Pharmaceutics Questions - Pharmacy Prep PDF

Pharmacy Prep Pharmaceutical Sciences Q&A Misbah Biabani, Ph.D Director Toronto Institute of Pharmaceutical Sciences (TIPS) Inc. Toronto, ON...

Pharmacy Prep Pharmaceutical Sciences Q&A Misbah Biabani, Ph.D Director Toronto Institute of Pharmaceutical Sciences (TIPS) Inc. Toronto, ON M2N K7 Pharmacy Prep Professional Exams Preparation Center 4789 Yonge St. Suites 415-417 Toronto ON M2N 5M5, Canada WWW.PHARMACYPREP.COM 416-223-PREP (7737) / 647-221-0457/416-696-2455 Toronto Institute of Pharmaceutical Sciences Inc. © 2000- 2019 TIPS Inc. All Rights Reserved. Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is strictly prohibited and it is illegal to reproduce without permission. This manual is being used during review sessions conducted by PharmacyPrep  Disclaimer Your use and review of this information constitutes acceptance of the following terms and conditions: The information contained in the notes intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor or pharmacist can provide you with advice on what is safe and effective for you. Pharmacy prep make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, Pharmacy prep do not assume any responsibility or risk for your use of the pharmacy preparation manuals or review classes. In our teaching strategies, we utilize lecture-discussion, small group discussion, demonstrations, audiovisuals, case studies, written projects, role play, gaming techniques, study guides, selected reading assignments, computer assisted instruction (cai), and interactive video discs (ivd). Our preparation classes and books does not intended as substitute for the advise of NABPLEX®. Every effort has been made to ensure that the information provided herein is not directly or indirectly obtained from pebc® previous exams or copyright material. These references are not intended to serve as content of exam nor should it be assumed that they are the source of previous examination questions. ©2000-2019 TIPS. All rights reserved. Foreword by Misbah Biabani, Ph.D Coordinator, Pharmacy Prep Toronto Institute of Pharmaceutical Sciences (TIPS) Inc 4789 Yonge St. Suites 415-417 Toronto ON M2N 5M5, Canada Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is strictly prohibited and it is illegal to reproduce without permission. This manual is being used during review sessions conducted by PharmacyPrep Content Abbreviations Part 2. Pharmaceutical Sciences 25% 20. Pharmacokinetics 21. Rates and Orders of Reactions 22. Pharmacodynamics 23. Basics of Medicinal Chemistry 24. Medicinal Chemistry and Pharmacology of Autonomic Nervous System Drugs. 25. Medicinal Chemistry and Pharmacology of Histamines, Serotonin, Prostaglandin and Non-Steroidal Anti-inflammatory Drugs 26. Medicinal Chemistry and Pharmacology of Cardiovascular Drugs 27. Medicinal Chemistry and Pharmacology of Psychiatric & Neurological Drugs 28. Medicinal Chemistry and Pharmacology Endocrine Drugs 29. Medicinal Chemistry and Pharmacology of Respiratory Drugs 30. Medicinal Chemistry and Pharmacology of Musculoskeletal Drugs 31. Medicinal Chemistry and Pharmacology of Antimicrobial Drugs 32. Drug Metabolism 33. Biopharmaceutics 34. Physical Pharmacy 35. Pharmaceutical Excipient 36. Rheology 37. Pharmaceutical Dosage Forms 38. Drug Delivery Systems 39. Pharmaceutical Analysis Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is strictly prohibited and it is illegal to reproduce without permission. This manual is being used during review sessions conducted by PharmacyPrep Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is strictly prohibited and it is illegal to reproduce without permission. This manual is being used during review sessions conducted by PharmacyPrep  Pharmacokinetic Calculations PHARMACOKINETIC CALCULATIONS 1. A dose of 240 mg was given to a patient; his total body clearance is 3.5 L/min and the drug excreted unchanged in the urine is 80 mg. What is his non-renal clearance? A. 240 ml/min CLT = CLR+CLNR 240 mg ……..3.5L B. 2.3 L/min CLNR = CLT- CLR 80 mg …….? C. 3.3 L/min CLNR = 3.5L/min – 1.16L = 1.16L D. 1.16 L/min = 2.3L/min Ans: B 2. A drug is hepatically metabolized and renally excreted. Patient is receiving this medication has chronic renal disease thus, has low renal clearance. What is correct about the drug’s metabolism? A. Metabolites are excreted in stools. B. Metabolites accumulate in the blood. C. Metabolites half-life decreases. D. Hepatic metabolism decreases. Ans: B 3. A 40 year old patient who weighs 70 kg, needs intravenous infusion of amoxicillin. The desired C ss of drug is 15mg/dL. The physician ordered antibiotic infused for 10 hours. Amoxicillin has t 1/2 = 1 hour and Vd = 9L. What rate of iv is recommended for this patient? (no loading dose was given); A. 135 mg/hr Css= R/CLt B. 936 mg/hr R= Css x CLt C. 1000 mg/hr R = 15 mg/dL x kel x vd D. 333 mg/hr R = 15 mg/dL x 0.693/1hrx90 dL Ans: B R = 936 mg/hr R= rate of infusion 1 dL = 100 mL 1L = 10 dL 4. Use of loading dose? A. I-To achieve therapeutic concentration immediately B. II-Loading dose = desired concentration x V d C. III-Steady state will be achieved immediately and maintained D. I and II only Ans: D Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This 20-1 manual is being used during review sessions conducted by PharmacyPrep.  Pharmacokinetic Calculations 5. Calculate renal clearance if V d = 300 mg/20 mg/ml = 15 mL; D = 3.3 L x 10 mg/L = 33 mg and C p = 100 mg/1.5 L = 66.7 mg/L. If the rate of infusion of the drug is 500 mg q8h and clearance is 7.3 L/hr, what is the steady state concentration? A. 85.6 mg/L Css = Rate of infusion B. 856 mg/L Clearance C. 8.56 g/L Css = 500 mg/8hr 7.3L/hr D. 8.56 mg/L Css = 62.5 mg/hr Ans: D 7.3L/hr Css = 8.56 mg/L 6. A person weighs 71.7 kg and infusion rate of iv 5.5 mg/kg/hr. Steady state concentration 17 mcg/ml. What is the total clearance? A. 23.194 L/hr CL = Rate infusion B. 231,764 mcg/L Css C. 23 mg/mL = 394.3 mg/hr x1000 D. 2.3 mg/L 17 mg/ml Ans: A = 23194 ml/hr = 23.194 L/h 7. A drug was found to have zero order kinetic 100 mg ⇒ after 6 days ⇒ 99 mg. How long it will take to eliminate the entire drug from the body? A. 100 days 1mg--------6days B. 200 days 100mg----- X C. 300 days X= 600 days D. 600 days Ans: D 8. A patient was given 100 mg drug orally. The drug absorbs at rate of 10 mg/min and follows zero order kinetics. After 5 min how much drug will be absorbed? A. 10 mg B. 50 mg 10 mg ------ 1min C. 75 mg x ----- 5 min D. 100 mg x ----- 50mg Ans: B 9. A patient was given 100 mg drug orally. The drug absorbs at rate of 10 mg/min and follows zero order kinetics. How long will it take for the drug to be completely absorbed? A. 10 min B. 50 min C. 75 min Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This 20-2 manual is being used during review sessions conducted by PharmacyPrep.  Pharmacokinetic Calculations D. 100 min Ans: A 10. Ampicillin in 5% dextrose degrades by first order kinetic, at rate constant of 0.026 h. What is the shelf life of ampicillin? A. 4 hr B. 8hr T90 = 0.105/K C. 2hr T90 = 0.105/0.026 = 4hrs D. 16hr Ans: A 11. Approximately 50% of Cloxacillin is excreted unchanged in the urine. If the normal dosage schedule for Cloxacillin is 125 mg q6h, a patient with renal function 20% of normal should receive? A. 25 mg q6h Renal Cloxacillin 50% = 62.5 mg B. 31.25 mg q6h Non-renal Cloxacillin 50% = 62.5 mg C. 62.5 mg q6h 12.5+ 62.5 mg = 75 mg D. 75 mg q6h Ans: D OR 50-20 = 30% 50%.............125 ? 12. A drug of which dose is 1500 mg is given every 24 hours. The renal clearance of this drug is 1.2 mg/dL. Calculate the clearance in ml/min. A. 98.6 ml/min B. 76.8 ml/min C. 86.8 ml/min D. 66.8 ml/min 1.2 mg --------100 ml 125000 mls--------1440 min (60 min x 24 hrs) Ans: C 1500 mg---------X X---------------1 min X = 125000 mls X = 86.8 ml/min or 125000 ml/1440 min = 86.6 ml/min 13. If a drug rate with 50% metabolism and half-life drugs is 1 hr. What is the percentage of blood concentration after 4hrs? A. 50% 1 hr 2hr 3 hr 4 hr B. 25% 100  50  25  12.5  6.25 C. 12.5% or D. 6.25% Drug concentration = 100% Ans: D t1/2 (decrease the drug by half) = 50% 2t1/2 = 25% → 3t1/2 = 12.5% → 4t1/2 = 6.25% Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This 20-3 manual is being used during review sessions conducted by PharmacyPrep.  Pharmacokinetic Calculations 14. A new antifungal was given at a dose of 5mg/Kg by a single intravenous bolus injection to a 32 years old female who weighs 75Kg. The antifungal has an elimination half life of 2 hours and apparent volume of distribution of 0.28L/Kg. What is the initial plasma drug concentration in this patient? A. 36 mg/L Cp = Do Cp = 5 mg/Kg = 17.8 mg/L B. 1.8 mg/L Vd 0.28L/kg C. 17.8 mg/L D. 1.79 mg/L Ans: C 15. Following the anterior information, calculate the predicted plasma concentration 8 hours after the dose: A. 15mg/L B. 111mg/L Cp initial = 17.9mg/L and elimination t1/2 is 2hours C. 11.1mg/L Cp = 17.9 after 2 hours = 8.95 D. 1.11mg/L Cp = 8.95 after 2 hours = 4.47 Ans: D Cp = 4.47 after 2 hours = 2.23 Cp = 2.23 after 2 hours = 1.11 IN 8 HOURS OR 17.9  8.9 4.42.231.1 16. Following the same anterior information, calculate how much drug remains in the patient’s body, 8 hours after the administrated dose: A. 23mg D = 375mg after t1/2 of 2 hours = 187.5mg B. 112mg after t1/2 of 2 hours = 93.75, Continue the same as the anterior question!!! C. 100mg After 8 hours, you will have 23mg D. 15.3mg 375 mg  187.5 mg 93.75 mg 46.8 mg  23.4 mg Ans: A Let us assume the following characteristics of the drug in a 70kg man. -Therapeutic effective plasma concentration: 2 mg/L -Biologic half-life: 90 min -Apparent volume of distribution: 0.70Kg/L 17. Following the anterior information, how long after the dose is exactly 75% eliminated from the patient body? A. 2 hours B. 3 hours 100% 50% 25% C. 6 hours D. 8 hours Ans: B Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This 20-4 manual is being used during review sessions conducted by PharmacyPrep.  Pharmacokinetic Calculations 18. What is the recommended rate of infusion for this drug? A. 85mg/min R = K x Vd x Css → R = 0.0087 x 49 x 2 = 0.85mg/min B. 58mg/min K = 0.693/80min = 0.0087 C. 0.85mg/min Vd = 0.70 x 70Kg = 49L D. 8.5mg/min Ans: C 19. What is the total body clearance for this patient? A. 33L/min B. 43mls/min CLT = K x Vd → ClT = 0.0087 x 49 = 0.43L/min C. 43L/min D. 0.43L/min Ans: D 20. Still following the information of the anterior questions, calculate the corresponding loading dose: A. 98mg B. 160mg LD = Vd x Css → LD = 49 x 2 = 98mg C. 48mg D. 24mg Ans: A 21. Drug A binds to 28% with protein when given at a dose 150 mg/day. If the drug is given 300 mg/day, what % of drug A would bind with protein. Mol. Wt of protein is more than drug A. A. 56% B. 28% C. 14% D. 80% Ans: B 22. First order elimination, EXCEPT: A. Increase plasma concentration ↑ rate of drug metabolism. B. Rate of metabolism is proportional to drug concentration. C. Half life is constant (t1/2 = time to metabolise 50% of drug). D. Rate of drug metabolism is constant. E. Slope is –k/2.303. Ans: D 23. Drug A V d is 3.3 L and Drug B V d is 5.5 L. What is the correct statement? A. Drug A is given at high dose B. Drug B is given at high dose Vd = Dose/Cp C. Drug A and B been given the same dose D. Drug A plasma concentration lower than Drug B Ans: B Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This 20-5 manual is being used during review sessions conducted by PharmacyPrep.  Pharmacokinetic Calculations 24. A drug in plasma fluid measures 30 mg/L. If the dose is 100 mg, what is the volume of distribution? A. 30 mg Vd = D/Cp B. 30 L Vd = 100 mg C. 3.3 mg D. 3.3 L 30 mg/L Ans: D Vd = 3.3 L 25. A drug concentration is 10 mg and plasma concentration is 20 mg/L. What is the apparent volume of distribution? A. 5 L Vd = dose/Cp B. 500 mL Vd = 10 mg/20 mg/L C. 10 L Vd = 0.5 L or 500 mL D. 2 L Ans: B 26. What is the drug concentration if plasma concentration is 2 mg/L and apparent volume of distribution is 5000 mL? A. 100 mg Dose = Vd x Cp B. 10 mL Dose = 5 L x 2 mg/L C. 10 mg Dose = 10 mg D. 10 L Ans: C 27. What is the property of drug that can be found in high concentration in breast milk? A. High molecular weight B. Low lipid solubility C. High acidic drugs D. High basic drug Ans: D Tips: Drug Factors effects on excretion of drug into breast milk; PKa (dissociation constant), Molecular size, Lipid solubility, Oral bioavailability, Long acting drugs or drugs with long half distribute and High basic 28. Concentration of drug in breast milk exceeds than plasma if drug is/has? A. Basic B. Protein bind Breast milk is acidic and C. Acidic but not protein bound base drug secrete in breast D. Large volume of distribution milk Ans: A Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This 20-6 manual is being used during review sessions conducted by PharmacyPrep.  Pharmacokinetic Calculations 29. If a drug has half life of 30 min, what is the drug elimination rate constant? A. 0.3 mg/min B. 0.02 mg/min Kel = 0.693/t1/2 C. C 30 mg/min Kel = 0.693/30 min D. 15 mg/min Kel = 0.02 mg/min Ans: B 30. Aspirin V d 40 L/100 kg and Vancomycin 16 L/100 kg. What is true? A. Aspirin retains more drug in plasma. B. Vancomycin retains more drug in plasma. Vd = D/Cp C. Aspirin and Vancomycin retain equally in plasma. D. Can infer drug plasma concentration from V d Ans: B 31. ZM is a 20-year-old woman receiving Phenytoin 300 mg for the treatment of a generalized disorder secondary to a motor vehicle accident 1 year ago. Although she has been seizure-free for the past 6 months, she now reports being increasingly confused and lethargic. Nystagmus is detected at physical examination. She is taking no other medications but has been dieting to lose weight before her upcoming wedding. A total Phenytoin concentration is obtained and is reported to be 14 mg/L (desired range, 10 to 20 mg/L). Other laboratory results are as follows: Na: 138 mEq/L (135-145 mEq/L), K: 3.5 mEq/L (3.5-3 mEq/L): BUN: 10 mg/dL (8- 20 mg/dL): Cl: 98 mEq/L (96-106 mEq/L). Cr: 1.0 mg/dL (0.7 – 1.5 mg/dL); ALT: 8 IU/L (0-35 IU/L), AST: 10 IU/L (0-40 IU/L), and Albumin 2.5 g/dL (3.5-5 g/dL). What is the patient’s primary drug-related problem? A. Phenytoin toxicity secondary to impaired hepatic function. B. Phenytoin toxicity secondary to impaired renal function. C. Phenytoin toxicity secondary to a decreased protein binding. D. Phenytoin toxicity secondary to a decreased in free phenytoin concentration. Ans: C Tips: Phenytoin is highly protein bound, particularly to albumin. A decrease in serum albumin can increase the concentration of free Phenytoin, which is the pharmacologically active component. Patients with low albumin concentrations or impaired protein binding may have drug toxicity despite “normal” serum Phenytoin concentrations. 32. Which of the following side effects of Phenytoin therapy is not related to increased serum concentrations? A. Ataxia (incoordination) B. Sedation C. Hirsutism D. Nystagmus Ans: C Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This 20-7 manual is being used during review sessions conducted by PharmacyPrep.  Pharmacokinetic Calculations Tips: Hirsutism is a common chronic side effect of Phenytoin and is not correlated with serum phenytoin concentration. Ataxia, nystagmus and sedation are concentration-dependent side effects. 33. What is true about drug clearance at steady concentration? A. Elimination is equal to metabolism B. Elimination is equal to absorption C. Absorption is equal to metabolism D. Absorption is greater than elimination Ans: B 34. Which of the following statements about elimination half-life is true? A. If total body clearance is doubled, elimination half-life is decreased. B. If volume of distribution is doubled, elimination half-life is increased. C. If total body clearance and volume of distribution are both decreased to the same degree, there will be no effect on elimination half-life. D. CL T = V d x (0.693/t 1/2 ) E. All of the above Ans: E CL T = V d x (0.693/t 1/2 ) CL T = V d x Kel Total clearance is inversely proportional Total clearance and Vd are directly to half life. proportional 35. When a drug circulating in blood and highly perfused organs is called? A. Central compartment B. Two compartment C. Peripheral compartment D. Multi compartment Ans: A 36. Non-linear pharmacokinetics: I. First order kinetics II. Michaelis-Menten kinetics III. Enzyme kinetics IV. Saturation kinetic A. I only B. IV only C. II and III only D. II, III and IV only E. all of the above Ans: B Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This 20-8 manual is being used during review sessions conducted by PharmacyPrep.  Pharmacokinetic Calculations 37. A drug with first order rate of reaction and half-life of 3 hours. The half-life will be related to the following statement? A. Increase when concentration of drug increases. B. Decrease when concentration of drug increases. C. Independent of initial drug concentration. D. Decrease in patient with renal impairment. E. There is no change with drug levels in blood. Ans: C Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This 20-9 manual is being used during review sessions conducted by PharmacyPrep.  Pharmacokinetic Calculations Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This 20-10 manual is being used during review sessions conducted by PharmacyPrep.  Rates and Orders of Reaction RATES AND ORDERS OF REACTIONS 1. Plot of log of concentration against time produces a straight line with a: A. Slope of –K/2.303 B. Slope of –K/t 1/2 C. Slope of –K o D. slope of K/2.303 E. slope of K/0.693 Ans: 2. AUC of drug can be determined by a graph using the following rule A. The Trapezoidal rule B. The Fick’s first law C. Rule of nine D. Henderson Hassel Bach rule Ans: A 3. Two drugs to be pharmaceutical equivalent, the drugs must: A. contain same excipient B. Contain it salts C. Same therapeutic moiety D. Same therapeutic moiety and salts Ans: D 4. The time it takes to infused drug to reach plasma steady state concentration (Css) depends on: A. Elimination half-life of drug. B. Fraction of free excreted in urine C. Plasma concentration curve D. Drug concentration Ans: A 5. A drug plasma concentration was 64 mg, t 1/2 =0.7 hrs. After 7 hours from the initial dose, what is the drug's concentration? A. 0.06 mg Total time 7hrs and Half-life 0.7hr B. 1 mg 7/0.7 = 10 half life C. 2 mg 64 --> 32 --> 16 -->8-->4 -->2-->1-->0.5 -->0.25 -->0.125-->0.06 D. 3 mg Ans: A or -kt C = Co. e K = 0.693/t1/2 K = 0.693/0.7 = 0.999 C = 64 x e(-0.999x7) = 0.06 Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 21-1  Rates and Orders of Reaction 6. Time to reach steady state is determined by the? A. Elimination half life B. Loading dose C. Maintenance dose D. The absorption rates Ans: A 7. What is correct about a drug with first order elimination? A. Drug elimination depends on initial concentration. B. Drug elimination depends on time only. C. Drug elimination depends on concentration and half-life. D. drug elimination depends renal and hepatic function. Ans: C 8. The elimination constant unit is? A. ml/minute B. liter/minute C. min -1 D. hours E. minutes Ans. C 9. If the reactant in a first order reaction is disappearing the rate of 23% percent in an hour, the half-life of the reaction is: A. 2 hours B. 3 hours C. 4.5 hours D. 6 hours Ans: B Tips: t 1/2 = 0.693 = 0.693 = 3 hours K 0.230 9. If the half-life of a reaction which is first order is 4 hours, what percent of the reactant will remain unreacted after 12 hours? A. 12.5 percent B. 25 percent C. 75 percent D. 87.5 percent Ans: A Tips: 0.5% → 4 hours 0.25%→ 8 hours 0.125%→ 12 hours 0.125% x 100 = 12.5% Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 21-2  Rates and Orders of Reaction 10. If one of the reactants in a second order reaction is kept at a large concentration compared to the other reactant, the reaction is said to be: A. First order B. Zero order C. Pseudo first order D. Pseudo second order Ans: C 11. The esterification of acetic acid with ethanol is a second order reaction of the reaction is conducted in water. If the reaction were conducted in ethanol, the reaction order would be: A. First order B. Pseudo first order C. Zero order D. Pseudo second order Ans: B 12. The absorption of a low solubility drug from the gastro intestinal tract will follow which of the following order of kinetics? A. Zero order B. First order C. Second order D. Does not follow reaction kinetics Ans: B Tips: All drugs follow first order depending on their conc. in blood stream & reversibly binding to receptor. In intoxication due to saturation of receptors, it follows zero order. 13. The elimination rate constant k for first order reactions may be defined as: A. The fraction of reactant present undergoing reaction per unit time. B. The inverse relationship of rate with concentration of reactant. C. Variation of reaction rate with half-life of the reaction. D. The time required for half the molecules present to react. Ans: A 14. the rate of reaction is proportional to the first power of concentration of one reactant, the reaction order is said to be: A. First order B. Second order C. Zero order D. Any of the above Ans: A Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 21-3  Rates and Orders of Reaction 15. The decay of radioisotopes is an example of which of the following reaction orders? A. First order B. Second order C. Zero order D. None of the above Ans: A Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 21-4  Pharmacodynamics PHARMACODYNAMICS 1. What is incorrect about competitive antagonism? A. Action of agonist is blocked if concentration of antagonist is ↑. B. Antagonism can be reversed or overcome by ↑ conc. Of agonist. C. ED 50 of agonist ↑ in the presence of antagonist. D. Morphine effects can be antagonized by Naloxone. E. Naloxone potentiates the effects of Morphine. Ans: E Tips: Naloxone is the antidote of choice for opioid toxicity by reversing their action. 2. T2DM patient is using Glyburide. Which of the following may potentiate the hypoglycemic effect? A. Smoking B. Alcohol C. Antacids D. Dairy products Ans: B 3. Lethal dose LD 50 is classified as: A. Dose causes 50% of toxic response in tests B. Dose causes 50% of effect response in tests C. Dose cause 50% of death response in tests D. All of the above Ans: C 4. The k m value of an enzyme is numerically equal to, in first order kinetics A. The maximum velocity (V max ) expressed in moles/liter is equal to Michaelis Menten constant. B. Velocity of a reaction divided by substrate concentration. C. Substrate concentration in moles/liter necessary to achieve half the maximum velocity of a reaction. D. Maximum velocity divided by half the substrate concentration in moles necessary to achieve maximum velocity E. Substrate concentration divided by velocity of a reaction Ans: C First order: Km = 1/2 V max Zero order: Km = V max 5. Which of the following combination therapy is likely the least concern presented by a patient? A. Warfarin + ASA Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 22-1  Pharmacodynamics B. Clonazepam and taking alcohol C. Ibuprofen + warfarin D. Diazepam + codeine E. Codeine + Acetaminophen Ans: E 6. Phenytoin binds with? A. Albumin B. Globulin C. Lipoprotein D. Acetylcholine E. glycoprotein Ans: A Tips: Phenytoin is 95% bound to protein, particularly Albumin. 7. In renal failure, decreased albumin levels can cause: A. Increase in free Phenytoin levels. B. Decrease in free Phenytoin levels. C. No change in Phenytoin levels. D. Increased albumin levels. Ans: A 8. Characteristics of agonist drugs may include which of the following statements? A. Bind to a receptor site and produces 100% of biological response. B. Bind to a receptor site but do not produces 100% of the biological response. C. Bind to a receptor site and produces 100% biological response only when given in high doses. D. Bind to receptor site and block the biological response E. Bind to the receptor site and block the biological response in 50% Ans: A Tips: An agonist drug is a compound that binds to a receptor and produces the biological response. 9. Drug dosages that can kill 50% of the experimental animals receiving the drug is called: A. Effective dose B. Minimum dose effect C. Lethal dose D. Maximum dose effect E. Therapeutic index Ans: C Tips: The lethal dose is the dose that kills 50% of the animals that receive it. The lethal dose is mainly compared with the effective dose to determine the therapeutic window of a drug. Effective methodology in determining both the range of effective drug concentration and the safety of the drug. Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 22-2  Pharmacodynamics 10. Which of the following provides information about the variation in the sensitivity to the drug within population studied? A. Therapeutic index B. Drug potency C. Maximal potency D. LD50 E. ED50 Ans. B 11. Which of the following provides information about the largest response a drug can produce, regardless of dose? A. Affinity B. Efficacy C. Potency D. Tolerance E. Therapeutic index Ans. B 12. MP is 60-year old man with hypertension is to be treated with beta blockers. Drug X and Y have the same mechanism of action. Drug X in a dose of 5 mg produces the same magnitude of antihypertensive action as 500 mg of drug Y. This suggests that? A. Drug X is about 100 times more potent than drug Y B. Drug Y is about 100 times more potent than drug X C. Drug Y is less efficacious than drug X D. Drug X is less efficacious than drug Y Ans. A 13. Competitive (reversible antagonist). Ag (agonist) + E + Ag*(antagonist) AgE + Ag*E If we use more concentration of Ag what will happen? A. Concentration of AgE increase and Ag*E decrease B. Concentration of Ag*E increase and AgE decrease C. Concentration of AgE and Ag*E decrease D. Concentration of AgE and Ag*E increase E. No change in AgE and Ag*E rate Ans: A Tips: Competitive (reversible antagonist). The antagonist effect can be overcome by increasing the concentration of agonist. Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 22-3  Pharmacodynamics Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 22-4  Medicinal Chemistry PHARMACY PREP. MEDICAL CHEMISTRY 1. Which of the following essential ring for penicillin’s and cephalosporins mechanism of action? A. Thiazolidine ring B. Beta lactam ring C. Heterocyclic ring D. Beta lactamase ring E. Esters and amide chain Ans. B 2. How many chiral centers are in Fexofenadine? O H3C H3C OH CH3 CH3 CH3 HO N HO N OH OH Terfinadine Fexofenadine A. One B. Two C. Three D. Four E. Five Ans: A 3. How many chiral centers are present in Desloratadine? N N N COOCH2CH3 NH Cl Cl Loratadine Desloratadine A. One B. Two C. Three D. Four E. None Ans: E 4. Diastereoisomers have the opposite configuration at only one of two or more tetrahedral stereogenic centers present in their respective molecular entities are epimers. Interconversion of epimers is called epimerization. Which of the following class of antibiotics is known to have epimerization properties? A. B-lactams B. Quinolones C. Vancomycin D. Tetracycline Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 23-1  Medicinal Chemistry E. Cephalosporins Ans: D Tips: Epimerization is the reaction responsible for the transfer of tetracycline to epi- tetracycline 5. Oxidation of alkyl group results into alcohol, aldehyde and finally carboxylic acids. What type of alkyl group mostly undergoes oxidation to an acid? A. Terminal alkyl group of aliphatic structure B. Terminal Aromatic alkyl group of structure C. Benzylic alkyl group attached to aromatic ring structure D. Heterocyclic ring structure carbons E. Cyclic ring structure carbons Ans: C Tips: Benzylic carbon group undergoes oxidation easily to form an acid. 6. Amines are one of the most common groups present in the molecular structure of drugs. Primary amines are mainly metabolized by phase II metabolism: A. Deamination B. Dealkylation C. Acetylation D. Hydrolysis E. Oxidation Ans: C Tips: Acetylation is a phase II metabolism reaction characterized by the gain of an acyl group, and the main reaction that undergoes primary amines. 7. Compound considered a constitutional or structural isomer of hexane include: A. Cyclohexane B. Cyclopentane C. 1-methyl-pentane D. 1-methyl-cyclohexane E. None of the above Ans: C Tips: Isomers are compounds that have the same molecular formula but different chemical structure, hexane and 1-methyl-pentane are examples of isomers. 8. Molecular structures (drugs) having carboxylic acid, amide, alcohol and/or thio group are mainly metabolized by: A. Oxidation B. Hydrolysis C. Conjugation D. Esterification E. Deamination Ans: C Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 23-2  Medicinal Chemistry Tips: Conjugation is a phase II metabolism reaction characterized by an incorporation of endogenous substrate on the molecular structure of drugs normally coming from phase I metabolism reaction. Molecular structures (drugs) having carboxylic acid, amide, alcohol and/or thio group are mainly metabolized by a conjugation. 9. For an antihistaminic drug to be effective, it must have which of the following molecular characteristics on its structure? A. A terminal tertiary nitrogen. B. More than one aryl or heteroaryl group. C. Presence of C−O−C bonds. D. All are correct. Ans: D Tips: In order for an antihistaminic drug to be effective, they must have a terminal tertiary nitrogen and more than one aryl or heteroaryl group on their molecular structure. 10. What is incorrect about the structure activity of acetylcholine agonist? A. Acetylcholine dissociates into acetyl and choline by acetylcholinesterase enzyme. B. Methacholine has one extra methyl group than Ach. C. Carbachol has one carbamate group. D. Bethanechol has one carbamate and methyl group than Ach. E. Acetylcholine is the major neurotransmitter of sympathetic system. Ans: E Tips: Acetylcholine is the major neurotransmitter of the parasympathetic nervous system which acts on muscarinic and nicotinic cholinergic receptors. 11. Arrange the following groups from the most reactive to the least reactive: COOH CH4 OCH3 COOˉ A. COOˉ→COOH→OCH3→CH4 B. COOH→CH4 →COOˉ→OCH3 C. OCH3 →COOH→COOˉ→CH4 D. CH4→OCH3→COOˉ→COOH E. COOH→OCH3→CH4 →COOˉ Ans: A Tips: Molecules may be classified as more or less reactive depending on the presence of hydrogen and oxygen. Less hydrogen molecules and more oxygen molecules increase the reactivity of the compound or substance. 12. Conformational isomerism are stereo isomers produced by? A. Rotation around single bond. B. Typically, rapidly interconverting at room temperature. C. They can be enantiomers. D. All of the above Ans: D Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 23-3  Medicinal Chemistry Tips: Conformational isomerism’s are stereoisomers produced by rotation around single bond, typically rapidly interconverting at room temperature. They are normally classified as enantiomers and diastereomers. 13. Geometrical isomerism may be classified as CIS and TRANS depending on the spatial position of the molecule around a bond with restricted rotation. Which of the following is an example of geometrical isomerism? A. Butene B. 1-Butene C. 2-Butene D. 3-Butyne E. 1-Butane Ans: C Tips: Geometric isomers may be classified as CIS and TRANS depending on the spatial position of the molecule around a bond with restricted rotation. 2-Butene is an example of molecule having geometric isomerism. 14. Cyclohexane may form a chair and boat conformations. Each carbon has equatorial and axial conformations. For compounds 1,4-dimethyl-cyclohexane, what is the conformation of the 2-methyl groups? A. Equatorial-equatorial B. Conformational-conformational C. Equatorial-spatial D. Geometric-geometric E. Spatial-spatial Ans: A Tips: Equatorial-equatorial is a structural formation of a molecule occurring at the same distance from each extremity of an axis. 15. Strength of acids and base may depend on several electronic factors of molecule. Which of the following electronic factors makes chloroacetic acid stronger than acetic acid? A. Higher ionization effect B. Higher molecular weight Chloroacetic acid Acetic acid C. Higher disintegration rate Chemical Formula C 2 H 3 O 2 Cl CH 3 COOH D. Electron withdrawal effect Molecular weight 94.5 g/mol 60.05 g/mol E. All are right Ans: D Tips: Chloroacetic acid is stronger than acetic acid due to higher withdrawing affect. 16. Pyridine is a mono heterocyclic compound that is very important in the activity of many different drugs. The molecular structure 1,4-dihydropyridine is found in: A. Verapamil Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 23-4  Medicinal Chemistry B. Digoxin C. Clonidine D. Nifedipine E. Diltiazem Ans: D Tips: Nifedipine is calcium channel blocker that has 1,4-dihydropyridine on its structure responsible for its mechanism of action 17. Quinolone structure may be found in which of the following substances? A. Vitamin K B. Thiamine C. Cyanocobalamin D. Folic acid Ans: A Tips: Vitamin K has a quinolone on its molecular structure. That is why chemically, Vitamin K1 is called phylloquinone and Vitamin K2 is menaquinone. 18. If a drug chemical structure has 3 chiral carbons. How many optical isomers are possible? A. 2 B. 4 2n = 22 =2x2=4 C. 8 n= number of chiral centers D. 9 23 = 2 x 2 x 2 = 8 Ans: C 19. Steroid structures are common in hormones, such estrogen, progesterone, and testosterones. Steroid contains how many cyclohexane and cyclopentane respectively in it skeleton. A. 2 and 3 B. 3 and 2 C. 3 and 1 General structure of D. 1 and 3 STEROIDS Ans: C Most of the steroid compounds have three cyclohexane rings (Rings A, B and C) and one cyclopentane (Ring D) ring on their molecular structure. 20. Phase I metabolism reaction is also known as functionalization metabolism. During this phase drug, will be metabolized to obtain functional groups such as hydroxyl group or carboxyl group. Further metabolism of these groups takes place in Phase II metabolism. Which of the following conjugation reaction will these group undergo mostly? A. Acetylation B. Glucuronidation C. Reduction D. Hydrolysis Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 23-5  Medicinal Chemistry Ans: B Tips: Glucuronidation is the main reaction of phase II metabolism reactions, and is responsible mainly for the metabolism of drugs having hydroxyl, carboxyl and amide group on their molecular structure. 21. The most common reactions in stomach is hydrolysis. Which of the following functional group is more susceptible to hydrolysis? A. R-COO-R B. R-O-R C. R-NHCH3 D. R-COOH E. R-CH=O Ans: A Tips: Amides and esters are the only groups undergoing hydrolysis. 22. The Bronsted-Lowry theory describes acid as a proton (hydrogen ion) donor. Phenol is an acid. The acidic properties of phenol is due to: A. Stable Cation resonance B. Weak dissociation C. Common ion effect D. Stable anion resonance E. Fast dissociation is lipophilic solutions Ans: D Tips: Phenol is a weak acid due to stable anion resonance. 23. Wrong statement regarding optical isomerism includes: A. To be optical isomers, molecules should contain a minimum of one chiral or stereogenic center. B. Diastereomers are non-superimposable mirror image. C. Optical isomers rotate plane polarized light. D. Enantiomers are non-superimposable mirror images. E. Has one or more chiral center. Ans: B Tips: Diastereomers must have more than one stereogenic center and are not mirror image, they have superimposed image. 24. R-COOH is an acid while R-OH is not due to: Acetic acid: pKa=4.76 A. Presence of dipole Phenol: pKa=10.00 B. Presence of stable anionic resonance in acid Ethanol pKa=16.00 C. Presence of stable cationic resonance in alcohol D. Presence of stable non-ionic resonance in acid E. Complexation Ans: B Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 23-6  Medicinal Chemistry Tips: R-COOH is an acid while R-OH is not due to presence of stable anionic resonance, which is an indication of the extent of activity of free radicals in an organic reaction. The factors to consider: Two of the factors which influence the ionization of an acid are the strength of the bond being broken and the stability of the ions being formed. 25. The pH value is calculated mathematically as the: A. Log of the hydroxyl ion (OH ˉ) concentration B. Negative log of the OH ˉ concentration C. Log of the hydrogen ion (H+) concentration D. Negative log of the H+ concentration E. Ratio of H+/OH ˉ concentration Ans: D Tips: pH is the measure of the acidity or basicity of a solution that is calculated mathematically as the negative log of the H+ concentration. 26. This reaction is known as: NH 4 + + OH ˉ → H 2 O + NH 3 A. First order reaction B. Ionization reaction C. Neutralization reaction D. Equilibrium reaction E. Protonated reaction Ans: C Tips: NH 4 + + OH ˉ → H 2 O + NH 3 is an example of neutralization reaction. 27. Correct statements regarding bioisosters may include? A. Molecules containing one different group or atom but electronically equivalent B. May act as antagonist to a normal metabolite C. Molecules that differs only in the length of the side chain D. Bioisosters are analogs E. Bioisosters are homologs Ans: A Tips: Bioisosters are functional group or atoms that impact similar physical and chemical properties on biological activity of molecule. 28. Which of the following is the molecular structure of isotretinoin, used in oral treatment of acne? A. 13-CIS Retinoic acid B. 13-TRANS Retinoic acid C. 13-CIS-TRANS Retinoic acid D. Retinoic acid E. None of the above Ans: A Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 23-7  Medicinal Chemistry Tips: The molecular structure of isotretinoin, used in oral treatment of acne is 13-CIS Retinoic acids. The TRANS molecular structure is only used in topical preparations. 29. Morphine is the prototype of opioid analgesics. The analgesic activity of morphine is dependent on which molecular structure? A. Phenolic hydroxyl group B. p-phenyl-N-alkylpiperidine C. Methyl substitution D. Piperidine E. Phenolic amino group Ans: B Tips: The analgesic activity of morphine is dependent of p-phenyl-N-alkylpiperidine 30. Imidazoline is a molecular structure that contains a heterocyclic ring which is present on which of the following drugs? A. Prazosin B. Nifedipine C. Atropine D. Clonidine E. Allopurinol Ans: D Tips: Clonidine is an antihypertensive drug that depends on its imidazoline molecular structure to be effective. 31. Which of the following cardiovascular medications is chemically classified as glycoside? A. Digoxin B. Warfarin C. Nitrates D. Nitrites E. Angiotensin converting enzyme inhibitors Ans: A 32. What is incorrect in catecholamine biosynthesis? A. Tyrosine is the precursor. B. Dopamine produces norepinephrine by hydroxylation. C. Epinephrine produces norepinephrine by methylation. D. Levodopa is catalyzed by dopadecarboxylase to Dopamine. E. Norepinephrine catalyzed by methyl transferase to Epinephrine. Ans: C 33. What functional group is responsible for the metallic taste or taste changes in Captopril? A. Sulfonamide B. Sulfide C. Sulfhydril group Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 23-8  Medicinal Chemistry D. Proline ring Ans: C 34. Fexofenadine, how many optical isomers are possible? O H3C H3C OH CH3 CH3 CH3 HO N HO N OH OH Terfinadine Fexofenadine A. 1 B. 2 C. 3 D. 4 Ans: B Tips: One chiral center and two optical isomers. 35. Which of the following drug causes bradycardia? A. Amlodipine B. Nicardipine C. Nifedipine D. Verapamil Ans: D 36. Which of the following metabolic reactions is catalyzed by mono amine oxidase (MAO) enzyme? A. Oxidation B. Reduction C. Oxidative deamination D. Hydrolysis E. Glucuronidation Ans: C 37. What is the name of drugs class analogs? O 9 COOH HO 11 A. Leukotrienes B. Prostaglandins C. Arachidonic acid D. Opioids Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 23-9  Medicinal Chemistry E. Antihistamines Ans. B 38. Which of the following drug structure can form epimers? A. B-lactams antibiotics B. Quinolones C. Tetracycline D. Sulfanilamide E. Erythromycin Ans: C Tips: Tetracycline epimerizes to epitetracycline, which is more stable than tetracycline. 39. Pyrrolidine and piperidine are important heterocyclic compounds in the structure of drugs. Which of the following drugs has these heterocyclic rings on its structure? A. Folic acid B. Clonidine C. Imipramine D. Atropine Ans: D Tips: Atropine is an antimuscarinic agent that has pyrrolidine and piperidine heterocyclic rings on its molecular structure. Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 23-10  Medicinal Chemistry of autonomic nervous system Pharmacy Prep Medicinal Chemistry of Autonomic Nervous System 1. The difference between dopamine and amphetamine? A. One methyl group B. One hydroxyl group C. 2 hydroxyl group and 1 methyl group D. 2 methyl group and 1 hydroxyl group E. One methyl and one hydroxyl group Ans: C NH2 HO Dopamine OH OH H OH H H NH2 CH3 N CH3 N CH3 N CH3 CH3 NH2 CH3 CH3 CH3 Amphetamine Dextroamphetamine Ephedrine Pseudoephedrine Methamphetamine A B C D E 2. Difference between pseudoephedrine and methyl amphetamine is? A. One methyl group B. One hydroxyl group C. 2 hydroxyl group and 1 methyl group D. 2 methyl group and 1 hydroxyl group E. One methyl and one hydroxyl group Ans: B 3. What chemical reaction converts pseudoephedrine to crystal meth? A. Hydroxylation B. Dehydroxylation C. Hydrolysis D. Methylation E. Glucuronidation Ans: B 4. Beta blockade effect can be reversed by? A. Metoprolol B. Salbutamol C. Prazosin D. Propranolol E. Pseudoephedrine Ans: B Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-1  Medicinal Chemistry of autonomic nervous system Tips: Beta blockade can be reversed by beta agonist by displacement from occupied receptors if large amount of agonist is given because all beta blockers are competitive antagonist. 5. One of the major inhibitory neurotransmitters in the brain includes: A. GABA B. Serotonin C. Acetylcholine D. Enkephalin E. Epinephrine Ans: A Tips: GABA or gamma aminobutyric acid is the major inhibitory neurotransmitter in the mammalian CNS and has both a primary amine and a carboxylic acid as functional groups. 6. Agents well known as precursor of dopamine include: A. Epinephrine B. Tyrosine C. Tyramine D. Norepinephrine E. Thiamine Ans: B Tips: Tyrosine is catalyzed by tyrosine hydroxylase forming L-Dopa. L-Dopa is then catalyzed by Dopa-decarboxylase in the presence of PLP (Pyridoxal phosphate) to form Dopamine, which is the first catecholamine synthesized in the catecholamine synthesis. 7. The sympathetic and parasympathetic systems exert opposite antinomic affect on the following effects, except? A. Intestinal motility B. Branchial C. Heart rate D. Atrial refractory period E. Pupil diameter Ans. D 8. Competitive non-depolarizing neuromuscular junction blocker (NMJ) may include: A. Pancuronium B. Succinylcholine C. Nicotine D. Bungarotoxin E. Tetradotoxin Ans: A 9. Correct statements regarding Succinylcholine may include which of the following? I. Non-competitive depolarizing neuromuscular blocker Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-2  Medicinal Chemistry of autonomic nervous system II. Used in general anesthesia providing skeletal relaxation III. It is a sympathetic agent. A. I only B. III only C. I and II only D. II and III only E. All of the above Ans: C 10. Chemical mediator/s that is/are released from the end nerve of sympathetic system: I. Adrenaline II. Noradrenaline III. Acetylcholine A. I only B. III only C. I and II only D. II and III only E. All of the above Ans: C 11. Chemical mediator/s that is/are released from the end nerve of parasympathetic system: I. Adrenaline II. Noradrenaline III. Acetylcholine A. I only B. III only C. I and II only D. II and III only E. All of the above Ans: B Tips: Acetylcholine is the only chemical mediator that is released from the end nerve of parasympathetic system. 12. Tolerance of narcotics is normally characterized by which of the following statements? I. Decrease duration of analgesia II. Decrease sensitivity to receptors III. The dose should be first adjusted instead to change for a stronger narcotic. A. I only B. III only C. I and II only D. II and III only E. All of the above Ans:E Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-3  Medicinal Chemistry of autonomic nervous system 13. Which of the following is catecholamine? A. Phenylephrine B. Atropine C. Norepinephrine D. Benztropine E. Scopolamine Ans. C 14. Which of the following organ is innervated by only parasympathetic nerves? a. Ciliary muscle b. Sweat glands c. Iris muscle d. Peristalsis movement e. Splenic capsule Ans. A 15. All the following group of drugs has direct action on CNS, EXCEPT: A. Cardiotonics B. Analgesics C. Anesthetics D. Antidepressives E. Antipsychotics Ans: A 16. All of the following are important neurotransmitters, EXCEPT: A. Acetylcholine B. Dopamine C. Norepinephrine D. Muscarinic-M1 E. Serotonin Ans: D Tips: Muscarinic-M1 is an acetylcholine receptor of the parasympathetic nervous system. 17. Methamphetamine can be produced from? A. Epinephrine B. Dextromethorphan C. Diphenhydramine D. Senna E. Pseudoephedrine Ans: E Tips: Methamphetamine is produced from Pseudoephedrine through dehydroxylation (Removal of a hydroxyl group) reaction. Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-4  Medicinal Chemistry of autonomic nervous system 18. Drug interactions between the following pair of drugs are associated with sympathetic receptor agonist and antagonist actions? A. Propranolol and Metoprolol B. Propranolol and Isoproterenol C. Methyldopa and Prazosin D. Salbutamol and Benztropine E. Tiotropium and Salbutamol Ans. B 19. Organophosphate produced toxicity can be antagonized by administering? A. Neostigmine B. Physostigmine C. Rivastigmine D. Atropine E. Pilocarpine Ans. D 20. Which of the following sympathetic agonist can have dose related withdrawal syndrome if the drug is withdrawn too quickly, leading to rebound hypertension? A. Doxazosin B. Terazosin C. Clonidine D. Salbutamol E. Salmeterol Ans. C 21. All of the following are anticholinesterases, EXCEPT: A. Memantine B. Donepezil C. Galantamine D. Rivastigmine E. Physostigmine Ans: A Tips: Memantine is an NMDA receptor antagonist, used for the treatment of Alzheimer’s dementia. 22. All of the following drugs are used to treat Alzheimer dementia, EXCEPT: A. Memantine B. Donepezil C. Galantamine D. Rivastigmine E. Physostigmine Ans: E Tips: Physostigmine is not used for Alzheimer’s. It is used as antidote of atropine. Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-5  Medicinal Chemistry of autonomic nervous system 23. Reaction that converts Norepinephrine to Epinephrine is normally called: A. Catecholinization B. Methylation C. Oxidation D. Deamination E. Glutathione conjugation Ans: B Tips: Norepinephrine is converted to Epinephrine by the action of Phenylethanolamine N- methyltransferase in a process called, Methylation. 24. Neurotransmitter with an indole group in its structure include: A. Serotonin B. Acetylcholine C. Histamine D. Dopamine E. PABA Ans: A 25. Example of amino acid neurotransmitter may include: A. Tyrosine B. Thiamine C. Histamine D. Glycine E. Glutamate Ans: D Tips: Glycine is the major inhibitory neurotransmitter in the spinal cord but they are also found in the brainstem and retina. 26. Which of the following is used to manage cardiogenic shock? A. Epinephrine B. Norepinephrine C. Dopamine D. Levodopa E. Acetylcholine Ans: C Tips: Dopamine inotropic (increase force of contraction) and increase chronotropic (heart rate) and vasoconstriction. 27. The major dopaminergic receptor that controls the extrapyramidal system includes: A. D1 B. D 2 C. D3 D. D4 E. D5 Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-6  Medicinal Chemistry of autonomic nervous system Ans:B 28. Which of the following is an example of pure narcotic antagonist? A. Pentazocine B. Butorphanol C. Naltrexone D. Naloxone E. C and D are pure narcotic antagonists Ans: D 29. Example of opioid class of medication used for the treatment of alcoholism includes: A. Morphine B. Naloxone C. Hydrocodone D. Naltrexone E. Codeine Ans:D Tips: Naltrexone blocks opiod receptors in the brain, thereby reducing cravings and the potential rewards thagt may come from drinking. 30. Opioid widely used during labor due to its less liability to induce neonate respiratory depression includes: A. Meperidine B. Morphine C. Methadone D. Oxycodone Ans: A 31. Intense pruritus and vasodilatation are side effects of classic opioids due to stimulation and release of: A. Adrenaline B. Histamine C. Serotonin D. Mu receptors E. Histidine Ans:B 32. Endorphins may be classified as which of the following? A. Endogenous neurotransmitter B. A new class of topical anti-inflammatory agents C. Neuromuscular blocking agents D. Biogenic amines believed to cause schizophrenia E. Endogenous opioid peptides neurotransmitters Ans: E Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-7  Medicinal Chemistry of autonomic nervous system Tips: Endorphins are opioid endogenous neurotransmitters. 33. Inhaled corticosteroids indicated in asthma’s long term prevention symptoms, suppression, control of inflammation employ use of space/holding chamber devices and mouth washing after inhalation because these: I. Decrease local side effects II. Decrease systemic absorption III. Increase systemic absorption A. I only B. III only C. I and II only D. II and III only E. All of the above Ans:C 34. The action of acetylcholine released from parasympathetic fibers in visceras is mediated by which receptor? A. Muscarinic B. Nicotinic C. Adrenergic D. Dopaminic E. Serotonergic Ans. A Tips: All of the parasympathetic postganglionic fibers release acetylcholine. At the target organ, acetylcholine interacts with muscarinic receptors. 35. Which of the following neurotransmitters is used by all preganglionic fibers of the autonomic nervous system? A. Dopamine B. Acetylcholine C. Epinephrine D. Norepinephrine E. GABA Ans: B Tips: All preganglionic neurons release acetylcholine as their transmitter. The acetylcholine binds to nicotinic receptors on the postganglionic cell. 36. The major neurotransmitter for sympathetic postganglionic fibers is known as: A. Dopamine B. Acetylcholine C. Epinephrine D. Norepinephrine E. GABA Ans: D Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-8  Medicinal Chemistry of autonomic nervous system Tips: Most of the sympathetic postganglionic fibers release norepinephrine. At the target organ, norepinephrine interacts with a variety of receptors. 37. Stimulation of blood vessels by α 1 -receptors may cause: A. Dilation B. Constriction C. Increase in blood flow D. Vasodilatation E. All are wrong Ans: B Tips: Activation of alpha-receptors causes contraction or constriction, mostly vasoconstriction. 38. Optic nerve is? A. Peripheral B. CNS C. Cranial D. Auxiliary E. Sensory Ans: C 39. Acetylcholine is an ester neurotransmitter synthesized from: A. Glutamine B. Tyrosine C. Acetyl CoA D. Dopa E. Cathecolamines Ans: C Tips: Acetylcholine is synthesized from acetyl coenzyme A (acetyl CoA) and choline. It is action is terminated by acetylcholinesterase. 40. Nicotinic receptors are mainly found in: I. Motor end plate II. Adrenal medulla III. Autonomic ganglia A. I only B. III only C. I and II only D. II and III only E. All of the above Ans: E Tips: Nicotinic receptors are found at the motor end plate, in all autonomic ganglia, and in the adrenal medulla. 41. Prototype of muscarinic antagonist class of drugs: A. Atropine Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-9  Medicinal Chemistry of autonomic nervous system B. Scopolamine C. Ipratropium D. Benztropine E. Oxybutynin Ans: A Tips: Atropine is the prototype of parasympathetic anticholinergic group of drugs. 42. Botulism toxins are used in the treatment of prolonged muscle spasm where a small amount of the toxin is injected directly into a muscle fiber, causing the muscle to relax. What is the action of botulism toxins in acetylcholine? A. It blocks the release of acetylcholine by acting ganglionic nicotinic receptors B. It increases the release of acetylcholine. C. It inhibits the nicotinic receptors. D. It stabilizes the serum acetylcholine. E. It increases the action of acetylcholine. Ans: A Tips: Botulism toxins prevent and/or completely block acetylcholine release. 43. Malignant hyperthermia can be a side effect of general anesthetics and may be treated by: A. Aminophylline B. Terbutaline C. Dantrolene D. Pancuronium E. Dobutamine Ans: C Tips: Dantrolene may be used in the treatment of malignant hyperthermia, a side effect associated with the use of general anesthetics. 44. Which of the following antianxiety agents causes the least sedation? A. Diazepam B. Buspirone C. Chlordiazepoxide D. Oxazepam E. Chlorazepate Ans: B Tips: Buspirone is an atypical anxiolytic agent that binds to dopamine and serotonin. It is very well preferred when compared with other anxiolytic agents due to its least side, non-drowsiness, no addiction and no CNS depressant activity. 45. Which of the following does NOT cause miosis? A. Bethanechol B. Methacholine C. Pilocarpine D. Tiotropium Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-10  Medicinal Chemistry of autonomic nervous system E. Physostigmine Ans: D Tips: Tiotropium is a muscarinic blockers and causes mydriasis. The other options are all Ach agonist. 46. Which of the following does NOT increase blood pressure? A. Pseudoephedrine B. Ephedrine C. Phenylephrine D. Clonidine E. Tyramine Ans: D 47. Physostigmine is an antidote of? A. Organophosphate B. Neostigmine C. Atropine D. Pilocarpine E. benzodiazepine Ans: C 48. Atropine is an antidote of? A. Organophosphate B. Neostigmine C. Atropine D. Pilocarpine E. benzodiazepine Ans: A 49. Which of the following clients is at greatest risk for digitalis toxicity? A. A 25-year-old client with congenital heart disease B. A 50-year-old client with CHF C. A 60-year-old client after myocardial infarction D. An 80-year-old client with CHF Ans: D 50. Identify all correct statements regarding GABA? except A. GABA inhibits brain activity and primary found inter neuron space B. GABA is synthesized from amino acid glutamate by the enzyme L-glutamic acid decarboxylate using vitamin B6 as coenzyme C. GABA agonist induce anxiety and convulsions Ans: C 51. Which increases heart rate but causes hypotension when give parenterally? A. Carbachol B. Epinephrine C. Isoproterenol Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-11  Medicinal Chemistry of autonomic nervous system D. Propranolol E. Nadolol Ans: C Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 24-12  Medicinal Chemistry of autocoids and analgesics PHARMACY PREP MEDICINAL CHEMISTRY OF AUTOCOIDS AND ANALGESICS 1. What cells control the release of histamines? A. Red blood cells B. Platelets C. Mast cells D. Basophils E. Lymphocytes Ans. C Tips: Mast cells are involved in complex control of releasing antihistamine and other medications basophils, eosinophils and neutrophils. 2. Which of the following drug structure is a derivative of N-methyl-p-phenyl piperidine (ethyl 1-methyl-4-phenylpiperidine)? Ester hydrolysis A. Haloperidol CH3 CH3 B. Phenytoin N N C. Meperidine OC2H5 OH + C2H5OH D. Phenobarbital O E. Procainamide Meperidine O Ans: C Tips: N-methyl-p-phenyl piperidine is the common to opioid analgesic and ethyl 1- methyl-4-phenylpiperidine, a derivative present in Meperidine. 3. Allyl group is present in opioids structure responsible for which of the following activity? A. Agonist B. Partial agonist C. Antagonist D. Mixed agonist and antagonist E. Partial antagonist Ans: C Tips: Naloxone antagonist activity is due to presence of allyl group on opioids structure. 4. For a first-generation antihistaminic drug to be effective, it must have which of the following molecular characteristics on its structure? A. A terminal tertiary nitrogen B. More than one aryl or heteroaryl group C. Presence of C−C between C−O and C-N groups D. All of the above Ans: D Tips: In order for an antihistaminic drug be effective, they must have a terminal tertiary nitrogen and more than one aryl or heteroaryl group on their molecular structure. Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 25-1  Medicinal Chemistry of autocoids and analgesics CH3 CH3 HC O CH2 CH2 N CH2 N CH2 NH2 CH3 H O Conjugation HC O CH2 C OH Metabolism of diphenhydramine 5. What is minimum dose acetylsalicylic acid (ASA) has antiplatelet action? A. 60-80 mg only B. 81 to 325mg only C. 81 mg to 650 mg D. 650 mg to 975mg E. 325 mg to 650 mg Ans: A 6. Anti-inflammatory action of ASA is due to? A. Irreversible inhibition of platelet aggregation B. Prevention of prostaglandin synthesis C. Inhibition of COX-I receptors D. Irreversible inhibition of Cox-1 and Cox-II receptors E. Inhibition of Cox-II receptors Ans: D 7. What is the antidote of acetyl salicylic acid? A. N-acetylcysteine B. Flumazenil C. Naloxone D. Naltrexone E. None of the above Ans: E Tips: Sodium bicarbonate is the antidote for ASA overdose by enhancing elimination of ASA in the urine. 8. Which of the following is the urinary tract analgesic? A. Acetyl salicylic acid B. Naproxen C. Ibuprofen D. Phenazopyridine E. Sulindac Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 25-2  Medicinal Chemistry of autocoids and analgesics Ans: D 9. Which of the following is the strongest analgesic for acute pain? A. Acetyl salicylic acid B. Naproxen C. Ibuprofen D. Acetaminophen E. Ketorolac (Toradol) Ans: E 10. Which of the following analgesic is least likely to cause addiction? A. Morphine B. Heroin C. Codeine D. Tramadol E. Methadone Ans: D Tips: World Health Organizations Expert Committee on Drug Dependence reports low dependence associated with Tramadol use. 11. Tramadol acts on? A. NE reuptake only B. NE reuptake and mu receptors C. Mu receptors only D. mu, delta, and kappa receptors E. Delta and kappa receptors only Ans: B Tips: Tramadol works by binding to mu-opioid receptor and as SNRI (Serotonin- Norepinephrine Reuptake Inhibitor). 12. The following groups are essential for antihistaminic pharmacological activity: I. Aromatic or heteroaromatic rings in structure II. Tertiary amines in structure III. Chain of alkyl group in structure A. I only B. III only C. I and II only D. II and III only E. I, II, III Ans: E 13. H 2 receptor antagonists; I. Reduce gastric acid secretion II. Reduce allergic symptoms III. Bronchoconstriction Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 25-3  Medicinal Chemistry of autocoids and analgesics A. I only B. III only C. I and II only D. II and III only E. I, II, III Ans: A 14. All of the following are side effects of Atropine EXCEPT: A. Dry mouth B. Urinary retention C. Constipation D. Blurred vision “sandy eyes” E. Diarrhea Ans: E Tips: Diarrhea is a cholinergic effect. (DUMBBELS: Diarrhea, Urination, Miosis (Eye pupil constriction), Bronchoconstriction, Bradycardia, Emesis, Lacrimation, Salivation/Sweating). 15. Which of the following drugs will decrease stomach acid secretions, by mechanistically blocking H 2 histaminic receptors? A. Hydroxyzine B. Cetrizine C. Fluoxetine D. Omeprazole E. Ranitidine Ans: E Tips: Hydroxyzine and Cetirizine are H 1 antagonist. Omeprazole---is a Proton pump inhibitor. Ranitidine-H 2 antagonist. 16. Eicosanoids are? A. Leukotrienes B. Prostaglandins C. serotonins D. Histamines E. A and B Ans: B 17. Lipoxygenases function in the following mechanism: A. Conversion of arachidonic acid to prostaglandin B. Conversion of histidine to histamine C. Conversion of tryptophan to serotonin D. Conversion of arachidonic acid to leukotriene E. Inhibition of leukocyte migration. Ans: D Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 25-4  Medicinal Chemistry of autocoids and analgesics 18. The mechanism of action of Acetyl salicylic acid that results in greater effect as an antiplatelet drug is because of: A. Selective COX I inhibition B. Selective COX II inhibition C. COX I and COX II inhibition D. Irreversible inhibition/inactivation of the acetylate cyclooxygenase E. Inhibition of the lipoxygenase as well as cyclooxygenase. Ans: D Tips: ASA is the only drug that irreversibly inhibits the enzyme. This action permits a longer duration of action causing platelet aggregation and acetylation of cyclooxygenase 19. Serotonin: A. Imidazole B. Tryptophan C. Indole D. Piperidine E. Pyrrolidine Ans: C 20. Ondansetron is? A. Serotonin type 1 antagonist B. Serotonin type 2 antagonist C. Serotonin type 3 antagonist D. Serotonin type 3 agonist Ans: C 21. Misoprostol is used for prevention of NSAID induced ulcers, is classified as: A. Prostaglandin analog PGF 2alpha B. Prostaglandin analog PGE 2 C. Prostaglandin analog PGE 1 D. 5HT 2 antagonist Ans: C Tips: Misoprostol is PGE1 analog that binds and stimulates PGE1 receptors. 22. What drug does not cause hypertension? A. Ibuprofen B. Celecoxib C. Naproxen D. Diclofenac E. ASA 81 mg Ans: E Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 25-5  Medicinal Chemistry of autocoids and analgesics Tips: NSAIDs with the exception of ASA, block the prostaglandin-mediated effect of afferent arteriole dilation of the glomeruli of the kidney giving rise to constriction of these vessels, thereby, hypertension occurs. 23. Which of the following prostaglandin inhibitors is indicated in the treatment of Open angle glaucoma? A. Latanoprost B. Timolol C. Pilocarpine D. Misoprostol E. Dinoprostone Ans: A Tips: Latanoprost is a prostaglandin F 2α analog. Timolol is a beta blocker. Pilocarpine is an acetylcholine agonist. Misoprostol is also prostaglandin analog however it is not used for glaucoma. 24. What is the mechanism of action of montelukast? A. Lipo-oxygenase inhibitors B. LTC 4 and LTD 4 inhibitors C. Cyclooxygenase inhibitors D. 5HT 1D inhibitors E. Antihistamines Ans: B 25. Allylic is a common group in the molecular structure of drugs. Which of the following groups is commonly called a vinyl group? A. H2C=CH B. H3C−O− C. H2C=CH−CH2− D. H3C−C− E. HC≡C− Ans: A Tips: Vinyl group is the univalent group CH2:CH. 26. The activity of which of the following drug depends on p-phenyl-N-alkypiperidine moiety? A. Acetaminophen B. Acetyl salicylic acid C. Naproxen D. Diazepam E. Morphine Ans: E 27. Which of the following prescription requires written prescription only? Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 25-6  Medicinal Chemistry of autocoids and analgesics A. Tylenol 1 B. Tylenol 2 C. Tylenol 3 D. Tylenol 4 E. Tylenol 3 and 4 Ans: D 28. All of the following are propionic acid derivatives EXCEPT: A. Naproxen B. Ibuprofen C. Ketoprofen D. ASA E. Carprofen Ans: D 29. Pyrazole ring is present in the following drug structure/s: A. Aspirin B. Acetaminophen C. Celecoxib D. Ibuprofen E. Ketoprofen Ans: C 30. All of the following are catecholamine neurotransmitters EXCEPT: A. Tyrosine B. Dopa C. Dopamine D. Dihydroxyphenyl alanine (DOPA) E. Norepinephrine Ans: A Tips: Tyrosine is an amino acid that is the precursor of catecholamines. 31. Serotonin (5HT) is synthesized from tryptophan. Tryptophan contains an indole ring that is catalyzed to 5-hydroxy tryptophan by the following enzyme: NH2 NH2 NH2 HOOC HOOC HO HO Aromatic amino acid decarboxylase N N N H H H Tryptophan (5-HTP) Serotonin (5-HT) A. Aromatic amino acid decarboxylase Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 25-7  Medicinal Chemistry of autocoids and analgesics B. Tryptophan decarboxylase C. Tryptophan hydroxylase D. Indole hydroxylase E. Tryptophan dehydroxylase Ans: C 32. Which of the following is an endogenous pain producer? A. Bradykinin B. Pyrogen C. Prostaglandin E 2 D. Thromboxane E. Eicosanoids Ans: A (What about Prostaglandin E 2 ?) 33. Which of the following pain reliever has sulfa allergy? A. Acetyl salicylic acid (ASA) B. Acetaminophen C. Ibuprofen D. Celecoxib E. Rumirocoxib Ans: D 34. A mother of a patient phones the pharmacy for her 10-year old son suffering from pharyngitis, sore throat infection. She got prescription for Amoxicillin 125 mg for 5 days. He has fever and pain. Currently she is using Rn What is the appropriate recommendation of the pharmacist? A. Give Acetaminophen through rectal route. B. Give Ibuprofen syrup. C. Do not give any analgesic. D. Use cold sponge E. Do not give any analgesic and antipyretics and advise salt gargle Ans: B 35. Acetyl salicylic acid metabolized by? A. Acetylation B. Glycine conjugation C. Glucuronidation D. Glutathione conjugation E. Cytochrome CYP 450 Ans: B 36. Which phase I metabolic reaction occurs at position R 3 ? Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 25-8  Medicinal Chemistry of autocoids and analgesics R1 R2 R3 = OH N R3 Lorazepam R4 NH Oxazepam Temazepam A. Oxidation B. Hydroxylation C. Reduction D. Demethylation E. Carboxylation Ans: B 37. What type of metabolic reaction is involved in Terfenadine metabolized to Fexofenadine? O H3C H3C OH CH3 CH3 CH3 HO N HO N OH OH Terfinadine Fexofenadine A. Oxidation B. Hydroxylation C. Reduction D. Demethylation E. Carboxylation Ans: A 38. A man was Acetaminophen overdosed 5 hours ago. At what time should n- acetylcysteine be administered? A. It is too late for acetyl cysteine treatment. B. Can be administered any time after overdose. C. Can be administered now. D. Treat by sodium bicarbonate first. E. There is no antidote for Acetaminophen. Ans: C 39. Glutathione is? A. cysteine, glycine and lysine B. cysteine, glycine and tryptophan C. cysteine, glycine and glutamate D. Cysteine, glycine and isoleucine Ans: C 40. MP is 75-year old women. Which of the following is the most concern? Copyright © 2000-2019 TIPS Inc. Unauthorized reproduction of this manual is prohibited. This manual is being used during review sessions conducted by PharmacyPrep. 25-9  Medicinal Chemistry of autocoids and analgesics A. Dimenhydrinate B. Diphenhydramine C. Loratadine D. Desloratadine E. Cetirizine Ans: B Tips: diphenhydramine or first generation antihistamine cause severe sedation and anticholinergic side effects in elderly patient. Preferably second generation antihistamines are recommended in elderly. 41. A patient is using ASA 81 mg enteric coated tablet. What is incorrect about enteric coated ASA? A. Enteric coated decreases GI bleeding. B. Enteric coated decreases GI irritation. C. Enteric coated is meant to be absorbed in small intestine. D. Enteric coated is used for chronic therapy. E. Uncoated is used to prepare liquid formulations. Ans: A 42. Which of the following drugs have structural similarity to diphenhydramine? Diphenhydramine (Benadryl) Cyclizine (Marezine) CH3 O CH2CH2 N CH N N CH3 CH3 A. Dimenhydrinate B. Cetrizine C. Fexofenadine D. Loratadine E. Cyclizine Ans: A 43. What are the two enzymes that catalyze tryptophan to serotonin? A. Hydroxylase and decarboxylase B. Dehydroxylase and decarboxylase C. Hydroxylase and methyl transferase D. Dehydroxylase and methyl transferase E. Demethylation and hydroxylation Ans: A 44. A customer of your pharmacy brings a prescription ASA 650 mg q 4 to 6 h for 7 days for arthritis. Currently, she is on ASA 81 mg and Warfarin 2 mg, for heart problems. She wants to kno