ware ® s TNERS D 32° This is a Granulocyte-macrophage colony-stimulating factor {L 43- Most useful in patients with Red Cell deficiency caused by renal disegse or depression of the bone marrow. —E- B 54> Essential for the endocytosis of iron into Red Cell Proginators A AS- Deficiency during pregnancy increases the risk of neural tube defects in the newborn. SETE B A~ AMINOCAPROIC ACID. — B— WARFARIN 4” p PROTAMINE. — ‘ D~ ENOXAPARIN, WHOLE PLASMA . ¢ x 56~ Used for rapid reversal of effects of warfarin 57 ~ Small ayntetc nonprotein chemical used forthe treatment ofan ace bleeding episode in hemophiig ‘58 — Polymer of Molecular weight 2000-6000 that inhibits activated factor XK — 7 59 ~ Smal lipid soluble molecule that actin the iver hes of ann dependent cers — Co-Uled forthe tenon otecdng se wenessbepeing nn € sere A- Anema z o_ansrenust C=FacToR x p = anbeanc AD E-TICLOPIDINE ® c 61 —Human protein used in hemophiliacs to prevent or treat bleeding 62 ~ A long-acting thrombolyt 63 ~ This drug is a monoclonal ‘agent composed of a bacterial protein and recombinant human protein ntibody that blocks platelet receptors 64- This is an antiplatelet drug that requires several days for full effect; it has no effect on cyclooxygenase 65 —An orally active drug that inhibit fibrinolysis by Inhibiting plasminogen activation. SETS ‘A~ OPRELVEKIN B~ PEGFILGRASTIN (C—PTEROYLGLUTAMIC ACID (D~ DEFERASIROX €-ROMIPLASTIN: 66 ~This drugs an oral iron chelator 67 - This drug is a myeloid Growth factor (68 ~ This is a Megakaryocyte Growth Factor 69 ~ This is a Hematopoietic Growth factor that activates the thrombepoietin receptor 70 ~ This is necessary for the synthesis of purines and for the formation of tymidylic acid SETH A~SARGRAMOSTIN B-BIVALIRUDIN (C-FILGRASTIN D- TRANEXAMIC ACID E- EPTIFIBATIDE 71 = This drug is used to accelerate the recovery of granulocytes after cancer chemotherapy and other marrow suppressing therapies. 32 - This drug stimulates the production of Neutrophils, and has no effect on cell ines other than granulocytes 73—This drug is a direct thrombin inhibitor 74 This fibrinolytic drug blocks the platelet glycoprotein ij|-A Receptors 75~ This agent is an orally active drug that inhibit fibrinolysis by inhibiting plasminogen activation, -S-College of Mee OGY ARMACOLOGY Drugs Acting on THE CNS ats is followed By ANSWERS oF bY jon that 1s BEST in cac! ems oF Incomph rod ‘or Complet por the Lotter of Our 1 — Dircetions: Each of the Numbered I INS of the Statement, Select the ONE Lette zl ET, completely blacker the case. On the Allowed. Answer.No Erasures OF Alterations ea and amenorrhea c eth 1. A 45 year old woman develops akathisias. parkinsonian-Hike dyskinesias, galacto ; in Which of the following Rirug-receptor-base’ ‘mechanisms most tikely caused these dunng drug therapy 7 cr Dy Supersensitivity of €opam E. Stimulation of nicotine receptors >. Which of the following focal anesthetics 1s suitable for topical administration (cg. to mucous 1 cannot be given parenterally because “ofits physio-chemical properties which renders tt D- Mepivacaine E- Procaine the following, is it still C- Etidocaine w available, for which of ser and more efficacious drugs no’ iate to use PHE! BARBITAL?. 3- Inspite of news considered reasonable and appropri ‘4. Alcohol withdrawal signs/symptoms oy E- Sleep disorders like B- Anxiety management Jo Certain epilepsies best describes the side effects of adverse responses that are Most likely to occur ricyclic antidepressant such as IMIPRAMINE?” D- Nephrotoxicity E- Seizures insomia 4- Which of the following g jinistration of @ Tr ffects rogressive Parkinson's Disease and not ‘antiparkinson drug that is @ ‘ould that be ? with moderate, P! decide to empirically assess an rrgamine oxidase type B Which ‘of the following drugs BC: E- Trany Ieypromine 5- We have a 53 year ‘old male patient responding well to current drug therapy. We selective inhibitor of mo! emTORPALINS side effects of Chlorpromazine and Haloperidol are qualitatively similar, but more frequently with Which of the following effects typically occur ¢ actions and 6- Many quantitatively 3 a they differ . B- Intcnse atropine-ike ST C- Lethal blood dyscrasias D- Orthostatic hypotension E- Urinary retension 7- Which of the following best describes the actions of PHENCYCLIDINE ? ‘A- Causes its effects via the antimuscarinic properties = val symptoms genic properti D — Has strong opioid-rece] Factivating acuvity E ~ Overdoses should be treated with Flumezenil0 Me 70 yeat od oman with long history of ansiety diet to tile ber b wo days late she became exremely lethargic and nouespnsive, with ‘cacton to painful simul Respiration is slow and shallow, Which of specifically to reverse these signs and symptoms ? “TITTIES THRE 1A EELS has ec rated for Lada icas for about a yar, in Bory Which ofthe following drugs isthe most likely cause 7 imantadiyy D- Levodopa plus carbidopa, THB pune E © Levodopa (alone) 13. A young boy Fisch ey foc mo thana yr, devclapd massive overgronth, D sings iuaat’ poe of the following dug i ne me Catamazepine EPheovioin B Lorazepam © Valprow Red © Phenobarbital I} ~ An elderly male patient with undisgnosed coronary artery dscasg ‘was given a medication. Shortly 4 thereafter, he developed acute myocardial ischemia Which of the following drugs most likely caused this reaction ? A~ Clozapune D - Sunatnpaan B ~ Peatozocine ES Peirce C~ Phenytomn 15 A att wath stats cplcpes has cs an Vd of LORAZEPAM Phyo to ie Biven bat he atendig psa og Fugieyion Which ofthe flowy ea sa the main advantage sf Fospbssadasouedinan em a Naan ste, ead B ~ Directly stmulates ventilation that ts compromused™ ee ‘more effective anticonvulsant action than plain phenstoin ~2-D - Has a long duration of action E-Itslows lorazepam clearance, thereby prolonging its action 16 A patient develops a severe and rapidly worsening adverse response toa drug, The physician orders Prompt administration of anupyretics, 1V hydration and bromocriptine or dantrolene to manage the Symptoms Which ofthe following drugs most likely causes these adverse responses? D-Phenytoin E - Selective serotonin reuptake inhibitors (SSRIs) 17- ROPINIROLE is a relatively new dn the brain. Given this mechanism of action, for this drug ? 9 Daytime anxiety D- Schizophrenia 5 ia E- Status Epilepticus ig that works as a dopamine receptor agonist in certain parts of 1. which of the following disorders is most likely an indication 18 - A 36 year old man with mild anxiety and depression symptoms took BUSPIRONE for short-term symptom control. Which of the following best describes an important property of this drug ? A ~ Associated with severe withdrawal syndrome B — Has a significant potential for abuse (C-|Is likely to potentiate the CNS depressant effects of Benzodiazepines and sedative antihistamines D— Requires almost - i , dosage titrations 19 ~ A patient in the hospital develops Status Epilepticus. Which of the following is the first IV drug to give? A cpine D - Phenytoin ” Doras E~Valproic acid “Phenobarbital 20 ~ Your patient developed severe allergic reaction to an Ester-type local anesthetic. Which of the following drugs is the most likely anesthetic he received? ‘A~ Bupivieaine D-Py B - Lidocaine E Wetracai C~ Mepivacaine 21- A 67 year old woman presents with mild to moderate symptoms of Alzheimer’s disease. Which of the following pharmacologic approaches will you use tt slow down the underlying brain pathology’ ? A~ Activate a population of serotonin receptors B — Block dopamine release or receptor activation ic yylcholinesterase mo E ~ Dissolve cerebral vascular thrombi 22- The Pediatrician writes for a 12 year old boy, a prescription for a combination product that contains Dextromethorpan. Which of the following is the most likely purpose for which the drug was prescribed ? ‘A~ Control mild to moderate pain for a broken wrist bone B ~ Manage diarrhea caused by food-borne bacteria C ~ Provide sedation because the child has attention deficit disorder ( ADD ) D ~ Suppress severe cough associated i a bout of influenza c resis ( bed-wettin 2 * prettier are posed on overshe-pouncr sale of phamacologc products that contain pscudoephedrine, that is because pseudoephedrine ean easily be used to synthesize which of the following, highly psychoactive and abuse prone drug ? A~ Methamphetamine D-- Pentozocine B~ Morphine E- Pheneyelidine €- OxycodoneB - Nitrazepam E- Flurazepam C ~ Chlorpromazine 33 — Which of the following Hypnotics is prefered for elderly patients” A Diazepam D- Flurazxpam B - Phenobarbitone E = Clorazepate C-Temazepam 34 Ina severely asthmatic patient the safest agent to induce sleep 15 ‘A ~ Morphine D - Phenobarbitone B- Chlorhydrate E- Allof the above are safe (C —Nitrazepam 36 — Which of the following Benzodiazepines has the Shortest half? ‘A- Clorazepate B- Diazepam smazep: C- Flurazepam 36 — CHLORPROMAZINE has the following effects, Except A — Antitryptaminergic actions B — Antihistaminergic action C - Anticholinergic action D ~ Ganglion blocking action E - Antidopaminergie action 37 = Which one ofthe following is Least likely to be causod by treatment with moderate to large doses of DIAZEPAM” 'A Decreased performance on tests of psychomotor function B- Anterograde amnesia with continued use C — Hyperreflexia and seizures with abrupt discontinuance after chronic use D - Increased synthesis of Porphyrine E ~ Additive depression of the CNS with alcoho! 38 ~ Concerning the clinical uses of Benzodiazepines, which one ofthe following Statements 1s NOT CORRECT? 'A-~ Alprazolam has selctive anxiolytic effects in patients with Agoraphobia B ~ Clonazepam is used for absessive-compulsive disorders C ~ Diazepam is used for muscle spasticity in patients with cerebral palsy 1D Intravenous Diazepam is useful in Status Epilepticus FE ~ Symptoms of alcohol withdrawal state may be alleviated by treatment with Chlordiazepoxide 39 ~ Regarding the Characteristic properties of BUSPIRONE, the physician should inform the patient to anticipate ‘A — Additive CNS depression with alcoholic beverages BA significant effect on memory C~ That the drug will take a week or so to begin working D~ A nced to gradually increase drug dosage because of tolerance E That if he stops taking the drug abruptly he will experience withdrawal signs 40 — A30 year old woman has sporadic attacks of intense anviety with marked physical symptoms including hyperventilation, tachycardia, and sweating, If she is diagnosed as suffering from a panic disorder, the most appropriate drug to use 15 A Chloral Hydrate D- Meprobamate B- Clonazepam E - Propranolot C— FlurazepamE-t converted to the false ncurot vansmitter- Carbidopamine Inhibits moncamine oxidace type B A following pharmaceutical gents is an Plotd antagonists » D- Meperidine E-Levomhanot B - Phenmetra E- Methaqualo Baction igfo / A- Imipramine D - Doxepin B ~ Nortriptyline E - Clomipramine C - Fluvoxamine consists of Lettered Options followed by Numbered jost closely associated with it Letter of your Answer. No Il ~ Directions . Each set of Matching Questions Items. For cach Numbered Item, Select the ONE Lettered option that is m On the ANSWER SHEET, completely Blacken the Box corresponding to the Erasures or Alterations Allowed. SETI ‘A— Buspirone (Sedative-Hypnotics) B — Flurazepam C - Chloral Hydrate D Zolpidem E~ Phenobarbital Ge increase anticoagulant effects by displacement of qyarfarin Jrom plasma protein D 31- This drug may binding sites This drug, in the management oflcohol wal state; rsh incidence oF unwanted daytime sedation in » BS Used a8 in pe has caused @ F ciderty patients $4 This drug is least likely to alleviate with ofr in a patient who has abruptly discontinued Ese of high doses ofa barbiturate d minimal effects on sleep architecture. It binds to 35- This hypnotic drug, has no anticow action an B a ciass of Benzodiazepine receptors. SET 2 ‘A ~ Microsomal Ethanol-oxidizing System p D a C B - Alcohol Dehydrogenase C- Cytochrome P450 D - Aldehyde Dehydrogenase E ~ Pyruvate Dehydrogenase (Alcohols) A 56- A cytosolic zinc-containing enzyme that 1s primarily responsible for oxidation of low to moderate doses of thanol 57 _ The clinical use of disulfiram depends on its ability to inhibit this enzyme 58 — This enzyme utilizes NADPH as a coenzyme, its activity may be increased with chronic ingestion of d ethanol $0- Heavy use of ethanol increases the activity of this enzyme, resulting in the formation of toxic > - — metabolite of acetaminophen F 60) ~The activity is specifically decreased in the Wemicke-Karsakoff Syndrome SET3 A- Valproic Acid (Anticpileptics) B - Lamotrigine C - Carbamazepine D ~ Vigabau E — Phenytoin ty. Hirsutism and = 61 ~ This drug should be used cautiously in pregnancy because of possible teratoge gingival hyperplasia are relatively commom side effects 62 - In addition to its use in scizure states, this drug can be used in bipolar affective disorders in paticnts intolerant to Lithium 0 63 ~ The risk of hepatotoxicity due to this drug is greatest in children under 2 years of age. 64 — This drug is an inhibitor of GABA metabolism. It’s duration of action is much longer than its half- ® iife m plasma f 35; nabou 5% of adult patents, he drug causes a rash and a few patients develop the Stevens Johnson syndrome SET 4 A - Propofol ~4-cs ar ee =Succinylcholine B =Trazepam 78~ A spasmolytic drug that is also useful in treatment of convulsions caused by local anesthetics 32 Iisa nondepolanizing neuromuscular blocker that is hydrolyzed by plasma cholinesterase 80 ~ This is a volatile liquid. when inhaled it potentiates the nondepolanizing neuromuscular blockers. A ~ Pramipexole (Drugs for Parkinsonism) — B~ Amantadine [ C- Sclegiline D - Biperiden E- Pergolide imine Receptors but itis 81 ~ This drug direetly activates Dopa Not an ergot alkaloid 33 Ris drug isa selective inhibitor of MOA Type-B. Itmay merece brain 83 ~ This drug is an ergot derivative that dew effectiveness of Levodopa $4 ~ This drug is contraindicated 1m patients with prostatic hypertrophy or obstructive gastroimestinal discase # reuptake of Dopamine $5 This drug increases synthesis or rlease of Dopamine or inhibition of A~ Bromocriptinewt > wed aAbyom _ (Antipsychotic Drugs) B— Promethazine — eae [T D- Clozapine E — Halopcridol 86 — This drug is a as drug. It is given parenterally 87-— This drug is useful as a mood stabilizer in patients with bipolar affective disorders 1c symptoms of Schizophrenia but it may be useful in the 88 — This management 6f Neuroleptic Malignant 89 — A weekly blood count are Tory for patients who are taking this drug 90 — The calming and anticmetic properties of this drug, together with its atropinc-like properties, form the basis for its use in preoperative sedation. _ SET 9 A~ Amoxapine (Antidepressants) B= Mirtazapine C- Clomipramine D - Maprotiline 7 E - Moclobemide 01 — This is a heterocyclic selective inhibitor of norepinephrine reuptake; it has Sedative effects and Seizures may occur in Vt 92 - This tricyclic antidepressant is used p' Disorders. It is an effective blocker of the reuptake of Serotonin aso ‘Second Generation Antidepressant drug blocks Dopamine Receptors and has caused the Amenorrhea-galactorrhea syndrome as side effects sr ts drag is a selective inhibitor of Mao Type A. It has a short half-life of less than 1© hrs oe The antepressant action of this drug is blocking Histamine receptors, not on MAO or on reuptake systems for norepinephrine or scrotonine rimarily in the management of Obsessive-Compulsive A- Dextromethorpan~ SET 10 (Opioid Analgesics) B — Methadone ie C - Naltrexone D - Propoxyphene — E— Nalbuphine / 96 ~ This drug is an antagonist aaeseptor: Ms analgesic effect is equivalent to that of morphine 97 _A single oral dose of this drug wil block the effects of injected croup for up to 48 hrs 7 Of — This drug is an effective antitussive, it is free of addictive property and only rarely causes eZ constipation 99 - It has a full agonist action at opioid ressptors Withdrawal signs arc milder than those associated with withdrawal from morphine 100 ~ This opioid agonist has an anal Igesic efficacy no greater than that of a placebo. The drug may cause seizures in overdose. am