SCHOOL OF PHARMACY

MIDTERM EXAMINATIONS
CLINICAL PHARMACY 1 LEC
1sr Semester A Y 2022 - 2023
- VISION
Emilio Aguinaldo College envisions itself as an internationally recognized private non-sectarian, academic
institution rooted in the Filipino nationalist tradition that consistently pursues the advancement and welfare of
humanity.
MISSION
Emilio Aguinaldo College provides a learner-centered, inquiry-based, and socially relevant academic
community
NAME: DATE: _ _ _ __

1. A 32-year-old woman with hypertension wishes
to become pregnant. Her physician informs her that
she will have to switch to another antihypertensive
drug. Which of the following drugs is absolutely
contraindicated in pregnancy?
a. Atenolol
b. Captopril
c. Methyldopa
d. Prazosin
e. Propranolol
2. A patient is admitted to the emergency
department with severe tachycardia after a drug
overdose. His family reports that he has been
depressed about his hypertension. Which one of the
following drugs increases the heart rate in a dose-
dependent manner?
a. Captopril
b. Hydrochlorothiazide
c. Minoxidil
d. Prazosin
e. Verapamil
3. Which one of the following is characteristic of
captopril treatment in patients with essential
hypertension?
a. Competitively blocks angiotensin II at its receptor
b. Decreases angiotensin II concentration in the
blood
c. Decreases renin concentration in the blood
d. Increases sodium and decreases potassium in the
blood
e. Decreases sodium and increases potassium in the
urine
4. A 73-year-old man with a history of falling at
home is found to have moderately severe
hypertension. Which of the following drug groups is
most likely to cause postural hypotension and thus
an increased risk of falls?
a. ACE inhibitors
b. Alpha-receptor blockers
c. Arteriolar dilators
d. Beta I-selective receptor blockers
e. Nonselective Pblockers
5. A significant number of patients started on ACE
inhibitor therapy for hypertension are intolerant and
must be switched to a different class of drug. What
is the most common manifestation of this
intolerance?
a. Diarrhea
b. Glaucoma
d. Incessant cough
d. Lupus-like syndrome
e. Vomiting
6. Which one of the following is a significant
unwanted effect of the drug named?
a. Heart failure with hydralazine
b. Hemolytic anemia with atenolol
c. Fetal damage with losartan
d. Lupus-like syndrome with hydrocWorothiazide
e. Tachycardia with verapamil
7. Comparison of prazosin with atenolol shows that
a. Both decrease heart rate
b. Both increase cardiac output
c. Both increase renin secretion
d. Both increase sympathetic outflow from the CNS
e. Both produce orthostatic hypotension
8. A patient with hypertension is to receive a
calcium channel blocker. Verapamil is associated
with which one of the following?
a. Diarrhea
b. Hypoglycemia
c. Increased PR interval
d. Tachycardia
e. Thyrotoxicosis
9. A 45-year-old man is brought to the emergency
department with mental obtundation. He is found to
have a blood pressure of220/160 and retinal
hemorrhages. Which one of the following is used in
severe hypertensive emergencies, is short-acting,
acts on a G protein-coupled receptor, and must be
given by intravenous infusion?
a. Aliskiren
b. Captopril
c. Fenoldopam
d. Hydralazine
e. Losartan

QF-ACD-032 (09.20.2022) Rev.04


10. Which of the following is very short-acting and
acts by releasing nitric oxide?
a. Atenolol
b. Captopril
c. Diltiazem
d. Fenoldopam
e. Hydrochlorothiazide
11. A 9-year-old child is having learning difficulties
at school. He has brief lapses of awareness with
eyelid fluttering that occur every 5-10 min.
Electroencephalogram (EEG) studies reveal brief 3-
Hz spike and wave discharges appearing
synchronously in all leads. Which drug would be
effective in this child without the disadvantages of
excessive sedation or tolerance development?
a. Clonazepam
b. Ethosuximide
c. Gabapentin
d. Felbamate
e. Phenobarbital
12. Which statement concerning the proposed
mechanisms of action of anticonvulsant drugs is
inaccurate?
a. Diazepam facilitates GABA-mediated inhibitory
actions
b. Ethosuximide selectively blocks potassium ion
(K+) channels in thalamic neurons
c. Phenobarbital has multiple actions, including
enhancement of the effects of GABA, antagonism
of glutamate receptors, and blockade of sodium ion
(Na+) channels
d. Phenytoin prolongs the inactivated state of the
Na+ channel
e. Zonisarnide blocks voltage-gated Na+ channels
13. Which drug used in management of seizure
disorders is most likely to elevate the plasma
concentration of other drugs administered
concomitantly?
a. Carbamazepine
b. Clonazepam
c. Gabapentin
d. Valproic acid
e. Vigabatrin
14. A young female patient suffers from absence
seizures. Which of the following statements about
her proposed drug management is NOT accurate?
a. Ethosuximide and valproic acid are preferred
drugs
b. Gastrointestinal side effects are common with
ethosuximide
c. She should be examined every 2 or 3 mo for deep
tendon reflex activity
d. The use of valproic acid in pregnancy may cause
congenital malformations
e. Weight gain is common in patients on valproic
acid
15. Which statement concerning the
pharmacokinetics of antiseizure drugs is accurate?
a. Administration of phenytoin to patients in
methadone maintenance programs has led to
symptoms of opioid overdose, including respiratory
depression
b Although ethosuximide has a half-life of
a~proximately 40 h, the drug is usually taken twice
a day . 1· . . fi II 0 ws
c. At high doses, phenytom e 1mmat1on o
first-order kinetics .
d. Valproic acid may increase the synthesis of
porphyrins
e. Treatment with vigabatrin reduces the
effectiveness of oral contraceptives
16. With chronic use in seizure states, the adverse
effects of this drug include coarsening of facial
features, hirsutism, and gingival hyperplasia.
a. Carbamazepine
b. Felbamate
c. Phenytoin
d. Phenobarbital
e. Valproic acid
17. Abrupt withdrawal of antiseizure drugs can
result in increases in seizure frequency and severity.
Withdrawal is most easily accomplished if the
patient is being treated with
a. Carbamazepine
b. Diazepam
c. Ethosuximide
d. Phenobarbital
e. Phenytoin
18. The mechanism of antiseizure activity of
carbamazepine is
a. Block of sodium ion channels
b. Block of calcium ion channels
c. Facilitation of GABA actions on chloride ion
channels
d. Glutamate receptor antagonism
e. Inhibition of GABA transaminase
19. Which statement about phenytoin is accurate?
a. Displaces sulfonamides from plasma proteins
b. Drug of choice in myoclonic seizures
c. Half-life is increased if used with phenobarbital
d. lsoniazid (INH) decreases steady-state blood
levels of phenytoin
e. Toxic effects may occur with only small
increments in dose
20. A young male patient suffers from a seizure
disorder characterized by tonic rigidity of the
extremities followed in 15-30 s of tremor
progressing to massive jerking of the body. This
clonic phase lasts for 1 or 2 min, leaving the patient
in a stuporous state. Of the following drugs, which
is most suitable for longterm management of this
patient?
a. Carbamazepine
b. Clonazepam
c. Ethosuximide
d. Felbamate
e. Tiagabine
21. Characteristics of phase I depolarizing
neuromuscular blockade due to succinylcholine
include
a. Easy reversibility with nicotinic receptor
antagonists
b. Marked muscarinic blockade
OF-ACO-032 (09.20.2022) Rev.04
c. Muscle fasciculations only in the later stages of
block
d. Reversibility by acetylcholinesterase (AChE)
inhibitors
e. Sustained tension during a period of tetanic
stimulation
Questions 22 and 23. A patient underwent a surgical
procedure of 2 h. Anesthesia was provided by
isoflurane, supplemented by intravenous midazolam
and a nondepolarizing muscle relaxant.
At the end of the procedure, a low dose of
glycopyrrolate was administered followed by
pyridostigmine.
22. The main reason for administering the
muscarinic receptor antagonist was to
a. Enhance the action of pyridostigmine
b. Prevent spasm of gastrointestinal smooth muscle
c. Prevent activation of cardiac muscarinic receptors
d. Provide postoperative analgesia
e. Reverse the effects of the muscle relaxant
23. A muscarinic receptor antagonist would
probably not be needed for reversal of the skeletal
muscle relaxant actions of a nondepolarizing drug if
the agent used was
a. Cisatracurium
b. Mivacurium
c. Pancuronium
d. Tubocurarine
e. Vecuronium
24. Which of the following drugs is the most
effective in the emergency management of
malignant hyperthermia?
a. Baclofen
b. Dantrolene
c. Gabapentin
d. Secobarbital
e. Vecuronium
25. The clinical use of succinylcholine, especially in
patients with diabetes, is associated with
a. Antagonism by pyridostigmine during the early
phase of blockade
b. Aspiration of gastric contents
c. Decreased intragastric pressure
d. Histamine release in a genetically determined
population
e. Metabolism at the neuromuscular junction by
acetylcholinesterase
26. Which drug is most often associated with
hypotension caused by histamine release?
a. Baclofen
b. Pancuronium
c. Tizanidine
d. Tubocurarine
e. Vecuronium
27. Regarding the spasmolytic drugs, which of the
following statements is not accurate?
a. Baclofen acts on GABA receptors in the spinal
cord to increase chloride ion conductance
b. Cyclobenzaprine decreases both oropharyngeal
secretions and gut motility
c. Dantrolene has no significant effect on the release
of calcium from cardiac muscle
d. Diazepam causes sedation at doses commonly
used to reduce muscle spasms
e. lntrathecal use of baclofen is effective in some
refractory cases of muscle spasticity
28. Which drug is most likely to cause
hyperkalemia leading to cardiac arrest in patients
with extensive burns?
a. Baclofen
b. Cyclobenzaprine
c. Dantrolene
d. Rocuronium
e. Succinylcholine
29. Which drug has spasmolytic activity and could
also be used in the management of seizures caused
by overdose of a local anesthetic?
a. Baclofen
b. Cyclobenzaprine
c. Diazepam
d. Gabapentin
e. Tizanidine
30. Myalgias are a common postoperative
complaint of patients who receive large doses of
succinylcholine, possibly the result of muscle
fasciculations caused by depolarization. Which drug
administered in the operating room can be used to
prevent postoperative pain caused by
succinylcholine?
a. Baclofen
b. Cisatracurium
c. Dantrolene
d. Lidocaine
e. Morphine
31. A 70-year-old retired businessman is admitted
with a history of recurrent heart failure and
metabolic derangements. He has marked peripheral
edema and metabolic alkalosis. Which of the
following drugs is most appropriate for the
treatment of his edema?
a. Acetazolamide
b. Digoxin
c. Dobutamine
d. Hydrochlorothiazide
e. Spironolactone
32. A SO-year-old man has a history of frequent
episodes of renal colic with calcium-containing
renal stones. A careful workup indicates that he has
a defect in proximal tubular calcium reabsorption,
which results in high concentrations of calcium salts
in the tubular urine. The most useful diuretic agent
in the treatment of recurrent calcium stones is
a. Acetazolamide
b. Furosemide
c. Hydrochlorothiazide
d. Mannitol
e. Spironolactone
33. Which of the following is an important effect of
chronic therapy with loop diuretics?
a. Decreased urinary excretion of calcium
b. Elevation of blood pressure
c. Elevation of pulmonary vascular pressure
d. Metabolic acidosis
e. Ototoxicity
OF-ACD-032 (09.20.2022) Rev.~
 dent is planning to make~
2 40. A gra~uate. st~outh America while on vacation.
34. A GFR of >90mUmin/1. 73m indicates 10
a. Nonnal or high altitu~e chmb time to acclimate slowly to .
He will not have . ful in preventing h1gh-
b. Mildly decreased altitude. A drug t?at is use
c. Mildly to moderately decreased
altitude sickness ts
d. Kidney failure
35. Which of the following diuretics would be most a. Acetazolamide
useful in the acute treatment of a comatose patient b. Amiloride
with brain injury and cerebral edema? c. Demeclocycline
a. Acetazolamide d. Desmopressin
e Ethacrynic acid th
b.Amiloride 4·1. Which of the following drugs ac~e Ierates e
c. Ethacrynic acid
conversion of plasminogen to plasmm?
d. Furosemide
e. Mannitol a. Aminocaproic acid
36. A 62-year-old man with advanced prostate b. Heparin
cancer is admitted to the emergency department c. Lepirudin
with mental obtundation. d. Reteplase
An electrolyte panel shows a serum calcium of 16.5 e. Warfarin f h'
(nonnal ~8.5-10.5 mg/dL). Which of the following 42. If a fibrinolytic drug is used for treatment o t is
therapies would be most useful in the management woman's acute myocardial infarction, which of the
of severe hypercalcemia? following adverse drug effects is most likely to
a. Acetazolamide plus saline infusion occur?
b. Furosemide plus saline infusion a. Acute renal failure
c. Hydrochlorothiazide plus saline infusion b. Development of antiplatelet antibodies
d. Mannitol plus saline infusion c. Encephalitis secondary to liver dysfunction
e. Spironolactone plus saline infusion d. Hemorrhagic stroke
37. A 60-year-old patient complains of paresthesias e. Neutropenia
and occasional nausea associated with one of her 43. If this patient undergoes a percutaneous
drugs. She is found to have hyperchloremic coronary angiography procedure and placement of a
metabolic acidosis. She is probably taking stent in a coronary blood vessel, she may be given
a. Acetazolamide for glaucoma eptifibatide. Which of the following most accurately
b. Amiloride for edema associated with describes the mechanism of eptifibatide anticlotting
aldosteronism action?
c. Furosemide for severe hypertension and heart a. Activation of antithrombin Ill
failure b. Blockade of post-translational modification of
d. Hydrochlorothiazide for hypertension clotting factors
e. Mannitol for cerebral edema c. Inhibition ofthromboxane production
38. A 70-year-old woman is admitted to the d. Irreversible inhibition of platelet ADP receptors
emergency department because of a "fainting spell" e. Reversible inhibition of glycoprotein Ilb/Illa
at home. She appears to have suffered no trauma receptors
from her fall, but her blood pressure is 120/60 when 44. Hemophilia is an inherited bleeding disorder
lying down and 60/20 when she sits up. resulting from a congenital deficiency in factor:
Neurologic examination and an ECG are within a. VII or IX
normal limits when she is lying down. Questioning b. VIII or X
reveals that she has recently started taking "water c. VIII or IX
pills" (diuretics) for a heart condition. Which of the d. None of the above
following drugs is the most likely cause of her Questions 45-47. A 65-year-old man is brought to
fainting spell? the emergency department 30 min after the onset of
a. Acetazolamide right-sided weakness and aphasia (difficulty
b. Amiloride speaking). Imaging studies ruled out cerebral
c. Furosemide hemorrhage as the cause of his acute symptoms of
d. Hydrochlorothiazide stroke.
e. Spironolactone 45. Prompt administration of which of the following
39. A 58-year-old woman with lung cancer has drugs is most likely to improve this patient's
abnormally low serum osmolality. A drug that clinical outcome?
increases the formation of dilute urine and is used to a. Abciximab
treat SIADH is b. Alteplase
a. Acetazolamide c. Factor VIII
b. Amiloride d. Streptokinase
c. Conivaptan e. Vitamin K
d. Desmopressin 46. Over the next 2 d, the patient' s symptoms
e. Ethacrynic acid resolved completely. To prevent a recurrence of this

OF-ACO-032 (09.20.2022) Rev.04

~ ease, the patient is most likely to be treated
indefinitely with which of the following?
a. Aminocaproic acid
b. Aspirin
c. Enoxaparin
d. Lepirudin
e. Warfarin
4 7• If the patient is unable to tolerate the drug
identified in Question 46, he may be treated with
clopidogrel. Relative to
ticlopidine, clopidogrel
a. Has a shorter duration of action
b. Is less likely to cause neutropenia
c. ls more likely to induce antiplatelet antibodies
d. Is more likely to precipitate serious bleeding
e. Will have a greater antiplatelet effect
Questions 48 and 49. A 67-year-old woman
presents with pain in her left thigh muscle. Duplex
ultrasonography indicates the presence of deep vein
thrombosis (DVT) in the affected limb.
48. The decision was made to treat this woman with
enoxaparin. Relative to unfractionated heparin,
enoxaparin
a. Can be used without monitoring the patient's
aPTT
b. Has a shorter duration of action
c. Is less likely to have a teratogenic effect
d. Is more likely to be given intravenously
e. Is more likely to cause thrombosis and
thrombocytopenia
49. During the next week, the patient was started on
warfarin and her heparin was discontinued. Two
months later, she returned after a severe nosebleed.
Laboratory analysis revealed an INR (international
normalized ratio) of 7.0 (INR value in such a
warfarin-treated patient should be 2.0-3 .0). To
prevent severe hemorrhage, the warfarin should be
discontinued and this patient should be treated
immediately with which of the following?
a. Aminocaproic acid
b. Desmopressin
c. Factor VIII
d. Protamine
e. Vitamin Kl
50. A patient develops severe thrombocytopenia in
response to treatment with unfractionated heparin
and still requires parenteral anticoagulation. The
patient is most likely to be treated with which of the
following?
a. Abciximab
b. Cilostazol
c. Lepirudin
d. Plasminogen
e. Vitamin Kl