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11

OFFICE OF THE VICE PRESIDENT FOR ACADEMIC AFFAIRS

SCHOOL OF PHARMACY
MIDTERM EXAMINATIONS
CLINICAL PHARMACY 1 LEC
1sr Semester AY 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-}'ear-old ® man with hypertensio~n wishes 5. A significant number of patients started on ACE
to become pregnant. Her physician informs her that inhibitor therapy for hypertension are intolerant and
she will have to switch to another antihypertensive must be switched to a different class of drug .' What
drug. Which of the following drugs is absolutely is the most common manifestation of thisJ
contraindicated in pregnancy ? intolerance? 1
a. Atenolol a. Diarrhea
~ aptopril1 Glaucoma
V .Methyldopa Incessant cough
d. Prazosin Lupus-like syndrome
e. Propranolol e. Vomiting
2. A patient is admitted to the emergency 6. Which one of the following is a significant
department with severe tachycardia after a drug
1unwanted effect of the drug named?
overdose. His family reports that he has been a. Heart failure with hydralazine
depressed about his hypertension. Which one of the b. Hemolytic anemia with atenolol
following drugsrincreases the heart rate in a doset {c.'vetala amage"Wi.th los_artan -,
depenclent manner? f Y Lupus-like syndrome with hydrochlorothiazide
a. Captopril e. Tachycardia with verapamil
b Hydrochlorothiazide 7. Comparison of prazosin with atenolol shows that
toil-, a. Both decrease heart rate
. Prazosin b. Both increase cardiac output
e. Verapamil ~ncrease renin secretion
3. Which one of the following is characteristic of ~ rease sympathetic outflow-from the GN&,
captoQril treatment in patients with essential e. Both produce orthostatic hypotension
hypettension?l 8. A patient with hypertension is to receive a
a. Competitively blocks angiotensin II at its receptor calcium channel blocker. ~ erapamil is associatedJ
~ eases::angiotensin~H e0ncentration in thy with which one of the following?
a. Diarrhea
c. Decreases renin concentration in the blood b. Hypoglycemia
d. Increases sodium and decreases potassium in the (9. ~tBR.tmtettVa'.l
blood d. Tachycardia
e. Decreases sodium and increases potassium in the e. Thyrotoxicosis
urine 9. A 45-year-ola man\ is brought to the emergency
4. A 73-year-old man with a history of falling at department with mental obtundation. He is found to
home is found to have moderately severe have a blood pressure 0( 220/160 .and retinal
hypertension. Which of the following drug groups is hemorrhages. Which one of the following is used in
most likely to cause postural hypotension and thus severe hypertensive emergencies, is short-acting,
'allincreased risk of falls'? acts on a G protein-coupled receptor, and must be
,A ACE inhibitors given by intravenous infusion?
c_v~lpba,-reupror blockers . " a. Aliskiren
c. Arteriolar dilators b. Captopril
d. Betal-selective receptor blockers @enoldopam
e. Nonselective pblockers d. Hydralazine
e. Losartan

10. Which of the following is very short-acting and
acts by releasing nitric oxide?
a. Atenolol
b. Captopril
c. Diltiazem t\~\7('\~i\t}Q
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
@ tnosuximi"tle
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
~ j hosl,lXimide selectively 6locl<s potassiwn ion
"'-e< +) channels in thalamic neurons
c. Phenobarbital has multiple actions, including
enhancement of the effects of GABA, antagonism
of glutamate receptors, and blockade of sodiwn ion
(Na+) channels
d. Phenytoin prolongs the inactivated state of the
Na+ channel
e. Zonisamide blocks voltage-gated Na+ channels
13. Which drug used in management of seizure
disorders is most likely to.__elevate the plasm&..
'~oncentratiQD}of other drugs administered
concomitantly?
a. Carbamazepine
b. Clonazepam
c. Gabapentin
~ .alproic acid 1
e. Vigabatrin
14. A young female patient su ffers from absence
seizuresi 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
~ b~ hro:rld t,e'""eXfilffined every :2 oF 3 mo"for de·ep
~ clon1 eflex activity
d. The use of valproic acid in pregnancy may cause
congenital malfonnations
e. Weight gain is common in patients on valproic
acid
15. Which statement concerning the
\pharmacakinetics of anti seizure drugs is accurate?
a. Administration of phenytoin to patients in
methadone maintenance programs has led to
symptoms of opioid overdose, including respiratory
depression
f ~~Iltrm.rgh etlfosuximLde has a half -life.of
¼pproximately 40 h, the drug is usually taken twi ce
a day . 1· . . ti 11
c. At high doses, phenytom e 1mmat10n o ows
first-order kinetics .
d. Valproic acid may increase the synthesis of
porphyrins . .
e. Treatment with v1gabatrm reduces th e
effectiveness of oral contraceptives
16. With chronic use in seizure states, th e ad~erse
effects of this drug include coarsening of f~cial
features, hirsutism, and gingival hyperplasia.
a. Carbamazepine
b. Felbamate
;?["i'pfienytoin .,
\..d(Phenobarbital
e. Valproic acid
17. Abrupt withdrawal of anti seizure drugs can
result in increases in seizure frequency and severity.
Withdrawal is most easily accomplished if the
patient is being treated with
a. Carbamazepine
Diazepam
__,t hosuximide 11
henobarbital
e. Phenytoin
18. The mechanism of antiseizure activity of
carbamazepine is
('aJ31oclc of sociium ion chrumers
Y.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
~ ls of phenytoin
~)r oxicerfects may occur'wiffi only small'
fincffiinents~itr.a0set
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 longtenn management of this
patient?
('a.);arbamazepine
Y. Clonazepam
c. Ethosuximide
d. Felbamate
e. Tiagabine
21 . Characteristics of phase I depolarizing '
neuromuscular blockade due to succinylcholine
include
a. Easy reversibi lity with nicotinic receptor
antagonists
b. Marked muscarinic blockade
n t=.Ar. n .n~2 109 20 2022) Rev.04
 fasciculat' ,
block ions only m the later stages of
d. Reversibility b
inhibitors Y acetylcholinesterase (AChE)
@st·1mulation
ustai_ned1e nsionduring a period oftetanic
Questions 22 d .
an 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
gly~opy~olate was administered followed by
pyndostigmine.
22. The main reason for administering the
~rnuscarinic receptor antag9nist :was to
a. Enhance the action of pyridostigmine
b. Prevent spasm of gastrointestinal smooth muscle
~ v__ent activation of cardiac muscarinic i eceptors 1
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 atnondepolarizing drug if .
the agent used was 1
a. Cisatracurium
b. Mivacurium
r?'tie.ancuronium
V Tubocurarine
e. Vecuronium
24. Which of the following drugs is the most
effective in the emergency-management of:1
malignant hyperthermia?
~ aclofen
~ antro lene'
c. Gabapentin
d. Secobarbital
e. Vecuronium
25. The elinicaluse of,succinylcholine-, especially in
patients with diabetes, is associated with
a. Antagonism by pytiq_(l)_stigmine during the early
~ ase of blockade
\J;JKspiration of gastric contents.
c. Decreased intragastric pressure
d. Histamine release in a genetically determined
population
e. Metabolism at the neuromuscular junction by
acety lcholinesterase
26. Which drug is most often associated with
hypo_te_nsio_n caused by. histamine release?,
a. Baclofen
b. Pancuronium
c. Tizanidine
~ uraritrei
Vecuronium
27. Regarding the ~R,asmolytic dnrgs--;:which of the
~ g statements is not accurate?
C!.'~.~ _fen acts on GABA recept0r,s in;!be ~pirtal
cofd1oincrease chloride ion conduct@ce 11
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. Intrathecal 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 bwns?
a. Baclofen
b. Cyclobenzaprine
c. Dantrolene
d. Rocuronium
Te).~
'--19. Which drug has spasmolytic activity and could
also be used in the management of seizures caused
by QY..e.rcfose of a local anesthetic?
a. Baclofen
b. Cyclobenzaprine
fcJDmepRIII'
'---t. 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
mrevent J>.Ostogetative pain caused b:w
succinylcooline?
..}\ Baclofen
~@t~filr a~hriUfJ).""1
c. Dantrolene
d. Lidocaine
e. Morphine
31. A 7O-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 5O-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 ofm urrent.calcium ston~s is
/cLl~ lafflffle
'-o:' Furosemide
c. Hydrochlorothiazide
d. Mannitol
e. Spironolactone
33. Which of the following is an important effect o'lf
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
0>totoxicity l
OF-ACD-032 (09.20.2022) Rev.04
 1 40. A graduate student is planning to make a hi~h-
~ ~ W 1 . 7 3m indicates
b. Mildly decreased
c. Mildly to moderately decreased
d. Kidney failure
35. Which of the following diuretics would be most
useful in the acute treatment of a oomatose patient
with brain injnry and oerebral edema?
a Acetazolamide
b. Amiloride
c. Ethacrynic acid
A Furosemide
~ i•
36. A 62-year-old man with advanced prostate
cancer is admitted to the emergency department
with mental obtundatioru
An electrolyte panel shows a serum calcium of 16.5
(normal ~8.5-10.5 mg/dL). Which of the following
therapies would be most useful in the management
of severe hypercalcemia?
a.
a Acetazolamide plus saline infusion
f 1aq IIMJb:ft'lstolj,.
c. Hydrochlorothiazide plus saline infusion
d Mannitol plus saline infusion
e. Spironolactone plus saline infusion
37. A 60-year-old patient complains of ~ esiasl
and-occasional:na~ associated with one of her
drugs. She is found to have hyperchloremic
metabolic acidosis. She is probably taking
/~ lamideJor gl~
4. Amil~de for edema associated with
aldosteronism
c. Furosemide for severe hypertension and heart
failure
d. Hydrochlorothiazide for hypertension
e. Mannitol for cerebral edema
38. A 70-year-old woman is admitted to the
emergency department because of a "fainting spell"
at home. She appears to have suffered no trauma
from her fall, but her blood pressure is 120/60 when
lying down and 60/20 when she sits up.
Neurologic examination and an ECG are within
normal limits when she is lying down. Questioning
reveals that she has recently started taking "water
pills" (diuretics) for a heart condition. Which of the
following drugs is the most likely cause of her.
•fainting spell?
a. Acetazolamide
b. Amiloride
~ othiazide
e. Spironolactone
39. A 58-year-old woman with lung cancer has
abnormally low serum osmolality. A drug that
increases the formation of dilute urine and is used to
treat SlAD.HJs
a. Acetazolamide
b. Amiloride
~ ~aptaI}
Y.Desmopressin
e. Ethacrynic acid
altitude climb in South America while on vacauo n.
He will not have time to acclimate slowly to
altitude. A drug that is useful inrpreventing high~
altitude sickness is
~ ~~ide
c. Demeclocycline
d. Desmopressin
e. Ethacrynic acid
41. Which of the following drugs accelen1tes the
conversion of 11~ogen to plasm.in?
a. Aminocaproic acid
b. Heparin
~ epirudin
~ "Cteplase
e. Warfarin
42. If a~fibrino1ytic drug is used for treatment of this
woman's acute myocardial infarction, which of the
following adverse drug effects is most likely to
occur?
a. Acute renal failure
b. Development of anti platelet antibodies
A Encephalitis secondary to liver dysfunction
l_VH-emoimagic s@ke'
e. Neutropenia
43. If this patient undergoes a percutaneous
coronary angiography procedure and placement of a
stent in a coronary blood vessel, she may be given
eptifibatide. Which of the following most accurately
describes the l!Jlechanism of eptifib_atide anti clotting
action?
a. Activation of antithrombin III
b. Blockade of post-translational modification of
clotting factors
c. Inhibition of thromboxane production
d. Irreversible inhibition of platelet ADP receptors
@ ~versil5Ie,-ifiliioition 0f-g lycoprotein llo1I fla
~to.rs_.
44. Hemopru.lia is an inherited bleeding disorder
resulting from a congenital deficiency in factor:
a. VII or IX
b. VIII or X
~ ~eabove
Questions 45-47. A 65-year-old man is brought to
the emergency department 30 min after the onset of
right-sided weakness and aphasia ( difficulty
speaking). Imaging studies ruled out cerebral
hemorrhage as the cause of his acute symptoms of
stroke.
45. Rrompt administratibn of which of the following
drugs is most likely to improve this patient's
clinical outcome?
a. Abciximab
~lasey
Yfact~r VIII
d. Streptokinase
e. Vitamin K
46. Over the next 2 d, the patient' s symptoms
resolved completely. To prevent a recurrence of this
QF-ACD-032 (09.20.2022) Rev.04
 . isease~ the patient is most likely to be treated
rnd
efi~itely with which of the following?
~ proicacid

c.Enoxaparin
d. Lepirudin
e. Warfarin
7 • I~ the ~atient is unable to tolerate the drug
iden!1fied m Question 46, he may be treated with
c_lop1dogr~,l. Relative to
ticlopidine, clopidogrel
a. Has a shorter duration of action
~ s les~ liRely to cause neutmpenia
c. Is 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,

~ : ~ :, ~ witliout monitoring the'jlatient' s

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 ~ R €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
~ inKl-.
½6. ~ nt develops severe thrombocytopenia in
response to treatment with uhfractionated heparin ·
and still requires parenteral anticoagulation. The
patient is most likely to be treated with which of the
following?
a. Abciximab
b. Cilostazol
~ f i f cfilh
'---a1>t~ minogen
e. Vitamin Kl