Pharmacology Answer Key-PINK PACOP.pdf

PHARMACOLOGY, TOXICOLOGY, PHARMACOKINETICS 1. Two dose-response curve response plotted on the same graph showed sigmoid curves having the same slope and height. T curve is located to the right of the A curve. Which of the following statements is/are correct regardi...

PHARMACOLOGY, TOXICOLOGY, PHARMACOKINETICS 1. Two dose-response curve response plotted on the same graph showed sigmoid curves having the same slope and height. T curve is located to the right of the A curve. Which of the following statements is/are correct regarding curves A an: I. A is more effective than B II. A is more potent than B III. A and B have the same ceiling dose IV. B is the graph produced when A is given with its competitive antagonist V. B is the graph produced when A is given with its non-competitive antagonist a. Only I and III are correct b. Only II, III and IV are correct c. Only II and IV are correct d. Only III and V are correct e. Only V is correct 2. Two dose-response curve plotted on the same graph showed sigmoid curves A and B, where A is at the left of the graph with the height greater than B. Which of the following statements is/are correct regarding curves A and B? I. A and B has equal efficacy II. A and B have equal potency III. B is a partial agonist of A IV. B is the graph produced when A is given with its competitive antagonist V. B is the graph produced when A is given with its non-competitive antagonist  a. Only I and III are correct b. Only II, III and IV are correct c. Only II and IV are correct d. Only III and V are correct e. Only V is correct 3. The cumulative number of subjects who display a certain rersponse or effect to a drug is plotted on a graph as shown below. The graph on the left represents beneficial effect while the graph on the right represents toxic effect, what is the therapeutic index of the drug? a.0.5 b. 1.5 c. 2.5 d.4.0 e. 5.0 4. An administration of one drug leads to a shift in the log dose-response curve of another drug to the left a range in the maximal efficacy, this is called a. Agonism b. Partial agonism c. Non-competitive antagonism d. Competitive antagonism e. Potentiation 5. The action of this drug is dependent on a colligative property a. Mannitol b. Cocaine c. Reserpine d. Furosemide e. Losartan 6. Whiich of the following drug groups have mechanisms of aaction that involve binding to enzymes as target protiens a. Benzodiazepines b. Barbiturates c. Calcium channel blockers d. Non-steroidal anti-inflammatory agents e. Phenothiazine antipsychotics 7. Voltage-gated ion channels serve as site of actions for drugs such as I. Diltiazem and Nifedipine II. Lidocaine and Procaine III. Captopril and Losartan a. I only b. I and II c. III only  d. I and III e. I, II, and III 8. Drugs with mechanism of action that involves Tubulin-binding leading to loss of function of the structural protien include a. Cyclosporine b. Neostigmine c. Colchicine d. Glibenclamide e. Metformin 9. What type of protien is primarily targeted by Digitalis glycosides when they exert their effect on the heart? a. Receptors b. Ion channels c. Enzymes d. Transporters e. Structural protiens 10. Which of the following features cahracterize nicotinic, GABA-A, and Glutamate receptors? a. Thay control the movements of ions and out of the cell b. Their action is mediated bysecondary messengers c. They all have excitatory effect on the cell membrane d. They are located on the cytoplasm 11. Which of the following drugs bind to receptors located at the cell membrane? a. Thyroid hormone b. Prednisone c. Estrogen d. Insulin e. Vitamin D 12. Cyclic Adenosine Monophophate (cAMP) is generated as a secondary messenger by the action of the enzyme Adenylyl Cyclase. The substrate for the synthesis of cAMP is a. AMD b. ADP c. ATP d. GTP e. Adenosine 13. Stimulation of Beta-adrenoceptor, a G-protien-linked receptor involves a generation of a secondary messenger known as a. IP3 b. cGTP c. DAG d. cAMP e. Calcium ions 14. What is the mechanism of action of Sildenafil, a drug popularly known as viagra? a. Inhibits phosphodiesterase (PDE) leading to increase cAMP b. Inhibits PDE leading to increase cGMP c. Stimulates adenylyl cyclase leading to increase cAMP d. Stimulates guanylyl cyclase leading to increase cGMP e. Inhibits phosphodiesterase leading to increase cGMP 15. Drugs that activate the phospholipase C-inositol phosphate system such as alpha-adrenergic agonists like phenylephrine primarily cause an increase in the intracellular levels of which ion? a. Calcium  b. Magnesium c. Sodium d. Potassium e. Chloride 16. Which of the following stetements characterizes competitive antagonism? a. There is a shift of the agonist log concentration-effect curve to the right and downwards b. There is a shift of the agonist log concentration-effect curve to the right without a change on the slope or amplitude c. There is an exponential relationship between dose ratio and antagonist concentration d. There is no competition for the binding sites e. There is a shift of the agonist log-concentration effect curve to the left without a change in slope and amplitude 17. The minimum dose that produces the maximum achievable response is known as a. Potency b. ED50 c. LD50 d. Ceiling dose e. Minimum effective dose 18. The medium dose, or the dose of the drug that produces half of the maximum achievable response is called a. Potency d. Ceiling dose b. LD50 e. Binding constant c. Therapeutic index 19. What is described by the equation given as follows: Response=f (EN total. Xa / (Xa + Ka) a. Relationship between occupancy of receptor and the dose of the drug b. Relationship between occupancy of receptor and response to the drug c. Relationship between the dose of the drug and the response to the drug d. Relationship between the number of receptors and the dose of the drug e. Relationship between the response to the drug and the transducer function of the tissues 20. Competitive antagonist of the receptors of Dopamine and Benzodiazepine are expected to produced which effect? a. Reversal of the intrinsic activity of the receptors b. Maintain the consitutive activity of the receptors c. Stimulate the constitutive activity of the receptors d. Stimulate the constitutive activity of the recptorsin the absence of any ligand e. Produce a negative efficacy 21. The PT-INR of a patient with Warfarin has been maintained at 2.5 for the last 3 months. 1 week earlier, the patient was given Phenobarbital. What can be expected with the PT-INR of the patient? a. Increased PT-INR b. Decreased PT-INR c. Maintained PT-INR 22. Phenobarbital when given to a patient on chronic warfarin is classified as a. Pharmacodynamic antagonist b. Pharmacokinetic antagonist c. Physiologic antagonist d. Synergistic agonist e. Additive agonist 23. Digibind which effetively terminates the action of Digitalis glycosides is classified as what type of antagonist?  a. Pharmacodynamic antagonist b. Pharmacokinetic antagonist c. Physiologic antagonist d. Chemical antagonist e. Non-competitive antagonist 24. Omeprazole can inhibiy gastric acid secretion induced by Histamine and Acetylcholine. It is thus classified as what type of antagonist? a. Pharmacodynamic antagonist b. Pharmacokinetic antagonist c. Physiologic antagonist d. Chemivall antagonist e. Non-competitive antagonist 25. Which of the following mechanism may explain the development of tolerance to drugs? a. Increase in the quantity of mediators b. Decreased metabolic degradation of the active drug c. Decreased excretion or extrusion of drugs from cells d. Downregulation of receptors e. Inactivation of counterregulatory physiologic response 26. The prerequisite that drugs must be present in aqueous solution for them to be absorbed is true if the drugs are absorbed by which mechanism? I. Passive transport II. Carrier-mediated transport III. Pinocytosis a. I only b. I and II c. III only d. I and III e. I, II, and III 27. According to the Fick’s Diffusion Equation, the rate of transport of a drug by passive diffusion is a. Independent of the concentration gradient b. Inversely proportional to the membrane surface area c. Inversele proportional to the membrane thickness d. Inversely proportional to the partition coefficient e. Independent of the diffusion constant of drug 28. Which of the following feature common to all carrier-mediated transport processes? a. Movement is along a concentration gradient b. Involves non-specific binding to carriers c. Can be characterized by allosteric inhibition d. Displays a Michaelis-Menten Kinetics e. Non-energy requiring 29. Which of the following substances may be absorbed significantly by pinocytosis a. Vitamin K b. Cyanocobalamin c. Cardiac glycosides d. Quarternary ammonium compounds e. Inorganic and organic electrolytes 30. 100ml of aqueous solutionof a given drug has a concentration of 25%.50ml of Octanol was added and after equlibration, the concentration of the drug in the aqueous layer was 5%. What is the apparent lipid-water partition coefficient of the drug?>  a. 0.2 b. 2 c. 4 d. 6 e. 8 31. For drugs that are given constant rate, the time to reach steady rate state concentration dependent on a. Rate of administration b. Biologic half-life c. Volume distribution d. Peak plasma concentration achieved e. Amount of the drug in the body 32. A given drug has a biologic half life of 4 hours. How much of the drug will remain in the body 12 hours after a single dose? a. 75% b. 50% c. 25% d. 12.5% e. 6.25% 33. In compartmental analysis of serum drug concentration versus time plots, which of the following findings confirm a one compartment model of drug behavior? a. An AUC above the explorated line that is less than 10% of the total AUC b. An AUC above the explorated line that is less than 5% of the total AUC c. Slope of the last 3 terminal points differing by more than 10% for the slope of the first 3 terminal points d. Slope of the 3 terminal points differing by less than 20% from the slope of the 3 terminal points e. Cmax that is above the line explorated from the terminal points 34. What should be the rate of infusion of Theophylline if the desired plasma concentration is 10ug/mL in a 70 kg patient?Theophylline has a clearance of 0.6mL/minute per kg body weight. a. 6ug/min b. 4.2ug/min c. 17ug/min d. 420ug/min e. 1167ug/min 35. A given drug with a half life of 8 hours is being administered at 100mg every 8 hours. What is the amount remaining in the body after 32nd hour, just before administering the next dose? a. 50mg b. 75mg c. 87.5mg d. 93.75mg e. 100mg 36. What is the con centration at steady state of Phenobarbital if the drug is given to a 60kg patient as a 65mg tablet once daily with a bioavailability of 90%? The drug has volume distribution of 0.5liters/KBW and t1/2 of 100hrs a. 0.10mg/L b. 1.50mg/L c. 11.70mg/L d. 22.20mg/L e. 48.20mg/L 37. A 47 year old female diabetic is maintained on Tolbutamide for control of her hyperglycemia. Her fasting blood sugar is maintained at 102mg%. Three days prior to admission, she self-medicated with Indomethacin due to a joint pain. She was admitted at the emergency room unconscious and difficult to arouse. What laboratory finding may be consistent with the history of the patient? a. Capillary blood glucose of 20mg/dL b. Capillary blood glucose of 400mg/dL c. ALT level that is 3x elevated d. ALT level that is 6x elevated e. Platelet level of 100,000/ul 38. A drug molecule does not possess biologic activity by itself but it converted in the body to an active metabolite is called a/an a. Orphan drug b. Prodrug c. Prototype drug d. Parent drug e. Metabolic drug 39. Astemizole and Terfenadine have been withdrawn from the market because of their intrinsic cardiotoxicity. Tha risk of cardiotoxicity is increased with concominant intake of Grapefruit juiceor Erythromycin. The explanation for this interaction is a. Displacemnet from the protien binding of Astemizole or Terfenadine by Grapefruit juice of Erythromycin b. Decreased urinary excretion of Astemizole and Terfenadine c. Inhibtion of the CYP3A4 enzyme by Grapejuice or Erythromycin d. Increased absorption of Astemizole or Terfenadine e. Induction of metabolism of Astemizole and terfenadineby Grapefruit juice or Erythromycin 40. Paients who are poor Debrisoquin metabolizers have decreased activity of which enzyme system a. CYP 1A2 b. CYP 2C9 c. CYP 2D6 d. CYP 2C19 e. CYP 3A4 41. A patient has been assessed to have poor Debrisoquin metabolizing capability. Which of the following drugs will have an increased likelihood of causing toxicity in this patient? a. Thioridazine b. Amiodarone c. Acetaminophen d. Warfarin e. Theophylline 42. What is considered as dominant phase I metaabolic reaction? a. Oxidation b. Reduction c. Hydrolysis d. Glucuronidation e. Acetylation 43. Chloramphenicol when given to a nenonate or premature baby causes cardiovascular collapse manifestin as the so-called “Gray Baby Syndrome” This toxicity in such subsets of the patients is due to what age-related biologic feature? a. Decreased protien binding b. Decreased urinary excretion of the metabolite  c. Deficiency of Glucuronosyl acyl transferase d. Increased metabolism by nitro-reduction e. Increased volume of distribution 44. Cimetidine, Ketoconazole, and Allopurinol share a common pharmacokinetic property that predisposes patients taking other drugs concominantly with any of these agents to toxicity. What is this property? a. Inhibition of tubular secretion b. Increased systemic absorption c. Protien binding dsiplacement d. Enzyme induction e. Enzyme inhibition 45. Biotransformation of orally administerd drugs occuring primarily in the liver that reduces the amount of drug finally entering the systemic circulation is often referred to as __________. a. Enterohepatic recirculation b. Gastric emptying c. Elimination d. First-pass effect e. Enzyme induction 46. Charcoal-broiled foods, cruciferous vegetables and omeprazole induce the metabolism of drugs like tomoxifen, acetaminophen, theophylline and warfarin. This effect is due to induction of which CYP isoform? a. CYP1A2 b. CYP2A6 c. CYP2C9 d. CYP2D6 e. CYP4A4 47. In a patient with hepatic encelopathy, which of the following agents may lead tosevere drug toxicity even when given at usual doses? a. Diazepam b. Oral Neomycin c. Lactulose d. Propanolol e. IV Gentamicin 48. Which of the following features charcterizes the autonomic nervous system a. Single neuron transmission b. 0 c. Effects are under volitional control d. Conveys outpus from the CNS to the skeletal muscles e. Terminal neurotransmitter is mainly Serotonin 49. The preganglionic fibers of the sympathetic nervous system originate from which roots? a. Cranial nerves III, VII, IX, X b. Sacral roots S1- S4 c. Cervical roots C1-C7 d. Thoracolumbar roots 50. What neurotransmitter is released by preganglionic fibers as a response to sympathetic stimulation? a. Acetylcholine b. Norepinephrine c. Epinephrine d. Serotonin e. Dopamine 51. What is the dominant ganglionic receptor found in most sympathetic fibers? a. Alpha-1 b. Alpha-1 c. Beta-1 d. Nicotinic e. Muscarinic 52. What is the neurotransmitter mainly released by postganglionic parasympathetic fibers? a. Acetylcholine b. Norepinephrine c. Epinephrine d. 5-Hydroxyryptamine e. Dopamine 53. Which of the following non-adrenergic, non-cholinergic neurotransmitters is involved in the action of the enteric nervous system? a. ATP b. Dopamine c. GABA d. Glutamate e. Glycine 54. In synaptic neurotransmission, which of the following ions plays a significant role in neurotransmitter release a. Sodium b. Potassium c. Magnesium d. Calcium e. Chloride 55. The primary mechanism of neuro transmitter release is accomplished by what process? a. Diffusion b. Carrier-mediated c. Active transport d. Facilitated transport e. Exocytosis 56. What is the amino acid precursor in the synthesis of catecholamines? a. Phenylalanine b. Glycine c. Tyrosine d. Tryptamine e. Glutamic acid 57. In the biosynthesis of Norepinephrine, what step is considered rate-limiting? a. Active uptake of Tyrosine b. Conversion of tyrosine to dihydroxyphenylalanine c. Conversion of DOPA to dopamine d. Uptake of Dopamine in presynaptic storage vesicles e. Conversion of Norepinephrine to Epinephrine 58. Which of the following substances exert a negative feedback control on Tyrosine Hydroxylase which serves as the mechanis for moment-to-moment regulation of the rate catecholamine synthesis? a. Dopamine b. Acetylcholine c. DOPA  d. Epinephrine e. Norepinephrine 59. Reserpine, an alkaloid from Rauwolfia, can lower the blood pressure and depress the CNS. What enzyme or part of the biosynthetic pathway is inhibited by Reserpine to bring about these effects? a. DOPA decarboxylase b. Storage of catecholamines in the presynaptic vesicles c. Release of Norepinephrine from presynaptic terminals d. MAO enzymes e. Uptake-1 mechanism 60. What is the most important mechansim of termination of effects of released Norepinephrine which is the target of action of tricyclic antidepressants and Cocaine a. Degradation of COMT b. Degradation of MAO c. Sequestration into cells d. Reuptake into the presynaptic terminal e. Binding to presynaptic alpha-2 receptors 61. What is the main final metabolite of Norepinephrine and Epinephrine which when abnormally elevated is often used as a marker for the disease Pheochromocytoma? a. Dihydroxymandelic acid b. 3-Methoxy-4 hydromandelic acid c. 3-Methoxy-4 hydroxyphenylglycol d. 3,4-Dihydroxyphenylglycol e. Normetanephrine 62. Which of the following is an expected respose to alpha-1 adrenoceptor stimulation? a. Uterine smooth muscle relaxation b. Gastrointestinal sphincter constriction c. Ciliary muscle relaxation d. Gastrointestinal wall smoothe muscle contraction e. Platelet aggregation 63. A male patient wishes to purchase an over-the-counter tablet for colds. Which of the following data you gathered during an initial interview of the patient should prevent you from dispensing the medication? I. The patient is currently taking Nifedipine GITTS II. The patient is currently on Tranylcypromine III. The patient is an elderly with history of urinary hesitancy, intermittency, and frequency a. I only b. I and II c. III only d. I and III e. I, II, and III 64. Stimulation of Alpha-1 receptors leads to the formation of important secondary messengers that promote calcium release and activation of protien kinase C. These secondary messengers responsible for the effects of alpha-1 stimulation include which of the following? a. Inositol triphosphate b. Cyclic adenosine monophophate c. Adenosine triphosphate d. Cyclic guanosine monophosphate e. Adenosine diphosphate 65. In which of the following clincal conditions are the agonists of the alpha-1 adrenoceptors found to be useful?  I. Nasal congestion II. Hypotension III. Sympomatic bradycardia a. I only b. I and II c. III only d. I and III e. I, II, and III 66. Which of the following effects can be attributed to alpha-2 receptor stimulation? I. Vasodilation II. Inhibition of catecholamine release III. Vasoconstriction a. I only b. I and II c. III only d. I and III e. I, II, and III 67. A given adrenergic agent induces uterine relaxation and bronchial smooth muscle relaxation. These effects can be attributed to: a. Alpha-1 stimulation b. Alpha-2 stimulation c. Beta-1 inhibition d. Beta-1 stimulation e. Beta-2 stimulation 68. What is the dominant adrenergic receptor in the heart? a. Dopamine-1 b. Alpha-1 c. Alpha-2 d. Beta-1 e. Beta-2 69. Which of the following effects is/are consistent with the systemic use of the drug Clonidine? I. Initial transient increase in blood pressure II. “First-dose” phenomenon III. Lowering of the blood pressure a. I only b. I and II c. III only d. I and III e. I. II, and III 70. In terms of mechanism of action, which of the following drugs most closely resembles that of Clonidine? a. Phenylphrine b. Reserpine c. Guanethidine d. Methyldopa e. Amlodipine 71. Epinephrine is considered as the first line for the management of anaphylaxis and anaphylactic shock. Which of the following explain/s the mechanism of action of Epinephrine in anaphylaxis and anaphylactic shock? I. Inhibition of Histamine release by beta-2 receptor activation  II. Alpha-1 activation leading to vasoconstriction III. Beta-2 activation leading to bronchodilation a. I only b. I and II c. III only d. I and III e. I, II, and III 72. The activity of this drug is attributed to its metabolite which is a false neurotransmitter at the central nervous system a. Guanethidine b. Methyldopa c. Propanolol d. Labetalol e. Phenylpropanolamine 73. Which of the following inotropic agents is most useful for paatient with acute heart failure complicated by acute reduction in creatinine clearance? a. Epinephrine b. Norepinephrine c. Dopamine d. Dobutamine e. Digitalis 74. In the adrenal medulla, norepinephrine is converted to epinephrine by the action of which enzyme? a. DOPA decarboxylase b. Tyrosine hydroxylase c. Cathecol-0- nethyl transferase d. Monoamine oxidase e. Phenylethylamine N-methyl transferase 75. As an inotropic agent, Norepinephrine (Levophed) has been shown in some small clinical trials to be most useful in which of the following conditions? a. Cardiogenic shock b. Septic shock c. Acute renal failure d. Acute myocarditis e. Dilated cardiomyopathy 76. Which of the following statements is/are true regarding the drug methyldopa I. Is current clinical use is in the management of hypertension in pregnancy II. It is associated with warm antibody type of immunohemolytic anemia III. Toxic doses are associated with hepatotoxicity a. I only b. I andII c. III only d. I and III e. I, II, and III 77. What are known clinical uses beta-2 agonists? I. In the management of premature labor II. As part of the interventions employed for hyperkalemia III. Management of bronchial asthma a. I only b. I andII  c. III only d. I and III e. I, II, and III 78. Which of the following agents is classified as a selective direct-acting beta-2 agonist? a. Propanolol b. Mathoxamine c. Isoxsuphrine d. Prazosin e. Ephedrine 79. During the conduct of ACLS, what is the recommended dosing ofor Epinephrine in adults? a. 1mg every 3-5 minutes b. 3mg every 3-5 minutes c. Escalating dose, staring at 1mg then increasing by 1mg every 3-5 minutes d. 10ml of a 1:1000 solution every 3-5 minutes 80. Which of the following is an accepted indication for Epinephrine? a. Bronchodilator fo intermittent bronchial asthma b. Local vasoconstrictor c. Anti-arrythmic for supraventricular tachycardia d. Tocolytic agent for premature labor e. Inotropic for cardiogenic shock 81. A dominant alpha-1 agonist effect is expected when Epinephrine is given as an IV infusion at what doses? a. 50ug/kg/min 85. Guanfacine and Guanabenz are primarily agonists at what receeptors? a. Muscarinic-1  b. Nicotinic-N c. Presynaptic alpha-2 d. Postsynaptic alpha-2 e. Alpha-1 86. Which of the following is/are correct clinical indication for the drug Terbutaline I. Subcutaneously given as management of recalcitrant acute exacerbations of bronchial asthma II. To increase heart rate in symptomatic bradycardia III. Adjunct treatment of malignant hypertension a. I only b. I andII c. III only d. I and III e. I, II, and III 87. Which of the following drugs primarily stimulates beta-1 receptors? a. Dobutammine b. Ritodrine c. Yohimbine d. Phenoxybenzamine e. Oxymetazoline 88. A new drug is currently being developed whose mechanism of action is stimulation of the beta-3 receptors. In which condition will this drug have most likely usefulness? a. Obesity b. Bronchial asthma c. Hypertension d. Shock e. Acute renal failure 89. A patient complains of muscle weakness after several doses of Salbutamol nebulization. This condition can be attributed to _______________? a. Hypokalemia induced by Salbutamol therapy b. Hypocalcemia induced by Salbutamol therapy c. Metabolic alkalosis due to bronchial asthma d. Decreased firing of neuromuscular junction fibers as a direct effect of Salbutamol e. Respiratory alkalosis due to bronchial asthma 90. Which of the following beta-blockers also has peripheral vasodilating effect similar to Prasozin? a. Propanolol b. Betaxolol c. Nadolol d. Bisoprolol e. labetalol 91. Which of the following beta-blockers is considered cardio selective? a. Labetalol b. propanolol c. pindolol d. Esmolol e. Timolol 92. Rebound tachycardia and hypertension are expected complications of abrupt withdrawal of beta-blocker therapy. Which of the followingagents has the least likelihood of causing rebound effects when withdrawn? a. Labetalol b. Propanolol  c. Pindolol d. Metropolol e. Timolol 93. Which of the following beta-blockers has the shortest duration of action (half-life = 10 minutes) making is useful for administration as continuous IV infusion with rapid achievemnet of a steady state concentration a. Metoprolol b. Esmolol c. Atenolol d. Propanolol e. Pindolol 94. Which of the following beta-blockers has/have been proven in clinical trials to be useful in the management os stable congestive heart failure I. Carvedilol II. Bisoprolol III. Metoprolol a. I only b. I andII c. III only d. I and III e. I, II, and III 95. In which of the following conditions are beta-blockers found to be useful? I. Hypothyroidism II. Raynaud’s Phenomenon III. Initial therapy in Pheochromocytoma a. I only b. I andII c. III only d. I and III e. I, II, and III 96. Among diabetic patients using insulin or oral hypoglycemic agents (OHAs) why are beta-blockers are used with special caution if not totally avoided? a. Beta-blockers can induce hyperglycemia b. Beta-blockers can mask hypoglemic symptoms c. Beta-blockers can attenuate effect of insulin and OHAs d. Beta-blockers can induce insulin or OHA failure e. Beta-blockers can increase the risk of renal failure 97. In which subset/s of patients are beta-blockers used with caution if not avoided? I. Patients with bronchospastic disease like COPD and bronchial asthma II. Patients with peripheral vascular disease especially vasospastic type III. Patients with recent myocardial infarction a. I only b. I andII c. III only d. I and III e. I, II, and III 98. A 44-year old patient is started a week ago on the following medications: Metoprolol 100mg BIB, Diltiazem 30mb tablet BID and Indapamide 1.5 mg OD for poorly controlled hypertension and chronic stable angina pectoris. She is now admitted at the ICU for dizziness and two episodes of syncope. Her heart rate was 45 beats/min. What course of action would you suggest?  a. Continue her medication and suggest for a 12-lead ECG b. Stop Metoprolol and request for a 12-lead ECG c. Stop Diltiazem and request for a 12-lead ECG d. Stop indapamide and Diltiazem and request for a 12-lead ECG as well as serum potassium measurement e. Stop Metoprolol and Diltiazem and request for a 12-lead ECG 99. Methylphenidate and Dextroamphetamine are centrally acting sympathomimetics which have found use in which of the following conditions? a. Manic-depression b. Alcohol withdrawal c. Attention deficit hyperactivity disorder d. Generalized anxiety disorder e. Hypotensive epidoses 100. Which of the following effects is are consistent with direct stimulationof the muscarinic receptors? I. Peripheral vasodilation II. Relaxation of the ciliary muscles III. Negative dromotropic effect a. a. I only b. I andII c. III only d. I and III e. I, II, and III 101. The effect of muscarinic receptor activation in tissues like the exocrine glands and the extravascular smooth muscles have been linked with the generation of which second messenger molecule? a. IP3 b. cAMP c. cGMP d. ATP e. Adenosine 102. What is thw physiologic event that follows stimulation of the N M type cholinergic receptors? a. Opening of inward chloride channels b. Opening of outward potassium channels c. Opening of inward sodium channels d. Opening of the outward calcium channels e. Opening of the outwad sodium channels 103. Bethanecol is clinically used for which of the following conditions? a. Urinary retention in neurogenic bladder b. Intestinal obstruction c. Chronic glaucoma d. Supraventicular tachycardia e. Congestive heart failure 104. What is/are the clinical use/s of Edorphonium (Tensilon)? I. Reverse the effect of neuromuscular blockers after surgery II. Treatment of overdose of atropine III. Management of organophosphate poisoning a. I only b. I andII c. III only d. I and III  e. I, II, and III 105. Ambenonium, neostigmine, and pyridostigmine are most commonly used for which condition? a. Atropine overdose b. Myasthenia gravis c. Bronchial asthma d. COPD e. ADHD 106. Tacrine, Donepezil, Rivastigmine and Galantamine are indicated for which of the following condition? a. Supraventricular tachycardia b. Curare-induced muscle paralysis c. Accomodative esotropia d. Alzheimer’s disease e. Glaucoma 107. Which of the following agents maybe used for the management of glaucoma? I. Piocarpine-Physostigmine combination therapy II. Ecothiophate III. Demecarium a. I only b. I andII c. III only d. I and III e. I, II, and III 108. Which of the following findings maybe consistent with an overdose of or accidental exposure to an organophosphate a. Constipation b. Mydriasis c. Peeripheral vasodilation d. Emesis e. Decreased sweating 109. Which of the following effects can be attributed to atropine? I. Ciliary muscle contraction II. Contraction of the papillary constrictor muscles III. Blockade of vagal slowing of the heart a. I only b. I andII c. III only d. I and III e. I, II, and III 110. In comparison to other aantimuscarinic agents, Scopolamineis expected to exert significant CNS effects due to: a. Its being a tertiary amine b. Its being a quarternary amine c. The presence of a benzene ring structure d. The tropic acid structureits isomeric structure 111. Ipratropium, Oxytropium, and Tiotropium and antimuscarinic agents that are most useful as a. Mydriatics b. Cycloplegic agents c. Relaxants of bronchial smooth muscles d. Inhibitors of involuntary muscle contractions  e. Inhibitors of bronchial gland secretions 112. Oxynutinin, Dicyclomine, and Glycopyrrolate are clinically useful for which of the following conditions? a. Cholinomimetic agent overdose b. Gastrointestinal hypermotility and urinary incontinence c. Angina due to coronary artery vasospasm d. Motion sickness and Parkinsonism e. COPD and bronchial asthma 113. In most patients admitted to atropine overdose, most poison control experts recommend which of the following measures as primary management? I. Temperature control with cooling blankets II. Physostigmine as initial therapy III. Diazepam for seizure control a. I only b. I andII c. III only d. I and III e. I, II, and III 114. Poisoning resulting from ingestion of high dose quarternary antimuscarinic agents can be best managed with which of th following agents? a. Physostigmine b. Neostigmine c. Policarpine d. Atropine e. Scopolamine 115. Which of the following is/are important contraindication to the use of antimuscarinis agents or drugs with atropine-like properties? I. History of prostatic hyperplasia II. Glaucoma III. Hypertension a. I only b. I andII c. III only d. I and III e. I, II, and III 116. Trimethaphan is expected to produce which of the following effects? a. Excessive sweating b. Pupillary constriction c. Diarrhea d. Urinary incontinence e. Hypotension 117. What is the mechanism of skeletal muscle paralysis produces by Succinylcholine? a. Competitively inhibits binding of acetylcholine to the NM receptors b. Increased inward chloride conductance leading to hyperpolarization of the neuromuscular endplate membrane c. Sustained depolarization of the motor end plate making it unesponsive to other impulses upon repolarization cannot easily depolarized d. Repeated short depolarizations of the motor end plate leading to prolonged state of sodium channel inactivation  e. Irreversible and non-competitive inhibition of the NM receptors in both the ganglia and motor end plate with attenuation of depolarizing impulses 118. Which of the following findings is consistent with the skeletal muscle relaxant effect of Pancuronium and Rocuronium? a. Effect is enhanced with administration of succinylcholine b. Effect is reduced with co-administration of tubocurarine c. Initially cause depolarization of the motor end plate leading to fassiculations d. Effect is antagonized by Neostigmine e. Sustained response to tetanic stimulation 119. Which of the following inhilational anesthetics produces greatest augmentation of the effect of neuromuscular blockers? a. Isoflurane b. Sevoflurane c. Halothane d. Desflurane e. Nitrous oxide 120. Anaphylactoid reaction may be seen as a side effect with which of the following neuromuscular blockers? a. Pancuronium b. Vecuronium c. Gallamine d. Tubocurarine e. Rocuronium 121. Which of the following statements correctly describes the side effects of succinylcholine? I. Negative chonotropic and inotropic effects which can be attenuated by atropine II. Increase risk of emesis among diabetics and obese patients III. Hyperkalemia when given to burn or trauma patients or patients with close head injury a. I only b. I andII c. III only d. I and III e. I, II, and III 122. Which of the following mechanism may explain the ability of beta-blockers to reduce blood pressure in hypertension? a. Increased compliance of the capacitance vessels b. Relaxation of the primary resistance vessels c. Inhibition of renin release d. Direct inhibition of Angiotensin II receptors e. Decrease in total body stores of sodium 123. Which of the following equations describe the factors that contribute to blood pressure? a. BP=SV/SVR b. BP=COxSVR c. BP=SVxHR d. BP=CO/SVR e. BP=SVxSVR 124. Which of the following mechanism explains the blood pressure-lowering effect of thiazide diuretics? I. Reduction in blood volume and cardiac output II. Increased vascular compliance III. Decreased proximal tubular reabsorption of water and sodium a. I only  b. I andII c. III only d. I and III e. I, II, and III 125. Which of the following drugs inhibit enzyme carbonic anhydrase? a. Dichlorphenamide b. Tolazamide c. Astemizole d. Selegiline e. Donepezil 126. What is the primary mechanism of action of the drug Indapamide? a. Inhinition of the 2Cl-Na-K cotransporters in the convoluted tubule b. Inhibition of the Na-Cl contransporters at the convoluted tubule c. Inhibition of the Na-Cl cotransporters at the collecting duct d. Competitive inhibition of aldosterone binding to its receptors e. Competitive inhibition os vasopressin binding to V2 receptors 127. Which side effect of chlorthalidone is prominent especially among the elderly when Chlorthalidone is given at a dose of at leats 50mg/day and significantly reduced when doses are maintained below 50mg/day? a. Hyperuricemia b. Hyperglycemia c. Increased in serum LDL d. Allergic reactions e. Hyponatremia 128. What is the rationale behind the combination of amiloride and Hydrochlorothiazide (HCTZ) a. Minimize hyperglycemia due to HCTZ b. Reduce risk of renal stone formation with HCTZ c. Reduce hyperkalemia with amiloride d. Minimize bicarbonaturia with HCTZ e. Minimize hypokalemia due to HCTZ 129. The action of the drug Eplerenone most closely resembles which of the following agents? a. Spironolactone b. Amiloride c. Triamterence d. Metolazone e. Quinethazone 130. Which of the following agents exhibits pharmacodynamic interaction with the thiazide diuretics leading to a reduced diuretic effect? a. Furosemide b. Amiloride c. Enalapril d. Hydralzine e. Digoxin 131. Which of the following mechanism explain the effects of the drug Torsemide and Bumetanide? a. Inhibition of carbonic anhydrase at the proximal convoluted tubule b. Inhibition of the Na-K-2Cl co-transporter at the thick ascending limb of the Loop of Henle c. Inhibition of the Na-Cl co-transporter at the thin ascending limb of the Loop of Henle d. Inhibition of the Na-Cl co-transporter at the distal convoluted tubule e. Inhibition of the Na-Cl co-transporter at the distal tubule and collecting duct 132. Which of the following is/are accepted indication/s for the drug Spironolactone?  I. Adjunct in the management of CHF II. Conn’s Syndrome III. Nephrogenic Diabetis Insidipus a. I only b. III only c. I and II d. II and III e. I, II, and III 133. Which of the following is/are accepted indication/s for the drug Furosemide? I. Infusion-diuresis in hypercalcemia II. Oliguric acute renal failure III. Acute pulmonary edema a. I only b. III only c. I and II d. II and III e. I, II, and III 134. Which of the folling agents is primarily indicated for the management of increased intracranial pressure a. Mannitol b. Acetazolamide c. Furosemide d. Chlorthalidone e. Bumetanide 135. Which of the following agents is most useful for the management of nephrolithiasisndue to idiopathic hypercalciuria? a. Ethacrynic acid b. HCTZ c. Dorzolamide d. Vasopressin e. Triamterene 136. Which of the following statements correctly describes the characteristics of Indapamide as a drug for hypertension? I. Its diuretic effect is self-limiting, and may not account for its hypertensive effect after about 2-4 weeks of therapy II. Long-term use leads to improved blood vessel compliance III. Has modest vasodilating property a. I only b. II only c. I and III d. II and III e. I, II, and III 137. Which of the following agents maybe associated with ototoxicity which may have increased risk of occuring when patient also recieve aminoglycoside antibiotic? a. Furosemide b. Chlorthalidone c. Dorzolamide d. Amiloride e. Spironolactone 138. Which of the following mechanisms explains best the action of drug methyldopa?  a. The molecule releases norepinephrine in the presynaptic vesicles and is released by nerve stimulation to interact with postsynaptic adrenergic receptors b. The molecule is converted first to alpha-methyldopamine and alpha-methylnorepinephrine which replace norepinephrine in the presynaptic vesicles and are released by nerve stimulation to interact with postsynaptic adrenergic receptors c. The molecule is converted first to alpha-methyldopamine and alpha-norepinephrine which stimulate central alpha receptors d. The molecule is converted first to alpha-methyldopamine and alpha-norepinephrine which inhibit central alpha receptors e. The molecule directly inhibits peripheral alpha and beta receptors 139. What is the most frequent side effect of methyldopa which can be seen particularly at the onset of treatment? a. Sedation b. Depression c. Extrapyramidal signs d. (+) coomb’s test e. Galactorrhea 140. A 45 years old female in clonidine 1.0mg/day for thee last ffour weeks was brought to the hospital for 1 day history of nervousness, tachycardia and abrupt increase in her blood pressure to 180/130mmHg. Her last intake of clonidine was last 2 days prior to admission. Which of the following is/are appropriate interventions that you can suggest for the patient? I. Start patient on Propanolol 50mg BID II. Re-institute Clonidine 1.0mg/day III. Start Labetalol 200mg/day a. I only b. III only c. I and II d. II and III 141. Which of the following side effects is/ are common to the three drugs: Hydralazine, Diazoxide, and Minoxidil? a. Hypertrichosis b. Glucose intolerance c. Reflex tachycardia d. Lupus-like side effect e. Dyslipidemia 142. In which subset of patients should Hydralazine be avoided or used with caution? a. Patients with arrythmias b. Patient with hypertension c. Patients with DM d. Patients with Ischemic Heart disease e. Patients with CHF 143. Which of the following drugs if combined with Minoxidil may minimize latter drug’s side effect? a. Hydralazine+HCTZ b. Guanethidine+Reserpine c. Metoprolol+Chlorthalidone d. Amlodipine e. Amlodipine+Prazosin 144. In the management of Pparoxysmal hypertensionin pheochromocytoma, which of the following drugs is the most appropriate initial therapy?  a. Phentolamine b. Metoprolol c. Guanfacine d. Reserpine e. Clonidine 145. Orthostatic hypotension and syncope are manifestations of a phenomenon associated with the first dose of which agent? a. Labetalol b. Methyldopa c. Fenoldopam d. Irbesartan e. Doxazosin 146. The mechanism of action of the drug clonidine most closely resembles that of ______________? a. Methyldopa b. Propanolol c. Carvedilol d. Guanethidine e. Reserpine 147. Constipation, Urinary retention, tachycardia, mydriasis and anhidrosis are expected effects based on the mechanism of action of which of the following drugs? a. Clonidine b. Trimethaphan c. Reserpine d. Sodium nitropusside e. Nicardipine 148. Which of the following drugs may be used safely for the control of hypertension in pregnant patients with pre-eclampsia? I. Magnesium Sulfate II. Methyldopa III. Hydralazine a. I only b. II only c. I and II d. II and III e. I, II, aand III 149. Which of the following mechanisms explains the action of the drug Sodium Nitropusside? a. Activation of guanylyl cyclase with increase of cGMP b. Release of N20 with subsequent increase in cAMP c. Inhibition of the secretion of renin d. Stimulation of A1 receptors e. Increase conductance of outward potassium channels 150. Which of the following agents is pure anteriolar vasodilaator? a. Prazosin b. Sodium Nitropusside c. Diazoxide d. Phentolamine e. Pindolol 151. Which of the following agents can be used for hypertensive emergencies I. Enalaprilat  II. Diazoxide III. Sodium nitropusside a. I only b. II only c. I and II d. II and III e. I, II, and III 152. The decrease in arterial tone due to vasorelaxant action of sodium nitropusside is associated with a. Increase in smooth muscle cGMP levels b. Increase in smooth muscle cAMP levels c. A decrease in calcium entry through L-type channels d. A local anethetic effect on smooth muscle cells e. Stimulation of inward K-channel 153. Whgich of the following effects can be attributed to Angiotensin II? I. Stimulation of release of nitric oxide II. Stimulation of synthesis and release of Aldosterone III. Stimulation of release of Norepinephrine a. I only b. II only c. I and II d. II and III e. I, II, and III 154. What is the primary advantage of Angiotensin II receptor blockers over the ACE-Inhibitors? a. Lesser incidence of coughs b. Absence of risk interstitial nephritis c. Safe for pregnant patients with hypertension d. Faster onset of action e. Lesser incidence of hyperkalemia 155. Which of the following ACE-Inhibitors require hydrolysis to the active metabolite/s in the body to produce effects? I. Enalapril II. Ramipril III. Perindopril a. I only b. II only c. I and II d. II and III e. I, II and III 156. In which of the following conditions are ACE-inhibitors found to be clinically useful as first-line treatment? I. Angina pectoris II. CHF III. Diabetic Nephropathy a. I only b. II only c. I and II d. II and III e. I, II, and III 157. The efficacy of ACE-inhibitors in the management of hypertension may be reduced in the presence of certain drugs such as ___________? a. Ibuprofen b. Felodipine c. Indapamide d. Eprenolone e. Hydralazine 158. In which subset of patients which are ACE-inhibitors avoided as treatment option? I. Patients with bilateral renal artery stenosis II. Patients with hyperkalemia III. Pregnant patients in their 2nd and 3rd trimesters of pregnancy a. I only b. II only c. I and II d. II and III e. I, II, and III 159. Which of the following calcium channel blockers has greater activity on calcium channels in myocardial tissues than calcium channels in the vascular smooth muscles? a. Diltiazem b. Verapamil c. Nifedipine d. Amlodipine e. Felodipine 160. What is the mechanism of action of the diydropyridine calcium channel blockers? a. Inhibit the L-type calcium channels in the arteriolar smooth muscles b. Inhibit the L-type calcium channels in the anteriolar and venous smooth muscles c. Equally inhibit the L-type calcium channels in the vascular and cardiac tissues d. Inhibit the S-type calcium channels in the anteriolar smooth muscles e. Inhibit the S-type calcium channels in the anteriolar and venous smooth muscles 161. In the long-term management of hypertensiion, which of the following agents is/are considered as appropriate maintenance therapy? I. Regular Nifedipine capsules II. Enalapril tablets III. Indapamide tablets a. I only b. II only c. I and II d. II and III e. I, II, and III 162. What is the most common side effect of Enalapril? a. Angioedema b. Interstitial nephritis c. Coughs d. Hypotension e. Drug fever 163. Which of the following anti-hypertensive agents is the most appropriate for elderly male patients with benign prostatic hyperplasia? a. Prazosin b. Amlodipine  c. Metoprolol d. HCTZ e. Enalapril 164. Which of the following anti-hypertensive agents may be more appropriate to use for diabetic patients with evidence of renal disease? a. Prazosin b. Amlodipine c. Metoprolol d. HCTZ e. Enalapril 165. Chinese patients are most likely to be more sensitiveto effects of which of the following drugs for hypertension that lower doses may have to be used? a. Prazosin b. Amlodipine c. Metoprolol d. HCTZ e. Enalapril 166. In the management of hypertensive emergencies, which of the following goals or interventions is/are correct? I. Rapid normalization of the blood pressure within 24 hours II. Lowering of the mean arterial pressure by about 25% III. Initiation of oral hypertensives early as soon adequate blood pressure lowering has been achieved a. I only b. II only c. I and II d. II and III e. I, II, and III 167. Which of the following are important considerations regarding the proper handling of Nitroglycerin tablets I. Formulations used in the medicine are explosive II. Sublingual tablets lose their potency when stored in plastic containers III. These are sensitive to light a. I only b. II only c. I and II d. II and III e. I, II, and III 168. Which of the availabe nitrovasodilators has a bioavailabilty of about 100%? a. Isosorbide mononitrate b. Isosorbide dinitrate c. Amyl nitrite d. Glyceryl trinitrate e. None aqs all undergo significant first pass effect when given orally 169. Which of the following statements most closelydescribes the primary mechanism of action of the nitrovasodilator? a. Denitrification by glutathione S-transferase leads to release of nitrite ion which is then converted to nitric oxide, a molecule that activates adenylyl cyclase leading to increase cAMP b. Denitrification by glutathione S-transferase leads to release of nitrite ion which is then converted to nitric oxide, a molecule that activates guanylyl cyclase leading to increase cGMP  c. Nitrate ion released upon denitrification directly stimulas outward K-channels leading to hyperpolarization of the vascular smooth muscles d. Nitrate ion released upon denitrification directly stimulas outward K-channels leading to hyperpolarization of the vascular smooth muscles e. Nitrate ion released upon denitrification stimulates the production of prostacylin leading to vasodilation 170. Which of the following tissues exhibit the greatest sensitivity to nitrovasodilators at the lowest effective doses? a. Arteries b. Arterioles c. Capillaries d. Veind e. Myocardial tissues 171. Which of the following statements correctly explains the primary mechanism of relief of angina pectoris with the use of nitrovasodilators when given at usual doses? a. Peripheral dilation of the veins leading to reduction in cardiac preload and myocardial oxygen demand b. Vasodilation of epicardial coronary arteries leading to improved oxygen delivery to myocardial tissues c. Increase in diastolic perfusion time leading to improved perfusion to ischemic myocardium d. Decrease total peripheral resistance with arteriolar vasodilation e. Decrease in myocardial contractility leading to reduction in myocardial oxygen demand 172. Which of the following agents classified as nitrovasodilators is useful in the management of cyanide poisoning? a. Sodium nitrite b. Amyl nitrite c. Sodium thiosulfate d. Nitroglycerin e. Isosorbide mononitrate 173. Which of the following nitrovasodilators may induce conversion of hemoglobin to methemoglobin (methemoglobinemia) which can lead to cyanosis? a. Nitroglycerin b. Isosorbide mononitrate c. Isosorbide dinitrate d. Tetrathyl trinitrate e. Amyl nitrite 174. This side effect of nitrovasodilators is explained in part by the depletion of sulfhydryl moieties in vascular smooth muscles with continuous use of the drugs, and may be partly reversed bysulfhydryl-regenerating compunds. a. Tolerance b. Increased intracranial pressure c. Reflex tachycardia d. Methemoglobenia e. carcinogenicity 175. Which of the following agents is/are considered useful as single agent in the acute treatment of vasospastic angina pectoris? I. Nitrovasodilators II. Beta-blockers III. Calcium channel blockers  a. I only b. II only c. I and II d. II and III e. I, II, and III 176. What is the primary limitation with the use of Dihydropyridine Calcium Channel Blockers in the management of angina pectoris? a. Tendency to reduce cardiac preload b. Tendency to cause reflex tachycardia c. Tendency to induce reflex vasospam when stopped d. Tendency to cause peripheral edema e. Tendency to reduce cardiac end-diastolic pressure 177. What is the most important role of beta-blockers in the management of angina pectoris a. Causes coronary artery vasodilatation thus useful in the management of acute anginal attacks b. Dilates the epicardial coronary vessels thus useful in patients with ongoing prinzmetal angina c. Reduces myocardial oxygen demand by reducing the total peripheral resistance making it useful for chronic stable angina pectoris d. Reduces myocardial oxygen demand by reducing myocardial perfusion time making it useful for chronic stable angina pectoris e. Reduces myocardial oxygen demand by decreasing myocardial perfusion time making it useful for all types of angina pectoris 178. Which of the following drugs or drug combination is/are useful in the management of chronic stable angina pectoris? I. Regular release Nifedipine capsule II. Metoprolol tablet III. Metoprolol tablet + Diltiazem tablet a. I only b. II only c. I and III d. II and III e. I, II, and III 179. What is the principal mechanism of action of cardiac Glycosides? a. Stimulate the release of calcium for the sarcoplasmic reticulum leading to release in an increase intracellular calcium b. Inhibition of the cell membrane outward calcium transporter preventing calcium extrusion c. Stimulation of inward calcium transporter leading to an increase in intacellular calcium d. Inhibition of the Na-K-ATPase leading to increase in intracellular sodium and preventing calcium extrusion e. Inhibition oh the Na-Ca exchanger in the sarcoplasmic reticulum leading to increase in intracellular calcium 180. Which of the following statements on pharmacokinetic parameters must be considered for patients taking Digoxin? a. In about 10% of patients, use of antibiotics can lead to increased oral bioavailability b. Renal clearance of the drug is inversely proprtional to the creatinine clearance c. Half-life is long, at about 168 hours due in part to extensive enterohepatic recirculation d. Hepatic metabolism accounts for more than 80% of the elimination of the drug e. It is primarily distributed within the intravascular space due to its high protein binding 181. Which of the following is/are mechanical effects of digoxin on myocardial tissues I. Increase in contractility of myocardial tissues  II. Increase in conduction velocity in the AV node III. A positive inotropic effect a. I only b. II only c. I and III d. II and III e. I, II, and III 182. Which of the following is/are expected electrical effect/s of digoxin on myocardial tissues? I. Decrease in the refractory period of atrial muscles II. Increase in the refractory period of the AV node III. A positive inotropic effect a. I only b. II only c. I and III d. II and III e. I, II, and III 183. Which of the following condition may augment the effect of digitalis glycosides in myoccardial tissues? I. Concurrent use of captopril II. Reduced oxygenation of myocardial tissues III. Concurrent administration of calcium gluconate a. I only b. II only c. I and III d. II and III e. I, II, and III 184. Which of the following is/are the primary indication/s of Digitalis Glycosides? I. First line drug for the initial management of CHF II. Useful in controlling the rate of ventricular response in atrial fibrillation III. Useful in pregnant patients with CHF a. I only b. II only c. I and III d. II and III e. I, II, and III 185. What is the major mechanism of interaction between Digoxin and Quinidine? a. Displacement of digoxin from tissue binding site b. Decreased hepatic metabolism of digoxin c. Decresed renal clearance of digoxin d. Increase binding of digoxin with ion transporters in the myocardium e. Increase intestinal absorption of digoxin 186. A 50 years old male patient with CHF was started on the following medications: digoxin 0.25 mg OD, Hydralazine 10mg BID, furosemide 20mg OD, and ISMN 60mg OD. 1 week after initiating therapy, the patient was admitted for blurring of vision and palpitation. He feels nauseated and has problems discriminating colors. Which of the following sourses of action is appropriate? a. Suggest discontinuing Hydralazine and starting patient on amlodipine b. Suggest giving of metoclopramide for the nausea and examining the probable eye problem c. Suggest starting patient on beta-blocker therapy  d. Suggest discontinuing digoxin and furosemide and checking for serum K levels for necessary correction e. Suggest discontinuing all medications and starting patient instead on an ACE inhibitor, vasodilator and a thiazide 187. Which of the following intervention may be appropriate in the management of severe cases of digitalis intoxicationsuch as in children and in suicidal overdose? I. Administration of digoxin immune fab II. Aadministration of KCl III. Administration of MgSO4 a. I only b. II only c. I and III d. II and III e. I, II, and III 188. What is considdered as the toxic plasma concentration of digoxin? a. >0.5mg/mL b. >150mgng/mL c. >10ng/mL d. >5ng/mL e. >2ng/mL 189. What is the primary use of drugs like Inamirone and Milrinone? I. Alternative to digoxin in patients with chronic CHF II. Management for acute heart failure III. Management of exacerbation of chronic CHF a. I only b. II only c. I and III d. II and III e. I, II, and III 190. What is the mechanism of action of Inamrinone and Milrinone in the management of heart failure? a. Increase the levels of cAMP by activating the enzyme adenylyl cyclase b. Increase the levels of cAMP by inhibiting the enzyme phosphodiesterase III c. Increase the levels of cGMP by inhibiting the enzyme guanylyl cyclase d. Inhibit the outward calcium flux leading to increased intracellular calcium e. Primarily cause peripheral vasodilation leading to reduced cardiac preload 191. Inotropic activity oh the heart in CHF can be increased by which of the following agents? I. Bipyridines II. ACE inhibitors III. Beta-1 agonists a. I only b. II only c. I and III d. II and III e. I, II, and III 192. Which of the following agents for the heart failure may be associated with arrythmia, thrombocytopenia, aand hepatotoxicity which limit their use in patients with chronic CHF? A. Bipyridines B. Digitalis glycosides C. Beta-1 agonists  D. ACE inhibitors E. Angiotensin II antagonists 193. Which of the following statements correctly describe/s the appropriate use of drugs for CHF I. Beta-blockers when used for patients with stable CHF can be given at doses similar to the dose used for hypertension II. ACE inhibitor dose must be carefully titrated to the maximum allowable or tolerable dose III. Spironolactone has been found to be most useful as initial drug therapy for CHF even prior to the use of ACE inhibitors or casodilators a. I only b. II only c. I and III d. II and III e. I, II, and III 194. Which of the following drugs or drug combinations can reduce both the cardiac preload and afterload in CHF? I. Hydralazine + Nitrovasodilators II. Beta-blockers + Loop diuretics III. Loop diuretics + Digitalis a. I only b. II only c. I and III d. II and III e. I, II, and III 195. Which of the following interventions may be beneficial in the management of CHF? I. Replacement of chronic digoxi dose with ACE inhibitors II. Add-on therapt with Aldosterone antagonist on patients already on digoxin or ACE-inhibitors III. Use of calcium channel blockers in patient who cannot recieve beta-blockers a. I only b. II only c. I and III d. II and III e. I, II, and III 196. Which of the following drugs is a sodium channel blockers that can prolong the duration of the action potential and dissociates from the channel with intermediate kinetics? a. Lidocaine b. Flecainide c. Quinidine d. Bretylium e. Diltiazem 197. Which of the following drugs is a sodium channel blockers which has no significant effect on the duration of the action potential and dissociate from the channel with slow kinetics? a. Lidocaine b. Flecainide c. Quinidine d. Bretylium e. Sotalol 198. Which of the following beta-blockers have been found to be most useful as anti-arrythmic agent/s? I. Esmolol II. Metoprolol  III. Propanolol a. I only b. II only c. I and III d. II and III e. I, II, and III 199. Which of the following anti-arrythmic agents has been associated with lupus-like side effects? a. Quinidine b. Lidocaine c. Propafenone d. Amiodarone e. Procainamide 200. What is the drug of choice for the management of sustained ventricular arrythmia associated with acute myocardial infarction? a. Procainamide b. Lidocaine c. Amiodarone d. Verapamil e. Adenosine 201. What is the preferred drug for the management of ventricular arrythmias associated with digitalis intoxication? a. Procainamide b. Lidocaine c. Amiodarone d. Verapamil e. Adenosine 202. What is the preferred drug for the management of acute episodes of supraventricular tachycardia? a. Quinidine b. Verapamil c. Amiodarone d. Bretylium e. Adenosine 203. What is the preferred drug for the management of chronic paroxysmal supreventricular tachycardia? a. Quinidine b. Verapamil c. Amiodarone d. Bretylium e. Adenosine 204. What is the primary mechnism of action of the drug Amiodarone? a. Prolong the action potential with block of the sodium channels b. Shorten the action potential with block of the sodium channels c. Prolong the action potential with block of the potassium channels d. Shorten the action potential with block of the potassium channels e. Inhibit intrinsic sympathetic stimulation by preventing activation of the enzyme adenylyl cyclase 205. What side effect/s may be expected with the use of Amiodarone? I. Hypothyroidism or Htperthyroidism II. Fatal pulmonary fibrosis III. Symptomatic bradycardia and heart block particularly in patients with atrioventricular nodal disease  a. I only b. II only c. I and III d. II and III e. I, II, and III 206. Measurement of the serum ALT prior to and during therapy of arrythmia is indicated when which of the following drugs for arrythmia is/are used? a. Propafenone b. Moricizine c. Amiodarone d. Flecainide e. Diltiazem 207. Which of the following calcium channel blockers is most useful in arrythmia therapy? a. Verapamil b. Diltiazem c. Nifedipine d. Lidocaine e. Propafenone 208. Which of the following effects can be attributed to histamine binding to its H1 receptor? I. Extravascular smooth muscle contraction II. Vascular smooth muscle contraction III. Gastric acid secretion a. I only b. II only c. I and III d. II and III e. I, II, and III 209. The triple response of Lewis following intradermal injection of Histamine includes which of the following? I. Sensory nerve ending stimulation producing flare II. Erythema caused by contraction of vascular smooth muscles III. Endothelian cell contraction leading to exudation of fluids a. I only b. II only c. I and III d. II and III e. I, II, and III 210. Which of the following effects may be expected as a direct consequence of blockade of the H1 receptots I. Sedation II. Resolution of initial allergic response III. Anti-nausea and Anti-emetic effect (anti-motion sickness) a. I only b. II only c. I and III d. II and III e. I, II, and III 211. Dimenhydrinate and Diphenhydramine are H1 antihistamines that belong to what chemical class of agents? a. Alkylamines  b. Phenothiazine c. Piperazine d. Ethanolamine e. Ethylaminediamine 212. Which of the following agents is used primarily for its sedating property as the active ingredient of an OTC sleeping aid called Unisom? a. Carbinoxamine b. Doxylamine c. Hydoxyzine d. Meclizine e. Tripelenamine 213. What class of H1-antihistamines include drugs that sre used as components of OTC “cold” medications a. Alkylamines b. Phenothiazine c. Piperazine d. Ethanolamine e. Ethylaminediamine 214. What is the active metabolite of hydroxyzine which is also available as an H1-antihistamine without significant sedating side-effect? a. Fexofenadine b. Astemizole c. Cetirizine d. Loratidine e. Terfenadine 215. Which of the following H1 anti-histamine chemical groups possess significant atropine-like effect? a. Alkylamines b. Phenothiazine c. Piperazine d. Ethanolamine e. Piperidines 216. Which of the following H1-antihistamines has significant blocking effects on 5-HT receptors? a. Promethazine b. Cyproheptadine c. Pyrilamine d. Carbinoxamine e. Cetirizine 217. Which of the following H1-antihistamines has significant anti-cholinergic effect to be useful for the management of dytonia and pseudoparkinsonism associated with the use of neuroleptic agents? a. Diphenhydramine b. Brompheniramine c. Promethazine d. Cyproheptadine e. Cyclizine 218. Which of the following H1-antihistamines can block sodium channels in excitable membranes bringing about local anesthetic effect? a. Diphenhydramine b. Meclizine c. Doxylamine d. Pyrilamine  e. Cyproheptadine 219. What is the primary mechanism of action of the drug Ondansetron and Granisetron? a. Partiaal agonist effect at the 5-HT1A receptor b. Antagonist effect at the 5-HT1B receptor c. Full agonist effect at the 5-HT2A receptor d. Antagonist effect at the 5-HT3 receptor e. Partial agonist effect at the 5-HT4 receptor 220. What is the clinical use of the drugs Ondansetron and Granisetron? a. Appetite suppressants b. Anti-emetic c. Treatment of acute migraine attack d. Migraine prophylaxis e. Motility enhancing agent 221. What is the clinical use of the drugs that primarily stimulate the 5-HT1B and 5-HT1D receptors? a. Appetite suppressants b. Anti-emetic c. Treatment of acute migraine attack d. Migraine prophylaxis e. Motility enhancing agent 222. Sumatriptan is contrindicated in which subset of patients? a. Patients with broncospastic disease b. Patients with acute attacks of migraine c. Patients with ischemic heart disease d. Patients with hypertension e. Patients with Wolff-Parkinson-White syndrome 223. Which of the following statements is/are correct regarding Arachidonic acid? I. It is 20-carbon known as eicosapentaenoic acid II. It is mobilized from phospholipids by the enzyme phospholipase A2 III. It is released from phospholipids by the action of the enzymes phopholipase C and Diglyceride lipase a. I only b. II only c. I and III d. II and III e. I, II, and III 224. Which of the following eicosanoids is a product of the metabolism of Arachidonic acid by the cyclooxygenase enzyme? a. Leukotrienes b. Isoprostanes c. Epoxides d. Lipoxins e. Prostaglandins 225. Which of the following correctly differentiate/s COX-1 from COX-2 isozymes? I. COX-1 is widely distributed and constitutively expressed II. COX-1 is expressed upon stimulation by sytokines and growth factors III. COX-2 is expressed by inflammatory and immune cells a. I only b. II only c. I and III  d. II and III e. I, II, and III 226. Epoprostenol, a drug that is being used in the management of primary pulmonary hypertension is an analogue of which eicosanoid? a. PGD2 b. PGI2 c. PGE1 d. PGE2 e. PGF2-alpha 227. Which of the following eicosanoids has an analogue that is primary indicated as cytoprotectant in peptic ulcer disease? a. PGD2 b. PGI2 c. PGE1 d. PGE2 e. PGF2-alpha 228. Which of the following effects is caused by Prostacylin? a. Bronchoconstriction b. Vasoldilation of the blood vessels c. Inhibition of gastric acid secretion d. Contraction of the uterus e. Inhibition of renin secretion 229. What is the primary indication of the prostaglandin analogue Latanoprost? a. Management of glaucoma b. Smooth muscle relaxant in erectile dysfunction c. Abortifacient d. Inhibition of platelet aggregation e. Vasoconstrictor in episodes of hypertension 230. Which of the following statement correctly describes the effects of glucocorticosteroids in eicosanoid synthesis? I. Dexamethasone inhibits the expression of the COX-2 gene II. Glucocorticosteroids inhibit the synthesis of annexins leading to decreased activity of Phospholipase C III. Glucocorticosteroids stimulates the syntheis of lipocortins which inhibit the activity of Phospholipase A2 a. I only b. II only c. I and III d. II and III e. I, II, and III 231. Which of the following drugs classified as NSAIDs inhibit/s the COX-1 more than the COX-2 isozymes? a. Indomethacin b. Ibuprofen c. Mefenamic acid d. Naproxen e. Celecoxib 232. Which of the following drugs classified as NSAIDs inhibit/s the COX-2 morre than the COX-1 isozymes? a. Indomethacin  b. Ibuprofen c. Mefenamic acid d. Naproxen e. Celecoxib 233. Which of the following statement/s is correctly describe/s the pharmacokinetics of Aspirin? I. Aspirin can be absorbed in the stomach and the small intestines in the hydrolyzed form II. Elimination of aspirin can be best descrined as following a Michaelis-Menten kinetics III. Acidification of the urine facilitates renal elimination of Salicylates a. I only b. II only c. I and III d. II and III e. I, II, and III 234. Which of the following mechanisms may play a role of anti-inflammatory effect of Aspirin? I. Decreased synthesis of prostaglandins II. Inhibition of neutrophil migration and adherence III. Stabilize iysosomes of neutrophils a. I only b. II only c. I and III d. II and III e. I, II, and III 235. At what usual adult dose of aspirin is its anti-inflammatory effect observed? a. 0.3-2.4g/day b. 190mg/dL 242. A number of the NSAIDs cannot be given to patients with Gouty Arthritis as these may precipitate an acute attack of gout or induce uric acid stone formation. Which of the following NSAIDs should no be given to patient with gout? a. Tolmetin b. Ibuprofen c. Indomethacin d. Diclofenac e. Mefenamic acid 243. Which of the following NSAIDs with minimal anti-inflammatory activity is/are primarily indicated as analgesic especially in the management of post-operative pain? I. Diclofenac II. Ketorolac III. Etodolac a. I only b. II only c. I and III d. II and III e. I, II, and III 244. All the know NSAIDs are weak acids. Which of the following drugs is the only exception? a. Piroxicam b. Sulindac c. Nabumetone d. Ketorolac e. Tolmetin 245. Which of the following statement/s is/are correct regarding Mefenamic Acid, a popular NSAID? I. It is more toxic than Aspirin II. The drug should not be used for more than 1 week III. It should not be given to children a. I only b. II only c. I and III d. II and III e. I, II, and III 246. What is the most important toxicity associated with pyrazolone derivatives like Phenylbutazone which necessitated the withdrawal of a number of these drugs from the market? a. Hepatoxicity b. Hematologic toxicities c. Nephrotoxicity d. Gastric ulceration e. Stevens-johnson syndrome 247. Which of the following NSAIDs is most useful as an analgesic and has been used successfully to replace morphine in some situation involving mild to moderate post surgical pain? When used with an opioid, it may decrease the opioid requirement by as much as 25-50%. a. Naproxen b. Ketorolac c. Tenoxicam d. Diclofenac e. Mefenamic acid 248. What is the primary advantage od drugs like Celecoxib and etericoxib? a. Less incidence of gastric irritation or ulceration b. Less incidence of nephrotoxicity c. Less incidence of hematologic toxicities d. Minimal risk of causing worsening hypertension e. Less likelihood of inhibiting platelet aggregation 249. A number of drugs classified as specificCOX-2 inhibitors like Rofecoxib (Vioxx) have been withdrawn from the market or are marketed with “black box” warning. What is the primary reason for such actions to be taken against these drugs? a. They are associated with severe agranulocytosis b. They cause severe irreversible hepatic necrosis c. They increase the risk of bleeding in patient on Warfarin d. They increase the risk of thrombosis and cardiac deaths e. They cause worsening of DM and Hypertension 250. Which of the following agents is currently used as the first-line DMARDs in the management of Rheumatoid Arthritis? a. Hydroxychloroquine b. Auranofin c. Penicillamine  d. Azathioprine e. Methotrexate 251. When the methotrexate is used for the management of rheumatoid arthitis, what is the usual maintenance dosing regimen given to patients? a. 150mg OD b. 15mg OD c. 15mg once a week d. 150mg BID e. 15mg BID 252. Which of the following statement/s is/are correct regarding the drug Methotrexate when used for rheumatoid arthritis? I. The primary mechanism of action involves inhibition of AICAR (aminomidazolecarboxamide) transformylase and thymydylate synthase II. Toxicity of the drug may be minimized with the use of Leucovorin III. The drug is contraindicated in pregnancy a. I only b. II only c. I and III d. II and III e. I, II, and III 253. Which of the following statements is/are correct regarding the drug acetaminophen? I. It is a weak inhibitor of COX-1 and COC-2 isozymes in peripheral tissues II. It has significant anti-inflammatory activity III. It is equivalent to Aspirin as analgesic and anti-pyretic a. I only b. II only c. I and III d. II and III e. I, II, and III 254. Which of the following agent is most useful in the management of acetaminophen poisoning? a. N-acetylcysteine b. S-carboxymethylcysteine c. Dantrolene d. Atropine e. Sodium Bicarbonate 255. Which of the following condition when present may increase of formation of the toxic intermediate N- acetyl-p-iminobenzoquinone with regular doses of acteminophen? I. Patient with viral hepatitis II. Patients on warfarin therapy III. Chronic alcoholics a. I only b. II only c. I and III d. II and III e. I, II, and III 256. Which of the following drugs used for gout produces its effect by inhibiting the enzyme xanthine oxide a. Allopurinol b. Colchicine c. Indomethacin  d. Probenecid e. Sulfinpyrazone 257. Which of the following drugs used for gout produces its effect by inhibiting the synthesis of microtubules? a. Allopurinol b. Colchicine c. Indomethacin d. Probenecid e. Sulfinpyrazone 258. Which of the following is/are appropriate indication/s of Allopurinol? I. In the management of chronic tophaceous gout II. In preventing massive uricosuria in patients to be given chemotherapeutic agents for acute leukemia III. In patients with recurrent renal urate stones a. I only b. II only c. I and III d. II and III e. I, II, and III 259. In the management of acute gouty attack, which of the following statement/s is/are correct? I. Uricosuric agent are given at the onset of acute attack to reduce the duration of the episode II. Indomethacin is preffered for the management of the pain of an acute attack III. Colchine relieves the pain and inflammation of an acute attack in 12-24 hours a. I only b. II only c. I and III d. II and III e. I, II, and III 260. Which of the following groups can relax the brochial smooth muscles and are primarily used as bronchodilators in bronchial asthma? I. Methylxanthines II. Beta-2 agonists III. Anticholinergic agents a. I only b. II only c. I and III d. II and III e. I, II, and III 261. In the management of bronchial asthma, which of the following medications is/areconsidered as controller medications? I. Low-dose inhaled glucocorticosteroids II. Short-acting beta-2 agonists III. Long-acting inhaled beta-2 agonists a. I only b. II only c. I and III d. II and III e. I, II, and III 262. Which of the following advice should you give to a patient with bronchial asthma regarding the use of medications for his condition based on the current recommendations?  I. Oral bambuterol must be taken on PRN basis for acute exacerbations of bronchial asthma II. Inhalation of salbutamol for acute relief of attack mest be used for not more than three times a day III. He must adequately gargle about 5x after each use Fluticasone inhaler a. I only b. II only c. I and III d. II and III e. I, II, and III 263. Which of the following drugs for bronchial asthma can be given subcutaneously during acute episodes of bronchospasm? a. Salnutamol b. Isoproterenol c. Terbutaline d. Budesonide e. Theophylline 264. Which of the following mechanisms may explain the actions of methylxanthines in bronchial asthma? I. May inhibit the late phase allergic reaction occuring about 2-8hours after an acute attack II. May inhibit the enzyme phosphodiesterase leading to an increase in the levels of cAMP III. May antagonize the action of Adenosine a. I only b. II only c. I and III d. II and III e. I, II, and III 265. Which of the following statements describe/s the clinical use of Theophylline? I. May reduce the nocturnal attack of bronchial asthma when given as sustained-release preparation II. May improve response to high dose inhaledd beta-2 agonists when given intravenously concurrently with beta-2 agonists during acute exacerbation of asthma III. May improve contratility of the diaphragm improving ventilatory response to hypoxia a. I only b. II only c. I and III d. II and III e. I, II, and III 266. Which of the following statements is an important consideration regarding the toxicities and side effects of Theophylline? a. Toxicities and side effects do not occur as long as the serum levels of Theophylline do not exceed 20mg/L b. Adults, neonates, and young infants have faster clearance of Theophylline than children c. Clearance may be decreased with inhibition of hepatic enzymes among chronic smokers d. Seizures and arrythmias are more common when serum levels exceed 40mg/L e. Hepatic dysfunction does not alter significantly the clearance of Theophylline and can thus be safely used for patients with liver disease 267. Which of the following statements describe the use of anti-cholinergic agents in COPD and bronchial asthma? I. They can be safely given at high doses by inhalations to saturate the muscarinic receptors II. Available agents are tertiary ammonium compunds III. They are more effective than beta-2 agonists in bronchial asthma but less effective in COPD a. I only  b. II only c. I and III d. II and III e. I, II, and III 268. What is the mechanism of action of Nedocromil? a. Increase outward potassium conductance leading to hyperpolarization of mast cell membrane b. Increase inward chloride conductance leading to hyperpolarization of mast cell membrane c. Increase inward sodium conductance leading to depolarization of mast cell membrane d. Increase outward calcium conductance leading to repolarization of mast cell membrane e. Increase inward potassium conductaance leading to depolarization of mast cell membrane 269. What is the mechanism of action of Zafirlukast and Montelukast? a. Pharmacologic antagonism of Luekotriene D4 action b. Pharmacologic antagonism of Leukotriene C4 action c. Inhibition of the enzyme 5-lipoxygenase d. Inhibition of citokine release by macrophages e. Inhibition of Histamine-1 receptors 270. Which of the following agents has/have experimental effect as bronchodilator/s? I. Omalizumab II. Nifedipine III. Nitric oxide a. I only b. II only c. I and III d. II and III e. I, II, and III 271. Which of the following correctly describes the action of cromolyn sodium? a. Induces relaxation of bronchial smooth muscles b. Blocks the degranulation of mast cells c. Inhibits release of cytokines by inflammatory cells d. Inhibits binding of IgE to mast cell membrane e. Inhibits degradation of cGMP 272. Which of the following effects observe with acute or chronic use of opioids like morphine can be attributed to stimulatio of the mu-receptors? I. Respiratory depression II. Psychosis III. Miosis a. I only b. II only c. I and III d. II and III e. I, II, and III 273. Which of the following statement correctly describe the mechanism of action of the opioids? I. They mimic the action of endogenous opioid peptides II. The stimulate the release of endogenous opioid peptides III. They bind to receptors like the mu, kappa, and delta a. I only b. II only c. I and III d. II and III  e. I, II, and III 274. Which of the following is an opioid receptor that is responsible for inducing analgesia most especially among women? a. Kappa b. Delta c. Alpha d. Epsilon e. Mu 275. Tolerance is an expected consequence with chronic use of most of the available opioids. Which of the following effects of opioids is tolerance NOT observed? a. Respiratory depression b. Analgesia c. Euphoria d. Constipation e. Sedation 276. Which of the following statements regarding the development of tolerance to opioids is/are correct? I. Develops in 2-3 weeks of continuous use especially when large doses are used over short intervals II. Gross-tolerance develops among predominantly kappa-receptor full agonists III. Partial agonists induce cross-tolerance with strong agonists and antagonists a. I only b. II only c. I and III d. II and III e. I, II, and III 277. A 45-year old male admitted for severe chest painwas diagnosed with AMI. He was being given morphine 2mg IV for relief of the chest pain. Which of the following is/are important findings that must be observed as expected consequence/s of the use of Morphine? I. Tachycardia II. Hypotension III. Vasospasm a. I only b. II only c. I and III d. II and III e. I, II, and III 278. Which of the following opioids is not associated with biliary colic and thus can be used for severe pain associated with this condition? a. Morphine b. Pentazocine c. Fentanyl d. Meperidine e. Codeine 279. Abstinence syndrome is a rebound effect characterized by rhinorrhea, lacrimation, yawning, chills, gooseflesh, hyperventilation, and hostility observed in which of the following situations? I. Abrupt withdrawal of an opioid agonist in a patient taking the drug chronically II. In a newborn of a mother illicitly taking heroin during her pregnancy III. Administration of Nalbuphine on a patient chronically on morphine a. I only b. II only  c. I and III d. II and III e. I, II, and III 280. Which of the following oral doses of morphine is quivalent to 10mg of an IV dose? a. 200mg b. 180mg c. 100mg d. 40mg e. 10mg 281. Diacetylmorphine is the chemical name of which of the following opioids? a. Apomorphine b. Morphine c. Heroin d. Codeine e. Meperidine 282. Tramadol is weak mu-receptor agonist that does not require as S2 license for dispensing. It is a synthetic analogue ofwhich of the following opiates/opioids? a. Codeine b. Thebaine c. Morphine d. Meperidine e. Diphenoxylate 283. Which of the listed opioid below is along the recommended drugs for the management of acute pulmonary edema? a. Nalbuphine b. Codeine c. Morphine d. Meperidine e. Apomorphine 284. What is the primary mechanism involved in the utility of opioids in the management of acute pulmonary edema? a. Induction of osmotic diiuresis of edema fluuids b. Peripheral vasodilation reducing venous return c. Decreased cardiac inotropism d. Improved mobilization of edema fluid by osmosis e. Increased glumerolar filtration rate 285. Which of the following is/are possible therapeutic classification/s for available opiates and opioids? I. Cough supressants II. Emetics III. Analgesics a. I only b. II only c. I and III d. II and III e. I, II, and III 286. What is the main reason why atropine is always given with diphenoxylate (lomotil)? a. The anticholinergic after-effects with Atropine discourages abuse of Diphenoxylate b. The anti-motility effect of Atroppine augments the constipating effect of Diphenoxylate c. Atropine minimizes the respiratory depression expected with Diphenoxylate  d. Atropine reduces the absorption and systemic toxicity of Diphenoxylate e. Atropine inhibits the hepatic metabolism of diphenoxylate effectively reducing the dose requuired for diarrhea 287. What is the primary indication for the drug methadone? a. Analgesic substitute for Morphine b. Antitussive substitute for Codeine c. Weaning off patients addicted to Heroin or Morphine d. Management of biliary colic e. Anesthetic premedication 288. Which of the following agents is a strong full agonist of opioid receptors a. Hydromorphone b. Hydrocodone c. Codeine d. Propoxyphene e. Pentazocine 289. Which of the following agents is classified as a partial agonist of opioid receptors? a. Meperidine b. Methadone c. Levallorphan d. Fentanyl e. Nalbuphine 290. Which of the following agents is/are classified as opioid antagonist/s? I. Nalorphine II. Naloxone III. Naltrexone