Pharmacology

SET I I. Type A：DIRECTIONS: Each question below contains five suggested answers. Choose the best one response to each question. 1. True statement about T3 or T4 include all the following except (A) T3 readily penetrates cellular membrane (B) The daily releasing amount of T4 is much more than that of T3 (C) The plasma protein binding rate of T4 is much more than that of T3 (D) They all bind to receptors in nucleus (E) The T1/2 of T4 is shorter than that of T3. 2. The action of propylthiouracil is thought to involve which of the following mechanisms? (A) Blocking the enzymatic oxidation of iodide (B) Preventing the uptake of iodide (C) Preventing the synthesis of thyroglobulin (D) Inhibiting the release of thyroid stimulating hormone (E) Blocking the release of thyroxine 3. The insulin preparation having the longest duration of action is which of the following? (A) Insulin injection (regular insulin) (B) Prompt insulin zinc suspension (C) lsophane insulin suspension, or NPH insulin (D) Insulin zinc suspension (E)Protamine zinc insulin suspension 4. Which of the following drug has a hypoglucemic action through stimulating release of insulin? (A) Metformin (B) Phenformin (C) Rosiglitazone (D) Glimepiride (F) Acarbose 5. Which of the following drug is agonist of PPAR receptor? (A) Metformin (B) Phenformin (C) Rosiglitazone (D) Glimepiride (E) Acarbose 6. Which of the following drug is suitable for treatment of diabetes with obesity? (A) Metformin (B) insulin (C) Rosiglitazone (D) Glimepiride (E) Acarbose 7. Aluminum and calcium salts inhibit the intestinal absorption of which of the following agents? (A) Isoniazid (B) Chloramphenicol (C) Penicillin V (D) Erythromycin (E) Tetracycline 8. In the treatment of gonococcal infection in adults, the drug of choice is

(A) Pyrimethamine (B) Benzathine penicillin G (C) Penicillin G (D) Erythromycin (E) Tetracycline 9. Clavulanic acid, a new type of ?-lactam antibiotic, is important because it (A) Easily penetrates gram-negative microorganisms (B) Is specific for gram-positive microorganisms (C) Is a potent inhibitor of cell wall transpeptidase (D) Inactivates bacterial ?-lactamases (E) Has a spectrum of activity similar to penicillin G 10. In the treatment of infections caused by Pseudomonas aeruginosa, the antimicrobial agent that has proven to be effective is (A) penicillin G (B) carbenicillin (C) oxacillin (D) erythromycin (E) tetracycline 11. The therapy of choice in the treatment of meningococcal meningitis is (A) erythromycin, intravenously (B) amphotericin B, intravenously (C) penicillin G, intravenously (D) streptomycin, intramusclarly (E) tetracycline, intravenously 12. The aminoglycoside most likely to remain a useful therapeutic agent in the event of gentamycin resistance is (A) streptomycin (B) amikacin (C) neomycin (D) penicillin G (E) kanamycin 13. For the treatment of a patient with Legionella pneumonia, the drug of (A) penicillin G (B)chloraphenicol (C) erythromycin (D) SMZ (E) lincomyin 14. A possible treament for Mycoplasma pneumoniae would be (A) penicillin G (B) tetracycline (C)vancomycin (D)gentamycin (E)bacitracin 15. Cephalothin, a first generation cephalosporin, has antibacterial activity based on a mechanism of action that includes (A) interference with cross linking of peptidoglycan strands (B) competitive antagonism of pteroylglutamic acid synthesis (C) functiona] alteration of 30 S ribosomal synthesis (D) inhibition of nucleic acid synthesis (E) inhibition of protein synthesis 16. All the following penicillins are resistant to penicillinase EXCEPT (A) oxacillin (B) cloxacillin (C) amoxycillin (D) nafcillin (E) dicloxacillin II. Type K: DIRECTIONS: Each question below contains four suggested answers of which one or more is correct. Choose the answer: A

if

1, 2, and 3

B

if

1 and 3

are correct are correct

C

if

2 and 4

are correct

D

if

4

E

if

1, 2, 3, and 4

are correct are correct

1. True statements about oxytocin include which of the following? (1) It is approved for use in elective induction of labor (2) It causes postpartum hemorrhage (3) It causes a large increase in blood pressure (4) It should be administered intravenously to induce labor 2. True statements concerning the pharmacologic properties of thyroxine (T4) and triiodothyronine (T3) in humans include which of the following? (1)T4 is more potent than T3 (2)T4 has a longer half-life than T3 (3)T4 shows greater oral absorption than T3 (4)T4 has a greater affinity for serum protein than does T3 3. Vigorous exercise by a well-controlled for insulin-dependent diabetic person can promote (l) Glycosuria (2) An increased insulin requirement (3) Hyperglycemia (4) Glucose transport into muscle cells 4. Drugs that promote the release of insulin include which of the following? (1) Chlorpropamide (2) Glyburide (3) Acetohexamide (4) Glipizide 5. Insulin deficiency enhances which of the following conversions? (1) Protein to glucose (2) Fat depots to plasma free fatty acids (3) Protein to urinary ammonia and urea (4) Glucose to glycogen 6. Streptomycin and other aminoglycosides inhibit bacterial protein synthesis by binding to (1) peptidoglycan units in the cell wall (2) messenger RNA (3) DNA

(4) 30 S ribosomal subunit

7. Correct statements concerning cephalosporins in comparison with penicillins include which of the following? (1) Their structures are closely related

(2) Their mechanism of action is analogous (3) Cephalosporins have an unusually broader antimicrobial spectrum (4) Their hypersensitivity reactions can produce similar symptoms, including anaphylactic reactions 8. Penicillin has little or no antibacterial action against (1) Treponema pallidum (2) actively growing bacterial cells (3) meningococci (4) resting bacterial cells 9. Common complications of cephalothin therapy in hospitalized patients include (1) fever, eosinophilia, and anaphylaxis (2) superinfection with G+ organisms (3) thrombophlebitis

(4) hemolytic anemia

10. Correct statements about the clinical application of carbenicillin include which of the following? (1)It frequently causes diarrhea (2)It is resistant to penicillinase (3)It can cause hyperkalemic alkalosis (4)It has greater activity against gram-negative bacteria than penicillin G 11. Probenecid is sometimes given as an adjuvant in penicillin therapy because probenecid (1) Inhibits the renal tubular transport of penicillin (2) Has a synergistic bactericidal action with penicillin (3) Allows for higher serum levels of penicillin (4) Enhances directly the diffusion of penicillin through bacterial membranes 12. Aminoglycosides frequently are combined with another antibiotic to treat certain infections. The reasons for employing such combinations include (1) Obtaining a synergistic effect (2) preventing the emergence of resistant bacteria(3) increasing the antimicrobial spectrum (4) increasing oral absorption 13. Resistance of bacteria to penicillins can be caused by which of the following? (1) ?-Lactamase (2) amidase activity (3) modified PBPs (4) Decarboxylase activity 14. Neuromuscular blockade produced by tubocurarine is potentiated by which of the following agents? (1) Neomycin (2) Polymyxin (3) Streptomycin (4) Penicillin 15. Bacterial protein synthesis is directly inhibited by which of the following antibiotics? (1) Rifampin (2) Chloramphenicol (3) Penicillin (4) Tetracycline 16. True statements concerning cephalosporin antibiotics include which of the following?

(1) Cephalosporins are bactericidal against multiplying bacteria (2) Cephalosporins and penicillins have a similar spectrum of activity (3) Cross-hypersensitivity exists between cephalosporins and penicillins (4) Cephalosporins are resistant to inactivation by ?-1actamases 17. Correct statements concerning the adverse reactions caused by aminoglycosides include (1) produce ototoxicity (2) are common and potent neuromuscular blockers (3) produce nephrotoxicity during or after use (4) have a high incidence of hypersensitivity reactions similar to those of penicillins 18. Erythromycin (1) Inhibits bacterial protein synthesis by interaction with a 23 S rRNA receptor (2) May cause a hypersensitivity-based cholestatic hepatitis. (3) Is a useful alternative to penicillins for coccal infections in allergic patients (4) Is associated with a high incidence of pseudomembranous colitis. 19. Gentamicin is a commonly used antibiotic, especially in hospitals,its adverse effects include (1) Tinnitus and loss of perception of high-frequency sounds. (2) Elevation of serum iron, {3) Acute tubular necrosis. (4) The "gray baby" syndrome. III. Type B: DIRECTIONS: The groups of questions below consist of lettered choices followed by several numbered items. For each numbered item select the one lettered choice with which it is most closely associated. Each lettered choice may be used once,more than once, or not at all. Questions 37-41 For each description that follows, choose the drug with which it is most likely to be associated. (A) Chloramphenicol (B) Doxycycline (C) Erythromycin (D) Ethambutol (E) Penicillin G 37. This drug, which normally is excreted as glucuronide by the kidneys, reaches toxic levels in newborn infants

deficient in glucuronyl transferase (A) 38. This drug becomes concentrated in the liver and is excreted in an active form in the bile (C) 39. Can inhibit hepatic microsomal enzymes and increase the half-lives and toxicity of other drugs metabolized by this system (A) 40. It interferes with synthesis of cellular wall (E) 41. It may cause optic neuritis when large dose is used (D) Questions 53-56 For each of the following antibiotics, select the appropriate mode of action. (A) Blocking transcription by binding to DNA (B) Inhibition of binding of aminoacyl tRNA to 50 S ribosomal subunit (C) Inhibition of peptide chain cross-linkage in bacterial cell walls (D)Inhibition of production of folic acid (E)Inhibition of synthesis of membrane sterols 53. Penicillin G (C) 54. Erythromycin (B 55. SIZ (D) 56. Amphotericin B (E) IV. Questions 1. How to classify the -1actams? 2. List the antimicrobal spectrum ,mechanism and indications of penicillin G ,macrolides, lincomycin, aminoglycosides and tetracyclines.

Collected By: Mr. Keshav Bhattarai (Nepal) Chongqing Medical University 2006 Batch, MBBS Student www.esnips.com/web/cqmu-pharmacology [email protected] [email protected] [email protected] [email protected]

SET II Chapter 1 General Principles I.Type A：DIRECTIONS: Each question below contains five suggested answers. Choose the best one response to each question. 1. Supposing passive transport of nonionized forms of the following drugs determines the rate of their absorption, which of the following drugs will be best absorbed in the small intestine?(Supposing pH is 6.0 in bowel) (A) Aspirin, weak acid (pKa = 3.0)

(B) Ethacrynic acid, weak acid (pKa = 3.5)

(C) Sulfamethoxazole, weak acid(pKa=5.6)(D)Secobarbital, weak acid (pKa = 7.8) (E) Theophylline, weak base (pKa = 8.8) 2. If 91 percent of quinine，a weak base, is ionized in the blood, pKa of the drug is approximately(supposing pH is 7.4 in blood) (A) 2.6

(B) 4.7 (C) 6.4 (D) 8.4 (E) 9.3

3. Drugs may be released slowly from various drug reservoirs over long periods of time. The body reservoir that holds the largest amount of the barbiturate thiopental is (A) fat (B) lung (C) liver (D) muscle (E) serum albumin 4. Drug accumulation will occur after repeated injections if a drug is (A) not metabolized by the liver (B) administered intravenously (C) administered at the t1/2 of the drug (D) distributed quickly into the extracellular space (E) significantly protein-bound in the plasma 5. The route of excretion for drugs or their metabolic derivatives that is quantitatively the LEAST significant is which of the following? (A) Biliary tract (B) Kidneys (C) Lungs (D) Feces (E) Milk 6. Oxidizable drugs form a complex with and are oxidized by which of the following iron-containing pigments in the microsomal fraction of liver? (A) Cytochrome a (B) Cytochrome b (C) Cytochrome c (D) Cytochrome c1 (E) Cytochrome P-450 7. In the presence of impaired renal function, the time interval between maintenance doses needs to be lengthened for all the following antibiotics EXCEPT (A) ciprofloxacin (B) streptomycin (C) sulfisoxazole (D) chloramphenicol (E) ethambutol Questions 8-11 Drug A 200 mg was administered intravenously to a 70-kg man, The plasma concentrations of the drug were determined at various times after injection, as shown in the figure below. 8. The elimination haft-life (T1/2) of Drug A in this patient is about (A) 0.4 hr (B) 0.8 hr (C) 1.5 hr (D) 2.3 hr (E) 4.0 hr 9. The elimination rate constant (kc) of Drug A in this patient is (A) 0.l_ 1hr (B) 0.2_ 1hr (C) 0.3_1 hr (D) 0.4_1 hr (E) 0.5_1 hr 10. The apparent volume of distribution of Drug A in this individual is about

(A) 1.6 liters (B) 39 liters (C) 59 liters (D) 111 liters (E) 200 liters 11. The total body clearance of the drug is (A) 33.5 liters/hr (B) 48.0 liters/hr (2) 60.0 liters/hr (D) 255.0 liters/hr (E) 370.5 liters/hr 12. If a drug has an elimination half-life (t1/2) of 25 hr and 10 mg is administered intravenously every 12.5 hr, the expected average total body store of drug would be how many times greater than the 10 mg dose? (A) 1.5 (B) 3.0 (C) 4.5

(D) 6.0 (E) 12.0

13. It was determined that 95 percent of an oral 80-mg dose of verapamil was absorbed in a 70-kg test subject. However, because of extensive biotransformation during its first pass through the portal circulation, the bioavailability of verapamil was only 25 percent. Assuming a liver blood flow of 1500 ml/min, the hepatic clearance of verapamil in this situation was (A) 60 ml/min (B) 375 ml/min (C) 740 ml/min (D) lll0 ml/min (E) 1425 ml/min 14. An enteric-coated dosage form can be used to avoid all the following problems possible from oral drug administration EXCEPT (A) irritation to the gastric mucosa with nausea and vomiting (B) formation of nonabsorbable drug-food complexes (C)unpleasant taste of the drug (D) destruction of the drug by gastric acid or digestive enzymes (E)variability in absorption caused by fluctuations in gastric emptying time 15. The figure below shows the change in mean blood pressure as a result of increasing doses of norepinephrine and the antagonism of this response by drugs X and Y. Using the information provided in the diagram, which statement is correct? (A) Drug X is a more potent antagonist than drug Y (B) Drug X is a more effective antagonist than drug Y (C) Drug Y shows the characteristics of competitive antagonism (D) Drug Y shows the characteristics of noncompetitive antagonism (E) None of the above 16. The pharmacokinetic value that most reliably reflects the amount of drug reaching the blood flow after oral administration is the (A) Peak blood concentration

(B) Time to peak blood concentration

(C) Elimination half-life (D) Volume of distribution (E) Area under the blood concentration-time curve

II.Type K: DIRECTIONS: Each question below contains four suggested answers, which one or more is correct? Choose the answer: A

if

1, 2, and 3

are correct

B

if

1 and 3

are correct

C

if

2 and 4

are correct

D

if

4

are correct

E

if

1, 2, 3, and 4

are correct

17.From the graph below, correct statements include tha (1) Drug A is more potent than Drug B

(2) Drug A is less effective than Drug C

(3) Drug B is less effective than Drug C (4) Drug A is more selective than Drug B 18. Agents that appear to act via cellular receptors include (1) Diazepam (2) Nimodipine (3) Cimetidine (4) ferrous sulfate 19. Monitoring the blood levels of a drug is particularly important if the (1) Interpatient variability is considerable (2) Therapeutic index of the drug is low (3) Biological effect is difficult to monitor (4)the drug is easily accumulated 20. Biotransformation reactions classified as nonsynthetic include which of the following? (1) Oxidation (2) Reduction (3) Hydrolysis (4) Acetylation 21. True receptors that mediate the biological actions of neurotransmitters, hormones, and drugs include certain: (1) Regulatory proteins (2) Transport protein (3) Enzymes (4) Plasma proteins 22. Some drugs are transported across lipoid membranes by facilitated diffusion. This is a process that (1) is carrier-mediated (2)can be saturated (3)is selective for certain compounds (4)requires energy to function 23. Which of the following can only be biotransformed to become a pharmacologically active product? (1) Propranolol (2) Diazepam (3)) Procainamide (4) Chloral hydrate

III.Type B: For each description of a drug response that follows, choose the term with which it is most likely to be associated. Questions 24-26 (A) Supersensitivity (B) Tachyphylaxis (C) Tolerance (D) Hyposensitivity (E) Anaphylaxis 24. lmmunologically mediated drug reaction observed soon after drug administration 25. A rapid reduction in the effect of given dose of a drug after only one or two doses 26. Hyperreactivity to a drug seen as a result of denervation Questions 27-29 For each description that follows, select the transmembranal transport mechanism it best defines. (A) Filtration (B) Simple diffusion

(C) Facilitated diffusion (D) Active transport (E) Endocytosis 27. Lipid-soluble drugs cross the membrane at a rate proportional to the concentration gradient across the membrane and the lipid:water partition coefficiency of the drug 28. Bulk flow of water through membrane pores, resulting from osmotic differences across the membrane, transports drug molecules that fit through the membrane pores 29. Cell membranes engulf droplets of solutions that are released inside the cell Questions 30-32 For each type of incompatibility described below, select the pair of substances that illustrates it. (A) Tetracycline and ferrous iron (B) Penicillin G and sreptomycin (C) Isoproterenol and propranolol (D) Hydralazine and reserpine (E)Doxycycline and trimethoprim 30.Therapeutic incompatibility 31.Physical incompatibility 32.Chemical incompatibility Questions 33-36 Many families of drugs consist of members that vary only with respect to substituents on a common ring structure. For each type of pharmacologic effect that follows, select the ring structure with which it is most likely to be associated. (A) Containing steroid nucleus (B) Containing pentacyclic opiate structure (C) Containing -lactam (D) Containing Phenothiazine nucleus 33.Analgesic 34.Antipsychotic 35.Antimicrobial 36.Anti-inflammatory Questions 37-41 For each description that follows, choose the drug with which it is most likely to be associated. (A) Chloramphenicol (B) Doxycycline (C) Erythromycin

(D) Ethambutol (E) Penicillin G 37. This drug, which normally is excreted as glucuronide by the kidneys, reaches toxic levels in newborn infants deficient in glucuronyl transferase 38. This drug becomes concentrated in the liver and is excreted in an active form in the bile 39. Can inhibit hepatic microsomal enzymes and increase the half-lives and toxicity of other drugs metabolized by this system 40. It interferes with synthesis of cellular wall 41. It may cause optic neuritis when large dose is used IV.Questions 42. Which is the most common process for drug transfer across cell membranes and point out its characteristics. 43. Drug A is a weak acid with a pKa of 4, a weak base drug with a pKa of 4, what proportion of total will be nonionised at pH of 2 for the two drugs? 44. List the characteristics of plasma protein binding of drugs. 45. How is drug action terminated? 46. Are the biotransformation, drug metabolism and detoxication synonymous? 47. Describe the main process of drug metabolism. 48. What is the hepatic microsomal enzymes? List their main characteristics. 49. How is the excretion of salicylic acid influenced by the administration of sodium bicarbonate? How is the excretion of penicillin G influenced by the administration of probenecid? 50. What is the characteristic of first order kinetics for a drug. 51. What is the difference between the action and the effect of a drug? 52. Use receptor-action theory to elucidate what is the difference between the competitive antagonist and the non-competitive antagonist. 53. Which indecies are used to evaluate safety and effect? 54. What is pA2 and pD2? List their important meaning. Chapter 2 Chemotherapy I.Type A：DIRECTIONS: Each question below contains five suggested answers. Choose the best one response to each question. 1. A 32-year-old cancer patient, who has smoked two packs of cigarettes a day for 10 years, presents a decreased pulmonary function test. Physical examination and chest x-rays suggest preexisting pulmonary disease. All the following drugs may be prescribed EXCEPT (A) Vinblastine (B) Doxorubicin (Adriamycin) (C) Busulfan (D) Bleomycin (E) Cisplatin 2. Kernicterus in newborn or premature infants treated with sulfonamides is due to (A) Enhanced synthesis of bilirubin (B) Displacement of bound bilirubin from albumin

(C) Inlhibition of bilimbin degradation (D) Inhibition of urinary excretion of bilirubin (E) Deposition of crystalline aggregates in the kidneys 3. Aluminum and calcium salts inhibit the intestinal absorption of which of the following agents? (A) Isoniazid (B) Chloramphenicol (C) Penicillin V (D) Erythromycin (E) Tetracycline 4. The drug most effective against malarial parasites in the liver but not effective against parasites within erythrocytes is (A) Primaquine (B) Pyrimethamine (C) Quinine (D) Chloroquine (E) Artemisinin 5.Sulfisoxazole specifically inhibits which of the following processes? (A) Conversion of tetrahydrofolic acid to dihydrofolic acid (B) Converting deoxyuridine mono phosphate to thymine ribonucleoside monophosphate (C) Synthesis of methionine and serine (D) Synthesis of pteroylglutamic acid(dihydrofolic acid) (E) Reduction of ribonucleotides 6. In the treatment of gonococcal infection in adults, the drug of choice is (A) Pyrimethamine (B) Benzathine penicillin G (C) Penicillin G (D) Erythromycin (E) Tetracycline 7. Indicate from the diagram below the site of action of penicillinase. (A) A (B) B (C) C (D) D (E) E 8. Clavulanic acid, a new type of ?-lactam antibiotic, is important because it (A) Easily penetrates gram-negative microorganisms (B) Is specific for gram-positive microorganisms (C) Is a potent inhibitor of cell wall transpeptidase (D) Inactivates bacterial ?-lactamases (E) Has a spectrum of activity similar to penicillin G 9. In the treatment of infections caused by Pseudomonas aeruginosa, the antimicrobial agent that has proven to be effective is (A) penicillin G (B) carbenicillin (C) oxacillin (D) erythromycin (E) tetracycline 10. The therapy of choice in the treatment of meningococcal meningitis is (A) erythromycin, intravenously (B) amphotericin B, intravenously (C) penicillin G, intravenously (D) streptomycin, intramusclarly (E) tetracycline, intravenously

11. Ethambutol is administered concurrently with other antitubercular drugs in the treatment of tuberculosis in order to (A) reduce the pain of injection (B) facilitate penetration of the blood brain barrier (C) retard the development of organism resistance (D) delay excretion of other antitubercular drugs by the kidney (E) retard absorption after intramuscular injection 12. Antimetabolic drugs include all the following EXCEPT (A) cyclophosphamide (B) cytarabine (C) 5-fluorouracil (D) 6-mercaptopurine (E) methotrexate 13. The aminoglycoside most likely to remain a useful therapeutic agent in the event of gentamycin resistance is (A) streptomycin (B) amikacin (C) neomycin (D) penicillin G (E) kanamycin 14. The drug used both in the treatment of active tuberculosis and most commonly in the chemoprophylaxis of tuberculosis is (A) ethambutol (B) cycloserine (C) streptomycin (D) isoniazid (E) p-aminosalicylic acid 15. Which of the following statements about the neurotoxicity of isoniazid is true? (A) It can be prevented by streptomycin (B)It can be treated with vitamin B1 (C) It is responsive to pyridoxine therapy (D) It only occurs in toxic dose level (E) It interferes with the therapeutic effect 16. Candidiasis of the vagina, gastrointestinal tract, and oral cavity is treated primarily by which of the following drugs? (A) Nystatin (B) Miconazole (C) Rifampin (D) Griseofulvin (E) Iodide 17. Amoxicillin, a semisynthetic penicillin that resembles ampicillin EXCEPT for (A) spectrum of activity (B) more absorption after oral (C) skin rash (D) hypersensitivity reactions (E)CNS penetration 18. For the treatment of a patient with Legionella pneumonia, the drug of (A) penicillin G (B)chloraphenicol (C) erythromycin (D) SMZ (E) lincomyin 19. A possible treament for Mycoplasma pneumoniae would be (A) penicillin G (B) tetracycline (C)vancomycin (D)gentamycin (E)bacitracin 20. Cephalothin, a first generation cephalosporin, has antibacterial activity based on a mechanism of action that includes (A) interference with cross linking of peptidoglycan strands

(B) competitive antagonism of pteroylglutamic acid synthesis (C) functiona] alteration of 30 S ribosomal synthesis (D) inhibition of nucleic acid synthesis (E) inhibition of protein synthesis 21 The nucleophilic attack on DNA causing the disruption of base pairing occurs as a result of which of the following drug? (A) Cyclophosphamide (B) Fluorouracil (C) Methotrexate (D) Prednisone (E) Thioguanine 22. All the following penicillins are resistant to penicillinase EXCEPT (A) oxacillin (B) cloxacillin (C) amoxycillin (D) nafcillin (E) dicloxacillin 23. Chloramphenicol is the drug of choice for the treatment of (A) typhoid fever (B) gonorrhea (C) S. aureus infections (D) anthrax (E) gas gangrene II.Type K: DIRECTIONS: Each question below contains four suggested answers of which one or more is correct. Choose the answer: A

if

1, 2, and 3

are correct

B

if

1 and 3

are correct

C

if

2 and 4

are correct

D

if

4

E

if

1, 2, 3, and 4

are correct are correct

24. Streptomycin and other aminoglycosides inhibit bacterial protein synthesis by binding to (1) peptidoglycan units in the cell wall (2) messenger RNA (3) DNA (4) 30 S ribosomal subunit 25. True statements concerning griseofulvin include that it (1) inhibits the growth of dermatophytes (2) inhibits cell wall synthesis (3) is administered primarily by the oral route (4) is used primarily as a short-term drug 26. In the treatment of malaria, primaquine is useful because of its ability to destroy malarial (1) primary tissue schizonts (2) blood schizonts (3) gametocytes (4) sporozoites 27. True statements regarding isoniazid include that it (1) is structurally similar to pyridoxine (2) inhibits the synthesis of mycolic acids (3) is metabolized by acetylation (4) can be hepatotoxic

28. Correct statements concerning cephalosporins in comparison with penicillins include which of the following? (1) Their structures are closely related (2) Their mechanism of action is analogous (3) Cephalosporins have an unusually broader antimicrobial spectrum (4) Their hypersensitivity reactions can produce similar symptoms, including anaphylactic reactions 29. Penicillin has little or no antibacterial action against (1) Treponema pallidum (2) actively growing bacterial cells (3) meningococci (4) resting bacterial cells 30. Cardiotoxicity limits the clinical usefulness of which of the following antitumor antibiotics? (1) Dactinomycin (2) Doxorubicin (Adriamycin) (3) Bleomycin (4) Daunorubicin 31. Common complications of cephalothin therapy in hospitalized patients include (1) fever, eosinophilia, and anaphylaxis (2) superinfection with G+ organisms (3) thrombophlebitis

(4) hemolytic anemia

32. The acute toxic effects of methotrexate are reduced by the administration of (1) ascorbic acid (2) folic acid (3) niacin (4) tetrahydrofolate 33. Correct statements about the clinical application of carbenicillin include which of the following? (1)It frequently causes diarrhea (2)It is resistant to penicillinase (3)It can cause hyperkalemic alkalosis (4)It has greater activity against gram-negative bacteria than penicillin G 34. Resistance to penicillinase is found in which of the following penicillins? (1)Ampicillin (2)Oxacillin (3)Carbenicillin (4)Dicloxacillin 35.Second-generation cephalosporins include (1)cefazolin (2)cefuroxime (3)cefotaxime (4)cefamandole 36. Metronidazole is an effective treatment for which of the following infectious diseases? (1) Amebiasis

(2) Air way inflammatory disease

(3) Trichomonas infections (4) Moniliasis 37. Probenecid is sometimes given as an adjuvant in penicillin therapy because probenecid (1) inhibits the renal tubular transport of penicillin (2) has a synergistic bactericidal action with penicillin (3) allows for higher serum levels of penicillin (4) enhances directly the diffusion of penicillin through bacterial membranes 38. Causal prophylaxis of malarial infections may be achieved by treatment with (1)quinine (2) primaquine (3) chloroquine (4) pyrimethamine

39. Sulfonamides may cause renal damage that has been shown to be the result of precipitation of crystals in the collecting tubules of the kidney. Predisposing factors to such crystal formation include (1) high urinary concentration of the drug (2) low urinary solubility of the drug (3) a urine pH of less than 5.0 (4) simultaneous administration of several sulfonamides 41. An infection caused by extraintestinal Entamoeba histolytica can be effectively treated with (1) metronidazole (2) tinidazole (3) chloroquine (4) iodoquinol 42. Aminoglycosides frequently are combined with another antibiotic to treat certain infections. The reasons for employing such combinations include (1) obtaining a synergistic effect (2) preventing the emergence of resistant bacteria(3) increasing the antimicrobial spectrum (4) increasing oral absorption 43. Resistance of bacteria to penicillins can be caused by which of the following? (1) ?-Lactamase (2) amidase activity (3) modified PBPs (4) Decarboxylase activity 44. The activity of dihydrofolate reductase is inhibited by (1)SD (2)trimethoprim (3)sulfisoxazole (4)pyrimethamine 45. Neuromuscular blockade produced by tubocurarine is potentiated by which of the following agents? (1) Neomycin (2) Polymyxin (3) Streptomycin (4) Penicillin 46. Bacterial protein synthesis is directly inhibited by which of the following antibiotics? (1) Rifampin (2) Chloramphenicol (3) Penicillin (4) Tetracycline 47. True statements concerning cephalosporin antibiotics include which of the following? (1) Cephalosporins are bactericidal against multiplying bacteria (2) Cephalosporins and penicillins have a similar spectrum of activity (3) Cross-hypersensitivity exists between cephalosporins and penicillins (4) Cephalosporins are resistant to inactivation by ?-1actamases 48. Correct statements concerning the adverse reactions caused by aminoglycosides include (1) produce ototoxicity (2) are common and potent neuromuscular blockers (3) produce nephrotoxicity during or after use (4) have a high incidence of hypersensitivity reactions similar to those of penicillins 49. The pharmacologic properties of amphotericin B include (1) effectiveness when administered orally (2) usefulness in the treatment of systemic mycoses (3) damage of membrane (4) severe renal toxicity 50. Drugs considered to be cell-cycle specific include (1) 5-fluorouracil (2) methotrexate (3) 6-mercaptopurine (4) vincristine 51. Inhibition of the sulfonamide bacteriostatic mechanism can occur by the administration of (1) acetylsalicylate (2) folic acid (3) vitamin B6 (4) p-aminobenzoic acid 52. The "gray syndrome," which is caused by chloramphenicol in the newborn, is

(1) frequently fatal (2) related to immature hepatic conjugating mechanism (3) related to inadequate renal excretory function (4) characterized by life-threatening hyperthermia III.Type B: DIRECTIONS: The groups of questions below consist of lettered choices followed by several numbered items. For each numbered item select the one lettered choice with which it is most closely associated. Each lettered choice may be used once, more than once, or not at all. Questions 53-56 For each of the following antibiotics, select the appropriate mode of action. (A) Blocking transcription by binding to DNA (B) Inhibition of binding of aminoacyl tRNA to 50 S ribosomal subunit (C) Inhibition of peptide chain cross-linkage in bacterial cell walls (D)Inhibition of production of folic acid (E)Inhibition of synthesis of membrane sterols 53.penicillin G 54.erythromycin 55.SIZ 56.amphotericin B Questions 57-58 For each of the following chemotherapeutic agents, choose the neoplasm against which it is most likely to be effective. (A) Chronic myelogenous leukemia (B) Choriocarcinoma (C) Embryonal carcinoma (D) Prostatic carcinoma (E) Burkitt's lymphoma 57.Busulfan 58.Methotrexate Questions 59-61 For each of the following drugs, choose the adverse reaction with which it is most closely asssociated. (A)Aseptic hemorrhagic cystitis (B)Nephrotoxicity

(C)Oral and GI ulceration (D)Peripheral neuropathy (E)Pancreatitis 59.Fluorouracil 60.Cyclophosphamide 61.VCR IV.Questions 62.What is the resistant mechanism of microbial to antimicrobal drugs? 63.List pharmacological basis in combination of trimethoprim (TMP) and sulphamethoxazole (SMZ)? 64.Explain how sulphonamide cryetalluria can be prevented or reversed? 65.How to classify the -1actams? 66.List the antimicrobal spectrum ,mechanism and indications of macrolides, lincomycin, aminoglycosides and tetracyclines. 67.List the pharmacokinetic and pharmacodynamic characteristics of rifampicin 68.List the indications of metronidazole. 69.What is the main common untoward reaction of antitumor agents? Chapter 3 Central Nervous System I.Type A：DIRECTIONS: Each question below contains five suggested answers. Choose the best one response to each question. 1. The use of morphine is contraindicated in (A) myocardial infarction (B) acute pulmonary edema (C) simple diarrhea (D) kidney colic

(E) bronchial asthma

2. An important action of imipramine is inhibition of (A)norepinephrine release (B)norepinephrine uptake (C)acetylcholine release (D)dopamine uptake (E)serotonin synthesis 3. Gingival hyperplasia is a complication of long-term antiepileptic treatment with (A) phenobarbital (B) primidone (C) diazepam (D) phenytoin (E) valproic acid 4. The agent most effective in acute treatment of migraine headache is (A) primidone (B) methysergide (C) clonidine (D) ergotamine (E) amitriptyline 5. The onset and duration of action of a barbiturate are mainly a function of its (A) lipid solubility (B) molecular weight (C) plasma binding (D) renal excretion (E) method of administration 6. Effects of phenothiazines include all the following EXCEPT (A) orthostatic hypotension, constipation, and urinary retention

(B) Parkinson-like syndrome (C) hypoprolactinemia (D) antiemesis (E) control of psychotic behavior 7. All the following statements about oral doses of chloral hydrate are true EXCEPT that they (A) irrtate the gastric mucosa (B) produce physical dependence (C) produce hypnosis rapidly (D) produce obvious analgesia (E) can be rapidly absorbed 8. which effect of chlorpromazine is comparable to its extrapyramidal action? (A) antipsychotic effect (B) sedative effect (C) hypotension (D) urinary retention

(E) nasal congestion

9. Grand mal or focal seizures are best treated with which of the following drugs? (A) Chlorpromazine (B) Phenytoin (C) Ethosuximide (D) minodipine (E) Thioridazine 10. The preferred treatment of status epilepticus is intravenous administration of which of the following drugs? (A) Chlorpromazine (B) Diazepam (C) Succinylcholine (D) Ethosuximide (E) Thioridazine 11. The mechanism of action of haloperidol is the blockade of (A) serotonin receptors (B) dopamine receptors (C) GABA receptors (D) 2 adrenergic receptors (E) glutamate receptors 12. Which of the following barbiturates has the shortest duration of action? (A) Amobarbital (B) Pentobarbital (C) Phenobarbital (D) Secobarbital (E) Thiopental 13. The pharmacologic effects of meperidine include all the following EXCEPT (A) mydriasis (B) respiratory depression (C) nausea (D) diarrhea (E) orthostatic hypotension II.Type K: DIRECTIONS: Each question below contains four suggested answers of which one or more is correct. Choose the answer: A

if

1, 2, and 3

are correct

B

if

1 and 3

are correct

C

if

2 and 4

are correct

D

if

4

E

if

1, 2, 3, and 4

are correct are correct

14. True statements about triazolam include that it (1) may cause psychological dependence (2) is useful as an antianxiety agent

(3) has a short duration of action (less than 10 hours) (4) only it`s metabolite has pharmacological activity 15. Side effects of Phenytoin when used in control of tonic-clonic seizures include (1) nystagmus and ataxia (2) megaloblastic anemia (3) gingival hyperplasia (3) extrapyramidal motor effects 16. Pharmacologic properties of phenothiazine derivatives include the ability to (1) produce -adrenoceptor-blocking effects (2) potentiate the effects of antiepileptic drugs (3) produce anticholinergic effects (4) inhibit the reuptake of GABA 17. Toxic, dose-related effects of phenothiazines include which of the following? (1) Parkinsonism (2) dystonia (3) Akathisia (4) Hypopigmentation of the skin 18. The pharmacological properties of acetylsalicylic acid include (1) rapid and effective reduction in elevated temperature (2) promotion of platelet aggregation (3) alleviation of pain by inhibition of prostaglandin synthesis (4) potency equal to that of acetaminophen as an antiinflammatory agent 19. Side effects of chlorpromazine include (1) palpitations (2) orthostatic hypotension (3) blood dyscrasias (4) obstructive jaundice 20. Drugs that are especially useful in the treatment of petit mal epilepsy include (1) Phenobarbital (2) Phenytoin (3) Carbamazepine (4) Ethosuximide 21. Which of the following classes of compounds has markedly antipsychotic properties? (1) Butyrophenones (2) Thioxanthenes (3) Phenothiazines (4) Benzodiazepines 22. Characteristics of lithium carbonate include (1) a general sedative action similar to that of the phenothiazines (2) the side effects of tremors and nephrogenic diabetes insipidus (3) a relatively late peak plasma level, which occurs 24 hr after ingestion (4) usefulness in treatment of bipolar affective (manic-depressive) disorders 23. True statements about codeine include that it (1) produces naloxone-reversible respiratory depression (2) may cause hypotension as a result of histamine release (3) has antitussive properties (4) is partially biotransformed to morphine

24. Correct statements about tardive dyskinesia resulting from therapy with thioridazine include which of the following? (1)It is a condition of impaired control over voluntary oral and facial muscles (2)It has symptoms that often occur after the therapy ends (3)It often persists as a permanent condition in elderly institutionalized patients (4)It is a condition that responds favorably to treatment with L-dopa III.Type B: DIRECTIONS: The groups of questions below consist of lettered choices followed by several numbered items. For each numbered item select the one lettered choice with which it is most closely associated. Each lettered choice may be used once,more than once, or not at all. Questions 25-28 For each of the following descriptions, select the drug with which it is most closely associated. (A) Ethosuximide (B) Phenytoin (C) Carbamazepine (D) Valproic acid (E) Diazepam 25. Drug of choice in petit mal 26. May act by facilitating GABA levels in the brain 27. Useful in treatment of trigeminal neuralgia and mania 28. Drug of first choice in grand mal Questions 29-31 (A)Psychic dependence (B)Tolerance only (C)Physical dependence only (D)Tolerance and physical dependence (E)None of the above 29.meperidine 30.Secobarbital 31.Chlorpromazine IV.Questions 32.What is the mechanism of central actions of benzodiazepines? 33.In what respects do benzodiazepines differ from the barbituerats? 34.What is the site and mechanism of antipsychotic actions of chlorpromazine?

35.List the CNS actions and main adverse reactions of chlorpromazine? 36.List the CNS actions, mechanism and indications of morphine. 37.How do chlorpromazine compare with aspirin in reducing hyperthermia? 38.How do pethidine compare with aspirin in analgesic actions? 39.How dose aspirin influence blood clotting? 40.What is the relationship between dose and pharmacology of aspirin? 41.What is the untoward effects of aspirin and how to prevent it? Chapter 4 Autonomic Nervous System I.Type A：DIRECTIONS: Each question below contains five suggested answers. Choose the best one response to each question. 1. The drug of choice for the treatment of anaphylactic shock is (A) histamine (B) epinephrine (C) norepinephrine (D) isoproterenol (E) diphenhydramine 2. Phentolamine often causes an increase in heart rate and in the force of contraction by which of the following mechanisms: (A) Directly stimulating cardiac 1 receptors (B) Antagonizing the vagal transmitter (C) Releasing histamine from mast cells, which stimulates the heart (D) Blocking peripheral vasoconstriction, which produces reflex stimulation of the heart (E) Increasing the amount of calcium available to the heart 3. Diphenhydramine is effective in the therapy of all the following conditions EXCEPT (A)motion sickness (B)seasonal rhinitis (C)bronchial asthma (D)allergic dermatosis (E)parkinsonism 4. A 24-year-old man is brought to the emergency room by a group of friends who said that he had suddenly become restless, confused, and uncoordinated after taking some pills. Physical examination reveals increased body temperature, tachycardia, cutaneous flush, and widely dilated pupils unresponsive to light. The patient complains of dryness of the mouth. He probably ingested which of the following drugs? (A) Codeine (B) Aspirin (C) Secobarbital (D)atropin (E) Chlordiazepoxide 5. Functionally, a patient with myasthenia gravis resembles a person who has been treated with low doses of (A) atropine (B) tubocurarine (C) pilocarpine (D) muscarine (E) propranolol 6. Cimetidine is effective in treating duodenal ulcer because it (A) strengthens the protective coating on the intestinal wall (B) reduces parasympathetic-induced gastrointestinal secretions by competing at muscarinic receptors (C)is an agonist at H1 receptors and therefore reduces pepsin secretion (D)blocks histamine stimulation of gastric acid secretion by H2 receptors (E)increases bicarbonate ion secretion, neutralizing the pH

7. All the following targets respond to -adrenergic receptor stimulation EXCEPT for (A) the radial muscle of the iris (B) the ciliary muscle of the iris (C) bronchial muscle (D) atrioventricular node (E) sinoatrial node 8. Phenylethanolamine-N-methyl-transferase catalyzes the methylation which of the following substances? (A) Epinephrine (B) Norepinephrine (C) Serotonin (D) Histidine (E) Dopamine 9. The adrenal medulla secretes epinephrine in response to administration of (A) atropine (B) tubocurarine (C) succinylcholine (D) methyldopa (E) nicotine 10. In certain patients, the duration of apnea produced after administration of succinylcholine is hours rather than a few minutes. These patients probably have a deficiency of (A) liver transglucosylase (B) liver hydroxymethylase (C) plasma cholinesterase (D) plasma glycine transamidase (E) red blood cell glucose 6-phosphate dehydrogenase 11. Norepinephrine, after having interacted with the receptor of the effector cell, is subject to inactivation by (A) aromatic L-amino acid decarboxylase (B) catechol-O- methyltransferase (C) phenylethanolamine-N-methyl-transferase (D)dopamine -hydroxylase (E)tyrosine hydroxylase 12. Phenylephrine (Neosynephrine),which is included in over-the-counter cold remedies, (A) causes vasoconstriction by a -receptor stimulation (B) prevents vasodilation by blocking -receptors (C) stimulates the central nervous system to increase blood flow (D) reduces secretion by inhibiting parasympathetic stimulation (E) is an antihistamine that reduces secretion 13. A predictably dangerous side effect of propranolol, which constitutes a contraindication to its clinical use in susceptible patients, is the induction of (A) hypertension (B) cardiac arrhythmia (C) asthmatic attacks (D) respiratory depression (E) hypersensitivity 14. The major urinary metabolite of epinephrine is (A) normetanephrine (B) metanephrine (C) 3,4-dihydroxymandelic acid (D) 3-methoxy-4-hydroxymandelic acid

(E) 3-methoxy-4-hydroxyphenylglycol

15. The preferred drug for confirming the presence of pheochromocytoma in a patient who is severely hypertensive is (A) piperoxan (B) phenoxybenzamine (C) histamine (D) phentolamine (E) methacholine 16.Mechanism of action of long-lasting organic phosphate anticholinesterases is (A) splitting of polypeptide bonds in cholinesterases

(B) phosphorylation of the esteratic site of cholinesterases (C) acetylation of the anionic site of cholinesterases (D) phosphorylation of the anionic site of cholinesterases (E)acetylation of the esteratic site of cholinesterases 17. The most common adverse effect associated with the use of first generation antihistamine drugs is (A)sedation (B)xerostomia (C)urticaria (D)hypotension (E)tinnitus II.Type K: DIRECTIONS: Each question below contains four suggested answers of which one or more is correct. Choose the answer: A

if

1, 2, and 3

are correct

B

if

1 and 3

are correct

C

if

2 and 4

are correct

D

if

4

are correct

E

if

1, 2, 3, and 4

are correct

18. Drugs having affinity for both  and -adrenergic receptors include (1)propranolol (2)labetalol (3)methyldopa (4)epinephrine 19. Presynaptic 2 receptors are blocked by which of the following drugs? (1) Atropine (2) Clonidine (3) Prazosin (4) Phentolamine 20. Bronchodilation can be produced by administration of (1) theophylline (2) aminophylline (3) isoproterenol (4) phenoxybenzamine 21. Which of the following drugs will cause mydriasis after instillation into the eye? (1) Timolol (2) Phenylephrine (3) Pilocarpine (4) Homatropine 22. Which of the following drugs can turn over the BP increase of intravenous epinephrine? (1) prazosin (2) chlorpromazine (3) phentolamine (4) morphine 23. True statements about terbutaline include that it (1)is a direct-acting selective -adrenergic receptor agonist (2)may produce tremors, tachycardia, headache, and nervousness (3)will stimulate adenylate cyclase activity in bronchiolar smooth muscle (4)will undergo extensive first-pass biotransformation when administered orally 24. The symptoms of patients who have myasthenia gravis may be transiently improved by treatment with (1)neostigmine (2)tubocurarine chloride (3)edrophonium (4)atropine 25. Drugs that contain a quaternary amino group are therefore hard to cross biologic membranes include (1)physostigmine (2)neostigmine (3)epinephrine (4)acetylcholine 26. The combination of -adrenergic stimulation and -adrenergic blockade causes (1) uterine relaxation (2) bronchodilation (3) vasodilation (4) mydriasis

27. Neostigmine differs from physostigmine because neostigmine (1)has an additional direct effect at neuromuscular junctions (2)is less well absorbed from the gastrointestinal tract (3)is a quaternary ammonium compound, and physostigmine is a tertiary amine (4)is a reversible cholinesterase inhibitor, whereas physostigmine is an irreversible one 28. Epinephrine is added to local anesthetics in order to (1)stimulate local wound to repair (2)promote hemostasis (3)facilitate their dissemination along nerves (4)retard their absorption III.Type B: DIRECTIONS: The groups of questions below consist of lettered choices followed by several numbered items. For each numbered item select the one lettered choice with which it is most closely associated. Each lettered choice may be used once, more than once, or not at all. Questions 29-33 For each pharmacologic action listed, select the drug with which it is most likely to be associated. (A) Pralidoxime (B) Prazosin (C) Scopolamine (D) Timolol (E) Phenoxybenzamine 29.reduce intraocular pressure 30.counters toxic effects of organophosphate. 31.blocks the muscarinic sites in periphery and central nervous system 32.reacts irreversibly with receptor 33.decreases heart rate, especially when sympathetic activity is high Questions 34-36 For each anatomic site listed, select the catecholamine neurotransmitter with which it is most likely to be associated. (A) Dopamine (B) Serotonin (C) Epinephrine (D) Norepinephrine (E) Acetylcholine 34.Adrenergic fibers 35.Adrenal medulla 36.Caudate nucleus

Questions 37-40 For each of the following drugs, select the enzyme that it inhibits. (A) Carbonic anhydrase (B) Cholinesterase (C) Monoamine oxidase (D) Phosphodiesterase (E) Xanthine oxidase 37.phenelzine 38.acetazoamide 39.neostigmine 40.theophyline Questions 41-43 For each of the following actylcholine-sensitive receptors, select the most effective actylcholine antagonist (A)Muscarine (B)Tubocurarine (C)Atropine (D)Nicotine (E)Hexamethonium 41.cardiac muscle 42.Skeletal muscle 43.Ganglia IV.Questions 44.Compare the Pharmacology of physostigmine and neostigmine. 45.Compare ocular effects of pilocarpine, physostigmine, atropine and phenylephrine. 46.Which pharmacological actions of atropine are replaced by the following drugs: scopolamine, eucatropine, and propantheline? 47.Compare the Pharmacology of Noradrenaline, adrenaline, and isoprenaline? 48.List the indications and the contraindications of propranolol? Chapter 5 Cardiovascular System I. Type A：DIRECTIONS: Each question below contains five suggested answers. Choose the best one response to each question. 1. Methyldopa is an antihypertensive agent that acts by (A) blocking -adrenergic receptors (B) preventing conversion of angiotensinogen to angiotensin

(C) stimulating -adrenergic receptors in the central nervous system (D) directly dilating arteriolar smooth muscle (E) producing catecholamine depletion at postganglionic sympathetic nerve endings 2. As contrasted to epinephrine, the infusion of small amount of norepinephrine increases all the following cardiovascular parameters EXCEPT (A) systolic pressure (B) diastolic pressure (C) mean pressure (D) heart rate (E) peripheral resistance 3. Hypotension resulting from spinal anesthesia can be corrected with (A) atropine (B) ephedrine (C) phentolamine (D) phenoxybenzamine (E) reserpine 4. An antiarrhythmic agent that has relatively few electrophysiological effects on normal myocardial tissue but that suppresses the arrhythmogenic tendencies of ischemic myocardial tissues is (A) propranolol (B) procainamide (C) quinidine (D) lidocaine (E) disopyramide 5. Which of the following drugs is a very effective blocker of sodium channels but tends to be most active in myocardial tissues with long action potentials? (A) Lidocaine (B) Quinidine (C) Amiodarone (D) Procainamide (E) Propranolol 6. A person is likely to be more susceptible to digitoxin toxicity if digitoxin is taken with which of the following drugs? (A) Neomycin (B) Hydrochlorothiazide (C) Phenobarbital (D) Thioridazine (E) Estradiol 7. In a hypertensive patient who is taking insulin to treat diabetes, which of the following drugs is to be used with extra caution and advice to the patient? (A) Hydralazine (B) Prazosin (C) Guanethidine (D) Propranolol (E) -Methyldopa 8. Which of the following drugs is considered to be most effective in relieving and preventing ischemic episodes in patients with variant angina? (A) Propranolol (B) Nitroglycerine (C) Sodium nitroprusside (D) Nifedipine (E) Isorbide dinitrate 9. A major biochemical effect of cardiac glycosides is (A) enhancement of cardiac ribosome function in protein synthesis (B) enhancement of muscarine endplate receptor function in the heart (C) inhibition of acetylcholinesterase (D) enhancement of adenylate cyclase (E) inhibition of Na+, K+ ATPase 10. Verapamil exerts its effects through which of the following actions? (A) Preventing entry of calcium through slow channels (B)Preventing depolarization of the cell membrane

(C) Increasing sodium entry (D) Antagonizing the opening of the fast sodium channel (E) Enhancing potassium efflux 11. The drug of choice for the treatment of a life-threatening hypertensive crisis is (A)chlorothiazide (B) Sodium nitroprusside (C)guanethidine (D)methyldopa (E)reserpine 12. Which of the following is thought to cause increased synthesis and secretion of aldosterone by the adrenal cortex? (A) Renin (B) Angiotensin I (C) Angiotensin II (D) Kallikrein (E) Kininogen 13. Which of the following antihypertensive drugs produces most of its effects by blocking 1-adrenergic receptors in arterioles and venules? (A) Pindolol (B) Prazosin (C) Minoxidil (D) Hydralazine (E) Clonidine 14. In treating with β blockers a patient with essential hypertension who is also on the verge of congestive heart failure, which of the following drugs would be preferred? (A) Propranolol (B) Pindolol (C) Nadolol (D) Timolol (E) Metoprolol 15. The use of hydralazine in some persons is associated with sympathetic reflex discharge that may cause tachycardia and arrhythmia. The drug that would be most useful in reducing this reflex stimulation of the heart is (A) atropine (B) isoproterenol (C) procainamide (D) propranolol (E) quinidine II. Type K: DIRECTIONS: Each question below contains four suggested answers of which one or more is correct. Choose the answer: A

if

1, 2, and 3

are correct

B

if

1 and 3

are correct

C

if

2 and 4

are correct

D

if

4

E

if

1, 2, 3, and 4

are correct are correct

16. Which of the following drugs would be indicated in a patient who still has heart failure mainly manifested by dyspnea after adequate therapy with diuretics and digoxin? (1) Dobutamine (2) Hydralazine (3) Minoxidil (4) Nitroglycerine 17. -Adrenergic receptors can be separated into two subclasses: 1 and 2 receptors. The 1 receptors are involved in which of the following adrenergic responses? (1) Stimulatiing myocardial contractility (2) Relaxing bronchial smooth muscle (3) Stimulating renin secretion (4) Relaxing gastrointestinal smooth muscle 18. Digitalis is given to patients with atrial fibrillation because it (1)decreases the excitability of the atria (2)depresses conductivity in the AV node (3)decreases automaticity of the atria

(4)increases the effective refractory period in the AV node 19. Nitroglycerine, a frequently used cardiovascular drug (1) can cause adverse reactions of headache and tachycardia (2)undergoes significant first-pass biotransformation (3)is used for congestive heart failure intravenously (4)increases total coronary blood flow 20. Verapamil, a drug that may be used in place of digitalis to treat arrhythmias (1) is useful in the management of supraventricular arrhythmias (2) can cause adverse reactions such as constipation and headaches (3) reduces calcium influx through voltage-dependent calcium channels (4)possesses significant first-pass biotransformation following oral administration 21. Digitalis intoxication may cause which of the following arrhythmias? (1) Ventricalar extrasystole (2) Partial atrioventricular block (3) Atrial fibrillation

(4) Ventricular fibrillation

22. Which of the following deficiencies or agents may cause megaloblastic anemia? (1) Deficiency of folic acid

(2) Methotrexate therapy for leukemia

(3) Trimethoprim therapy

(4) Phenytoin therapy for epilepsy

23. Significant relaxation of smooth muscle of both venules and arterioles is produced by which of the following drugs? (1) Hydralazine (2) Minoxidil (3) hydrochlorothiazide (4) Sodium nitroprusside 24. People with genetically low levels of N-acetyltransferase are more prone to develop a lupus erythematosuslike syndrome with which of the following drugs? (l) Propranolol (2) Procainamide (3) Digitoxin (4) Hydralazine 25.The mechanism of antihypertensive effect of losartan is (1) blocking  receptor (2) inhibiting ACE (3) blocking Ca2+ channel (4) blocking AT1 receptor 26 Agents that depress circulating angiotensin Ⅱ levels include which of the following? (1) Hydralazine (2) Propranolol (3) Sodium nitroprusside (4) Captopril 27. Pronounced hypotension often occurs after rapid intravenous administration of which of the following drugs? (1) Lidocaine (2) Procainamide (3) Propranolol (4) Quinidine 28. Fatal arrhythmias are likely to occur in fully digitalized patients who have (1)hypokalemia (2)acidosis (3)myocardial infarction (4)hypercalcemia 29. Drugs that produce vasodilation by acting directly on vascular smooth muscle include (1) hydralazine (2) phenoxybenzamine (3) sodium nitroprusside (4) captopril

30.Which of the following anemias wouldd be treated with ferrous sulfate? (1)Anemia in infants who are undergoing rapid growth (2)Anemia associated with dysphagia, and gastritis. (3)Anemia associated with small, bizarre cells poorly filled with hemoglobin (4)Anemia associated with methotrexate intoxication 31. Cardiotoxic doses of the cardiac glycosides commonly produce (1) prolonged P-R intervals (2) enhanced automaticity of Purkinje's fibers (3) ventricular tachyarrhythmias (4) enhanced conduction along Purkinje's fibers 32. An increased heart rate is often caused by which of the following drugs? (1)Propranolol (2)Reserpine (3)Methyldopa (4)Hydralazine 33. Hyperlipidemia can be treated by which of the following agents? (1) Clofibrate (2) Cholestyramine (3) Nicotinic acid (4) Propylthiouracil 34. Drugs that reduce the size of a preformed fibrin clot have recently proven to be especially useful. Agents capable of dissolving fibrin clots include which of the following? (1) Fibrinolysin (2) Urokinase (3) Streptokinase (4) Factor IX complex 35. Megaloblastic anemia may be responsive to administration of (1)cyanocobalamin (3)folie acid

(2)intrinsic factor concentrate (4)ferrous sulfate

36. Endogenous heparin is characterized by which of the following statements? (1)It is found largely in mast cells (2)It is a sulfonated mucopolysaccharide (3)It is inhibited by protamine sulfate (4)It increases the action of antithrombin Ⅲ 37. In the treatment of hypertension, hydralazine is rarely given alone because it (1)increases cardiac output through reflex sympathetic stimulation (2)causes severe postural hypotension (3)elevates plasma renin levels (4)compromises the metabolism of other drugs 38. True statements concerning calcium influx-blocking agents include which of the following? (1)Nifedipine is more suitable than diltiazem in the presence of atrioventricular conduction abnormalities (2)Heart failure is a contraindication to any of the calcium influx-blockers (3)In the presence of atrial tachycardia, flutter, or fibrillation, verapamil is a preferred drug (4)Nifedipine causes less arteriolar dilation than verapamil or diltiazem

II.Type B: DIRECTIONS: The groups of questions below consist of lettered choices followed by several numbered items. For each numbered item select the one lettered choice with which it is most closely associated. Each lettered choice may be used once,more than once, or not at all. Match each route of administration and treatment indication with the currect drug Questions 39-43 (A)isoproterenol (B)Terbutaline (C)Phenylephrine (D)Dextroamphetamine sulfate (E)Prazosin 39. Administered intravenously to terminate paroxysmal atrial tachycardia 40. Administered parenterally to produce myocardial stimulation 41. Administered orally in the treatmeat of narcolepsy 42. Administered topically as a nasal decongestant 43. Administered orally to produce bronchodilation Questions 44-48 For each description that follows, choose the antiarrhythmic drug with which it is most likely to be associated. (A) Lidocaine (B) Propranolol (C) Quinidine (D) Procainamide (E) Verapamil 44. Blocks the effects of catecholamines upon the heart 45. Can cause a syndrome resembling lupus erythematosus 46. Is usually given intravenously with local anesthetic effect 47. A naturally occurring substance 48. Can effectively block calcium channels Questions 49-51 Match the following. (A) Inhibits thrombin and early coagulation steps (B) Inhibits synthesis of prothrombin (C) Inhibits platelet aggregation in vitro (D) Activates plasminogen (E) Binds the calcium ion cofactor in some coagulation steps

49.Coumarin 50.Heparin 51.Streptokinase Questions 52-55 Match the following. (A) Angiotensin I (B) Angiotensin II (C) Clonidine (D) Minoxidil (E) Captopril 52. Formed by enzymatic cleavage of substrate by renin 53. Lowers blood pressure in hypertensive patients by stimulating imidazoline receptor 54. Formed by enzymatic cleavage of substrate by ACE 55. An vasodilator IV.Questions 56.Give a comparison of pharmacokinetics among digitoxin, digoxin, lanatoside C and strophathin K. 57.List the pharmacological actions and indications of the cardiac glycosides. 58.What is the signs of cardiac glycosides intoxication and how to prevent or treatment? 59.Classify the drugs for treatment of congestive heart failure and give examples and describe their mechanisms. 60.Briefly describe how to treat arrhythmia by drugs. 61.List the mechanism and indications of antiangina agents including nitroglycerin, propranolol and calcium channel blocker. 62.Describe the pharmacological basis of treating angina pectoris in combination of nitroglycerin and propranolol. 63. Classify the drugs for antihypertention and give examples. 64.List the mechanism and indications of ACEI and lorsartan. 65.Describe the factors which influence on the absorption of iron from gastrointestinal tract. 67.Give a comparison of pharmacology between heparin and warfarin Chapter 6

Renal System

I.Type A：DIRECTIONS: Each question below contains five suggested answers. Choose the best one response to each question. 1. Hyperkalemia is a contraindication to the use of which of the following drugs? (A) Acetazolamide (B) Chlorothiazide (C) Ethacrynic acid (D) Furosemide (E) Spironolactone 2. A reduction in insulin release from the pancreas may be caused by which of the following diuretics? (A) Furosemide (B) Chlorothiazide (C) Spironolactone (D) Acetazolamide (E) Triamterene

3. The maximum phosphaturia for any given degree of natriuresis is caused by which of the following diuretics? (A) Ethacrynic acid (B) Furosemide (C) Hydrochlorothiazide (D) Acetazolamide (E) Triamterene 4. Ototoxicity is a rare but serious manifestation of (A) mannitol (B) ethacrynic acid (C) spironolactone (D) triamterene (E) Acetazolamide II.Type K: DIRECTIONS: Each question below contains four suggested answers of which one or more is correct. Choose the answer: A

if

1, 2, and 3

are correct

B

if

1 and 3

are correct

C

if

2 and 4

are correct

D

if

4

E

if

1, 2, 3, and 4

are correct are correct

5. Adverse reactions reported with administration of hydrochlorothiazide include (1) hypernatremia (2) hypokalemia (3) hyperchloremia (4) hyperuricemia 6. Correct statements concerning the administration of spironolactone, a homologue of aldosterone, include which of the following? (1)It is contraindicated in the presence of hyperkalemia (2)It interfere with the functions of sex hormones (3)It can produce CNS side effects (4)It interferes with aldosterone synthesis 7. Side effects associated with furosemide include (1)hyperuricemia (2)metabolic alkalosis (3)fluid and electrolyte imbalance (4)hypernatremia 8. Inhibition of sodium and chloride ion reabsorption is caused by which of the following diuretics? (1)Hydrochlorothiazide (2)Ethacrynic acid (3)Chlorthalidone (4)Bumetanide 9. Chlorothiazide increases the excretion of ions of (1)potassium (2)magnesium (3)sodium (4)calcium 10. The administration of furosemide or ethacrynic acid results in an increased excretion of which of the following cations? (1)Potassium (2)Sodium (3)Magnesium (4)Calcium 11. Hydrochlorothiazide is clinically useful in the treatment of (1) edema caused by chronic cardiac failure (2)acute pulmonary edema (3)hypertensive disease with or without overt edema (4)glaucoma, by reducing intraocular pressure 12. Diuretics that function primarily in ascending limb of Henle loop include (1)triamterene (2)chlorothiazide (3)spironolactone (4)furosemide

13. The therapeutic effect of digoxin may be altered with (1)hydrochlorothiazide (2)furosemide (3)ethacrynic acid (4)chlorthalidone 14. Furosemide can increase toxicities of which of the following drugs when they are administered concurrently? (1) Warfarin (2) Aspirin (3) Cephaloridine (4) Norepinephrine Ⅲ. Type B: DIRECTIONS: The groups of questions below consist of lettered choices followed by several numbered items. For each numbered item select the one lettered choice with which it is most closely associated. Each lettered choice may be used once,more than once, or not at all. Questions 15-18 For each of the following diuretic agents, choose the anatomic site in the renal nephron where the principal action of the agent occurs. (A) Glomemlus (B) Proximal tubule (C) Ascending limb of the loop of Henle (D) Distal tubule (E) Collecting duct 15.Acetazolamide 16.Amiloride 17.Bumetanide 18.hydrochlorothiazide Questions 19-23 For each of the following pharmacologic effects, select the diuretics that is most likely to cause it. (A) Theophylline (B) Triamterene (C) Spironolactone (D) Chlorothiazide (E) Acetazolamide 19. Increases cardiac output; mild diuretic action 20. Competitive antagonist of aldosterone 21.Inhibiting Na+-Ka+/2Cl- cotransportor 22. Inhibiting Na+-2Cl- cotransportor 23.Inhibiting carbonic anhydrase IV.Questions 24.Describe the mechanism of action and indications of furosemide. 25.compare the sites and mechanisms of action of loop diuretics, thiazides and K+-sparing diuretics.

Chapter 7 Endocrine

System

I.Type A：DIRECTIONS: Each question below contains five suggested answers. Choose the best one response to each question. 1.True statement about T3 or T4 include all the following except (A) T3 readily penetrates cellular membrane (B) The daily releasing amount of T4 is much more than that of T3 (C) The plasma protein binding rate of T4 is much more than that of T3 (D) They all bind to receptors in nucleus (E) The T1/2 of T4 is shorter than that of T3. 2. The action of propylthiouracil is thought to involve which of the following mechanisms? (A) Blocking the enzymatic oxidation of iodide (B) Preventing the uptake of iodide (C) Preventing the synthesis of thyroglobulin (D) Inhibiting the release of thyroid stimulating hormone (E) Blocking the release of thyroxine 3. The steroid having the LEAST mineraldocorticoid potency is which of the following?. (A) Cortisone (B) Fludrocortisone (C) Spironolactone (D) desoxycorticosterone (E) Hydrocortisone 4. The steroid having the greatest anti-inflammatory potency is which of the following? (Al Cortisone (B) Hydrocortisone (C) Prednisone (D) Dexamethasone (E) Triamcinolone 5. Protamine is added to insulin in order to (A)speed the absorption of insulin from the injection site by increasing insulin solubility (B)speed the absorption of insulin by increasing the local blood flow (C)slow the absorption of insulin by constricting blood vessels (D)slow the absorption of insulin by promoting insulin binding to tissue proteins (E)slow the absorption of insulin by forming a relatively insoluble complex 6. The insulin preparation having the longest duration of action is which of the following? (A) Insulin injection (regular insulin) (B) Prompt insulin zinc suspension (C) lsophane insulin suspension, or NPH insulin (D) Insulin zinc suspension (E)Protamine zinc insulin suspension 5. Which of the following drug has a hypoglucemic action through stimulating release of insulin? (A) Metformin (B) Phenformin (C) Rosiglitazone (D) Glimepiride (F) Acarbose

6. Which of the following drug is agonist of PPAR receptor? (A) Metformin (B) Phenformin (C) Rosiglitazone (D) Glimepiride (E) Acarbose 7. Which of the following drug is suitable for treatment of diabetes with obesity? (A) Metformin (B) insulin (C) Rosiglitazone (D) Glimepiride (E) Acarbose II.Type K: DIRECTIONS: Each question below contains four suggested answers of which one or more is correct. Choose the answer: A

if

1, 2, and 3

are correct

B

if

1 and 3

are correct

C

if

2 and 4

are correct

D

if

4

E

if

1, 2, 3, and 4

are correct are correct

8. True statements about oxytocin include which of the following? (1) It is approved for use in elective induction of labor (2) It causes postpartum hemorrhage (3) It causes a large increase in blood pressure (4) It should be administered intravenously to induce labor 9. True statements concerning the pharmacologic properties of thyroxine (T4) and triiodothyronine (T3) in humans include which of the following? (1)T4 is more potent than T3 (2)T4 has a longer half-life than T3 (3)T4 shows greater oral absorption than T3 (4)T4 has a greater affinity for serum protein than does T3 10. Vigorous exercise by a well-controlled for insulin-dependent diabetic person can promote (l) glycosuria (2) an increased insulin requirement (3) hyperglycemia (4) glucose transport into muscle cells 11. Dexamethasone can produce which of the following effects? (1)Deposition of glycogen in the liver (2)Increase in amino acid content of muscles (3)Redistribution of body fat (4)Lowering of serum glucose levels 12. Steroids that are secreted by the adrenal cortex include which of the following? (1)Hydrocortisone (2)Testosterone (3)11-Desoxycorticosterone (4)Prednisolone

13. Corticosteroids can be used to treat (1)chronic bronchial asthma (2)Cushing's syndrome (3)leukemia (4)osteoporosis 14. Drugs that promote the release of insulin include which of the following? (1) Chlorpropamide (2) Glyburide (3) Acetohexamide (4) Glipizide 15. Insulin deficiency enhances which of the following conversions? (1) Protein to glucose (2) Fat depots to plasma free fatty acids (3) Protein to urinary ammonia and urea (4) Glucose to glycogen III.Type B: DIRECTIONS: The groups of questions below consist of lettered choices followed by several numbered items. For each numbered item select the one lettered choice with which it is most closely associated. Each lettered choice may be used once,more than once, or not at all. Questions 16-18 For each inhibitory effect on thyroid hormone synthesis listed below, select the agent that causes it. Sodium thiocyanate (B) Methimazole (Tapazole) (C) Triiodothyronine (D) Radioactive iodine (E) Iodide 16. Inhibits the peroxidase-catalyzed oxidation of iodide and thus interferes with the incorporation of iodide into an organic structure 17. Inhibits the peroxidase-catalyzed coupling of iodotyrosines to form iodothyronines 18. Inhibits the secretion of hormone IV.Questions 18.List the indications of insulin. 19.Briefly describe the classification and mechanism of oral hypoglycaemic agents 20.Compare the mechanism and indications of propylthiouracil with that of iodide. 21.List the mechanism and indications of glycocorticoids. 22.To a patient suffered from Addison`s disease, how and why a doctor use the glycocorticoids. 23. List the effects of glycocorticoids on blood cell components.

Examination I I.Type A. DIRECTIONS (items 1-32): Each numbered item or incomplete statement in this section is followed by answers or by completions of the statement. Select the ONE lettered answer or completion that is BEST in each case. 1. Common effects of muscarinic stimulant drugs include all of the following EXCEPT (A) Tachycardia. (B) Increased peristalsis. (C) Miosis. (D) Stimulation of sweat glands. (E) Increased secretion by salivary glands. 2. A patient is admitted to the emergency department for treatment of an overdose of a drug. The identity of the drug is unknown, but it is observed that when the urine pH is acid, the renal clearance of the drug is less than the glomerular filtration rate; and that when the urine pH is alkaline, the clearance is greater than the glomerular filtration rate. The drug is probably a (A) strong base (B) weak acid (C)nonelectrolyte (D) weak base (E)strong acid 3. Drugs that block the alpha-receptor on effector cells at adrenergic synapses cause (A) reverse of the effects of norepinephrine on heart (B) reverse of the effects of epinephrine on blood pressure (C) reverse of the effects of epinephrine on adenylate cyclase (D) an increasing in glucose (E)mydriasis 4. Aminophylline, dobutamine, and digoxin: each can (A) Increase cAMP. (B) Increase cardiac contractile force. (C) Degrease conduction velocity in the atrioventricular node (D) Increase peripheral vascular resistance. (D) decrease venous return 5. The polypeptide agent with the strongest vasodilater properties is (A) Bradykinin (B) Glucagon (C) Methysergide (D) Prostacyclin (E) Angiotensin II. 6. Common adverse effects of cimetidin (A) Agranulocytosis (B) Systemic lupus erythematosus (C)Inhibition of hepatic metabolism of other drugs (D)Antiestrogenic effects (F) Hypertension 7. One property of quinidine that procainamide does not have is (A) Effectiveness in the control of atrial arrhythmias. (B) Effectiveness in the control of ventricular arrhythmias. (C) Activity of the oral route (D) Prolongation of the PR interval (E) Enlarging the QRS. 8. A patient discharged from the hospital after a myocardial infarction is receiving small doses of quinidine to suppress a ventricular tachycardia. One month later, his local physician prescribes hydrochlorothiazide for the treatment of ankle edema, which he ascribes to congestive heart failure. One week after beginning thiazide therapy, the patient is readmitted to the hospital with a rapid multifocal ventricular tachycardia. The most probable cause of this arrhythmia is

(A) Quinidine toxicity caused by inhibition of quinidine metabolism by the thiazide. (B) Direct effects of hydrochiorothiazide on the pacemaker of the heart. (C)Thiazide toxicity caused by qninidine's effects on the kidney. (D) Reduction of serum sodium caused by the diuretic action of hydrochlorothiazide. (E)Reduction of serum potassium caused by the diuretic action of hydrochlorothiazide. 9. Important therapeutic or toxic effects of hydrochlorothiazide when used in the treatment of hypertension include (A) Decreased heart rate. (B) Decreased blood volume. (C) Increased total body potassium (D) Metabolic acidosis. (E) Increased serum sodium. 10. Contraindications to the use of propranolol include (A) Angina pectoris (B) Migraine (C) Tachycardia (D) Asthma (E) Hypertension. 11. Soon after being put to bed for a nap, a 4-year-old child is found convulsing. Diarrhea,and a warm, moist skin are apparent. The heart rate is 70/min, and the pupils are markedly constricted. Drug intoxication is suspected. The most probable cause is (A) An organophosphate-containing insecticide. (B) A nicotine-containing insecticide. (C) Amphetamine-containing diet pills. (D) Phenylephrine-containing eye drops. (E) An atropine-containing medication. 12. Most weak acid drugs as well as weak base drugs are absorbed primarily from the small intestine after oral administration, because (A) Both types are more ionized in the small intestine. (B) Both types are leas ionized in the small intestine. (C) The blood flow is greater in the small intestine than in other parts of the gut. (D) The surface area of the small intestine is greater than most other parts of the gut. (E)The small intestine has nonspecific carriers for most drugs. 13. A drug suitable for producing mydriasis and cycloplegia lasting more than 24 hours is (A) Atropine (8) Tropicamide (C) Echothiophate (D) Edrophonium (E) Ephedrine. 14. Neostigmine and physostigmine differ in that (A) Neostigmine is inactive when given orally. (B) Physostigmine is inactive when given orally. (C) Neostigmine is irreversible in its effects.

(D) Physostigmine has more effect on the central nervous system (E) Neostigmine has less effect on skeletal muscle. 15. A drug that deceases blood pressure by a CNS action is (A) Guanethidine (8) Trimethaphan (C) Nitroprusside (D) Prazosin (E) Clonidine. 16. When treating hypertension, orthostatic hypotension is greatest with (A) Hydralazine (B) Guanethidine (C) Propranoiol (D) Clonidine (E) Methyldopa. 17. The antihypertensive drug most likely to aggravate angina pectoris is (A) Clonidine (8) Guanethidine (C) Propranolol (D) Hydralazine (E) Methyldopa. 18. A drug lacking vasodilator properties that is useful in angina is (A) Nitroglycerin (B) Nifedipine (C) Metoprolol (D) isosorbide dinitrate (E) Verapamil 19. A drug that reduces clotting of blood is (A) Prostaglandin E2 (B) Prostaglandin F2 (C) Prostacyclin (D) Thromboxane A2 (E) Leukotriene B4. 24. A potent facilitator of platelet aggregation is (A) Prostaglandin E2 (B) Prostaglandin F2 (C) Prostacyclin (D) Thromboxane A2 (E) Leukotriene B4 20. A drug useful in the treatment or prevention of asthma, although it lacks bronchodilator action, is (A) Aminophylline (B) Isoproterenol (C) Ephedrine (D) Metaproterenol (E) Cromolyn. 21. The most common route of drug entry into cells is (A)uptake by special carrier (B)diffusion through the lipid phase (C)pinocytosis after combined with coated pits (D)aqueous diffusion (E)transport by amino acid carrier 22. Epinephrine reverses many effects of histamine, although it dose not act at the histamine receptor. Epinephrine is a (A) Competitive inhibitor of histamine. (B) Noncompetitive antagonist of histamine. (C) Physiologic antagonist of histamine. (D) Chemical antagonist of histamine. (E) Metabolic inhibitor of histamine. 23. Most drug receptors are (A) Small molecules with a molecular weight of between 100 and 1000 (B) Lipids arranged in a bilayer configuration. (C) Proteins located on cell membranes or in the cytosol. (D) Deoxyribonucleic acids.

(E) Ribonucleic acids. 24. After intravenous bolus administration of a drug, the major factors determining the initial plasma concentration are (A) Dose and clearance. (B) Dose and apparent volume of distribution. (C) Apparent volume of distribution and clearance. (D) Clearance and half-life. (E) Half-life and dose. 25. Propranolol and hydralazine have which of the following effects in common? (A) Tachycardia. (B) Bradycardia. (C) Increased vascular resistance. (D) Decreased mean arterial blood pressure. (E) Decreased cardiac output. 26.Intravenous administration of norepinephrine in a patient already taking an effective dose of atropine will (A) Increase heart rate. (B) Decrease total peripheral resistance. (C) Decrease blood sugar. (D) lncrease skin temperature. (E) Reduce pupil size. 27. A drug that will produce mydriasis without cycloplegia is (A) Tropicamide. (B) Phenylephrine. (C) Isoproterenol. (D) Atropine. (E) Cyclopentolate II.Type B. DIRECTIONS (items 33-50): Each group of items in this section consists of lettered headings followed by a set of numbered phrases. For each phrase, select the ONE lettered heading that is most closely associated with it. Items 28-30: (A) Diphenhydramine. (B) Ergotamine tartrate (C) Terfenadine. (D) Cimetidine. (E) Ranitidine.

28. A drug that has significant action against motion sickness. 29. A drug that decreases gastric acid secretion and has antiandrogenic effects. 30. A drug with partial agonist effects at serotonin receptors and alpha-receptors Items 31--34: (A) prazosin. (B) Guanethidine. (C) Reserpine. (B) Methyldopa. (E) Captopril. 31. A drug that appears to block postsynaptic receptors more effectively than presynaptic receptors. 32. A drug that blocks a carrier mechanism located in the membrane of synaptic transmitter storage vesicles. 33. A drug that inhibits a peptidase enzyme in the blood. 34. A drug that is converted into the active form in the brain. Items 35-38 (A) Quinidine. (B) Digoxin. (C) Verapamil. (D) Lidocaine. (E) Propranolol. 35. A drug that predictably prolongs the PR interval and increases cardiac contractility. 36. A drag that is useful in supraventricular tachycardias and angina pectoris--and not contraindicated in asthma. 37. A drag that is useful in ventricular and atrial arrhythmias; may cause tinnitus. 38. A drug that is very useful in early post-myocardial infarction ventricular arrhythmias but not very effective in atrial arrhythmias. Items 39-41: (A) Neostigmine. (B) Nicotine. (C) Bethanechol. (D) Acetylcholine (E) Malathion 39. Converted to active form by substitution of oxygen for sulfur; rapidly detoxified in mammals. 40. Direct-acting muscarinic agonist with minimal susceptibility to cholinesterase 41. Cholinoceptor agonist that causes vasoconstriction.

III.Type K. DIRECTIONS (items 42-60): For each item in this section, ONE or MORE of the numbered options are correct. Select A if only (1), (2), and (3) are correct

B if only (1) and (3) are correct

C if only (2) and (4) are correct

D if only (4) is correct

E if all are correct.

42. Which of the following statements is (are) correct? (1) "Maximum efficacy" of a drug is directly correlated with its potency. (2) The "therapeutic index" is the LD50 (or TD50) divided by the ED50. (3) A "partial agonist" has no effect on its receptors unless another drug is present. (4) Quantal dose-response data provide information about the standard deviation of sensitivity to the drug in the population studied. 43. The heart rate response to the infusion of a moderate dose of phenylephrine in conscious patients can be blocked by (1) Hexamethonium (2) Atropine (3) Phenoxybenzamine (4) Neostigmine. 44. Scopolamine (1) Has depressant actions on the CNS. (2) May cause hallucinations. (3) Is similar to atropine in reducing gastrointestinal motility. (4) May prevent motion sickness when applied as a patch to the skin. 45. Differences between propranolol and timolol include which of the following? (1) Timolol is a selective 1-blocker. (2) Propranoiol cannot be given orally, (3) Timolol has no cardiac effects. (4) Propranolol has more local anesthetic action.. 46. Differences between hydralazine and nitroglycerin include which of the following? (1) Nitroglycerin cannot be given orally. (2) Hydralazine has a much longer half-life. (3) Hydralazine induces methemoglobinemia. (4) Hydralazine causes primarily arterial vasodilatation. 47. The increase in heart rate and force of cardiac contraction normally induced by sympathetic nerve discharge can be blocked by (1) Propranolol (2) Pindolol (3) Nadolol (4) Metoprolol. 48. Treatments of angina that increase the exercise time in a treadmill test without increasing the product of heart rate and blood pressure at which anginal symptoms occur include (1) Nitroglycerin (2) Propranolol (3) Nifedipine (4) Coronary bypass surgery. 49. Verapamil and diltiazem may diminish the symptoms of angina pectoris by (1) Reducing blood pressure (2) Reducing heart rate

(3) Reducing cardiac contractile force (4) Increasing heart size. 50. Which of the following has (have) a self-limited diuretic action even when volume contraction is prevented? (1) Hydrochlorothiazide (2) Triamterene (3) Furosemide (4) Acetazolamide. 51. In a patient receiving digoxin for congestive heart failure, conditions that may facilitate the appearance of toxicity include (1)Hypercalcemia (2) Hypomagnesemia (3)Hypokalemia (4) hypernatremia 52. Forms of digitalis toxicity include (1) Nausea and vomiting. (2) Junctional tachycardia arrhythmia. (3) Atrial fibrillation arrhythmia. (4) Ventricular extrasystoles and tachycardia. 53. Methylxanthine drugs such as aminophylline (1) Cause vasodilatation in many vascular beds. (2) Increase cAMP in mast cells. (3) Cause bronchodilatation. (4) Inhibit the enzyme phosphodiesterase. 54. Drugs used in asthma that often cause tachycardia and tremor include (1) Isoproterenol (2) Cromolyn sodium (3) Aminophylline (4) Beclomethasone. 55. Drugs with potentially useful effects in the treatment of inoperable metastatic pheochromocytoma include (1) Phenoxybenzamine (2) Propranolol (3) Phentolamine (4) Metoprolol. 56. Agents that can readily cause edema if released into the circulation include (1) Histamine (2) Serotonin (3) Bradykinin (4) Angiotensin II. 57. Typical results of beta-receptor activation include (1) Hyperglycemia (2) Lipolysis (3) Glycogenolysis (4) Increased renin secretion. 58. Drugs that may be useful in the treatment of atrial fibrillation include (1) Quinidine (2) Digoxin (3) Procainamide (4) Lidocaine. 59. Hexamethonium and similar ganglion blockers can (1) Block the cardiac acceleration induced by preganglionic sympathetic nerve stimulation. (2) Block the cardiac acceleration induced by intravenous infusion of nitroglycerin. (3) Block the vasoconstriction induced by intravenous administration of nicotine. (4) Block the vasoconstriction induced by the intravenous infusion of tyramine. 60. Drugs that readily enter the central nervous system when given intravenously include (1) Amphetamine (2) Dopamine (3) Methyldopa (4) Bethanechol.

Examination II I.Type A. DIRECTIONS (items 1-22): Each numbered item or incomplete statement in this section is followed by answers or by completions of the statement. Select the ONE lettered answer or completion that is BEST in each case. 1. Which of the following is an important factor regarding the use of anticoagulant drugs? (A) Heparin is contraindicated in pregnancy. (B)Warfarin has a long onset of action that is related to the half-lives of blood clotting components (C)heparin in activated in the liver to an active agent (D)Warfarin effect is monitored by measuring the bleeding time (E)Heparin is inactive in vitro. 2.In the treatment of thromboembolic disorders. (A)Aspirin is contraindicated. (B)Urokinase, especially when readministered in a patient, carries a major risk of an allergic reaction. (C)antiplatelet drugs may act through the inhibition of platelet thromboxane synthesis (D)aminocaproic acid may be a useful antithrombotic agent (E)patient intake of Vk should be reduced 3. Plasmid-mediated bacterial resistance to this drug group involves synthesis of transferase enzymes that inactivate by addition of acetyl or other groups. (A) Macrolides (B) Tetracyclines (C) Aminoglycosides (D) Penicillins (E) Sulfonamides. 4. All of the following antimicrobials inhibit bacterial protein synthesis EXCEPT (A) Erythromycin (B) Cefazolin (C) Amikacin (D) Tetracycline (E) Clindamycin 5.Which of the following adverse effects associated with the use of methicillin (A)Phototoxicity (B) skin rashes (C)Interstitial nephritis (D)Agranulocytosis (E)Acute hemolytic anemia. 6. Of the following penicillins, which is most suitable for oral? infection proved by culture to be due to a beta-hemolytic streptococcus? (A) Procaine penicillin G (B) Penicillin VK (C) Indanyl carbenicillin (D) Nafcillin (E) Ticarcillin. 7. In addition to its effectiveness in infections caused by penicillinase-producing staphylococci, cefazolin has useful activity against (A)Pseudomonas spp (B)Treponema pallidum (C)Mycoplasma pneumonia (D)Bacteroides fragili (E)Klebsiella spp 8.All of the following statements about tetracyclines are accurate EXCEPT (A)They bind to 30S ribosomal subunits of bacteria. (B)They axe active against Chlamydia. (C)They may cause candidal superinfcctions.. (D)Resistance involves production of inactivating enzymes. (E)Oral absorption may be decreased by multivalent cation

9.A valid clinical use of chloramphenicol is (A)Chlamydial infections of the urinary tract. (B)Viral infections of the upper respiratory tract (C)Treatment of syphilis in penicillin allergy. (D)Empiric treatment of neonatal Sepsis. (E)Ampicillin-resistant Haemophilus infiuenzae 10. A drug active against methicillin-resistant staphylococcal strains is (A) Gentamicin (B) Cephalothin (C) Erythromycin (D) Vancomycin (E) Tetracycline, 11. An inhibitor of DNA-dependent RNA polymerase, useful in tuberculosis, is (A) Isoniazid (B) Streptomycin (C) Rifampin (D) Ethambutol (E) Ethionamide. 12. All of the following statements about aminoglycosides are accurate EXCEPT (A) They may cause dose-dependent vestibular dysfunction. (B) They are bactericidal inhibitors of protein synthesis. (C) They are primary drugs for gram-negative bacterial infections, (D) They are effective against anaerobes, including Bacteroides spp, (E) They are polar compounds eliminated mainly by renal glomerular filtration. 13. The mechanism of antibacterial action of trimethoprim is to (A) Inhibit dihydropteroate synthase. (B) Competitively inhibit thymidylate synthase. (C) Block cell uptake of PABA. (D) Inhibit glucose-6-phosphate dehydrogenase. (E) Inhibit dihydrofolate reductase. 14. All of the following drugs have clinically useful activity against Candida albicans EXCEPT (A) Nystatin (B) Ketoconazole (C) Griseofuivin (D) Amphotericin B (E) Flucytosine. 15. Resistance to this drug involves methylation of the 23S rRNA receptor and block of drug binding. (A) Streptomycin (B) Tetracycline (C) Chloramphenicol (D) Sulfamethoxazole (E) Erythromycin. 16. A valid clinical use of clindamycin is (A) Treatment of gonorrhea. (B) Severe infection due to Bacteroides spp. (C) Respiratory infection due to Mycoplasma spp. (D) Clostridium difficile gastrointestinal infection. (E) Rickettsial infections. 17. This antimalarial is a blood schizonticide active against all 4 types of malaria, but resistant strains of Plasmodium falciparum occur. The drug may cause dose-dependent retinal damage.

(A) Chloroquine (B) Quinine (C) Primaquine (D) Pyrimethamine (E) Amodiaquine. 18. This anticancer drug with specificity for the S phase of the cell cycle is activated by kinases to form an inhibitor of DNA polymerase. (A) Prednisone (B) Cyclophosphamide (C) Methotrexate (D) Doxorubicin (E) Cytarabine. 19. The mechanism of the anticancer action of doxorubicin involves (A) Inhibition of folate reductase. (B) Block of lymphoid cell differentiation. (C) Intercalation between the base pairs of DNA. (D) Interaction with tubulin to block mitosis. (E) Inhibition of thymidylate synthase. 20. This anticancer drug is a component of regimens effective in testicular carcinoma. Its distinctive toxicity includes hyperkeratosis, fever with dehydration,pulmonary dysfunction and anaphylactoid reactions. (A) dactinomycin (B) vinblastin (C) cyclophosphamide (D) bleomycin (E) mercaptopurine 21. Characteristic toxic effects of the anticancer plant alkaloid vincristine include (A) Cardiac abnormalities and tachycardia. (B) Pulmonary infiltrates. (C) Areflexia, peripheral neuritis, and paralytic ileus. (D) Adrenal suppression. (E) Renal dysfunction. II.Type B. DIRECTIONS (items 41-76): Each group of items in this scction consists of lettered headings followed by a set of numbered phrases. For each phrase, select the ONE lettered heading that is most closely associated with it. Items 22-25: (A)Oral tolbutamide. (B)Subcutaneous ultralente insulin (C)Intravenous crystalline insulin. (D)Intramuscular glucagon. (E) Oral hypertonic (50%) glucose. 22.Appropriate initial therapy for severe ketoacidosis 23. Appropriate initial emergency room therapy for a comatose patient with known insulin-dependent diabetes. 24. Appropriate outpatient therapy for a patient with non-insulin-dependent diabetes. 25. Appropriate self-medication during early symptoms of hypoglycemia in a patient with insulin-dependent diabetes. Items 26-29: (A) Propylthiouracil, (B) Fludrocortisone.

(C) Spironolactone. (D) Methylprednisolone (E) Corticotropin. 26. Steroid useful in the management of inflammatory disease, 27. Orally active agent useful in the treatment of thyrotoxicosis 28. Corticosteroid with high ratio of mineralocorticoid to glucocorticoid actvity 29.Competitive inhibitor of aldosterone Items 30-32. (A) Amoxiciilin. (B) Cefazolin. (C) Erythromycin. (D) Chloramphenicol. (E) Streptomycin. 30. Effective against Mycoplasma pneumoniae and penicillinase-producing staphylococci. 31. Detoxification normally is carried out by hepatic glycuronyl transfernses, which may be deficient in neonates. 32. Antibacterial activity may be enhanced by clavulanic acid Items 33-35: (A) Tetracycline. (B) Griseofulvin (C) Nystatin. (D) Isoniazid. (E) Amphotericin B. 33. This polyene antibiotic is given intravenously and causes "shake and bake" chills and fever, electrolyte imbalance, cardiac irregularities, and nephrotoxicity. 34. This antifungal drug interferes with microtubule function. Its adverse effects include headaches, confusion, gastrointestinal upsets, and changes in liver function. It may be teratogenic. 35. The neurotoxic adverse effects of this antimicrobial drug can be alleviated by administration of pyridoxine. Items 36-38 (A) Sulfisoxazole. (B) Nafciilin. (C) Methenamine. (D) Vancomycin. (E) Trimethoprim. 36. This drug is an appropriate choice for treatment of hospital-acquired staphylococcal infections, including those caused by methici!iin-resistant strains.

37. Bacterial dihydrofolate reductases may be as much as 104 times more sensitive to inhibition by this drug than mammalian forms of the enzyme. 38. Aikalization helps to avoid urinary crystallization of this drug and does not reduce its antibacterial activity. Items 39-41: (A) Procarbazine. (B) Mechlorethamine. (C) Cytarabine. (D) Vincristine. (E) Cyclophosphamide 39. A component of the "MOPP" regimen effective in Hodgkin's disease, this drug causes arrest of cancer cells in the M phase of the cell cycle. 40. This S phase-specific antimetabolite is used primarily in the treatment of acute myelogenous leukemia. 41. This useful anticancer drug is biotransformed to a metabolite that inhibits MAO and can cause drug interactions. Unfortunately, the drug is leukemogenic and has teratogenic and mutagenic effects. III.Type K. DIRECTIONS (items 42-58): For each item in this section, ONE or MORE of the numbered options are correct. Select A if only (1), (2), and (3) are correct

B if only (1) and (3) are correct;

C if only (2) and (4) are correct

D if only (4) is correct

E if all are correct.

42. Drugs that are useful in the treatment of Parkinson's disease include (1) Amantadine (2) Levodopa (3) benztropin (4) Bromocriptine. 43. Common adverse effects of the tricyclic include (1) Sedation (2) Thyroid malfunction (3) Anticholinergic effects such as dry mouth (4) Increased blood pressure. 44. Documented effects of many phenothiazine neuroleptic drugs include (1) Blockade of peripheral aipha-adrenoceptors. (2) Blockade of central dopamine receptors. (3) Production of an extrapyramidal condition that resembles Parkinson's disease (4) Blockade of peripheral acetyicholine receptors. 45. In the treatment of arthritis, (1) Aspirin (dally dose 4000 mg) is less efficacious than piroxicam (daily dose 20 mg). (2) Gastrointestinal toxicity is one of the most common limiting factors in the use of nonsteroidal antiinflammatory drugs. (3) Phenylbutazone is associated with an increased incidence of thromboembolism. (4) Renal toxicity is an important toxic effect of long-term therapy with nonsteroidal antiinflammatory drugs. 46. In the therapy of inflammatory joint disease, (I) Gold salts are able to halt the destruction of joint cartilage and bone. (2) Corticosteroids are effective in reducing symptoms temporarily but have major toxicity when used chronically.

(3) Antimalarial drugs are useful in some patients who are unresponsive to nonsteroidal antiinflammatory agents. (4) The renal toxicity of nonsteroidal anti-inflammatory drugs is readily reversible by switching to other drugs. 47. Naloxone would he expected to reverse (1) Constipation induced by heroin in an addict. (2) Analgesia induced by meperidine in a cancer patient (3) Respiratory depression induced by methadone overdose (4) Miosis induced by morphine abuse. 48. Characteristics of the penicillins include which of the following? (1) Ampicillin is active against penicillinase-producing staphylococci. (2) Carbenicillin is active against Pseudomonas aeruginosa. (3) Aminoglycosides antagonize the action of penicillin G against enterococci (4) Penicillin G is eliminated by the kidney via active tubular secretion. 49. Valid clinical use(s) of tetracycline include treatment of (1) Chlamydial infections. (2) Upper respiratory tract infections due to Mycoplasma pneumoniae (3) Gonorrhea. (4) A hospital-acquired staphylococcal osteomyelitis. 50. Aminoglycoside antibiotics (1) Inhibit phosphoryl-group transferases. (2) Intercalate between base pairs of DNA. (3) Inhibit DNA-dependent RNA polymerase. (4) Bind to the 30S ribosomal subunit to block initiation of peptide formation 51. In the chemotherapy of tuberculosis, (1) Combination drug therapy is desirable to delay the emergence of resistance (2) Adverse effects of rifampin include hepatotoxicity, decreased antibody responses, and a "flu" syndrome (3) Liver metabolism of isoniazid via acetylation may be slow or fast depending on genetic background. (4) Adverse effects of ethambutol include optic neuritis. 52. Characteristics of the cephalosporin drug group include which of the following? (1) They are beta-lactam inhibitors of cell-wall synthesis. (2) Cefazolin is active against strains of staphylococci resistant to methicillin. (3) Cephalothin is active against staphylococci, Escherichia coli, and Klebsiella spp. (4) First-generation drugs can be used as alternatives to penicillin G in meningococcai meningitis. 52. Characteristics of the broad-spectrum antimicrobial drug chloramphenicol include which of the following? (1) It blocks peptidyltransferase by binding to the 50S ribosomal subunit.

(2) It causes dose-dependent, reversible bone marrow depression. (3) Resistance to the drug may involve plasmid-mediated induction of inactivating acetyltransferases. (4) It binds to cations in bone to delay long bone growth. 54. Mechanisms of action of trimethoprim-sulfamethoxazole include which of the following? (1) trimethoprim,an antimetabolite of PABA,inhibits the synthesis of FH2. (2) The effects of sulfamethoxazole may be decreased by increased synthesis of PABA (3) Sulfamethoxazole stimulates the formation of G6PD (4) When used together,the 2 drugs cause a sequential block of folic acid synthesis 55. Gentamicin is a commonly used antibiotic, especially in hospitals,its adverse effects include (1) Tinnitus and loss of perception of high-frequency sounds. (2) Elevation of serum iron, {3) Acute tubular necrosis. (4) The "gray baby" syndrome. 56. Characteristics of ketoconazole include which of the following? (1) It inhibits 14a-demethylation of lanosterol, an enzyme important in fungal sterol synthesis. (2) It is an inhibitor of mammalian steroid-synthesizing and drug-metabolizing enzymes. (3) It is active against Blastomyces, Coccidioides, and Candida albicans infections. (4) Its principal toxicity is reversible bone marrow depression. 57. Valid clinical uses of metronidazole include (1) Bacterial infections due to Gardnerella vaginalis and resistant Bacteroid fraglis strains. (2) Urogenital trichomoniasis. (3) Intestinal giardiasis. (4) Eradication of amebic tissue infections 58. Erythromycin (1) Inhibits bacterial protein synthesis by interaction with a 23S rRNA receptor (2) May cause a hypersensitivity-based cholestatic hepatitis. (3) Is a useful alternative to penicillins for coccal infections in allergic patients (4) Is associated with a high incidence of pseudomembranous colitis.

ANSWERS OF SET II Chapter 1 2 3 4 D D A C A B D B A B C E A B B D D Chapter 1 2 3 4 C B E A C A B D A C A D B D D B A A B C D A C B D Chapter 1 2 3 4 E B D D B E D A A C E A B

1 5 C D B C

General 6 7 8 9 E D D C E B A E A B A E A A C A

Principles 10 D A C E

2 5 D C B C A D

Chemotherapy 6 7 8 9 10 C E D B C A B C B A B E E A C B B D A / C E A C E E A B C A

3 5 A A A

Central 6 7 8 9 C D A B B A B E E C B D

Chapter 1 2 3 4 B D C D B A C D C A A B C E D D C B E Chapter 1 2 3 4 C D B D B C B B E E D C A D A A D C B B D A C B Chapter 1 2 3 4 E B D B B D E B / D E Chapter 1 2 3 4 E A B D 5 D 6 C B B B E

4 5 B D C C

Autonomic Nervous System 6 7 8 9 10 D B B E C B A C D A D A D D C A C A B D

5 5 B D D A D D 6 5 C B

Cardiovascular System 6 7 8 9 10 B D D E A C B C E B C D E B B E B B C A A C E B A

Nervous System 10 B D D

Renal System 6 7 8 9 10 A A E A E DC C D A C

7 Endocrine System 5 6 7 8 9 10 E E A D C D A B B E

Examination I 1 A A B A B A

2 B D C C C E

3 B A C E B E

4 B D B B E B

5 A E D B D E

6 C A A C C E

Examination 1 2 3 4 5 6 A B C B B B C A E C E B C C C A E D D A E B D D A E B E C C E A A C B B

7 E D B A E E

8 E C A D C A

9 B C D E A A

10 D (24D) E B C D B

II 7 8 B D A E A B E A E C E A

9 E C C D A

10 D D C C D

Collected By: Mr. Keshav Bhattarai (Nepal) Chongqing Medical University 2006 Batch, MBBS Student www.esnips.com/web/cqmu-pharmacology [email protected] [email protected] [email protected] [email protected]