Duriko’s quiz chapter 1,2,3 quiz close/open questions

Which of the following routes of administration has the highest bioavailability?

A. Intramuscular
B. Intravascular
C. Oral
D. Subcutaneous
E. Sublingual

Answer: B
2. A patient was given a 200 mg dose of a drug IV, and 100 mg was eliminated during the
first 2 hours. If the drug follows first-order elimination kinetics, how much of the drug will
remain 6 hours after its administration?
A. None
B. 25 mg
C. 50 mg
D. 75 mg
E. 100 mg

Answer: B
3. Drugs that are administered IV are
A. Rapidly absorbed
B. Subject to first-pass metabolism
C. 100% bioavailable
D. Rapidly excreted by the kidneys
E. Rapidly metabolized by the liver

Answer: c
4. Drugs that are highly bound to albumin:
A. Effectively cross the BBB
B. Are easily filtered at the glomerulus
C. Have a large Vd
D. Often contain quaternary nitrogen
E. Can undergo competition with other drugs for albumin binding sites

Answer: e
5. The data presented in the figure below show that:

A. Drugs A and B have equal efficacy

B. Drug Band C have equal efficacy
C. Drug B is a partial agonist
D. Drugs A and C have the same affinity and efficacy
E. Drugs A and B have equal potency

Answer: a
6. A 500-mg dose of a drug has therapeutic efficacy for 6 h. If the half-life of the drug is 8 h,
for how long would a 1-g dose be effective?
A. 8 h
B. 12 h
C. 14 h
D. 16 h
E. 24 h

Answer: c
7. Which statement is accurate for the drug shown in the example below?
100 mg 2hr › 50 mg 2hr > 25 mg 2hr > 12.5 mg
A. The rate of elimination is constant
B. The elimination half-life varies with the dose
C. The volume of distribution varies with the dose
D. The clearance varies with the dose
E. The rate of elimination varies directly with the dose

Answer: e
8. What characteristic gives cortisol the ability to target intranuclear receptors?
(A) Diffuse through lipid membranes
(B) Interact with adenylyl cyclase
(C) Interact with G-protein-coupled receptors
(D) Recruit intracellular kinases
(E) Undergo autophosphorylation
Answer: a
9. A 66-year-old man is admitted to the hospital with confusion, nausea, and blurred
vision. He is currently on digoxin for the treatment of heart failure. On physical exam,
his heart rate is 120 bpm. Further evaluation reveals a digoxin level of 5.3 ng/mL (normal
range: 0.5-2 ng/mL). The doctor believes his symptoms are due to digoxin toxicity. Which
parameter is used to indicate the ability of digoxin to produce the desired effect relative
to a toxic effect?
(A) Bioavailability
(B) Efficacy
(C) Intrinsic activity
(D) Potency
(E) Therapeutic index

Answer: e
10. An 82-year-old woman is admitted to the hospital for management of a heart failure
exacerbation. She has peripheral edema and ascites due to the exacerbation. Further
evaluation also reveals a urinary tract infection requiring antibiotic treatment. Due to her
history of heart failure, changes in what pharmacodynamic parameter should be
considered prior to choosing the most appropriate antibiotic dose?
(A) Impaired blood flow to the intestine
(B) Increased protein binding of various drugs
(C) Increased volume of distribution
(D) Increased drug elimination

Answer: c
11. Which of the following terms is used to describe the elimination rate via metabolism
catalyzed by alcohol dehydrogenase when the enzyme is saturated?
(A) Biotransformation
(B) Clearance
(C) First-order elimination
(D) Redistribution
(E) Zero-order kinetics

Answer: e
12. A 38-year-old woman presents to her psychiatrist for the management of depression.
She feels that her current treatment is ineffective and would like to switch medications.
The patient reveals that she drinks alcohol every night to relieve her feelings of sadness and
guilt. Blood work is positive for elevated liver enzymes. The doctor starts imipramine, which
has an extensive first-pass metabolism. How Would this drug be affected?
A. Decreased half-life
(B) Decreased absorption
(C) Decreased solubility
(D) Increased concentration
(E) Increased pH

Answer: d
13. A 24-year-old female is prescribed erythromycin for gastroparesis. It is prescribed
four times daily due to its short half-life. What is the rationale for such a frequent dosing?
(A) Achieve the steady-state plasma concentration of the drug
(B) Aid more complete distribution of the drug
(C) Avoid the toxicity of the drug because of its low therapeutic index
(D) Ensure that the drug concentration remains constant over time
(E) Inhibit the first-pass metabolism of the drug

Answer: c
14. A 78-year-old woman is started on digoxin for the management of congestive heart
failure. Her initial dose is 0.25 mg. The Co, obtained by extrapolation of the elimination
phase, is determined to be 0.05 mg/L. What is the patient's estimated volume of
distribution?
(A) 0.0125 L
(B) 0.2 L
(C) 0.5 L
(D) 1L
(E) 5 L

Answer: e
15. A 35-year-old woman is started on ceftriaxone as empiric therapy for meningitis.
Following intravenous administration, the initial rates of drug distribution to different
tissues depend primarily on which of the following parameters?
(A) Active transport of the drug out of different cell types
B) Blood flow to the tissues
(C) Degree of ionization of the drug in the tissues
(D) Fat content of the tissues
(E) Specific organ clearances

Answer: b
Open ended questions
1. Signaling Mechanisms &Drug Action;
2. Drug safety - Therapeutic index and therapeutic window (definition)
Volume of Distribution(Vd), calculation, interpretation, examples of drugs with high and low
Vd
4. Drug Clearance through Metabolism - kinetics of metabolism: first order and zero order
kinetics of elimination, drug examples
5. Bioavailability-definition, calculation, Extent of Absorption, First-Pass Elimination
 Tsisana’s quiz chapter 1, 2, 3
1. All the statements are true in regard of drug volume of distribution(Vd) EXCEPT:
a. It may be calculated by dividing drug dose by plasma concentration of the drug
b. If the drug has more tendency to bind plasma proteins than tissue proteins, then it
of distribution will be similar to plasma volume
C. If drug molecule is lipid-soluble Its Vd is expected to be large
d. If drug Vd is large, then its plasma-half-life will be short

Answer: D
2. Which of the following statement describes correctly drug physical properties in rel
their permeation and action on receptors:
a. Molecular size is less than 100 Daltons
b. Charged particles better penetrate membranes than neutral molecules
C. The shape of the drug molecule does not play any role
d. The drugs with more than 1000 Daltons can't fit with binding site of the receptor
e. Lipid-soluble substances usually have effects on CNS

Answer: E
3. Which of the following is true in relation of bonds between the drug and the receptor:
a. Covalent bond between the drug and the receptor makes the drug duration of action
shorter
b. Hydrogen bond makes the drug to be less selective
C. The drug that forms van der Waals bonds with the target is expected to be irreversible
d. Overdose with the drug that forms covalent bond with the receptor may be treated by
administration of the drug that activates other receptors

Answer: d
4. Which of the following statement is correct in relation of loading dose:
a. Loading dose increases if desirable Cs increases
b. Loading dose does not depend on route of administration
C. It takes four half-lives to reach steady state after giving initial loading dose
d. Loading dose is used at the end of treatment regimen to ensure longer duration of
therapeutic effect

Answer: A
5. Which of the following statement is true in relation of maintenance dose:
a. If initial dosing interval is increased, the dose given in each dosing interval should be
increased to keep the steady-state concentration in the blood
b. If initial dosing interval is increased, the dose given in each dosing interval should be
decreased to keep the steady-state concentration in the blood
C. If the drug is infused at constant infusion, the rate of infusion is not affected by the ability
of the patient to clear the drug from plasma
d. Oral route of administration better maintains steady state concentration in plasma

Answer: A
6. Which of the following transduction systems is affected by nitroprusside and n
a. Adenylyl cyclase and cAMP
b. Guanyl cyclase and cGMP
c. Phospholipase C, IP3 and DAG
d. Cytokine receptors with JAK-STAT systems

Answer: B
7. Which of the following statement describes correctly the drug-receptor interaction:
a. Partial agonist is the drug that has less affinity to the binding site of the receptor compared
with full agonist.
b. Antagonist lowers constitutive activity of the receptor
C. When given with full agonist, partial agonist behaves like antagonist - decreases E max
full agonist
d. The greater is dissociation constant of competitive antagonist, the more amount of agi
is needed to surmount antagonist effect

Answer: C
8. Which of the following statements is true in relation of dose-response relationships:
a. Drug's potency is related to its Emax
b. EC50 directly points to the affinity of the drug to the receptor.
c. EC50 may be much less than Kd in the presence of spare receptors.
d. In the presence of spare receptors Kd is reduced and may be less than EC50

Answer: C
9. Which of the following is correct in relation of drug safety:
a. Safer drugs must have lower maximal efficacy
b. The dose-response curves for drugs with narrow therapeutic window are shifted to the right
on concentration axis
c. The drug with therapeutic index of 3 has broader therapeutic window than the drug with
fraction of TD50/ED50=4
d. The drugs with steeper dose-response curves in general, are less safe.

Answer: D
10. All the statements below are correct in relation to drug response EXCEPT:
A. Tolerance is related to diminished response to the same dose of drug over the course
of Treatment
b. Tachyphylaxis is an unusual, immune system mediated response to the drug action.
c. Idiosyncratic reactions usually are severe and may be life-threatening
d. Side effects usually are seen at therapeutic doses

Answer: B
11. The patient was given 100 mgs of drug by I/V infusion, after 2 hours the drug plasma
concentration halved. How many hours will take elimination of the 200 mg of the same drug
in this patient in case of first order kinetics?
a. 4h
b. 8h
C. 12h
d. 20h

Answer: B
13. the patient was administered the drug with pK=6.8. at which pH the drug will be absorbed
best if it is a weak base?
a. pH = 5
b. pH=7
C. pH=3
d. pH=9

Answer: D
14. the drug Y undergoes clinical trials. The researcher determined that the drug undergoes
first order elimination kinetics and its Ke=0.35h. how many hours will take for this drug to
reach zero concentration in plasma after stopping its infusion?
a. 6h
b. 8h
C. 12h
d. 16h
e. 24h

Answer: B
15. Which of the following methods will be used to calculate the clearance of the drug when
the
elimination is first order?
a. Clearance is the area under the curve(AUC) of the time-concentration profile after a dose
b. Clearance is the area under the curve(AUC) of the time-concentration profile after a dose
di.. the dose
c. Clearance is the dose divided by the AUC of the time-concentration profile after a dose
d. Clearance is the dose multiplied by the AUC of the time-concentration profile after a dose
e. none of the above

Answer: C
Quiz 2- chapters 4, 36,39 duriko
. A 60-year-old man on long-term therapy with a drug develops hypertension
hyperglycemia, and decreased bone density. Blood tests indicate anemia. Some of his stool
samples initially were positive for occult blood. Which drug is most likely responsible for the
patient's symptoms?
a. Beclomethasone
(b) Fludrocortisone
c. Celecoxib
d. Indomethacin
e. Prednisone

answer: e
2. A 27-year-old woman is diagnosed with hypercortism. To determine whether cortisol
production is independent of pituitary gland control, you decide to suppress ACTH
production by giving a high-potency glucocorticoid. Which drug would be the best choice for
this purpose?
(.a.) Dexamethasone
b. Hydrocortisone
c. Methylprednisolone
d. Prednisone
e. Triamcinolone

3. A woman goes into premature labor early enough that there are great concerns about
inadequate fetal lung development and the risk of fetal respiratory distress syndrome.
Which drug, specifically for the purpose of reducing the risks and complications of the
newborn's immature respiratory system development?
a. Hydrocortisone
(b) Betamethasone
c. cortisone
d. Indomethacin
e. Magnesium sulfate
4. A 67-year-old man injures his shoulder in an ATV accident. Over-the-counter ibuprofen is
unable to control the pain satisfactorily. The patient asks about glucocorticoid injections, so
his doctor begins to explain the myriad effects of glucocorticoids in the body. Which of the
following glucocorticoid actions would be most desirable in this patient?
(A) Antiemetic
(B) Decreasing synthesis of HGF, a growth factor
(C) Decreasing translocation of GLUT4 receptors to the cell membrane
(D) Increasing synthesis of IKB
((E) Stimulating gluconeogenesis
- A patient has severe Cushing disease. Surgery cannot be scheduled for several months, so
the physician plans to treat the patient in the interim with a drug that she describes as a
"potent inhibitor of corticosteroid synthesis." Which drug best fits that description?
a. Dexamethasone
b. Hydrocortisone
/.d) Ketoconazole
d. Prednisone
e. Spironolactone
6. A37-year-old kidney transplant recipient presents to her primary care physician for
follow-up. She has been taking daily prednisone for the past 2 months since her transplant.
If she runs out of prednisone and cannot get it refilled, what is she most at risk for
developing?
(A) Cardiovascular collapse (adrenal crisis)
(B) Osteoporosis
(O) Increased risk of infection
(D) Insomnia (short-term oral/parenteral)
(E) Nausea/vomiting (short-term oral/parenteral)
7. A 66-year-old woman with a history of Cushing's disease treated with oral glucocorticoids
presents to her primary care physician for follow-up. She was recently hospitalized for a hip
fracture following a fall. What is the most likely mechanism for hip fracture in this patient?
(A) Increased intestinal calcium absorption
(B) Increased sex hormone synthesis
(C) Inhibition of bone formation (osteoblasts)
(D) Osteoarthritis
(E) Osteochondroma
8. Regarding the release of ACTH from the anterior pituitary in a 24-year-old man who is a
marathon runner, which of the following is the next step in the process?
(A) Activation of protein S
(B) Increase of CGMP (NOT CAMP :)
(c) Stimulation of conversion of cholesterol to pregnenolone
(D) Release of adrenocorticosteroids
(E) Synthesis of pulmonary ACTH
9. A 67-year-old man injures his shoulder in an ATV accident, Over-the-counter and
prescription ibuprofen is unable to control the pain and swelling satisfactorily. The patient
asks about glucocorticoid injections. How might glucocorticoids help this patient?
a. Enhance the immune system to protect against possible underlying infection
(B) Decrease activity of phospholipase a2
C) Improve healing by enhanced collagen production
10) Increase blood flow by vasodilation
(E) Stabilize the joint by causing skeletal muscle hypertrophy
10. A 74-year-old woman with a long history of rheumatoid arthritis has been receiving
prednisone for the past 3 months. She also has been receiving captopril to treat her
hypertension. Which of the following laboratory results would be most likely to occur in this
patient?
a. Hyponatremia
b. Hypercalcemia
c. Hypokalemia
d. Hyperglycemia
e. Hypocholesterolemia

11. A 42-vear-old woman, recently diagnosed with lupus erythematosus, started a therapy
with high-dose dexamethasone. Which of the following best explains why synthetic
glucocorticoids are usually preferred over cortisol in the therapy of nonendocrine disorders
A. Lack of ulcerogenic activity
B. Less prone to induce salt and water retention
C. Less prone to induce myopathy
D. Less prone to induce opportunistic infection.
E. Lack of diabetogenic effects
12. 49-year-old woman underwent a blood test during a routine clinic visit. The woman,
recently diagnosed with lupus erythematosus, had been receiving high-dose prednisone for
3 weeks, Which of the following changes in the patient's blood cell concentration most likely
occurred as a result of her therapy?
A. Decreased neutrophils
B. Decreased erythrocytes
C Increased basophils
D. Decreased lymphocytes
E. Increased eosinophils
13. A 12-year-old boy, recently diagnosed with acute lymphoblastic leukemia, received a
multidrug treatment that included prednisone. The therapeutic effect of the drug is most
likely mediated by the drug-receptor complex binding to which of the following molecular
targets?
a. Final sequence on peptidyl RNA
b. Specific nucleotide sequence on DNA
c. Final sequence on ribosomal RNA
d. Interleukin-6
e. COCX-2

4. The mother of a 17-month-old girl took the baby to the pediatrician because she found
that her daughter's rectal temperature was 39,5 °C. After physical examination, the
pediatrician prescribed ibuprofen. Which of the following molecular actions most likely
mediated the antipyretic effect of the drug in this patient?
A. Blockade of prostaglandin receptors in the hypothalamus
B. Inhibition of phospholipase A2 in the hypothalamus
C Decreased interleukin concentration in the hypothalamus
D. Decreased concentration of prostaglandins in the hypothalamus
E. Inhibition of cyclooxygenase in peripheral tissues
F. Blockade of oxidative phosphorylation in skeletal muscle
15. A 45-year-old alcoholic woman, brought to the emergency department by her husband,
was disoriented, combative, and complained of headache, vertigo, and "ringing in my ears
The husband reported that she recently said she wanted to commit suicide. Which of the
following drugs most likely caused the patient's poisoning?
a. Paracetamol
b. Celecoxib
c. Indomethacin
d. Aspirin
e. Ibuprofen

16. A 45-year-old alcoholic woman, brought to the emergency department by her husband
was disoriented, combative, and complained of headache, vertigo, and ringing in my ears
The husband reported that she recently said she wanted to commit suicide. Which of the
following acid-base abnormality is expected in this patient JUST after few hours of
intoxication
a. Metabolic acidosis
b. Respiratory alkalosis and metabolic acidosis
c. Respiratory acidosis and metabolic acidosis
d. Respiratory alkalosis and metabolic alkalosis
e. Respiratory alkalosis

17. A 65-year-old man had been recently diagnosed with osteoarthritis. Six months ago, the
patient suffered from peptic ulcer disease that healed after triple antiulcer therapy. Which of
the following nonsteroidal anti-inflammatory drugs would be most appropriate for this
patient?
An Ibuprofen
B. Piroxicam
C Indomethacin
D ketorolac
E celecoxib
18. A. 32-year-old man called his physician because of fever (102.2*F, 39.0° C) for the past 4
hours. Past medical history of the patient was significant for a serious allergic reaction to
sulfonamides (think about sulfa drug allergy)-A diagnosis of flu was made. which of the
following antipyretic drugs would be contraindicated in this patient?
a. Aspirin
b. Celecoxib
c. Naproxen
d. Acetaminophen
e. Ibuprofen

19. A.32-year-old woman had been suffering severe pain during menses. The only relevant
history was that she had undergone conization 6 months earlier for a fibroid of the cervix.
ibuprofen as needed was able to relieve the menstrual pain. Which of the following
molecular actions most likely mediated the analgesic effect of the drug in the patient's
disorder?
a. Binding of the drug to prostaglandin receptors in myometrium
b. Decreased production of prostaglandin by the endometrium
c. Inhibition of prostaglandin biosynthesis in spinal cord
d. Anti-inflammatory action of the drug In the pelvic area
e. Decreased production of leukotrienes by endometrium

20. A 60-year-old man recently diagnosed with osteoarthritis asked his physician for an
because of intermittent pain in both hips. Past history of the patient was
significant for myocardial infarction 2 years ago and for pronounced aspirin hypersensitivity
Which of the following
would be the best advice to Rive to this patient at this time?
À. To use a propionic acid derivative like naproxen
B. To take only very low doses of aspirin
c. take aspirin with misoprostol
D. To use indomethacin
E. To avoid all nonsteroidal anti-Inflammatory drugs

59-year-old Japanese man with atrial fibrillation presented to his physician complaining
of red urine. The man had been receiving a standard dose of
warfarin, which is an anticoagulant drug bio-transformed by CYP2C9 isozyme. Which of the
following was the most likely cause of the parent's disorder?
A. Increased protein binding of warfarin
B. Decreased renal excretion of warfarin
C. Genetic polymorphism of CYP2C9
D. Decreased metabolism bf CYP2C9
E. Increased CYP2C9 synthesis in a person of Asian origin
23. A 35-year-old Caucasian man complained to his physician of tingling sensation in his
limbs and noted that his arms some-times felt heavy. The man, recently diagnosed with
pulmonary tuberculosis, had been receiving isoniazid and rifampin for 2 months. He was
diagnosed with peripheral neuropathy, a known adverse effect of isoniazid. Which of the
following events most likely caused the patient's symptoms and signs?
Worsening of the disease, despite the therapy
Allergic reaction to rifampin
inherited deficiency of N-acetyltransferase
E. Allergic reaction to isoniazid
24. A 20-year-old college student is brought to the emergency department after taking an
overdose or a non-prescription drug. The patient is comatose. He has been hyperventilating
and is now dehydrated with an elevated temperature. Serum analyses demonstrate that the
patient has an anion gap metabolic acidosis.
A. Toxic exposure to which of the following drugs is the most likely cause of these signs and
symptoms?
(A) Aspirin
(B) Acetaminophen
(C) Dextromethorphan
(D) Diphenhydramine
(E) Ethanol
B. In the management of this patient, it would be most appropriate to
(A) Administer acetylcysteine
(B) Administer fomepizole
(C) Administer glucagon
(D) Alkalinize the urine
(E) Induce vomiting with syrup of ipecac

26. We administer highly lipid-soluble drug and monitor its elimination in Vivo and in vitro
All the data indicate that it is transformed to a variety of more polar and oxidized metabolites
by a group Of heme proteins that activate molecular oxygen to a form that IS
capable of interacting with organic substrates such as our test drug. What enzyme or
enzyme system is most likely involved in the initial metabolism of this drug?
a. cytochrome P450s (CyP system, mixed-function oxidases)
b. Monoamine oxidase
c. Nicotinamide adenine dinucleotide phosphate (NADPH)
d. UDP-glucuronosyltransferase
27. A new drug, drug A, undergoes a series of Phase I metabolic reactions before its
metabolites ultimately are eliminated. Which statement best describes the characteristics of
drug A, or the role of Phase I reactions in its metabolism or actions?
a. Complete metabolism of drug A by Phase I reactions will yield products that are less likely
to undergo renal tubular reabsorption
b. Drug A is a very polar substance
c. Drug A will be biologically inactive until it is metabolized
d. Phase I metabolism of drug A involves conjugation, as with glucuronic acid or sulfate
e. Phase I metabolism of drug A will increase its intracellular access and actions
28. An 82-year-old woman presents to her physician complaining of difficulty sleeping and
problems coping throughout the day since the recent death of her husband. She requests a
medication that will help her through this time of her life. Her physician prescribes
oxazepam. The most likely rationale behind prescribing this drug is that oxazepam
a. Does not deplete liver glutathione
b. Does not have first pass metabolism
c. Does not require phase 1 metabolism
d. Does not require phase 2 metabolism
e. Induces cytochrome p450
29. which of the following factors is likely to increase the duration of action of a drug that is
metabolized by CYP3A4 in the liver?
a. chronic administration of rifampin during therapy with the drug in question
b. chronic therapy with amiodarone
c. displacement from tissue binding sites by another drug
d. increases cardiac output
e. chronic administration of carbamazepine
30. which of the following drugs may inhibit the hepatic microsomal p450 responsible for
warfarin metabolism?
a. amiodarone
b. ethanol
c. phenobarbital
d. procainamide
e. rifampin

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