True/False Pharma 2 PDF: Past Paper Questions

**[True/False Pharma 2]** **1.** Vasodilator therapy with vasodilators nitroprusside or nitroglycerin is often used for acute severe failure with congestion and can be dramatically effective, especially in cases in which increased afterload is a major factor. **A.**True **B.** False **2.** Corre...

**[True/False Pharma 2]** **1.** Vasodilator therapy with vasodilators nitroprusside or nitroglycerin is often used for acute severe failure with congestion and can be dramatically effective, especially in cases in which increased afterload is a major factor. **A.**True **B.** False **2.** Correction of potassium deficiency (caused, eg, by diuretic use) is of no value in chronic digitalis intoxication. **A.**True **B.** False **3.** Considerable evidence indicates that angiotensin antagonists, certain β-adrenoceptor blockers, and the aldosterone antagonists spironolactone and eplerenone also have long-term beneficial effects in congestive heart failure. **A.**True **B.** False **4.** Chronic heart failure is best treated with loop diuretic; if severe, a prompt-acting positive inotropic agent such as a β agonist or phosphodiesterase inhibitor and and vasodilators. **A.**True **B.** False **5.** Beta blockers are of no value in acute failure and may be detrimental if systolic dysfunction is marked. **A.**True **B.** False **IHD** *β-Blockers* **1.** Conditions that discourage the use of β-blockers include reversible bronchospastic disease such as asthma, second- and third-degree heart block, and severe peripheral vascular disease. **A. True** **B. False** **2.** **Nebivolol is a selective blocker of β~1~ receptors,** which also increases the production of nitric oxide, leading to vasodilation. **A. True** **B. False** **3.** The β-blockers reduce blood pressure primarily by decreasing cardiac output. They may also decrease sympathetic **outflow from the central nervous system (CNS) and inhibit the** release of renin from the kidneys, thus decreasing the formation of angiotensin II and the secretion of aldosterone. **A. True** **B. False** **4.** Beta blockers are used in angina only for acute attack; they are of no value in an prophylactic therapy. **A.**True **B.** **False** **5.** Beta blockers initially decrease cardiac output, but in chronic use their action may include an increase in **vascular resistance as a contributing effect**. **A.True** **B. False** *Calcium channel-blockers* **6.** *Verapamil* is the most selective of any calcium channel blocker and has significant **effects only on cardiac m**uscle cells. **A. True** **B. False** **7.** In the treatment of effort-induced angina, calcium channel blockers reduce myocardial oxygen consumption by increasing vascular resistance, thereby increasing afterload. **A. True** **B. False** **8.** *Diltiazem* affects both cardiac and vascular smooth muscle cells, but it has a less pronounced negative inotropic effect on the heart compared to that of ***verapamil. Diltiazem* has a favorable side effect profile.** **A. True** **B. False** **9.** Calcium blockers relax blood vessels and, to a lesser extent, the uterus, bronchi, and gut. **A.True** **B.** False **10.** Nifedipine and other dihydropyridines evoke greater vasodilation then verapamil and diltiazem , and the resulting sympathetic reflex prevents bradycardia and may actually increase heart rate. **A.True** **B.** False **Antihypertensives** **1.** The ACE inhibitors are useful in heart failure and diabetes as well as in hypertension. **A.**True **B.** False **2.** Alpha1-selective agents (eg, prazosin, doxazosin, terazosin) are the most effective antihypertensive drugs. **A.**True **B.** False **3.** Compensatory responses to diuretics, beta blockers and angiotensin-**renin antagonists is minimal.** **A.**True **B.** False **4.** Less than 20% of cases of hypertension are due to ("secondary" to) factors that can be clearly defined and corrected. This type of hypertension is associated with pheochromocytoma, coarctation of the aorta, renal vascular disease, adrenal cortical tumors, and a few other rare conditions. **A.**True **B.** False **5.** **Nitroprusside is oral**, short-acting vasodilator used in hypertensive emergencies. **A.**True **B.** False **Diuretics** **1.** Thiazides are not useful in combination therapy with a other antihypertensive agents, including β-blockers, ACE inhibitors, ARBs, and potassium-sparing diuretics. **A. True** **B. False** **2.** With the exception of *metolazone*, thiazide diuretics are not effective in patients with inadequate kidney function (estimated glomerular filtration rate less than 30 mL/min/m2). **A. True** **B. False** **3.** Loop diuretics increase renal vascular resistance and decrease renal blood flow. **A. True** **B. False** **4.** The loop diuretics (*furosemide*, *torsemide*, *bumetanide*, and *ethacrynic acid*) act promptly by blocking sodium and chloride reabsorption in the kidneys, even in patients with poor renal function or those who have not responded to thiazide diuretics. **A. True** **B. False** **5.** Thiazide diuretics can induce hypokalemia, hyperuricemia and, to a lesser extent, hyperglycemia in some patients. **A. True** **B. False** **6.** Like thiazides, loop diuretics can cause hypokalemia. However, unlike thiazides, loop diuretics increase the Ca^2+^ content of urine, whereas thiazide diuretics decrease it. **A. True** **B. False** **7.** Potassium-sparing diuretics are never used in combination with loop diuretics and thiazides **A. True** **B. False** **8.** Aldosterone antagonists doesn't have the additional benefit of diminishing the cardiac remodeling that occurs in heart failure. **A. True** **B. False** **9.** *Amiloride* and *triamterene* (inhibitors of epithelial sodium transport at the late distal and collecting ducts) as well as *spironolactone* and *eplerenone* (aldosterone receptor antagonists) increase potassium loss in the urine. **A. True** **B. False** **Coagulation** **1.** Heparin is highly basic and can be neutralized by acidic molecules as protamine. **A.**True **B.** False **2.** Prolonged use of unfractionated **heparin is associated with osteoporosis**. **A.**True **B.** False **3.** Unfractionated heparin binds to endogenous antithrombin III (ATIII) via a key **pentasaccharide sequence.** **A.**True **B.** False **4.** Anticlotting drugs are divided in three groups : antiplatelets, anticoagulants and thrombolitics. **A.**True **B.** False **5.** Enoxaparin and other LMW heparins have less bioavailability and **shorter durations of action than unfractionated heparin** **A.**True **B.** False **Antimicrobials** **1.** Acutely ill patients with infections of unknown origin---for example, a neutropenic patient or a patient with meningitis - require immediate treatment. **A. True** **B. False** **2.** Bacteriostatic drugs arrest the growth and replication of bacteria at serum (or urine) levels achievable in the patient, thus limiting the spread of infection until the immune system attacks, immobilizes, and eliminates the pathogen. **A. True** **B. False** **3**. Bactericidal drugs kill bacteria at drug serum levels achievable in the patient. **A. True** **B. False** **4.** The minimum inhibitory concentration (MIC) is the highest antimicrobial concentration that prevents visible growth of an organism after 24 hours of incubation. **A. True** **B. False** **5.** The minimum bactericidal concentration (MBC) is the lowest concentration of antimicrobial agent that results in a 99.9% decline in colony count after overnight broth dilution incubations **A. True** **B. False** **6.** Adequate levels of an antibiotic must reach the site of infection for the invading microorganisms to be effectively eradicated. **A. True** **B. False** **β Lactams** **1.** The penicillins interfere with the last step of bacterial cell wall synthesis (transpeptidation or cross-linkage), resulting in exposure of the osmotically less stable membrane. **A. True** **B. False** **2.** Penicillins are **only effective against** slowly growing organisms that synthesize a peptidoglycan cell wall. **A. True** **B. False** **3.** These penicillin-binding proteins (PBPs) are bacterial enzymes involved in the synthesis of the cell wall and in the maintenance of the morphologic features of the bacterium. **A. True** **B. False** **4.** Alterations in some of the PBPs provide the organism with resistance to the penicillins. Methicillin-resistant Staphylococcus aureus (MRSA) arose because of such an alteration. **A. True** **B. False** **5.** Gram-positive microorganisms have cell walls that are easily traversed by penicillins, and, therefore, in the absence of resistance, they are susceptible to these drugs. **A. True** **B. False** **6**. Penicillins are not susceptible to inactivation by β-lactamases (penicillinases) that are produced by the resistant bacteria. **A. True** **B. False** **7.** Ampicillin and amoxicillin have an antibacterial spectrum similar to that of penicillin G but are more effective against gram negative bacilli. **A. True** **B. False** **8.** Formulation with a β-lactamase inhibitor, such as clavulanic acid or sulbactam, does not protect amoxicillin or ampicillin, respectively, from enzymatic hydrolysis and narrows their antimicrobial spectra. **A. True** **B. False** **9.** β-Lactamase is the family of enzymes that hydrolyzes the cyclic amide bond of the β-lactam ring, which results in loss of bactericidal activity. **A. True** **B. False** **10.** Gram-positive organisms **secrete β-lactamases extracellularly**, whereas gram-negative bacteria inactivate β-lactam drugs in the periplasmic space. **A. True** **B. False** **11.** Most of the penicillins are completely absorbed after oral administration, but they reach the intestine in insufficient amounts to affect the composition of the intestinal flora. **A. True** **B. False** **12**. Food decreases the absorption of all the penicillinase-resistant penicillins because as gastric emptying time increases, the drugs are destroyed by stomach acid. Therefore, they should be taken on an empty stomach. **A. True** **B. False** **13.** All the penicillins cross the placental barrier, but none have been shown to have teratogenic effects. However, penetration into bone or cerebrospinal fluid (CSF) is insufficient for therapy unless these sites are inflamed. **A. True** **B. False** **14.** Penicillin levels in the prostate are insufficient to be effective against infections. **A. True** **B. False** **15.** *Probenecid* inhibits the secretion of penicillins **by competing for active tubular secretion** via the organic acid transporter and, thus, can increase blood levels. **A. True** **B. False** **16.** Penicillins are among the **safest drugs**, but blood levels should be monitored. However, adverse reactions may occur. **A. True** **B. False** **17.** Penicillins, particularly *methicillin*, have the potential to cause acute interstitial nephritis. Because of this side effect methicillin is therefore no longer used clinically. **A. True** **B. False** **18.** **Cytopenias have been associated** *with Penicillin's* therapy of greater than 2 weeks, and therefore, blood counts should be monitored weekly for such patients. **A. True** **B. False** **19.** The first-generation cephalosporins act as penicillin G substitutes. They are resistant to the staphylococcal penicillinase (that is, they cover MSSA) and also have activity against Proteus mirabilis, E. coli, and K. pneumoniae. **A. True** **B. False** **20.** The second-generation cephalosporins display greater activity against three additional gram-negative organisms: *H. influenzae, Enterobacter aerogenes*, and some *Neisseria species*, whereas activity against gram-positive organisms is weaker. **A. True** **B. False** **21.** Although third generation of cephalosporins is less potent than first-generation drugs against MSSA, the third-generation cephalosporins have enhanced activity against gram-negative bacilli, including those mentioned above, as well as most other enteric organisms plus Serratia marcescens **A. True** **B. False** **\ ** **22.** Ceftriaxone and cefotaxime are not agents of choice in the treatment of meningitis. **A. True** **B. False** **23.** Third-generation cephalosporins are **not associated with significant** "collateral damage," essentially meaning the induction and spread of antimicrobial resistance. **A. True** **B. False** **24.** Cephalosporins are not eliminated through tubular secretion and/or glomerular filtration. Therefore, doses must not be adjusted in cases of renal dysfunction. **A. True** **B. False** **25.** Patients who have had an anaphylactic response, Stevens-Johnson syndrome, or toxic epidermal necrolysis to penicillins should not receive cephalosporins. **A. True** **B. False** **26.** *Meropenem* is known to reach therapeutic levels in bacterial meningitis even without inflammation. **A. True** **B. False** **27.** *Imipenem* undergoes cleavage by a dehydropeptidase found in the brush border of the proximal renal tubule. This enzyme forms an inactive metabolite that is potentially nephrotoxic. **A. True** **B. False** **Tetracyclines** **1.** The *tetracyclines* are bacteriostatic antibiotics effective against a wide variety of organisms, including gram-positive and gram-negative bacteria, protozoa, spirochetes, mycobacteria, and atypical species. They are commonly used in the treatment of acne and *Chlamydia* infections. **A. True** **B. False** **2.** The *tetracyclines* concentrate well in the bile, liver, kidney, gingival fluid, and skin. They does not bind to tissues undergoing calcification (for example, teeth and bones) or to tumors that have a high calcium content. **A. True** **B. False** **3.** Rarely hepatotoxicity may occur with high doses of *tetracyclines*, particularly in pregnant women and those **with preexisting hepatic dysfunction or renal impairment.** **A. True** **B. False** **Aminoglycosides** **4.** The highly polar, polycationic structure of the aminoglycosides prevents adequate absorption after oral administration. Therefore, all aminoglycosides (except neomycin) must be given parenterally to achieve adequate serum levels. **A. True** **B. False** **5.** Aminoglycosides does not cross the placental barrier and does not accumulate in fetal plasma and amniotic fluid. **A. True** **B. False** **6.** Ototoxicity (vestibular and auditory) of aminoglycosides is directly related to high peak plasma levels and the duration of treatment. The antibiotic accumulates in the endolymph and perilymph of the inner ear. **A. True** **B. False** **Macrolides** **7.** Although less active against streptococci and staphylococci than erythromycin, azithromycin is far more active against respiratory infections due to *H. influenzae* and *Moraxella catarrhalis*. **A. True** **B. False** **8.** Metronidazole undergoes a reductive bioactivation of its nitro group by ferredoxin (present in aerobic parasites) to form non-reactive cytotoxic products. **A.True** **B. False**