BASIC PHARMACOLOGY EVALS 4 RATIONALIZATION

INTRODUCTION TO PRESCRIPTION WRITING, PREPARATION OF HERBAL MEDICINES,

ANTIMALARIALS, TREATMENT OF ASTHMA, ANTITUSSIVES, ANTI-TUBERCULOSIS,
TETRACYCLINES AND QUINOLONES

INTRODUCTION TO PRESCRIPTION WRITING

1. According to the Generics act of 1988:
Select one:
a. The generic names of the drug shall be used in all prescriptions
b. Fixed dose drug combinations are not allowed
c. The brand name may be indicated by enclosing in a parenthesis
and written above the generic name
d. All of the above
The correct answer is: The generic names of the drug shall be used in all
prescriptions
Ratio
B. Under Sec. 3 of Generics Act of 1988: “For drugs with TWO or MORE
active ingredients, the generic name as determined by BFAD shall be
used in prescribing”.
C. It is in Erroneous prescription: where the generic name is in the one in
parentheses; it should be the brand name

2. Controlled substances that fall under Schedule I will include all of The correct answer is: Codeine
the following, EXCEPT: All the drugs stated are under schedule 1 except codeine because it
Select one: belongs to schedule 2.
a. Marijuana
b. Codeine
c. Heroin
d. Cocaine
3. The penalty of life imprisonment to death and a fine ranging from The correct answer is: All of the above
Php 500,000 to Php 10,000,000 shall be imposed upon any person Under section 11 - possession of dangerous drug; it’s stated that drug with
who unless authorized by law shall possess any dangerous drugs in the specific weight in option A,B and C can be considered illegal.
the following quantities regardless of the purity: For this kind of act the doctor can be given a penalty of life imprisonment
Select one: to death and a fine ranging from Php 500,000 to Php 10,000,000 shall be
a. 10 grams or more of cocaine imposed upon any person who unless authorized by law shall possess any
b. 500 grams or more of marijuana dangerous drugs in the following quantities regardless of the purity
c. 50 grams or more of methamphetamine hcl or “shabu”
d. All of the above
4. The following constitutes a violative prescription: The correct answer is: All of the above
Select one:
a. The generic name is not written ● a - according to The Generics Act of 1988, it is the generic name of
the drug that should be used in writing prescriptions
b. The brand name is indicated and an instruction “no substitution” ● b - the patient has the right to be given options for drug therapies
is added (to either take the “branded” one or the “generic” one)
c. The generic name is written but not legible ● c - illegibility may cause the prescription to be read as a different
d. All of the above drug that can be fatal to the patient
5. The symbol Rx is part of the: The correct answer is: Superscription
Select one:
a. Subscription SUPERSCRIPTION: Patient info and Rx symbol
b. Signatura (Patient Name, Age, Gender, Weight Address, Date, Rx)
c. Inscription
d. Superscription INSCRIPTION: Drug Info/Body
(Generic Name, Form/Preparation, Concentration, Strength)

SUBSCRIPTION: Directions to PHARMACIST

(Dispense no.- quantity to be dispensed)

SIGNATURA/ LABEL: Directions to PATIENT

(Route of administration, Dose, Frequency, Duration)

PRESCRIBER’S INFO: Physician info

(Name MD, Signature, License no., PRC no., S2)
6. Who is/are required to undergo drug testing? The correct answer is: A and B only
Select one:
a. Government officials Mandatory drug testing:
b. Applicants for driver/s license 1. Application for driver’s license
c. Physicians 2. Application for firearms license and for permit to carry firearms
d. All of the above outside of residence
e. A and B only 3. Students of secondary and tertiary schools
4. Oddicersand employees of Public and Private offices
5. Officers and members of the military, police, and other law
enforcement agencies
6. Criminal offenders with imposable penalty of imprisonment not less
than 6 years and 1 day
7. All candidates for public office, appointed or elected, national or
local
7. Exempt regulated drug/s preparations not in injectable form The correct answer is: All of the above
which can be prescribed in ordinary prescription form but will
require S2 number will include:
Select one: Per DDB Resolution No. 8 s 2004 - preparations not in injectable form i.e.
a. Diazepam capsule, tablet or syrup, to be prescribed thru Ordinary Rx (Personalized
b. Zolpidem Rx) with S2, 1 DDP per RX, Partial Filling allowed, No Refill.
c. Phenobarbital
d. All of the above Alpazolam
Bromazepam
Clonazepam
Chlorazepate Dipotassium
Diazepam
Estazolam
Flurazepam
Mazindol
Midazolam
Nitrazepam
Phenobarbital Sodium
Phentermine Resin
Zolpidem

Reference: page 68 of Pharmacology Lab Manual

8. To be able to prescribe a controlled substance, a physician must The correct answer is: None of the above
have all of the following, EXCEPT:
Select one:
a. Professional tax receipt (PTR) number All of these are requirements to be able to prescribe a controlled
b. Opium license (S2) number substance
c. A negative drug test
d. None of the above - Prescriber’s Data consist of the prescriber’s name and signature
followed by the initials M.D. with PRC License number and the
Professional Tax Receipt (PTR) number written below. The
Opium License Number (S2 number) is written when prescribing
a regulated or prohibited drug.

- The following shall be subjected to undergo drug testing:

(d) ​officers and employees of public and private offices -officers

and employees of public and private offices, whether domestic or
overseas, shall be subjected to undergo a random drug test as contained
in the company’s work rules and regulations, which shall be borne by the
employer, for purposes of reducing the risk in the workplace. Any officer or
employee found positive for use of dangerous drugs shall be dealt with
administratively which shall be a ground for suspension or termination,
subject to the provisions of Article 282 of the Labor Code and pertinent
provisions of the Civil Service Law
 Reference: page 76 no. 5 and page 61 paragraph d of Pharmacology Lab
Manual
9. The act by a validly-registered pharmacist of filling a prescription The correct answer is: Dispensing
or a doctor’s order is:
Select one: Dispesnsing - act by a validly-registered pharmacist of filling a
a. Dispensing prescription or doctor’s order on the patient’s chart.
b. Subscribing
c. Retailing Subscription - Direction to the dispenser Pharmacist; Contains the total
d. Selling quantity to be dispensed based on the frequency of administration and the
duration of treatment.

R​etailing - ​selling of merchandise and certain services to consumers

(Brittanica.com); healthcare that is delivered in what are colloquially
referred to as "retail clinics"; formally known as convenient care
clinics (medpagetoday.com)
10. A medical practitioner who will prescribe a dangerous drug to The correct answer is: All of the above
any person whose physical and physiological condition does not According to ​Section 18. Unnecessary Prescription of Dangerous
require its use will be given the following penalty/ies: Drugs the following penalties shall be imposed to a practitioner who will
Select one: prescribe a dangerous drug to any person whose physical and
a. Imprisonment physiological condition does not require its use or the dosage prescribed
b. Fine of Php 100,000.00 to Php 500,000.00 therein :
c. Revocation of his/her license to practice ● Imprisonment of 12 years and 1 day to 20 years
d. All of the above ● Fine of Php 100,000.00 to Php 500,000.00
● Revocation of his/her license to practice
PREPARATION OF HERBAL MEDICINES
11. The best time to harvest herbal plants to be used as medicine is The correct answer is: 9-10 am
between:
Select one: Collection / Harvest
a. 6-8 am 1. Best time: 9 to 10am - minerals (essence) contained in
b. 9-10 am plants are more concentrated
c. 1-3 pm 2. Better to collect during summer than during the rainy season
d. 4-6 pm 3. Better to collect in a less polluted environment
4. Plants should be cut systematically and aesthetically
5. Best time to collect specimens: stage when the plant flowers,
or is ready to bloom (stage when minerals are more
concentrated)
● Flowers - before blooming or right after blooming
 ● Seeds - during dry season; when plant is more than 2
years old
● Bark - during dry season; when plant is more than 2
years old
● Stem - when the plant is ready to bloom; the more
mature the stem, the less the mineral content
● Leaves - when the plant flowers are ready to bloom

12. The herbal plant preparation recommended for the treatment of The correct answer is: SBL oil extract
inflammatory conditions:
Select one: INDICATIONS
a. Kakawati ointment Kakawati ointment
b. Akapulko ointment ● scabies
c. ABK decoction
d. SBL oil extract Akapulko ointment
● fungal skin infections

ABK decoction
● diarrhea

SBL oil extract

● inflammatory conditions like insect bites, joint pains, and muscle
aches.
13. Coconut oil is used to extract the active ingredient of which of The correct answer is: Kakawati Ointment
the following herbal preparations?
Select one: Kakawati ointment ingredients include: 2 cups Kakawati leaves, 2 cups
a. ABK decoction Coconut Oil, and 1 tablespoon candle scrapings (for every 3
b. Ginger Syrup tablespoonfuls of extract).
c. SLK syrup
d. Kakawati Ointment Other herbal preparation that uses coconut oil:

● Akapulko ointment (in a 2 cups Akapulko leaves to 2 cups Coconut oil

ratio)

● SBL oil extract (in a 1 part solid ingredients to 2 parts coconut oil ratio)

14. ABK decoction is prepared by boiling the herbal plants in water The correct answer is: 15-20 minutes
for how many minutes?
Select one:
a. 5-10 minutes Abukado, Bayabas, Kaimito Decoction
b. 15-20 minutes
c. 30 minutes Ingredients:
d. 60 minutes
30 grams dried leaves (60 grams fresh leaves) of abukado
30 grams dried leaves (60 grams fresh leaves) of bayabas
30 grams dried leaves (60 grams fresh leaves) of kaimito
900ml. water

Procedure:

1. Put all together the dried leaves of abukado, bayabas, and kaimito in
900 ml. of water
2. Boil the mixture for ​15-20 minutes
3. Strain using a cheese cloth
4. Let the decoction cool. Add sugar to improve flavor (you may use honey
or fruit juice in place of sugar if available)
5. Place in sterilized bottles and put the labels
15. The herbal plants used in SLK syrup include: The correct answer is: Sampalok, luya, kalamansi
Select one:
a. Sampalok, luya, kakawati SLK (Sampalok, Luya, Kalamansi) Syrup
b. Sili, luya, kalamansi SBL (Sili, Bawang, Luya) Oil extract
c. Sampalok, luya, kalamansi ABK (Abukado, Bayabas,Kaimito) Decoction
d. Sampalok, luya, kaimito
16. What is used to extract the active ingredient in the preparation The correct answer is: Water
of SLK syrup?
Select one: INGREDIENTS OF SLK (Sampalok, Luya, Kalamansi) Syrup
a. Water
b. Alcohol ● 5 cups of water
c. Coconut oil ● 3 handfuls of washed sampalok (tamarind) leaves
● 10 tablespoons of luya (ginger) extract
● 3 ½ cups of brown sugar
● 28 pieces regular-sized calamansi

PROCEDURE

● Prepare ginger extract:

○ Weigh 200 grams of ginger
○ Add 200 mL water
○ Mix in a blender
 ○ Strain using cheese cloth
○ Set aside
● Boil sampalok leaves in water for 15-20 minutes
● Strain the mixture and continue boiling the extract
● Add the ginger extract and the brown sugar
● Continue boiling until the mixture assumes a syrup-like consistency
● Add kalamansi juice and stir
17. What is the best time to collect leaves for use as herbal The correct answer is: When the flowers are ready to bloom
medicine?
Select one: Collection/Harvest
a. When the flowers are ready to bloom Best time: 9-10 am- the minerals/essence contained in plants are more
b. The stem of the plant is already mature concentrated
c. When the seeds have grown into a plant for more than 2 years Better to collect during the summer than during the rainy season.
d. All of the above Better to collect in a less polluted environment—do not collect plants
near dumpsites or along the streets.
Plants should be cut systematically and aesthetically
​Best time to collect specimens: stage when the plant flowers or is
ready to bloom (stage when minerals are more concentrated)
Flowers- before blooming or right after blooming
​Seeds- during dry season ; when plant is more than 2 years old
Bark- during dry season; when plant is more than 2 years old
Stem- when the plant is ready to bloom; the more mature the stem,
the less mineral content
Leaves- when the plant flowers are ready to bloom

18. Herbal medicine preparation/s used for the symptomatic relief of The correct answer is: SLK syrup
cough will include:
Select one: ABK (Abukado, Bayabas, Kaimito) decoction- Diarrhea
a. SLK syrup SBL (Sili, Bawang, Luya) Oil extract- joint pains, muscle aches and insect
b. ABK decoction bites
c. SBL Oil extract
d. All of the above
19. The ointment consistency of Kakawati and Akapulko preparation The correct answer is: Candle scrapings + coconut oil
is attributed to:
Select one: Kakawiti - 2 cups Kakawati leaves, ​2 cups coconut oil, 1
a. Candle scrapings tablespoonful candle scrapings (preferably white) for every 3
b. Coconut oil tablespoonful’s of extract
c. Candle scrapings + coconut oil
d. Water
 Akapulko - 2 cups akapulko leaves, ​2 cups coconut oil, 1 tablespoonful
candle scrapings​​ (preferably white) for every 3 tablespoonful’s of extract

20. In the preparation of Bayabas ointment what is the proportion of The correct answer is: 1 tablespoonful of candle scrapings: 1
candle scrapings and the oil extract? tablespoonful of oil extract
Select one:
a. 1 tablespoonful of candle scrapings:2 tablespoonfuls of oil extract Bayabas ointment- 1 tablespoonful of candle scrapings:
b. 1 tablespoonful of candle scrapings:3 tablespoonfuls of oil extract 1 tablespoonful of oil extract
c. 2 tablespoonfuls of candle scrapings:1 tablespoonful of oil extract Kakawati Ointment- 1 tablespoonful of candle scrapings:3 tablespoonfuls
d. 1 tablespoonful of candle scrapings:1 tablespoonful of oil extract of oil extract
Akapulko Ointment- 1 tablespoonful of candle scrapings:3 tablespoonfuls
of oil extract
ANTIMALARIALS
21. Which antimalarial interfere with heme handling by inhibiting the The correct answer is: Chloroquine
heme polymerase activity? MOA of Primaquine is unknown but it may be converted to electrophiles
Select one: that act as oxidation - reduction mediators.
a. Primaquine MOA of Atovaquone is that it inhibits electron transport and collases the
b. Chloroquine mitochondrial membrane potential.
c. Atovaquone MOA of Artemisinin is that it acts in two steps in the first step heme iron
d. Artemisinin within the parasite catalyzes cleavage of the endoperoxide bridge.In the
second step there is rearrangement to produce carbon centered radical
that alkylates and damages macromolecules in the parasite.
Ref: Dr.Enriquez lecture.
22. Blackwater fever is a rare hypersensitivity reaction to Quinine The correct answer is: P. falciparum
characterized by massive hemolysis, hemoglobinemia and
hemoglobinuria and usually associated with what specific species of Blackwater Fever ​is usually associated with ​P. falciparum. ​It is rare
Plasmodium causing malaria? hypersensitivity reaction to Quinine characterized by massive hemolysis,
Select one: hemoglobinemia and hemoglobinuria leading to anuria, renal failure and
a. P. vivax death. It is a rare side effects but it still happens.
b. P. malariae
c. P. falciparum
d. P. ovale
23. Chloroquine can be used as an alternative treatment for which The correct answer is: Hepatic Amebiasis
parasitic infection?
Select one: Chloroquine is the DOC for malaria which targets heme synthesis. It is
a. Trypanosomiasis very effective in prophylaxis and treatment of acute attacks of malaria
b. Hepatic Amebiasis caused by ​P. ovale, P. vivax and P. malariae​. Also, it is used to treat
c. Schistosomiasis Hepatic Amoebiasis ​and are secondary drugs for variety of chronic
d. Trichomoniasis inflammatory diseases including rheumatoid arthritis, SLE, discoid lupus,
 sarcoidosis and photosensitivity diseases such as porphyria cutanea
tarda.

Trypanosomiasis or sleeping sickness is a vector-borne disease from

parasites coming from the genus ​Trypanosoma​. Schistosomiasis is a
disease caused by parasitic flatworms schistosomes. DOC for
schistosomiasis is praziquantel. Trichomoniasis is an STD caused by a the
parasite Trichomonas vaginalis. DOC for trichomoniasis is Metronidazole.
24. Which of the following quinolines is primarily excreted via the The correct answer is: Mefloquine
fecal route? A. Quinine is primarily excreted via urine acidification (Renal)
Select one: B. Primaquine - renal secretion
a. Quinine C. Mefloquine- excreted mainly via fecal route.
b. Primaquine D. Chloroquine- excreted via urine acidification (Renal)
c. Mefloquine
d. Chloroquine
25. Which antimalarial when used alone is associated with a high The correct answer is: Artemisinin
level of parasite recrudescence? RATIO: Artemisinin, also known as QINGHAOSU, when used alone can
Select one: be associated with a high level of ​parasite recrudescence.
a. Quinine Recall: Recrudescence is the recurrence of symptoms after a temporary
b. Artemisinin abatement of symptoms due to parasites surviving in the blood as a result
c. Atovaquone of inadequate treatment.
d. Chloroquine Source: Doc Rustan’s ppt on anti malarials
26. Which antimalarial inhibits the electron transport and collapses The correct answer is: Atovaquone
the mitochondrial membrane potential of plasmodium? A. Pyrimethamine:​ Inhibit dihydrofolate reductase of plasmodia
Select one: B. Artemisinin: Heme iron within the parasite catalyzes cleavage of
a. Pyrimethamine the endoperoxide bridge followed by rearrangement to produce a
b. Artemisinin carbon-centered radical that alkylates & damages macromolecules
c. Lumefantrine in the parasite
d. Atovaquone C. Lumefantrine:​ MOA is unknown
D. Atovaquone: Inhibits electron transport and collapses the
mitochondrial membrane potential
27. Excessive doses of this antimalarial can cause megaloblastic The correct answer is: Pyrimethamine
anemia due to the inhibition of folate synthesis?
Select one: A. Pyrimethamine
a. Pyrimethamine - MOA: Inhibition of dihydrofolate reductase of plasmodia
b. Proguanil - Toxicity: megaloblastic anemia; Fansidar: teratogenic
c. Quinine B. Proguanil
d. Atovaquone - MOA: Inhibition of dihydrofolate reductase-thymidilate
synthetase of sensitive plasmodia
 - Toxicity: Vomiting, abdominal pain, diarrhea, hematuria,
transient appearance of epithelial cells and casts in urine
C. Quinine
- MOA: Acts against asexual erythrocytic forms and little
effect on hepatic forms of malarial parasites
- Triad of toxicity: Cinchonism, hypoglycemia, hypotension
D. Atovaquone
- MOA: Inhibits electron transport and collapses
mitochondrial membrane potential
- Toxicity: Abdominal pain, nausea, vomiting, diarrhea,
headache and rash

Source: Doc Rusty’s PPT

28. The plasma level time profile of this antimalarial often shows a The correct answer is: Atovaquone
double peak which possibly reflects its enterohepatic circulation: The double peak that can be seen in Atovaquone is indicative of
Select one: enterohepatic circulation. 1st peak can be appreciated after 1-8 hours
a. Pyrimethamine while 2nd peak after 1-4 days.
b. Chloroquine
c. Artemisinin The other drugs among the choices do no undergo enterohepatic
d. Atovaquone circulation; therefore, there’s no double peak.
29. Malarone is the combination of which 2 antimalarials? The correct answer is: Atovaquone + Proguanil
Select one:
a. Atovaquone + Proguanil Atovaquone is usually given in combination with Proguanil, for prophylaxis
b. Pyrimethamine + Proguanil and treatment of malaria. Choice C is wrong.
c. Atovaquone + Sulfadoxine
d. Pyrimethamine + Sulfadoxine Pyrimethamine is usually given in combination with Sulfonamides or
sulfones, not Proguanil. Choice B is wrong.

Pyrimethamine + Sulfadoxine = Fansidar, which is restricted to the

treatment of chloroquine-resistant ​P. falciparum ​malaria in areas where
resistance to antifolates has not yet fully developed. Choice D is wrong.

Source: Anti-Malarial Drugs 2021 trans

30. Which antimalarial is the most commonly used treatment of The correct answer is: Quinine
malaria during the first trimester of pregnancy?
Select one: WHO recommends Quinine + Clindamycin for the treatment of
a. Artemisinin uncomplicated malaria during the first trimester of pregnancy. Quinine
b. Quinine can stimulate uterine contractions, especially in the third trimester.
c. Chloroquine However, this effect is mild, and quinine and quinidine remain
d. Pyrimethamine appropriate for treatment of severe falciparum malaria even during
 pregnancy.
The WHO recommends artemisinin-based combination therapies for the
treatment of uncomplicated falciparum during malaria during the second
and third trimester of pregnancy.

Reference: Katzung, BG et al. Basic & Clinical Pharmacology. 13th edition

(pages 892-893)
31. Which antimalarial is contraindicated in patients with G6PD The correct answer is: Primaquine
deficiency?
Select one: Primaquine is contraindicated in patients with G6PD deficiency as it may
a. Atovaquone cause hemolytic anemias in these patients.
b. Artemisinin
c. Primaquine Other choices are contraindicated in pregnant women and young children.
d. Lumefantrine
Source: Anti-Malarial Drugs 2021 trans
32. Cinchonism is one of the adverse effects of this antimalarial? The correct answer is: Quinine
Select one:
a. Pyrimethamine Quinine toxicity may result to cinchonism, hypoglycemia and hypotension.
b. Chloroquine
c. Primaquine Pyrimethamine can cause occasional rashes and depression of
d. Quinine hematopoiesis. Excessive doses may result to megaloblastic anemia.

Chloroquine adverse effects include GI upset, headache, visual

disturbances, urticaria, pruritus among dark-skinned persons, and
discoloration of nail beds and mucous membranes.

Primaquine adverse effects include mild to moderate abdominal distress,

mild anemia, leukocytosis, methemoglobinemia in patients with NADH
methemoglobin reductase deficiency, and hemolytic anemias in
G6PD-deficient patients.

Source: Anti-Malarial Drugs 2021 trans

For numbers 33-36:
MATCHING TYPE.​​ Match the antimalarial with its general classification.
A. CLASS I
B. CLASS II
C. CLASS III
Ratio:
a. CLASS I Anti-Malarial Drugs: Artemisinin, Chloroquine, Mefloquine, Quinine/Quinidine, Tetracycline
b. CLASS II Anti-Malarial Drugs: Atovaquone + Proguanil - Malarone/Malanil , Sulfadoxine + Pyrimethamine - Fansidar
 c. CLASS III Anti-Malarial Drugs: Primaquine
33. Lumefantrine The correct answer is: A
34. Fansidar The correct answer is: B
35. Primaquine The correct answer is: C
36. Artemisinin The correct answer is: A
TREATMENT OF ASTHMA
For numbers 37-41:
CASE​​: A 25 year old student had episodic cough and dyspnea for 5 years triggered by exposure to dust and perfume which was relieved by
nebulization with Salbutamol. A year ago, he consulted and was advised to take Prednisone 20 mg OD for a week, which afforded relief. From
then on he would occasionally use Prednisone during attacks until recently because of persistent wheezing he took it almost daily.
37. Upon examination he was noted to have moon facie, humpback The correct answer is: Suppression of HPA axis
and truncal obesity. This is likely an adverse reaction to the drug Prednisone is a Glucocorticoid, and the listed adverse effects of
that caused: Glucocorticoids are:
Select one: ● HPA axis suppression
a. Inhibition of immune response ● Bone resorption
b. Metabolic changes ● Carbohydrate and Lipid metabolism
c. Suppression of HPA axis ● Cataract
d. Alteration in the fluid and electrolytes ● Skin thinning
● Purpura
● Dysphonia
● Candidiasis
● Growth Retardation

From Dr. Feliciano’s ppt

38. He was noted to have wheezing upon consultation at the ER. The correct answer is: Short acting B2 agonist
The first drug to be administered should be an inhaled:
Select one:
a. Short acting B2 agonist
b. Long acting B2 agonist
c. Short acting antimuscarinic
d. Corticosteroids

39. Since patient is having severe exacerbation, IV Hydrocortisone The correct answer is: 6th
was already given in anticipation that the peak plasma The IV form of Systemic Glucocorticoids, such as ​Hydrocortisone ​and
Methylprednisolone, are given to patients with acute exacerbation or
concentration of this drug will be reached on the ______ hour after chronic severe asthma which are unresponsive to oral to inhaled steroids
administration. every 6 hours​​ with a concentration of 3mg/kg.
Select one:
a. 2nd from 2020 & 2021 Pharmacotherapy of Asthma trans
b. 6th
c. 8th
d. 4th
40. Patient improved after proper management at the ER. What The correct answer is: Budesonide
drug should be given to control this patient’s symptoms of asthma? Ratio:
Select one: The patient was already given inhaled short acting B2 agonist at the ER;
a. Budesonide short acting B2 agonists must be ​used in conjunct with inhaled
b. Salmeterol steroids.​
c. Montelukast
d. Theophylline Budesonide- inhaled steroid
Salmeterol- long acting B2 agonist
Montelukast- Leukotriene antagonist
Theophylline- Methylxanthine

41. On review of history he also had allergic rhinitis. Aside from The correct answer is: Synthesis of cysteinyl leukotriene
maintaining him on inhaled steroids, the drug that best control both
his asthma and allergic rhinitis should act by inhibiting: Ratio:
Select one: - Allergic rhinitis is a sign of elevated levels of IgE, which is a sign of
a. Synthesis of cysteinyl leukotriene increased synthesis of Cysteinyl Leukotrienes. Inhibition of the
b. Cyclic nucleotide phospodiesterase synthesis of Cysteinyl Leukotrienes (a proinflammatory mediator)
c. Mediator release from mast cells has been associated with an improvement in lung function and
d. IgE from binding in the Fc region asthma symptoms.
42. How will you administer Omalizumab in a patient with severe The correct answer is: Subcutaneously every 4 weeks
asthma and high level of IgE?
Select one:
a. Orally every day
b. Subcutaneously every 4 weeks
c. Intravenously every 2 weeks
d. Inhaled 2x a day
43. Which of the following parameters is needed in administering The correct answer is: Fast inspiratory flow
dry powder inhaler among asthmatics?
Select one:
a. Coordination with actuation and inhalation
b. Breath holding at the end of inhalation
c. Hydrofluoroalkane (HFA) propellant
d. Fast inspiratory flow
44. Which among the following inhaled drug should be administered The correct answer is: Terbutaline
to effect bronchodilation in less than 5 minutes in an asthma *​Terbutaline:
patient? ● Short-acting beta-adrenoceptor agonist – Immediate effect, must
Select one: be used in conjunct with inhaled steroids
a. Nedocromil Na ● Pharmacokinetics:
b. Indacaterol ▪ Onset of action: ​1-5 minutes
c. Terbutaline ▪ Duration of action: 2-6 hours
d. Formoterol ● Most effective drugs in ​relaxing airway smooth muscle and
reversing bronchoconstriction
● Other types: Salbutamol, Fenoterol, Levalbuterol,
Metaproterenol, Pirbutero

*Formoterol:
● Long-acting beta-adrenoceptor agonist – only used as an adjunct
to inhaled steroids
● Pharmacokinetics:
▪ Duration of action: Over 12 hours
● Other type: Salmeterol

*Indacaterol:
● Ultra-long-acting beta-adrenoceptor agonist
● Pharmacokinetics:
▪ Duration of action: Over 24 hours
● Other Types: Caterol, Olodaterol, Vilanterol

*Nedocromil Na: a type of Sodium Cromoglycate which prevents asthmatic

attacks in mild to moderate asthma for 12 years or older
45. In which of the following co-morbid illness should the dose of The correct answer is: Epilepsy taking phenytoin
Theophylline in an asthmatic patient be increased?
Select one: METHYLXANTINES’ Drug Interactions (Oral: ​Theophylline​,​ Doxofylline;
a. Epilepsy taking phenytoin Parenteral: Aminophylline)
b. Pneumonia taking erythromycin
c. Congestive Heart Failure taking furosemide Increased clearance (must increase dose of methylxanthine)
d. Liver Cirrhosis taking Vit. B complex ● Enzyme reduction
○ Phenytoin
○ Barbiturates
○ Rifampicin
○ Ethanol
○ Oral contraceptives
● Smoking (tobacco, marijuana)
 ● High protein, low carbohydrate diet
● Barbecued meat
● Childhood

Decreased clearance (increase half-life; must decrease dose

of methylxanthine)
● Enzyme inhibition
○ Cimetidine
○ Erythromycin
○ Allopurinol
○ Zileuton
○ Zafirlukast
● Congestive heart disease
● Liver disease
● Pneumonia
● Viral infection and vaccination
● High carbohydrate diet
● Old age

46. An asthmatic patient who uses Inhaled Fluticasone 250 mcg 2 The correct answer is: Salmeterol
puff BID still uses Salbutamol MDI 4-5x a week. Based on GINA
guideline, what drug should be added? Based on GINA guideline, in addition to a low dose ICS (Fluticasone), a
Select one: Long Acting B2 adrenergic receptor agonist (Salmeterol) should be used.
a. Doxofylline
b. Montelukast
c. Cromolyn Na
d. Salmeterol
47. Which bronchodilator has a duration of action of every 12 hours, The correct answer is: Formoterol
hence should be given at least twice a day.
Select one: RATIO:
a. Salbutamol Short acting drugs​ are those with Immediate effects include:
b. Terbutaline Salbutamol, Terbutaline​​, Fenoterol, Levalbuterol, Metaproterenol,
c. Doxofylline Pirbuterol. These have a duration of action for ​2-6 hours.
d. Formoterol
Long- acting drugs have a duration of over ​12 hours ​and these drugs
include Salmeterol and ​Formoterol.

Doxofylline is a methylxanthine and is not used as a primary drug for

bronchodilation.
For numbers 48-52:
MATCHING TYPE​​. Match the type of drugs for asthma with their potential adverse drug reactions.
A. Beta-2 Adrenergic Agonists
B. Anticholinergics
C. Methylxanthines
D. Sodium Cromoglycate
E. Leukotriene Antagonists
48. Sudden death due to cardiac arrhythmia The correct answer is: C

49. Hypokalemia, tachycardia & tremors
50. Dryness of mouth & urinary retention
51. Bronchospasm, cough or wheezing, laryngeal edema
52. Systemic eosinophilia, vasculitis
RATIO: Methylxanthines - Adverse Effects
a.) sudden death with rapid administration of aminophylline (may be due to
cardiac arrhythmia)
b.) headache, dizziness, nausea, vomiting, palpitation, diuresis,
hypotension, precordial pain, tachycardia, severe restlessness, agitation,
and emesis (if > 20 ug/mL); focal seizure (rare below < 40 ug/mL)
c. behavioral toxicity: anxiety, fear or panic
The correct answer is: A
RATIO: Beta-2 Adrenergic Agonists - Adverse effects
INHALED:
a.) few side effects at recommended doses
b.) at higher doses: tachycardia, cardiac arrhythmias, CNS effects
(restlessness, apprehension, anxiety), tremor
ORAL:
a.) Tremors, muscle cramps, cardiac tachyarrhythmias (due to
hypokalemia), metabolic disturbances
The correct answer is: B
RATIO: Anticholinergic - Adverse reactions
a.) Tachycardia, inhibition of secretions (dry mouth)
b.) Rarely, glaucoma and urinary retention (especially those with Benign
Prostatic Hyperplasia)
The correct answer is: D
RATIO: Sodium cromoglycate - Adverse reactions
a.) Minor and infrequent (1 in 10,000 patients)
b.) Bronchospasms, cough or wheezing, laryngeal edema, joint swelling
and pain, angioedema, headache, rash and nausea
c.) Rarely, anaphylaxis
d.) Bad taste
The correct answer is: E
 RATIO: Leukotriene antagonists - Adverse reactions

ZAFIRLUKAST and MONTELUKAST

a.) Systemic eosinophilia

b.) Vasculitis
c.) Zafirlukast may interact with warfarin and increase prothrombin time

ZILEUTON

a.) Elevation of liver enzymes

b.) decreased clearance of theophylline
ANTITUSSIVES
53. Which of the following agents increase effectivity of cough by The correct answer is: Carbocysteine
unsticking highly adhesive secretions from the airway wall?
Select one: DIPHENHYDRAMINE- anti-histamine; with antitussive (cough
a. Diphenhydramine suppressant), anticholinergic, antiemetic and sedative properties; used for
b. Lidocaine acute cough due to common colds or in chronic cough due to upper airway
c. Carbocysteine syndrome
d. Dextromethorphan
LIDOCAINE- local anesthetic; blocks sodium voltage channels in sensory
nerves; antitussive (inhibits cough by selectively inhibiting Aδ fibers in the
lungs

CARBOCYSTEINE- mucolytic; reduces mucus viscosity and facilitate

expectoration

DEXTROMETHORPHAN- centrally acting cough suppressant; suppress

cough by altering the threshold for cough initiation via its effects as NMDA
antagonist at the level of antagonizing glutamate receptors in the nucleus
of Tractus solitarius in CNS

54. Which of the following drugs mitigate reflux cough due to The correct answer is: Domperidone
aspiration
into the airway? LIDOCAINE- local anesthetic; blocks sodium voltage channels in sensory
Select one: nerves; antitussive (inhibits cough by selectively inhibiting Aδ fibers in the
a. Lidocaine lungs
b. Acetylcysteine
c. Domperidone
d. Dextromethorphan
 ACETYLCYSTEINE- mucolytic; reduces mucus viscosity by reducing
disulfide bridges that bind glycoproteins to other proteins such as albumin
and IgA

DOMPERIDONE- antacid; for reflex cough (caused by stomach acidity)

DEXTROMETHORPHAN- centrally acting cough suppressant; suppress

cough by altering the threshold for cough initiation via its effects as NMDA
antagonist at the level of antagonizing glutamate receptors in the nucleus
of Tractus solitarius in CNS
55. Which of the following drugs inhibit cough by inhibiting Aδ fibers The correct answer is: Lidocaine
in the lungs during tracheal intubation?
Select one: ACETYLCYSTEINE- mucolytic; reduces mucus viscosity by reducing
a. Acetylcysteine disulfide bridges that bind glycoproteins to other proteins such as albumin
b. Diphenhydramine and IgA
c. Lidocaine
d. Metoclopramide DIPHENHYDRAMINE- anti-histamine; with antitussive (cough
suppressant), anticholinergic, antiemetic and sedative properties; used for
acute cough due to common colds or in chronic cough due to upper airway
syndrome

LIDOCAINE- (intravenous) local anesthetic; blocks sodium voltage

channels in sensory nerves; antitussive (inhibits cough by selectively
inhibiting Aδ fibers in the lungs

METOCLOPRAMIDE- antacid; peripheral dopamine agonist like

Domperidone

56. Which of the following is a peripherally-acting cough The correct answer is: Levodropropizine
suppressant?
Select one: BUTAMIRATE- centrally acting cough suppresant; for dry and
a. Butamirate non-productive cough
b. Levodropropizine
c. Dextromethorphan LEVODROPROPIZINE- peripherally-acting cough suppressant; inhibits
d. Codeine firing of sensory C fibers in the respiratory tract.

DEXTROMETHORPHAN- centrally acting cough suppressant; suppress

cough by altering the threshold for cough initiation via its effects as NMDA
 antagonist at the level of antagonizing glutamate receptors in the nucleus
of Tractus solitarius in CNS

CODEINE- centrally-acting cough suppressant; works through

conjugation of codeine and its metabolite by UGT 2B7 to 3 and 6
glucuronides
57. Which of the following agents are developed anti-cancer The correct answer is: Erlotinib
therapies that are currently found to inhibit mucus hypersecretion in
COPD patients? RATIO: EGFR (epidermal growth factor) inhibitors: GEFITINIB &
Select one: ERLOTINIB: anti-cancer therapies, being assess as treatment for mucus
a. Carboxymethylcysteine hypersecretion in COPD
b. DNAse
c. Morphine
d. Erlotinib
58. Chemical-evoking cough that may be future pharmacologic The correct answer is: Any of the above
targets for the treatment of cough is/are which of the following?
Select one: RATIO: BRONCHOPULMONARY (AFFERENT NERVE) SUBTYPES: C
a. Capsaicin fibers
b. Bradykinin - Evokes cough by activation by the ff chemicals:
c. Acrolein - Bradykinin and by agonists of the ionotropic receptors
d. Any of the above - TRPV1 agonists (capsaicin, resiferatoxin, protons)
- TRPA1 agonists (allylisothiocyanate, acrolein, cinnameldehydr)
59. The drug Dextromethorphan treats cough by which of the The correct answer is: Inhibit N-methyl-d-aspartate receptors in the brain
following mechanisms?
Select one: RATIO: COUGH SUPPRESSANTS: Dextrometorphan
a. Breaks disulfide bonds within the mucus - MOA: binds series of receptors: NMDA, δ1, nicotinic, serotonergic
b. Inhibit N-methyl-d-aspartate receptors in the brain receptors
c. Increasing mucus volume - Suppress cough by altering the threshold for cough initiation via its
d. Inducing more cough to help expectorate the phlegm effects as NMDA antagonist at the level of antagonizing glutamate
receptors in the Nucleus Tractus Solitarius in CNS
60. A common side effect expected with morphine at its antitussive The correct answer is: Constipation
dose is:
Select one: RATIO: OPIATES: MORPHINE
a. Euphoria - Characteristic: Adverse effect at antitussive dose: Constipation (common
b. Respiratory depression to all opiates including codeine)
c. Constipation Answer: Constipation
d. Somnolence
SOURCE: Treatment of Cough (Dra. Carungcong) Batch 2020
transcription
61. Ceiling dose for morphine’s antitussive effect is: The correct answer is: 20 mg/day
Select one:
a. 10 mg/day Even though 10 mg/day is still within therapeutic range, the question asks
b. 20 mg/day for ​ceiling dose​​.
c. 30 mg/day The ceiling dose of Morphine for antitussive action is a dose of 20 mg daily
d. 40 mg/day because there are no additional benefits for doses exceeding 20 mg/day.
Hence, both 30 mg/day and 40 mg/day will be rendered useless.
62. Which of the following drugs acts peripherally to suppress The correct answer is: Lidocaine
cough?
Select one: Butamirate citrate, Morphine, and Pentoxyverine are centrally-acting
a. Butamirate drugs. The inhibit coughing centrally by acting in the CNS. Though not
b. Lidocaine listed as a peripherally acting drug in the trans, Lidocaine is considered as
c. Morphine peripherally acting due to is mechanism of action by blocking the Na​+
d. Pentoxyverine voltage channels in the sensory nerve.
63. Which of the following is a centrally-acting cough suppressant The correct answer is: Butamirate
with no addiction potential?
Select one: Morphine and Codeine are opioid derivatives hence it is considered to
a. Morphine have an addictive potential. Dextromethorphan is a sigma-1 receptor
b. Butamirate agonist and N-methyl-D-aspartate (NMDA) receptor antagonist, it has a
c. Codeine similar pharmacodynamic effect to, for instance, lysergic acid diethylamide
d. Dextromethorphan (LSD), ketamine, or psilocybin. Hence, binding to their receptors may
induce addiction. Butamirate, on the other hand,
64. Which of the following drugs will best benefit a terminally-ill The correct answer is: Benzonatate
patient with refractory cough resistant to opioids’ antitussive action?
Select one: Benzonatate is a local anesthetic used for chronic cough resistant to other
a. Acetylcysteine therapy (e.g. TB) and for refractory cough or cough resistant to opioids in
b. Benzonatate palliative care setting.
c. Erdosteine
d. Bromhexine
For numbers 65-68:
CASE 1​​: A 32 year old female with fever, pleuritic chest pain and cough productive of thick, tenacious, yellowish sputum of 1 week duration
consulted at the OPD. She claims not being able to sleep well at night due to persistent coughing.
65. Which of the following is the most likely cause of the cough in The correct answer is: Bacterial pneumonia
Case 1? RATIO: Bacterial pneumonia is a lung infection wherein the sacs are filled
Select one: with fluid, pus, and cellular debris. Since the patient presents with
a. Viral yellowish sputum, we could conclude that this is caused by a bacteria.
b. Post-nasal drip Productive cough is associated with tuberculosis, bacterial pneumonia,
c. Bacterial pneumonia and bronchitis
d. Gastroesophageal reflux disease
e. Any of the choices A is wrong because a viral infection causes dry, hacking cough
B is wrong because post-nasal drip is secondary to nasal or sinus disease
66. Which of the following is the best therapeutic objective for the The correct answer is: Reduce mucus viscosity
case? RATIO: Reduce mucus viscosity since patient’s cough is productive of
Select one: thick, tenacious, yellowish sputum and needs to be loosened from the
a. Suppress the cough peripherally to avoid central effects respiratory tract and coughed up.
b. Promote gastric motility to avoid regurgitation of acid from the
stomach
c. Suppress the cough centrally to aid in sleep
d. Reduce mucus viscosity
67. Cough in Case 1 is most likely originating at what level of the The correct answer is: Lung parenchyma
respiratory tract? RATIO:
Select one:
Origin Causes Characteristics
a. Trachea
b. Larynx Pharynx Post nasal drip usually persistent
c. Lung parenchyma
d. Pharynx Larynx Laryngitis, tumor, Harsh, barking,
whooping cough, painful, persistent
croup

Trachea Tracheitis Painful

Lung Parenchyma Tuberculosis, Productive often at

pneumonia, night
bronchiectasis

68. Symptomatic relief of coughing described in Case 1 is best The correct answer is: Guaifenesin
relieved by which of the following supportive cough drug? RATIO: Guaifenesin is an expectorant AND antitussive and it ​acts by
Select one: loosening mucus in the airways and the patient has thick yellowish
a. Guaifenesin sputum that needs to be expectorated
b. Esomeprazole
c. Dextromethorphan B is wrong because Esomeprazole is an antacid
d. Diphenhydramine C is wrong because Dextromethorphan is a centrally acting cough
suppressant
D is wrong because it is an antihistamine
ANTI-TUBERCULOSIS
For numbers 69-73:
For the following questions, classify where the following patients will be registered based on the National Tuberculosis Program Manual of
Procedure.
CHOICES: New
Relapse
Treatment after failure
 Previous treatment, outcome unknown
Treatment after lost to follow-up
69. L.M. 45/F was diagnosed with TB and received prior treatment The correct answer is: Previous treatment, outcome unknown
which was completed.
70. G.B. 22/M, unremarkable past medical history, consulted for The correct answer is: New
weight loss, general body malaise, loss of appetite and persistent Ratio: ​Unremarkable past medical history → ​gives a clue that this is a
cough. Work-ups done and patient was diagnosed with pulmonary new case
TB and prescribed treatment.
71. D.L. 35/F was already a registered patient of the DOTS program The correct answer is: Treatment after lost to follow-up
in their locality. Due to work issues, she was transferred and
returned to the facility for consult. Record of her last visit revealed
that she was seen twice but she should be currently on the 3rd
month of maintenance treatment.
72. S.M. 40/F on her 6th month of quadruple anti-TB treatment. On The correct answer is: Treatment after failure
follow-up sputum culture revealed growth of Mycobacteria.
73. R.S. 50/M consulted because of progressive weight loss, night The correct answer is: Relapse
sweats and body malaise. Past medical history revealed he was
diagnosed and treated for TB during his early thirties. A signed
certificate of clearance from the DOTS center where he received
treatment was given to the patient. Current work-ups and physical
exam findings warrant another course of anti-TB medication.
For numbers #74-78:
MATCHING TYPE.​​ Match the anti-TB drugs to its appropriate description/property.
A. Isoniazid
B. Bedaquiline
C. Co-trimoxazole
D. Rifampicin
E. Ethambutol
74. Dose adjustment needed in those with renal disease The correct answer is: E
75. Prophylaxis for those with TB/HIV coinfection The correct answer is: C
76. Increases levels of Carbamazepine The correct answer is: A
77. Reduces levels of antihypertensives The correct answer is: D

Rifampicin is a ​potent CYP P450 Inducer ​which increases the elimination

of the ff:

anticoagulants
methadone
cyclosporine
anticonvulsants,
 protease inhibitor
non-nucleoside reverse transcriptase
inhibitors,
contraceptives, et al.
antihypertensives(​ source:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC
5015508/)

Due to being a ​potent CYP450 Inducer, it is contraindicated in patients

with HIV. ​RIFABUTIN ​is used instead which has less CYP P450 inducer
activity. (Source: 2021 Trans TB disease and treatment)
78. Causes QT prolongation The correct answer is: B

Bedaquiline Fumarate which is one of the newly approved anti-TB drugs

launched in December 2012 indicated for MDR-TB.

However, it can cause fatal arrhythmias due to QT prolongation; therefore,

should only be given as a drug of last resort.

Source: 2021 trans TB disease and Treatment

79. Based on WHO guidelines, in treating TB in children under
The correct answer is: Streptomycin
Category II regimen which among the following is no longer
recommended? RATIO: According to the WHO guidelines (2010) TB Drug Dosage
Select one: guidance for children include the ff:
a. Isoniazid
b. Ethambutol
c. Streptomycin 1) The dosages of the following four TB drugs should be:
d. Pyrazinamide ● Isoniazid(H) 10mg/kg (range 10-15 mg/kg); maximum
dose 300 mg/day
● Rifampicin(R) 15mg/kg (range 10-20 mg/kg); maximum
dose 600 mg/day
● Pyrazinamide(Z) 35mg/kg (30-40) mg/kg)
● Ethambutol(E) 20mg/kg (15-25 mg/kg)

As children approach a body weight of 25kg, adult dosages can be

used.

2) In some settings, for example where the prevalence of HIV is high,

or where resistance to Isoniazid is high, or both, children should be
treated with a four drug regime (HRZE) for 2 months, followed by a 2
drug regime (HR) for four months at the above dosages.
 STREPTOMYCIN​​ is not included in the major recommendations by WHO.

80. Pharmacokinetic studies in children have been favorable and The correct answer is: Ethambutol
supports the addition of this drug in the treatment of TB in children:
Select one: In 2006, WHO revised its recommendations ​on the use of ethambutol in
a. Pyrazinamide children, following an extensive review of efficacy and safety. The
b. Rifampicin outcome of that review was to amend the recommended daily dose of
c. Ethambutol ethambutol for children of all ages to 20 mg/kg, with a range of 15–25
d. Streptomycin mg/kg. The process of carrying out that review and amending the
recommendations highlighted two issues: first, that children metabolize TB
medicines differently to adults, and second, that there was evidence
available to inform dosage recommendations about “old” drugs. Neither of
these findings are new but the systematic consideration of them to inform
WHO recommendations is important​.

Source: http://www.who.int/bulletin/volumes/86/9/08-056804/en/
81. D.S. a 26 year old primigravid was diagnosed with tuberculosis. The correct answer is: Regimen would be 2HRZE/4HR
In the approach to treatment which among the following is correct:
Select one:
a. Regimen would be 2HRZE/4HR
b. Isoniazid treatment would entail Vit. B6 supplementation of
25mg/kg/day
c. Explain the risks to the fetus when taking anti-TB medications
d. Treatment with Streptomycin should be started after the third
trimester of pregnancy.
82. In terms of Hepatotoxicity of anti-TB meds which among the The correct answer is: Enzyme elevation >5x the upper limit of normal
following is correct: without signs and symptoms will warrant treatment modification
Select one:
a. Enzyme elevation >5x the upper limit of normal without signs and
symptoms will warrant treatment modification
b. Pyrazinamide is the least hepatotoxic among the three first line
drugs
c. Signs and symptoms of drug induced hepatitis only requires dose
adjustments and not cessation of treatment
d. Enzyme elevation >5x the upper limit of normal with signs and
symptoms should warrant modification of treatment
83. Current TB guidelines for children based on WHO, recommends The correct answer is: 10-15
that daily dosing of INH should be (in mg/kg/BW):
Select one: Isoniazid -> 10-15 mg/kg
a. 8-12 Rifampicin -> 10-20 mg/kg
b. 10-15 Pyrazinamide -> 30-40 mg/kg
c. 15-20 Ethambutol -> 15-25 mg/kg
d. 20-30
*As per WHO National Guidelines On Management of Tuberculosis in
Children

84. Mycobacterial resistance to Isoniazid may result in: The correct answer is: Non-conversion of drug to its active form
Select one:
a. Defects in DNA repair mechanisms INH resistance is primarily due to the presence of the katO in the
b. Drug is extruded before reaching target site mycobacteria.This binds with the drug enzyme, preventing conversion of
c. Altered protein structure the pro-drug into it’s active form. Non-activation leads to resistance
d. Non-conversion of drug to its active form
Source: batch 2021 trans: TB disease and treatment, Fig. 2, mechanism of
action of the mycobacterium against certain drugs
QUINOLONES AND TETRACYCLINES
85. J.B.is a very busy male executive who is diagnosed with The correct answer is: Levofloxacin
prostatitis. Select which of these Fluoroquinolones would best be
prescribed for his condition? Levofloxacin is the first line of drug used for Prostatitis
Select one: Can also use: Norfloxacin, Ciprofloxacin, Ofloxacin
a. Levofloxacin
b. Ofloxacin
c. Norfloxacin
d. Ciprofloxacin Source: batch 2021 trans: quinolones and tetracycines
86. Which of these Fluoroquinolones/Quinolones reaches the The correct answer is: Ofloxacin
highest concentration in the cerebrospinal fluid compared to the
serum levels?
Select one:
a. Ofloxacin
b. Norfloxacin
c. Nalidixic acid
d. Ciprofloxacin
87. Which of these enzymes interferes with the separation of The correct answer is: Topoisomerase IV
replicated chromosomal DNA into respective daughter cells during
cell division? Mechanism of Action of Fluoroquinolones
Select one: Quinolones block bacterial DNA synthesis by inhibiting bacterial
a. Topoisomerase I (DNA gyrase) topoisomerase II (DNA gyrase) and topoisomerase IV.
b. Topoisomerase II
c. Topoisomerase III
d. Topoisomerase IV ● Inhibition of ​topoisomerase II DNA gyrase - ​prevents the relaxation
of positively supercoiled DNA that is required for normal transcription
and replication.
● Inhibition of ​topoisomerase IV -​interferes with separation of
replicated chromosomal DNA into the respective daughter cells
during cell division.

Katzung’s Basic & Clinical Pharmacology 12th Ed.(page 835)

88. R.D. is a 42 year old male diagnosed with community-acquired The correct answer is: Moxifloxacin
pneumonia but his laboratory test also revealed less than normal
creatinine clearance (<50 ml/min). Which of these drugs would be Pharmacokinetics
safe to administer to him? Dosage adjustment is required for patients with creatinine clearances less
Select one: than 50ml/min, the exact adjustment depending on the degree of renal
a. Norfloxacin impairment and the specific fluoroquinolone being used. ​Dosage
b. Ciprofloxacin adjustment for renal failure is not necessary for ​moxifloxacin.​
c. Ofloxacin
d. Moxifloxacin Primary route of excretion for Moxifloxacin is nonrenal, while other
fluoroquinolones are mostly renal.

Katzung’s Basic & Clinical Pharmacology 12th Ed.(page 836)

89. Select which Fluoroquinolone is the drug of choice for anthrax The correct answer is: Ciprofloxacin
infection?
Select one: Ciprofloxacin ​- is a drug of choice for prophylaxis and ​treatment of
a. Ciprofloxacin anthrax
b. Gatifloxacin Gatifloxacin - increased serum digoxin; associated with hyperglycemia in
c. Moxifloxacin diabetic patients and with hypoglycemia in patients also receiving oral
d. Levofloxacin hypoglycemic agents.
Moxifloxacin - hepatic clearance
Levofloxacin - first line of drug used for prostatitis
Katzung’s Basic & Clinical Pharmacology 12th Ed
Batch 2021’s trans
90. Which of these fluoroquinolones is used against atypical The correct answer is: Levofloxacin
pneumonia infections?
Select one:
a. Ciprofloxacin
b. Levofloxacin
c. Norfloxacin
d. Ofloxacin
91. Which of these adverse drug effects caused by The correct answer is: Tendonitis
Fluoroquinolones is potentially more severe when it occurs in
adults?
Select one: It is severe since adults are more prone mechanical causes include poor
a. Neuropathy gastrocnemius-soleus flexibility, low-flexibility shoes, muscle fatigue
b. Photosensitivity resulting in tendon elongation, and micro tearing.
c. Tendon rupture MOA is not clear - however, theoretically it is possible that
d. Tendonitis fluoroquinolones have direct cytotoxic effect on enzymes found in
mammalian musculoskeletal tissue.

92. Which of these mechanisms of resistance applies more to The correct answer is: Plasmid-mediated resistance
Ciprofloxacin in recent years?
Select one: Video transcript from Doc Deo’s Lecture
a. Reduced cell permeability Recently discovered: For ciprofloxacin, there is mutation
b. Drug protein ejection mechanism of the chromosomal DNA through the introduction of
c. Plasmid-mediated resistance plasmid proteins. This is known as ​Plasmid-associated
d. Decreased affinity for DNA ribosomes resistance​​. For example, acetyltransferase enzymes are
produced so that drug will not be able to bind to the
target area.

93. T.L. is a 28 year old, female who consulted because of dysuria. The correct answer is: Nalidixic acid
Her vital signs were normal but she was diagnosed to have
uncomplicated urinary tract infection. Which of these drugs would Clincal Uses
be appropriate for her? ● Nalidixic acid: uncomplicated UTI
Select one: ● Gatifloxacin: complicated UTI and catheter-related infections, STDs
a. Nalidixic acid (uncomplicated ​N. gonorrhea​), acute bacterial bronchitis,
b. Gatifloxacin Community-acquired pneumonia in hospitalized and non-hospitalized
c. Moxifloxacin patients with risk factors for penicillin-resistant pneumococcal infection
d. Norfloxacin ● Moxifloxacin: intra-abdominal infections
● Norfloxacin: uncomplicated pyelonephritis, GIT infections (by ​Shigella
spp., enterotoxigenic E. coli, Campylobacter jejuni)​
94. A. J. is a 35 year old male with cystic fibrosis. He was admitted The correct answer is: Ciprofloxacin
to the hospital where his laboratory tests revealed a pseudomonal
infection of the soft tissue. Which of these Fluoroquinolones is best
for treating his condition? Fluoroquinolones are used in infections of soft tissues, bones and joints
Select one: and in intra abdominal respiratory infections including ​Pseudomonas and
a. Norfloxacin Enterobacter .T​ he drug of choice and the coverage of atypical pathogens
b. Ofloxacin specially ​Pseudomonas aeruginosa ​is Ciprofloxacin.
c. Nalidixic acid
d. Ciprofloxacin
95. Which of these antibiotics inhibit the initiation of translation by The correct answer is: Tetracycline
binding to the 30S ribosomal subunit?
Select one:
a. Clindamycin Tetracyclines enter microorganisms in part by passive diffusion and in
b. Levofloxacin part by an energy-dependent process of active transport. Susceptible
c. Tetracycline organisms concentrate the drug intracellularly. Once inside the cell,
d. Erythromycin tetracyclines ​bind reversibly to the 30S subunit of the bacterial ribosome,
blocking the binding of aminoacyl-tRNA to the acceptor site on the
mRNA-ribosome complex. This prevents addition of amino acids to the
growing peptide.

Clindamycin​​, like ​Erythromycin​​, inhibits protein synthesis by interfering

with the formation of initiation complexes and with aminoacyl translocation
reactions. The binding site for clindamycin on the 50S subunit of the
bacterial ribosome is identical with that for erythromycin​.

Quinolones block bacterial DNA synthesis by ​inhibiting bacterial

topoisomerase II (DNA gyrase) and topoisomerase IV​… Fluorinated
derivatives (ciprofloxacin, ​Levofloxacin​​, and others have greatly improved
antibacterial activity compared with nalidixic acid and achieve bactericidal
levels in blood and tissues.

(Katzung, B. (2018) Basic and Clinical Pharmacology (14th Edition)

Chapters 44-46, pp 816, 821, 837. McGraw-Hill Education.
96. The most preferred Tetracycline for parenteral administration is? The correct answer is: Doxycycline
Select one:
a. Minocycline Tetracycline and Oxytetracycline are eliminated rapidly by glomerular
b. Doxycycline filtration as unchanged drugs and thus have shortest half-lives.
c. Tetracycline Demelocycline and Methacycline are intermediate. Minocycline has a low
d. Demelocycline renal clearance and less than 10% of a dose is recovered unchanged in
urine. The drug undergoes enterohepatic circulation and maybe
metabolized to a significant extent. The elimination of Doxycycline, the
longest-acting Tetracycline differs from all other analogues and is
independent of both renal and hepatic function. This drug is excreted in
the feces largely as an inactive chelated product. Thus the dose does not
require modification in patients with renal or hepatic insufficiency.
97. D.L. is a 28 year old male travel blogger who exhibited The correct answer is: Doxycycline
headaches, fevers and some skin lesions after a camping trip in a
U.S. forest. He was diagnosed with Lyme disease on the 2nd day of
his infection. Which Tetracycline can prevent the development of his Lyme disease is caused by bacteria, ​Borrelia burgdorferi ​that are
disease? transmitted to humans through a bite from an infected black-legged or
Select one: deer tick. (googled)
a. Tetracycline
b. Minocycline All tetracycline (options mentioned) inhibit bacterial protein synthesis
c. Doxycycline through its mechanism of action in bacterial ribososmes.
d. Demelocycline (Note:Tetracycline is also included in the group of tetracycline drugs)

Doxycycline is the DOC for the following:

Lyme disease (Spirochetes-Borrelia)
Pelvic inflammatory disease
Chronic bronchitis
Community acquired pneumonia

98. Resistance has limited the clinical use of Tetracyclines. Which The correct answer is: Inability of the bacteria to accumulate the drug
of these mechanisms is the major cause of resistance?
Select one: Resistance of Bacteria to Tetracycline:
a. Production of bacterial proteins resulting in preventing drug
ribosomal binding 1. Decreased intracellular accumulation​​: (drug is not able to enter
b. Inability of the bacteria to accumulate the drug the cytoplasm)
c. Mutation of ribosomal target a. Impaired influx - not allowed by the bacteria to go in
d. Enzymatic drug inactivation b. Increased efflux secondary to active transport protein
pumps (MOST IMPORTANT MECHANISM OF
RESISTANCE FOR TETRACYCLINES) - bacteria
produces ejector pumps which actively transports the drug
out of the bacterial cytoplasm.
2. “Ribosome protection” - production of proteins which interfere with
drug binding to ribosome
a. If the drug can penetrate the bacteria, on the way to the
tRNA, to the 30s subunit, ribosomal protection happens.
Ribosome will produce proteins which will now interfere
with the drug binding of Tetracycline to ribosome
3. Enzymatic inactivation - bacteria produces enzymes that will
metabolize the drug so it doesn’t reach the target, 30s

Source: 2021 trans, Katzung, Doc Deo’s lecture

99. K. A is a 24 year old male suspected to be a meningococcal The correct answer is: Minocycline
carrier having come from a place with a recent outbreak of the
disease. Which of these Tetracyclines will be able to achieve CSF Trans: Minocycline: high concentration in tears and saliva (useful
therapeutic concentrations? for eradication of meningococcal carrier state – usually do
Select one: not have sign and symptoms, they just carry the bacteria)
a. Doxycycline o Doxycycline, minocycline ➜ sustained at therapeutic
b. Tetracycline CSF levels ➜ useful for treatment of meningitis
c. Demelocycline
d. Minocycline Katzung: Minocycline, 100 mg orally twice daily for 5 days, can eradi-
cate the meningococcal carrier state, but because of side effects
and resistance of many meningococcal strains, ciprofloxacin or
rifampin is preferred.
100. Which of these adverse effects of Tetracyclines is the most The correct answer is: Epigastric distress
common cause on non-compliance in taking the drug further?
Select one:
a. Hepatotoxicity
b. Photosensitivity
c. Teeth discoloration
d. Epigastric distress

WRITTEN EXAM (20 POINTS)

I. Give the English meaning of the following Latin abbreviations: (0.5 point each)
1. p.r.n. : ​ if necessary ​-
2. h.s. : ​ hour of sleep or at bedtime ​-
3. non rep : ​ not to be repeated ​-
4. a.c. : ​ before meals ​-
5. stat : ​ immediately ​-

II. Give the apothecary equivalents of the following: (0.5 point each)
1. 3 teaspoonfuls = 15 mL
2. ½ glassful = 25 teaspoonfuls
3. 10 grains = 600 mg
4. 25 tablespoonfuls = 75 teaspoonfuls
5. 5 teaspoonfuls = 500 drops

COMPUTATION:
1. 1 teaspoonful = 5 mL → 3 teaspoonful x 5 mL/1 teaspoonful = ​15 mL
2. 1 glassful = 250 mL; 1 teaspoonful = 5 mL → ½ glassful x 250 mL/1 glassful x 1 teaspoonful/5 mL = ​25 teaspoonful
3. 1 grain = 60 mg → 10 grains x 60 mg/1 grain = ​600 mg
4. 1 tablespoonful = 3 teaspoonfuls → 25 tablespoonful x 3 teaspoonful/1 tablespoonful = ​75 teaspoonfuls
5. 1 teaspoonful = 5 mL; 1 mL = 20 drops → 5 teaspoonfuls x 5 mL/1 teaspoonful x 20 drops/1 teaspoonful = ​500 drops

III. Prescription Writing (5 points each)

1. Write a complete prescription for the control of chronic arthritic pain in a 60 year old male with degenerative osteoarthritis using Etoricoxib
60 mg once a day for one month. (Etoricoxib tablet is available in 60 mg and 90 mg tablets)

Juan Dela Cruz, 60/Male November 28, 2018

Imus, Cavite

Rx
Etoricoxib Tablet 60 mg
Dispense No. 30
Label: Take one tablet, once a day for 1 month

-​signature-
Rusty Enriquez, M.D.
License No.: 12345
PTR No.: 12345

2. Write a complete prescription for the treatment of recurrent otitis media in a 6 year old boy weighing 27 kg using Co-Amoxiclav at a dose of
35 mg/kg/day in three divided doses good for 14 days. (Co-Amoxiclav Suspension is available at a concentration of 156.25/5 mL and 312.5
mg/5 mL in 60 mL bottles)

Vincent Santos, 6/Male (27 kg) November 28, 2018

Imus, Cavite

Rx
Co-Amoxiclav Suspension 312.5 mg/5 mL
Dispense No. 4 bottles (60 mL)
Label: Give 5 mL (1 teaspoonful) every 8 hours or three times a day for 14 days

-​signature-
Rusty Enriquez, M.D.
License No.: 12345
PTR No.: 12345
COMPUTATION:
Dose = 27 kg x 35 mg/kg = 945 mg/3 divided doses = 315 mg → 312.5 is okay because it is less than 10% in deviation
Total dose = 5 mL x 3 times a day x 14 days = 210 mL
Dispense No. = 210 mL/60 mL = 3.5 bottles → 4 bottles
 3. Write a complete prescription for the treatment of anaphylactic shock, in a 20 year old male using Epinephrine at a dose of 0.5 mg
subcutaneously every 5 minutes as necessary for 3 doses. (Epinephrine Solution for injection is available in one mL ampoules containing 1
mg/mL)

Billy Reyes, 20/Male November 28, 2018

Imus, Cavite

Rx
Epinephrine Solution for Injection 1 mg/mL
Dispense No. 2 ampoules (1 mL)
Label: ​For injection. ​Inject 0.5 mL subcutaneously every 5 minutes
as necessary for 3 doses.

-​signature-
Rusty Enriquez, M.D.
License No.: 12345
PTR No.: 12345

RATIONALIZATION HEADS : H.A. and M.A.