ORION May 2023 Pharmacy Exam Questions PDF

‫صيــــــــادلة بتخدمـك‬ ORION May 2023 ‫ تم اضافة ملف االسئلة من تصحيح الصيدالنية مرام‬،‫تصحيح منى نصر‬ ‫ وإن أسأت أو أ...

‫صيــــــــادلة بتخدمـك‬ ORION May 2023 ‫ تم اضافة ملف االسئلة من تصحيح الصيدالنية مرام‬،‫تصحيح منى نصر‬ ‫ وإن أسأت أو أخطأت فمن نفسي والشيطان‬،‫ فإن أحسنت فمن اهلل‬،‫هذا ما عندي‬ ‫ إعادة ترتيـــــــــــب أسئلة يزيـــــد وعباس واحتفظنا بنفس ترقيم أسئلتهم‬# 2023-5-1# ‫االسئلة مصنفة كل قسم لوحــــدة اختصارا للوقت وتقليل التشتت‬# ‫دعواتكم بخالص التوفيــــق والنجـــــــــــــــــــــــــاح‬# 54- Mortality of children was 8 in 2012 and 6.4 in 2017, This mean? A- More hospital open B- Improve health C C- Nothing, more information need 1 ADM 38- What database do insurance companies use? A- C.L.U.E.” database A 2 Comprehensive Loss Underwriting Exchange ADM 39- Sources of data in insurance companies? A- CLAIMS A 3 b- Health data C- Information collection ADM is 49- Which of the following error detection strategies result in limiting detection? A- bar-coding B- trigger tools ADM C- voluntary reporting ‫التقارير التطوعية تقلل من الكشف على االخطاء الدوائية‬ D D- mandatory reporting ‫التقارير االلزامية تساهم في الكشف على االخطاء الدوائية‬ 4 55- Mid goal to long term future goal? A- Mission ADM 5 B- Vision C- Plan B 77- Preventive and curative institution? A. primary ADM B. secondary 6 C. tertiary A D. specialty 177- Mission and vision can be present in which strategy? A. Planning strategic planning is to align a company's mission with its vision B. Organization 7 C ADM C. Strategic Strategies are a series of ways of using the mission to achieve the vision 183- Long term plan use all aspects in organization A- strategy B- operation C- organization A 8 ADM 1 ‫صيــــــــادلة بتخدمـك‬ ORION May 2023 184- Pharmacist wrote email to another pharmacist to ask add medication to theformulary in the hospital this is consider as ? A. Inter institutional ADM B. Intra institutional C. Written communication 9 D. Non Verbal communication C 206-Head of pharmacy decide to make group to arrange formulary drugs in hospital? A. organizing B. planning ADM C. Leading B 10 252- who's responsible for accreditation of health care system? A- SFDA B- WHO ADM C- MOH D 11 D- CBAHI 360- You received a prescription on a plain paper what to do ? A. Tell the manager ADM B. Talk to the prescriber and don't dispense 12 A Don’t dispense the medicine and refer the patient to prescriber 409- pharmacist manager screamed on one of the pharmacist who dispensed wrongmedication in front of all the staff what is the good response ? A. he should punish him in separate area B. ask for a meeting with the staff ADM C. cut from his salary D. Try to find the cause of the error and set solutions D 13 14) Which of the following is the function of the pharmacy and therapeutic committee in ahospital? A. Responsible for poison management B. Monitor the adverse reaction reporting ADM C. Monitor the medication error reporting 14 D. Responsible for drug formulary management D 70- Which of the following distribution systems works better for medicine requiring a higherlevel of control? A. Bulk ward stock B. Direct procurement ADM Or unit dose system (UDS) C. Automated dispensing C 15 D. Individual medication order 2 ‫صيــــــــادلة بتخدمـك‬ ORION May 2023 77- Which of the following committees is dedicated to developing and maintaining a list ofapproved medicine for the hospital medicines for the hospital use ? A. Medical records ADM B. Medication audit D C. Quality assurance 16 D. Pharmacy and therapeutics 66- Which of the following is the definition of management? A) The art of maximizing profitability ADM B) The art of maximizing productivity The primary goal of management is to create an environment that lets employees work ef ciently and productively 17 C) The art of maximizing possibilities B D) The art of maximizing predictability 72- A 65-year-old man presents to the pharmacy for a refill his medications. On review of his refill history, the pharmacist noticed that he does not refill his medications regularly. Upon asking him, the patient started that he has multiple medications that require complex administration. Which of the following non adherence factors affecting above patient? ADM A. Patient related factors 18 B. Provider related factors D C. Health care system factors Polypharmacy D. Medication and condition factor 24- which of the following need to be considered first by a pharmacist in order to rationalize drug therapy decisions? ADM A. Care plan 19 B. Follow-up evaluations C. Pharmacotherapy workup C 75- It is the broad range of health care services provided by in order to optimize therapeuticoutcomes for individual patients Which of the following is the term used to describe the above- mentioned definition? ADM A. Pharmaceutical care B. Medication counseling 20 C. Medication reconciliation D. Medication therapy management D 91- Free medical sample drugs (formulary or non-formulary) are provided by pharmaceuticalsales representatives to physicians or members of the health care team. Which of the following is the most appropriate recommended policy for dealing with sample drugs? A. Dispense them directly to the patient ADM B. Keep them with the rest of original items C. Keep in outpatient clinics or nursing units D 21 D. Exclude them from in-patient pharmacy, drug store or doctors' offices 3 ‫صيــــــــادلة بتخدمـك‬ ORION May 2023 The hierarchy is showing Hospital X organizational chart. A pharmacist assigned as a clinicalpharmacist in neuroscience ward (see image) Which of the following managerial position will the coworker re submitting a complaint? 22 ADM A) Pharmacy Director B) Medical affair Director C) Neuroscience ward director D) Clinical pharmacy department Head D 157- Most on prescription? A- Patient name - mrn- date B- Phystion name - number - signature 23 ADMIN C- Patient name - age - sex - diagnosis D- all above C 36-which of the following medication has a side effect metallic taste ? A) cefuroxime ADVERSE 24 B) azithromycin C) ciprofloxacin D D) metronidazole 118- What is the type of anemia Lack of intrinsic factor?A- Megaloblastic anemia B- Pernicious anemia Vit.B12 de ciency 25 ANEMI C- Hemolytic anemia B D- Aplastic anemia 42- which of the following anesthetics drug has a higher risk of causing hepatic toxicity? A) propofol Risk of Hypotension 26 ANES B) ketamine Risk of hypertension C) isoflurane Risk of hepatotoxicity C D) nitrous oxide Risk of cardiotoxicity and anemia 16- Which of the following is the advantage of using intravenous anesthetic drug? A. Produce fast onset of anesthesia 27 ANESTH B. Helps in maintaining anesthesia C. Increases the minimum alveolar concentration (MAC) of the anesthetic drugs A D. Produce less cardiovascular and respiratory suppression 84- Which of the following is the mode of action of Phentolamine? A. beta-adrenergic blocker 28 ANS B. beta-adrenergic agonist C. alpha-adrenergic agonist D D. alpha-adrenergic blocker (non selective alpha blocker) 22- Which of the following is a consequence of stimulation of ꭤ1-Adrenoceptors? A. A flushing Adrenergic Receptors vasoconstriction leads to high blood pressure 29 ANS B. increased heart rate C. elevated blood pressure C 4 ‫صيــــــــادلة بتخدمـك‬ ORION May 2023 24- which drug is used to treat an anaphylactic reaction? A. Atropine ANS B. Adrenaline B 30 C. Isoprinosine D. Phentolamine 30- Which of the following is a property of amphetamine? A. It does not cross the blood brain barrier ANS B. It stimulates the release of stored acetylcholine 31 C. It stimulates the release of stored norepinephrine C D. It stimulates the release of five hydroxytryptophan (5-HT) 50-A 25-year-old driver was held for reckless driving and confronting a policeman. He is tooconfident, talkatiye.restless and continuously walking around the hall. Which of the following is the drug that the driver is abusing? ANS A. Diazepam B. Theophylline C CNS stimulants and increase ego 32 C. Amphetamine D. Lysergic acid diethylamide (LSD) 72- What is the pharmacological classification of Ipratropium bromide? A. Beta agonist ANS B. Alpha agonist 33 C. Cholinergic agonist D D. Antimuscarinic agent 14- Which of the following is a consequence of stimulation of ꭤ1 - adrenoceptors? A. flushing Repeated ANS B. increased heart rate D 34 C. constricted bronchioles D. elevated blood pressure 77- Which of the following describes the mechanism of action of rivastigmine? A. cholinesterase inhibitor ANS B. alpha-a receptor inhibitor A 35 C. serotonin reuptake inhibitor D. angiotensin converting enzyme inhibitor 106- Drug to reverse action of Atropine? A. Physostigmine B. Benztropine ANS C. Disulfiram A 36 D. Propranolol 5 ‫صيــــــــادلة بتخدمـك‬ ORION May 2023 301-Catechol amine with COMT ? ANS A- rapid metabolism 37 B- slow metabolism A 55- A 21-year-old patient went through respiratory depression after receiving anesthetic agent. Which of the following agents will counteract post-anesthetic respiratory depression? A. morphine ANSE B. picrotoxin B 38 C. diazepam D. thiopental 76- Which of the following drugs would decrease the amount of minimum alveolarconcentration (MAC) for an anesthetic drug? Or other benzodiazepines A. diazepam ANSE B. buspirone 39 C. ephedrine A D. loratadine 83- Which of the following anesthetics drugs has a higher risk of causing anemia? A. propofol ANSE B. ketamine C. isoflurane D 40 D. nitrous oxide Nitrous oxide inactivates methionine synthase via oxidation of the cobalt in vitamin B12 and may lead to megaloblastic anemia. 71- Which depolarizing neuromuscular blocker is less potent than tubocurarine? A. succinylcholine (Anectine) ANSE B. rocuronium (Zemuron) C. pipecuronium (Arduan) A 41 D. doxacurium (Nuromax) 100- Which of the following is heparin antidote? A. Protamine Sulphate B. Octreotide ANTIDO C. N-Acetylcysteine A 42 D. Naloxone Hydrochloride 32- What is the antidote for heparin toxicity? A. Protamine sulfate antidote B. Sodium salicylate 43 C. Naloxone Repeated A D. Glucagon 9- Which of the following situation is most likely to be controlled by administering parenteral calcium as an antidote? A. Hypokalemia ANTIDOTE B. Verapamil overdose CCB 44 C. Heroine intoxication B D. Cocaine intoxication 6 ‫صيــــــــادلة بتخدمـك‬ ORION May 2023 11-A 55-year-old man presents with an excessive bronchial and oconasal secretions. History revealed, is exposed to an organophosphate insecticide. Which of the following is the best management? 45 ANTIDOTE A. Atropine IV B. Diphenhydramine orally A C. Pralidoxime intramuscularly D. Physostigmine intramuscularly 40- In case a patient develops toxicity from midazolam. Which of the following medications can be given as an antidote? A. Atropine 46 ANTIDOTE B. Flumazenil Antidote of benzodiazepine B C. Amifostine D. Acetylcysteine (3) Which of the following is the precursor for 5_hydroxytryptamine? A) proline Serotonin, also known as (5-HT) 47 BIOch B) alanine D C) glutamine D) tryptophan 30- Which of the following enzymes regulate supercoiling of DNA? A) Helicases 48 BIOch B) Primases C) Topoisomerases C D) Reverse transcriptase 83- Where dose the electron transport chain reaction pathway take? A) Cell cytoplasm 49 BIOch B) Golgi apparatus C) Outer mitochondrial membrane D D) Inner mitochondrial membrane 99. Which of the following vitamin deficiency can cause scurvy? A. vitamin A 50 BIOch B. vitamin B6 C C. vitamin C D. Vitamin D 7 ‫صيــــــــادلة بتخدمـك‬ ORION May 2023 The diagram shows the role of a vitamin as coenzyme for cystathionine synthase and cystathionase enzymes which catalyze the transsulfuration of methionine to cysteine (see image). Which of the following is the vitamin indicated by the star* in the figure? D BIOch 51 A. B2 B. B3 methionine C. B5 Cysteine it Homocysteine D. B6 2- pH difference between extracellular and intracellular fluid is A. Nil B. 0.2 BIOch C. 0.4 52 C D. 0.8 3- Role of ATP ? A. Energy carrier BIOch B. Oxygen carrier A 53 C. Amino acid carrier 5- which is cytokine in ammatory mediators A. Leukotriene 54 BIOch B. Adrenaline A C. Gonadotropin 7- Which process does Insulin work on or increase ? A. Glycogenolysis B. Glyconeogenesis BIOch C. Glucogensis E 55 D. Ketogenesis E-Glycogenesis storingglucoseinliver 13-The synthesis of glycogen from glucose called?A- BIOch A 56 Glycogenesis 42- How much molecule ATP molecules are produced for every glucose. A- 12 B- 24 BIOch C- 38 C 57 8 ‫صيــــــــادلة بتخدمـك‬ ORION May 2023 61- Which Amino acid we give for anorexia? A. Alanine 58 BIOch B. arginine C C. Valine 62- starch is digested in saliva by ? BIOch A. Amylase 59 B. lipase A 64- POLYSACCHARIDE? A- BIOch B- Glucose 60 b- glycogen c- glucagon B 73- Which of the following is the precursor for 5- hydrotryptamine (serotonin)? A. Proline bioch B. Alanine 61 C. Glutamine Repeated D D. Tryptophan 79- How much ATP molecules are produced for every glucose molecule? A. 12 BIOCH B. 24 Repeated C. 38 C 62 101- Which process does Insulin work on increase? A- Glycogenolysis BIOCH B- Glyconeogenesis C- Glucogensis Repeated 63 D C- Ketogenesis D- Glycogenesis 131- Krebs cycle for production of ? produces carbon dioxide, NADH, FADH2, and ATP or GTP. BIOCH A- ATP A 64 Julyz 134- DNA ligase enzyme for ligation of ? A. mRNA with TRNA r B. 2mRNA molecules BIOCH C. 2tRNA molecules D 65 D. 2DNA strands ligase is sealed DNA that has been broken or synthesized via okazaki fragments. 138- use Glucosamine for uses ?? A- Osteoporosis 66 BIOCH B- Osteomyelitis C- Osteoarthritis C 155- Where dose the electron transport chain reaction A. pathway take B. Cell cytoplasm BIOCH C. Golgi apparatus Repeated D. Outer mitochondrial membrane 67 E. Inner mitochondrial membrane E 9  ORION 163- How many amino acid in the human body ? A A. 20 68 BIOCH B. 30 C. 40 181- Which parameter used when we give statin and there is rhabdomyolysis ? A- Creatine kinase 69 BIOCH B- Crcl A 210- Purpose of mitochondria ?A- Synthesis of DNA B- Synthesis of RNA 70 BIOCH C- Produce ATP C 270- Which is complex protein ? A. Pr B. Sec 71 BIOCH C. Tri D D. Quaternary in structure 356- acetyl-CoA to form malonyl- coA which vitamine is used ? A. biotin (B7) B. riboflavin 72 BIOCH C. pyridoxine A D. nicotinamide 357- coenzyme for cystathionine synthase and cystathionase enzymes which catalyze the transfiguration of methionine to cysteine ? A- B2 B- B3 73 BIOCH C- B5 D- B6 Cysteine Homocysteine it methionine its D 358- Acetyl coA and citric acid cycle which vitamin is used ? A. B6 B. B12 74 BIOCH C. B2 C D. B9 365-Which the carrier in Krebs Cycle? A. Carrier in cycle 75 BIOCH B. oxaloacetate The carrier of the citric acid cycle is Oxaloacetate C IC. Citric acid 403- Number of ATP in glycolysis ? A- 1 B- 22 76 BIOCH C- 24 D D- 2 10  ORION 12) What the function of small nuclear (snRNAs) in protein synthesis? A. Act as catalyst 77 BIOCHE B. Modifies mRNA molecules C. Genetic blueprint for the protein B D. Translates genetic code to amino acid 25) Which of the following pairs represents the purines nitrogenous bases? Guanine Cytosine Adenine Thymine A. Adenine (A) and Uracil (U) 78 BIOCHE B. Cytosine (C) and Uracil (U) Purines (adenine and guanine) are two-carbon nitrogen ring bases. Pyrimidines (cytosine and thymine) are one-carbon nitrogen ring bases. C. C)Adenine (A) and guanine (G) C D. D)Cytosine (C) and guanine (G) 30) Which of the following is the process of breaking down of glycogen ? A. Glycolysis 79 BIOCHE B. Glycogenesis C. Glycogenolysis C D. Gluconeogenesis 40) Which of the following inhibits gluconeogenesis? A. Insulin 80 bioche B. Glucagon C. Epinephrine A D. Glucocorticoid 73- Which of the following is a non-essential amino acid? A) Lysine B) Valine 81 BIOCHE C) Cysteine D) Isoleucine C N.B:-The 9 essential amino acids are: histidine, isoleucine, leucine, lysine, methionine,phenylalanine, threonine, tryptophan, and valine. 154- which of the following inhibits gluconeogenesis A- insulin B- glucagon Repeated A 82 BIOCHE C- epinephrine D- glucocorticoids 197- which the Carbohydrates produce more energy A. glucose 83 BIOCHE B. maltose All Produce Same amount of Energy per ‫ــــــــــــ‬ C. sucrose gram ‫ــــــــــــ‬ ‫ـ‬  ORION 48) Which of the following compounds is urea cycle a biochemical reaction that produce ureafrom? A. Sucrose B. Glucose 84 biochem D C. Glycogen D. Ammonia (NH3)  ORION 86-Click image to enlarge 85 BIOCHEM A water-soluble vitamin catalyzes the carboxylation of acetyl-COA to form malonyl-CoA, whichis required for the synthesis of fatty acids (see image) Which of the following vitamins plays this role? A. biotin (b7) A B. riboflavin C. pyridoxine D. nicotinamide 28) Which of the following is a function of alcohol dehydrogenase enzyme? A. Accelerates the reduction of ethanol B. Accelerate the addition of hydrogen to ethanol 86 BIOCHEM C. Accelerates the addition of phosphate to ethanol D. Accelerates the removal of hydrogen from ethanol D 86- Which of the following enzymes is responsible for forming DNA copy from RNA? A. Reverse transcriptase 87 BIOCHEM B. DNA polymerase A C. Helicase D. Primase 46- Which of the following is a potential serious side effect that is common among all anticoagulant agents? A. Hypokalemia. 88 blood B. Major Bleeding C. Liver Dysfunction B D. Renal Dysfunction 6) Which of the following is an example of a parenteral direct thrombin inhibitor? A) enoxaparin 89 blood B) argatroban & Bivalirudin C) fondaparinux B D) unfractionated heparin 11- which of the following anti platelets is contraindicated patients with transient ischemicattack (TIA) or stroke? 90 blood A. Prasugrel B. Ticagrelor A C. Clopidogrel  ORION D. Dipyridamole 26- which of the following antiplatelet agents the highest risk of causing dyspnea ? A. Prasugrel B BLOOD B. Ticagrelor 91 C. Clopidogrel D. Dipyridamole (34) Which of the following is the recommended anti-coagulation strategy for atrial fibrillation __ patient with a CHA2DS2-VACS score of 5? A. aspirin BLOOD B B. dabigatran orany noAc 92 C. clopidogrel D. no anticoagulation (47) Which of the following could lead to decrease in international normalization ratio (INR) in a patient of warfarin therapy? A. decrease the consumption of dietary vitamin K BLOOD B. carbamazepine therapy B 93 C. cotrimoxazole therapy D. metronidazole therapy 64- Which of the following is the preferred anticoagulant therapy during hemodialysis procedure? A. Enoxaparin BLOOD D B. Dabigatran 94 C. Rivaroxaban D. Unfractionated heparin (UFH) 71- A 51-year-old man diagnosed with pulmonary embolism. The patient planned for warfarinand started combination with warfarin until INR is therapeutic (see lab result). Weight 80kg Hight 160cm Test Result Normal value Creatinine 85 44-115 umol/L C BLOOD CREATININ CLERANCE 103 70-103 umol/L 95 Which of the following enoxaparin dose regimen should the patient receive? A. Enoxaparin 30 mg SC every 24h InglisB B. Enoxaparin 40 mg SC every 24h C. Enoxaparin 80 mg SC every 12h D. Enoxaparin 160 mg SC every 12h  ORION 2- Which of the following medications is an anticoagulant agent? A. Aspirin Antiplatelet BLOOD B. Warfarin Antiplatelet 96 C. Clopidogrel B D. D. Streptokinase thrombolytic (16) Which of the following is the mechanism of action of apixaban? A. an indirect inhibitor of thrombin BLOOD B. an indirect inhibitor of factor Xa 97 C. a direct inhibitor of thrombin D D. a direct inhibitor of factor Xa 45- Which of the following can decrease the effect of warfarin? The most accurate answer A. Antibiotics BLOOD B. Paracetamol 98 C. Multivitamins (contain vit k) C D. Calcium supplement 73- Which of the following best represents the activity of dipyridamole? A. It has fibrinolytic activity BLOOD B. It has antifibrinolytic activity C 99 C. It is a platelet aggregation inhibitor D. It is a phosphodiesterase enzyme inducer 25- What is the route of administration of Enoxaparin? A. Intrathecal bolus BLOOD B. Transdermal injection 100 C. Subcutaneous injection C D. Intramuscular injection 97- Which of the following drugs can be used to lyse fibrin clots? A. heparin BLOOD B. warfarin 101 C. enoxaparin D. streptokinase D 18- Which of the following can decrease the effect of warfarin? A. antibiotics BLOOD B. paracetamol Repeated C 102 C. multivitamins D. calcium supplement 41- Which of the following medications produces antiplatelet effect by inhibiting Adenosine Diphosphate (ADP) receptors? A. aspirin BLOOD B. abciximab 103 C. clopidogrel C D. streptokinase  ORION 63- Which of the following is recommended regarding air bubble in the syringe for a patientstarting on enoxaparin subcutaneous Injection? A. inject the dose with the air bubble BLOOD B. Inject the air bubble if the volume is small 104 C. remove the air bubble to avoid wastage of the dose D. remove air bubble and adjust volume before injection A 74- Which of the following is a potential serious side effect that is common among all anticoagulant agents? A. hypokalemia BLOOD B. major bleeding Repeated 105 C. liver dysfunction D. renal dysfunction B 75- Which of the following statements describes unfractionated heparin? A. enolic acid derivative BLOOD B. propionic acid derivative 106 C. acetyl ester of salicylic acid D. mucopolysaccharide polymers D 71- Which of the following is recommended regarding air bubble in the syringe for a patient starting on enoxaparin subcutaneous injection? A. Inject the dose with the air bubble Repeated BLOOD B. inject the air bubble if the volume is small 107 C. remove air bubble to avoid wastage of the dose D. remove air bubble and adjust volume before injection A 22- Risk factor cause DVT? A. Age blood B. food rich of VK 108 C. surgery C 59- The recommended DVT prophylaxis dose for postpartum in women with heigh risk of DVT is? A. 3 weeks 6weeks to 12 weeks depend on risk factor BLOOD B. 6 weeks mostaccurateanswer C. 3 months D. 6 months B,c 109 92- Which of the following is parenteral direct thrombin inhibitor? A. Argatroban Repeated B. Dabigatran BLOOD C. Heparin A 110 D. Warfarin  ORION 96- Which of the following antiplatelet working by inhibition of adenosine diphosphate receptor? A. Aspirin C Repeated BLOOD B. Abciximab C. Clopidogrel D. Streptokinase 111 113- Which direct anticoagulant needs premedication 5-10 dayswith anticoagulant ? 112 BLOOD Note: endoxaban > Apixaban >Dabigatran 98ft 136- how ibuprofen inhibit antiplatelet effect of aspirin ? BLOOD A- Ibuprofen bind to cox1 and hinder it's acetylation by aspirin 113 141- Ptient on Warfarin and has mechanical valve and INR 3.5, what should you do ? A- No management BLOOD B- decrease warfarin dose normalvalue 2.5 3.5 114 A 146- Neonate with coagulopathy which vit K route will you use ? A. Suppository B. Iv C. Sc BLOOD D. Im Child is IM 115 Coagulopathy.. IV B 239- antiplatelet C.I. in patients with transient ischemic attack ?A- dipyradimole B- clopidogrel Repeated BLOOD C- prasugrel 116 D- ticagrelor C 253- INR monitoring after initiation as outpatient ?A- next day B- 2-5 days BLOOD C- 1 month 117 D- 3 months B 318- treatments of pulmonary embolism? A- Enoxaparin 40 mg sc once daily B- Rivaroxaban BLOOD C- Enoxaparin 1 mg/ kg twice dailyOr 2 118 mg/ kg once daily C 334- patient is taking warfarin 4.5 mg PO daily came to the clinic with INR of 5.1 withoutany signs of active bleeding, what is the appropriate management for her ? A. Hold warfarin and give vit K IV BLOOD B. Hold warfarin and resume with lower dose C. Hold warfarin and give platelet 119 Omit warfarin dose , monitor INR and resume when it be in therapeutic range B  ORION 345- in pregnancy what the trimester can be use warfarin ? A. first If possible, warfarin therapy should be avoided during B. second pregnancy. If warfarin therapy is essential, it should be BLOOD C. third trimester avoided at least during the rst trimester (because of teratogenicity) and from about 2 to 4 weeks before 120 D. avoided use in pregnancy delivery to reduce risk of hemorrhagic complications. D 397- Pt use Warfarin 10mg and INR low why ? A. Low dose BLOOD B. Diet orDrug interaction 121 C. Low bioavailability of warfarin B 425- which the fallowing uses in prophylaxis strock A. anticoagulant blood B. thrombolytic drug 122 C. antiplatelet C 427- Which the fallowing drugs inducing thrombocytopenia A- UFH heparin B- LMWH blood C- warfarin 123 D- Aspirin A 428- Which the fallowing drugs treatment thrombocytopenia A- UFH H B- LMWH blood C- warfarin 124 D- Argatroban D 110- Medication for osteoporosis in menopausal women given monthly? A. Zoledronic acid B. ibandronate 150 mg orally monthly BONE C. raloxifene 125 B 119- Medication for osteoporosis in women given once per a year ? A- Zoledronic acid 5 mg IV once yearly B- ibandronateC- BONE raloxifene 126 A 120- Medication for osteoporosis in women given weekly ? A- Zoledronic acid B- ibandronate BONE C- raloxifene D- Alendronate 70 mg PO once weekly 127 D 202- gold standard test for Osteoporosis ? BONE A- (DEXA) 128 dual-energy x-ray absorptiometry A 17  ORION 285- Patient with Osteoporosis which need for Diagnosis? A- X-ray 129 BONE B- MRI A C- CT (39) Which of the following osteoporosis drugs can cause esophageal ulcer s? A. denosumab BONE B. teriparatide 130 C C. alendronate D. zelodronic acid 73- Which of the following medications for osteoporosis will significantly reduce the risk of hip fracture? Bisphosphonates A. Phosphate BONE B. Risedronate 131 C. Raloxifene B D. Calcitonin 14-A 65-year patient suffered from Osteomalacia with finger numbness, tingling and burning of extremities. The doctor prescribed vitamin D and an IV calcium supplement. Which of the followingcalcium salts did the physician most likely prescribed ? A. Calcium citrate (21%calcium) B. Calcium lactate(13%calcium) BONE C. Calcium gluconate (9%calcium) Calcium gluconate is a calcium salt used to directly replete serum calcium levels 132 D. Calcium phosphate (39% calcium) C N.B:-Ca phosphate no more effective — and may in fact be less effective — than calcium citrateor calculation calcium carbonate. questions at the end of the le by 56- A 25-year-old man with leukemia admitted to hematology oncology center. Who is allowed to ph.Maram read the patient file without additional permission? A) Patient's cousin who is working as out-patient nurse in the hospital CANC B) Medical resident in pediatric who wants to explore the risk leukemia 242 C) Clinical nutritionist who is assigned to calculate the requires for the patient C D) Pharmacy resident who is planning to do a research cell transplant 57 -Which of the following anti-neoplastic medications is known to cause bone marrowsuppression? A. bleomycin B. vincristine CANCER C. doxorubicin 243 D. l-asparaginase C 3 9  ORION 59- Which of the following is an alkylating anticancer agent? A. cyclophosphamide CANCER B. fluorouracil C. doxorubicin 244 D. etoposide A (11) 42-year-old woman, a mother of 2 boys is diagnosed with cancer, treatment options includes either hysterectomy or chemotherapy The patient refused the surgery because she still wants to daughter, and do not want to receive any chemotherapy in protect her hair and beauty.What will be the most appropriate suggestion for her? CANCER A-To starts chemotherapy with very low doses and less frequency B- To go with the option of surgery immediately because it is 245 C-To discuss the risk and benefit with the patient and take the decision D-To force the patient to receive chemotherapy and wear syn hair extensions C 67- Which of the following anti-cancer alkaloids act by stabilizing the microtubule polymer and protecting it from disassembly? A. Paclitaxel CANCER B. Colchicine C. Vinblastine 246 D. Camptothesin A 26. Which of the following is a recommendation to reduce the inadvertent intrathecal administration of vincristine? A. dispense the syringe without needle CANCER B. dispense vincristine in 60-ml syringe C. dispense vincristine in mini bag instead of syringe 247 D. dispense the vial for the nurse to prepare at the bedside C 8- What is the most common adverse reaction of doxorubicin? A. Bone marrow depression B. Hepatic toxicity CANCER C. Cardiac toxicity D. Skin necrosis 248 BELOMYCIN _ pulmonary fibrosis MITOMYCIN _nephrotoxicity C 35- What is the therapeutic indication fo r nilotinib ? A. Ulcerative colitis CANCER B. Familial hyperlipidemia C. Highly active and relapsing remitting multiple sclerosis 249 D. Philadelphia chromosome positive chronic myelogenous leukemia D 3 10  ORION 29- 40 years old women with breast cancer, topoisomerase is elevated, which drug shouldbe used A- Cyclophosphamide CANCER B- Melphalan Irinotecan inhibits the action of C- Irinotican 250 D- Methotrexate C 129- Immune system works an important role in cancer treatment by ? A. Macrophage CANCER B. cytotoxic 251 C. complex B 173- prevention breast cancer ? A. Vit A 100 B. Vit D 200 CANCER C. None of them D. Vit A + vit d 252 B 196- Prevention breast cancer ? Repeated A. Vit A 100 B. Vit D 200 CANCER C. None of them B D. Vit A + vit d 253 N.B : Deficiency of Vitamin D is combined with tumor progression , Metastasis 265- Immune system works an important role in cancer treatment by ? A. Macrophage B. cytotoxic Repeated CANCER C. complex 254 B 267-Cysteine in chemotherapy agent benefit ? A- Increase Target B- Increase effects can abrogate the effects of the majority of oxidative or alkylating drugs used in cancer therapy CANCER C- increase solubility B D- More information need 255 90- Click image to enlarge Acetaminophen is an antipyretic and an analgesic drug. It binds to a cytosolic protein (see image). Which of the following types of bonds is formed between the protonated amine of theacetaminophen and the cytosolic acid of the aspartate residue of the protein? CHEM A. ionic bond B. covalent bond 256 C. hydrogen bond D. VAN_der walls interaction C 63- Which of the following molecules contains double bond? A. CH3 CHEM B. CNH H EF C. C2H2 257 D. C2H4 D 3 11  ORION 65) Quinine is an important antimalarial drug with very complicated structure and is very sensitive stereochemistry (see image). chem Which pharmacological activity the drug will possess stereochemistry at the arrow has changedfrom R O to S? 258 A. anticancer D B. antimalarial C. anticoagulant D. antiarrhythmic S stracter Quinidine 80) Click image to enlarge Acetaminophen is an anti pyretic and an analgesic drug. It binds to a cytosolic protein (see image). Which of the following types of bonds is formed between the protonated amine of theacetaminophen and the carboxylic acid of the aspartate residue of the protein? chem A) lonic bond Repeated C B) covalent bond 259 C) hydrogen bond D) van-der walls interaction (14) Which of the following can be used safely in a patient with sulfa allergy? A) gliclazide CHEM B) furosemide Furosemide is associated with an extremely low risk of minor reactions in patients with sulfa allergies C) sulfamethoxazole D 260 D) sodium thiosulfate 13) The structure of norepinephrine-serotonin reuptake inhibitor (NSRI) (see image) Which of the following structure modifications can transform this drug into a selective norepinephrine re- CHEM uptake inhibitor (SNRI) analogue? D A. quaternization of the side chain amino group B. transformation of the side chain amino group into a primary amine 261 C. replacement of the side chain N.N-dimethylamino group with a hydroxyl group D. demethylation of the side chain tertiary amino group to yield a secondary amino group 40  ORION 23- Thalidomide is a potent immunomodulatory drug used to treat leprosy Thalidomide exist intwo conformation structures with different pharmacological and toxicological activates teratogenicity is believed to becaused on conformational structure (see image ). CHEM Which of the following is the most appropriate term used tocall the two conformations of the thalidomide? C A. Isomers 262 B. Epimers C. Enatntimomers D. diasteriomers 28) A structure of the glibenclamide (glyburide)(see image) Glyburide is an N-sulfonylurea that is acetohexamide in which the acetyl group is replaced by a 2-(5- chloro-2-methoxybenzamido)ethyl group chem Which of the following pharmacophore does Glibenclamide (glyburide) contain? A. Benzenesulfate urea D 263 B. Benzenesulfinyl urea C. Benzenesulfhydryl urea D. Benzenesulphonyl urea 29- Aspirin is well-known antiplatelet aggregating agent (see image) c chem What is the role of the acetyle group in its antiplatelet activity? 264 A. it represents a good leaving group to form the active salicylic acid B. it provides hydrogen binding with tyrosine moiety on COX binding C. it provides covalent binding with serine moiety found on COX binding site D. it provides hydrophobic binding with a tryptophan moiety on COX binding site 38) Examine the drug in the figure (see image). Codeine CHEM 265 C 41  ORION What is the effect of replacement of the methoxyl group (boxed) with a hydroxyl group? A. Decrease in analgesic activity B. Decrease in addition activity C. Reduction in the antitussive activity D. Lower affinity to morphine receptors N.B:-structure in pic is codeine (anti tussive) convert into morphine(analgesic) 40- The structure of erythromycin (see image) CHEM 266 D Which of the following is the reason why erythromycin is sensitive to acidic pH? A. The presence of lactone group in the ring B. The presence of two basic sugars at position 3 and 5 C. The presence of 6 months methyl groups at alternate positions of the macrolide ring D. Ketal fomation between hydroxyl group (6 and 12) and ketone at position 9 35- Which of the following polymorphic enzyme is responsible for the conversion of codeine to morphine? A. CYP2D6 CHEM 267 B. CYP2C9 A C. CCR5 corecptor D. N-Acetyltransferase 38- Structures of four antidepressant drugs (see image) CHEM A Which of the following antidepressant structure undergoes a photo- oxidation reaction uponexposure 268 to the light? A. 1 B. 2 C. 3 D. 4 39- The chemical structure of four non-steroidal anti-inflammatory agents (NSAIDs) (see image). CHEM 269 B 42  ORION Which of the following NSAIDs has minimal possible gastric side effects? A. (ibuprofen) B. (celecoxib) selective cox-2 C. (indomethacin) D. (diclofenac) 10- Which of the following is the most common cause of drug instability? A. oxidation CHEM B. racemization C. epimerization 271 D. decarboxylation A 30- Which of the following molecules contains double bond? A. CH3 CHEM B. CNH Repeated C. C2H2 272 D. C2H4 D 50- Structure of ciprofloxacin (SEE IMAGE ) CHEM 273 D 43  ORION Which of the following is the benefit of the piperazine group at position? A. Increases drug resistance to β-lactamase A. improves the oral bioavailability of the drug B. Increases lipophilicity and hence penetration of the bacterial cell wall D C. Improves the spectrum of antibacterial activity (especially Gram- negative) 51- Which one of the following is the effect to alkaline buffers that have in commercial formulations of aspirin? A. they have one effect on the rate of absorption. B. they increase the rate of its absorption by alkalinizing the pH of the stomach CHEM C. they reduce the rate of absorption of aspirin by converting it to the less readily absorbed lonic form 274 D. they Increase the rate of absorption by increasing the PH immediately around the disintegrating aspirin particles and accelerating their dissolution D 73-Examine the chemical structure of diclofenac (see image‫ ب‬.‫)تقري‬. CYP2ca CHEM Which of the following structures best represents a major active metabolite of diclofenac? D A.1 275 B.2 C.3 D.4 78- Click image to enlarge The presented structure belongs to the proton pump inhibitor tenatoprazol (see image). B CHEM Which of the following metabolic reactions can occur at the pointed arrow on the structure? A. sulfation 276 B. oxidation C. demethylation D. glucoronidation Click image to enlarge CHEM Which of the following medications contains triazole moiety? (see image) 277 44  ORION 98- Click image to enlarge Histamine (pKa=9.4) is endogenous chemical release when allergic reaction happened. As a pharmacist you are responsible to understand the mechanism and the conformation of this chemical in the blood (see image). Which of the following is the least dominant tautomer of the histamine?at the physiological pH? C CHEM 278 A. a B. b C. c D. d 45  ORION 80- Click image to enlarge D-Galactose and D-Mannose are monosaccharide sugar. They have the same number of carbons and the same functional group, but they differ in their configurations. This reflects their pharmacoceutical uses (see image) CHEM 279 Which of the following types of stereo-isomerization do these sugars represent? A. isomers B. epimers C. anomers D D. diasteromers 8) - Ropivancain e is an important local anesthetic. The figure shows the chemical structures of ropivacaine and 4 other local anesthetics (see image). Which of the following is the bioisoster for ropivacaine? CHEM A. Etidocaine 280 D B. Bupivacaine C. Mepivacaine D. Levobupivacaine 60- Amphotericin undergo which reaction? A. Hydrolysis B. Alkylation A CHEM C. Reduction 281 D. Oxidation 63- epimor of glucose? A. Ribose B CHEM B. galactose 282 C. deoxyribose 66- two chemical configurations for the same drug, one is R and A CHEM the other is S what it is called ? 283 A- Enantiomer 46  ORION 74- Morphine to heroine? Acetylation CHEM A. Carboxylation 284 B. Esterification B 124- Morphine to heroine?? Repeated CHEM A- Carboxylation 285 B- esterification B bond 135- type of bond between amino acids ? orpeptide A. amide bond B. disulfide bond CHEM C. Ionic bond A 286 D. Van der vals bond 145- Aspirin metabolism ? A- Methylation 287 CHEM b- Hydroxylation c- Conjugation B 169- Bond between Carboxyl and amine ? peptide bond = covalent chemical bond A. hydrogen bond 288 CHEM B. b- ionic bond C. Vander wal A 246-Banzimidazole and pyridine connected together with ? CHEM A- disulphide bond 289 A methylene -ch2- 295-Structures of zidovudine antivirals, marked 4 area on structure and asked about which part to remove that make the antiviral drug not effective ? A. N3 B. CH3 CHEM C. C=O 290 D. OH Any Modification to Chemical Structure of AZT may affect its ability to mimic thymidine and inhibit reverse transcriptase effectively so inhibit its antiviral activity 364- Which element is not involve in heterocyclic compounds ? A. N B. H CHEM C. Se 291 D. Fe D 367- which the least dominant Tautomerism of the histamine at the 292 CHEM physiological ph ? A- NH3 I structer depend on charge 375- ephedrine phenylephrine additional of hydroxyl group what do to activity ? A. increase alpha 1 B. decrease alpha 1 CHEM C. increase alpha 2 293 D. decrease alpha 2 A 47  ORION 82- Which of the following is the active metabolite of primidone? A. phenytoin CNS B. dopamine C. phenobarbital 294 D. methsuximide C 85- Which of the following is the therapeutic indication for methylphenidate? A. eczema CNS B. insomnia C. anorexia nervous 295 D. attention deficit disorder in children DAD D 96- A 6-year-old boy is brought with complaint of uncontrollable spasm-like movements and excessive eye blinking for four months. Chronic motor disorder was diagnosed.Which of the following is the best management? Patient have extrapyramidal symptoms, best choice is chlorzoxazone to remove EPS symptoms. CNS A. pregabalin B B. Haloperidol 296 C. Methadone D. Chlorzoxazone Which of the following is an inhibitory neurotransmitter? A. Aspartate CNS B. Sertonin D C. Glutamate 297 D. Gama aminobutyric acid (GABA) 44) 67-year-old man presents with complaints of tremors trouble waiding and masked face Parkinson’s disease is suspected levodopa is prescribed along with a compound to lower requireddose of levodopa and to achieve an effective brain dopamine concentration which of the following is that most likely compound? CNS A. pergolide C B. selegiline 298 C. carbidopa D. entacapone 64) Which of the following is a potential side effect of using chlorpromazine in an elderly person? A. dyskinesia D CNS B. constipation C. urinary retention 299 D. tardive dyskinesia 40) 14 years-old man expressed withdrawal symptoms from using benzodiazepine drug which included Irritability and aggression which of the following types of benzodiazepines is more likely associated with these B CNS symptoms? A) long-acting benzodiazepines 300 B) ultra-short acting benzodiazepines Short-acting benzodiazepines have stronger withdrawal effects and can be more addictive than long-acting ones. C) benzodiazepines WITH ACTIVE METABOLITES 48  N ORION D) benzodiazepines with high plasma protein binding 21) A 38-year-old man is using citalopram 20mg po daily for depression which he has been taking for 1 year. A week ago, he had an infection and was prescribed linezolid 600 mg PO q12h for a total of 14 days. The patient began to get confused and easily agitated like he was breathing rapidly and started to sweat and developed. He was noticeably shaking. CNS Which of the following is name of this drug-drug interact happened to this patient? A) Hepatotoxicity B) Seizure activity 301 C) Serotonin syndrome D) Stevens Johnson syndrome C 60- An elderly man presented to the emergency room with dizziness consciousness, and respiratory depression. He was recently medication for inability to sleep. Which of the following medications is the most likely drug involve toxicity? CNS A) Aspirin B) Naproxen 302 C) Diazepam D) Acetaminophen C 6- An 18-year-old boy with a history of illicit drug use is suspected to have an overdose of a benzodiazepines and is experiencing ataxia, drowsiness and nystagmus. Which of the following would be the best antidote? CNS A. Activated charcoal 50grams B. Flumazenil 300 mcg intravenously 303 C. Naloxone 400 mcg intramuscularly D. Haloperidol 10 mg intramuscularly B 28- which of the following is considered first line therapy for the management of partial seizures? A. Carbamazepine CNS B. Phenobarbital C. Gabapentin 304 D. Primidone A (49) Which of the following electrolyte imbalances predispose to lithium toxicity? A. magnesium CNS B. potassium C. calcium 305 D D. sodium 68- Which of the following anticonvulsants needs serum level monitoring for optimize safetyand efficacy? CNS A. Phenytoin 306 B. Locosamide A 49  ORION C. Topiramate D. Levetiracetam 76- Which of the following dosage regimen is approved for severe Alzheimer's disease? A. Donepezil 23 mg daily If Donepezil is not available choose memantine CNS B. Memantine 5 mg daily 307 A C. Rivastigmine 6 mg twice daily D. Galantamine 12 mg twice daily 9