Blue Pharmacology Answer Key PDF

PHILIPPINE ASSOCIATION OF COLLEGES OF PHARMACY Pharmacology and toxicology BLUE PACOP 1. A stereoisomer of methylated derivative of levorphanol used as antitussive: A. Noscapine B. Levopropoxyphene C. Codeine...

PHILIPPINE ASSOCIATION OF COLLEGES OF PHARMACY Pharmacology and toxicology BLUE PACOP 1. A stereoisomer of methylated derivative of levorphanol used as antitussive: A. Noscapine B. Levopropoxyphene C. Codeine D. Dextromethorphan 2. An example of a weakly basic prodrug that when protonated, form covalent disulfide linkages with H+/K+ ATPase and inactivates it: A. Maalox® B. Nexium® C. Tagamet® D. Buscopan® 3. Anti-ulcerant drugs exert their effect through which of the following mechanism/s: I. Stimulation of protein kinases that phosphorylate H+/K+ ATPase II. Preventing histamine from binding to its receptor in parietal cells. III. Activate inhibitory proteins that block histaming activation of adenylate cyclase. A. I only B. II only C. I and II only D. II and III only E. I, II and III 4. Evaluate the following statements regarding the action of opioid analgesics. Statement 1: It decreases the resonse to pain stimuli through enhancement of neuronal K+ influx. Statement 2:It decreases neurotransmitter release through stimulation of Ca++ influx. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 5. Which H2-receptorblocker has an almost complete oral bioavailability? A. Nizatidine B. Famotidine C. Ranitidine D. cimetidine 6. Which of the following is/are true about Zyflo®, an anti-asthmatic medication? I. A 5-epoxygenase inhibitor, containing zilueton as its active ingredient. II. A 5-lipoxygenase inhibitor, containing zilueton as its active ingredient. III. A 5-epoxygenase inhibitor, containing zafirlukast as its active ingredient. A. I only B. II only C. I and II only D. II and III only E. I, II and III 7. Evaluate the following statements regarding emetics. Statement 1: These are drugs that induce vomiting. Statement 2: They may cause a vomiting reflex by irritating the upper GI tract. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 8. Evaluate the following statements regarding laxatives. Statement 1: They accelerate fecal passage in the colon. Statement 2: They increase fecal consistency. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 9. Different antacids are combined in a single preparation to: I. Antagonize the side effect of the other component. II. Obtain a product with a rapid onset and sustained action. III. Lower the dose of each component. A. I only B. II only C. I and II only D. II and III only E. I, II and III 10. Antacids prevent the formation of this proteolytic enzyme that is thought to mediate tissue injury in gastric ulceration. A. Pepsin B. Pepsinogen  C. Chymotrypsin D. Chymotripsinogen 11. Evaluate the following statements regarding the action of Theo-Dur®. Statement 1: It promotes the decline of cAMP levels in the lungs. Statement 2: It inhibits the enzyme phosphodiesterase. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 12. Gastric acid secretion by parietal cells is/are regulated by: I. Neurocrine cells II. Paracrine cells III. Endocrine cells A. I only B. II only C. I and II only D. II and III only E. I, II and III. 13. The drug of choice fr the management of respiratory depression induced by opioid analgesics: A. Narcan® B. Nubain® C. Revex® D. Depade® 14. Evaluate the following statements regarding DuoNeb®. Statement 1: This preparation contains salbutamol ( a beta – 2 agonist) and ipratropium (an antimuscarinic agent). Statement 2: This also contains guaifenesin to expectorate mucus production. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 15. Antitussive medications exert their effect through: I. Depression of the medullary center. II. Increasing the threshold of peripheral reflexogenous zones. III. Interuruption of tussal impulses in the afferent limb of the cough reflex. A. I only B. II only C. I and II only D. II and III only E. I, II and III 16. This acts as the common mediator and the most potent stimulus of gastric acid secretion: A. Acetylcholine B. Histamine C. Gastrin D. None of the above 17. One of the most common adverse effect associated with inhaled corticosteroids: A. Huskiness of voice B. Dysphonia C. All of the above D. None of the above 18. Prostaglandin analogs increases gastric mucosal resistance to injury by: I. Increasing mucus secretion II. Increasing bicarbonate secretion III. Increasing gastric emptying time A. I only B. II only C. I and II only D. II and III only E. I, II and III. 19. Aspirin’s anti-inflammatory effect is due to: A. Its reversible acetylation of COX. B. Its irreversible acetylation of COX. C. Its reversible salicylation of COX. D. Its irreversible salicylation of COX. 20. Evaluate the following statements regarding the action of prostaglandin analogs. Statement 1. It inhibits  gastric acid secretion. Statement 2: It increases gastric mucosal protection. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 21. Which of the following inhaled corticosteroids is/are equipotent with flunisolide in the management of asthma? I. Beclomethasone diproprionate II. Triamcinolone acetonide III. Budesonide A. I only B. II only C. I and II only D. II and III only E. I, II and III. 22. Antacids are compared quantitatively in terms of acid-neutralizing capacity (ANC). ANC is defined as the: A. # of mmol of HCl required to maintain 1mL of an antacid suspension at pH 3 for 2hrs in vitro. B. # of mEq of HCl required to maintain 1mL of an antacid suspension at pH 3 for 2hrs in vitro. C. # of mOsmol of HCl required to maintain 1mL of an antacid suspension at pH 3 for 2hrs in vitro. D. # of mEq of HCl required to maintain 1mL of an antacid suspension at pH 3 for 2hrs in vivo. 23. Evaluate the following statements regarding leukotrienes: Statement 1: Leukotriene D4 is a potent bronchodilator. Statement 2: It is synthesized from arachidic acid. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 24. H2- receptor antagonists inhibit: I. Histamine – stimulated acid secretion. II. Acetylcholine - stimulated acid secretion III. Gastrin - stimulated acid secretion A. I only B. II only C. I and II only D. II and III only E. I, II and III. 25. Evaluate the following statements regarding cycloxygenase. Statement 1: COX-1 isoenzyme contains isoleucine as the amino acid at position 523. Statement 2: COX- 2 isoenzyme contains valine as the amino acid at position 523 for selective binding of COX-2 inhibitors. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 26. Considered as one of the major inhibitor of dastric acid secretion through its inhibition of histamine release from ECL cells: A. Somastostatin B. Somatostatin C. All of the above D. None of the above 27. Which of the following antacids has a slow onset of action? I. Aluminum hydroxide II. Calcium carbonate III. Magnesium hydroxide A. I only B. II only C. I and II only D. II and III only E. I, II and III. 28. Evaluate the following: Statement 1: Mucolytics increase the amount of respiratory tract fluid so that demulcent action s exerted. Statement 2: Expectorants decrease the viscosity of bronchial secretions and facilitate their elimination. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct  D. Both statements are wrong 29. Which is the correct sequence for decreasing potency of inhaled corticosteroids? A. Fluticasong proprionate > beclomethasone dipropionate > Triamcinolone acetonide > Budesonide B. beclomethasone dipropionate > Triamcinolone acetonide > Budesonide > Fluticasong proprionate C. Fluticasong proprionate > Budesonide > beclomethasone dipropionate > Triamcinolone acetonide D. None of the above 30. Which of the ff antacid/s has a long duration of action? I. Aluminum hydroxide II. Calcium carbonate III. Magnesium hydroxide A. I only B. II only C. I and II only D. II and III only E. I, II and III. 31. Which COX-2 inhibitor has the highest COX – 2 : COX 1 selectivity ratio? A. Celecoxib B. Etoricoxib C. Rofecoxib D. Valdecoxib E. I, II, and III 32. Evaluate the ff: Statement 1: Singulair® contains montelukast as active ingredient. Statement 2: This drug prevents inflammation and promotes broncodilation. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 33. Attempts are made to selectively inhibit COX – 2 for pain relief because: I. COX – 2 tends to facilitate inflammatory response. II. COX – 1 tends to be homeostatic in function. III. COX – 2 has cardioprotective effects A. I only B. II only C. I and II only D. II and III only E. I, II and III. 34. What is the final common pathway of acid secretion in the stomach? A. Proton pump B. H2 – receptor C. All of the above D. None of the above 35. Which nonsteroidal anti-inflammatory drug when co-administered with opioids, reduces opioid requirements by 25%? A. Ibuprofen B. Ketorolac C. Mefenamic acid D. Indomethacin 36. Buprenorphine, an opioid analgesic, has the following characteristics/s: I. Dissociates slowly from mu receptor II. Partial mu agonist III. Resistant to the reversal effect of naloxone A. I only B. II only C. I and II only D. II and III only E. I, II and III. 37. Which of the ff antacid/s has a fast onset of action, yet has a long duration of action? A. Aluminum hydroxide B. Magnesium hydroxide C. Calcium carbonate D. Sodium bicarbonate 38. Evaluate the following statements regarding gastric acid secretion. Statement 1: Histamine is first released from the parietal cells. Statement 2: Histamine binds to H2 – receptors in ECL cells to initiate acid secretion.  A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 39. Nalbuphine, an opioid analgesic, has the ff characteristic/s: I. Mu receptor agonist II. Kappa receptor agonist III. Gamma receptor agonist A. I only B. II only C. I and II only D. II and III only E. I, II and III. 40. Which of the ff. H2 – receptor blocker has the highest potency? A. Cimetidine B. Ranitidine C. Famotidine D. Nizatidine 41. Absorption of which vitamin is reduced especially during prolonged therapy of proton pump inhibitors? A. Vitamin B12 B. Vitamin B6 C. Vitamin B3 D. Vitamin B1 42. Which of the ff. is/are taken prophylactically for asthma? I. Tilade® II. Myambutol® III. Rifadin® A. I only B. II only C. I and II only D. II and III only E. I, II and III. 43. This nonsteroidal anti-inflammatory drug should not be used for trivial or minor problems associated with pain due to its potential serious untoward effects? A. Ibuprofen B. Diclofenac C. Indomethacin D. Naproxen 44. Evaluate the ff. Statement 1: Prostaglandin synthesis is prevented by nonsteroidal anti0inflammatory drugs. Statement 2: Prostaglandins amplify pain signal. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 45. Nonsteroidal anti-inflammatory drug has the ff. characteristic/s: I. Generally highly protein- bound II. Causes gastric irritation due to prostaglandin synthesis inhibition III. Interfere with glumerular filtration regulation A. I only B. II only C. I and II only D. II and III only E. I, II and III. 46. Which was the proposed maintenance drug in the treatment programs for opioid addiction? A. Naloxone B. Naltrexone C. Nalbuphine D. None of the above 47. This nonsteroidal anti-inflammatory drug is as effective as mefenamic acid in relieving dysmenorrheal: A. Naproxen B. Diclofenac C. Indomethacin D. Ibuprofen 48. Evaluate the ff. regarding beta-2 agonists. Statement 1: Serevent® contains a long acting beta – 2 agonist Statement 2: Formeterol is also a long acting beta -2 agonist A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 49. Evaluate the ff. Statement 1: Accumulation of intracellular calcium in parietal cells initiates gastric acid secretion. Statement 2: Conversion of ATP to cAMP inactivates protein kinase, thereby preventing gastric acid secretion. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 50. Evaluate the ff. Statement 1: Nonsteroidal anti-inflammatory drugs provide pain relief through their anti-inflammatory action. Statement 2: Acetaminophen also provide pain relief through its anti-inflammatory effect. A. Statement 1 is correct while statement 2 is wrong B. Statement 1 is wrong while statement 2 is correct C. Both statements are correct D. Both statements are wrong 51. A 70 year old, male, patient post coronary angiography bypass graft ( CABG) with elevated LDL is managed with Simvastatin. What is the mechanism of action of Simvastatin? A. Decreased hepatic secretion of VLDL B. Decreased oxidation of plasma lipids. C. Sequestration of bile acids. D. Inhibition of HMG-CoA reductase 52. A 501 year old, female patient arrives to the Emergency Department due to the severe chest pain. Electrocardiogram revealed that she has an acute myocardial infarction. The medical resident-on-duty gave Streptokinase as her first dose. What is the mechanism of action of Streptokinase? A. It inhibits the conversion of fibrinogen to fibrin B. It promotes the conversion of fibrin to fibrin-split products C. It inactivates the conversion of plasminogen to lasmin D. It inhibits the conversion of prothrombin to thrombin 53. Which of the ff. statement/s are true for Clonidine? I. It is a lipid-soluble and rapidly enters the brain from the circulation II. Concomittant traetment with TCA may block the antihypertensive activities f Clonidine. III. It has a long half-life that is related to its anti-hypertensive properties A. I only B. II only C. I and II only D. II and III only E. I, II and III. 54. The ECG of the patient with Digoxin as his treatment in the therapeutic dose range would likely to show A. Widening of the QRS complex B. Elevation of the ST segment C. Prolongation of the QT interval D. Prolongation of the PR interval 55. The major segment of the nephron where the diuretic action of the thiazides took p[lace A. Cortical collecting tubule B. Medullary collecting tubule C. Distal convoluted tubule D. Proximal convoluted tubule 56. The ff statement/s are true for the Carbonic anhydrase inhibitors. I. Depresses HCO3- reabsorption in the Depresses HCO3- reabsorption in the cortical collecting tubule II. Depresses HCO3- reabsorption in the Depresses HCO3- reabsorption in the proximal convoluted tubule III. Causes significant hyperchloremic metabolic acidosis A. I only B. II only C. I and II only D. II and III only  E. I, II and III. 57. What segments of nephron where the diuretic action of Spironolactone took place? A. cortical collecting tubule B. thick ascending limb of Henle’s loop C. thin ascending limb of Henle’s loop D. Medullary collecting duct 58. The activity of propranolol in the treatment of angina pectoris is the result of this mechanism A. Decreased requirement for myocardial oxygen B. Increased sensitivity to catecholamines C. Reduced production of catecholamines D. Dilation of the coronary vasculature 59. A 56 year old male patient, with hypertension and DM type 2. He managed his diabetes by insulin. What antihypertensive drug should not be used on his case? A. Metoprolol B. Propranolol C. Methyldopa D. Hydralazine 60. The ff. statement/s are true for Potassium-sparing diuretics I. Inhibition of Na+ influx through ion channels in the luminal membrane II. Inhibition by direct pharmacologic antagonism of mineralocorticoid receptors III. Renal K+ wasting may occur A. I only B. II only C. I and II only D. II and III only E. I, II and III. 61. The ff. statement/s are true for Quinidine. I. Prolongs the QRS duration II. Induction of Torsades de Pointes arrhythmia III. Shortens the action potential duration by nonspecific blockade of K+ channels. A. I only B. II only C. I and II only D. II and III only E. I, II and III. 62. The ff. drug is considered to be the most effective in the prevention of ischemic episodes in patients with angina. A. Na nitroprusside B. Isosorbide dinitrate C. Propranolol D. Amlodipine 63. The diuretic agent that conserves the K+ ions in the body A. Triamterene B. Bumetanide C. Hydrochlorothiazide D. Furosemide 64. A case of a 60 year old male patient with developed gynecomastia and erectilr dysfunction due to the treatment of this particular diuretic agent. A. Hydrochlorothiazide B. Spironolactone C. Triamterene D. Furosemide 65. The ff. statement/s are true for Lidocaine I. Extensive first-pass hepatic metabolism II. Plasma clearance is increased in liver damage III. Vol of distribution is decreased in liver damage. A. I only B. II only C. I and II only D. II and III only E. I, II and III. 66. The ff. are the results of vasodilating activity of Na nitroprusside I. Activation of guanylyl cyclase II. Increased intracellular cGMP  III. Decreased intracellular cGMP A. I only B. II only C. I and II only D. II and III only E. I, II and III. 67. The ff. are the mechanism of actions of most of the drugs with vasodilating actions I. Increasing cGMP II. Promoting depolarization of the vascular smooth muscles III. Increased intracellular Ca2+ A. I only B. II only C. I and II only D. II and III only E. I, II and III. 68. What is the effect of combining Digoxin to Verapamil? A. Verapamil may enhance the AV-blocking effect of Digoxin B. Verapamil may increase the metabolism of Digoxin C. Increased effects of Verapamil D. Decreased serum concentration of Digoxin 69. The ff. are the mechanism of actions of Guanethidine I. Inhibits the release of NE from sympathetic nerve endings II. Increases sensitivity to the hypertensive effects of amines III. Replaces NE stores in the nerve endings. A. I only B. II only C. I and II only D. II and III only E. I, II and III. 70. The patient was given Mannitol 100g for the treatment of his oliguria. Of the following, which is the least likely to be associated with the effect of Mannitol. A. Effectiveness as nonelectrolytic, osmotically active particles B. Capacity to be freely filtered C. Ability to be metabocally altered to an active form D. Retention of water in the tubular fluid 71. The ff. are the mechanism of the clinical effects of Ca++ channel blockers: I. Increases atrioventricular nodal conduction II. Decreases in left ventricular wall stress III. Increases myocardial oxygen delivery in patients with vasospastic angina. A. I only B. II only C. I and II only D. II and III only E. I, II and III. 72. The rationale of the beta blocker agents as a management for angina pectoris. I. Increase in diastolic perfusion time that may increase coronary perfusion II. Decreased heart rate, blood pressure and contractility III. Increase in end-diastolic volume and ejection time A. I only B. II only C. I and II only D. II and III only E. I, II and III. 73. Which of the ff. diuretics caused hyperglycemia, hypomagnesemia and hyperuricemia? A. Spironolactone B. Furosemide C. Acetazolamide D. Hydrochlorothiazide 74. Prophylactic drug for paroxysmal atrial tachycardia A. Verapamil B. Nifedipine C. Procainamide D. Adenosine 75. Patient has an angina pectoris treated with sublingual nitroglycerin. Which of the ff. is involved in the mechanism of actions of nitroglycerin? A. Phosphorylation of light chains of myosin B. α-adrenergic activity C. cGMP D. Phosphodiesterase activity 76. Which of the ff. is/are the clinical uses of Captopril? I. Congestive heart failure II. Prevention of LV dysfunction following MI III. Diabetic nephropathy A. I only B. II only C. I and II only D. II and III only E. I, II and III. 77. Patient has hypertension and diabetic neuropathy. His medication is Losartan. What would be the mechanism of actions of his medication? A. Interacts irreversibly at the AT1 and AT2 receptors B. Have effect on bradykinin metabolism C. Increases excretion of Cl, Mg, uric acid, Ca, and phosphate D. Decreases urinary flow rate 78. The ff. statements are true about the mechanisms of action of Carvedilol in the treatment of CHF, EXCEPT A. Decreased pulmonary capillary wedge pressure B. Decreased systemic vascular resistance C. Decreased stroke volume index D. Decreased right arterial pressure 79. Which of the ff. beta blockers could be administered on a once a day dose? I. Carvedilol II. Bisoprolol III. Betaxolol A. I only B. II only C. I and II only D. II and III only E. I, II and III. 80. What is the therapeutic effect of Digoxin in the atrioventricular node? A. Increase in PR interval B. Decrease in refractory period C. Decrease in conduction velocity D. Decrease in QT interval 81. What is the effect of digoxin in atrial muscle at toxic dose? A. Arrrythmia B. Tachycardia C. Extrasystoles D. Fibrillation 82. What is the therapeutic effect of digoxin in Purkije system? A. Increase in refractory period B. Decrease in refractory period C. Increase in PR interval D. Decrease in QT interval 83. What is the toxic effect of digoxin in Purkije system? A. Arrrythmia B. Tachycardia C. Bradycardia D. Asystole 84. Which of the ff. diuretic agent bhas no effect or no changes in K+ urinary electrolytes? A. Hydrochlorothiazide B. Furosemide C. Spironolactone D. Acetazolamide 85. Among the diuretic agents, which of the ff. would decrease the body pH? I. Potassium-sparing diuretics II. Carbonic anhydrase inhibitors III. Loop diuretics A. I only B. II only C. I and II only D. II and III only E. I, II and III. 86. Among the diuretic agents, which of the following would decrease the K+ level? I. Potassium-sparing diuretics  II. Carbonic anhydrase inhibitors III. Loop diuretics A. I only B. II only C. I and II only D. II and III only E. I, II and III. 87. Among the diuretic agents, which of the following has no changes in NaHCO3 in urine? I. Furosemide II. Ethacrynic acid III. Indapamide A. I only B. II only C. I and II only D. II and III only E. I, II and III. 88. Patient has secondary, acute glaucoma. He was given 2501mg IV q4 of Acetazolamide. The mechanism of actions of acetazolamide in this particular case include which of the ff.: I. Increase in renal excretion of Na+, K+, HCO3-, and water II. Reduction of aqueous humor formation III. Reduction of H+ ion secretion at renal tubule A. I only B. II only C. I and II only D. II and III only E. I, II and III. 89. What are the consequences of the noncompetitive inhibition of carbonic anhydrase? I. Increase in urine volume II. Change in alkaline pH III. Increase in excretion of ammonia A. I only B. II only C. I and II only D. II and III only E. I, II and III. 90. What are the consequences of the inhibition of sodium reabsorption by amiloride in the distal tubule, cortical collecting tubule and collecting duct? I. Decrease in potassium retention II. Reduction of excretion of both potassium and hydrogen excretion III. Decrease in Natriuretic activity A. I only B. II only C. I and II only D. II and III only E. I, II and III. 91. What are the antihypertensive mechanisms of actions of indapamide? I. Temporary increase in glomerular filtration rate II. Direct arteriolar vasodilation through Ca2+ channel blockade III. Decreases total body sodium A. I only B. II only C. I and II only D. II and III only E. I, II and III. 92. What electrolyte is primarily decreased in the combination of ethacrynic acid and cardiac glycosided? A. Magnesium B. Potassium C. Calcium D. Chloride 93. What is the coagulation factor released by Desmopressin? A. Factor VIII B. Factor IX C. Factor X D. Factor X 94. The statements about esmolol include which of the ff? I. β1-selectiveblocker metabolized by hydrolysis of red blood cell estrerases II. used in hypertension with associated tachycardia III. longer half lives A. I only B. II only C. I and II only D. II and III only E. I, II and III. 95. The mechanisms of action of felodipine include which of the ff? I. Inhibits calcium ions from entering the “slow channels” or select voltage—sensitive areas of vascular smooth muscle and myocardium during depolarization II. Relaxation of coronary vascular smooth muscle and coronary vasodilation III. Increases myocardial oxygen delivary in patients with vasospastic angina A. I only B. II only C. I and II only D. II and III only E. I, II and III. 96. The mechanisms of action of ramipril include which of the ff? I. Must undergo enzymatic saponification by esterases in the liver to its biologically active metabolite II. Effects of ramipril result from the high affinity, competitive, reversible binding of ramiprilat III. Vasoactive kallikriens may be increased in conversion to active hormones by ACE inhibitors A. I only B. II only C. I and II only D. II and III only E. I, II and III. 97. The mechanisms of action of pindolol include which of the ff? I. Has positive inotropic and chronotropic effects and can significantly increase AV nodal conduction II. Blocks beta 1- and beta 2-receptors and has mild intrinsic sympathomimetic activity III. Augmentive action of antidepressants thought to be mediated via a serotonin 1A autoreceptor antagonism A. I only B. II only C. I and II only D. II and III only E. I, II and III. 98. What are the mechanisms of action of antihypertensive activities of valsartan? I. Produces indirect antagonism of the angiotensin II (AT2) receptors II. Displaces angiotensin II from the AT1 receptor by antagonizing AT1-induced vasoconstriction III. Produces direct antagonism of the angiotensin II (AT2) receptors A. I only B. II only C. I and II only D. II and III only E. I, II and III. 99. The mechanisms of action of clopidogrel include which of the ff? I. Irreversibly blocks the P2Y12 component of ADP receptors on the platelet surface II. Prevents activation of the GPIIb/IIIa receptor complex III. Increase platelet aggregation A. I only B. II only C. I and II only D. II and III only E. I, II and III. 100.The mechanisms of action of Imdur include which of the ff? I. Decrease preload as measured by pulmonary capillary wedge pressure and left ventricular end diastolic volume and pressure II. Average reduction in left ventricular end diastolic volume is 25% at rest III. Increase in ejection fractions of 50% to 60% A. I only B. II only C. I and II only D. II and III only E. I, II and III. 101. This mode of hepatocyte death is associated with cell shrinkage, nuclear fragmentation and lack of  inflammation? A. Apoptosis B. Necrosis C. Hepatosis D. Steatosis 102.The first clinically used chelating agent A. Penicillamine B. Deferoxamine C. BAL D. EDTA 103.Chemical name of British Anti-Lewisite A. 2,3-dimercaptopropanol B. 2,3-dimercapto-1-propaesulfonic acid C. Dimethylcysteine D. Ethylene diamine tetraacetic acid 104.A hydrolytic product of penicillin used for the removal of copper in persons with Wilson’s disease A. EDTA B. BAL C. Penicillamine D. Deferoxamine 105.An orally active chelating agent alternative for persons who have developed a sensitivity to penicillamine. A. Triethylene tetramine B. DTPA C. BAL D. Deferoxamine 106.In cases of chlorinated hydrocarbon ingestion, the following medication(s) is/are given: I. Activated charcoal II. epinephrine III. diazepam A. I only B. II only C. I and II only D. II and III only E. I, II and III. 107. Peripheral vascular disease has been observed in persons with chronic exposure to this toxic metal drinking water in Taiwan and in Chile. The disease is manifested by acrocyanosis and Raynaud’s Phenomenon A. Mercury B. Arsenic C. Cadmium D. Beryllium 108.Acrocyanosis is a feature of Raynaud’s disease. It is defined as: A. Disorder affecting the fingers and toes causing them to become blue and cold at low temperatures. B. Disorder affecting the fingers and toes causing them to become blue and cold at high temperatures C. All of the above D. None of the above 109.A potent hemolytic agent formed by the reaction of hydrogen with arsenic and is generated as a by-product in the nonferrous metals A. Arsenite B. Arsine C. Arsenous gas D. Arsenate 110.Exposure to insoluble compounds of this toxic metal produced as syndrome, first described among fluorescent lamp workers, characterized by shortness of breath, clubbing of fingers and cyanosis. The toxic metal is: A. Cadmim B. B. Beryllium C. Magnesium D. Arsenic 111.The most ubiquitous toxic metal A. Cadmium B. Lead C. Arsenic D. Mercury 112. Clinically overt encephalopathy may occur in children with high exposure to this toxic metal. Symptoms begin with lethargy, irritability, loss of appetite, dizziness progressing to obvious ataxia, a reduced level of consciousness which may progress to coma and death. This toxic metal is: A. Cadmium B. Lead C. Arsenic D. Mercury 113. Metallic nickel combines with carbon monoxide to form nickel carbonyl, which decomposes to pure nickel and carbon monoxide on heating to 200°C. this is extremely toxic. The preferred drug for nickel toxicity is: A. BAL B. EDTA  C. Deferoxamine D. Sodium diethyldithiocarbamate 114. Cardiomyopathy has been caused by an excessive intake of this essential metal, particularly from drinking of beer to which 1ppm of this metal was added to enhance its foaming qualities. This essential metal is: A. Iron B. Magnesium C. Cobalt D. Zinc 115.The puffrfish poison, tetrodotoxin, are one and the same with the newt poison called: A. Newtoxin B. Amphibitoxin C. Tarichatoxin D. Saxitoxin 116.Treatment of choice for acid ingestion A. use of emetics and lavage B. dilution or therapy with milk or wter immediately after ingestion C. use f alkaline substances D. all of the above 117.Treatment of choice for alkali ingestion A. Dilution or therapy with milk or wter immediately after ingestion B. Vinegar and lemon juice C. Both D. None of the above 118.The ff. may be given for patients with salicylate poisoning: I. Activated charcoal II. Sodium bicarbonate III. Acetazolamide A. I only B. II only C. I and II only D. II and III only E. I, II and III. 119.Sea turtle poisoning symptoms are vomiting, diarrhea, sore lips and tongue, foul breath, white coating on the tongue, tightness of the chest, coma and death. The etiologic agent is: A. Saxitoxin B. Chelonitoxin C. Ciguatoxin D. Tetrodotoxin 120.Route of administration of deferoxamine includes: I. intramuscular II. intravenous III. oral A. I only B. II only C. I and II only D. II and III only E. I, II and III. 121.Denotes the absorption, distribution, excretion, and metabolism of toxins, toxic doses of therapeutic agents and their metabolites A. Toxicokinetics B. Toxicodynamics C. All of the above D. None of the above 122.Used to denote the injurious effects of toxins, toxic doses of therapeutic agents and their metabolites on vital function A. Toxicokinetics B. Toxicodynamics C. All of the above D. None of the above 123.Specific antidote for Fluoride poisoning: I. Calcium II. acetylcysteine III. atropine A. I only B. II only C. I and II only D. II and III only E. I, II and III. 124.Cocaine: crack as ____ : crank  I. shabu II. methamphetamine III. methylenedioxymethamphetamine A. I only B. II only C. I and II only D. II and III only E. I, II and III. 125.Antidote for caffeine poisoning: A. Acetylcysteine B. Calcium C. Esmolol D. Fomepizole 126.The Nitrosoureas are highly lipid-soluble and cross the blood-brain barrier, making them useful in the treatment of brain tumors. Which of the ff. belong to the group Nitrosoureas? I. Lomustine II. Altretamine III. Semustine A. I only B. II only C. I and II only D. II and III only E. I, II and III. 127.A folic acid antagonist that binds to the active catalystic site of dihydrofolate reductase, interfering with the synthesis of the reduced form that accepts one-carbon units A. Methotrexate B. Mercaptopurine C. Cisplatin D. Allopurinol 128.Methotrexate also has important applications in the treatment of: A. Tuberculosis B. Rheumatoid arthritis C. Congestive heart failure D. Infectios 129.The firt of the thiopurine series found useful as an anticancer drug A. Cisplatin B. Methotrexate C. Fluouracil D. Mercaptopurine 130.Frequently used with chemotherapu in hematologic cancers to prevent hyperuricemia after tumor cell lysis A. Allopurinol B. Cisplatin C. Fluorouracil D. Mercaptopurine 131.Major toxicities of Fluorouracil are: I. Myelosupression II. Mucositis III. Vomiting A. I only B. II only C. I and II only D. II and III only E. I, II and III. 132.Enzyme responsible for cutting and relegating single DNA strands. Inhibition of this enzyme results in DNA damage. A. Topoisomerase I B. Topoisomerase II C. Aromatase D. Asparaginase 133.Natural products that interfere with the activity of Topoisomerase I A. Vincristine B. Podophyllotoxins C. Camptothecins D. Taxanes 134.An alkaloid ester derived from the Western Yew (Taxus brevifolia) and the European Yew ( Taxus baccata) A. Cisplatin B. Paclitaxel C. Vincristine D. Podophyllotoxins 135.Paclitaxel has significant activity in ovarian and advanced breast cancer. Its primary dose-limiting toxicities includes: I. Neutropenia II. Thrombocytopenia III. Peripheral neuropathy A. I only B. II only C. I and II only D. II and III only E. I, II and III. 136.Used in combination with surgery and vincristine in the adjuvant treatment of Wilm’s tumor A. Doxorubicin B. Dactinomycin C. Plicamycin D. Mitomycin 137.Major dose-limiting toxicity of dactinomycin A. Alopecia B. Vomiting C. Bone marrow depression D. Thrombocytopenia 138.Formerly known as Mithramycin, isolated from Streptomyces plicatus A. Plicamycin B. Dactinomycin C. Dodorubicin D. Mitomycin 139.Mitomycin is isolated from: A. Streptomyces plicatus B. Streptomyces caespitosus C. Streptomyces peucetius D. Streptomyces nodosus 140.A series of antineoplastic antibiotics produced by Streptomyces verticillus A. Plicamycin B. Bleomycin C. Doxorubicin D. Mitomycin 141.Sex hormones are employed in cancer of the female and male breast, cancer of the prostate, and cancer of the endometrium of the uterus. Its adverse reaction(s) include(s): I. Fluid retention II. Hypertension III. Diabetes A. I only B. II only C. I and II only D. II and III only E. I, II and III. 142.Tamoxifen has proved to be extremely useful for the treatment of breast cancer. Most frequent side effect of Tamoxifen is: A. Hot flushes B. Nausea C. Fluid retention D. Alopecia 143.Predominant form of leukemia in childhood and the most common form of leukemia in children. A. Acute lymphoblastic leukemia B. Acute myelogenous leukemia C. Hairy cell leukemia D. Chronic lymphocytic leukemia 144.First metastatic cancer cured with chemotherapy A. Breast cancer B. Testicular carcinoma C. Choriocarcinoma of the uterus D. Thyroid carcinoma 145.Metastatic melanoma is one of the most difficult neoplasms to treat. Most active cytotoxic agent(s) for this include(s) I. Dacarbazine II. Cisplatin III. fluorouracil A. I only B. II only C. I and II only  D. II and III only E. I, II and III. 146.Chronic myelogenous leukemia arises from a chromosally abnormal hematopoetic stem cell. Patients who are not eligible for bone marrow transplantation may make use of the ff. to provide temporay improvement: I. Alpha-interferon II. Mercaptopurine III. Cisplatin A. I only B. II only C. I and II only D. II and III only E. I, II and III. 147.Current treatment of choice for Stages II and IV of Hodgkin’s disease includes the combination chemotherapy of: I. Vinblastine II. Doxorubicin III. Bleomycin A. I only B. II only C. I and II only D. II and III only E. I, II and III. 148.Current treatment of choice for carcinoma of the ovary includes: A. Cisplatin and paclitaxel B. Progestins and tamoxifen C. Vincristine and vinblastine D. Chlorambucil and prednisone 149.An enzyme that is isolated from various bacteria used to treat childhood acute leukemia A. Asparaginase B. Topoisomerase I C. Topoisomerase II D. Aromatase 150.This anthracene compound whose structure resembles the anthracycline ring was recently approved for treatment of refractory acute leukemia A. Mitomycin B. Mitoxanthrone C. Mitotane D. Mitotaxin 151.What is the safest 1st generation sulfonylurea for elderly diabetics A. Chlorpropramide B. Tolbutamide C. Tolazamide D. None of the above 152.Which among the ff. insulin is the most recently developed long acting insulin analog that has a dose- dependent onset of action of 1-2 hours and duration of action of more than 24 hours. A. NPH insulin B. Insulin glargine C. Insulin detemir D. None of the above 153.The ff. is/are true about Type 4 Diabetes Mellitus I. It is defined as any abnormality in glucose levels noted for the first time during pregnancy. II. The designation refers to multiple other specific causes of an Elevated blood glucose: nonpancreatic diseases and drug therapy etc. III. It is characterized by tissue resistance to the action of insulin combined with a relative deficiency in insulin secretion. A. I only B. II only C. I and II only D. II and III only E. I, II and III. 154.Which among the ff. sulfonylureas achieves blood glucose lowering at the lowest dose A. Tolbutamide B. Glyburide C. Glipizide D. Glimepiride 155.These are drugs which are ligand of peroxisome proliferator-activated receptor-gamma (PPAR-gamma) A. Thiazolidinediones  B. Meglitinides C. Sulfonylurea D. None of the above 156.Which among the ff. is/are the cause/s of hypoglycemia with patients under tight glycemic control? I. delay in taking meal II. inadequate carbohydrate consumed III. unusual physical exertion A. I only B. II only C. I and II only D. II and III only E. I, II and III. 157. What is the first incretin therapy to become availabe in the treatment of diabetes. A. Sitagliptin B. Pramlintide C. Exenatide D. Rosiglitazone 158. It is a 69-amino acid peptide which contains the glucagon sequence interposed between peptide extensions A. Glicentin B. Pepsin C. Glucagon-like peptides D. Phosphodiesterases 159. Which among the ff. is available in inhaled form of rapid acting insulin A. insulin aspart B. Insulin lispro C. Human insulin recombinant D. Insuline glulisine 160. This hormone modulates appetite, gastric emptying time and glucagon and insuling secretion. A. Islet amyloid polypeptide B. Somatostatin C. Pancreatic peptide D. None of the above 161. This is a soluble "peakless" ultra long acting insulin analog A. Insulin glargine B. Insulin detemir C. NPH D. None of the above 162. Which ic/are not true about thioamides I. Methimazole and propylthiouracil are major drugs for treatment of thyrotoxicosis II. Methimazole is less potent than propylthiouracil III. Carbimazole is converted to methimazole in the body A. I only B. II only C. I and II only D. II and III only E. I, II and III. 163. It is the end state of untreated hypothyroidism which is associated with progressive weakness, stupor, hypothermia, hypoventilation, hypoglycemia and death. A. Hashimoto's thyroiditis B. Grave's Disease C. Myexedema coma D. None of the above 164. It is the sudden acute exacerbation of all the symptoms of thyrotoxicosis, presenting as a life-threatening syndrome. A. Grave's syndrome B. Opthalmopathy C. Thyroid storm D. Dermopathy 165. Which oh the ff. is not a sign nor symptom of Grave's Disease I. Plummer's nail II. Endophthalmos III. Decreased sweating A. I only B. II only C. I and II only D. II and III only E. I, II and III. 166. It is a syndrome of thyroid enlargement without excessive thyroid hormone production. A. Nontoxic goiter  B. Hashimoto's Disease C. Thyroid storm D. None of the above 167. Which of the ff. is/are not the physiologic effect/s of compound F. I. Regulation of intermediary metabolism II. Cell necrosis III. Immunity A. I only B. II only C. I and II only D. II and III only E. I, II and III. 168. This is usally the result of bilateral adrenal hyperplasia secondary to an ACTH-secreting pituitary adenoma A. Aldosteronism B. Addison's Disease C. Grave's Disease D. Cushing's syndrome 169. :) 170. This compound destroys seminiferous epithelium but does not significantly alter the endocrine function of the testis A. Levonorgestrel B. Progestin C. Cyproterone acetate D. Gossypol 171. A potent substituted anilide antiandrogen which is not a steroid but it behaves like a competitive antagonist at the androgen receptor A. Flutamide B. Bicalutamide C. Nilutamide D. Finasteride 172. The ff. are the manifestations of malignant hyperthermia syndrome except I. Rapid onset of tachycardia and hypertension II. Hypotension III. Severe muscular rigidity IV. Hyperkalemia A. I only B. II only C. I and II only D. II and III only E. I, II and III. 173. Which of the ff. is/are characteristic/s of an ideal anesthetic drug I. Induce loss of consciousness smoothly and rapidly while allowing for prompt recovery of cognitive function after its administration II. Possess a wide margin of safety III. Devoid of adverse effects A. I only B. II only C. I and II only D. II and III only E. I, II and III. 174. The ff. anesthetics are correctly matched: I. Ketamine- opioid anesthetics II. Cocaine- ester containing local anesthetics III. Lidocaine- xylocaine A. I only B. II only C. I and II only D. II and III only E. I, II and III. 175. Which among the ff. anesthetics have a depressant effect on arterial pressure as a result of a decrease in systemic vascular resistance with minimal effect on cardiac output. I. Halothane II. Desflurane III. Enflurane IV. Sevoflurane V. Isoflurane A. I only B. II only C. I and II only D. II, IV and V E. I, II, III and IV 176. At what stage of anesthesia does recurrence of regular respiration and extension to complete cessation of spontaneous respiration occur? A. Stage of modullary depression B. Stage of excitement C. Stage of analgesia D. Stage of surgical anesthesia 177. Which among the ff. is the correct order of increasing depth of nervous system depression? I. Stage of surgical anesthesia II. Stage of excitement III. Stage of analgesia IV. Stage of modullary depression A. I-II-III-IV B. III-II-I-IV C. IV-II-I-III D. III-I-II-IV 178. Which of the ff. is/are not true about inhaled anesthetics I. Increases the metabolic rate of the brain II. Increases the glomerular filtration rate and renal blod flow depending on the concentration III. Decreases mean arterial pressure in direct proportion to alveolar concentration A. I only B. II only C. I and II only D. II and III only E. I, II and III 179. It is the commonly used barbiturate to induce anesthesia A. Thiopental B. Phenobarbital C. Secobarbital D. Amobarbital 180. At what site does amide containing local anesthetics is converted to more water soluble metabolites and then excreted in the urine? A. Kidney B. Plasma C. Liver D. Lungs 181. Which of the ff. local anesthetics are correctly matched in terms of potency? I. Lidocaine< bupivacaine II. Ropivacaine> mepivacaine III. Tetracaine> procaine A. I & II only B. II & III only C. III only D. II & III only 182. Which is not true about local anesthetics? I. Possesses membrane stabilizing effects II. Used to treat patients with neuropathic pain syndrome III. Commonly used as adjuvants A. I only B. II only C. I and II only D. II and III only E. None of the above 183. The ff. statement/s is/are true about vitamin D. I. Vitamin D is secosteroid produced in the skin from 7-dehydrocholesterol under the influence of UV II. Vitamin D is a prohormone that serves as a precursor to a number of biologically active metabolites III. Both the natural form and the plant derived form are present in the diet A. I only B. I and II only C. II and III only D. I, II and III 184. All the ff. are major causes (other than thiazide therapy) of hypercalcemia except: I. Hyperparathyroidism II. Hypothyroidism III. Hypervitaminosis D IV. Sarcoidois A. I only B. I and II only C. II and III only D. I, II and III 185. Which among the ff. is/are not associated with hypophosphatemia? I. Fanconi's Disease II. Hypothyroidism  III. Hyperparathyroidism A. I only B. I and II only C. II and III omly D. I, II and III 186. The ff. are clinical manifestations of hypothyroidism except: I. Pale, cool, puffy skin II. Pleural effusions III. Increased erythropoiesis IV. Hypermenorrhea A. I, II and III B. II only C. III omly D. II, III and IV only 187. Which is/are not a characteristic/s of dissociative anesthetic state? I. Catatonia II. amnesia III. analgesia A. I and II only B. III and IV only C. III only D. None of the above 188. Which is/are not true about opioid anesthetics? I. Opioid anesthetics are used in combination with large doses of benzodiazepines II. Low doses during surgery causes chest wall rigidity thereby impairing ventilation III. Opioid anesthetics can be administered in very low doses by epidural and subarachnoid route A. I only B. II only C. I and II only D. II and III only E. I, II, and III 189. Which among the ff. pair/s of "etiology/pathogenesis" of hypothyroidism is/are correct? I. Cretinism/blocked hormone formation II. Hashimoto's thyroiditis/autoimmune destruction of thyroid III. Dyshormogenesis/impaired synthesis of T4 due to enzyme deficiency A. I only B. II only C. I and II only D. II and III only E. I, II, and III 190. This serves as a precursor of aldosterone A. Deoxycortisone B. Fludrocortisone C. ACTH D. Cortisone 191. It blocks the conversion of cholesterol to pregnenolone and causes a reduction in the synthesis of all hormonally active sterois A. Mifepristone B. Metypyrone C. Aminoglutethimide D. Mitotane 192. Which among the ff. has a strong antiprogestin activity and initially was proposed as a contraceptive- contagestive agent I. RU 486 II. 11B-aminophenyl-substituted 19-norsteroid III. Mifepristone A. I only B. I and II only C. II and III only D. I, II, and III 193. Which of the ff. is/are not true about ketamine I. Markedly increases cerebral blood flow, oxygen consumption and intracranial pressue II. Increases the respiratory rate, upper airway muscle tone is well maintained and airway reflexes are usually preserved III. The only IV anesthetic that possesses both analgesic properties and the ability to produce dose- related cardiovascular stimulation A. I only B. II only C. I and II only D. II and III only E. I, II, and III  194. Which among the ff. is/are not a mild advers effect/s of hormonal contraceptives? I. Nausea II. Breakthrough bleeding III. myocardial infarction A. I only B. II only C. I and II only D. II and III only E. I, II, and III 195. Which among the ff. is/are not a physiologic effect of insulin? I. Inhibits glycogenesis II. Increase glucose transport III. Promotes intracellular lipase A. I only B. II only C. I and II only D. II and III only E. I, II, and III 196. This drug inhibits dipeptidyl peptidase-4 (DPP-4) A. Sitagliptin B. Pramlintide C. Exenatide D. Acarbose 197. Which among the ff. is/are the physiologic effect/s of amylin: I. modulate insulin release by acting as a negative feedback ion insulin secretion II. reduces glucagon secretion III. slows gastric emptying by vagally medicated mechanism A. I only B. II only C. I and II only D. II and III only E. I, II, and III 198. This aldosterone antagonist is more selective than spironolactone and has no reported effects on androgen receptors A. Drospirenone B. Fludrocortisone C. Eplerenone D. Mifepristone 199. Which of the ff. is/are the effect/s of estrogen therapy? I. Nausea & breast tenderness II. Uterine bleeding III. Cancer A. I only B. II only C. I and II only D. II and III only E. I, II, and III 200. The following is/ are clinical manifestation/s of hypocalemia. I. Hyperthyroidism II. Tetany III. Paresthesia A. I only B. II only C. I and II only D. II and III only E. I, II and III 201. The first-line antimycobacterial agent which, if given in high doses, indicates periodic assessment of visual acuity and red-green color discrimination. A. Streptomycin B. Ethambutol C. Pyrazinamide D. Rifampicin 202. Urinary tract infection caused by Chlamydia trachomatis on a pregnant patient is best treated with. A. Co-trimoxazole B. Levofloxacin C. Erythromycin D. Tetracycline 203. Ciprofloxacin is used for the treatment of chronic UTI. If a patient appears unresponsive to the antibiotic, which of the following agents is most likely the cause? A. Aspirin B. Sodium bicarbonate C. Phenytoin D. Ferrous sulfate 204. Urethral discharge which when cultured shows Neiserria gonorrhoeae should be treated with A. Ceftriaxone B. Co-trimoxazole C. Benzathine penicillin G D. Amikacin 205. Pseudomonas aeruginosa is found in urine culture and blood cultures of a patient with acute pyelonephritis. Combined therapy should be instituted with an aminoglycoside and which of the following? A. Vancomycin B. Azithromycin C. Piperacillin D. Clavulanic acid 206. Clarithromycin, used in combination with other agents for the treatment of duodenal ulcers, inactivates which enzyme? A. Na+, K+ - ATPas B. Na+, K+, Cl- co-transporter C. Cytochrome P450 D. Dihydrofolate reductase 207. Trichomoniasis, manifested by itching in the vulval area, is preferably treated with A. Metronidazole B. Pyrimethamine C. Doxycycline D. Pentamidine 208. Pneumonia characterized by a sputum culture that is positive for a B-lactamase-positive staphylococcal strain should be treated with which penicillin? A. Carbenicillin B. Ticarcillin C. Oxacillin D. Ampicillin 209. The following are general principles of antimicrobial surgical prophylaxis EXCEPT: A. The antibiotic should be active against common surgical would pathogens. B. Broad spectrum antibiotics should be used to ensure complete protection against post-surgical infections. C. The antibiotic concentrations must be greater than the MIC of suspected pathogens at the time of incision. D. Ideally, a single dose of antibiotic should be used. E. Newer, broad spectrum antibiotics should be reserved for therapy of resistant infections. 210. Which of the following agents used to treat chronic UTI could cause acute alcohol intolerance? A. Moxifloxacin B. Cefotetan C. Co-trimoxazole D. Tetracycline 211. Which of the antiviral agent should be administered to an immunocompromised patient with herpes simplex keratitis? A. Amantadine B. Indinavir C. Zidovudine D. Trifluridine 212. A geriatric patient develops fever and a cough that produces blood-tinged sputum. Gram-positive cocci in clusters are found in a sputum smear. A chest x-ray shows increased density in the right upper lobe. Which of the following penicillins is most likely to be ineffective? A. Cloxacillin B. Nafcillin C. Oxacillin D. Ticarcillin 213. Otitis externa that is positive for Pseudomonas organisms is treated with topical polymyxin. What is the mechanism of action of polymyxin? A. Disruption of membrane permeability B. Inactivation of protein sulfhydryl groups C. Formation of reactive cytotoxic products D. Inhibition of protein synthesis 214. Which of the following statements best characterizes amoxicillin? A. It has better oral absorption then ampicillin B. It is effective for uncomplicated salmonella gastroenteritis C. It is effective against Pseudomonas D. It is effective for shigellosis 215. Indinavir, used in the treatment of AIDS in combination with other agents, exerts its action by what mechanism? A. Inhibition of nucleoside reverse transcriptase B. Inhibition of nonnucleoside reverse transcriptase C. Inhibition of viral protease D. Blockage of viral entry 216. The following drugs are used to treat pneumocystosis caused by Pneumocystis jiroveci EXCEPT: A. Trimethoprim-sulfamethoxazole B. Clindamycin-primaquine C. Pentamidine D. Metronidazole 217. Echinocandins, the newest class of antifungal agent to be developed, exert their action by A. Inhibition of B(1-3) glucan synthesis B. Inhibition of fungal DNA synthesis C. Inhibition of fungal cytochrome P450 enzymes D. Inhibition of fungal enzyme squalene epoxidase 218.The following statements are true about tobramycin. I. Tobramycin may be used for treatment of Pseudomonas aeruginosa lower respiratory tract infections complicating fibrosis. II. Gentamicin and tobramycin may by interchangeable clinically with a few exceptions. III. Nephrotoxicity of tobramycin is greater than that of gentamicin, but is less ototoxic. A. I only B. II only C. I and II only D. II and III only E. I, II and III 219. The following statements are true about linezolid. I. Linezolid should be reserved for treatment of infections caused by multidrug-resistant gram-negative bacteria. II. The principal toxicity of linezolid is generally mild and reversible. III. Linezolid is active in-vitro against Mycobacterium tubercolosis. A. I only B. II only C. I and II only D. II and III only E. I, II and III 220. Arrange the following tetracyclines according to serum half-life. I. Doxycycline II. Tigecycline III. Methecycline IV. Tetracycline A. I > II > III > IV B. II > III > I > IV C. III > II > I > IV D. III > I > II > IV E. II > I > III > IV 221.The following cephalosporins are correctly matched. I. First-generation – Cephradine II. Second-generation – Cefaclor III. Third-generation – Moxalactam IV. Fourh-generation – Cefdinir A. I, II and III B. I and III C. II and IV D. IV only E. All are correctly matched 222. The following antiretroviral agents are correctly matched. I. Protease inhibitor – Tipranavir II. Nucleoside reverse transcriptase inhibitor – Efavirenz III. Nonnucleoside reverse transcriptase inhibitor – Nevirapine IV. Fusion inhibitor – Elvucitabine. A. I, II and III B. I and III C. II and IV D. IV only E. All are correctly matched 223. The following antiviral agents may be used for influenza. I. Ritonavir II. Amantadine III. Zanamivir A. I only B. II only C. I and II only D. II and III only E. I, II and III 224. The following are the actions of interferon-alfa. I. Inhibition of viral penetration, translation, transcription, protein processing, maturation, and release II. Increased expression of major histocompatibility complex antigens III. Augmentation of the proliferation and survival of cytotoxic T cells A. I only B. II only C. I and II only D. II and III only E. I, II and III 225. The following are major mechanisms of antimicrobial synergism EXCEPT A. Blockade of sequential steps in a metabolic sequence B. Induction of enzymatic inactivation C. Inhibition of enzymatic inactivation D. Enhancement of antimicrobial agent uptake 226. The main chemical form of mercury that poisoned the local population surrounding Minamata Bay in the 1960s after consuming fish and shellfish is A. Elemental mercury (Hg0) B. Mercurous salts (Hg+) C. Mercuric salts (Hg2+) D. Methylmercury (CH3Hg) E. Dimethylmercury (CH3HgCH3) 227. What is the site of action of nephrotoxicity of inorganic mercury salts? A. Proximal tubular cells B. Distal tubular cells C. Loop of Henle D. Bowman’s capsule E. Collecting duct 228. What is the site of action of nephrotoxicity following long term exposure to cadmium? A. Proximal tubular cells B. Distal tubular cells C. Loop of Henle D. Bowman’s capsule E. Collecting duct 229. The mechanism of chromium carcinogenicity is the reduction of hexavalent chromium (Cr+6) to the trivalent form (Cr+3) and generation of reactive intermediates, leading to A. Breast cancer B. Brain cancer C. Endometrial cancer D. Leukemia E. Lung cancer 230. Blackfoot Disease, or gangrene of the lower extremities, is caused by very high levels of exposure to A. Boron B. Silicon C. Arsenic D. Antimony E. Lead 231. The most toxic form of Arsenic is A. Elemental arsenic (As0) B. Pentavalent arsenic (As+5) C. Trivalent arsenic (As+3) D. Arsine gas (AsH3) E. Arsenic trioxide (As2O3) 232. The US EPA “category use” classification of pesticides that are generally nontoxic and have an oral LD50 less than or equal to 15,000 mg/kg. A. Category I B. Category II C. Category III D. Category IV E. Category V 233. The rate of penetration of toxicants across the skin follows this order I. Abdomen II. Scrotal III. Scalp IV. Palm A. I > II > III > IV B. II > III > I > IV C. III > II > I > IV D. III > I > II > IV E. II > I > III > IV 234. The mammalian skin that is usually predictive of dermal absorption of most drug and pesticides in human skin. A. Pig skin B. Primate skin C. Rabbit skin D. Hairless guinea pig skin E. Rat skin 235 The circulating protein to which toxicants are most likely to bind to is A. Albumin B. a1-acid glycoprotein C. Lipoproteins D. Globulins E. Creatine 236. The effects of this teratogen are not seen in the offspring until they reach puberty. A. Thalidomide B. Isotretinoin C. Diethylstilbestrol D. Alcohol E. Lithium 237. These agents are associated with liver necrosis and fatty liver EXCEPT: A. Carbon tetrachloride B. Tetracycline C. Chloroform D. Acetaminophen E. Methimazole 238. These agents are associated with drug-induced cholestasis EXCEPT: A. Diazepam B, Estradiol C. Chlorpromazine D. Indomethacin E. Sulfanilamide 239. These agents are associated with drug-induced hepatitis EXCEPT: A. Safrole B. Isoniazid C. Papaverine D. Colchicine E. Halothane 240. These agents are associated with hepatic necrosis EXCEPT: A. Aflatoxin B1 B. Galactosamine C. Urethane D. Polychlorinated biphenyls E. Pyrrolizidine alkaloids 241. The following statements are true about hepatic necrosis. I. Cell necrosis is usually an acute injury. II. Necrosis may affect only a few hepatocytes or an entire lobe. III. Necrotic lesions are not necessarily critical. IV Changes in blood chemistry resemble those seen with fatty liver, except they are quantitatively smaller. A. I, II and III B. I and III C. II and IV D. IV only E. All are true 242. The following statements are true about hepatic apoptosis. I. Apoptosis is a controlled form of cell death II. Apoptosis is the counterpoint of cell division by mitosis III. Tumor growth may result from inhibition of apoptosis IV. Apoptosis is a normal physiological process whereas necrosis is induced by exogenous factors. A. I, II and III B. I and III C. II and IV D. IV only E. All are true 243. The following statements are true about cholestasis I. Cholestasis is the suppression or stoppage of bile flow II. Cholestasis is usually drug induced III. Inflammation or blockage of the bile ducts results in bilirubin accumulation, leading to jaundice IV. Changes in membrane permeability of either hepatocytes or biliary canaliculi may cause cholestasis. A. I, II and III B. I and III C. II and IV D. IV only E. All are true 244. The following statements are true about cirrhosis. I. In cirrhosis, the accumulation of fibrous material causes severe restriction in blood flow. II. Cirrhosis results mostly from chronic chemical injury III. Chronic use of ethanol is the signle most important cause of cirrhosis in humans. IV. Cirrhosis is a progressive disease characterized by the deposition of collagen throughout the liver. A. I, II and III B. I and III C. II and IV D. IV only E. All are true 245. The following statements are true about chemically induced cell injury I. The chemical agent is activated to form the initiating toxic agent. II. The initiating toxic agent is either detoxified or causes molecular changes in the cell. III. The cell recovers or there are irreversible changes. IV. Irreversible changes may culminate in cell death. A. I, II and III B. I and III C. II and IV D. IV only E. All are true 246. The following statements are true about hepatotoxic agents. I. Carbon tetrachloride is converted to highly reactive free radicals by a P450 isozyme in the centrilobular liver cells. II. Ethanol increases the formation of superoxide by Kupffer cells thus implicating oxidative stress in ethanol- induced live disease. III. Bromobenzene induces hepatic necrosis through the formation of reactive epoxides IV. High doses of acetaminophen progressively deplete hepatic glutathione levels, resulting in extensive noncovalent binding of the reactive metabolie to liver macromolecules. A. I, II and III B. I and III C. II and IV D. IV only E. All are true 247 The following statements are true about the kidney and its susceptibility to toxicants. I. Although the kidneys comprise less than 1% of the body mass, they receive around 25% of the cardiac output, and thus receive significant amounts of xenobiotics. II. As the kidneys remove water and salts from tubular fluid, a nontoxic concentration of any chemical in the plasma is converted to one that is toxic in the tubules. III. Some regions of the kidney have considerable levels of xenobiotics metabolizing enzymes, in which reactive metabolites may form. IV. High levels of glutathione play an important role in the detoxification process. A. I, II and III B. I and III C. II and IV D. IV only E. All are true 248. The following statements are true about nephrotoxic metals. I. Cadmium is excreted in the urine mainly as a complex with the protein metallothionein, which is a low molecular weight protein synthesized in the kidney. II. Lead, as Pb2+, is taken up readily by distal tubule cells, where it damages mitochondria and inhibits mitochondrial function. III. Plasma uranium is bound, as the uranyl ion, to citrate, which is then filtered by the glomerulus. IV. Organomercurials, in the absence of other effective drugs, still prove to be effective, sometimes life-saving, diuretics. A. I, II and III B. I and III C. II and IV D. IV only E. All are true 249. The following statements are true about nephrotoxic agents EXCEPT: A. In the proximal tubule, aminoglycosides are reabsorbed by binding to cationic membrane phospholipids, followed by endocytosis and sequestration in lysosomes. B. Amphotericin B, as a surface-active agent, binds to membrane phospholipids, disrupting the integrity of the membrane and resulting in leaky cells. C. Chloroform is converted to phosgene, which is capable of binding to cellular proteins to produce cellular necrosis in the kidney. D. Hexachlorobutadiene first forms a glutathione conjugate, which is further metabolized to a cysteine conjugate, which is then cleaved to a reactive intermediate. E. Tetrafluroethylene is first methabolized to a cysteine conjugate, which is metabolized to a reactive product that can bind to cellular macromolecules. 250. The following statements are true about the mechanism of MPTP as a neurotoxicant EXCEPT: A. MPTP is converted to the damaging metabolite, MPP+ B. The damaging metabolite is not distinguished from serotonin by the uptake transporter, so it is taken up as well. C. The damaging metabolite kills substantia nigra neurons by affecting mitochondrial energy production and promoting free radical formation D. The death of neurons in the substantia nigra results in a lack of neurotransmitter release in the stratum. E. The neurotransmitter loss causes the hallmark symptoms of Parkinsonism. 251. Which of the following statements are correct? A. Weak bases are absorbed efficiently across the epithelial cells of the stomach. B. Coadministration of atropine speeds the absorption of a second drug. C. Drugs showing large Vd can be efficiently removed by dialysis of the plasma D. Stressful emotions can lead to a slowing of drug absorption. 252. Which of the following is true for a drug whose elimination from plasma shows first-order kinetics? A. The half-life of the drug is proportional to the drug concentration in plasma B. The amount eliminated per unit time is constant C. The rate of elimination is proportional to the plasma concentration D. A plot of drug concentration versus time is a straight line. 253. The addition of glucuronic acid to a drug A. Decrease its water solubility B. Usually leads to inactivation of the drug C. Is an example of Phaase I reaction D. Involves cytochrome P-450 254. A drug given as 100mg single dose, results in a peak plasma concentration of 20ug/ mL. The apparent volume of distribution is A. 0.5 L B. 1 L C. 2 L D. 5 L 255. All of the following statements concerning the autonomic nervous system are true EXCEPT for which one? A. The autonomic nervous system is composed entirely of efferent neurons. B. The sympathetic division is activated in response to stressful situations C. The parasympathetic division originates from cell bodies in the CNS D. The parasympathetic nervous system is not required of life. 256. Which of the following statements concerning the parasympathetic nervous system is CORRECT? A. The parasympathetic system uses norepinephrine as a neurotransmitter B. The parasympathetic system often discharge as a single functional system C. The parasympathetic division is involved in accommodation of near vision, movement of food and urination D. The parasympathetic system controls the secretion of the adrenal medulla. 257. Which of the following is characteristic of parasympathetic stimulation? A. Decrease in intestinal motility B. Inhibition of bronchial secretion C. Contraction of sphincter muscle in the iris of the eye (miosis) D. Contraction of sphincter of urinary bladder 258. Which of the following is not an expected symptom of poisoning with isoflurophate? A. Paralysis of skeletal muscle B. Increased bronchial secretion C. Miosis D. Tachycardia 259. Pilocarpine’s A. Is used to lower intraocular pressure in glaucoma B. Is cleaved by acetylcholinesterase C. Selectively binds to nicotinic receptors D. Inhibits secretions such as sweat, tears and saliva. 260. Neostigmine A. Is contraindicated in glaucoma B. Has a shorter duration of action than edrophonium C. Decreases acetylcholine concentration at neuromuscular junction D. May result in bowel hypermotility, salivation and sweating 261. Which one of the following drugs most closely resembles atropine in its pharmacologic actions? A. Scopolamine B. Physostigmine C. Acetylcholine D. Carbachol 262. Which one from the following drugs does not produce miosis (marked constriction of the pupil)? A. Carbachol B. Isoflurophate C. Atropine D. Pilocarpine 263. Which one from the following drugs would be useful in long-term treatment of myasthenia gravis? A. Carbachol B. Isoflurophate C. Atropine D. Pilocarpine 264. A 50-years-old male farm worker is brought to the emergency room. He was found confused in the orchard and since then has lost consciousness. His heart rate is 45 and his blood pressure is 80/40 mmHg. He is sweating and salivation profusely. Which of the following treatment is indicated? A. Physostigmine B. Norepinephrine C. Trimethaphan D. Atropine 265. Diastolic pressure is increased after the administration of which of the following drugs? A. Norepinephrine B. Epinephrine C. Isoproterenol D. Albuterol 266. Which of these statements is incorrect? A. Among the physiologic responses caused by alpha-receptor stimulation are vasoconstriction, mydriasis and decreased GIT motility. B. Among the physiologic responses caused by beta-receptor stimulation are vasoconstriction, cardiac stimulation and bronchial relaxation. C. Norepinephrine has a stronger affinity for alpha receptors compared to beta-receptors D. Dobutamine is a potent vasoconstrictor 267. All of the following statements concerning phenylephrine are correct, except A. It is an alpha agonist that causes vasoconstriction B. It is synthetic direct-acting agonist C. It is used to prevent bronchospasm D. It causes mydriasis when introduced into the eye 268. Systolic pressure is decreased after the injection of which of the following drugs? A. Norepinephrine B. Dopamine C. Ephedrine D. Reserpine 269. Which of the following drugs is useful in treating tachycardia? A. Phenoxybenzamine B. Isoproterenol C. Phentolamine D. Propranolol 270.SWhich of the following statements is correct? A. Chlorpromazine is indicated in treating nausea of levodopa treatment B. Vitamin B6 increases the effectiveness of levodopa C. Administration of dopamine is an effective treatment of Parkinson’s disease D. Levodopa-induced nausea is reduced by carbidopa 271. All of the following statements are correct, except A. Atropine blocks the cholinergic pathway in the neostriatum B. Antimuscarinic agents are generally less efficacious than levodopa in the treatment of Parkinson’s disease. C. Bromocriptine directly activates dopaminergic receptors D. Amantadine inhibits the metabolism of levodopa. 272. Which of the following is not a characteristic of cocaine overdose? A. Dilation of pupils B. Euphoria C. Tachycardia D. Peripheral vasodilation 273. Which of the following statements about amphetamine is incorrect? A. Overdosage can be managed with chlorpromazine B. It is used as an adjunct with MAO inhibitors in the treatment of depression C. Amphetamine has a longer duration of action than cocaine D. Amphetamine depresses the hunger center in the hypothalamus 274. Which of the following statements concerning tetrahydrocannabinot (THC) is correct? A. It decrease heart rate B. It increase muscle strength C. It decrease appetite D. It has antiemetic action 275. Which of the following is an appropriate therapeutic use for imipramine? A. Insomnia B. Epilepsy C. Bed-wetting in children D. Glaucoma 276. MAO inhibitors are contraindicated with all of the following except A. Indirect adrenergic agents, such as ephedrine B. Tricyclic antidrepressants C. Beer and cheese D. Aspirin 277. Which of the following statements concerning tricyclic antidepressant is correct? A. All of the tricyclic antidepressants show similar therapeutic efficacy B. Hypertension is a common adverse effect C. These drugs show an immediate therapeutic effect D. These drugs must be administered intramuscularly 278. Which of the following is common to the tricyclic antidepressants and MAO inhibitors? A. They can produce sedation B. They can produce physical dependence C. They show strong interaction with certain foods. D. They can produce postural hypotension 279. Which of the following antidepressant agents exhibits an amphetamine-like CNS stimulation? A. Imipramine B. Lithium salts C. Tranylcypromine D. Trazodone 280. A very upset mother brings her 10-year-old son to ask help dealing with his bed wetting. Which of the following drugs might alleviate this problem? A. Fluoxetine B. Imipramine C. Tranylcypromine D. Trazodone 281. The neurolepic drug A. Are equally effective against the positive and negative symptoms of schizophrenia. B. Can cause blurred vision, urinary retention and other sings of muscarinic blockade C. Bind selectively to D2-dopaminergic receptors D. Have antiparkinsonism effects similar to levodopa 282. All of the following are observed in patients taking neuroleptic drugs, except A. Sexual dysfunction B. Increased blood pressure C. Altered endocrine function D. Constipation 283 All of the following statements concerning methadone are correct except A. It has less potent analgesic activity than that of morphine B. It has a longer duration of action than that of morphine C. If is effective by oral administration D. It causes a milder withdrawal syndrome than morphine 284. Which of the following statements about pentozocine is incorrect? A. It is a mixed agonist-antagonist B. It may be administered orally or parentally C. It produces less euphoria that morphine. D. It is often combined with morphine for maximal analgesic effects 285. Which of the following statement about morphine is incorrect? A. It is used therapeutically to relieve pain caused by severe head injury B. Its withdrawal symptoms can be relieved by methadone C. It cause constipation D. It is most effective by parenteral administration 286. All of the following are useful in treating complex partial seizure except A. Ethosuximide B. Phenobarbital C. Carbamazepine D. Phenytoin 287. For which one of the following drugs is the therapeutic indication incorrect? A. Ethosuximide – absence seizure B. Phenobarbital – febrile seizure in children C. Diazepam – status epilepticus D. Primidone – hepatotoxicity 288. Which of the following drug-toxicity pairs is incorrect? A. Valproic acid – nausea and vomiting B. Ethosuximide – steven-johnson syndrome C. Carbamazepine – bone marrow depression D. Primidone – hepatotoxicity 289. Which of the following drug acts at central presynaptic alpha-2 receptors? A. Minoxidil B. Verapamil C. Clonidine D. Enalapril 290. Which of the following antihypertensives is more likely tp cause reflex tachycardia? A. Propranolol B. Nifedipine C. Prazosin D. Hydralazine 291. From the list of antihypertensive drugs below, select the one most likely to lower blood sugar A. Prazosin B. Propranolol C. Nifedipine D. Captopril 292. Which of the following drugs should not be given to a pregnant, hypertensive woman? A. Hydrochlorothiazide B. Propranolol C. Alpha-methyldopa D. Lisinopril 293. The anticoagulant activity of warfarin can be potentiated by all of the following except A. Rifampin B. Aspirin C. Phenylbutazone D. Cimetidine 294. Which of the following is the most common side effect of antihyperlipidemic drug therapy? A. Elevated blood pressure B. Gastrointestinal disturbance C. Neurological problems D. Heart palpitations 295. Which of the following is the most important approach in healing peptic ulcers? A. Coating the ulcer crater B. Eradicating infection with H. pylori C. Inhibiting secretion of gastric acid at the proton pump D. Blocking receptor activation of gastric acid secretion 296. All of the following are adverse effect associated with the used of oral contraceptive agents except A. Edema B. Breast tenderness C. Nausea D. Increased risk of ovarian cancer 297. Effects of estrogen replacement therapy in menopausal women A. Restore bone loss accompanying osteoporosis B. May induce “hot flashes” C. May cause atrophic vaginitis D. Most effective if instituted as the first signs of menopause 298. Progestins A. Are not produced in males B. Increase HDL and decrease LDL C. Attenuate the increase risk of endometrial cancer associated with estrogen-only oral contraceptives D. Progesterone is widely used in oral contraceptives. 299. Which of the following is a synthetic estrogen used in oral contraceptives? A. Mestranol B. Norgestrol C. Clomiphene D. Estradiol 300. All of the following statements about methenamine are correct except A. Used us chronic suppressive therapy of urinary tract infections B. It has its major antibacterial effect at alkaline pH C. It is contraindicated in renal insufficiency D. It may cause gastric disturbances