Pharmacology Multiple-Choice Questions PDF

Multiple-Choice Questions ========================= 1. \*\*Drug metabolism in humans usually results in a product that is\*\* - Less lipid soluble than the original drug - More likely to distribute intracellularly - More likely to be reabsorbed by kidney tubules - M...

Multiple-Choice Questions ========================= 1. \*\*Drug metabolism in humans usually results in a product that is\*\* - Less lipid soluble than the original drug - More likely to distribute intracellularly - More likely to be reabsorbed by kidney tubules - More lipid soluble than the original drug 2. \*\*Which of the following cytochrome isoforms is responsible for metabolizing the largest number of drugs?\*\* - CYP1A2 - CYP2C9 - CYP2C19 - CYP3A4 3. \*\*Your 37-year-old patient has been diagnosed with a rare metastatic carcinoid tumor. This neoplasm is releasing serotonin, bradykinin, and several unknown peptides. The effects of serotonin in this patient are most likely to include\*\* - Constipation - Episodes of bronchospasm - Hypersecretion of gastric acid - Hypotension 4. \*\*Which drug does not activate opioid receptors, has been proposed as a maintenance drug in treatment programs for opioid addicts, and with a single oral dose, will block the effects of injected heroin for up to 48 h?\*\* - Fentanyl - Nalbuphine - Naloxone - Naltrexone 5. \*\*Which drug is a full agonist at opioid receptors with analgesic activity equivalent to morphine, a longer duration of action, and fewer withdrawal signs on abrupt discontinuance than morphine?\*\* - Fentanyl - Hydromorphone - Methadone - Nalbuphine 6. \*\*Total intravenous anesthesia with fentanyl has been selected for a frail elderly woman about to undergo cardiac surgery. Which statement about this anesthesia protocol is accurate?\*\* - Fentanyl will control the hypertensive response to surgical stimulation - Marked relaxation of skeletal muscles is anticipated - Opioids such as fentanyl provide useful cardiostimulatory effects - Patient awareness may occur during surgery, with recall after recovery 7. \*\*A 32-year-old woman underwent segmental mastectomy for a breast tumor of 3 cm diameter. Lymph node sampling revealed 2 involved nodes. Because chemotherapy is of established value in her situation, she underwent postoperative treatment with antineoplastic drugs. The regimen consisted of doxorubicin followed by cyclophosphamide/methotrexate/fluorouracil. Adjunctive drugs included tamoxifen because the tumor cells were hormone receptor-positive. The chemotherapy undertaken by this patient caused acute hemorrhagic cystitis. Which drug was most likely to be responsible for this toxicity? \*\* - Cyclophosphamide - Doxorubicin - Fluorouracil - Methotrexate 8. \*\*A 32-year-old woman underwent segmental mastectomy for a breast tumor of 3 cm diameter. Lymph node sampling revealed 2 involved nodes. Because chemotherapy is of established value in her situation, she underwent postoperative treatment with antineoplastic drugs. The regimen consisted of doxorubicin followed by cyclophosphamide/methotrexate/fluorouracil. Adjunctive drugs included tamoxifen because the tumor cells were hormone receptor-positive. After several cycles of chemotherapy, the patient was found to have a high resting pulse rate. A noninvasive radionuclide scan revealed evidence of cardiomyopathy. The drug that is most likely responsible for the cardiac toxicity is\*\* - Cyclophosphamide - Doxorubicin - Fluorouracil - Tamoxifen 9. \*\*A patient with multiple myeloma was started on bortezomib after 2 rounds of other combination chemotherapy did not have any effect. What is the mechanism of action of bortezomib?\*\* - Cross-linking of double-stranded DNA - Inhibition of DNA-dependent RNA synthesis - Interference with the activity of topoisomerases I - Inhibition of the 26S proteasome 10. \*\*An adult patient is being treated for acute leukemia with a combination of anticancer drugs that includes cyclophosphamide, mercaptopurine, methotrexate, vincristine, and prednisone. He is also using ondansetron for emesis, a chlorhexidine mouthwash to reduce mucositis, and laxatives. The patient complains of "pins and needle" sensations in the extremities and muscle weakness. He is not able to execute a deep knee bend or get up out of a chair without using his arm muscles. He is also very constipated. If these problems are related to the chemotherapy, which of the following is the most likely causative agent?\*\* - Cyclophosphamide - Mercaptopurine - Methotrexate - Vincristine 11. \*\*A cancer cell that is resistant to the effects of both vincristine and methotrexate probably has developed the resistance as a result of which of the following mechanisms?\*\* - Changes in the properties of a target enzyme - Decreased activity of an activating enzyme - Increased expression of a P-glycoprotein transporter - Increased production of drug-trapping molecules 12. \*\*All the following agents have been used in drug regimens for the treatment of breast carcinoma. Which one has specific activity in a subset of female breast cancers?\*\* - Cyclophosphamide - Doxorubicin - Fluoxymesterone - Trastuzumab 13. \*\*Cyclosporine is effective in organ transplantation. Which of the following most accurately describes the immunosuppressant action of cyclosporine?\*\* - Activation of NK cells - Blockade of tissue responses to inflammatory mediators - Increased catabolism of IgG antibodies - Inhibition of the gene transcription of interleukins 14. \*\*Which of the following is a widely used drug that suppresses cellular immunity, inhibits prostaglandin and leukotriene synthesis, and increases the catabolism of IgG antibodies?\*\* - Cyclophosphamide - Cyclosporine - Infliximab - Prednisone 15. \*\*A 36-year-old man presents with swollen, painful heels, nail changes, and left lower back pain that wakes him from sleep. The back pain gets better with exercise. He reports 1--2 h of morning stiffness. He has a history of psoriasis and psoriatic arthritis since age 12 years. You decide to change his current regimen of indomethacin to a biologic that targets TNF-α. Which of the following is a chimeric monoclonal antibody that binds to TNF-α and inhibits its action?\*\* - Etanercept - Infliximab - Sirolimus - Trastuzumab 16. \*\*A 24-year-old woman underwent kidney transplantation. A week later, she developed alloantibody-mediated acute rejection (acute humoral rejection \[AHR\]). She was successfully treated with tacrolimus and a second drug that targets both B and T lymphocytes. Which of the following is an immunosuppressant that suppresses both B and T lymphocytes via inhibition of de novo synthesis of purines?\*\* - Cyclophosphamide - Methotrexate - Mycophenolate mofetil - Tacrolimus 17. \*\*Which of the following is an immune modulator that increases phagocytosis by macrophages in patients with chronic granulomatous disease?\*\* - Aldesleukin - Interferon-γ - Lymphocyte immune globulin - Prednisone 18. \*\*A 30-year-old woman undergoes abdominal surgery. In spite of minimal tissue damage, complete ileus (absence of bowel motility) follows, and she complains of severe bloating. She also finds it difficult to urinate. Mild cholinomimetic stimulation with bethanechol or neostigmine is often effective in relieving these complications of surgery. Neostigmine and bethanechol in moderate doses have significantly different effects on which one of the following?\*\* - Gastric secretory cells - Vascular endothelium - Salivary glands - Sweat glands 19. \*\*Ms Brown has been treated for myasthenia gravis for several years. She reports to the emergency department complaining of recent onset of weakness of her hands, diplopia, and difficulty swallowing. She may be suffering from a change in response to her myasthenia therapy, that is, a cholinergic or a myasthenic crisis. Which of the following is the best drug for distinguishing between myasthenic crisis (insufficient therapy) and cholinergic crisis (excessive therapy)?\*\* - Atropine - Edrophonium - Physostigmine - Pralidoxime 20. \*\*The primary mechanism of antibacterial action of the penicillins involves inhibition of?\*\* - Beta-lactamases - Cell membrane synthesis - N-acetylmuramic acid synthesis - Peptidoglycan cross-linking 21. \*\*A patient needs antibiotic treatment for native valve, culture-positive infective enterococcal endocarditis. His medical history includes a severe anaphylactic reaction to penicillin G during the last year. The best approach would be treatment with?\*\* - Amoxicillin-clavulanate - Aztreonam - Ceftriaxone - Vancomycin 22. \*\*The mechanism of antibacterial action of tetracycline involves\*\* - Antagonism of bacterial translocase activity - Binding to a component of the 50S ribosomal subunit - Inhibition of DNA-dependent RNA polymerase - Interference with binding of aminoacyl-tRNA to bacterial ribosomes 23. \*\*The primary mechanism of resistance of gram-positive organisms to macrolide antibiotics including erythromycin is:\*\* - Decreased drug permeability of the cytoplasmic membrane - Methylation of binding sites on the 50S ribosomal subunit - Formation of drug-inactivating acetyltransferases - Formation of esterases that hydrolyze the lactone ring 24. \*\*A 26-year-old woman was treated for a suspected chlamydial infection at a neighborhood clinic. She was given a prescription for oral doxycycline to be taken for 14 d. Three weeks later, she returned to the clinic with a mucopurulent cervicitis. On questioning she admitted not having the prescription filled. The best course of action at this point would be to\*\* - Delay drug treatment until the infecting organism is identified - Rewrite the original prescription for oral doxycycline - Treat her in the clinic with a single oral dose of azithromycin - Treat her in the clinic with an intravenous dose of amoxicillin 25. \*\*Regarding the mechanism of action of aminoglycosides, the drugs\*\* - Are bacteriostatic - Bind to the 50S ribosomal subunit - Cause misreading of the code on the mRNA template - Inhibit peptidyl transferase 26. \*\*Which statement is accurate regarding the antibacterial action of the aminoglycoside amikacin?\*\* - Antibacterial activity is often reduced by the presence of an inhibitor of cell wall synthesis - Antibacterial action is not concentration-dependent - Efficacy is directly proportional to the duration of time that the plasma level is greater than the minimal inhibitory concentration - The drug continues to exert antibacterial effects even after plasma levels decrease below detectable levels 27. \*\*Regarding the toxicity of aminoglycosides which statement is accurate?\*\* - Gentamicin and tobramycin are the least likely to cause renal damage - Ototoxicity due to amikacin and gentamicin includes vestibular dysfunction, which is often irreversible - Ototoxicity is reduced if loop diuretics are used to facilitate the renal excretion of aminoglycoside antibiotics - Reduced blood creatinine is an early sign of aminoglycoside nephrotoxicity 28. \*\*Trimethoprim-sulfamethoxazole is established to be effective against which of the following opportunistic infections in the AIDS patient?\*\* - Cryptococcal meningitis - Herpes simplex - Oral candidiasis - Toxoplasmosis 29. \*\*Which statement about the fluoroquinolones is accurate?\*\* - Antacids increase their oral bioavailability - Contraindicated in patients with hepatic dysfunction - Fluoroquinolones are drugs of choice in a 6-year-old child with a urinary tract - Gonococcal resistance to fluoroquinolones may involve changes in DNA gyrase 30. \*\*Which statement about ciprofloxacin is accurate?\*\* - Antagonism occurs if used with dihydrofolate reductase inhibitors - Ciprofloxacin is active against MRSA strains of staphylococci - Organisms that commonly cause ear infections are highly resistant - Tendinitis may occur during treatment 31. \*\*Which statement about fluconazole is accurate?\*\* - Does not penetrate the blood-brain barrier - Drug of choice in treatment of aspergillosis - Induces hepatic drug-metabolizing enzymes - Has the least effect of all azoles on drug metabolism 32. \*\*A 37-year-old woman with leukemia was undergoing chemotherapy with intravenous antineoplastic drugs. During treatment, she developed a systemic infection from an opportunistic pathogen. There was no erythema or edema at the catheter insertion site. A white vaginal discharge was observed. After appropriate specimens were obtained for culture, empiric antibiotic therapy was started with gentamicin, nafcillin, and ticarcillin intravenously. This regimen was maintained for 72 h, during which time the patient's condition did not improve significantly. Her throat was sore, and white plaques had appeared in her pharynx. On day 4, none of the cultures had shown any bacterial growth, but both the blood and urine cultures grew out Candida albicansAt this point, the best course of action is to:\*\* - Continue current antibiotics and start griseofulvin - Continue current antibiotics and start amphotericin B - Stop current antibiotics and start itraconazole - Stop current antibiotics and start amphotericin B 33. \*\*A 28-year-old man living on the East Coast was transferred by his employer to California for several months. On his return, he complains of having influenza-like symptoms with fever and a cough. He also has red, tender nodules on his shins. His physician suspects that these symptoms are due to coccidioidomycosis contracted during his stay in California.Which is the drug of choice if this patient is suffering from persistent lung lesions or disseminated disease caused by Coccidioides immitis?\*\* - Amphotericin B - Flucytosine - Itraconazole - Micofungin 34. \*\*Which statement about the mechanisms of action of antiviral drugs is accurate?\*\* - Acyclovir has no requirement for activation by phosphorylation - Ganciclovir inhibits viral DNA polymerase but does not cause chain termination - Increased activity of host cell ribonucleases that degrade viral mRNA is one of the actions of interferon-α - The initial step in activation of foscarnet in HSV-infected cells is its phosphorylation by thymidine kinase 35. \*\*A 27-year-old nursing mother is diagnosed as suffering from genital herpes. She has a history of this viral infection. Previously, she responded to a drug used topically. Apart from her current problem, she is in good health. Which drug to be used orally is most likely to be prescribed at this time?\*\* - Foscarnet - Ritonavir - Trifluridine - Valacyclovir 36. \*\*More than 90% of this drug is excreted in the urine in intact form. Because its urinary solubility is low, patients should be well hydrated to prevent nephrotoxicity. Which drug is described?\*\* - Acyclovir - Efavirenz - Indinavir - Zidovudine 37. \*\*A 55-year-old lawyer is brought to the emergency department 2 h after the onset of severe chest pain during a stressful meeting. He has a history of poorly controlled mild hypertension and elevated blood cholesterol but does not smoke. ECG changes (ST elevation) and cardiac enzymes confirm the diagnosis of myocardial infarction. The decision is made to attempt to open his occluded artery.If a fibrinolytic drug is used for treatment of this man's acute myocardial infarction, which of the following adverse drug effects is most likely to occur?\*\* - Acute renal failure - Development of antiplatelet antibodies - Encephalitis secondary to liver dysfunction - Hemorrhagic stroke 38. \*\*Among NSAIDs, aspirin is unique because it:\*\* - Irreversibly inhibits its target enzyme-cyclooxygenase - Prevents episodes of gouty arthritis with long-term use - Reduces fever - Reduces the risk of colon cancer 39. \*\*Which of the following is an analgesic and antipyretic drug that lacks an anti-inflammatory action?\*\* - Acetaminophen - Celecoxib - Colchicine - Indomethacin 40. \*\*A 16-year-old girl comes to the emergency department suffering from the effects of an aspirin overdose. Which of the following syndromes is this patient most likely to exhibit as a result of this drug overdose?\*\* - Bone marrow suppression and possibly aplastic anemia - Fever, hepatic dysfunction, and encephalopathy - Hyperthermia, metabolic acidosis, and coma - Rapid, fulminant hepatic failure 41. \*\*Which of the following drugs is most likely to increase serum concentrations of conventional doses of methotrexate, a weak acid that is primarily cleared in the urine?\*\* - Acetaminophen - Allopurinol - Colchicine - Probenecid 42. \*\*The main advantage of ketorolac over aspirin is that ketorolac\*\* - Can be combined more safely with an opioid such as codeine - Does not prolong the bleeding time - Is available in a parenteral formulation that can be injected intramuscularly or intravenously - Is less likely to cause acute renal failure in patients with some preexisting degree of renal impairment 43. \*\*An 18-month-old boy dies from an accidental overdose of acetaminophen. Which of the following is the most likely cause of this patient's death?\*\* - Arrhythmia - Hemorrhagic stroke - Liver failure - Noncardiogenic pulmonary edema 44. \*\*A 52-year-old woman presented with intense pain, warmth, and redness in the first toe on her left foot. Examination of fluid withdrawn from the inflamed joint revealed crystals of uric acid.Over the next 7 mo, the patient had 2 more attacks of acute gout. Her serum concentration of uric acid was elevated. The decision was made to put her on chronic drug therapy to try to prevent subsequent attacks. Which of the following drugs could be used to decrease this woman's rate of production of uric acid?\*\* - Allopurinol - Aspirin - Colchicine - Hydroxychloroquine 45. \*\*Which antifungal agent is MOST likely to cause renal insufficiency?\*\* - Fluconazole - Amphotericin B - Itraconazole - Posaconazole 46. \*\*A 56-year-old woman with diabetes complains of thickening of the nail of the right big toe and a change in\ color (yellow). The podiatrist diagnoses the patient with onychomycosis of the toenails. Which is the most\ appropriate choice for treating this infection?\*\* - Terbinafine - Micafungin - Itraconazole - Griseofulvin 47. \*\*Which drug is relatively free of drug--drug interactions?\*\* - Voriconazole - Itraconazole - Micafungin - Terbinafine 48. \*\*Which drug works by creating pores/channels in the fungal cell membrane?\*\* - Fluconazole - Anidulafungin - Amphotericin B - Flucytosine 49. \*\*A 32-year-old man presents to an outpatient clinic with a 5-day history of productive cough, purulent\ sputum, and shortness of breath. He is diagnosed with community-acquired pneumonia (CAP). It is noted\ that this patient has a severe ampicillin allergy (anaphylaxis). Which would be an acceptable treatment for\ this patient?\*\* - Levofloxacin - Ciprofloxacin - Penicillin VK - Nitrofurantoin 50. \*\*A 22-year-old woman presents with a 2-day history of dysuria with increased urinary frequency and urgency.\ A urine culture and urinalysis are done. She is diagnosed with a urinary tract infection caused by E. coli.\ Which agent should be avoided in the treatment of her UTI?\*\* - Levofloxacin - Cotrimoxazole - Moxifloxacin - Nitrofurantoin 51. \*\*Which is a common adverse effect of cotrimoxazole?\*\* - Hyperkalemia - Pulmonary fibrosis - Tendon rupture - Blood glucose disturbances 52. \*\*The pharmacokinetics of a new drug are under study in a phase 1 clinical trial. Which statement about the distribution of drugs to specific tissues is most correct?\*\* - Distribution to an organ is independent of blood flow - Distribution is independent of the solubility of the drug in that tissue - Distribution into a tissue depends on the unbound drug concentration gradient between blood and the tissue - Distribution is increased for drugs that are strongly bound to plasma proteins 53. \*\*Which of the following statements about the testing of new compounds for potential therapeutic use in the treatment of hypertension is most correct?\*\* - Animal tests cannot be used to predict the types of clinical toxicities that may occur because there is no correlation with human toxicity - Human studies in normal individuals will be done before the drug is used in individuals with hypertension - The degree of risk must be assessed in at least 3 species of animals, including 1 primate species - The animal therapeutic index must be known before trial of the agents in humans