MCQs in Pharmacology PDF

 MCQs in PHARMACOLOGY  MCQs 3rd Ed itio n in PHARMACOLOGY Based on...

 MCQs in PHARMACOLOGY  MCQs 3rd Ed itio n in PHARMACOLOGY Based on Tripathi’s Essentials of Medical Pharmacology Fifth Edition K.D. TRIPATHI MD Ex-Director-Professor of Pharmacology Maulana Azad Medical College and associated L.N. and G.B. Pant Hospitals New Delhi JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi Published by Jitendar P Vij Jaypee Brothers Medical Publishers (P) Ltd EMCA House, 23/23B Ansari Road, Daryaganj New Delhi 110 002, India Phones: 23272143, 23272703, 23282021, 23245672 Fax: 91-11-23276490, 23245683 e-mail: [email protected] Visit our website: www.jaypeebrothers.com Branches 202 Batavia Chambers, 8 Kumara Kruppa Road Kumara Park East, Bangalore 560 001, Phones: 22285971, 22382956 Tele Fax: 22281761 e-mail: [email protected] 282 IIIrd Floor, Khaleel Shirazi Estate, Fountain Plaza Pantheon Road, Chennai 600 008, Phone: 28262665 Fax: 28262331 e-mail: [email protected] 4-2-1067/1-3, 1st Floor, Balaji Building Ramkote Cross Road, Hyderabad 500 095 Phones: 55610020, 24758498 Fax: 24758499 e-mail: [email protected] 1A Indian Mirror Street, Wellington Square Kolkata 700 013, Phone: 22451926 Fax: 22456075 e-mail: [email protected] 106 Amit Industrial Estate, 61 Dr SS Rao Road Near MGM Hospital, Parel, Mumbai 400 012 Phones: 24124863, 24104532 Fax: 24160828 e-mail: [email protected] MCQs in Pharmacology © 2004, KD Tripathi All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher. This book has been published in good faith that the material provided by author is original. Every effort is made to ensure accuracy of mate- rial, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only. First Edition: 1996 Second Edition: 2000 Reprint: 2002 Third Edition: 2004 ISBN 81-8061-364-X Typeset at JPBMP typesetting unit Printed at Gopsons Papers Ltd. A-14 Sector 60, Noida  Preface Because of their reliability and objective nature the Multiple Choice Questions (MCQs) are widely used in entrance tests, competitive examinations and at some places in certifying examinations. However, MCQ items have been criticized mostly for their lack of relevance to the core or essential learning objectives, because they mostly tend to emphasize on the rare or the unusual. It is therefore of utmost importance to induct MCQ items which test knowledge, understanding and application ability of the student in relevant areas. This book attempts to introduce a series of MCQs in Pharmacology and Therapeutics in topics which cover important learning objectives. MCQs are also an important method of self study and self assessment. An overwhelming amount of detailed information about an ever increasing number of drugs is now available. A mental exercise in the considerations that underlie choice of one drug over the other in specific situations has to be practised. Solving MCQs could help crystallization and assimi- lation of the fundamental Pharmacological principles as well as factual information about drugs needed for their safe and effective use. This purpose is best served if the MCQs relate to the text that the student has been using for study. With the above objectives, a MCQs book based on the 3rd edition of the textbook ‘Essentials of Medical Pharmacology’ written by me was published in 1996. This was enlarged and improved in the year 2000 based on the 4th edition of the textbook. The success vi MCQs in Pharmacology of the earlier two editions of the MCQs book in achieving its objectives has encouraged undertaking a similar endeavour based on the revised and updated 5th edition (2003) of the textbook. In preparing this edition, all earlier MCQ items were reconsidered in the light of new knowledge as well as changed therapeutic scenario, and suitably modified/improved or deleted. About 300 new MCQ items have been added. However, all items are of the most popular 'one best response' type and the format has not been changed. The MCQs are numbered chapterwise and the page number of the book which provides answer to the subject matter of the MCQ item is given after each item for quick reference. It is advised that after studying a chapter, the student answers the MCQs and then finds out for himself what all he has learnt correctly, what he missed, and what has been understood incorrectly. Used in this manner the present book will facilitate acquisition of relevant and clear-cut knowledge about drugs. I am thankful to my colleagues and many users of the previous MCQs book for constructive criticism and useful suggestions. The motivating influence of Mr. Jitendar P Vij and the meticulous preparation of the manuscript by the editorial staff of Jaypee Brothers is gratefully appreciated. 1st May 2004 KD Tripathi  Contents 1. General Pharmacological Principles................. 1 2. Drugs Acting on Autonomic............................... 30 Nervous System 3. Autacoids and Related Drugs............................ 61 4. Respiratory System Drugs.................................. 92 5. Hormones and Related Drugs........................... 102 6. Drugs Acting on Peripheral (Somatic)............. 148 Nervous System 7. Drugs Acting on Central Nervous..................... 161 System 8. Cardiovascular Drugs........................................ 217 9. Drugs Acting on Kidney..................................... 259 10. Drugs Affecting Blood and................................ 273 Blood Formation 11. Gastrointestinal Drugs....................................... 295 12. Antimicrobial Drugs........................................... 318 13. Chemotherapy of Neoplastic Diseases............ 401  General Pharmacological Principles 1 1 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 General Pharmacological Principles CHOOSE THE MOST APPROPRIATE RESPONSE 1.1 `Essential drugs’ are: A. Life saving drugs B. Drugs that meet the priority health care needs of the population C. Drugs that must be present in the emergency bag of a doctor D. Drugs that are listed in the pharmacopoia of a country (p. 5) 1.2 An 'orphan drug' is: A. A very cheap drug B. A drug which has no therapeutic use C. A drug needed for treatment or prevention of a rare disease D. A drug which acts on Orphanin receptors (p. 5, 6) 1.3 Drug administered through the following route is most likely to be subjected to first-pass metabolism: A. Oral B. Sublingual C. Subcutaneous D. Rectal (p. 7, 8, 25) 1.1 B 1.2 C 1.3 A 2 MCQs in Pharmacology 1.4 Transdermal drug delivery systems offer the following advantages except: A. They produce high peak plasma concentration of the drug B. They produce smooth and nonfluctuating plasma concentration of the drug C. They minimise interindividual variations in the achieved plasma drug concentration D. They avoid hepatic first-pass metabolism of the drug (p. 8, 9) 1.5 In addition to slow intravenous infusion, which of the following routes of administration allows for titration of the dose of a drug with the response: A. Sublingual B. Transdermal C. Inhalational D. Nasal insufflation (p. 9) 1.6 Which of the following drugs is administered by intra- nasal spray/application for systemic action: A. Phenylephrine B. Desmopressin C. Azelastine D. Beclomethasone dipropionate (p. 9, 540) 1.7 Compared to subcutaneous injection, the intramus- cular injection of drugs: A. Is more painful B. Produces faster response C. Is unsuitable for depot preparations D. Carries greater risk of anaphylactic reaction (p. 9, 10) 1.4 A 1.5 C 1.6 B 1.7 B  General Pharmacological Principles 3 1.8 Select the route of administration which carries the highest risk of adversely affecting vital functions: A. Intra arterial injection B. Intrathecal injection C. Intravenous injection D. Intramuscular injection (p. 10) 2.1 Alkalinization of urine hastens the excretion of: A. Weakly basic drugs B. Weakly acidic drugs C. Strong electrolytes D. Nonpolar drugs (p. 13, 26) 2.2 Majority of drugs cross biological membranes primarily by: A. Passive diffusion B. Facilitated diffusion C. Active transport D. Pinocytosis (p. 12) 2.3 Diffusion of drugs across cell membrane: A. Is dependent upon metabolic activity of the cell B. Is competitively inhibited by chemically related drugs C. Is affected by extent of ionization of drug mole- cules D. Exhibits saturation kinetics (p. 12) 2.4 Which of the following drugs is most likely to be absorbed from the stomach: A. Morphine sulfate B. Diclofenac sodium C. Hyoscine hydrobromide D. Quinine dihydrochloride (p. 12) 1.8 C 2.1 B 2.2 A 2.3 C 2.4 B 4 MCQs in Pharmacology 2.5 Which of the following is a weakly acidic drug: A. Atropine sulfate B. Chloroquine phosphate C. Ephedrine hydrochloride D. Phenytoin sodium (p. 12) 2.6 The most important factor which governs diffusion of drugs across capillaries other than those in the brain is: A. Blood flow through the capillary B. Lipid solubility of the drug C. pKa value of the drug D. pH of the medium (p. 13) 2.7 Active transport of a substance across biological membranes has the following characteristics except: A. It is specific B. It is pH dependent C. It is saturable D. It requires metabolic energy (p. 13) 2.8 Tricyclic antidepressants can alter the oral absorption of many drugs by: A. Complexing with the other drug in the intesti- nal lumen B. Altering gut motility C. Altering gut flora D. Damaging gut mucosa (p. 14, 411) 2.9 Bioavailability of drug refers to: A. Percentage of administered dose that reaches systemic circulation in the unchanged form B. Ratio of oral to parenteral dose C. Ratio of orally administered drug to that excre- ted in the faeces D. Ratio of drug excreted unchanged in urine to that excreted as metabolites (p. 15) 2.5 D 2.6 A 2.7 B 2.8 B 2.9 A  General Pharmacological Principles 5 2.10 Bioavailability differences among oral formulations of a drug are most likely to occur if the drug: A. Is freely water soluble B. Is completely absorbed C. Is incompletely absorbed D. Undergoes little first-pass metabolism (p. 16) 2.11 The most important factor governing absorption of a drug from intact skin is: A. Molecular weight of the drug B. Site of application C. Lipid solubility of the drug D. Nature of the base used in the formulation (p. 15) 2.12 If the total amount of a drug present in the body at a given moment is 2.0 g and its plasma concentration is 25 μg/ml, its volume of distribution is: A. 100 L B. 80 L C. 60 L D. 50 L (p. 17) 2.13 The following attribute of a drug tends to reduce its volume of distribution: A. High lipid solubility B. Low ionisation at physiological pH values C. High plasma protein binding D. High tissue binding (p. 17, 18) 2.14 Marked redistribution is a feature of: A. Highly lipid soluble drugs B. Poorly lipid soluble drugs C. Depot preparations D. Highly plasma protein bound drugs (p. 17) 2.10 C 2.11 C 2.12 B 2.13 C 2.14 A 6 MCQs in Pharmacology 2.15 A nonvolatile, highly lipid soluble drug is metabolized at a rate of 15% per hour. On intravenous injection it produces general anaesthesia for 10 min. Which pro- cess is responsible for termination of its action: A. Metabolism in liver B. Plasma protein binding C. Excretion by kidney D. Redistribution (p. 17, 342) 2.16 The blood-brain barrier, which restricts entry of many drugs into brain, is constituted by: A. P-glycoprotein efflux carriers in brain capillary cells B. Tight junctions between endothelial cells of brain capillaries C. Enzymes present in brain capillary walls D. All of the above (p. 17, 18) 2.17 Which of the following is not true of the blood-brain barrier: A. It is constituted by tight junctions between the endothelial cells of brain capillaries and the glial tissue B. It allows passage of lipid soluble drugs into the brain C. It limits entry of highly ionized drugs into the brain D. It regulates passage of substances from brain into blood (p. 17, 18) 2.18 Weakly acidic drugs: A. Are bound primarily to α1 acid glycoprotein in plasma B. Are excreted faster in alkaline urine C. Are highly ionized in the gastric juice D. Do not cross blood-brain barrier (p. 18, 26) 2.15 D 2.16 D 2.17 D 2.18 B  General Pharmacological Principles 7 2.19 High plasma protein binding: A. Increases volume of distribution of the drug B. Facilitates glomerular filtration of the drug C. Minimises drug interactions D. Generally makes the drug long acting (p. 18) 2.20 The plasma protein bound fraction of a drug: A. Contributes to the response at the given moment B. Remains constant irrespective of the total drug concentration C. Remains constant irrespective of the disease state D. Is not available for metabolism unless actively extracted by the liver (p. 18, 19) 2.21 Biotransformation of drugs is primarily directed to: A. Activate the drug B. Inactivate the drug C. Convert lipid soluble drugs into nonlipid solu- ble metabolites D. Convert nonlipid soluble drugs into lipid solu- ble metabolites (p. 20) 2.22 Which of the following is a prodrug: A. Hydralazine B. Clonidine C. Captopril D. Enalapril (p. 20) 2.23 A prodrug is: A. The prototype member of a class of drugs B. The oldest member of a class of drugs C. An inactive drug that is transformed in the body to an active metabolite D. A drug that is stored in body tissues and is then gradually released in the circulation (p. 20) 2.19 D 2.20 D 2.21 C 2.22 D 2.23 C 8 MCQs in Pharmacology 2.24 Which of the following cytochrome P450 isoenzymes is involved in the metabolism of largest number of drugs in human beings and has been implicated in some dangerous drug interactions: A. CYP 3A4 B. CYP 2C9 C. CYP 2E1 D. CYP 1A2 (p. 21, 142) 2.25 The following is not true of the cytochrome P450 isoenzyme CYP2D6: A. It generates the hepatotoxic metabolite N-acetyl benzoquinone immine from paracetamol B. It is involved in demethylation of codeine into morphine C. Its altered form is responsible for poor capacity to hydroxylate many drugs including metoprolol D. It is inhibited by quinidine (p. 21, 23) 2.26 The most commonly occurring conjugation reaction for drugs and their metabolites is: A. Glucuronidation B. Acetylation C. Methylation D. Glutathione conjugation (p. 22) 2.27 Microsomal enzyme induction can be a cause of: A. Tolerance B. Physical dependence C. Psychological dependence D. Idiosyncrasy (p. 24) 2.28 The following drug metabolizing reaction is entirely nonmicrosomal: A. Glucuronide conjugation B. Acetylation C. Oxidation D. Reduction (p. 23) 2.24 A 2.25 A 2.26 A 2.27 A 2.28 B  General Pharmacological Principles 9 2.29 Which of the following types of drug metabolizing enzymes are inducible: A. Microsomal enzymes B. Nonmicrosomal enzymes C. Both microsomal and nonmicrosomal enzymes D. Mitochondrial enzymes (p. 23, 24) 2.30 Induction of drug metabolizing enzymes involves: A. A conformational change in the enzyme protein to favour binding of substrate molecules B. Expression of enzyme molecules on the surface of hepatocytes C. Enhanced transport of substrate molecules into hepatocytes D. Increased synthesis of enzyme protein (p. 24) 2.31 Select the drug that undergoes extensive first-pass metabolism in the liver: A. Phenobarbitone B. Propranolol C. Phenylbutazone D. Theophylline (p. 25) 2.32 Drugs which undergo high degree of first-pass meta- bolism in liver: A. Have low oral bioavailability B. Are excreted primarily in bile C. Are contraindicated in liver disease D. Exhibit zero order kinetics of elimination (p. 25) 2.33 Glomerular filtration of a drug is affected by its: A. Lipid solubility B. Plasma protein binding C. Degree of ionization D. Rate of tubular secretion (p. 26) 2.29 A 2.30 D 2.31 B 2.32 A 2.33 B 10 MCQs in Pharmacology 2.34 If a drug undergoes net tubular secretion, its renal clearance will be: A. More than the glomerular filtration rate B. Equal to the glomerular filtration rate C. Less than the glomerular filtration rate D. Equal to the rate of urine formation (p. 27) 2.35 The plasma half life of penicillin-G is longer in the new born because their: A. Plasma protein level is low B. Drug metabolizing enzymes are immature C. Glomerular filtration rate is low D. Tubular transport mechanisms are not well developed (p. 27) 2.36 If a drug is excreted in urine at the rate of 10 mg/hr at a steady-state plasma concentration of 5 mg/L, then its renal clearance is: A. 0.5 L/hr B. 2.0 L/hr C. 5.0 L/hr D. 20 L/hr (p. 27) 2.37 Which of the following is not a primary/fundamental, but a derived pharmacokinetic parameter: A. Bioavailability B. Volume of distribution C. Clearance D. Plasma half life (p. 29) 2.38 If a drug is eliminated by first order kinetics: A. A constant amount of the drug will be elimi- nated per unit time B. Its clearance value will remain constant C. Its elimination half life will increase with dose D. It will be completely eliminated from the body in 2 × half life period (p. 27-28) 2.34 A 2.35 D 2.36 B 2.37 D 2.38 B  General Pharmacological Principles 11 2.39 If a drug has a constant bioavailability and first order elimination, its maintenance dose rate will be directly proportional to its: A. Volume of distribution B. Plasma protein binding C. Lipid solubility D. Total body clearance (p. 29) 2.40 If the clearance of a drug remains constant, doubling the dose rate will increase the steady-state plasma drug concentration by a factor of: A. × 3 B. × 2 C. × 1.5 D. × 1.3 (p. 29) 2.41 When the same dose of a drug is repeated at half life intervals, the steady-state (plateau) plasma drug con- centration is reached after: A. 2–3 half lives B. 4–5 half lives C. 6–7 half lives D. 8–10 half lives (p. 30) 2.42 The loading dose of a drug is governed by its: A. Renal clearance B. Plasma half life C. Volume of distribution D. Elimination rate constant (p. 30) 2.43 Monitoring of blood levels of diuretic drugs is not practised because: A. No sensitive methods for measuring blood levels of diuretics are available B. It is easier to measure the effect of these drugs C. Response to diuretics is not related to their blood levels D. Diuretics need activation in the body (p. 31) 2.39 D 2.40 B 2.41 B 2.42 C 2.43 B 12 MCQs in Pharmacology 2.44 Monitoring plasma drug concentration is useful while using: A. Antihypertensive drugs B. Levodopa C. Lithium carbonate D. MAO inhibitors (p. 31) 2.45 Sustained/controlled release oral dosage form is appropriate for the following type of drug: A. An antiarthritic with a plasma half life of 24 hr B. A sleep inducing hypnotic with a plasma half life of 2 hours C. An antihypertensive with a plasma half life of 3 hours D. An analgesic with a plasma half life of 6 hours used for relief of casual headache (p. 31) 2.46 Microsomal enzyme induction has one of the following features: A. Takes about one week to develop B. Results in increased affinity of the enzyme for the substrate C. It is irreversible D. Can be used to treat acute drug poisonings (p. 24, 34, 35) 3.1 Which of the following drugs acts by inhibiting an enzyme in the body: A. Atropine B. Allopurinol C. Levodopa D. Metoclopramide (p. 34) 3.2 The following is a competitive type of enzyme inhibitor: A. Acetazolamide B. Disulfiram C. Physostigmine D. Theophylline (p. 34, 35) 2.44 C 2.45 C 2.46 A 3.1 B 3.2 C  General Pharmacological Principles 13 3.3 What is true in relation to drug receptors: A. All drugs act through specific receptors B. All drug receptors are located on the surface of the target cells C. Agonists induce a conformational change in the receptor D. Partial agonists have low affinity for the receptor (p. 35-37) 3.4 Drugs acting through receptors exhibit the following features except: A. Structural specificity B. High potency C. Competitive antagonism D. Dependence of action on lipophilicity (p. 45) 3.5 Study of drug-receptor interaction has now shown that: A. Maximal response occurs only when all recep- tors are occupied by the drug B. Drugs exert an ‘all or none’ action on a receptor C. Receptor and drugs acting on it have rigid complementary ‘lock and key’ structural features D. Properties of ‘affinity’ and ‘intrinsic activity’ are independently variable (p. 36-37) 3.6 A partial agonist can antagonise the effects of a full agonist because it has: A. High affinity but low intrinsic activity B. Low affinity but high intrinsic activity C. No affinity and low intrinsic activity D. High affinity but no intrinsic activity (p. 37) 3.7 Receptor agonists possess: A. Affinity but no intrinsic activity B. Intrinsic activity but no affinity C. Affinity and intrinsic activity with a + sign D. Affinity and intrinsic activity with a – sign (p. 37) 3.3 C 3.4 D 3.5 D 3.6 A 3.7 C 14 MCQs in Pharmacology 3.8 Agonists affect the receptor molecule in the following manner: A. Alter its amino acid sequence B. Denature the receptor protein C. Alter its folding or alignment of subunits D. Induce covalent bond formation (p. 38) 3.9 Receptors perform the following function/functions: A. Ligand recognition B. Signal transduction C. Both ligand recognition and signal transduction D. Disposal of agonists and antagonists (p. 45) 3.10 The following receptor type has 7 helical membrane spanning amino acid segments with 3 extracellular and 3 intracellular loops: A. Tyrosine protein kinase receptor B. Gene expression regulating receptor C. Intrinsic ion channel containing receptor D. G protein coupled receptor (p. 39-40) 3.11 Which of the following is a G protein coupled recep- tor: A. Muscarinic cholinergic receptor B. Nicotinic cholinergic receptor C. Glucocorticoid receptor D. Insulin receptor (p. 40, 42) 3.12 The following receptor has an intrinsic ion channel: A. Histamine H1 receptor B. Histamine H2 receptor C. Adrenergic alfa receptor D. GABA-benzodiazepine receptor (p. 42) 3.8 C 3.9 C 3.10 D 3.11 A 3.12 D  General Pharmacological Principles 15 3.13 Select the receptor that is located intracellularly: A. Opioid μ receptor B. Steroid receptor C. Prostaglandin receptor D. Angiotensin receptor (p. 42, 43) 3.14 Agonist induced autophosphorylation, internalization and down regulation is a distinctive feature of: A. G-protein coupled receptors B. Intrinsic ion channel containing receptors C. Tyrosine protein kinase receptors D. Receptors regulating gene expression (p. 43) 3.15 All of the following subserve as intracellular second messengers in receptor mediated signal transduction except: A. Cyclic AMP B. Inositol trisphosphate C. Diacyl glycerols D. G proteins (p. 39-42) 3.16 The receptor transduction mechanism with the fastest time-course of response effectuation is: A. Adenylyl cyclase-cyclic AMP pathway B. Phospholipase C-IP3: DAG pathway C. Intrinsic ion channel operation D. Protein synthesis modulation (p. 43) 3.17 A receptor which itself has enzymatic property is: A. Insulin receptor B. Progesterone receptor C. Thyroxine receptor D. Glucagon receptor (p. 43, 239) 3.13 B 3.14 C 3.15 D 3.16 C 3.17 A 16 MCQs in Pharmacology 3.18 Down regulation of receptors can occur as a consequence of: A. Continuous use of agonists B. Continuous use of antagonists C. Chronic use of CNS depressants D. Denervation (p. 43, 45) 3.19 The following statement is not true of log dose-response curve: A. It is almost linear except at the ends B. It is a rectangular hyperbola C. It facilitates comparison of different agonists D. It can help in discriminating between competitive and noncompetitive antagonists (p. 46) 3.20 When therapeutic effects decline both below and above a narrow range of doses, a drug is said to exhibit: A. Ceiling effect B. Desensitization C. Therapeutic window phenomenon D. Nonreceptor mediated action (p. 46) 3.21 Which of the following drugs exhibits ‘therapeutic window’ phenomenon: A. Captopril B. Furosemide C. Diazepam D. Imipramine (p. 46, 410) 3.18 A 3.19 B 3.20 C 3.21 D  General Pharmacological Principles 17 3.22 The following statement is not true of ‘potency’ of a drug: A. Refers to the dose of the drug needed to produce a certain degree of response B. Can be related to that of its congeners by the relative position of its dose-response curve on the dose axis C. It is often not a major consideration in the choice of a drug D. It reflects the capacity of the drug to produce a drastic response (p. 47) 3.23 ‘Drug efficacy’ refers to: A. The range of diseases in which the drug is beneficial B. The maximal intensity of response that can be produced by the drug C. The dose of the drug needed to produce half maximal effect D. The dose of the drug needed to produce thera- peutic effect (p. 47) 3.24 Which of the following is always true: A. A more potent drug is more efficacious B. A more potent drug is safer C. A more potent drug is clinically superior D. A more potent drug can produce the same response at lower doses (p. 47) 3.25 Higher efficacy of a drug necessarily confers: A. Greater safety B. Therapeutic superiority C. Capacity to produce more intense response D. Cost saving (p. 47) 3.22 D 3.23 B 3.24 D 3.25 C 18 MCQs in Pharmacology 3.26 If the dose-response curves of a drug for producing different actions are widely separated on the dose axis, the drug is: A. Highly potent B. Highly efficacious C. Highly toxic D. Highly selective (p. 47-48) 3.27 The therapeutic index of a drug is a measure of its: A. Safety B. Potency C. Efficacy D. Dose variability (p. 48) 3.28 Compared to the drug named within parenthesis, which of the following drugs has a higher potency but lower efficacy: A. Pethidine (morphine) B. Furosemide (hydrochlorothiazide) C. Diazepam (pentobarbitone) D. Enalapril (captopril) (p. 47) 3.29 If the effect of combination of two drugs is equal to the sum of their individual effects, the two drugs are exhibiting: A. Potentiation B. Synergism C. Cross tolerance D. Antagonism (p. 49) 3.30 The antagonism between adrenaline and histamine is called ‘physiological antagonism’ because: A. Both are physiologically present in the body B. They act on physiological receptors C. Both affect many physiological processes D. They have opposite physiological effects (p. 49) 3.26 D 3.27 A 3.28 C 3.29 B 3.30 D  General Pharmacological Principles 19 3.31 The antidotal action of sodium nitrite in cyanide poison- ing is based on: A. Physical antagonism B. Chemical antagonism C. Physiological antagonism D. Noncompetitive antagonism (p. 49, 492) 3.32 A drug ‘R’ producing no response by itself causes the log dose-response curve of another drug ‘S’ to shift to the right in a parallel manner without decreasing the maximal response: Drug ‘R’ is a: A. Partial agonist B. Inverse agonist C. Competitive antagonist D. Noncompetitive antagonist (p. 50) 3.33 A drug which does not produce any action by itself but decreases the slope of the log dose-response curve and suppresses the maximal response to another drug is a: A. Physiological antagonist B. Competitive antagonist C. Noncompetitive antagonist D. Partial agonist (p. 50) 3.34 The following is not a feature of competitive antagonists: A. Chemical resemblance with the agonist B. Parallel rightward shift of the agonist log dose- response curve C. Suppression of maximal agonist response D. Apparent reduction in agonist affinity for the receptor (p. 50) 3.35 The following is a competitive antagonist of GABA but a noncompetitive antagonist of diazepam: A. Picrotoxin B. Muscimol C. Flumazenil D. Bicuculline (p. 50, 364, 435) 3.31 B 3.32 C 3.33 C 3.34 C 3.35 D 20 MCQs in Pharmacology 3.36 The dose of the following class of drugs has to be adjusted by repeated measurement of the affected physiological parameter: A. Oral contraceptives B. Antiepileptics C. Antidepressants D. Oral anticoagulants (p. 51) 3.37 A drug which is generally administered in standard doses without the need for dose individualization is: A. Insulin B. Mebendazole C. Prednisolone D. Digoxin (p. 51) 3.38 Which of the following statements is not true of fixed dose combination formulations: A. They are more convenient B. Contraindication to one of the components does not contraindicate the formulation C. The dose of any one component cannot be independently adjusted D. The time course of action of the different compo- nents may not be identical (p. 51-52) 3.39 Fixed dose combination formulations are not necessarily appropriate for: A. Drugs administered in standard doses B. Drugs acting by the same mechanism C. Antitubercular drugs D. Antihypertensive drugs (p. 51, 515-17, 704) 3.40 A fixed dose combination preparation meant for internal use must not contain the following class of drug: A. Thiazide diuretic B. Fluoroquinolone antimicrobial C. Corticosteroid D. H2 blocker (p. 52) 3.36 D 3.37 B 3.38 B 3.39 B 3.40 C  General Pharmacological Principles 21 3.41 Interindividual variations in equieffective doses of a drug are most marked if it is disposed by: A. Glomerular filtration B. Tubular secretion C. Both glomerular filtration and tubular secretion D. Hepatic metabolism (p. 52) 3.42 The pharmacokinetics of drugs in the neonate differs from that in adults, because their: A. Intestinal transit is fast B. Drug metabolizing enzymes are overactive C. Tubular transport mechanisms are not well developed D. Glomerular filtration rate is high (p. 53) 3.43 Which adverse drug effect is more common in children than in adults: A. Isoniazid induced neuropathy B. Chlorpromazine induced muscle dystonia C. Digoxin induced cardiac arrhythmia D. Penicillin hypersensitivity (p. 53, 397) 3.44 The elderly patients are relatively intolerant to: A. Digoxin B. Salbutamol C. Propranolol D. Nifedipine (p. 54, 463) 3.45 The following drug adverse effect is specially noted in men compared to women: A. Tardive dyskinesia due to neuroleptics B. Levodopa induced abnormal movements C. Ampicillin induced loose motions D. Ketoconazole induced loss of libido (p. 54, 720) 3.41 D 3.42 C 3.43 B 3.44 A 3.45 D 22 MCQs in Pharmacology 3.46 Which racial difference in response to drugs has been mentioned incorrectly below: A. Africans require higher concentration of atro- pine to dilate pupils B. Black races are more responsive to antihyper- tensive action of beta blockers C. Japanese are more prone to develop SMON due to halogenated hydroxyquinolines D. Chloramphenicol induced aplastic anaemia is rare among Indians (p. 54) 3.47 Which of the following adverse drug reactions is due to a specific genetic abnormality: A. Tetracycline induced sunburn like skin lesions B. Quinidine induced thrombocytopenia C. Metoclopramide induced muscle dystonia D. Primaquine induced massive haemolysis (p. 54) 3.48 Drug metabolism can be induced by the following factors except: A. Cigarette smoking B. Acute alcohol ingestion C. Exposure to insecticides D. Consumption charcoal broiled meat (p. 55, 351) 3.49 A drug which produces qualitatively different actions when administered through different routes is: A. Phenytoin sodium B. Hydralazine C. Magnesium sulfate D. Nitroglycerine (p. 55) 3.50 Which of the following is true of ‘placebos’: A. Placebo is a dummy medication B. Placebo is the inert material added to the drug for making tablets C. Placebos do not produce any effect D. All patients respond to placebos (p. 55) 3.46 B 3.47 D 3.48 B 3.49 C 3.50 A  General Pharmacological Principles 23 3.51 In patients of hepatic cirrhosis: A. The extent of change in pharmacokinetics of drugs can be predicted from the values of liver function tests B. High doses of furosemide can be safely used C. Metformin is the preferred oral hypoglycaemic D. Disposition of atenolol is not significantly affected (p. 56) 3.52 In patients with renal insufficiency the clearance of the following drug is reduced parallel to the reduction in creatinine clearance: A. Propranolol B. Digoxin C. Lignocaine D. Verapamil (p. 56) 3.53 The following statement is not correct for uremic patients: A. Attainment of steady-state plasma concentration of drugs eliminated through the kidney is hastened B. Pethidine can cause seizures C. Diazepam produces exaggerated CNS depression D. Tetracyclines further raise blood urea level (p. 56) 3.54 In congestive heart failure patients: A. Volume of distribution of all drugs is increased B. Hepatic clearance of drugs is unaffected C. Orally administered diuretics may not be effec- tive, but the same may work parenterally D. Inotropic action of digoxin is attenuated (p. 56-57) 3.51 D 3.52 B 3.53 A 3.54 C 24 MCQs in Pharmacology 3.55 Interaction between the following pair of drugs can be avoided by making suitable adjustments: A. Levodopa and metoclopramide B. Furosemide and indomethacin C. Tetracyclines and ferrous sulfate D. Clonidine and chlorpromazine (p. 57, 670) 3.56 Drug cumulation is the basis of organ toxicity of the following drug when used for prolonged periods: A. Prednisolone B. Chloroquine C. Aspirin D. Hydralazine (p. 58, 740) 3.57 Tolerance is generally not acquired to: A. Antisecretory action of atropine B. Sedative action of chlorpromazine C. Emetic action of levodopa D. Vasodilator action of nitrates (p. 58, 384, 490) 3.58 Significant tolerance does not develop to the following action of morphine: A. Analgesia B. Euphoria C. Sedation D. Miosis (p. 58, 423) 3.59 In an anaesthetized dog, repeated intravenous injec- tion of ephedrine shows the phenomenon of: A. Anaphylaxis B. Tachyphylaxis C. Idiosyncrasy D. Drug resistance (p. 59) 3.55 C 3.56 B 3.57 A 3.58 D 3.59 B  General Pharmacological Principles 25 4.1 An undesirable effect of a drug that occurs at thera- peutic doses and can be predicted from its pharma- cological actions is called: A. Side effect B. Toxic effect C. Allergic reaction D. Idiosyncrasy (p. 61) 4.2 Which of the following is a type B (unpredictable) adverse drug reaction: A. Side effect B. Toxic effect C. Idiosyncrasy D. Physical dependence (p. 60, 62) 4.3 The side effect of a drug which has been used as a therapeutic effect in another condition is: A. Constipation caused by codeine B. Cough caused by captopril C. Uterine stimulation caused by quinine D. Diarrhoea caused by ampicillin (p. 61) 4.4 A ‘toxic effect’ differs from a ‘side effect’ in that: A. It is not a pharmacological effect of the drug B. It is a more intense pharmacological effect that occurs at high dose or after prolonged medication C. It must involve drug induced cellular injury D. It involves host defence mechanisms (p. 61) 4.5 The following statement is true in relation to ‘drug toxicity’ and ‘poisoning’: A. The two terms are synonymous B. When a toxic effect requires specific treat- ment, it is called poisoning C. A toxic effect which endangers life by markedly affecting vital functions is called poisoning D. Toxicity is caused by drugs while poisoning is caused by other harmful chemicals (p. 61, 62) 4.1 A 4.2 C 4.3 A 4.4 B 4.5 C 26 MCQs in Pharmacology 4.6 Use of an emetic to remove the ingested poison is contraindicated in following poisonings except that by: A. Strychnine B. Caustic soda C. Ferrous sulfate D. Kerosene (p. 62, 600) 4.7 Which of the following is an idiosyncratic adverse drug reaction: A. Muscle dystonia caused by triflupromazine B. Insomnia after taking pentobarbitone C. Precipitation of asthma by morphine D. Gum hyperplasia caused by phenytoin (p. 62) 4.8 An immunologically mediated reaction to a drug pro- ducing stereotyped symptoms unrelated to its pharma- codynamic actions is: A. Hypersensitivity B. Supersensitivity C. Intolerance D. Idiosyncrasy (p. 62, 63) 4.9 Drugs producing allergic reactions generally act as: A. Complete antigens B. Haptenes C. Antibodies D. Mediators (p. 63) 4.10 The following allergic drug reaction is caused by circulating antibodies: A. Serum sickness B. Anaphylactic shock C. Systemic lupus erythematosus D. Angioedema (p. 63) 4.6 C 4.7 B 4.8 A 4.9 B 4.10 A  General Pharmacological Principles 27 4.11 Which of the following is the only life saving measure in case of anaphylactic shock: A. Intravenous hydrocortisone hemisuccinate B. Intravenous chlorpheniramine maleate C. Intramuscular adrenaline hydrochloride D. Intravenous glucose-saline (p. 63, 64) 4.12 The type II, type III and type IV hypersensitivity reactions can be suppressed by: A. Adrenaline B. Antihistaminics C. Corticosteroids D. Sod. cromoglycate (p. 64) 4.13 The most appropriate route of administration for adrenaline in a case of anaphylactic shock is: A. Intracardiac B. Intravenous C. Intramuscular D. Subcutaneous (p. 63) 4.14 Intradermal drug sensitivity tests can detect the pres- ence of following type of hypersensitivity: A. Type I (anaphylactic) B. Type II (cytolytic) C. Type III (retarded) D. All of the above (p. 64) 4.15 An addicting drug which produces little or no physical dependence is: A. Diazepam B. Phenobarbitone C. Amphetamine D. Methadone (p. 65, 113) 4.11 C 4.12 C 4.13 C 4.14 A 4.15 C 28 MCQs in Pharmacology 4.16 The essential feature in drug addiction is: A. Physical dependence B. Psychological dependence C. Both physical and psychological dependence D. Psychiatric abnormality (p. 65) 4.17 Adaptive neurophysiological changes produced by repeated administration of a drug, which result in the appearance of characteristic withdrawal syndrome on discontinuation of the drug is called: A. Drug addiction B. Drug abuse C. Psychological dependence D. Physical dependence (p. 65) 4.18 Which of the following constitutes ‘drug abuse’: A. Physician prescribed use of penicillin G for the cure of viral fever B. Self administration of aspirin to relieve headache C. Repeated self administration of morphine to derive euphoria D. All of the above (p. 65) 4.19 ‘Addiction’ and ‘habituation’: A. Are fundamentally different phenomena B. Are produced by different set of drugs/substances C. Differ from one another by the presence or absence of physical dependence D. Differ from each other in the degree of attendant psychological dependence (p. 65) 4.16 B 4.17 D 4.18 C 4.19 D  General Pharmacological Principles 29 4.20 Adverse consequences may follow sudden discon- tinuation of the following drug after chronic intake: A. Cocaine B. Cannabis C. Clonidine D. All of the above (p. 65, 510) 4.21 The most vulnerable period of pregnancy for the causation of foetal malformations due to drugs is: A. 18-55 days of gestation B. 56-84 days of gestation C. Second trimester D. 36 weeks onwards (p. 65) 4.22 The following is a proven human teratogen: A. Chloroquine B. Warfarin sodium C. Dicyclomine D. Methyldopa (p. 66, 517, 601, 740) 4.23 Select the drug which has been found to be a strong human teratogen: A. Isoniazid B. Isotretinoin C. Hydralazine D. Propylthiouracil (p. 66, 232, 512, 707, 801) 4.20 C 4.21 A 4.22 B 4.23 B 30 MCQs in Pharmacology 2 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 Drugs Acting on Autonomic Nervous System CHOOSE THE MOST APPROPRIATE RESPONSE 5.1 Which of the following organs is innervated only by parasympathetic nerves: A. Iris muscles B. Ciliary muscle C. Sweat glands D. Splenic capsule (p. 72) 5.2 The sympathetic and parasympathetic systems exert functionally opposite influences on the following para- meters except: A. Heart rate B. Atrial refractory period C. Pupil diameter D. Intestinal motility (p. 72) 5.3 Tetrodotoxin blocks nerve impulse/junctional trans- mission by: A. Anticholinergic action B. Depleting acetylcholine C. Blocking Na+ channels D. Blocking Ca2+ channels (p. 74) 5.1 B 5.2 B 5.3 C  Autonomic Nervous System 31 5.4 The cotransmitter may serve the following function/ functions: A. Regulate the release of the primary trans- mitter from the nerve ending B. Alter postjunctional action of the primary transmitter C. Itself act as an alternative transmitter D. All of the above (p. 75) 5.5 The following cotransmitter is most probably involved in mediating nonadrenergic noncholinergic (NANC) relaxation of the gut: A. Neuropeptide Y (NPY) B. Adenosine C. Nitric oxide (NO) D. Kallidin (p. 75, 603) 6.1 The major postjunctional cholinergic receptor is of the muscarinic type at the following site: A. Postganglionic parasympathetic B. Adrenal medulla C. Autonomic ganglia D. Neuromuscular junction (p. 77) 6.2 Pseudocholinesterase differs from true cholinesterase in that: A. It does not hydrolyse acetylcholine B. It hydrolyses acetylcholine at a slower rate C. It is more susceptible to inhibition by physo- stigmine D. It is the only form of circulating cholinesterase (p. 78) 6.3 The choline ester resistant to both true and pseudo- cholinesterase is: A. Methacholine B. Bethanechol C. Benzoylcholine D. Butyrylcholine (p. 78, 80) 5.4D 5.5C 6.1 A 6.2B 6.3B 32 MCQs in Pharmacology 6.4 Muscarinic cholinergic receptors: A. Are located only on parasympathetically innervated effector cells B. Mediate responses by opening an intrinsic Na+ ion channel C. Are present on vascular endothelium which has no cholinergic nerve supply D. Predominate in the autonomic ganglia (p. 77, 78) 6.5 The cardiac muscarinic receptors: A. Are of the M1 subtype B. Are of the M2 subtype C. Are selectively blocked by pirenzepine D. Function through the PIP2 → IP3/DAG path- way (p. 78) 6.6 Cholinergic muscarinic receptor stimulation produces the following effects except: A. Sweating B. Rise in blood pressure C. Bradycardia D. Urination (p. 80) 6.7 The smooth muscle structure that is relaxed by choli- nergic drugs is: A. Colon B. Gastric fundus C. Major bronchi D. Bladder trigone (p. 80) 6.8 Which of the following secretions is not stimulated by acetylcholine: A. Tear B. Bile C. Pancreatic juice D. Sweat (p. 80) 6.4 C 6.5 B 6.6 B 6.7 D 6.8 B  Autonomic Nervous System 33 6.9 Acetylcholine has no therapeutic application because: A. None of its actions are beneficial in any condition B. Its effects are transient C. It produces wide spread actions affecting many organs D. Both ‘B’ and ‘C’ are correct (p. 80) 6.10 Pilocarpine is used for: A. Glaucoma B. Paralytic ileus C. Urinary retention D. All of the above (p. 81) 6.11 Actions of pilocarpine include the following except: A. Sweating B. Salivation C. Miosis D. Cycloplegia (p. 81) 6.12 The following inhibitor binds only to the ani-onic site of the cholinesterase enzyme: A. Neostigmine B. Physostigmine C. Edrophonium D. Dyflos (p. 83) 6.13 Reactivation of cholinesterase enzyme occurs on hydrolysis of the inhibitor by the same enzyme mole- cule in case of the following anticholinesterase: A. Edrophonium B. Neostigmine C. Dyflos D. Tacrine (p. 83) 6.9 D 6.10 A 6.11 D 6.12 C 6.13 B 34 MCQs in Pharmacology 6.14 The anticholinesterase action of edrophonium is short lasting because termination of its action depends on: A. Dissociation and diffusion of the drug from the enzyme B. Hydrolysis of the drug by the enzyme C. Synthesis of fresh enzyme molecules D. A combination of the above three processes (p. 83) 6.15 The organophosphates produce irreversible inhibition of cholinesterase because: A. They bind to an allosteric site of the enzyme resulting in unfavourable conformation of este- ratic site to bind acetylcholine B. Regeneration time of the phosphorylated enzyme is longer than the turnover time of the enzyme molecules C. Phosphorylation results in rapid degradation of enzyme molecules D. They are neither metabolized nor excreted from the body (p. 83) 6.16 Out of two anticholinesterases, drug ‘X’ is a tertiary amine while drug ‘Y’ is a quarternary ammonium com- pound. Then: A. Drug ‘X’ is likely to be more potent than ‘Y’ B. Drug ‘X’ will be more suitable to be used as a miotic C. Drug ‘Y’ will be completely metabolized in the body D. Drug ‘Y’ will produce CNS effects (p. 84) 6.14 A 6.15 B 6.16 B  Autonomic Nervous System 35 6.17 Neostigmine is preferred over physostigmine for treat- ing myasthenia gravis because: A. It is better absorbed orally B. It has longer duration of action C. It has additional direct agonistic action on nicotinic receptors at the muscle end plate D. It penetrates blood-brain barrier (p. 84, 89) 6.18 The mechanism by which neostigmine improves con- traction of myasthenic muscle involves: A. Repetitive binding of the acetylcholine mole- cules to the same receptors at the muscle end- plate B. Diffusion of acetylcholine released from motor nerve endings to a wider area activating neigh- bouring receptors C. Activation of motor end-plate receptors by neostigmine molecules themselves D. All of the above (p. 89) 6.19 Pyridostigmine differs from neostigmine in that: A. It is more potent orally B. It is longer acting C. It produces less muscarinic side effects D. It does not have any direct action on NM receptors (p. 84) 6.20 Edrophonium is more suitable for differentiating myas- thenic crisis from cholinergic crisis because of its: A. Shorter duration of action B. Longer duration of action C. Direct action on muscle end-plate D. Selective inhibition of true cholinesterase (p. 84, 90) 6.17 C 6.18 D 6.19 B 6.20 A 36 MCQs in Pharmacology 6.21 Which of the following is a relatively cerebroselective anticholinesterase found to afford symptomatic improvement in Alzheimer's disease: A. Donepezil B. Gemfibrozil C. Pyridostigmine D. Pyritinol (p. 84-85, 439) 6.22 Pilocarpine reduces intraocular tension in open angle glaucoma by: A. Contracting sphincter pupillae B. Increasing tone of ciliary muscle C. Reducing aqueous formation D. Enhancing uveo-scleral outflow (p. 87) 6.23 The site of action of miotics for therapeutic effect in angle closure glaucoma is: A. Canal of Schlemm B. Ciliary body C. Ciliary muscle D. Sphincter pupillae muscle (p. 89) 6.24 Currently, the first choice drug for open angle glaucoma is: A. Miotic eye drops B. Ocular α2 adrenergic agonists C. Ocular prostaglandin analogues D. Ocular β adrenergic blockers (p. 85, 88) 6.25 Timolol eye drops are preferred over pilocarpine eye drops by glaucoma patients because: A. Timolol is more effective than pilocarpine B. Timolol acts by enhancing uveo-scleral outflow C. Timolol produces less ocular side effects D. There are no contraindications to timolol (p. 85, 86) 6.21 A 6.22 B 6.23 D 6.24 D 6.25 C  Autonomic Nervous System 37 6.26 Beta adrenergic blockers lower intraocular tension by: A. Down regulating adenylyl cyclase in ciliary body through reduced activation of β2 adreno- ceptors B. Constricting ciliary blood vessels C. Blocking adrenergic action on trabecular meshwork D. Reducing aqueous formation unrelated to beta adrenoceptor mediation (p. 85) 6.27 Agonistic action on which of the following adrenergic receptors located on ciliary epithelial cells reduces aqueous secretion: A. β1 receptor B. β2 receptor C. α1 receptor D. α2 receptor (p. 87, 88) 6.28 To be used as a topically applied ocular beta blocker a drug should have the following properties except: A. Strong local anaesthetic activity B. High lipophilicity C. High ocular capture D. Low systemic activity (p. 85) 6.29 Betaxolol differs from timolol in that it: A. Is a β1 selective blocker B. Is more efficacious in glaucoma C. Produces less ocular side effects D. Is longer acting (p. 87) 6.30 Select the longer acting ocular beta blocker: A. Timolol B. Betaxolol C. Cartiolol D. Levobunolol (p. 87) 6.26 A 6.27 D 6.28 A 6.29 A 6.30 D 38 MCQs in Pharmacology 6.31 The following is an α2 adrenergic agonist used as eyedrops to lower intraocular pressure: A. Brinzolamide B. Bambuterol C. Brimonidine D. Latanoprost (p. 88) 6.32 Which of the following is a prodrug of adrenaline used topically in glaucoma: A. Brimonidine B. Dipivefrine C. Phenylpropanolamine D. Dorzolamide (p. 88) 6.33 Apraclonidine is a clonidine congener which is used: A. To suppress opioid withdrawal syndrome B. To suppress menopausal syndrome C. As Analgesic D. To reduce intraocular tension (p. 88) 6.34 Dorzolamide is a: A. Topically applied ocular carbonic anhydrase inhibitor B. Second generation sulfonylurea hypoglycaemic C. Topical sulfonamide antibacterial D. Luminal amoebicide (p. 88) 6.35 Choose the correct statement about latanoprost: A. It is a PGF2α derivative used in glaucoma B. It is a selective α1 blocker used in benign hypertrophy of prostate C. It is a 5-α-reductase inhibitor used to reduce the size of enlarged prostate gland D. It is a PGE2 analogue used intravaginally for cervical priming (p. 88) 6.31 C 6.32 B 6.33 D 6.34 A 6.35 A  Autonomic Nervous System 39 6.36 Select the diuretic that is most effective in acute congestive glaucoma: A. Indapamide B. Amiloride C. Mannitol D. Furosemide (p. 89) 6.37 Neostigmine is beneficial in cobra envenomation because: A. It binds to and inactivates cobra toxin B. It reverses coma due to cobra toxin C. It counteracts the cardio-depressant action of cobra toxin D. It antagonizes the paralysing action of cobra toxin (p. 91) 6.38 A suspected case of poisoning has been brought to the casualty with weakness, fainting, involuntary passage of urine and stools, profuse sweating, salivation, water- ing from nose and eyes. His pulse is 120/min, low volume, BP 90/60 mm Hg, respiration shallow, pupil constricted, muscles flabby with occasional fascicu- lations. Which is the most likely type of poisoning: A. Belladonna B. Barbiturate C. Anticholinesterase D. Dicophane (DDT) (p. 91) 6.39 Which is the most important drug in the treatment of organophosphate poisoning: A. Atropine sulfate B. Pralidoxime C. Diazepam D. Adrenaline (p. 91) 6.36 C 6.37 D 6.38 C 6.39 A 40 MCQs in Pharmacology 6.40 Atropine does not antagonise the following feature of anticholinesterase poisoning: A. Hypotension B. Central excitation C. Muscle paralysis D. Bronchoconstriction (p. 91) 6.41 Pralidoxime can reactivate cholinesterase enzyme that has been inactivated by: A. Carbamate anticholinesterases B. Organophosphate anticholinesterases C. Both carbamate and organophosphate anti- cholinesterases D. Reversible anticholinesterases (p. 91-92) 7.1 Initial bradycardia caused by intramuscular injection of atropine is believed to be caused by: A. Stimulation of medullary vagal centre B. Stimulation of vagal ganglia C. Blockade of M2 receptors on SA nodal cells D. Blockade of muscarinic autoreceptors on vagal nerve endings (p. 94) 7.2 Atropine does not exert relaxant/antispasmodic effect on the following muscle: A. Intestinal B. Ureteric C. Bronchial D. Laryngeal (p. 94, 98-99) 7.3 Atropine produces the following actions except: A. Tachycardia B. Mydriasis C. Dryness of mouth D. Urinary incontinence (p. 94, 95) 6.40 C 6.41 B 7.1 D 7.2 D 7.3 D  Autonomic Nervous System 41 7.4 The organ most sensitive to actions of atropine is: A. Gastric glands B. Salivary glands C. Urinary bladder muscle D. Heart (p. 95) 7.5 Hyoscine differs from atropine in that it: A. Exerts depressant effects on the CNS at relati- vely low doses B. Exerts more potent effects on the heart than on the eye C. Is longer acting D. Has weaker antimotion sickness activity (p. 96) 7.6 The quarternary analogues of belladonna alkaloids are preferred over the natural alkaloids for antisecretory/ antispasmodic indications because: A. They have additional nicotinic receptor block- ing activity B. They are incompletely absorbed after oral administration C. They are devoid of CNS and ocular effects D. Dose to dose they are more potent than atropine (p. 107) (Note: Many quarternary anticholinergics do have addi- tional nicotinic blocking activity and because of high ionization they are incompletely absorbed. But the reason for preferring them is lack of central and ocular effects. Most compounds are dose to dose less potent than atropine.) 7.4 B 7.5 A 7.6 C 42 MCQs in Pharmacology 7.7 Inhaled ipratropium bromide has the following advan- tages except: A. It does not alter respiratory secretions B. It does not depress airway mucociliary clearance C. It has faster onset of bronchodilator action than inhaled salbutamol D. It only rarely produces systemic side effects (p. 97) 7.8 Which of the following anticholinergic drugs is primarily used in preanaesthetic medication and during surgery: A. Glycopyrrolate B. Pipenzolate methyl bromide C. Isopropamide D. Dicyclomine (p. 97) 7.9 Children are more susceptible than adults to the following action of atropine: A. Tachycardia producing B. Cycloplegic C. Gastric antisecretory D. Central excitant and hyperthermic (p. 94, 95, 99) 7.10 Glycopyrrolate is the preferred antimuscarinic drug for use before and during surgery because: A. It is potent and fast acting B. It has no central action C. It has antisecretory and vagolytic actions D. All of the above (p. 97, 98) 7.11 Choose the relatively vasicoselective anticholinergic drug used for urinary frequency and urge incontinence due to detrusor instability: A. Pirenzepine B. Oxybutynin C. Oxyphenonium D. Glycopyrolate (p. 97, 98) 7.7 C 7.8 A 7.9 D 7.10 D 7.11 B  Autonomic Nervous System 43 7.12 Which of the following mydriatics has the fastest and briefest action: A. Atropine B. Homatropine C. Tropicamide D. Cyclopentolate (p. 98) 7.13 The following mydriatic does not produce cycloplegia: A. Phenylephrine B. Tropicamide C. Cyclopentolate D. Homatropine (p. 99, 113) 7.14 The most suitable mydriatic for a patient of corneal ulcer is: A. Atropine sulfate B. Homatropine C. Cyclopentolate D. Tropicamide (p. 99) 7.15 The mydriatic incapable of producing cycloplegia sufficient for refraction testing in children is: A. Atropine B. Hyoscine C. Homatropine D. Cyclopentolate (p. 98, 99) 7.16 Choose the correct statement about drotaverine: A. It is a smooth muscle antispasmodic acting by non-anticholinergic mechanisms B. It is a papaverine congener used in peripheral vascular diseases C. It is a synthetic atropine substitute used to control diarrhoea D. It is a M1/M3 selective antagonist used for spastic constipation (p. 98) 7.12 C 7.13 A 7.14 A 7.15 C 7.16 A 44 MCQs in Pharmacology 7.17 The most effective antidote for belladonna poisoning is: A. Neostigmine B. Physostigmine C. Pilocarpine D. Methacholine (p. 100) 7.18 Atropine is contraindicated in: A. Pulmonary embolism B. Digitalis toxicity C. Iridocyclitis D. Raised intraocular tension (p. 100) 7.19 Choose the correct statement about nicotine: A. It selectively stimulates parasympathetic gan- glia B. It has no clinical application C. It is used as an aid during smoking cessation D. It is used in Alzheimer's disease (p. 101) 7.20 Ganglion blocking drugs are no longer used in thera- peutics because: A. They have few and weak pharmacological actions B. They produce many side effects C. They are inactive by oral route D. They have short duration of action (p. 102) 8.1 Which of the following is a noncatecholamine sympathomimetic: A. Adrenaline B. Ephedrine C. Dopamine D. Isoprenaline (p. 103, 113) (Note: Ephedrine has no-OH group on the benzene ring; hence it is a phenylamine.) 7.17 B 7.18 D 7.19 C 7.20 B 8.1 B  Autonomic Nervous System 45 8.2 The rate limiting enzyme in the synthesis of catecho- lamines is: A. Tyrosine hydroxylase B. Dopa decarboxylase C. Dopamine β-hydroxylase D. Noradrenaline N-methyl transferase (p. 103) 8.3 The most efficacious inhibitor of catecholamine syn- thesis in the body is: A. α-methyl-p-tyrosine B. α-methyldopa C. α-methyl-norepinephrine D. Entacapone (p. 103, 107) 8.4 Tyramine induces release of noradrenaline from adre- nergic nerve endings: A. By depolarizing the axonal membrane B. By mobilizing Ca2+ C. By a nonexocytotic process D. Only in the presence of MAO inhibitors (p. 104) 8.5 The following type/types of noradrenaline uptake is blocked by reserpine: A. Axonal uptake B. Granular uptake C. Extraneuronal uptake D. All of the above (p. 104) 8.6 The principal process which terminates the action of noradrenaline released from adrenergic nerve ending is: A. Degradation by MAO B. Methylation by COMT C. Axonal uptake D. Extraneuronal uptake (p. 104) 8.2 A 8.3 A 8.4 C 8.5 B 8.6 C 46 MCQs in Pharmacology 8.7 Which of the following is not the basis for subclassi- fying β adrenergic receptors into β1 and β2 : A. Selectivity of agonists B. Selectivity of antagonists C. Transducer pathway of response effectuation D. Organ selective location (p. 105, 106) (Note: Both β1 and β2 adrenoceptors utilize the adenylyl cyclase-cyclic AMP pathway.) 8.8 The β3 adrenoceptor differs from the other subtypes of β receptor in that it: A. Is not blocked by the conventional doses of propranolol B. Is located primarily in the heart C. Regulates blood sugar level D. Is not coupled to G proteins (p. 106) 8.9 The α2 adrenoceptors are: A. Located exclusively on the adrenergic nerve endings B. Prejunctional, postjunctional as well as extra- junctional in location C. Selectively activated by phenylephrine D. Selectively blocked by clonidine (p. 106) 8.10 The following is a selective α2 adrenoceptor antagonist: A. Prazosin B. Phentolamine C. Yohimbine D. Clonidine (p. 106, 122) 8.7 C 8.8 A 8.9 B 8.10 C  Autonomic Nervous System 47 8.11 A sympathomimetic amine that acts almost exclu- sively by releasing noradrenaline from the nerve endings is: A. Ephedrine B. Dopamine C. Isoprenaline D. Tyramine (p. 106, 107) 8.12 The following sympathomimetic amine has agonistic action on α1 + α2 + β1 + β3 adrenoceptors, but not on β2 receptors: A. Adrenaline B. Noradrenaline C. Isoprenaline D. Phenylephrine (p. 107) 8.13 The following action of adrenaline is mediated by both α and β receptors producing the same directional effect: A. Cardiac stimulation B. Intestinal relaxation C. Dilatation of pupil D. Bronchodilatation (p. 109) 8.14 The following action of adrenaline is not mediated by β receptors: A. Dilatation of blood vessels B. Dilatation of pupil C. Bronchodilation D. Renin release from kidney (p. 109, 110) 8.15 Low doses of adrenaline dilate the following vascular bed: A. Cutaneous B. Mucosal C. Renal D. Skeletal muscle (p. 109, 111) 8.11 D 8.12 B 8.13 B 8.14 B 8.15 D 48 MCQs in Pharmacology 8.16 Vasomotor reversal phenomenon after administration of an α adrenergic blocker is seen with: A. Adrenaline B. Noradrenaline C. Isoprenaline D. All of the above drugs (p. 110, 119) 8.17 Adrenergic β2 agonists produce muscle tremor by: A. Facilitating neuromuscular transmission B. Incomplete fusion of contractile response of individual fibres C. Enhanced firing of muscle spindles D. Both (b) and (c) are correct (p. 110) 8.18 Adrenaline is inactive orally because it is: A. Not absorbed from the gastrointestinal tract B. Destroyed by gastric acid C. Completely metabolized in the intestinal mucosa and liver before reaching systemic circulation D. Taken up by adrenergic nerve endings of the intestinal wall, liver and lungs (p. 111) 8.19 Adrenaline raises blood glucose level by the following actions except: A. Inducing hepatic glycogenolysis B. Inhibiting insulin secretion from pancreatic β cells C. Augmenting glucagon secretion from pan- creatic α cells D. Inhibiting peripheral glucose utilization (p. 110-111) 8.20 The metabolic actions of adrenaline include the follo- wing except: A. Glycogenolysis in liver and muscle B. Inhibition of neoglucogenesis in liver C. Lipolysis in adipose tissue D. Release of potassium from liver followed by its uptake (p. 111) 8.16 A 8.17 D 8.18 C 8.19 D 8.20 B  Autonomic Nervous System 49 8.21 Noradrenaline is administered by: A. Subcutaneous injection B. Intramuscular injection C. Slow intravenous infusion D. All of the above routes (p. 111) 8.22 Dopaminergic D1 and D2 as well as adrenergic α and β1, but not β2 receptors are activated by: A. Dopamine B. Dobutamine C. Methoxamine D. Phenylephrine (p. 112) 8.23 Dobutamine differs from dopamine in that: A. It does not activate peripheral dopaminergic receptors B. It does not activate adrenergic β receptors C. It causes pronounced tachycardia D. It has good blood-brain barrier penetrability (p. 112) 8.24 Choose the drug which is used as a short-term inotropic in severe congestive heart failure and has selective adrenergic β1 agonistic activity but no dopaminergic agonistic activity: A. Dopamine B. Dobutamine C. Amrinone D. Salmeterol (p. 112) 8.25 Ephedrine is similar to adrenaline in the following feature: A. Potency B. Inability to penetrate blood-brain barrier C. Duration of action D. Producing both α and β adrenergic effects (p. 113) 8.21 C 8.22 A 8.23 A 8.24 B 8.25 D 50 MCQs in Pharmacology 8.26 At therapeutic doses, actions of amphetamine include the following except: A. Prolongation of attention span B. Wakefulness C. Lowering of seizure threshold D. Delaying fatigue (p. 113) 8.27 Amphetamine potentiates the following class of drugs: A. Diuretics B. Analgesics C. Neuroleptics D. Antihypertensives (p. 113) 8.28 Which pressor agent acts directly as well as indirectly and produces both vasoconstriction and cardiac stimulation: A. Phenylephrine B. Methoxamine C. Noradrenaline D. Mephentermine (p. 114) 8.29 Phenylephrine instilled in the eye produces: A. Mydriasis but no cycloplegia B. Cycloplegia but no mydriasis C. Both mydriasis and cycloplegia D. Neither mydriasis nor cycloplegia (p. 113, 117) 8.30 While undergoing a surgical procedure a patient deve- lops hypotension. Which drug can be injected intramuscularly to raise his BP: A. Noradrenaline B. Isoprenaline C. Mephentermine D. Isoxsuprine (p. 114) 8.26 C 8.27 B 8.28 D 8.29 A 8.30 C  Autonomic Nervous System 51 8.31 Which of the following drugs has been used both as orally active nasal decongestant as well as appetite suppressant, and has been implicated in precipitating haemorrhagic stroke: A. Dexfenfluramine B. Phenylpropanolamine C. Isoxsuprine D. Oxymetazoline (p. 115) 8.32 The following is true of fenfluramine except: A. It lacks CNS stimulant action B. Its use has been associated with cardiac abnormalities and pulmonary hypertension C. It causes weight loss independent of reduced food intake D. It enhances serotonergic transmission in the brain (p. 115, 117) 8.33 Choose the correct statement about sibutramine: A. It is an anorectic drug used to assist weight reduction B. It is an atypical antidepressant C. It is a 5-HT1D receptor antagonist D. Both A and C are correct (p. 116) 8.34 Vasoconstrictors should not be used in: A. Neurogenic shock B. Haemorrhagic shock C. Secondary shock D. Hypotension due to spinal anaesthesia (p. 116) 8.35 Adrenaline injected with a local anaesthetic: A. Reduces local toxicity of the local anaesthetic B. Reduces systemic toxicity of the local anaes- thetic C. Shortens duration of local anaesthesia D. Makes the injection less painful (p. 116, 323) 8.31 B 8.32 C 8.33 A 8.34 C 8.35 B 52 MCQs in Pharmacology 8.36 The most likely complication of prolonged use of nasal decongestant drops is: A. Atrophic rhinitis B. Hypertrophy of nasal mucosa C. Naso-pharyngeal moniliasis D. Blockage of eustachian tubes (p. 116) 8.37 Isoxsuprine increases limb blood flow in normal indivi- duals, but is of limited efficacy in Buerger’s disease, because in this disease: A. Vasodilator β adrenoceptors are deficient B. There is loss of sympathetic innervation C. Blood flow to the affected limb is reduced by organic obstruction D. The drug is not delivered to the affected site (p. 116, 501) 8.38 Dexamphetamine produces an apparently paradoxical effect in: A. Addicts B. Athletes C. Parkinsonian patients D. Hyperkinetic children (p. 117) 9.1 Adrenergic neurone blocking drugs: A. Block the action of adrenaline on neuronal α2 adrenoceptors B. Block both α and β adrenoceptor mediated effects of injected adrenaline C. Do not block any effect of injected adrenaline D. Do not block the effects of sympathetic nerve stimulation (p. 119, 120) 8.36 A 8.37 C 8.38 D 9.1 C  Autonomic Nervous System 53 9.2 The nonselective α adrenergic blockers produce the following actions except: A. Postural hypotension B. Bradycardia C. Miosis D. Inhibition of ejaculation (p. 119, 120) 9.3 The drug which produces vasoconstriction despite being an α adrenergic blocker is: A. Phenoxybenzamine B. Ergotamine C. Dihydroergotoxine D. Tolazoline (p. 121) 9.4 The bladder trigone and prostatic muscles are relaxed by: A. Adrenergic α1 agonists B. Adrenergic α1 antagonists C. Adrenergic α2 agonists D. Adrenergic α2 antagonists (p. 120) 9.5 The primary reason for preferring phentolamine as the α adrenergic blocker for performing diagnostic test for pheochromocytoma is: A. It produces rapid and short lasting α-adre- nergic blockade B. It equally blocks α1 and α2 adrenoceptors C. It is the most potent α blocker D. It has no additional β adrenergic blocking property (p. 121) 9.2 B 9.3 B 9.4 B 9.5 A 54 MCQs in Pharmacology 9.6 Prazosin is an effective antihypertensive while non- selective α adrenergic blockers are not because: A. It is the only orally active α blocker B. It improves plasma lipid profile C. It does not concurrently enhance noradrena- line release D. It improves urine flow in males with prostatic hypertrophy (p. 121, 123) 9.7 Phentolamine test is considered positive for pheochro- mocytoma if there is a: A. Rise in BP by more than 35 mm Hg systolic and 25 mm Hg diastolic B. Rise in systolic but fall in diastolic BP C. Fall in both systolic and diastolic BP by less than 20 mm Hg D. Fall in BP by more than 35 mm Hg systolic and more than 25 mm Hg diastolic (p. 122) 9.8 Select the drug which affords faster and greater symptomatic relief in benign hypertrophy of prostate: A. Terazosin B. Desmopressin C. Finasteride D. Sildenafil (p. 123) 9.9 Select the drug which can improve urinary flow rate in benign prostatic hypertrophy without affecting pros- tate size: A. Amphetamine B. Prazosin C. Finasteride D. Goserelin (p. 123) 9.6 C 9.7 D 9.8 A 9.9 B  Autonomic Nervous System 55 9.10 Which of the following is a selective α1A receptor bloc- ker that affords symptomatic relief in benign prostatic hypertrophy without producing significant fall in blood pressure: A. Terazosin B. Doxazosin C. Trimazosin D. Tamsulosin (p. 122, 124) 9.11 Sildenafil is contraindicated in patients taking the following class of drugs: A. α-adrenergic blockers B. β-adrenergic blockers C. Organic nitrates D. Angiotensin converting enzyme inhibitors (p. 124) 9.12 What is true of sildenafil: A. It enhances sexual enjoyment in normal men B. It delays ejaculation C. It improves penile tumescence in men with erectile dysfunction D. It blocks cavernosal α2 adrenoceptors (p. 124) 9.13 Select the drug which is administered orally for erectile dysfunction in men: A. Yohimbine B. Papaverine C. Alprostadil D. Sildenafil (p. 124) 9.14 The β adrenergic blocker having β1 selectivity, intrinsic sympathomimetic activity and membrane stabilizing property is: A. Carvedilol B. Atenolol C. Acebutolol D. Metoprolol (p. 128, 129) 9.10 D 9.11 C 9.12 C 9.13 D 9.14 C 56 MCQs in Pharmacology 9.15 All of the following contribute to the antihypertensive action of propranolol except: A. Direct vasodilatation B. Decreased renin release from kidney C. Adaptation of blood vessels to reduced cardiac output D. Less noradrenaline release from sympathetic nerve endings (p. 125, 126) 9.16 The effect of propranolol on heart rate is least marked under the following condition: A. Physical exercise B. Rest C. Anxiety D. Sick sinus syndrome (p. 125) 9.17 Propranolol can be used to allay anxiety associated with: A. Chronic neurotic disorder B. Schizophrenia C. Short-term stressful situations D. Endogenous depression (p. 130, 402) 9.18 Propranolol does not block the following action of adrenaline: A. Bronchodilatation B. Lipolysis C. Muscle tremor D. Mydriasis (p. 126) 9.19 Which of the following drugs attenuates the antihyper- tensive action of β-blockers: A. Cimetidine B. Indomethacin C. Chlorpromazine D. Imipramine (p. 127) 9.15 A 9.16 B 9.17 C 9.18 D 9.19 B  Autonomic Nervous System 57 9.20 Select the drug which can impair carbohydrate tolerance in prediabetics but prolongs insulin hypoglycaemia: A. Salbutamol B. Propranolol C. Prazosin D. Nifedipine (p. 127, 242) 9.21 The following disease is worsened by propranolol: A. Glaucoma B. Raynaud’s disease C. Benign prostatic hypertrophy D. Parkinsonism (p. 127) 9.22 β-adrenergic blockers are indicated in the following conditions except: A. Hypertrophic cardiomyopathy B. Congestive heart failure C. Vasospastic angina pectoris D. Dissecting aortic aneurysm (p. 127, 130) 9.23 Select the ultrashort acting cardioselective β adre- nergic blocker: A. Bisoprolol B. Timolol C. Sotalol D. Esmolol (p. 129) 9.24 Esmolol has the following features except: A. Rapidly developing, shortlasting β adrenergic blockade B. Cardioselectivity of action C. Intrinsic sympathomimetic activity D. Suitability for intraoperative use (p. 129) 9.20 B 9.21 B 9.22 C 9.23 D 9.24 C 58 MCQs in Pharmacology 9.25 In a patient of hypertension, the dose of propranolol that normalized blood pressure, reduced resting heart rate to 50/min. Which of the following β blockers will be most suitable for him as an alternative so that heart rate is not markedly reduced: A. Pindolol B. Celiprolol C. Bisoprolol D. Atenolol (p. 129) 9.26 In patients of congestive heart failure, β-adrenergic blockers: A. Are absolutely contraindicated B. Can prolong survival C. Can improve haemodynamics after compen- sation has been restored D. Both B and C are correct (p. 130, 469) 9.27 The basis for use of β-adrenergic blockers in congestive heart failure (CHF) is: A. They exert positive inotropic effect in CHF B. They counteract deleterious effect of sympa- thetic overactivity on the myocardium C. They exert antiischaemic effect on the heart D. They prevent cardiac arrhythmias (p. 130, 469) 9.28 Adrenergic β1 selective blockers offer the following advantages except: A. Lower propensity to cause bronchospasm B. Less prone to produce cold hands and feet as side effect C. Withdrawal is less likely to exacerbate angina pectoris D. Less liable to impair exercise capacity (p. 127-128) 9.25 A 9.26 D 9.27 B 9.28 C  Autonomic Nervous System 59 9.29 The following is not a feature of cardioselective beta blockers, when compared to propranolol: A. They are ineffective in suppressing muscle tremor B. They are safer in diabetics C. They are less likely to cause bradycardia D. They are less likely to worsen Raynaud’s disease (p. 128) 9.30 Select the β adrenergic blocker that is primarily eliminated unchanged by renal excretion: A. Propranolol B. Metoprolol C. Esmolol D. Atenolol (p. 128, 129) 9.31 In a patient of myocardial infarction, β adrenergic blockers are used with the following aim/aims: A. To reduce the incidence of reinfarction B. To prevent cardiac arrhythmias C. To limit size of the infarct D. All of the above (p. 130) 9.32 Select the β-adrenergic blocker that has additional α1 blocking, vasodilator and antioxidant properties: A. Carvedilol B. Celiprolol C. Acebutolol D. Metoprolol (p. 131) 9.33 In hyperthyroidism, β adrenergic blockers are used: A. To induce euthyroid state B. As definitive therapy C. For rapid control of certain symptoms while awaiting response to carbimazole D. To reduce basal metabolic rate (p. 130, 234) 9.29 C 9.30 D 9.31 D 9.32 A 9.33 C 60 MCQs in Pharmacology 9.34 Select the drug that suppresses essential tremor, but not parkinsonian tremor: A. Procyclidine B. Propranolol C. Promethazine D. Prochlorperazine (p. 131) 9.35 Labetalol has: A. More potent β adrenergic blocking than α blocking activity B. More potent α adrenergic blocking than β blocking activity C. Equal α and β adrenergic blocking activity D. β1 agonistic activity in addition to α and β adrenergic blockade (p. 131) 9.36 Labetalol differs from propranolol in that: A. It has additional α1 blocking property B. It is a selective β1 blocker C. It does not undergo first pass metabolism D. All of the above (p. 131) 9.34 B 9.35 A 9.36 A  Autacoids 61 3 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 1234567890123456789 Autacoids and Related Drugs CHOOSE THE MOST APPROPRIATE RESPONSE 10.1 Autacoids differ from hormones in that: A. Autacoids are involved only in the causation of pathological states B. Autacoids do not have a specific cell/tissue of origin C. Autacoids generally act locally at the site of generation and release D. Both ‘B’ and ‘C’ are correct (p. 134) 10.2 Which of the following is a selective H1 receptor agonist: A. 4-methyl histamine B. Impromidine C. 2-Thiazolyl ethylamine D. Chlorpheniramine (p. 137) 10.3 The action of histamine that is not mediated through H1 receptors is: A. Release of EDRF from vascular endothelium resulting in vasodilatation B. Direct action on vascular smooth muscle causing vasodilatation C. Bronchoconstriction D. Release of catecholamines from adrenal medulla (p. 136, 137) 10.1 D 10.2 C 10.3 B 62 MCQs in Pharmacology 10.4 Histamine exerts the following actions except: A. Dilatation of large blood vessels B. Dilatation of small blood vessels C. Stimulation of isolated guineapig heart D. Itching (p. 136) 10.5 Fall in blood pressure caused by larger doses of histamine is blocked by: A. H1 antihistaminics alone B. H2 antagonists alone C. Combination of H1 and H2 antagonists D. None of the above (p. 136) 10.6 The following statement about histamine is not correct: A. It is the sole mediator of immediate hyper- sensitivity reaction B. It plays no role in delayed hypersensitivity reaction C. It serves as a neurotransmitter in the brain D. All types of histamine receptors are G protein coupled receptors (p. 137, 138) 10.7 Histamine is involved as a mediator in the following pathological condition: A. Delayed hypersensitivity reaction B. Inflammation C. Carcinoid syndrome D. Variant angina (p. 138) 10.8 The drug that can directly release histamine from mast cells without involving antigen-antibody reac- tion is: A. Aspirin B. Procaine C. Morphine D. Sulfadiazine (p. 138) 10.4 A 10.5 C 10.6 A 10.7 B 10.8 C  Autacoids 63 10.9 High anticholinergic property is present in the following antihistaminic: A. Diphenhydramine B. Astemizole C. Cetirizine D. Terfenadine (p. 139) 10.10 The following H1 antihistaminic has additional anti 5-HT, anticholinergic, sedative and appetite stimu- lating properties: A. Promethazine B. Terfenadine C. Cyproheptadine D. Hydroxyzine (p. 139, 149) 10.11 The conventional H1 antihistaminics possess the following additional properties except: A. Local anaesthetic B. Vasopressor C. Antiarrhythmic D. Catecholamine potentiating (p. 139, 141) 10.12 The capacity of an antihistaminic to produce seda- tion depends on the following except: A. Relative affinity for central versus periphe- ral H1 receptors B. Ability to penetrate blood-brain barrier C. Individual susceptibility D. Ratio of H1:H2 blockade produced by the drug (p. 139) 10.13 While prescribing a first generation H1 antihistaminic the patient should be advised to avoid: A. Driving motor vehicles B. Consuming processed cheese C. Strenuous physical exertion D. All of the above (p. 139) 10.9 A 10.10 C 10.11 B 10.12D 10.13 A 64 MCQs in Pharmacology 10.14 The following is not a feature of second generation antihistaminics: A. Nonimpairment of psychomotor performance B. High antimotion sickness activity C. Absence of anticholinergic/anti5-HTactions D. Additional mechanisms of antiallergic action (p. 141, 144) 10.15 The second generation H1 antihistaminics have the following advantages except: A. Lack of anticholinergic side effects B. Lack of alcohol potentiating potential C. Recipient can drive motor vehicles D. Good antipruritic action (p. 141, 142) 10.16 The following second generation anti-histaminic is not likely to produce ventricular arrhythmias when administered along with ketoconazole: A. Mizolastine B. Ebastine C. Terfenadine D. Astemizole (p. 142, 143) 10.17 Select the antihistaminic which blocks cardiac K+ channels when given in high doses or along with drugs that inhibit CYP3A4 isoenzyme: A. Chlorpheniramine B. Promethazine C. Astemizole D. Loratadine (p. 142) 10.18 Select the antihistaminic which modulates calcium channels and has prominant labyrinthine suppressant property: A. Cyproheptadine B. Cinnarizine C. Clemastine D. Cetirizine (p. 144) 10.14 B 10.15D 10.16 A 10.17 C 10.18 B  Autacoids 65 10.19 Erythromycin should not be given to a patient being treated with terfenadine because: A. Erythromycin induces the metabolism of terfenadine B. Dangerous ventricular arrhythmias can occur C. Terfenadine inhibitis metabolism of ery- thromycin D. Terfenadine antagonizes the antimicrobial action of erythromycin (p. 142) 10.20 Fexofenadine differs from terfenadine in that: A. It undergoes high first pass metabolism in liver B. It is a prodrug C. It does not block cardiac delayed rectifier K+ channels D. It has high affinity for central H1 receptors (p. 142) 10.21 Select the H1 antihistaminic which is used topically in the nose for allergic rhinitis: A. Loratadine B. Cetirizine C. Fexofenadine D. Azelastine (p. 140, 143) 10.22 H1 antihistaminics are beneficial in: A. All types of allergic disorders B. Certain type I allergic reactions only C. Certain type IV allergic reactions only D. Bronchial asthma (p. 63, 143) 10.23 Benefit afforded by certain H1 antihistaminics in the following condition is not based on antagonism of histamine: A. Dermographism B. Insect bite C. Common cold D. Seasonal hay fever (p. 143, 144) 10.19 B 10.20 C 10.21D 10.22 B 10.23 C 66 MCQs in Pharmacology 11.1 The following biogenic amine is not actively taken up into its storage site by an active amine pump: A. Histamine B. 5-Hydroxy tryptamine C. Dopamine D. Noradrenaline (p. 145) (Note: Active uptake of 5-HT, noradrenaline and dopamine occurs into neurones, platelets and other storage cells, but no uptake mechanism exists for histamine.) 11.2 The following action of 5-Hydroxy tryptamine is mediated by the 5-HT3 receptor: A. Vasoconstriction B. Bradycardia C. EDRF release D. Platelet aggregation (p. 146, 147) 11.3 The typical response to intravenous injection of 5-HT in an anaesthetised animal is: A. Rise in BP B. Fall in BP C. Rise followed by brief fall in BP D. Transient fall, followed by brief rise, followed by prolonged fall in BP (p. 147) 11.4 The following 5-HT receptor is not a G protein coupled receptor: A. 5-HT1 B. 5-HT2 C. 5-HT3 D. 5-HT4 (p. 146) 11.1 A 11.2 B 11.3D 11.4 C  Autacoids 67 11.5 Tachyphylaxis to many actions on repeated injec- tion is a feature of the following autacoid: A. Histamine B. 5-Hydroxytryptamine C. Bradykinin D. Prostaglandin E2 (p. 146) 11.6 The following is a selective 5-HT1D receptor agonist: A. Buspirone B. Ondansetron C. Sumatriptan D. α-methyl 5-HT (p. 146, 153) 11.7 Actions of 5-HT2 receptor activation are primarily mediated by: A. Increased membrane permeability to Na+ ions B. Increased formation of cAMP C. Activation of guanylyl cyclase D. Generation of inositol trisphosphate and diacyl glycerols (p. 146) 11.8 The following serotonergic receptor functions pri- marily as an autoreceptor on neurones: A. 5-HT1A B. 5-HT2A C. 5-HT3 D. 5-HT4 (p. 146) 11.9 The smooth muscle stimulating action of 5-HT is most marked in the: A. Bronchi B. Intestines C. Ureter D. Biliary tract (p. 147) 11.5 B 11.6 C 11.7 D 11.8 A 11.9 B 68 MCQs in Pharmacology 11.10 5-HT appears to play a role in the following except: A. Regulation of normal BP B. Regulation of intestinal peristalsis C. Haemostasis D. Causation of migraine (p. 148) 11.11 The most important receptor involved in cytotoxic drug induced vomiting is: A. Histamine H1 receptor B. Serotonin 5-HT3 receptor C. Dopamine D2 receptor D. Opioid μ receptor (p. 146, 600, 606) 11.12 The following is a selective 5-HT4 agonist: A. Buspirone B. Sumatriptan C. Cis