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MODULE 4

MODULE 4. PHARMACOLOGY AND BIOPHARMACEUTICS. A drug that causes significant delay in the absorption of acetaminophen by reducing the rate of gastric emptying:. Anticholinergic Digoxin. c. Levodopa d. Propantheline. 2. Histabloc ® is a:. H1 agonist H1 antagonist . c. H2 agonist

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MODULE 4

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  1. MODULE 4 PHARMACOLOGY AND BIOPHARMACEUTICS

  2. A drug that causes significant delay in the absorption of acetaminophen by reducing the rate of gastric emptying: • Anticholinergic • Digoxin • c. Levodopa • d. Propantheline

  3. 2. Histabloc® is a: • H1 agonist • H1 antagonist • c. H2 agonist • d. H2 antagonist • Histabloc is Famotidine (H2 antagonist)

  4. 3. Schilling test is used for the detection of: • Pernicious anemia • Megaloblastic anemia • Iron deficiency anemia • Folate deficiency Pernicious anemia is caused by loss of gastric parietal cells, and subsequent inability to absorb vitamin B12. Megaloblastic anemia is an anemia (of macrocytic classification) that results from inhibition of DNA synthesis in red blood cell production.

  5. 4. Ambenonium, Neostigmine, and Pyridostigmine are most commonly used for which condition: c. Bronchial asthma d. COPD • Atropine overdose • Myasthenia gravis • Tacrine, Donepezil, Rivastigmine and Galantamine, all of which are anticholinesterase are indicated for Alzheimer’s Disease

  6. 5. 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? • Obesity • Bronchial asthma • c. shock • d. Acute Renal failure • Obesity as beta-3 receptor plays in lipolysis

  7. 6. Among diabetic patients using insulin or oral hypoglycemic agents (OHAs), why are beta-blockers used with special caution if not totally avoided? • Beta- blocker can induce hyperglycemia • Beta-blocker can mask hypoglycemic symptoms • Beta-blocker can attenuate effect of insulin and OHAs • Beta-blocker can induce insulin or OHA failure

  8. 7. The effects 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? c. ATP d. cGMP • IP3 • cAMP • IP3, leading to an increase in intracellular calcium

  9. 8. In schizophrenic syndrome there is primarily: • Decreased cholinergic activity • Decreased dopaminergic activity • Increased dopaminergic activity • Increased cholinergic activity • psychosis and schizophrenia - abnormally high dopaminergic transmission   • Parkinson’s disease - decreased dopamine activity

  10. 9. Chloramphenicol can cause: • Diarrhea • Blindness • c. emesis • d. bone marrow depression

  11. 10. A broad spectrum gram-negative cephalosporin: • Cefalexin • Cefotaxime • c. Cefamandole • d. AOTA • Cefotaxime – 3rd generation cephalosporins have a broad spectrum of activity and further increased activity against Gram-negative organisms • Cefamandole – second generation • Cefalexin-first generation

  12. 11. What is the most important mechanism of termination of effects of released Norepinephrine which is the target action of TCA’s and cocaine: • Degradation by COMT • Sequestration into cells • Degradation by MAO • Reuptake into the presynaptic terminal

  13. 12. A given adrenergic agent induces uterine relaxation and bronchial muscle relaxation and bronchial muscle relaxation. These effect can be attributed to: • Alpha-1 stimulation • Alpha-2 stimulation • c. Beta-1 stimulation • d. Beta-2 stimulation

  14. 13. In combination therapy for tuberculosis, the following are commonly administered orally EXCEPT: • Ethambutol • INH • c. Streptomycin • d. Rifampicin Streptomycin - IM

  15. 14. Furosemide is useful for the treatment of all the following EXCEPT: • Acute pulmonary edema • Hypertensive crisis • Hypoglycemia • Congestive heart failure

  16. 15. What is the dominant adrenergic receptor in the heart? • Alpha – 1 • Alpha – 2 • c. Beta – 1 • d. Beta – 2

  17. 16. In terms of mechanism of action, which of the following drugs most closely resembles that of clonidine: • Phenylephrine • Reserpine • c. Methyldopa • d. Amlodipine

  18. 17. In the adrenal medulla, Norepinephrine is converted to epinephrine by the action of which enzyme? • DOPA decarboxylase • Phenylethylamine N-methyl transferase • COMT • MAO

  19. 18. At what dose should Dopamine be given as IV infusion to produce a predominantly dopaminergic effect? • 0.5 – 5 ug/kg/min • 5-10 ug/kg/min • 10-20 ug/kg/min • 20-50 ug/kg/min

  20. 19. Prolonged therapeutic administration of cortisone induces: • Hypoglycemia • Hypofunction of the adrenal cortex • Hyperfunction of the pituitary gland • Hypofunction of the adrenal medulla

  21. 20. What is the mechanism of skeletal muscle paralysis produced by succinylcholine? • Competitively inhibits binding of acetylcholine to the NM receptor • Increase the inward chloride conductance leading to hyperpolarization of the neuromuscular endplate membrane • Sustained depolarization of the motor end plate making it unresponsive to other impulses and upon repolarization cannot easily be depolarized • Repeated short depolarization of the motor end plate leading to a prolonged state of sodium channel inactivation • Irreversible and non-competitive inhibition of the NN receptor in both the ganglia and motor end plate with attenuation of depolarization impulse

  22. 21. Which of the following inhalational anesthetics produces the greatest augmentation of the effect of neuromuscular blockers? • Isoflurane • Sevoflurane • c. Halothane • d. Desflurane

  23. 22. Anaphylactoid reaction may be seen as a side effect with which of the following neuromuscular blockers? • Pancuronium • Vecuronium • c. Tubocurarine • d. Rocuronium • Tubocurarineinduces a non-immune mediated histamine release by mast cells which can manifest as an anaphylaxis like reaction

  24. 23. This can decrease gastric emptying time: • Stress • Metoclopramide • c. None of these • d. Vigorous exercise • Stress – increase stomach contractions and emptying rate • Metoclopramide– gastroprokinetic agent

  25. 24. What is the primary mechanism of action of the drug Indapamine? • Inhibition of the 2Cl-Na-K contransporter in the distal convoluted tubule • Inhibition of the Na-Clcotransporter at the distal convoluted tubule • Inhibition of the Na-Clcotransporter at the collecting duct • Competitive inhibition of Aldosterone binding to its receptor • Competitive inhibition of Vasopressin binding to V2 receptor

  26. 25. What is considered as the toxic plasma concentration of Digoxin? • >0.5 mg/ml • >150 ng/ml • c. >10 ng/ml • d. >2 ng/ml

  27. 26. The drug of choice in the treatment of arrhythmia caused by digitalis intoxication: • Methyldopa • Phenytoin • c. Hydralazine • d. Phenylephrine

  28. 27. Inotropic activity of the heart in congestive heart failure can be increased by which of the following agents? • Bipyridines • ACE inhibitors • Beta-1 Agonist I only II only I and III II and III I, II and III

  29. 28. Which of the following anti-arrhythmic agents has been associated with lupus-like side effect? • Quinidine • Lidocaine • c. Amiodarone • d. Procainamide

  30. 29. Which of the following calcium channel blocker is most useful in arrhythmia therapy? • Verapamil • Diltiazem • c. Nifedipine • d. Lidocaine • Verapamilis the ONLY CCB with proven clinical role in arrhythmia therapy

  31. 30. Chinese patients are most likely to be more sensitive to the effects of which of the following drugs for hypertension that lower doses may have to be used? • Prazosin • Amlodipine • c. Metoprolol • d. HCTZ • Chinese patients are most likely to be more sensitive to the effects of beta blocker

  32. 31. Which of the following benzodiazepines has the shortest half-life and a rapid onset of action? • Lorazepam • Triazolam • c. Oxazepam • d. Diazepam • Triazolam and Midazolamhave the shortest half-lives with a rapid onset of action

  33. 32. Which of the following findings in a patient taking Phenytoin would warrant reduction in the dose? • Gingival hyperplasia • Nystagmus • c. Osteomalacia • d. Ataxia • Ataxia and diplopia are early manifestations of toxicity

  34. 33. Which of the following drugs for seizure is metabolized to yield Phenobarbital? • Lamotrigine • Vigabatrin • c. Primidone • d. Topiramate • Phenobarbital is one of the two active metabolites of Primidone

  35. 34. When Phenytoin is given intravenously, what is the maximum rate by which the drug can be administered? • 10mg/min • 20mg/min • 30mg/min • 50mg/min • When Phenytoin is given intravenously, the maximum rate by which the drug can be administered is 50mg/min

  36. 35. What is Entacapone? • A selective MAO-A inhibitor • A selective MAO-B inhibitor • A Dopamine-3 receptor agonist • COMT inhibitor • Entacapone is an inhibitor of COMT which can convert levodopa to 3-O-methyldopa, a metabolite which can interfere with the transport of Levodopa across the blood brain barrier

  37. 36. Which of the following drug is most useful in controlling the bradykinesia of Parkinsonism? • Levodopa • Bromocriptine • Selegeline • Entacapone

  38. 37. What type of protein is primarily targeted by Digitalis glycosides when they exert their effect on the heart? • Receptor • Ion channels • transporters • structural proteins • Cardiac glycosides inhibit Na+/K+ ATPase, the membrane bound transporter often called the sodium pump.

  39. 38. Biotransformation of orally administered drugs occurring primarily in the liver that reduces the amount of drug finally entering the systemic circulation is often referred to as: • Enterohepatic recirculation • Gastric emptying • First pass effect • Enzyme induction

  40. 39. What neurotransmitter is released by the preganglionic fibers as a response to sympathetic stimulation? • Acetylcholine • Norepinephrine • Serotonin • Dopamine • Acetylcholine is the preganglionic neurotransmitter in both the sympathetic and parasympathetic nervous system

  41. 40. A 55 year old male with kidney stones has been placed on a diuretic to decrease calcium excretion. However, after a few weeks, he develops an attack of gout. Which diuretic was he taking? • Furosemide • HCTZ • Spironolactone • d. Triamterene HCTZ can also inhibit the excretion of uric acid and cause its accumulation, leading to an attack of gout

  42. 41. A 45-year-old man has recently been diagnosed with hypertension and started on monotherapy designed to reduce peripheral resistance and prevent NaCl and water retention. He has developed a persistent cough. Which of the following drugs would have the same benefits but would not cause cough? • Losartan • Nifedipine • Prazosin • Propranolol • Losartan is an ARB that will have the same beneficial effects but will not produce cough.

  43. 42. What is the amino acid precursor in the synthesis of catecholamines? • Phenylalanine • Glycine • Tyrosine • Tryptamine • Tryptamine for 5HT/Serotonin

  44. 43. Which of the following beta-blockers is cardioselective? • Labetalol • Propranolol • Pindolol • Esmolol • BEAM = Bisoprolol, Esmolol, Atenolol, Metoprolol

  45. 44. Bethanechol is clinically used for which of the following conditions? • Urinary retention in neurogenic bladder • Intestinal obstruction • Chronic glaucoma • Supraventricular tachycardia • Due to its acetylcholine-like effect on the genitourinary tract

  46. 45. Which of the following findings may be consistent with an overdose of or accidental exposure to an organophosphate? • Constipation • Mydriasis • Emesis • Peripheral vasodilation • DUMBBELSS ( diarrhea, urination, miosis, bradycardia, bronchoconstriction, emesis, lacrimation, sweating, salivation)

  47. 46. Ipratropium, Oxytopium, and Tiotropium are antimuscarinic agents that are most useful as: • Mydriatics • Cycloplegic agents • Relaxant of bronchial smooth muscles • Inhibitors of involuntary muscle contractions • Inhibitors of bronchial gland secretions

  48. 47. Which of the following anti hypertensive agents is most appropriate for elderly male patients with benign prostatic hyperplasia? • Prazosin • Metoprolol • HCTZ • Enalapril • - alpha blocker, which can also relax the prostatic smooth muscles providing relief of urinary retention

  49. 48. Which of the following drugs classified as NSAIDs inhibit/s the COX-2 more than the COX-1 isozymes? • Indomethacin • Ibuprofen • Mefenamic acid • Celecoxib • Coxibs and Meloxicam inhibit the COX 2 more than the COX 1 isozymes

  50. 49. The most common prophylactic measure used worldwide to prevent tuberculosis: • INH • Bacillus calmetteguerine vaccine • Ethambutol • Streptomycin

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