PHARMACOLOGY *Drugs associated with AGRANULOCYTOSIS include

Preliminary Examinations NSAIDs, especially phenylbutazone, carbamizole, and

AY 2015 – 2016, First Semester clozapine, and sulfonamides. THROMBOCYTOPENIA is
a side effect of quinine, heparin, and thiazide diuretics.
APLASTIC ANEMIA is a side effect of chloramphenicol.
HEMOLYTIC ANEMIA is a side effect of methyldopa.

6. Which of the following antibiotics has a high

probability of causing anaphylaxis?

A. Aminoglycoside
B. Macrolide
C. Tetracycline
D. PENICILLIN (accounts for 75% of
anaphylactic deaths)

7. A type B reaction that occurs in patients taking

fenfluramine that led to the withdrawal of the
1. Which of the following diuretics can cause drug in 1973?
thrombocytopenia?
A. Anaphylaxis
A. Furosemide B. PULMONARY HYPERTENSION
B. Spironolactone C. Oculocutaneous Disease
C. THIAZIDE D. Obstructive Jaundice
D. Acetazolamide
8. What metabolite accumulates in paracetamol
2. Question is not clear in the recording. hepatotoxicity?

3. Which of the following anesthetic drugs A. Cystine Mercaptopuric

causes allergic liver damage? B. Glucoronide
C. Glutathione
A. Bupivacaine (side effect is cardiotoxicity) D. NAPBQI (N-acetyl-p-benzoquinone imine)
B. Enflurane (side effect is depressed normal
cardiac contractility)
C. HALOTHANE (causes halothane hepatitis)
D. Lidocaine (side effect is transient neurologic
symptoms – syndrome of transient pain)

4. Which of the following antihypertensive drugs

causes SLE-like symptoms?

A. Captopril (ACE inhibitor; side effects are

cough, angioedema, hyperkalemia, renal
failure, teratogenicity)
B. HYDRALAZINE (vasodilator; causes lupus-
like symptoms in slow acetylators at
higher doses)
C. Losartan (angiotensin receptor blocker; side
effect same as ACE inhibitors but less cough)
D. Metoprolol (beta blocker; side effect is
bradycardia)

5. Agranulocytosis occurs in this drug as a type

II reaction.
9. The hepatotoxicity caused by methotrexate is
A. Capsaicin
due to:
B. Corticosteroids
C. Opioids
A. Exposure to reactive metabolites
D. PHENYLBUTAZONE
B. INHIBITION OF DNA AND RNA SYNTHESIS
C. Generation of O2 radicals
D. Depletion of glutathione
10. Nephrotoxicity of NSAIDs is manifested as:
18. Kernicterus due to sulfonamide administration
A. PAPILLARY NECROSIS in the neonate is due to:
B. Glomerulonephritis
C. Nephrosclerosis A. DISPLACEMENT OF BILIRUBIN FROM
D. Tubular Interstitial Necrosis BINDING SITE
B. Increase metabolism of sulfonamide
11. Heavy proteinuria due to captopril intake is C. Creation of toxic metabolite from sulfonamide
due to: D. Enzyme induction by sulfonamide

A. Tubular Injury 19. What is the mechanism responsible for the

B. GLOMERULAR INJURY increased toxicity of lidocaine due to
C. Interstitial Injury propranolol?
D. Papillary Injury
A. CHANGE IN HEPATIC BLOOD FLOW
12. The anaphylactic shock due to penicillin is: (propranolol decreases heart rate, which
decreases hepatic blood flow)
A. TYPE I B. Dislodgement from protein binding
B. Type II C. Change in the acidity of the GIT
C. Type III D. Modification in absorption
D. Type IV
20. A 50-year old patient developed exacerbation
13. Adverse reaction occurring in halothane due to of asthma. He was prescribed oral
type II reaction: corticosteroids, beta-agonists, and
anticholinergics to control the exacerbation. A
A. LIVER DAMAGE few days after intake of the drug, he developed
B. Agranulocytosis hematoma due to capillary fragility. The patient
C. Thrombocytopenia is a heavy drinker and a smoker. Which of the
D. Nephropathy following substances will increased toxicity
due to corticosteroid intake?
14. Which of the following drugs inhibit renal
tubular secretion? A. ETHANOL (severe hepatic dysfunction due
to alcohol intake decrease metabolism of
A. THIAZIDE corticosteroids leading to toxicity)
B. Alpha Blocker B. Beta Agonist
C. Beta Blocker C. Nicotine
D. ACE Inhibitor D. Anticholinergic

15. A therapeutic drug that increases the risk of 21. A 25-year old married woman is diagnosed
cancer: with PTB. The patient was taking oral
contraceptive pills to prevent early pregnancy.
A. Glucocorticoid Which of the following anti-TB drugs will
B. ESTROGEN interact with the drug to cause a loss of effect
C. L-Tyramine of the OCP?
D. Insulin
A. RIFAMPICIN
16. Physiologic change in pregnant women that B. Isoniazid
increases the risk of toxicity due to drug C. Pyrazinamide
intake: D. Ethambutol

A. Increase body fat

B. Decrease GFR
C. DECREASE PLASMA ALBUMIN
D. Decrease metabolizing enzyme

17. Probenecid was developed to prolong

penicillin action. What effect does probenecid
has on penicillin?

A. INHIBIT ELIMINATION
B. Increase absorption
C. Increase metabolism
D. Increase protein binding
 25. Which of the following drugs will explain the
elevation of LFTs seen in this patient?

A. Diltiazem
B. Doxofylline
C. Salbutamol
D. ROSUVASTATIN

26. (DISCARDED: Answer is NOT in the choices.)

Which of the following will react with losartan?

A. Diltiazem
B. Doxofylline
C. Salbutamol
22. A 72-year old patient with COPD is admitted D. Rosuvastatin
due to exacerbation. Chest X-ray showed
pneumonia. Which of the following antibiotics 27. Pharmacodynamic interaction between ACE
will interact with his current medications of inhibitors and potassium-sparing diuretics is a
theophylline, beta-agonist, anticholinergic, form of:
and corticosteroids.
A. SYNERGISM
A. CIPROFLOXACIN B. Antagonism
B. Co-Amoxiclav C. Inverse Agonism
C. Cefuroxime D. Syllogism
D. Doxycycline
28. Toxicity due to isoniazid is a consequence of:
23. A 60-year old patient with hypertension and
arthritis was admitted due to uncontrolled A. VARIATION IN METABOLISM (some
blood pressure. He was prescribed losartan patients are considered slow acetylators
and metoprolol a few months ago with such as Americans and Europeans while
adequate control. However, recently, his blood some are considered fast acetylators such
pressure increased leading to admission. as Asians and Inuits)
Which of the following over-the-counter drug B. Reduction in clearance
for arthritis may have cause an interaction in C. Alteration in receptor
this patient? D. Idiosyncratic reaction

A. IBUPROFEN 29. A 65-year old female, hypertensive, developed

B. Paracetamol an adverse reaction to her antihypertensive
C. Glucosamine medications (A table is provided). What is the
D. Methylsalicylate effect of the reduction of albumin levels seen
in elderly individuals on metoprolol (pKa = 10;
24. CD, a 75-year old male, retired government F=38; protein binding = 97; t ½ = 3).
employee, lives alone in Angeles City. He was
brought to the hospital due to palpitation. A A. Increased toxicity
few weeks PTC, he experienced palpitation B. Decreased toxicity
occurring during the day. Referral to a C. Decreased efficacy
cardiologist failed to show a cardiovascular D. No effect
etiology for his palpitation which prompted a Given answer is A (rationale: due to increased
review of his current medications. CD has protein binding).
hypertension, type 2 diabetes mellitus, and
severe COPD. He takes NSAID for his arthritis 30. In which of the following drugs is toxicity most
without prescription. The patient is taking likely to occur due to decreased rate of gastric
diltiazem, doxofylline, salbutamol, emptying?
rosuvastatin, and losartan. Which of the
following may cause an interaction in this A. VALSARTAN (has a low pKA, considered a
patient which may explain her palpitation? weak acid, better absorbed in the stomach;
a decreased gastric emptying time will
A. DILTIAZEM + DOXOFYLLINE cause a longer duration of time of the drug
B. Salbutamol + Diltiazem in the stomach, leading to toxicity)
C. Salmeterol + ICS B. Hydrochlorothiazide
D. ICS + Diltiazem C. Diltiazem
D. Metoprolol
 35. Aside from reduction in renal function, the
31. Which drug is given once a day? reduction in elimination of benzodiazepine in
elderly individuals is due to:
A. Hydrochlorothiazide
B. Diltiazem A. Decreased body mass
C. Metoprolol B. REDUCTION IN HEPATIC FUNCTION
D. CLONIDINE (has a long half-life, which C. Decreased cardiac output
increases the duration of action, and D. Decreased gastric emptying
decreases the frequency the drug is given)
36. Opioid analgesics are underutilized in elderly
32. Which has the highest level of unchanged drug individuals because some are markedly more
in the systemic circulation? sensitive to the adverse effect of opioids which
is:
A. Diltiazem
B. CLONIDINE (bioavailability is the fraction A. Arrhythmia
of unchanged drug reaching the systemic B. Constipation
circulation) C. Hypotension
C. Metoprolol D. RESPIRATORY DEPRESSION
D. Valsartan
37. Among the benzodiazepines, which causes an
33. A 70-year old female is admitted due to age-related decrease in hepatic clearance?
infection. Creatinine is 1.4 mg/dL. What is the
creatinine clearance of the patient if the patient A. Diazepam
weighs 100 lbs (45.45 kgs)? B. Lorazepam
C. Flurazepam
A. 45 D. Clobazepam
B. 32
C. 27
D. 10

COMPUTATIONS:
(140 − age) × (wt in kgs) × (0.85 if female)
CC =
72 × serum creatinine in mg/dL

(140 − 70) × (45.45) × (0.85)

CC =
72 × 1.4
2704.28
CC = = 26.83 𝑜𝑟 27
100.80

34. (DISCARDED: Answer is NOT in the choices.)

What will be the loading dose for Drug A given
orally to achieve plasma peak concentration of
2mcg. Given: Vd = 500L/70kg, F = 70%?

A. 0.175 mcg
B. 0.28 mcg
C. 0.7 mcg
D. 1.43 mcg

COMPUTATIONS:
LD = (Vd x C)/F
LD = (500 x 0.002)/0.7
LD = 1.428 = 1.43 mg (The unit should be MG Given answer is B but Table 60-2 in Katzung’s
not MCG). Basic and Clinical Pharmacology states that
LORAZEPAM causes no age-related difference
in hepatic clearance.
38. Changes in the elderly patient which affects Serial monitoring of blood glucose levels
the distribution of drugs which are classified revealed persistent hypoglycemia. Which of
as weak bases: the following dugs when given to the mother
may cause the symptoms manifested by the
A. Increased cholesterol neonate in this case?
B. Decreased albumin
C. Increased globulin A. CHLORPROPRAMIDE
D. INCREASED OROSOMUCOID (ALPHA- B. Chlomipramine
ACID GLYCOPROTEIN) C. Ethanol
D. Methylthiouracil
39. In manic elderly patients taking lithium, which
antihypertensive drug will cause interaction? 44. Which of the following statements on oral drug
absorption of drugs in neonate compared to
A. ACE older children and adult is correct?
B. Beta Blocker
C. THIAZIDE (thiazides causes hyponatremia; A. Acetaminophen – Increased
hyponatremia increases the toxicity of B. AMPICILLIN – INCREASED
lithium in patients taking both) C. Phenobarbital – Increased
D. Calcium Channel Blocker D. Phenytoin – Increased

40. Which antihypertensive medication is the most 45. Glucuronide formation reaches adult value
useful among elderly non-diabetic without between:
cardiovascular complications because of its
efficacy and safety profile? A. 3 – 4 days of life
B. 3 – 4 hours of life
A. ACE Inhibitor C. 3 – 4 months of life
B. Clonidine D. 3 – 4 YEARS OF LIFE
C. Beta Blocker
D. CALCIUM CHANNEL BLOCKER (thiazides 46. Which of the following drugs can be given
are the first line agents but have several safely to a nursing mother?
side effects; beta blockers are hazardous;
ACE inhibitors are considered the agents A. Diazepam
of last resort; clonidine is not used due to B. Heroine
possible hypotensive episodes) C. Phenobarbital
D. THYROXINE (causes negligible effects to
41. Which of the following medications when the neonate; almost negligible amount of
given to a pregnant woman near term can the drug is detected in the breastmilk)
induce fetal hepatic enzymes responsible for
the glucuronidation of bilirubin? 47. The molecular weight of the drug influences
the rate of transfer and amount of drug
A. Chloramphenicol transferred through the placenta into the fetal
B. Corticosteroids circulation. Which of the following statements
C. Diazepam is incorrect?
D. PHENOBARBITAL (this drug causes early
maturation of the fetal hepatic enzymes, A. HEPARIN CAN READILY CROSS THE
thus, the ability of the neonate to PLACENTA.
metabolize certain drugs will be greater B. Warfarin is teratogenic and should be avoided
than expected) during pregnancy.
C. Maternal antibodies cross the placenta.
42. Which of the following drugs when given to the D. None of the above.
mother in the first trimester of pregnancy may
lead to the development of neural tube defects 48. Drug passes through the placenta is
in the fetus? dependent on lipid solubility and the degree of
drug ionization. Which of the following drugs
A. ACE Inhibitors can diffuse readily across the placenta and
B. Busulfan enter fetal circulation?
C. CARBAMAZEPINE
D. Lithium A. Heparin
B. SALICYLATE
43. Baby boy A, weighing 4.5 kg, was delivered by C. Succinylcholine
emergency CS to G4P4 mother with APGAR D. Tubocurarine
scores 8 and 9. Few hours after birth, he had
episodes of cyanosis, grunting, and jitteriness.
49. It reduces the incidence of neural tube defects 55. Which of the following drugs when given to the
when supplemented during pregnancy. mother in the third trimester may lead to
persistent pulmonary hypertension of the
A. Ferrous Sulfate newborn?
B. FOLATE
C. Vitamin B A. Misoprostol
D. Vitamin D B. SSRI
C. Tamoxifen
50. Which of the following periods of fetal D. Thalidomide
development is correct?

A. Ears: 20 – 34 weeks
B. Heart: 2 – 3 weeks
C. PALATE: 7 – 16 WEEKS
D. Upper Limbs: 4 – 9 days

51. Compute for the amount of metronidazole

125mg/5mL at a dose 30mg/kg/day for Carol
weighing 12.5 kgs.

A. 5mL every day

B. 15mL every day
C. 15mL every 8 hours
D. 5ML EVERY 8 HOURS

COMPUTATIONS:
Dose = (30mg/kg/day) x (12.5kg) / (3 doses) =
125mg/dose
Dose = 125mg / (125mg/5mL) = 5mL/dose
Dose = 5mL every 8 hours

52. As body composition changes with

development, the distribution of drugs is also
changed. Which of the following statements on
drug distribution is incorrect?

A. Organs that generally accumulate high

concentrations of lipid-soluble drugs in adults
may accumulate smaller amounts of these
agents in less matured infants.
B. Protein-binding of drugs is reduced in the
neonate.
C. NEONATE HAS LOWER PERCENTAGE OF
ITS BODY WEIGHT IN THE FORM OF
WATER.
D. None of the above.

53. The glomerular filtration rate (GFR) reaches

adult values at what age?

A. 4 – 8 months
B. 5 – 10 months
C. 6 – 12 MONTHS
D. 1 – 2 years

54. An alcohol solution in which the drug

molecules are dissolved and easily
distributed:

A. Suspension
B. ELIXIR