14, 65 year old male was diagnosed with BPH and concurrently was given Finasteride by his Urologist. How would you explain the mechanism of this drug? ‘, Relax the intemal urinary sphincter 3. Blocks the production of dihyrdotestosterone ©. Inhibits stimulation of DHEA D. Inhibition of Androgen Receptor 18. A851 year old female was found to have breast cancer HER2 NEU positive. After her surgery, she was treated with a drug that prevents the conversion of testosterone to estradiol. The drug sed for her treatment most likely was which of the following? | Ethinylestradiol 3. Finasteride 2. Spironolactone 5. Tamoxifen nastrozole 16. A 33 year old female consulted regarding her oral contraceptive. Which of the following will pe a serious side effect when she takes it in high doses? . Nausea 3. Breast Tenderness °. Breakthrough bleeding D. Thromboembolism E. Fluid Retention 17.8 ylo boy came in your clinic with history of experiencing absence seizures at school and has nterrupted his ability to pay attention and participate in their activities. Which medication is most appropriate for this patient?” 4. Diezepam 3. Carbamazepine 5. Ethosuximide D. Gabapentin 18. 29-year-old female with generalized seizures is well maintained on valproate. She consulted that she Is planning to be pregnant the following year. Upon carefully considering to her antiseizure medication, which of the following will be an ideal management? Shift her medication to Lamotrigine 3. Maintain her current medication ©. Consider adding another antiseizure drug D. Decrease the dose of her Valrpoate 19. A woman with generalized seizures is well maintained with lamotrigine. After then, becomes pregnant and begins to have breakthrough seizures. What is most likely happening? Lamotrigine is no longer efficacious for this patient . Lamotrigine concentrations are increasing. Lamotrigine concentrations are decreasing ). Her epilepsy is getting worse yo 20. A 49-year-old woman experienced multiple focal seizures with impaired consciousness over ‘he last 2 years. Which is the most appropriate initial therapy for this patient? 4. Carbamazepine 3. Diazepam . Ethosuximide D. Levetiracetam 21, Which is a firstine medication for generalized tonic-clonic seizures?C. Hypophosphatemia . Hyperphosphatemia 7. 72 year old female with osteoporosis was given Vitamin D supplements, can you identify its active form? A. 7 dehydrocholesterol B. Cholecalciferol C. 25 hydroxy D3 (caleiferol) D. 1,25 dihydroxy D3 (calcitro!) 8. Low calcium ion levels in the blood cause the parathyroid glands in neck to secrete Parathyroid Hormone (PTH) and Increases calcium ion levels by: A. stimulating osteoclasts to release stored calcium ions from the bone B. decreasing intestinal absorption of calcium C. kidneys release calcium ions D. calcium is absorbed slowly in intestines 9, Most common bacteria seen in community acquired pneumonia? A. Streptococcus Pneumonia 8B. Hemophilus Influenza C. Mycoplasma Pheumonia D. Legionella Pneumophilia 10. 17 year old male had productive cough with fever and was treated with Cefuroxime 500mg every 12 hours. How would this drug work A. Inhibition of cell wall synthesis B. Inhibition of protein synthesis (ribosome) C. Inhibition of nucleic acids (DNA) . Alterations of cellular membranes (cell membrane integrity disruptors) E, Antimetabolites (Metabolic pathway inhibitors) 11, 58 year old male who came in with cough (yellow sputum) and body malaise and headace who previously was given amoxicilin 3 months ago. You decided to give him CO-amoxiclav, what is the principle behind the antibiotic resistance for these patients? ‘A. Chemical modification of antibiotic, B. Inactivation of antibiotic through hydrolysis C. Alteration of antibiotic targets through mutation D. Alterations that affect permeability 12. 16 year old female had low grade fever, headache and dry cough. You started to give her Azithromycin, how does this drug work? A. Binds PBPs, thereby blocking peptidoglycan cross-linking B. binds to the 50S ribosomal subunit and inhibits the formation of the initiation complex C. binds the 30S bacterial ribosomal subunit and acts to inhibit the formation of the initiation complex D. Inhibition of bacterial DNA gyrase and Topoisomerase IV 13. A 75 year old male came in the OPD with difficulty in urination and decreased flow of urine. No burning pain when he urinates. Urinalysis is Normal. What medication would be best given as initial treatment for BPH? A. at-androgen inhibitors B. 5-a reductase inhibitor C. Phosphodiesterase Inhibitor . Steroid synthesis inhibitor1. 42 year old woman came in for follow-up with chronic gout and was on maintenance medications. Which of the following drugs could be used to decrease this woman's rate of production of uric acid? A. Aspirin B. Colchicine C. Hydroxychloroquine D. Probenecid E. Allopurinol 2. Which among these side effects are usually seen in treating acute gout with high doses of colchicine treatment? A. Severe Diarrhea B. Rash C. Severe GI bleeding D. High Blood pressure 3. 87 year old male complained of warmth, tenderness and swelling of right foot, which among these drugs is an inhibitor of cell mitosis in an acute gouty attack? A. Colehicine B. Indomethacin C. Allopurinol D. Febuxostat 4. A75 year old male has been taking aspirin for his Coronary Artery Disease. Being his attending physician, you know that aspirin has been found to be effective in reducing cardiovascular risk in such patients, it has also been found that other drugs can significantly interfere with aspirin’s beneficial effects if taken concomitantly. An example of the type of drug to be avoided in our patient is: A. Colcichine B. Febuxostat C. Ibuprofen D. Prednisone E. Methotrexate 5. 84 year old male diagnosed with Osteoporosis and having on and off back pain, being the doctor who saw him your plan is by suppressing bone formation and increase mineralization of his existing bone, which medication would best treat him? A. Bisphosphonates B. Teriparitide C. Calcium D. Caleitriot E. All of the above 6. 36 year old male who underwent thyroidectomy with incidental removal of parathyroid. After 4 hours postoperatively he began to have weakness, dysphagia and have (+) chovstek sign, which would best explain his condition? ‘A. Hypercalcemia B. Hypocalcemia‘A. Carbamazepine B. Topimarate C. Gabapentin D. Pregabalin 22. 69-year-old patient had a stroke approximately 30 days ago. Patient then is continuing to have ‘small focal seizures and fails to respond appropriately while talking. Which is the most appropriate treatment for this patient? A. Levetiracetam B. Phenytoin C. Phenobarbital D. Oxcarbazepine 23. A19-year-old female has along history of depression met a car accident that resulted in body aches and pain. Which of the following medications might help her condition? A. Phenelzino B. Duloxetine C. Fluoxetine D. Sertraline E. Amitryptiline 24, 60 year old male with bipolar disorder has elevated liver enzymes, which among these mood stabilizers would best treat his condition? A. Lithium B. Valproic acid C. Carbamazepine D. Risperidone 25. 17-year-old male was rushed to the emergency room after an accidentally taking SOtablets of midazolam Smg/tablet. He was seen unconscious and not considered a regular user of any medications or illicit drugs. How would you reverse this overdose? ‘A. Flumazenil B. Naloxone C. Alprazolam D. Diphenhydramine 26. Which one of the following statements is TRUE regarding benzodiazepines? ‘A. Benzodiazepines directly open Sodium channels. B. Benzodiazepines analgesic and anti-nflammatory effects C. Clinical improvement of anxiety requires 4 to 8 weeks of treatment D. All benzodiazepines have some sedative effects 27. What is the mechanism of Action of Barbiturates? ‘A. GABA-A receptor agonist B. Serotonin Norepinerphine Reuptake Inhibitor C. MAO-B Inhibitor D. Dopamine Antagonist 28. 19 year old came in for productive cough with yellowish phlegm, colds and fever, no history of allergies or other diseases. Last antibiotic was 2 years ago. What ideal treatment would you recommend? A. Azithromycin B. Levofloxacin C. Amoxicillin D. Co-amoxiclavE. Cefalexin 29. 65 year old male diabetic came in for cough with greenish phlegm and low grade fever, with history of allergies. What ideal treatment would you recommend to him? A. Azithromycin B. Levofloxacin C. Amoxicilin D. Co-amoxiclav E. Cefalexin 30. 67 year old male came in the Emergency room complaining of 8days of productive cough and fever after his trip from India, Vital signs were BP 90/40, RR (respiratory rate) 33. He was awake, conscious and coherent. Based on the CURB scoring, what would be your recommendation? A. Oulpationt Treatment B. Admission in Regular ward C. Admission in ICU D. Home Treatment with IV antibiotics E. Admit at Emergency Room 31. Community-acquired pneumonia is differentiated from hospital-acquired pneumonia mainly because of the most common bacteria causing the disease. Which of the following bacteria is the most common cause of pneumonia acquired in intensive care settings and in immunocompromised patients? ‘A. Mycoplasma pneumoniae B. Chlamydophila pneumoniae C. Moraxella catarrhalis D. Legionella pneumophila E. Pseudomonas aeruginosa 32. A 67 year old Male was treated with levofloxacin during his bronchitis exacerbation. The inhibition of which of the following bacterial enzymes most likely mediated the therapeutic effect Of the drug in the patient's disease? A. Peptidyl transferase B. Transglycosylase C. Dihydrofolatereductase D. DNA-dependent RNA polymerase E. Topoisomerase I 33. Which of the following bacterial structures most likely represents the primary binding site for cephalosporins? A. Ribosomes B. Peptidoglycan layer C. Inner plasma membrane D. Cytoplasm E.DNA 34. Haemophilus influenzae was found to be the cause of your Patient's Pneumonia, and the rod was resistant to ceftazidime, azithromycin, and levofloxacin. Which of the following mechanisms ‘most likely accounts for the resistance to all of these antibiotics? A. Alteration of ribosomal binding site that prevents drug binding B. Production of bacterial B-lactamases C. Decreased production of autolytic enzymes. D. Increased activity of a bacterial efflux pump E, Increased bacterial cell membrane permeability35. What phase 1 reaction is mé mixed-function enzymes? ‘A. Oxidation B. Hydrolysis, C. Reduction D. Deamination ly performed by the cytochrome P450 enzymes also called 36. What does lack of UDP-glucurony! transferase cause? A. Bilirubin Encephalopathy B. Neonatal Jaundice C. Kemicterus D. Both a and b E. All of the above 37. Which of the following is an antiepileptic drug that induces CYP3A4 and is also metabolized by CYP3A4? A Ketoconazole B. Tamoxifen C. Carbamazepine D. Mitomycin © D. Losartan 38. What enzyme will methanol and ethanol both compete for? ‘A. UDP glucorony! Transferase B. N-Acetyltransferase C. Vitamin K epoxidase D. Alcohol Dehydrogenase E. Pseudocholinesterase 39. The primary biological purpose of biotransformation is: A. to sequester drugs into peripheral lymph organs to be examined by dendritic cells, B. to inactivate and detoxify drugs and other foreign compounds that may cause harm to the body C. to modify drugs in ways that will promote reabsorption from the kidneys D. to incorporate drugs into extracellular matrix structures 40. In contrast to drugs after phase | biotransformation, drugs after phase Il have: ‘A. Less pharmacological activity and lower water solubility B. More pharmacological activity and lower water solubility C. Less pharmacological activity and greater water solubility D. More pharmacological acy and greater water solubity 41. If transcription of CYP is upregulated ‘A. Drug Interactions will be more likely B. Then CYP levels in the cytoplasm will be reduced C. More drug than usual must be given to reach therapeutic levels, D. less drug should be given to avoid toxicity 42, A 72-year-old patient diagnosed with Breast cancer. She begins has undergone chemotherapy and had suffered from severe vomiting. Which drug would be most effective to treat the emesis in this patient? ‘A. Palonosetron B. Droperidol C. Metoclopramide D. Diphenhydramine43, A 38-year-old woman complains of severe persistent heartbum and chest discomfort, acid- ike taste in her mouth. The doctors impression was she had gastroesophageal reflux disease (GERD). What drug is most appropriate? . Aluminum Hydorxide 3. Misoprostol 5. Esomeprazole 5: Sucratfate 44. 22 year old patient came in the ER that complained of nausea and vomiting with associated abdominal cramps. Patient was given an IV medication but began to exhibit extrapyamidal symptoms few minutes after giving. what medication will be the cause of the adverse side effects? '\. Metoclopramide 3. Bisacody! 5. Aprepitant D. Diphehydramine 45, A 24 year old G1PO Pregancy Uterine 28 weeks AOG was diagnosed with ulcer-like symptoms. Which of these medications would you avoid giving her? Calcium carbonate }. Misoprostol . Lansoprazole D. Famotidine 46. 19 year old athlete came in the ER with epigastric pain and nausea. He was given ‘netoclopramide IV and was relieved. What s the mechanism of action for this drug? ‘4. H2 receptor blocker 3. Anticholinergic 5. SHTS receptor blocker D. pamine receptor blocker 47. 30 year old male patient was scheduled for Exploratory Laparotomy with Appendectomy. A. 1-2 days B. 3.5 days C.5-7 days D.7-10 days 77. A36-year old hypertensive was prescribed with methyldopa. Which of the following adverse effects should you warn this patient about? A. Sedation B. Leg cramps C. Postural hypotension D.All 78. Which beta-blocker exhibits beta-1 selective blockade and a vasodilating property due to an increase in the release of ritric oxide in the endothelium? ‘A. Metoprolol B. Labetalol C. Nevibolol D. Atenolol 79. As a maintenance medication of a 1-year old male with acute anginal attack, which nitrate preparation is recommended for its relatively long halflife? ‘A. Isosorbide mononitrate PO B. Isosorbide dinitrate SL C. Pentaerythritol trinitrate PO D. Amy! nitrite vapor inhalation 80. Which water-soluble vitamin is used as a dyslipidemic drug? A. Fibrates B. PCSK9 C. Statin . Niacin 81. What does the term “bioavailability” mean? ‘A, Plasma protein binding degree of substance B. Permeabilty through the brain-biood barrier C. Fraction of an uncharged drug reaching the systemic circulation following any route administration D. Amount of a substance in urine relative to the initial dose32, A 36-year old HIV positive female is currently pregnanct. Which NNRTI is contraindicated in >regnancy due to high embryotoxicity and teratogenicity? \. Efavirenz 3. Nevirapine 2. Delavirdine >. Tenofovir 33, Which of the following anti-viral drugs is used as an adjunct in the treatment of Parkinson’s fisease? \. Oseltamivir 3. Amant 2. Cidofovi D.Lamivudine 34. Which anti-viral drug can induce interferon and reduce viral load associated with warts? \.Imiquimod 3. Interferon 3. Immunoglobulins >. Palivizumab 35, What does the abbreviation "pc" mean? \after 3. after meals 2. by mouth 2. asneeded 36. What is the term for the range between the minimum toxic dose and the minimum therapeutic Jose? 4 ED50 3. LD50 2. therapeutic index D. therapeutic window 37. A49-year-old man with diabetes mellitus takes subcutaneous insulin for his insulin-dependent siabetes mellitus. He takes 4 U of regular insulin every 12 h to maintain his blood sugar in the ‘ange of 80 to 140 mg/dL. This route of administration allows for absorption of insulin by which of he following processes? ‘Active transport 3. Facilitated transport 2. Osmosis >. Simple diffusion 38. A 27-year-old female with vulvovaginal candidiasis is given a one-time 100 mg dose of oral luconazole. She has no other pertinent medical problems and takes no prescription medications. \dministration of the medication results in a peak plasma concentration f 20 mg/mL. Whats the apparent volume of drug distribution? A O5L 3.1L 23k 2.5L 39. The dissociation constant (Kd) is closely related to: \ efficacy 3. toxicityC. potency D. intrinsic activity 90. A 50-year old male with head and neck cancer is undergoing chemotherapy with bleomycin. Which dose-limiting toxicity must be carefully monitored in this patient? A. Hemolytic uremic syndrome B. Pulmonary toxicity C.CNS toxicity D. Severe hypersensitivity reaction 91. A 4-year old child with acute lymphoblastic leukemia undergoing high dose methotrexate. What is the chemoprotective drug to prevent methotrexate toxicity in this child? A. Dexrazoxane B. Amifostine C.MESNA, D. Folinic acid 92. A.60-year old male in hear fallure was prescribed losartan potassium 50 mg tab taken once daily by mouth and enalaparil 20mg tablet once daily by mouth. What type of pharmacodynamic interaction may happen in this patient? A. addition B. antagonism C. potentiation D. synergy 93. A 4-year old child with acute lymphoblastic leukemia will undergo doxorubicin treatment. What dose-related cumulative toxicity associated with doxorubicin should be closely monitored? A. cardiotoxicity B. hepatotoxicity C. neurotoxicity D. nephrotoxicity 94. Which of the following anti-cancer drugs will require skin testing due to its high hypersensitivity reaction potential? A. vineristine B. cyclophosphamide C. L-asparaginase D. cisplatin 95. Which BEST describes the mechanism of action of enalapril? A. Inhibits dipeptidyipeptidase B. Inhibits calcium influx into smooth muscle C. Releases nitric oxide leading to increased cyclic GMP D. Depletes body sodium stores 96. Which of the following drug/s may worsen heart failure? A. Pioglitazone B. Propranolol . Disopyramide D.All 97. Which group of retroviral anti-viral drugs produce rash as a class side effect? A.NRTIs. B.NNRTIs C.PlsD. Entry inhibitors 98. Which organ system is MOST sensitive to the therapeutic effect of flucytosine? A.CNS B. Bone marrow c.cVvs D. Kidneys 99. A 45-year old hypertensive male complained of chest pain after heavy exertion. His ECG reveeled irregular heartbeats. Which calcium channel blocker can be safely given to him? A. Diltiazem B. Felodipine 100. A 60-year old male with congestive heart failure with high filing pressures came to the ER due to dyspnea. Which drug will you find most useful for this patient? A. Hydralazine B. Digitalis C. Nitrates D. Verapamil