Clinical Pharmacology Test RSD (PDF)

Министерство здравоохранения Республики Беларусь Учреждение образования «Гомельский государственный медицинский университет» Кафедра общей и клинической фармакологии КЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯ В ВОПРОСАХ И ОТВЕТАХ Учебно-методическое пособие для иностранных студент...

Министерство здравоохранения Республики Беларусь Учреждение образования «Гомельский государственный медицинский университет» Кафедра общей и клинической фармакологии КЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯ В ВОПРОСАХ И ОТВЕТАХ Учебно-методическое пособие для иностранных студентов учреждений высшего медицинского образования, обучающихся на английском языке по специальности 1-79 01 01 «Лечебное дело» CLINICAL PHARMACOLOGY IN QUESTIONS AND ANSWERS Teaching workbook for foreign students studying in English in higher medical education institutions on specialty 1-79 01 01 «General medicine» Гомель ГомГМУ 2022 УДК 615.2 (072)=111 ББК 52.81я73=432.1 К 78 Авторы: Е.И. Михайлова, О.Л. Палковский, Ж.В. Шуляк, А.В. Сенникова, Б.С. Ярошевич, Т.П. Яшина, Г.М. Бронская, Л.И. Новогран Рецензенты: кафедра фармакологии Гродненского государственного медицинского университета; кандидат медицинских наук, врач-клинический фармаколог Республиканского научно- практического центра радиационной медицины и экологии человека Д.И. Гавриленко Клиническая фармакология в вопросах и ответах: учебно-методическое пособие для иностранных студентов учреждений высшего медицинского образования, обучающихся на английском языке по специальности 1-79 01 01 «Лечебное дело» = Сlinical pharmacology in questions and answers: teaching workbook for foreign students studying in English in higher medical education institutions on specialty 1-79 01 01 «General medicine» / Е.И.Михайлова [и др.]. – Гомель: ГомГМУ, 2022. – 193 с. ISBN Учебно-методическое пособие является элементом единого учебно-методического комплекса. Оно представляет собой руководство для самостоятельной работы студентов, обучающихся на английском языке, по клинической фармакологии. Пособие составлено в соотвествии с программой по клинической фармакологии по специальности 1-79 01 01 «Лечебное дело». В обучающие задания введены контрольные вопросы, тестовые задания (MCQ's) по общим и частным вопросам клинической фармакологии (фармакодинамика, фармакокинетика, взаимодействие лекарственных средств, нежелательные эффекты, показания к назначению препаратов и их дозирование, противопоказания, особенности применения препаратов у детей и беременных женщин). Даны рекомендации к их выполнению. Утверждено и рекомендовано к изданию Научно-методическим советом УО «Гомельский Государственный медицинский университет» в качестве учебно-методического пособия _____________ г., протокол № ___. ДК 615.2 (072)=111 ББК 52.81я73=432.1 ISBN © Учреждение образования «Гомельский государственный медицинский университет», 2022 2  CONTENTS INTRODUCTION………………………………………..……………………....… 4 LIST OF ABBREVIATIONS……………………………………….…………...… 5 Chapter 1 Methodology for learning and passing tests in clinical pharmacology……….…..…6 Chapter 2 Test Tasks……………………………………..….....…………….…….….12 ANSWERS……………………………………………………………..……...….209 LITERATURE……………………………………………………..…….…..……216 3  INTRODUCTION The teaching aid is an element of a single educational and methodological complex. It is a guide for independent work of students studying in English, in the development of educational material on clinical pharmacology. The manual has been compiled in accordance with the program in clinical pharmacology in the specialty 1- 79 01 01 "General Medicine", Minsk, 2017. The educational tasks include control questions, test tasks (MCQ's) on general and specific issues of clinical pharmacology (pharmacodynamics, pharmacokinetics, drug interactions, undesirable effects, indications for prescribing drugs and their dosage, contraindications, peculiarities of the use of drugs in children and pregnant women)... Recommendations for their implementation are given. Completing assignments will allow the student to learn: - work with the nomenclature of drugs and distribute them according to pharmacotherapeutic groups, - to use knowledge of pharmacological effects, mechanisms of action, principles of dosage of drugs for effective and safe pharmacotherapy, - to be guided in the issues of the interchangeability of various drugs. The manual consists of 2 parts. The first part presents a methodology for preparing, passing and evaluating tests in clinical pharmacology, as well as control questions for sections of general and private clinical pharmacology. The second part presents test tasks, including the classification of drugs, mechanisms of action, pharmacological effects, indications and main contraindications for use, drug interactions with representatives of other pharmacological groups, metabolic features, etc. It consists of 1069 tests of various levels of complexity. Each question has 5 answers, one of which is correct. Correct answers are given at the end of each section. This helps to use the test both for teaching and for self- monitoring and control of the student's knowledge in pre-examination testing. Methodological work with the textbook will contribute to the assimilation of basic knowledge in clinical pharmacology and can become a good basis for further training in pharmacotherapy and successful passing of the exam to confirm the diploma of higher education at home. 4  LIST OF ABBREVIATIONS ACE — angiotensin converting enzyme AT — antithrombin AV — atrioventricular AMP — adenosine monophosphate CNS — central nervous system COX — cyclooxygenase cAMP — 3,5-cyclic adenosine monophosphate cGMP — 3,5-cyclic guanosine monophosphate DOCA — desoxycorticosterone acetate DOPA — dihydroxyphenyl alanine DEC — diethyl carbamazine citrate DNA — deoxyribose nucleic acid ECG — electrocardiogram etc. — et cetera (and so on) e.g. — exempli gratia (for example) GABA — gamma aminobutyrie acid g.i.t. — gastrointestinal tract HMG CoA — hydroxymethyl glutaryl coenzyme A reductase HIV — human immunodeficiency virus i.e. — id est (that is) IL — interleucine INH — isonicotinic acid hydrazide LTs — leukotriene(s) MAO — monoamine oxidase mRNA — messenger ribonucleic acid NO — nitric oxide O. volvulus — onchocerca volvulus P. falciparum — plasmodium falciparum P. vivax — plasmodium vivax PGI2 — prostacycline PG — prostaglandin PGs — prostaglandin(s) PAF — platelet activating factor PAS — paraamino salicylic acid RNA — ribonucleic acid S. haematobium — schistosoma haematobium T1/2 — half-life period TxA2 — thromboxane A2 t-RNA — transfer ribonucleic acid W. bancrofti — wuchereria bancrofti 5  Chapter I Methodology for learning and passing tests in clinical pharmacology The tests are intended to be used in the process of studying educational material on clinical pharmacology, as well as to control the level of knowledge of students during the exam in the subject. Knowledge of the tests allows you to reach the required level of student training, which is necessary for working with drugs. Selected questions on relevant topics can be used for teaching and monitoring in the current and final practical sessions. The first part of the manual presents control questions for sections of general and specific clinical pharmacology. The assimilation of theoretical questions for each studied section presented in the manual will help prepare for the successful passing of testing during the exam in clinical pharmacology. The second part of the manual contains test items that include sections on general and specific pharmacology for generally accepted pharmacological groups. Tasks for general pharmacology contain questions on the creation of drugs, the main aspects of clinical pharmacokinetics and pharmacodynamics. Tasks in private pharmacology include questions of classification, mechanism of action, pharmacological effects, indications for use, interactions, side effects and contraindications to the use of drugs from all major sections of private pharmacology. The tests are divided into several options, each of which contains 30 questions on different topics. Each question is followed by 5 possible answers, of which only one is correct. The list of correct answers to the asked questions, which help students to test themselves during independent work with tests, is presented on the last pages of the collection. With the written version of the test, the student receives a variant of the task containing 30 test questions compiled by the method of random sampling. On the exam, each student, after indicating their data (full name, group, course and faculty number), as well as the option number and the current date on the written answer sheet, carefully reads the questions, chooses the correct answers to them and notes in written answer sheet as follows: Question # - answer. For example: 1 - a 2 - b... 19 - c, etc. The work will be done with a ballpoint pen, neat, clear and legible handwriting. Blots when completing tasks are undesirable, since incomprehensible answers can be interpreted in the wrong way. Teachers check the students' examination sheets, assess the correctness of the answers given by the students and give marks on a ten-point system. The check evaluates the number of correct answers. Testing on a computer takes place in the Student Testing Program, Assistant II, located on the D drive of the computer, in the "Student Testing Program" folder. The order of testing on a computer is as follows: 6  1. After the "Assistant II" splash screen appears, use the cursor to select the desired section 2. Enter your last name and first name at the top of the Program. 3. In the lower right corner, click the Get Started button. 7  4. Choose one correct answer and click the "Next question" button. 5. Go to the next question. 6. After answering the last question, at the end of the program, click the "Yes" button. The total testing time for 30 questions is 20 minutes. At the end of the testing period, unanswered questions are considered incorrect. When giving marks for the passed testing of students, the teacher focuses on the following criteria: 8  Score on a 10-point scale % of correct answers 0-3 0-70 4 71-75 5 76-80 6 81-85 7 86-90 8 91-95 9 96-99 10 100 Upon receiving an unsatisfactory mark, the student must, after re-preparation, pass the test again at the time specially allocated for these purposes by the department. TOPIC AND CONTROL QUESTIONS FOR TEACHING TOPIC 1: General questions of clinical pharmacology. Goals and objectives of the academic discipline "Clinical Pharmacology", stages of development, relationship with other academic disciplines. Nomenclature of medicines. Original and generic medicines. Clinical trials and state regulation of medicines. Types of drug equivalence. Basics of Evidence-Based Medicine. The importance of evidence-based medicine principles for clinical practice. Clinical protocols for diagnosis and treatment. Rules for prescribing and dispensing medicines. Theoretical questions, based on the knowledge of which it is possible to complete the target tasks: 1). Goals and objectives of the discipline "Clinical Pharmacology", the main stages of development of clinical pharmacology, the relationship with other natural science and special disciplines. Clinical pharmacology as the basis for rational pharmacotherapy. Basic principles of evidence-based medicine. 2). Nomenclature of medicines (international non-proprietary and trade names). Principles for drug development. 3). Purpose, objectives and methods of clinical trials of drugs. Medical, methodological and ethical aspects of clinical trials. Ethics committee, its role and tasks. Types and phases of clinical trials. Biological and therapeutic equivalence of drugs. Principles for the study of bioequivalence of generic drugs. 4). State regulation of medicines. Pharmacological commission, its role and tasks. Prescription and non-prescription drugs. Regulation of the prescription of medicines. TOPIC 2: Clinical pharmacokinetics and pharmacodynamics of drugs. Drug interactions. Adverse drug reactions. Identification, registration and prevention of unwanted (side) reactions. Principles of drug use in women during pregnancy and lactation, in elderly patients, with liver and kidney diseases. Theoretical questions, based on the knowledge of which it is possible to complete the target tasks: 1. Clinical pharmacokinetics. Routes of drug administration, their characteristics. Distribution of drugs in the body. Drug metabolism. Basic pharmacokinetic 9 parameters. Bioavailability of medicines. Factors affecting the pharmacokinetics of drugs. Features of the pharmacokinetics of drugs with long-term use. 2. Clinical pharmacodynamics and assessment of its main parameters. Dose-effect relationship. The relationship between pharmacokinetics and pharmacodynamics. 3. The combined use of drugs. Types of drug interactions. Polypharmacy. 4. Peculiarities of pharmacokinetics and pharmacodynamics of drugs in elderly patients, in women during pregnancy and lactation, in patients with liver and kidney diseases. 5. Identification, registration and prevention of unwanted (side) reactions. Notification of suspected adverse (adverse) drug reactions. Informing patients about the possible manifestations of undesirable (side) reactions to drugs. TOPIC 3: Medicines and receptors. Pharmacological and allergological history of the patient. Clinical pharmacology of antiallergic drugs. Anaphylaxis, drug anaphylactic shock. Prehospital and hospital stages of emergency medical care. Theoretical questions, based on the knowledge of which it is possible to complete the target tasks: 1. The concept of receptors, types of receptors. Types of drug interactions with receptors. 2. Mechanisms of development of immediate-type hypersensitivity reactions (urticaria, angioedema, anaphylaxis, etc.). 3. Clinical and pharmacological characteristics of the main groups of antiallergic drugs. 4. Anaphylaxis, drug anaphylactic shock. Clinical manifestation, diagnosis, and prevention of drug anaphylactic shock. Prehospital and hospital stages of emergency medical care for anaphylactic shock. TOPIC 4: Clinical pharmacology of antibacterial drugs. The basics of rational antibiotic therapy. 1. Classification and clinical and pharmacological characteristics of antimicrobial drugs (beta-lactam antibiotics, macrolides, aminoglycosides, glycopeptides, oxazalidinones, tetracyclines, nitroimidazoles, fluoroquinolones, nitrofurans, combined sulfanilamide drugs). 2. The tactics of choosing antimicrobial drugs for the treatment of infectious and inflammatory diseases of the respiratory system, taking into account the age characteristics of the patient, previous antibiotic therapy, the nature of the disease, the presence of concomitant diseases. 3. Antibiotic resistance of bacterial pathogens when using antimicrobial drugs, the reasons for the formation, ways of overcoming and prevention. 4. Principles of combined antibiotic therapy. Monitoring the effectiveness and safety of anti-infective therapy. TOPIC 5: Clinical pharmacology of antiviral, antifungal and antiprotozoal drugs. Principles of treatment for acute respiratory viral infections 1. Classification of antiviral drugs. Clinical and pharmacological characteristics of anti-influenza drugs (M2 channel blockers, viral neuraminidase inhibitors, inhibitors of the fusion of the lipid envelope of the virus with the cell membrane, etc.), 10 antiherpetic and antiretroviral drugs, interferons, vaccines. Principles of treatment for acute respiratory viral infections. 2. Modern principles of pharmacological therapy of the most common fungal and parasitic diseases. 3. Classification of antifungal drugs: for topical use - polyene antibiotics, imidazoles, allylamines, drugs of other groups; for systemic use - polyene antibiotics, imidazoles, triazoles, allylamines, pyrimidine derivatives. 4. Clinical pharmacology of the main groups of drugs used for the treatment of parasitic diseases. TOPIC 6: Clinical pharmacology of steroid and non-steroidal anti-inflammatory drugs, narcotic analgesics. 1. Clinical and pharmacological characteristics of non-steroidal anti- inflammatory drugs and glucocorticoids. 2. Narcotic analgesics. Centrally acting non-opioid drugs with analgesic activity. Analgesics with a mixed mechanism of action. 3. The tactics of using non-steroidal anti-inflammatory, as well as combined drugs for hyperthermic and pain syndrome. TOPIC 7: Clinical pharmacology of drugs used in respiratory diseases. 1. Antitussive drugs of central, peripheral, mixed action. Expectorant and mucolytic drugs, especially their use. 2. Medicines for relief of broncho-obstructive syndrome (beta-2-adrenomimetics, M-anticholinergics, xanthines, combined medicines). 3. Clinical and pharmacological characteristics and features of the use of drugs for basic anti-inflammatory therapy of bronchial asthma (inhalation glucocorticoids, antagonists of leukotriene receptors, recombinant monoclonal antibodies). Use of mast cell membrane stabilizers in pediatrics. 4. Herbal medicine in pulmonology. TOPIC 8: Clinical pharmacology of drugs used in cardiology 1. Clinical pharmacology of antihypertensive drugs: diuretics, β-blockers, slow calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, agonists of central α2- and imidazoline receptors. 2. Representatives of other groups of antihypertensive drugs: α-blockers, inhibitors of renin synthesis, direct antagonists of aldosterone, etc. Principles of modern pharmacotherapy of arterial hypertension. 3. Clinical pharmacology of antianginal and anti-ischemic drugs: β-blockers, slow calcium channel blockers, nitrates, sydnonimines, cardiocytoprotectors. 4. Medicines correcting lipid metabolism (statins, fibrates, polyunsaturated fatty acids). Modern principles of the treatment of coronary heart disease. 5. Clinical and pharmacological characteristics of antiarrhythmic drugs (Vogen- Williams classification, mechanisms of antiarrhythmic action, indications and contraindications for their use, safety control). 6. Medicines used in the treatment of disorders of the cardiac conduction system. TOPIC 9: Clinical pharmacology of drugs used in gastroenterology 1. Clinical and pharmacological characteristics of antisecretory drugs (proton pump inhibitors, H2-histamine blockers, M-anticholinergics), antacids. 11  2. Medicines that have a protective effect and enhance the regeneration of the mucous membrane of the gastrointestinal tract. Helicobacter eradication schemes. 3. Classification of antiemetic drugs. Medicines affecting the motor function of the gastrointestinal tract. 4. Enzymatic drugs for substitution therapy. The use of choleretic drugs and hepatoprotectors. 5. Antidiarrheal and laxative medicines. Medicines regulating intestinal microbiocenosis. 6. Herbal medicine for diseases of the digestive system. TOPIC 10: Clinical pharmacology of drugs affecting the hemostatic system 1. The main reasons leading to dysfunction of the blood coagulation and anticoagulant systems. Clinical pharmacology of antiplatelet agents, direct and indirect anticoagulants, thrombolytic drugs. 2. The main drugs used to reduce the activity of the blood coagulation system: proaggregants, procoagulants, fibrinolysis inhibitors. Indications and contraindications for their use, methods for assessing effectiveness. TOPIC 11: Clinical pharmacology of antianemic drugs 1. Classification of anemias. Iron deficiency, B12 and folate deficiency anemias: etiology, clinical manifestations and principles of pharmacotherapy. 2. Clinical and pharmacological characteristics of antianemic drugs. Indications and contraindications for the use of iron-containing drugs and cyanocobalamin. Criteria for the effectiveness of pharmacological therapy. TOPIC 12: Clinical pharmacology of drugs used for the treatment of type 2 diabetes mellitus and thyroid diseases. 1. Clinical pharmacology of sulfonylurea derivatives, biguanides, meglitinides, thiazolidinediones and incretins. Insulin medicines. Indications and contraindications, methods of monitoring the effectiveness and safety. 2. Medicines for replacement therapy for hypothyroidism. Clinical pharmacology of antithyroid drugs. Chapter 2 Test Tasks Choose the correct answers 1. Serum level measurement of a drug is NOT useful in: Variants of answer: a) large person to person difference b) drug with low margin of safety c) drug activated in the body d) to check compliance e) knowledge of volume of distribution. 2. Concentration of a drug in blood is 40 microgm/ml. Dose of the drug is 200 mg. 12 Volume of distribution of the drug assuming minute elimination is: Variants of answer: a) 5 litre b) 0.5 litre c) 2.5 litre d) 3 litre e) 1 litre 3. A drug X has affinity to bind with albumin and Y has 150 times more affinity to bind with albumin than X. TRUE statement is: Variants of answer: a) drug X will be available more in tissues b) drug Y will be more available in tissues c) free content of drug X in blood will be more d) toxicity of Y will be more e) toxicity of 2 drugs are similar 4. A patient presents with nephrotic syndrome and hypoalbuminemia. Protein binding of which drug is not affected: Variants of answer: a) tolbutamide b) morphine c) diazepam d) valproate e) phenazepam 5. A drug is more likely to cause toxicity in elderly patients due to all of the following reasons, except: Variants of answer: a) decreased renal excretion of drugs b) decreased hepatic metabolism c) increased receptor sensitivity d) decreased volume of distribution e) increased volume of distribution 6. Km of an enzyme is: Variants of answer: a) dissociation constant b) the normal physiological substrate concentration c) the substrate concentration at half maximal velocity d) numerically identical for all isozymes that catalyze a given reaction e) constant of elimination 7. Therapeutic index is a measure of a drug’s: Variants of answer: 13 a) safety b) potency c) efficacy d) toxicity e) side effects 8. ED 50 is a measure of: Variants of answer: a) toxicity b) safety c) potency d) efficacy e) quality 9. A highly ionized drug: Variants of answer: a) is excreted mainly by the kidney b) can cross the placental barrier easily c) is well absorbed from the intestine d) accumulates in the cellular lipids e) is excreted by the intestine 10. A highly ionized drug: Variants of answer: a) is excreted mainly by the kidneys b) crosses the placental barrier easily c) is well absorbed from the intestine d) is highly protein bound e) accumulates in the cellular lipids 11. Which of the following is true? Variants of answer: a) as the concentration of a drug increases over the therapeutic range, the bound form of the drug increases b) the bound form is not available for metabolism but is available for excretion c) acidic drug binds to albumin; and basic drug binds zeta globulin d) binding sites are non-specific and one drug can displace the other e) ionized drug can cross the placentar barrier 12. All are reasons for reducing drug, except: Variants of answer: a) they are lean and their body mass is less b) have decreasing renal function with age c) have increased baroreceptor sensitivity 14 d) body water is decreased e) have decreased baroreceptor sensitivity 13. True statement regarding inverse agonist is: Variants of answer: a) binds to receptor and causes intended action b) binds to receptor and causes opposite action c) binds to receptor and causes no action d) binds to receptor and causes submaximal action e) binds to receptor and causes minimal action 14. Entropy in a biological system does not increase because: Variants of answer: a) it is an open system b) it is a closed system c) it is a governed by vitalism d) it is a related to thermodynamics e) it is an reduced system 15. Which of the following is true regarding a system which favours oscillatory responses: Variants of answer: a) proportional component b) has a greater gain c) has a lesser gain d) positive feedback system e) negative feedback system 16. Regarding efficacy and potency of a drug, all are true, except: Variants of answer: a) in a clinical setup, efficacy is more important than potency b) in the log dose response curve, the height of the curve corresponds with efficacy c) EDJ0 of the drug corresponds to efficacy d) drugs that produce a similar pharmacological effect can have different levels of efficacy e) bioavalaibility is 100% intravenously 17. ‘First-pass effect’ is seen with which route of administration: Variants of answer: a) oral b) sublingual c) intramuscular d) intravenous e) subcutaneous 15 18. Therapeutic index of a drug is an indicator of its: Variants of answer: a) potency b) safety c) toxicity d) efficacy e) side effects 19. All of the following statements regarding bioavailability of a drug are true, except: Variants of answer: a) it is the proportion (fraction) of unchanged drug that reaches the systemic circulation b) bioavailability of an orally administered drug can be calculated by comparing the Area Under Curve (0-oc) after oral and intravenous (iv) administration c) low oral bioavailability always and necessarily mean poor absorption d) bioavailability can be determined from plasma concentration or urinary excre-tion data e) bioavalaibility is 100% intravenously 20. Presence of food might be expected to interfere with drug absorption by slowing gastric emptying or by altering the degree of ionisation of the drug in the stomach. Which of the following statements is not correct example: Variants of answer: a) absorption of digoxin is delayed by the presence of food b) concurrent food intake may severely reduce the rate of absorption of phenytoin c) presence of food enhances the absorption of hydrochlorothiazide d) antimalarial drug halofantrine is more extensively absorbed if taken with food e) omeprazole must be taken before meal 21. Cardiac or central nervous system toxicity may result when standard lidocaine doses are administered to patients with circulatory failure. This may be due to the following reason: Variants of answer: a) lidocaine concentration are initially higher in relatively well perfused tissues such as brain and heart b) histamine receptors in brain and heart gets suddenly activated in circulatory failure c) there is a sudden out-burst of release of adrenaline, noradrenaline and dopamine in brain and heart d) lidocaine is converted into a toxic metabolite due to its longer stay in liver e) lidocaine have bad bioavailability 22. The extent to which ionisation of a drug takes place is dependent upon pKa of the drug and the pH of the solution in which the drug is dissolved. Which of the 16 following statements is not correct: Variants of answer: a) pKa of a drug is the pH at which the drug is 50% ionized b) small changes of pH near the pKa of a weak acidic drug will not affect its degree of ionization. c) knowledge of pKa of a drug is useful in predicting its behaviour in various body fluids. d) phenobarbitone with a pKa of 7.2 is largely ionized at acid pH and will be about 40% non- ionised in plasma e) pKa of a drug is the pH at which the drug is 50% nonionized 23. Dosage of drug is determined by following, except: Variants of answer: a) volume of distribution b) half-life c) lipid solubility d) excretion e) water solubility 24. The max effect of a drug is defined by its: Variants of answer: a) therapeutic index b) potency c) efficacy d) adversity e) toxicity 25. Characteristic feature of agonist is: Variants of answer: a) has affinity only b) has affinity as well as intrinsic activity c) has intrinsic activity only d) neither has affinity nor activity e) have ctivity only 26. True about efficacy and potency of drugs: Variants of answer: a) efficacy is clinically more important than potency b) height of DRC corresponds to efficacy c) the amount of drugs to produce certain response is called efficacy d) drugs having similar pharmacological action may have different efficacy e) potency is clinically more important than efficacy 27. On I.V. drug administration elimination of a drug depend on: Variants of answer: 17 a) lipid solubility b) volume of distribution c) clearance d) drug concentration e) proteins 28. Alkalinity of urine is done in: Variants of answer: a) barbiturate poisoning b) lithium toxicity c) alprazolam overdose d) diazepam toxicity e) clonidine toxicity 29. About acidic drug true is: Variants of answer: a) best absorbed in acidic medium b) best absorbed in alkaline medium c) not absorbed in acidic medium d) binds to alpha glycoprotein e) binds to beta glycoprotein 30. Drug transport mechanism includes: Variants of answer: a) active transport b) passive transport c) filtration d) all e) pinocytosis 31. IV drug duration of action depends on: Variants of answer: a) protein binding b) clearance c) distribution volume d) lipid solubility e) all f) absorbtion in stomach 32. True about Routes of drug administration: Variants of answer: a) 80% bio-availability by I.V. injection b) I.M. administration needs sterile technique c) I.D. injection produces local tissue necrosis and irritation 18 d) inhalation produces delayed systemic bio-availability e) 88% bio-availability by I.V. injection 33. Volume of distribution of drugs altered in: Variants of answer: a) obesity b) athletes c) pregnancy d) older age e) neonate 34. Drug distribution is Influenced by: Variants of answer: a) drug binding b) drug solubility c) degree of blood flow d) age e) nationality 35. In drug antagonist, 1st event to occur is: Variants of answer: a) deactivation of receptors b) receptor configuration changes c) A&B d) none e) decreasing of ensiivity 36. True regarding dose-response curve is: Variants of answer: a) cannot determine the potency of a drug b) log dose response curve is sigmoid shaped c) cannot find response to antagonist d) a wide range of doses cannot be plotted e) log dose response curve is delta shaped 37. Loading dose depends on: Variants of answer: a) volume of distribution b) clearance c) rate of administration d) half-life e) way of administration 38. Side effects of a drug arise due to the interactions of the drug to molecules other than the target. These effects of a drug can be minimized by its high: 19 Variants of answer: a) specificity b) affinity c) solubility d) hydrophobicity e) potency 39. Which of the following property of drug will enable it to be used in low concentrations: Variants of answer: a) high affinity b) high specificity c) low specificity d) high stability e) low stability 40. Loading dose depends upon: Variants of answer: a) volume of distribution b) plasma clearance c) route of administration d) half-life e) metabolism 41. Which of the following does NOT cause bone marrow suppression: Variants of answer: a) daunorubicin b) cisplatin c) cyclophosphamide d) vincristine e) vinblastin 42. All of the following Anticancer agents cause bone marrow depression, except: Variants of answer: a) chlorambucil b) daunorubicin c) doxarubicin d) flutamide e) karubicine 43. Which of the following is a side effect of chemotherapeutic agents: Variants of answer: a) dermatitis b) teratogenicity c) BM suppression 20 d) hypertension e) all 44. Non-myelosuppressive agent is: Variants of answer: a) vinblastine b) vincristine c) bleomycin d) methotrexate e) daunorubicine 45. Bone marrow aplasia is seen with all, except: Variants of answer: a) methicillin b) chloramphenicol c) alpha methylhydantoin d) phenylbutazone e) daunorubicine 46. Bone marrow depression is seen with chronic administration of: Variants of answer: a) isoflurane b) N2O c) ether d) halothane e) sevoflurane 47. All of the following can cause hemolytic anaemia, except: Variants of answer: a) isoniazid b) rifampicin c) co-trimoxazole d) propranolol e) phenylhydrasin 48. Most important side effect of dapsone is hemolytic anemia, the next adverse effect: Variants of answer: a) G-6-PD deficiency b) infectious mononucleosis like syndrome c) agranulocytosis d) lichenoid eruption e) skin pigmentation 49. Drug not causing active hepatitis: 21 Variants of answer: a) INH b) methyldopa c) chlorpromazine d) oxyphenacetin e) paracetamol 50. Hepatotoxic drugs are all, except: Variants of answer: a) N2O b) halothane c) enflurane d) chloform e) sevoflurane 51. Cholestatic jaundice is caused by: Variants of answer: a) INH b) glibenclamide c) rifampicin d) chlorpropamide e) nimesulide 52. All are used to treat hypercalcemia, except: Variants of answer: a) D-penicillamine b) corticosteroid c) biphosphonate d) mithramycin e) furosemide 53. All are used in management of hypercalcemia, except: Variants of answer: a) mithramycin b) penicillamine c) bisphosphonates d) steroids e) furosemide 54. Hyperglycemia can be caused by all, except: Variants of answer: a) theophylline b) chlorthiazides c) corticosteroids 22 d) furosemide e) indapamid 55. All of the following cause hyperglycemia, except: Variants of answer: a) thiazide b) diazoxide c) theophylline d) pentamidine e) furosemide 56. Hyperkalemia is caused by: Variants of answer: a) amphotericin B b) ACE inhibitors c) cyclosporine d) GM-CSF e) succinylcholine 57. Hyperkalemia is associated with: Variants of answer: a) ACE inhibitors b) chlorthalidone c) amphotericin B d) amiodarone e) rifampicin 58. All the following drugs may cause hyperkalemia, except: Variants of answer: a) cyclosporine b) amphotericin c) heparin d) NSAIDs e) spironolacton 59. Hyperlipidemia is caused by intake of: Variants of answer: a) calcium channel blockers b) beta-blocker c) methyldopa d) reserpine e) alfa-blocker 60. Hypernatremia is caused by: Variants of answer: 23 a) prednisolone b) fludrocortisone c) hydrocortisone d) dexamethasone e) triamcinolone 61. Which of the following drug does not cause hypokalemia: Variants of answer: a) gentamicin b) propranolol c) amphotericin B d) amiodarone e) spirpnolacton 62. Drug which causes hypothyroidism is: Variants of answer: a) carbamazepine b) lithium c) sulphur d) methotrexate e) beta-agonists 63. Intracranial pressure may be increased by all of the following drugs, except: Variants of answer: a) hypervitaminosis A b) corticosteroids c) quinolones d) aminoglycosides e) nitrogycerin 64. All of the following cause macrocytic anaemia, except: Variants of answer: a) primaquine b) methotrexate c) trimethoprim d) azathioprine e) phenacetin 65. Which one of the following drugs does not interfere with folic acid metabolism? Variants of answer: a) phenytoin b) gabapentin c) phenobarbitone d) primidone e) diphenin 24 66. Megaloblastic anemia is a side effect of long term therapy with: Variants of answer: a) diazepam b) INH c) phenobarbitone d) lithium e) lidocaine 67. Drugs causing metallic taste: Variants of answer: a) antimicrobials b) angiotensin receptor blockers c) anticancer drugs d) NSAID’s e) gold 68. The drug which does not cause myopathy is: Variants of answer: a) chloroquine b) betamethasone c) chloramphenicol d) zidovudine e) lamivudine 69. Statin induced myopathy is NOT exacerbated by which of the following drugs: Variants of answer: a) nicotinic acid b) enalapril c) erythromycin d) clofibrate e) fenofibrate 70. Drug induced myopathy can be caused by all of the following, except: Variants of answer: a) atorvastatin b) d-penicillamine c) ciprofloxacin d) chloroquine e) lovastatin 71. Which drug is implicated in the causation of nephrotic syndrome: Variants of answer: a) gold b) amphotericin B c) rifampicin 25 d) ibuprofen e) captopril 72. Which does NOT cause optic neuropathy: Variants of answer: a) penicillin b) INH c) ethambutol d) chloramphenicol e) digoxin 73. Regarding adverse reaction, all are correct, except: Variants of answer: a) Methysergide - Retroperitoneal fibrosis b) Rifampicin - Optic neuritis c) Saralasin - AT2 receptor antagonist d) Ethambutol - Retrobulbar neuritis e) Captopril-hyperkalemia 74. Which drug causes osteoporosis on long-term use: Variants of answer: a) estrogen b) progesterone c) GnRH analogues d) warfarin e) adrenalin 75. Drugs causing osteoporosis: Variants of answer: a) vit K b) lithium c) dilantin d) heparin e) etidronate 76. Osteoporosis is a recognized feature of: Variants of answer: a) early menopause b) heparin c) Marfan syndrome d) thyrotoxicosis e) all 77. Following drugs cause pancreatitis, except: Variants of answer: 26 a) captopril b) furosemide c) valproic acid d) didanosine e) etacrynic acid 78. Peripheral neuropathy may occur with the use of all the following, except: Variants of answer: a) vincristine b) cisplatin c) L-Asparaginase d) procarbazine e) vinblastine 79. The following drug has maximum propensity to cause peripheral neuropathy: Variants of answer: a) didanosine b) zidovudine c) stavudine d) lamivudine e) foscarnet 80. Drugs causing predominantly sensory neuropathy: Variants of answer: a) cisplatin b) pyridoxine excess c) GB syndrome d) suramine e) paracetamol 81. Motor neuropathy caused by: Variants of answer: a) dapsone b) cisplatin c) arsenic d) lead e) hypothyroidism 82. Pleural fibrosis caused by: Variants of answer: a) phenytoin b) methysergide c) amiodarone d) ergotamine e) ranitidine 27 83. Which of the following does not cause thrombocytopenia: Variants of answer: a) chlorpropamide b) phenobarbitone c) quinine d) thiazide e) heparin 84. One of the following drugs does not increase the serum level of Theophylline: Variants of answer: a) erythromycin b) corticosteroids c) ofloxacin d) ciprofloxacin e) norfloxacin 85. Theophylline concentration is NOT interfered by: Variants of answer: a) rifampicin b) clarithromycin c) erythromycin d) ciprofloxacin e) ofloxacin 86. Therapeutic effects of Theophylline is enhanced by all, except: Variants of answer: a) cimetidine b) smoking c) erythromycin d) congestive heart failure e) warfarin 87. Theophylline levels are increased in all, except: Variants of answer: a) erythromycin b) smoking c) cimetidine d) CHF e) warfarin 88. All are true regarding treatment with aminophylline, except: Variants of answer: a) it decreases the oxygen tension b) its dose is to be decreased in smokers c) it increases the contractility of the diaphragm 28 d) interaction with erythromycin can increase its toxicity e) interaction with cimetidine can increase its toxicity 89. A known case of COPD who is on theophylline develops severe respiratory infection. For treatment which of the following antibiotics should be avoided so as to avoid interaction with theophylline: Variants of answer: a) erythromycin b) ciprofloxacin c) amoxicillin d) cephalexin e) cephalosporin 90. Which enzyme is inhibited by aminophylline? Variants of answer: a) monoamine oxidase b) alcohol dehydrogenase c) phosphodiesterase d) cytochrome P-450 e) CYP2C19 91. With which of the following theophylline has an antagonistic interaction? Variants of answer: a) histamine receptors b) bradykinin receptor c) adenosine receptors d) imidazoline receptors e) alpha receptors 92. All of the following statements are true about theophylline, except: Variants of answer: a) increase in dose is required in cardiopulmonary disease b) increases cAMP c) increase in dose is required in smokers d) inhibits phosphodiesterase e) increases cathecholamines 93. All the following affect the metabolism of Theophylline, except: Variants of answer: a) erythromycin b) smoking c) cimetidine d) steroids e) CHF 29 94. If Theophylline is used with Ciprofloxacin: Variants of answer: a) toxicity of Theophylline increases b) efficacy decreases c) activity of Ciprofloxacin increases d) it decreases absorption of Theophylline e) it eliminates rapidly 95. Drugs which increase level of Theophylline include: Variants of answer: a) ciprofloxacin b) barbiturates c) cimetidine d) allopurinol e) phenytoin 96. The loading dose of Aminophylline is: Variants of answer: a) 50-75 mg/kg b) 0.5-1.0 mg/ kg c) 2.0-3.5 mg/kg d) 5-6 mg/kg e) 0.9-1.7 mg/ kg 97. Which of the following enzyme is inhibited by Aminophylline: Variants of answer: a) monoamine oxidase b) alcohol dehydrogenase c) cytochrome P-450 d) phosphodiesterase e) CYP2C19 98. True about Zafirlukast is: Variants of answer: a) it inhibits lipoxygenase pathway b) it decreases the frequency equal to glucocorticoids c) it blocks LT receptor d) it is effective in acute bronchial asthma e) given orally 99. All are long acting bronchodilators, except: Variants of answer: a) indacaterol b) salmeterol c) formoterol 30 d) adrenaline e) terbutalin 100. All increase blood Theophylline levels, except: Variants of answer: a) smoking b) erythromycin c) allopurinol d) cimetidine e) cyclosporine A 101. What is the mode of action of Sodium Cromoglycate: Variants of answer: a) mast cell stabilization b) antihistaminic c) anticholinergic d) none of the above e) antiadrenergic 102. An asthmatic patient is on theophylline suddenly developed infection, which of the following antibiotic should not be given to prevent side effects of theophylline: Variants of answer: a) ampicillin b) erythromycin c) cephalexin d) sparfloxacin e) ofloxacin 103. The drug NOT used in acute asthma is: Variants of answer: a) salbutamol b) ipratropium c) montelukast d) hydrocortisone e) prednisolone 104. Zileuton is: Variants of answer: a) 5-lipoxygenase inhibitor b) TXA2 inhibitor c) leukotriene receptor antagonist d) prostaglandins synthesis inhibitor e) mast cell membrane stabilizer 105. Inhibition of 5- lipoxygenase is useful in: 31 Variants of answer: a) cardiac failure b) bronchial asthma c) hepatic failure d) arthritis e) gout 106. Which one of the following is not an adverse effect of salbutamol: Variants of answer: a) tachycardia b) tolerance c) hypokalemia d) hypoglycemia e) dizziness 107. Which of the following is a leukotriene antagonist? Variants of answer: a) montelukast b) zileuton c) omalizumab d) nedocromil e) prednisolone 108. Ipratropium bromide is contraindicated in: Variants of answer: a) asthma b) urinary retention c) hypertension d) peptic ulcer e) COPD 109. Tiotropium is used for: Variants of answer: a) treating urinary retention b) treating ileus c) increasing salivation d) treating asthma e) treating myopia 110. The following are all true about Ipratropium bromide, except: Variants of answer: a) used by inhalation b) ↓ IOP c) dryness of mouth 32 d) scratching in trachea e) treating bronchial asthma 111. Cromolyn sodium is used for following actions: Variants of answer: a) mast cell stabilization b) H1-antihistamine c) phosphodiesterase inhibitor d) inhibition of cyclooxygenase e) leukotriene receptors inhibitor 112. Steroids in asthma: Variants of answer: a) decreases sensitivity of bronchial epithelium to allergen b) decreases inflammatory response c) increases action of bronchodilators d) cause potent bronchodilation e) can be taken subcutaneously 113. Uses of salbutamol are/is: Variants of answer: a) acute asthma b) premature labour c) bronchitis d) asthma prophylaxis e) COPD 114.True about Zafirlukast is: Variants of answer: a) it inhibits lipoxygenase pathway b) it decreases the frequency equal to glucocorticoids c) it blocks LT-1 receptor d) it is effective in acute bronchial asthma e) given orally 115. Long acting beta-2 agonist? Variants of answer: a) albuterol b) salmetarol c) pirbuterol d) orciprenaline e) salbutamol 116. Long acting beta-2 agonists: Variants of answer: 33 a) orciprenaline b) salmeterol c) albuterol d) pirbuterol e) salbutamol 117. Which of the following is used in β-blocker overdose: Variants of answer: a) atropine b) norepinephrine c) glucagon d) thyroxin e) protamine 118. Contraindications of β-blockers: Variants of answer: a) asthma b) CHF c) HTN d) arrhythmias e) arterial hypertension 119. Β-blockers are used in all, except: Variants of answer: a) hypertension b) thyrotoxicosis c) variant angina d) all of the above e) tachyarrythmias 120. Timolol can be given in all, except: Variants of answer: a) myocardial infarction b) bronchial asthma c) peptic ulcer d) Congestive Heart failure (CHF) e) thyrotoxicosis 121. All are true about β-blockers, except: Variants of answer: a) atenolol is longer acting than metoprolol b) labetalol has both alpha and beta blocking action c) carvedilol has alpha agonistic and selective beta-1 blocking action d) nadolol has longest half-life 34 e) propranolol is selective beta-blocker 122. The following is not true about the use of β-blockers in heart failure: Variants of answer: a) it should be initiated at very low dose b) it is most effective in new onset decompensated heart failure c) slow upward titration of dose is required d) carvedilol is most widely used in this condition e) it should be initiated at minimal dose 123. All of the following are nonselective β-blockers with additional actions, except: Variants of answer: a) carvedilol b) betaxalol c) dilevalol d) labetalol e) carvenal 124. All of the following are selective beta-1 blockers, except: Variants of answer: a) atenolol b) metoprolol c) labetalol d) betaxolol e) bisoprolol 125. Beta-blocker with peripheral vasodilator action is: Variants of answer: a) carvedilol b) propranolol c) atenolol d) acebutalol e) propranolol 126. Beta-blocker that can be used in renal failure is all, except: Variants of answer: a) propranolol b) pindolol c) sotalol d) oxyprenolol e) celiprolol 127. All the following are selective β-blockers, except: Variants of answer: 35 a) atenolol b) esmolol c) bisoprolol d) celiprolol e) metoprolol 128. Which of the following has the shortest plasma half-life: Variants of answer: a) propranolol b) esmolol c) timolol d) atenolol e) metoprolol 129. Which of the following does not cause bradycardia: Variants of answer: a) propranolol b) hydralazine c) clonidine d) reserpine e) metoprolol 130. Propranolol is indicated in all of the following conditions, except: Variants of answer: a) thyrotoxicosis b) variant angina c) migraine d) hypertension e) tachyarrithmias 131. Antiadrenergic drug which crosses the blood – brain barrier minimally is: Variants of answer: a) propranolol b) atenolol c) oxprenolol d) alprenolol e) bisoprolol 132. Beta-blocker acts by: Variants of answer: a) ↓ cardiac output b) ↓ HR c) ↓ BP d) all 36 e) ↓ conductivity 133. In a person with HR = 120, rate is reduced by: Variants of answer: a) propranolol b) phentolamine c) phenoxybenzamine d) prazosin e) doxazosin 134. Combination use of beta blockers and calcium channel blockers cause: Variants of answer: a) heart block b) hypertension c) hypotension d) bradycardia e) tachyarrhythimias 135. Use of timolol in the eye can cause: Variants of answer: a) AV block b) bradycardia c) hypertension d) hypotension e) asthma 136. Side effect of timolol maleate: Variants of answer: a) hypertension b) asthma c) depression d) tachycardia e) hypotension 137. True about Carvedilol: Variants of answer: a) alfa-1, beta-1 blocker b) beta-1 blocker c) beta-2 blocker d) antioxidant e) used in hypotension 138. Esmolol true is/are: Variants of answer: 37 a) alfa blocker b) long half-life c) not cardioselective d) used in LV decompensation e) cause bradycardia 139. True about Esmolol: Variants of answer: a) it is beta1, beta2-blocker b) it has no intrinsic activity c) it has longer half-life d) it precipitates heart failure e) alpha-blocker 140. True about Esmolol: Variants of answer: a) it is a cardioselective b) it increases the airway resistance c) it causes tachycardia d) its half-life is 4 hrs e) it indicates in AV-blockade 141. Combined Alfa & Beta blocker are all, except: Variants of answer: a) pindolol b) dilevalol c) carvedilol d) labetalol e) carvedilol 142. Properties making cardioselective beta blockers desirable are: Variants of answer: a) less bronchoconstriction b) adverse effect on lipid profile c) cause glucose intolerance d) may be used in Raynaud’s disease e) less liable to impair exercise capacity 143. High hepatic excretion ratio seen in: Variants of answer: a) propranolol b) lidocaine c) ampicillin d) imipramine e) theophylline 38 144. Blood brain barrier crossed by: Variants of answer: a) dopamine b) propranolol c) glycopyrrolate d) physostigmine e) streptomycine 145. B-blockers with intrinsic sympathomimetic properties are all, except: Variants of answer: a) propranolol b) oxprenolol c) practolol d) pindolol e) celiprolol 146. Bacteriocidal in ATT is: Variants of answer: a) pyrazinamide b) ethambutol c) PAS d) rifampicin e) isoniazid 147. Bactericidal in ATT is: Variants of answer: a) pyrazinamide b) ethambutol c) PAS d) rifampicin e) isoniazid 148. Pyridoxine deficiency is seen in: Variants of answer: a) isoniazid b) CRF c) L. congestive heart failure d) alcohol e) smokig 149. Administration of which drug may lead to neuropsychiatric symptoms: Variants of answer: a) cycloserine b) ethionamide c) rifampicin 39 d) cephalosporins e) neomycin 150. All are features of ethambutol toxicity, except: Variants of answer: a) retrobulbar neuritis b) colour vision defects c) hyperuricemia d) hypercalcemia e) skin rash 151. Hyperuricemia is a side effect of: Variants of answer: a) INH b) rifampicin c) streptomycin d) pyrazinamide e) ofloxacin 152. A middle aged old man, with chronic renal failure is diagnosed to have sputum-positive pulmonary tuberculosis. His creatinine clearance is 25ml/min. All of the following drugs need modification in doses, except: Variants of answer: a) isoniazid b) streptomycin c) rifampicin d) ethambutol e) kanamycin 153. Orange colored urine is due to: Variants of answer: a) rifampicin b) INH c) pyrazinamide d) ethambutol e) ofloxacin 154. A 30 year old pregnant woman developed tuberculosis. Which of the following antitubercular drugs should not be used: Variants of answer: a) INH b) rifampicin c) streptomycin d) ethambutol e) amikacin 40 155. Patients suffering from multidrug resistant tuberculosis can be treated with all the following drugs, except: Variants of answer: a) tobramycin b) amikacin c) ciprofloxacin d) clarithromycin e) INH 156. All of the following are examples of bactericidal drugs, except: Variants of answer: a) INH b) rifampicin c) ethambutol d) pyrazinamide e) rifabutine 157. All of the following are drugs for ATT, except: Variants of answer: a) kanamycin b) cycloserine c) 5-flucytosine d) ofloxacin e) amikacin 158. The treatment of contacts of meningococcal meningitis is by: Variants of answer: a) rifampicin b) erythromycin c) penicillin d) cephalosporins e) INH 159. A diabetic female on INH and rifampicin for TB suffers DVT; She is started on warfarin; PT is not raised; next step should be: Variants of answer: a) long term heparin therapy b) replace warfarin with acecoumarin c) switch ethambutol for rifampin d) use LMW heparin e)replace klopidogrel 160. The drug inhibiting DNA-dependent RNA polymerase in Mycobacteria is: Variants of answer: 41 a) INH b) rifampicin c) ciprofloxacin d) ethionamide e) amikacin 161. Which of the following is not a hepatotoxic drug: Variants of answer: a) ethambutol b) rifampicin c) INH d) cycloserine e) amikacin 162. Administration of one of the following drugs is known to result in neuropsychiatric symptoms: Variants of answer: a) rifampicin b) cycloserine c) ethionamide d) cephalosporine e) ofloxacin 163. Which antitubercular drug metabolism is under genetic control: Variants of answer: a) rifampicin b) INH c) cyclosporine d) PZM e) kanamycin 164. Drug given in the continuation phase of category II: Variants of answer: a) isoniazid b) streptomycin c) ethambutol d) pyrazinamide e) rifampicin 165. Hepatitis is a side effect of following, except: Variants of answer: a) INH b) rifampicin c) pyrazinamide 42 d) ethambutol e) paracetamol 166. Toxicity of cycloserine is enhanced by: Variants of answer: a) INH b) amphotericin B c) simvastatin d) alcohol e) ethambutol 167. ATT which is bactericidal: Variants of answer: a) INH b) pyrazinamide c) ethambutol d) PAS e) rifampicin 168. Hypothyroidism may be caused by: Variants of answer: a) ethionamide b) thiocetazone c) ethambutol d) streptomycin e) INH 169. Urine is colored by: Variants of answer: a) thiamine b) rifampicin c) mepacrine d) INH e) riboflavin 170. Cross resistance of isoniazid is seen with: Variants of answer: a) rifampicin b) ethionamide c) cycloserine d) ethambutol e) amikacin 171. All of the following are true about therapy for tuberculosis, except: Variants of answer: 43 a) ‘flu like syndrome’ is usually seen in people taking rifampicin on daily basis b) ethambutol accumulates in renal failure c) hyperuricemia is a recognized side effect of pyrazinamide d) red-green color impairment is an early sign of ethambutol induced optic neuritis e) deficiency of pyridoxine is for ethambutol 172. Which ATT will cause transient memory loss: Variants of answer: a) ethionamide b) INH c) ethambutol d) pyrazinamide e) amikacin 173. Clinically significant drug interaction occurs between pyridoxine and all the following drugs, except: Variants of answer: a) isoniazid b) cyclosporine c) levodopa d) hydralazine e) carbidopa 174. Altered taste sensation is caused by: Variants of answer: a) pefloxacin b) rifampicin c) ciprofloxacin d) captopril e) ofloxacin 175. Which of the following is NOT a prodrug: Variants of answer: a) lisinopril b) enalapril c) levodopa d) sulindac e) perindopril 176. Altered taste sensation is caused by: Variants of answer: a) pefloxacin b) ciprofloxacin c) captopril 44 d) rifampicin e) ethambutol 177. An elderly hypertensive has diabetes mellitus and bilateral renal artery stenosis. The best management is: Variants of answer: a) enalapril b) verapamil c) beta blockers d) thiazides e) alfa-blocker 178. Basanti , 23 year old pregnant woman presents with features of dilated cardiomyopathy. Which of the following drugs you will NOT give to treat her: Variants of answer: a) digoxin b) ACE inhibitors c) diuretics d) vasodilators e) NO donators 179. Which one of the following is not an adverse effect of ACE inhibitors: Variants of answer: a) cough b) hypokalemia c) angioneurotic edema d) skin rash e) bronchospasmus 180. Enalapril is contraindicated in all of the following, except: Variants of answer: a) diabetic nephropathy with albuminuria b) single kidney c) bilateral renal artery stenosis d) hyperkalemia e) CHF 181. All are side effects of Lisinopril, except: Variants of answer: a) dizziness b) jaundice c) cough d) angioneurotic edema e) hyperkalemia 45 182. Side-effects of Captopril are all, except: Variants of answer: a) cough b) hyperkalemia c) renal dysfunction d) hemolytic anemia e) hypotension 183. Which of the following is not true about enalapril: Variants of answer: a) it is a prodrug b) it is a dipeptide c) it is more effective than captopril d) has less adverse effects e) it must metabolize in the liver 184. Examples of prodrug are all, except: Variants of answer: a) levodopa b) omeprazole c) enalapril d) indomethacin e) perindopril 185. ACE inhibitors are contraindicated in: Variants of answer: a) U/L renal artery stenosis with single kidney b) proteinuria with DM c) MI d) hypotension e) CHF 186. ACE inhibitors cause all, except: Variants of answer: a) dry cough b) taste changes c) first dose hypotension d) ankle edema e) angioedema 187. All of the following are prodrugs, except: Variants of answer: a) phenytoin b) dipivefrine c) enalapril 46 d) mercaptopurine e) perindopril 188. Drugs which cause fetal renal anomalies: Variants of answer: a) enalapril b) furosemide c) amlodipine d) phenytoin e) thorasemide 189. Action of Angiotensin II: Variants of answer: a) systemic vasoconstriction b) systemic vasodilatation c) renal vasodilatation d) ↓ reabsorption of Na in proximal renal tubule e) decreases heart rate 190. Enalapril acts by: Variants of answer: a) angiotensin converting enzyme inhibition b) angiotensin receptor blockade c) calcium channel blockade d) direct vasodilation e) vasoconstriction 191. A patient was started on antihypertensive medications; developed renal failure, the drug offended is: Variants of answer: a) beta-blocker Alfa-blocker b) calcium channel blocker c) ACE inhibitor d) clonidine e) Sartans 192. All of the following are the indications for use of ACE inhibitors, except: Variants of answer: a) hypertension b) Myocardial infarction c) Left ventricular dysfunction d) pheochromocytoma e) CHF 193.The most significant adverse effect of ACE inhibition is: 47 Variants of answer: a) hypotension b) hypertension c) hypocalcemia d) hypercalcemia e) hyperuricemia 194. Which is a prodrug? Variants of answer: a) enalapril b) clonidine c) salmeterol d) acetazolamide e) lisinopril 195. Which of the following is not a prodrug: Variants of answer: a) enalapril b) oxcarbazepine c) chloral hydrate d) diazepam e) perindopril 196. Use of the following drug to treat hypertension with pregnancy is contraindicated: Variants of answer: a) enalapril b) methyldopa c) nifedipine d) labetolol e) metoprolol 197. One of the following is a prodrug: Variants of answer: a) enalapril b) neostigmine c) esmolol d) captopril e) Lisinopril 198. All are true about Losartan, except: Variants of answer: a) angiotensin II antagonist b) causes hyperuricemia c) does not cause cough 48 d) long acting metabolites e) group of sartans 199. ACE inhibitors are contraindicated in bilateral renal artery stenosis, because: Variants of answer: a) angiotensin II has direct effect on GFR b) enhances bradykinin action c) hyperreninism affects renal parenchyma d) affects prostaglandins e) affects leucotriens 200. A 60-year old hypertensive patient on Angiotensin II receptor antagonists (losartan) is posed for hernia repair surgery. The antihypertensive drug should be: Variants of answer: a) continued till the day of operation b) discontinued 24 hrs preoperatively c) discontinued one week preoperatively d) administered in an increased dosage on the day of operation e) discontinued one month preoperatively 201. All of the following statements are true regarding Losartan, except: Variants of answer: a) it is a competitive angiotensin receptor antagonist b) it has a long acting metabolite c) it is a prodrug d) causes hyperuricemia e) causes hyperkalemia 202. Uses of alfa-2 agonist, except: Variants of answer: a) sedation b) HTN c) glaucoma d) BPH e) ischemia 203. Which has maximum nicotinic effect: Variants of answer: a) bethanechol b) carbachol c) pilocarpine d) methacoline e) aceclidine 204. Which one of the following drugs increases gastro intestinal motility? 49 Variants of answer: a) glycopyrrolate b) atropine c) neostigmine d) fentanyl e) ipratropium 205. Sympathomimetic drugs are useful in the therapy of all of the following conditions, except: Variants of answer: a) acute decompensated heart failure b) hypotension c) hypertension d) erectile dysfunction e) bradyarrythmia 206. Neostigmine is a: Variants of answer: a) primary ammonium compound b) secondary ammonium compound c) tertiary ammonium compound d) quaternary ammonium compound e) primary chloride compound 207. Drug of choice in acute central anticholinergic syndrome is: Variants of answer: a) neostigmine b) physostigmine c) tacrine d) 4-aminopyridine e) pylocarpin 208. All of the following statements are true, except: Variants of answer: a) IV noradrenaline increases systolic and diastolic BP and causes tachycardia b) IV adrenaline increases systolic, decreases diastolic BP and causes tachycardia c) IV isoproterenol causes no change in systolic, decreases diastolic BP and causes tachycardia d) dopamine decreases peripheral resistance and improves renal perfusion e) IV adrenaline decreases systolic, decreases diastolic BP and causes tachycardia 209. All are alfa-adrenergic agonists, except: Variants of answer: a) mephentermine b) ritodrine c) methoxamine 50 d) phenylephrine e) mezaton 210. Buprenorphine is a: Variants of answer: a) partial agonist b) pure antagonist c) agonist-antagonist d) none of the above e) strong agonist 211. All of the following are reversible anticholinesterases, except: Variants of answer: a) physostigmine b) ambenonium c) pyridostigmine d) echothiophate e) neostigmin 212. All of the following are features of sympathetic stimulation of heart, except: Variants of answer: a) ↑ contractility b) ↑ heart rate c) ↑ refractory period d) ↑ conduction velocity e) ↑ automatism 213. All are classified as reversible anticholinesterases, except: Variants of answer: a) ambenonium b) physostigmine c) pyridostigmine d) echothiophate e) neostigmin 214. Max. nicotinic effect is seen with: Variants of answer: a) pilocarpine b) carbachol c) bethanechol d) methacholine e) atropin 215. Vasomotor reversal of Dale seen with: Variants of answer: 51 a) alpha blocker b) beta blocker c) alpha agonist d) beta agonist e) muscarinic agonist 216. Cheese reaction with MAO inhibitors is due to: Variants of answer: a) guanethidine b) resperpine c) cough remedies d) tyramine e) serotonin 217. Dales vasomotor reversal: Variants of answer: a) stimulation of alpha-1 receptors b) stimulation of alpha-2 receptors c) stimulation of beta-1 receptors d) stimulation of beta-2 receptors e) stimulation of muscarinic receptors 218. Neurochemical mechanism of analgesia: Variants of answer: a) VR-1 b) nicotinic cholinergic c) nocistatin pattern d) nociceptin pattern e) anandamide 219. True about tachyphylaxis: Variants of answer: a) direct sympathemimetic involved b) mechanism clearly understood c) ephedrine tachyphylaxis reversed with noradrenaline d) indirect sympathomimetics involved e) it is an anaphylaxis reaction 220. Alpha one stimulation produces: Variants of answer: a) HR ↑ b) BP ↓ c) HR ↓ d) None e) Bronchospasmus 52 221. Ganglion blockers act by: Variants of answer: a) inhibition of release of acetylcholine b) competing for acetylcholine receptor c) preventing conduction from pre-, postganglionic fiber d) inhibition of acetylcholine destruction e) inhibition of alpha receptors 222. Dale’s vasomotor reversal is due to: Variants of answer: a) alpha blocker b) beta blocker c) acetylcholine inhibitor d) all of the above e) nicotinic inhibitor 223. True of the following is/are: Variants of answer: a) beta-1 receptors in heart stimulate its contractions b) beta-2 receptors in heart stimulate its contractions c) beta-3 receptors are present in smooth muscles d) alpha-receptors cause preganglionic stimulation e) alpha 1-receptors in heart stimulate its contractions 224. Neostigmine: Variants of answer: a) it is a quaternary ammonium compound b) metabolised in liver c) it can cross the blood brain-barrier d) prominent effect on smooth muscles e) it is a primary ammonium compound 225. Which one of the following is not an alpha-adrenoreceptor agonist? Variants of answer: a) clonidine b) phentolamine c) guanabenz d) guanfacine e) betaxolol 226. Neostigmine antagonizes nondepolarizing blockade by all of the following mechanisms, except: Variants of answer: a) decreasing the breakdown of acetylcholine at the motor end plate b) preventing K+ efflux from the cell 53 c) increasing the release of acetylcholine at the motor end plate d) depolarization of the motor end plate e) preventing Cl- efflux from the cell 227. Impotence is most commonly caused by which antihypertensive agent: Variants of answer: a) calcium channel blockers b) ACE inhibitors c) AT1 receptor antagonists; d) beta-blockers e) Sartans 228. Drug used for postoperative reversal of muscular paralysis: Variants of answer: a) neostigmine b) pyridostigmine c) physostigmine d) d-tubocurarine e) galanthamin 229. All of the following can be associated with beta-2 agonists treatment, except: Variants of answer: a) hyperkalemia b) hyperglycemia c) detrusor relaxation d) relaxation of gut and bronchial muscles e) preventing of preterm labour 230. All of the following may be associated with the use of Beta agonist in preterm labour, except: Variants of answer: a) hyperkalemia b) hyperglycemia c) tachycardia d) relaxation of uterine muscles e) relaxation of gut and bronchial muscles 231. Which of the following drug increases serum level of Digitalis: Variants of answer: a) probenecid b) hydrochlorthiazide c) amiodarone d) captopril e) lisinopril 54 232. Which of the following is NOT indicated in Digitalis poisoning: Variants of answer: a) potassium b) hemodialysis c) phenytoin d) lidocaine e) digitalis-antidot 233. Dose of digoxin is NOT altered in: Variants of answer: a) old age b) hepatic disease c) renal disease d) hypercalcemia e) children 234. Mechanism of action of Digitalis is by inhibiting: Variants of answer: a) Ca2+ channels b) Na+/K+ pump c) myoneural junction d) Na+/H+ pump e) Cl-channels 235. Digitalis acts in atrial fibrillation by: Variants of answer: a) increasing AV node refractoriness b) decreasing AV node refractoriness c) both d) blocking Na+/K+-ATPase pump e) increasing Na+/K+-ATPase pump 236. Mechanism of action of digitalis is: Variants of answer: a) inhibits Na+/K+-ATPase pump b) inhibits Na+/H+-ATPase pump c) active metabolites are produced in the liver d) inhibits calcium concentration in blood e) increase chloride concentration in blood 237. All are used in Digoxin toxicity, except: Variants of answer: a) lidocaine b) hemodialysis c) phenytoin 55 d) potassium e) digitalis-antidot 238. Which of the following interacts with Digitalis maximally: Variants of answer: a) furosemide b) triamterene c) amiloride d) spironolactone e) mannitol 239. Digoxin dose has to be regulated in all, except: Variants of answer: a) hepatotoxicity b) old age c) hypokalemia d) hypoxia e) old people 240. If a patient on digitals develops ventricular tachycardia, which of the following drugs you will NOT use in management: Variants of answer: a) amiodarone b) quinidine c) phenytoin d) lidocaine e) drugs of potassium 241. The following drugs have significant drug interaction with digoxin, except: Variants of answer: a) cholestyramine b) thiazide diuretics c) quinidine d) amlodipine e) thiazide-like diuretics 242. A 60 year old man with rheumatic mitral stenosis with atrial fibrillation is on therapy for a fast ventricular rate. While on treatment, he developed a regular pulse of 64 beats/min. The most likely drug being administered was: Variants of answer: a) verapamil b) digoxin c) carvedilol d) propranolol e) labetalol 56 243. Digoxin is not indicated in: Variants of answer: a) atrial flutter b) atrial fibrillation c) high output failure d) PSVT e) heart failure 244. Digoxin is contraindicated in: Variants of answer: a) supraventricular tachycardia b) atrial fibrillation c) congestive heart failure d) hypertrophic obstructive cardiomyopathy e) stimulation of strength of the heart 245. The dose of Digoxin should be reduced when given along with: Variants of answer: a) quinidine b) rifampicin c) indomethacin d) antacids e) captopril 246. Digoxin toxicity can be precipitated by all, except: Variants of answer: a) phenytoin b) quinidine c) calcium d) verapamil e) lidocaine 247. Digitalis has inotropic action due to: Variants of answer: a) initiation of Na+/K+-ATPase b) trapping Ca2+ release c) inhibiting Na+/K+-ATPase d) increase in intracellular K+ e) increase in intracellular Cl- 248. Digoxin is used in CHF due to: Variants of answer: a) HOCM b) high output failure c) AF with high ventricular rate 57 d) all e) negative dromotropic action 249. Interaction occurring when quinine and digoxin are given together: Variants of answer: a) quinine increases excretion of digoxin b) quinine displaces digoxin from protein binding sites c) increases the metabolism of digoxin d) digoxin causes cinchonism e) they don’t interract 250. Best used in digoxin induced arrhythmia: Variants of answer: a) phenytoin b) lidocaine c) quinidine d) procainamide e) ethacizin 251. Digoxin toxicity aggravated in: Variants of answer: a) hypokalemia b) hyperkalemia c) hypercalcemia d) hypermagnesemia e) hypochloremia 252. Digoxin toxicity is precipitated by all, except: Variants of answer: a) electrolyte disturbance b) acute myocardial infarction c) hepatic disease d) renal disease e) old age 253. NRTI: Variants of answer: a) lamivudine b) zalcitabine c) nevirapine d) delavirdine e) ticlopidine 254. An HIV positive patient is on antiretroviral therapy with zidovudine, lamivudine and indinavir. He is proven to be suffering from genito-urinary 58 tuberculosis. Which one of the following drugs should not be given to this patient: Variants of answer: a) isoniazid b) rifampicin c) pyrazinamide d) ethambutol e) amikacin 255. Peripheral neuropathy is seen due to all prolonged use of all, except: Variants of answer: a) zalcitabine b) didanosine c) stamivudine d) lamivudine e) zidovudine 256. Dineshbhali Shah suffering from AIDS is on Zidovudine, Lamivudine and Indinavir therapy. He develops pulmonary tuberculosis for which treatment is to be started. Which of the following should be avoided in him? Variants of answer: a) rifampicin b) INH c) ethambutol d) pyrazinamide e) amikacin 257. Which of the following will be optimum treatment in a patient of chronic hepatitis B whose serum AST levels are raised: Variants of answer: a) lamivudine b) lamivudine + interferons c) immunoglobulins d) interferons e) all 258. All of the following drugs are protease inhibitors, except: Variants of answer: a) nelfinavir b) saquinavir c) abacavir d) ritonavir e) indinavir 259. Nevirapine is a: Variants of answer: 59 a) protease inhibitor b) nucleoside reverse transcriptase inhibitor c) non-nucleoside reverse transcriptase inhibitor d) fusion inhibitor e) serotonine inhibitor 260. Nevirapine belongs to the following group: Variants of answer: a) non-nucleoside reverse transcriptase inhibitor (NNRTI) b) protease inhibitor c) fusion inhibitor d) nucleoside reverse transcriptase inhibitor (NRTI) e) serotonine inhibitor 261. Which anti HIV drug does not cause peripheral neuropathy: Variants of answer: a) lamivudine b) stavudine c) didanosine d) zalcitabine e) indinavir 262. Zidovudine is given for HIV in pregnancy because: Variants of answer: a) decreases chance of vertical transmission b) decrease severity of infection in mother c) decrease severity of infection in new born d) cause no benefit e) less side effects 263. Regarding Ritonavir in AIDS patient which of the following is/are true: Variants of answer: a) interacts with terfenadine b) G.I. symptoms are seen c) contraindicated in renal failure d) it is NNRTI e) should not be used in AIDS patient with bleeding disorder 264. Complications of Zidovudine: Variants of answer: a) nausea & vomiting b) anemia c) steatosis d) all e) dizziness 60 265. Bone marrow depressive drugs in the treatment of AIDS patient are: Variants of answer: a) didanosine b) zalcitabine c) dapsone d) co-trimoxazole e) gancyclovir 266. Nucleoside reverse transcriptase inhibitors are: Variants of answer: a) zalcitabine b) delavirdine c) nevirapine d) stavudine e) lamivudine 267. Mechanism of action of zidovudine is: Variants of answer: a) protein synthesis b) reverse transcriptase inhibition c) nucleic acid synthesis d) cell membranes e) rhibosomes synthesis 268. AZT has following side effects, except: Variants of answer: a) ↓ platelet b) megaloblastic anemia c) pancreatitis d) cardiomyopathy e) trombocytopenia 269. Protease inhibitors are: Variants of answer: a) saquinavir b) nevirapine c) nelfinavir d) abacavir e) efavirenz 270. Resistance to zidovudine develops due to: Variants of answer: a) mutations at reverse transcriptase b) increased efflux of the drug from inside the cell c) increased metabolism of the drug 61 d) decreased zidovudine 5 triphosphate formation e) decreased metabolism of the drug 271. Nevirapine is: Variants of answer: a) protease inhibitor b) nucleoside reverse transcriptase inhibitor c) non-nucleoside reverse transcriptase inhibitor d) fusion inhibitor e) adrenergic inhibitor 272. False about protease inhibitors in HIV is: Variants of answer: a) they are powerful enzyme inhibitors b) of all the protease inhibitors saquinavir is the most powerful inhibitor of CYP3A4 c) they cause hepatic toxicity d) all protease inhibitors are substrates for P glycoprotein coded by MDR gene e) they can cause diabetes mellitus 273. Azidothymidine (Zidovudine), commonest side effect is: Variants of answer: a) hyperuricemia b) pancreatitis c) peripheral neuropathy d) macrocytic anaemia e) arrythmias 274. Aspirin is used in prophylaxis of MI, because: Variants of answer: a) it is an analgesic b) of antiplatelet action c) of sedative effect d) of prostaglandins inhibitory actions e) of serotoninergic effect 275. Aspirin is used in cerebrovascular accident because it: Variants of answer: a) inhibits TXA2 synthetase b) alters RBC membrane c) cyclooxygenase inhibition d) prostaglandin production inhibition e) leukotriene inhibitor 276. Aspirin is used in MI because it: Variants of answer: 62 a) decreases thromboxane synthesis b) has analgesic effect c) reduces prostaglandin synthesis d) reduces cardiac work e) leukotriene inhibitor 277. Prostaglandins (PGs) have effects on a variety of tissues. The different prostaglandins may have different effects. Which of the following statement is not correct: Variants of answer: a) the human arteriolar smooth muscle is relaxed by PGE2 and PGI2, whereas TXA2 and PGF2 alpha cause vasoconstriction b) PGE1 and PGI2 inhibit platelet aggregation, whereas TXA2 facilitate aggregation c) PGE2 has marked oxytocin action while PGF2 alpha has tocolytic action d) PGE2 is bronchodilator whereas PGF2 alpha is a bronchoconstrictor e) PGE2 has protective effect on mucous membrane of stomach 278. Therapeutic uses of prostaglandin E1 include all of the following, except: Variants of answer: a) medical termination of pregnancy b) impotence c) primary pulmonary hypertension d) maintenance of patent ductus arteriosus (PDA) e) all 279. Misoprostol is a: Variants of answer: a) prostaglandin El analogue b) prostaglandin E2 analogue c) prostaglandin antagonist d) antiprogestin e) androgen 280. Which of the following is beneficial in NSAID induced gastric ulcer? Variants of answer: a) PGE1 agonist b) PGE2 agonist c) PGD agonist d) PGF2 agonist e) PGI2 agonist 281. Which of the following drugs would be removed by dialysis? Variants of answer: a) digoxin b) salicylates c) benzodiazepines 63 d) organophosphates e) digitoxin 282. In low doses aspirin acts on: Variants of answer: a) cyclooxygenase b) thromboxane A2 c) PGI2 d) lipoxygenase e) leucotriens 283. Low doses of aspirin used in myocardial infarction act by: Variants of answer: a) inhibiting thromboxane synthetase b) inhibit cyclooxygenase c) releasing EDRF d) high protein binding activity e) protease inhibitor 284. Aspirin is given in MI because it: Variants of answer: a) ↓ PGI2; b) ↓ TXA2; c) ↓ histamine; d) ↓ fibrosis. e) decreases cholesterol 285. Drug to be given within 6 hours of MI: Variants of answer: a) aspirin b) metoprolol c) streptokinase d) diltiazem e) statin 286. Aspirin toxicity true are: Variants of answer: a) tinnitus early symptom b) 10-30 gm causes poisoning c) hyperthermia, tachypnea early complications d) cause thrombocytopenic purpura e) all 287. NSAID’s are useful because they inhibit: Variants of answer: 64 a) cyclooxygenase b) thromboxane c) histamine d) 5-HT e) phospholipase 288. In Aspirin mechanism of action: Variants of answer: a) lipoxygenase ↓; b) cyclooxygenase ↓; c) phospholipase ↓; d) lipoxygenase ↑; e) cyclooxygenase ↑ 289. Which prostaglandin is used in NSAID induced ulcer: Variants of answer: a) misoprostol b) carboprost c) mirtazapine d) milrinone e) atropin 290. Which of the following is cyclooxygenase inhibitor: Variants of answer: a) aspirin b) prednisolone c) misoprostol d) betamethasone e) triamcinolone 291. Which one of the following statements is not true about NSAIDs? Variants of answer: a) acetylsalicylic acid is an irreversible inhibitor of COX enzyme b) salicylic acid reduces in vivo synthesis of prostaglandins c) duration of action of aspirin is primarily related to the pharmacokinetic clearance of the drug from the body d) antiplatelet effect of low-dose aspirin is related to presystemic COX inhibition e) bleeding is a side effect of aspirin 292. Which of the following drugs has covalent interaction with its target: Variants of answer: a) aspirin b) penicillin c) nitric oxide 65 d) bosentan e) cephalosporin 293. Which NSAID undergoes enterohepatic circulation: Variants of answer: a) phenylbutazone b) aspirin c) ibuprofen d) piroxicam e) nimesulid 294. Mechanism of action of Aspirin in MI is: Variants of answer: a) thromboxane A2 synthesis inhibition b) thromboxane A2 synthesis stimulation c) antagonist of adenosine d) stimulation of PGF2 synthesis e) antagonist of serotonine 295. Chronic thiazide therapy causes persistent hypercalcemia due to: Variants of answer: a) renal tubular acidosis b) fanconi’s syndrome c) hypervitaminosis D d) hyperparathyroidism e) all 296. Glucose intolerance seen with drugs: Variants of answer: a) thiazide diuretics b) beta-blockers c) verapamil d) ACE inhibitors e) alpha-blockers 297. The diuretic group that does not require access to the tubular lumen to induce diuresis is: Variants of answer: a) carbonic anhydrase inhibitor b) Na-Cl symport inhibitor c) mineralocorticoid antagonist d) Na-K symport inhibitor e) loop diuretic 298. Spironolactone is contraindicated with of the following: 66 Variants of answer: a) enalapril b) atenolol c) verapamil d) none of the above e) furosemide 299. Which one of the following drug causes increased concentration of Na+ & Cl- in urine with normal bicarbonate: Variants of answer: a) ethacrynic acid b) furosemide c) acetazolamide d) bumetanide e) thorasemide 300. Furosemide causes all, except: Variants of answer: a) hyperuricemia b) ototoxicity c) hypercalcemia d) hypokalemia e) hyperglycemia 301. ADH acts on: Variants of answer: a) proximal convoluted tubule b) distal convoluted tubule c) loop of Henle d) collecting duct e) capsule 302. Furosemide and thiazides have similar properties in the following: Variants of answer: a) duration of action b) site of action c) effect on urate excretion d) well absorbed orally e) all 303. In chronic renal failure which one is contraindicated: Variants of answer: a) furosemide b) ethacrynic acid c) triamterene 67 d) bumetanide e) thorasemide 304. True about triamterene is all, except: Variants of answer: a) saluretic effect is greater than thiazide b) triamterene is often combined with thiazide c) action is just like amiloride d) it is a K+ sparing diuretic e) it decreases Na+ 305. Potassium sparing diuretics include all, except: Variants of answer: a) bumetanide b) triamterene c) amiloride d) spironolactone e) all 306. Carbonic anhydrase inhibitor is given in all, except: Variants of answer: a) sulfonamide hypersensitivity b) glaucoma c) mountain sickness d) epilepsy e) CHF 307. Osmotic diuretics cause following, excepts: Variants of answer: a) inhibit Renin release b) ↑ intravascular volume c) reduce salt reabsorption in ascending limb d) none of the above e) all 308. Free water clearance decreased by? Variants of answer: a) vincristine b) vinblastine c) chlorpropamide d) furosemide e) verapamil 309. Aldosterone antagonists are NOT useful in the treatment of: Variants of answer: 68 a) hypertension b) congestive heart failure c) gynaecomastia d) hirsutism e) liver cirrhosis 310. One of the following diuretics does not require its presence in the tubular lumen for its pharmacological effects: Variants of answer: a) thiazide diuretics b) loop diuretics c) carbonic anhydrase inhibitors d) aldosterone antagonists e) osmotic diuretics 311. Following is true about furosemide: Variants of answer: a) it is given only by IV route b) it causes mild diuresis c) it is used in pulmonary edema d) acts on PCT e) it is used in renal edema 312. Thiazides false is: Variants of answer: a) used in CCF b) causes hyperglycemia c) increases uric acid concentration in serum d) increases calcium excretion in urine e) causes hyponatremia 313. Administration of betamethasone during delivery causes all, except: Variants of answer: a) decrease neonatal mortality b) decrease incidence of ARDS c) decrease incidence of intraventricular haemorrhage d) decrease incidence of hyperbilirubinemia e) decreases uterus tone 314. All are side effects of steroids given in anti-inflammatory dosages, except: Variants of answer: a) diabetes mellitus b) hyperkalemia c) osteoporosis 69 d) Na+ and water retention e) hypertension 315. The lymphocytopenia seen a few hours after administration of a large dose of prednisone to a patient with lymphocytic leukemia is due to: Variants of answer: a) massive lymphocytic apoptosis b) bone marrow depression c) activation of cytotoxic cells d) stimulation of natural killer cell activity e) activation of T-killers 316. All of the following have receptors which are transcription factors, except: Variants of answer: a) insulin b) estrogen c) glucocorticoids d) vitamin D e) androgen 317. Which one of the following is true of adrenal suppression due to steroid therapy? Variants of answer: a) it is not associated with atrophy of the adrenal glands b) it does not occur in patients receiving inhaled steroids c) it should be expected in anyone receiving > 5mg of prednisolone daily d) following cessation, the stress response normalizes after 8 weeks e) it must be given at 12 o’clock 318. All of the following are correct about steroids, except: Variants of answer: a) inhibit the release of arachidonic acid from vessel wall through action of phospholipase b) bind plasma membrane receptors and following internalization influence nuclear changes c) inhibit vascular membrane permeability d) increase glucose synthesis, glycogen deposition in liver e) increase blood pressure 319. All the following belong to the steroid receptor superfamily, except: Variants of answer: a) vitamin D3 receptor b) thyroid receptor c) retinoid receptor 70 d) epinephrine receptor e) parathyroid receptor 320. Adrenal steroids are contraindicated in all, except: Variants of answer: a) severe hypertension b) osteoporosis c) diabetes mellitus d) glomerulonephritis e) infectious 321. Which of the following steroids can be administered by inhalation: Variants of answer: a) beclomethasone b) betamethasone c) prednisolone d) hydrocortisone e) triamcinolone 322. Estrogen acts on: Variants of answer: a) cellular membrane receptor b) cytoplasmic receptors c) nuclear receptors d) mitochondria e) rhibosomes 323. Which of the following is present intracellularly in muscle cells: Variants of answer: a) insulin b) corticosteroid c) epinephrine d) glucagon e) adrenaline 324. Amongt the following, least glucocorticoid activity is seen with: Variants of answer: a) fludrocortisone b) dexamethasone c) triamcinolone d) betamethasone e) beclomethasone 325. Prolonged use of steroids may cause: Variants of answer: 71 a) decrease in bone matrix protein b) hypoglycemia c) hypotension d) early healing of wound e) decrease of calcium 326. Intracellular receptor activation is by: Variants of answer: a) thyrotropin b) noradrenaline c) estradiol d) glucagon e) adrenaline 327. Reduced inflammation in airway produced by: Variants of answer: a) fluticasone b) budesonide c) theophylline d) salbutamol e) ipratropium 328. Glucocorticoids act in inflammation by: Variants of answer: a) ↓ Lipocortin b) ↑lL-2 c) ↑ Lipocortin d) ↑ CRP e) ↑ leucotriens 329. Glucocorticoids causes: Variants of answer: a) ↓ osteoid formation b) IGF stimulation c) ↑ Ca ++ absorption from stomach d) calcification of bone e) hypotension 330. Drug causing hyperglycemia is: Variants of answer: a) ACE inhibitor b) glucocorticoid c) alcohol d) indomethacin e) paracetamol 72 331. Repolarisation of ventricles is prolonged by which antiarrhythmic drug: Variants of answer: a) amiodarone b) quinidine c) lidocaine d) procainamide e) metoprolol 332. All are true regarding antiarrhythmic, except: Variants of answer: a) verapamil belongs to second group drugs b) it is drug of choice for PS VT c) it is contraindicated in complete heart block d) it depresses heart rate e) it causes bradycardia 333. A 50 year old man had an attack of myocardial infarction and developed ventricular ectopics and low ejection fraction. Which of the following antiarrhythmic drug to be given: Variants of answer: a) flecainide b) mexiletine c) beta-blocker d) radio-frequency ablation technique e) vinblastin 334.The following statement is not true about sotalol: Variants of answer: a) it is a non-selective beta-blocker b) it prolongs action potential duration throughout the heart c) it is excreted through bile following hepatic metabolism d) polymorphic ventricular tachycardia is a common side effect e) it causes bronchospasmus 335. Quinidine is a: Variants of answer: a) Na+channel-blocker b) K + channel blocker c) Ca++ channel blocker d) Cl- channel blocker e) Mg2+ channel blocker 336. SLE like syndrome is most commonly associated with administration of: Variants of answer: 73 a) rifampicin b) procainamide c) digitalis d) phenytoin e) lidocaine 337. Tocainide has the following properties, except: Variants of answer: a) used in ventricular tachycardia b) prolongs APD c) used as lidocaine analogue d) used orally e) decreases heart rate 338. Which of the following is the drug of choice for PSVT: Variants of answer: a) lidocaine b) verapamil c) flecainide d) tocavide e) ethacizine 339. The drug of choice in PSVT is: Variants of answer: a) digoxin b) propranolol c) lidocaine d) adenosine e) flecainide 340. Drug of choice in PSVT is: Variants of answer: a) verapamil b) propranolol c) D.C. shock d) digoxin e) flecainidide 341. Which of the following statements regarding adenosine is not true: Variants of answer: a) used in PSVT b) administered as rapid IV injection c) has short lived side effects d) disopyramide increases its therapeutic effect e) hypotension is side effect 74 342. Pharmacological defibrillator is: Variants of answer: a) adenosine b) bretylium c) lidocaine d) amiodarone e) metoprolol 343. Drugs producing ANA: Variants of answer: a) phenytoin b) penicillin c) INH d) procainamide e) rifampicin 344. True about Quinidine: Variants of answer: a) it increases effective refractory period b) used in hypertension c) causes paradoxical tachycardia d) it decreases absolute refractory period e) cinchonism is seen 345. PSVT is best treated by: Variants of answer: a) adenosine b) lidocaine c) phenytoin d) quinidine e) amiodaron 346. Drugs causing SLE: Variants of answer: a) INH b) hydralazine c) procainamide d) ranitidine e) methyldopa 347. Which antiarrhythmic is not class IC agent: Variants of answer: a) propafenone b) tocainide c) flecainide 75 d) encainide e) ethacizin 348. Drug of choice of paroxysmal supraventricular tachycardia is: Variants of answer: a) adenosine b) digitalis c) procainamide d) mexiletine e) lidocaine 349. Not an effect of bromocriptine is: Variants of answer: a) dopamine agonist b) increases prolactin release c) decreases prolactin release d) all of the above e) adrenalin agonist 350. Bromocriptine is NOT used in: Variants of answer: a) induction of ovulation b) galactorrhoea c) post pill amenorrhoea d) luteal phase defect e) decreases estrogen 351. Which one of the following statements is true regarding drugs used in treatment of parkinsonism? Variants of answer: a) amantadine causes ankle edema b) levodopa is particularly effective in reducing tremors c) amantadine is more effective then levodopa d) antimuscarinics are effective in drug induced parkinsonism e) MAO-B drugs are effective in drug induced parkinsonism 352. Prolactin secretion will be inhibited by: Variants of answer: a) haloperidol b) GABA (Gama aminobutyric acid) c) neurophysin d) dopamine e) valproat 353. Prolactin secretion is inhibited by: 76 Variants of answer: a) dopamine antagonist b) GABA c) neurophysin d) bromocriptine e) ephedrin 354. Antipsychotic drug-induced Parkinsonism is treated by: Variants of answer: a) anticholinergics b) levodopa c) selegiline d) amantadine e) dopamine 355. All the following statements regarding interactions of levodopa are correct, except: Variants of answer: a) in Parkinsonism, phenothiazines reduce its efficacy b) it is a prodrug c) pyridoxine reduces effect of levodopa in parkinsonism d) domperidone blocks levodopa induced emesis and its therapeutic potential e) side effect is orthostatic hypotension 356. Selegiline is a selective inhibitor of: Variants of answer: a) MAO-A b) MAO-B c) dopamine d) norepinephrine-uptake e) MAO-A and MAO-B 357. A patient of parkinsonism is managed with L-dopa. If Vit. B-complex is administered concurrently: Variants of answer: a) the action of L-dopa in brain will be potentiated b) decarboxylation of L-dopa in brain will be decreased c) side effects will be ameliorated d) decreased efficacy will result e) all 358. False statement about selegiline is: Variants of answer: a) it is a MAO-A inhibitor b) does not cause cheese reaction c) may be used in on-off phenomenon 77 d) it is used in parkinsonism e) it is a MAO-B inhibitor 359. L-dopa is given along with Carbidopa: Variants of answer: a) to prevent peripheral decarboxylation of L-dopa b) to reduce side effects c) to increase compliance d) to increase half-life e) to increase metabolism 360. Amantadine acts by action of: Variants of answer: a) inhibiting replication b) inhibits mRNA c) inhibits tRNA d) inhibits DNA e) inhibits DNA,RNA 361. Drugs causing parkinsonism include: Variants of answer: a) bromocriptine b) phenothiazine c) haloperidol d) amantadine e) carbidopa 362. Decreased prolactin level seen with: Variants of answer: a) phenothiazine b) reserpine c) dopamine d) verapamil e) fluoxetine 363. Treatment of Parkinson’s disease: Variants of answer: a) levodopa b) mazindol c) bromocriptine d) acyclovir e) benserazide 364. True regarding bromocriptine: Variants of answer: 78 a) natural derivative b) synthetic derivative c) has alfa-blocking action d) decrease GI motility e) acts on both D1 and D2 receptors 365. Ropinirole is the most useful for the treatment of: Variants of answer: a) Parkinson’s disease b) Wilson’s disease c) Hoffman’s syndrome d) carpal tunnel syndrome e) Myastenia gravis 366. Which drug has wide therapeutic index: Variants of answer: a) digoxin b) lithium c) phenytoin d) penicillin e) phenobarbital 367. A 70 year old man was administered penicillin intravenously. Within 5 minutes, he developed generalized urticaria, swelling of lips, hypotension and bronchospasm. The first choice of treatment is to administer: Variants of answer: a) chlorpheniramine inj b) epinephrine inj c) high dose hydrocortisone tablet d) nebulized salbutamol e) loratadine tab 368. The drug of choice for thoracic actinomycosis is: Variants of answer: a) amphotericin B b) penicillin c) co-trimoxazole d) itraconazole e) cephalexin 369. All of the following are therapeutic uses of penicillin G, except: Variants of answer: a) bacterial meningitis b) rickettsial infection c) syphilis 79 d) anthrax e) staphylococcus 370. Cell wall synthesis is inhibited by all of the following, except: Variants of answer: a) amoxycillin b) penicillin G c) tetracycline d) cefotetan e) penicillin V 371. All of the following statements regarding penicillin-G are true, except: Variants of answer: a) can be given orally b) active against gram positive organisms c) probenecid given along with penicillin-G increases its duration of action d) acts by inhibition of cell wall synthesis e) active against siphysilis 372. The drug of choice for treatment of neurosyphilis is: Variants of answer: a) benzathine penicillin G b) procaine penicillin G c) penicillin V d) tetracycline e) cephazolin 373. One of the following is not penicillinase susceptible: Variants of answer: a) amoxicillin b) penicillin G c) piperacillin d) cloxacillin e) penicillin V 374. A post-operative patient developed septicemia and was empirically started on combination chemotherapy by a new resident doctor. H