PHARMA 2ND SEMESTER MIDTERMS NOTES

1. Primary mechanism of Diuretics in lowering BP

- Depletion of sodium stores

2. Diuretics reduce the BP levels of most patients by

- 10-15 mmHg

3. The most common adverse effect of thiazide and loop diuretic

- Potassium depletion

4. The effect of thiazide diuretic on lipid levels?

- Increased LDL

5. Mechanism of increase uric acid in patients taking thiazide diuretic

- Impairment in renal clearance

6. Mechanism of action of loop diuretics?

- Inhibits NaCl reabsorption in the TAL

7. What is the duration of action of furosemide

- 2-3 hours

8. The ototoxicity of furosemide is related to?

- dose-related

9. Hyperuricemia due to furosemide intake is attributed to

- Dose

10. Hyperglycemia secondary to thiazide intake is primarily attributed to

- Impairment in insulin release

11. Peak concentration of beta receptor antagonist after oral intake occurs at
- 1-2 hours

12. Which of the following beta receptor antagonist has the highest half-life?
- Atenolol

13. Which of the following Beta receptor antagonist has the highest bioavailability?
- Bisoprolol

14. Effect of beta receptor antagonist on lipid levels

- Increase VLDL

15. Which of the following beta receptor antagonist may be less likely to cause bradycardia?
- Acebutolol

16. Beta Receptor antagonists act on the conduction mechanism of the heart through its effect
on
- AV Node

17. Beta Receptor Antagonist which may be safer in patients who experience
bronchoconstriction with intake of Propranolol
PHARMA 2ND SEMESTER MIDTERMS NOTES

- Metoprolol

18. Reduction in the secretion of Furosemide secondary to administration of Probenecid is due

to
- Competition in the Proximal Tubule

19. Which if the following diuretic is not associated with allergic cross sensitivity in patients who
are sensitive to Sulfonamides
- Ethacrynic Acid

20. The absence of tachycardia with intake of Prazosin is due to

- Blockade of alpha 1 >>> alpha 2 receptor

21. After protracted use, which of the following antihypertensive drug can result in hypertensive
crisis upon withdrawal?
- Clonidine

22. Which of the following antihypertensive drug is contraindicated in patients with depression?
- Clonidine

23. Hydralazine exerts its effect by dilating

- Arterioles only

24. Which of the following antihypertensive drugs is contraindicated in 2nd and 3rd trimester
pregnancy due to development of fetal death?
- Losartan

25. The development of SLE in patients taking hydralazine is attributed to

- Dose

For items 26-36, JNC 8 is used as reference

26. Which of the following antihypertensive drug is associated with increased risk of storke
during initial therapy of non-black patients with diabetes?
- Beta Blocker

27. Which of the following antihypertensive drug is associated with increased risk of stroke,
heart failure and combined outcomes than initial treatment of diuretic during initial therapy
of non-black patients with diabetes?
- Alpha Blocker

28. Which of the following antihypertensive drug is associated with increased risk of stroke
during initial therapy of black patients?
- ACE inhibitor

A 65 year old female, Filipino, is diagnosed to have hypertension. BP of 140/90, HR of 85, RR of

20; the rest of the PE findings are unremarkable. FBS of 90 mg/dl; Creatinine of 0.8mg/dl
29. Based on JNC 8, what is the target BP for this patient?
- <150/90 mmHg

30. Based on JNC 8, what is the recommended antihypertensive medication for this patient?
PHARMA 2ND SEMESTER MIDTERMS NOTES

- Hydrochlorothiazide

A 65 year old female, Filipino, is diagnosed to have hypertension. BP of 140/90, HR of 85, RR of

20; the rest of the PE findings are unremarkable. FBS of 250 mg/dl; SGPT of 25 mg/dl; Creatinine
of 3 mg/dl; Na of 135 mEqs; K of 3.9 mEqs; TC of 200 mg/dl. 12 lead ECG: Non-specific ST wave
changes

31. Based on JNC 8, what is the target BP for this patient?

- <140/90 mmHg

32. Based on JNC 8, what is the recommended anti hypertensive medication for this patient?
- Losartan

33. What laboratory test should be requested to monitor the adverse effect of the drug identified
above?
- Creatinine and Potassium

A 45 year old male, Filipino, is diagnosed to have hypertension. The patient is a non smoker and
non drinker. BP of 140/90, HR of 85, RR of 20; the rest of the PE findings are unremarkable.
Weight of 120 lbs, Heaight if 5’4”. FBS of 160 mg/dl; SGPT of 12 mg/dl;
Creatinine of 3 mg/dl; Na of 135 mEqs; K of 3.9 mEqs; TC of 200 mg/dl. 12 lead ECG: Normal

34. Based on JNC 8, what is the target BP for this patient?

- <140/90 mmHg

35. Based on JNC 8, what drug is not included in the recommendation for antihypertensive
medication?
- Atenolol

36. When is the right time for the patient to come for follow up?
- 1 month

For items 37-38, JNC 7 was used as reference

37. What non pharmacologic intervention may be recommended to this patient that will have a
maximum impact on the reduction of BP?
- Weight reduction

38. If a DASH eating plan is advised, by how many mmHg would the patient’s BP be lowered?
- 8-14

For items 39-49, Pharmacology by Katzung 12th Ed was used as reference

39. Which of the following statin has the longest plasma half life?
- Rosuvastatin

40. Simvastatin 80 mg/day is not recommended because of increased risk of

- Myopathy

41. Marked elevation in creatine kinase activity due to statin may lead to this condition if the
drug is not discontinued
PHARMA 2ND SEMESTER MIDTERMS NOTES

a. Myopathy
b. Myocardial damage
c. Hypothyroidism
d. Renal injury

42. Which of the following antibiotics will interfere with the metabolism of atorvastatin?
a. Cephalosporin
b. Fluoroquinolone
c. Macrolide
d. Penicillin

43. Which of the following statin will interact with grapefruit juice?
a. Atorvastatin
b. Fluvastatin
c. Pravastatin
d. Rosuvastatin

44. Hypersensitivity syndrome associated with statin

a. Angioedema
b. Hepatitis
c. Hemolytic disorder
d. Lupus like disorder

45. Concomitant use of statin and Amiodarone increases the risk of

a. Arrhythmia
b. Myopathy
c. Peripheral neuropathy
d. Hypersensitivity syndrome

46. Fibrates are primarily useful in cases with increased level of

a. LDL
b. VLDL
c. Chylomicron
d. Triglyceride

47. The risk of developing this disease condition increases with the combination of fibrate and
statin
a. Hyperglycemia
b. Gallstone
c. Neuropathy
d. Myopathy

48. The risk of developing this disease condition increases with the combination of fibrates
and bile acid binding resin
a. Hyperglycemia
b. Gallstone
c. Neuropathy
d. Myopathy

49. Primary mechanism of action of ezetimibe

a. Inhibit VLDL secretion
PHARMA 2ND SEMESTER MIDTERMS NOTES

b. Ligand for PPAR alpha

c. Up-regulation of LDL receptors in the liver
d. Reduced absorption of cholesterol leading to reduction in LDL

 For items 50 to 62 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to

Reduce Atherosclerotic Cardiovascular Risk in Adults is used as reference

50. Which of the following statin will lower the LDL C level >50%?
a. Atorvastatin 20mg
b. Lovastatin 20mg
c. Rosuvastatin 20mg
d. Simvastatin 20mg

51. Indication for requesting CK in patients taking statin

a. Routine testing
b. Muscle symptoms
c. LFT elevation
d. Abnormality in urination

52. Based on the Lipid Guideline 2013, in which of the following situation should you consider
reducing the dose of the statin?
a. After 6 months of treatment
b. Total cholesterol <160mg/dl
c. LDL-C <40mg/dl
d. HDL >50mg/dl

53. Aside from fasting lipid panel, which of the following is requested prior to starting statin
therapy
a. CBC and urinalysis
b. Creatinine & Uric acid
c. HBA1C & ALT
d. Ultrasound of the GB

54. Which of the following should be requested as baseline test for patients given Niacin?
a. Prothrombin time & CBC
b. Creatinine & SGPT
c. FBS & Uric acid
d. Serum Na & K

55. Before finofibrate is initiated, what laboratory test should be requested?

a. Creatinine
b. SGPT
c. HBA1C
d. Uric acid

56. Discontinuing BAS is associated with elevation of?

a. FBS
b. SGPT
c. Creatine kinase
d. Triglyceride
PHARMA 2ND SEMESTER MIDTERMS NOTES

 A 45 year old male with history of stable angina

BP-130/80; HR-80; RR-18
Total cholesterol-200mg/dl; LDL-C of 200mg/dl; HDL-50mg/dl; FBS-100mg/dl
ECG-IHD

57. What is the recommended management for this patient?

a. Counselling
b. High intensity statin
c. Moderate intensity statin
d. Lifestyle modification
 A 45 year old male with history of stable angina
BP-140/90; HR-80; RR-18
LDL-C of 100mg/dl; FBS-190mg/dl
ECG-IHD
ASCVD risk-5.3%

58. What is the recommended management for this patient?

a. Non statin treatment
b. High intensity statin
c. Moderate intensity statin
d. Counselling & Lifestyle modification

59. When will you request for fasting lipid panel to monitor response to treatment?
a. 1-3 months
b. 4-6 months
c. 8-10 months
d. One year

 A 45 year old male apparently well

BP-130/80; HR-80; RR-18
LDL-C of 100mg/dl; FBS-100mg/dl
ECG-normal
ASCVD risk-1.7%

60. What is the recommended management for this patient?

a. Non-statin treatment
b. High intensity statin
c. Moderate intensity statin
d. Counselling & Lifestyle modification

 A 45 year old male, smoker, alcohol drinker

BP-150/90; HR-80; RR-18
LDL-C of 100mg/dl; FBS-190mg/dl
ECG-normal
Medication: Amlodipine 5mg/day
ASCVD risk-13%

61. What is the recommended management for this patient?

a. Non-statin treatment
b. High intensity statin
PHARMA 2ND SEMESTER MIDTERMS NOTES

c. Moderate intensity statin

d. Counselling & Lifestyle modification

 A 75 year old female with old MI and history of stroke

BP-130/80; HR-80; RR-18
Laboratory test: LDL-C of 130mg/dl; FBS-190mg/dl
Medications: Aspirin 100mg OD
Losartan 50mg BID
Metformin 500mg BID

62. What is the recommended intervention for this patient aside from lifestyle modification?
a. Counselling on proper diet
b. Moderate intensity statin
c. High intensity statin
d. No pharmacologic treatment

 For items 63 to 80 Pharmacology by Katzung 12th ed/lecture is used as reference

63. Insulin is secreted in a pulsatile fashion with basal insulin value of 5-15mu/ml. What is the
half-life of insulin?
a. 3-5 min
b. 30 min
c. 1 hour
d. 4 hours

64. Which preparation of insulin has early peak more closely mimicking endogenous prandial
insulin secretion?
a. Regular insulin (Humulin R)
b. Insulin glargine (Lantus)
c. Insulin aspart (Novo Nordisk)
d. NPH insulin (Humulin N)

65. The only type of insulin that should be administered intravenously and useful in patients
with ketoacidosis.
a. Insulin glargine (Lantus)
b. Insulin aspart (Novo Nordisk)
c. Insulin glulisine (Apidra)
d. Regular insulin (Humulin R)

66. When injected SQ, this type of insulin dissociates into monomers allowing rapid absorption
with onset of action within 5-15 minutes.
a. Regular Novolin R
b. Regular Humulin R
c. NPH Humulin N
d. Insulin lispro

67. This type of insulin is made through recombinant DNA technology to produce a molecule
identical to that of human insulin. The hexameric nature causes delayed onset and
prolonged time to peak.
a. Insulin Detemir (Levemir)
b. Insulin lispro (Humolog)
PHARMA 2ND SEMESTER MIDTERMS NOTES

c. Regular insulin (Humulin R)

d. Premixed insulin

68. This type of insulin is combined with protamine.

a. Insulin Glargine (Lantus)
b. Insulin lispro (Humolog)
c. Regular insulin (Humulin R)
d. NPH insulin (Humulin N)

69. Which preparation of insulin analog is peakless with broad plasma concentration plateau?
a. NPH insulin (Humulin N)
b. Regular insulin (Humulin R)
c. Insulin Glargine (Lantus)
d. Insulin lispro (Humolog)

70. Which preparation of insulin is associated with less hypoglycemia than NPH insulin?
a. Insulin Detemir (Levemir)
b. Insulin lispro (Humolog)
c. Regular insulin (Humulin R)
d. Premixed insulin

71. In severe hypoglycemia due to insulin therapy where the patient is unconscious, the initial
treatment of choice according to Katzung 18th ed is?
a. Glucagon
b. Oral glucose
c. IV glucose
d. Discontinuation of insulin

72. Sulfonylurea exert its action by

a. Inhibition of calcium efflux
b. Inhibition of K efflux
c. Increase entry of Na
d. Closure of glucose transporter

73. Which drug is indicated in patients with allergy to sulfonylurea?

a. Gliclazide
b. Repaglinide
c. Tobutamide
d. Tolazamide

74. Which secretagogue has the lowest potential for hypoglycemia?

a. Glyburide
b. Nateglinide
c. Chlorpropamide
d. Tolbutamide

75. Which of the anti-diabetic drug does not depend on functioning pancreatic cells?
a. Glyburide
b. Repaglinide
c. Metformin
d. Sitagliptin
PHARMA 2ND SEMESTER MIDTERMS NOTES

76. Instruction for the intake of Acarbose?

a. After meals
b. Before meals
c. After the first mouthful
d. No relation to intake of food

77. Which among the anti-diabetic drug has the greatest abilty to lower the HbA1c?
a. Acarbose
b. Metformin
c. Pramlintide
d. Sitagliptin

78. What is the initial preferred drug for type 2 diabetes based on a well-conducted multi-
center RCT or Meta analysis?
a. Gliclazide
b. Metformin
c. Repaglinide
d. Acarbose

79. Weight gain due to sulfonylurea is due to?

a. Increase food intake due to hypoglycemia
b. Increase gluconeogenesis
c. Increase entry of glucose in the cells
d. Decrease lipolysis

80. A 65-year-old female with type 2 diabetes was started on insulin therapy. She was started
on Insulin glargine (Lantus solo star) at 10 units a day. The drug was given at 6:00pm.
When is the right time to check the blood sugar to determine the sugar level at onset of
action of the drug?
a. Between 6:15-6:30pm
b. Between 7:00-7:30pm
c. Between 8:30-9:30pm
d. Between 10:00-12:00mn