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Семестр: 8
Clinical pharmacology (clinical situations)
Опис:
4 course dentistry
Перелік питань:
1.
A.
B. *
C.
D.
E.
2.
A.
B.
C.
D.
E. *
3.
A.
B. *
C.
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E.
4.
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B. *
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5.
A.
B.
C.
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E.
The combination of hydralazine and nitrates has been shown to improve survival in patients of heart
failure. All of the following statements about this combination are true except:
The combination serves to decrease both afterload and preload.
Prazosin is as effective as the combination in treatment of congestive heart failure.
The concept of afterload reduction is principally derived from patients of significant mitral
regurgitation.
The VA cooperative study was a landmark trial demonstrating the beneficial effect of hydralazine
and nitrate combination in patients of heart failure.
The combination serves to increase both afterload and preload.
A 45-year-old woman has had recurrent episodes of atrial fibrillation. She is receiving phenytoin and
quinidine to control the atrial fibrillation. She is also taking a low dose of diazepam for insomnia and
estrogen replacement therapy.You learn today that she has been receiving ciprofloxacin for a urinary
track infection.The reason for her appointment today is that she has been having ringing in the ears,
headache, nausea, and blurred vision. She tells you that she is also having trouble hearing the
television. You suspect drug toxicity.The most likely agent is:
Ciprofloxacin
Estrogen
Phenytoin
Diazepam
Quinidine
You are asked to treat a 55-year-old patient for continuing ventricular arrhythmias.The patient is
receiving timolol drops for glaucoma, daily insulin injections for diabetes mellitus, and an ACE
inhibitor for hypertension.You decide to use phenytoin instead of procainamide because of what
pharmacological effect of procainamide?
The local anesthetic effect of procainamide would potentiate diabetes.
The anticholinergic effect of procainamide would aggravate glaucoma.
The hypertensive effects of procainamide would aggravate the hypertension.
The local anesthetic effect of procainamide would aggravate the hypertension.
The cholinergic effects of procainamide would aggravate the diabetes.
Exercise-induced ventricular tachycardia in persons without overt cardiac disease is an example of
delayed after-depolarizations and is characterized by an increase in intracellular ionized calcium.This
type of arrhythmia is known to often respond well to which of the following combinations?
Beta-Blocker and ACE inhibitor
Calcium channel antagonist and ACE inhibitor
Beta-blocker and ACE inhibitor
Beta-blocker and calcium channel antagonist
Alpa-blocker and calcium channel antagonist
Metoprolol would produce which beneficial effect in a patient with secondary angina?
A decrease in preload
An increase in collateral blood flow
An increase in afterload
An increase in diastolic filling time
An increase in blood flow through a concentric stenosis
6.
A.
B.
C. *
D.
E.
7.
A. *
B.
C.
D.
E.
8.
A.
B.
C.
D. *
E.
9.
A.
B.
C. *
D.
E.
10.
A.
B. *
C.
D.
E.
11.
A.
B.
C. *
D.
Although most antiarrhythmic drugs (and indeed most drugs) are chemically synthesized, some
compounds that occur endogenously in humans are useful. Indicate which of the following agents
occurs endogenously and is a useful antiarrhythmic agent.
Phenytoin
Digoxin
Adenosine
Quinine
Lidocaine
A patient comes to your office with effort-induced angina and resting tachycardia.You choose the
following drug to treat the patient because it slows heart rate by blocking L-type calcium channels in
the SA node:
Verapamil
Propranolol
Nitroglycerin
Isosorbide dinitrate
Metoprolol
Which of the following hemodynamic effects of nitroglycerin are primarily responsible for the
beneficial results observed in patients with secondary angina?
Reduction in the force of myocardial contraction
Reduction in systemic vascular resistance (afterload)
Increased heart rate
Reduction in venous capacitance (preload)
Increased blood flow to the subepicardium
A woman is prescribed a combination of drugs consisting of a nitroglycerin patch and a beta-blocker,
such as propranolol, to treat her attacks of secondary angina.Which effect of propranolol would
counteract an adverse effect of nitroglycerin?
A decrease in preload
A decrease in afterload
A decrease in heart rate
An increase in myocardial contractile force
A reduction in coronary vasospasm
A patient who has been taking propranolol for a long period for secondary angina comes to your
office complaining of increased frequency of chest pains on exertion.You decide to stop the
propranolol and give him diltiazem because you suspect he has a mixture of secondary and primary
angina. Why would diltiazem be more likely to relieve the angina if your new diagnosis is accurate?
Diltiazem produces a decrease in heart rate.
Diltiazem dilates coronary blood vessels in spasm.
Diltiazem produces AV blockade.
Diltiazem reduces myocardial contractility.
Diltiazem reduces afterload.
An accurate statement regarding the actions of both ACE inhibitors and AT1 receptor antagonists is
that
Both classes of drugs increase bradykinin.
Angiotensin II can act at the AT2 receptor with both classes of drugs.
Both classes of drugs reduce total peripheral resistance.
Both classes of drugs decrease circulating angiotensin II levels.
E.
12.
A. *
B.
C.
D.
E.
13.
A.
B.
C.
D.
E. *
14.
A.
B. *
C.
D.
E.
15.
A.
B. *
C.
D.
E.
16.
A.
B. *
C.
D.
E.
17.
A.
B.
C.
D.
E. *
18.
A.
B.
C. *
D.
Both classes of drugs are first-choice treatments for congestive heart failure.
Angiotensin II can:
Increase the synthesis and release of aldosterone
Reduce the activity of the sympathetic nervous system
Be a potent positive inotropic at the heart
Relax vascular smooth muscle
Reduce the growth of cardiovascular cell types
The most potent vasoconstrictor known is
Bradykinin
Angiotensin II
Angiotensin IV
Natriuretic peptide
Endothelin
The mechanism of action of captopril is
Angiotensin receptor antagonist
ACE inhibitor
Aldosterone receptor antagonist
Bradykinin antagonist
Diuretics
Which of the following antihypertensive agents would decrease renin release?
Prazosin
Clonidine
Captopril
Nitroprusside
Diazoxide
Which of the following calcium channel blockers would be most likely to suppress atrial
tachyarrhythmias involving the A-V node?
Nifedipine
Verapamil
Nicardipine
Amlodipine
Nimodipine
All of the following statements are applicable with regard to the systemic effects caused by
nifedipine EXCEPT:
It typically causes peripheral vasodilation.
It often elicits reflex tachycardia.
It causes coronary vasodilatation
It increases coronary blood flow.
Its benefit in the management of angina is related to the reduction in preload that it induces.
All of the following statements regarding the pharmacokinetics of calcium channel blockers are
correct EXCEPT
They are characterized by significant amount (~ 90%) of protein binding.
They undergo significant first-pass metabolism.
Their half-life is not altered by hepatic cirrhosis.
They can be administered orally.
E.
19.
A. *
B.
C.
D.
E.
20.
A. *
B.
C.
D.
E.
21.
A.
B.
C. *
D.
E.
22.
A.
B.
C.
D.
E. *
23.
A.
B.
C.
D.
E. *
24.
A.
B.
C.
D.
E. *
They can be administered IV
All of the following adverse effects are likely to occur with long-term use of calcium channel
blockers EXCEPT
Skeletal muscle weakness
Flushing
Dizziness
Headache
Renal damage
A 55-year-old patient has been referred to you. She complains about a skin rash and a cough. In the
course of history taking, she tells you that she takes high blood pressure medication but she doesn’t
remember the name.You suspect a drug toxicity. Which of the following antihypertensive agents is
the patient most likely taking?
Captopril
Nifedipine
Prazosin
Propanolol
Clonidine
Which of the following compounds depends least upon the release of EDRF (nitric oxide) from
endothelial cells to cause vasodilation?
Bradykinin
Histamine
Minoxidil
Hydralazine
Acetylcholine
Which of the following antihypertensive drugs is contraindicated in a hypertensive patient with a
pheochromocytoma?
Metyrosine
Labetalol
Prazosin
Phenoxybenzamine
Guanethidine
When a patient is treated with a thiazide diuretic for hypertension, all of the following are likely
EXCEPT:
The fall of blood pressure that occurs in the first 2 weeks of therapy results from a decrease of
extracellular volume.
The sustained fall in blood pressure that occurs after several weeks of therapy is due to a decrease of
intravascular resistance.
After the blood pressure is reduced, hypokalemia remains a complication.
Hyperuricemia may occur.
Hypoglycemia may occur.
Furosemide increases the excretion of all of the following EXCEPT:
Na+
K+
Ca++
Mg++
Uric acid
25.
A.
B.
C. *
D.
E.
26.
A.
B. *
C.
D.
E.
27.
A.
B. *
C.
D.
E.
28.
A. *
B.
C.
D.
E.
29.
A. *
B.
C.
D.
E.
30.
A. *
B.
C.
D.
E.
31.
A.
Which of the following drugs is an appropriate initial antihypertensive therapy in an otherwise
healthy adult with mild hypertension?
Bumetanide
Triamterene
Hydrochlorothiazide
Aldactone
Furosemid
When furosemide is administered to a patient with pulmonary edema, there is often symptomatic
relief within 5 minutes of starting treatment.This relief is primarily due to:
A rapid diuretic effect
An increase in venous capacitance
A direct effect on myocardial contractility
Psychological effects
A decrease in venous capacitance
A 60-year-old man with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta
adrenegic blockers and calcium channel antagonisst. What is the best treatment for this patient?
Aspirin, orally
Coronary artery bypass grafting
Antihypertensive therapy
Intravenous strpetokinase
Excercise testing
A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG:
tachycardia with heartbeat rate of 220/min. Ventricle complexes are deformed and widened. P wave
is absent. What medication is to be prescribed to provide first aid?
Lydocain
Seduxen
Novocainamides
Strophantin
Isoptin
A 46-year-old patient has ischemic heart disease, angina on exertion, II functional class. What is the
drug of choice in treatment of acute attack?
Nitroglycerin sublingually
Platelet inhibiting agents (aspirin)
Spasmolitics (No-spa) IV
Digitalis IV
Sedative agents (Seduxenum) orally
A 52-year-old patient complains of intensive and prolonged retrosternal pains, decreased exercise
tolerance for 5 days. Which of the following groops is the most useful?
nitrates
dyslipidemic drugs
diuretics
ACE inhibitors
digitalis
A 50-year-old patient was admitted to resusitation department with aqute myocardial infarction .
Which one of the following drugs is uneffective in this case?
Proranolol
B.
C. *
D.
E.
32.
A. *
B.
C.
D.
E.
33.
A. *
B.
C.
D.
E.
34.
A.
B.
C.
D. *
E.
35.
A.
B.
C. *
D.
E.
36.
A.
B. *
C.
D.
E.
37.
A.
B. *
C.
D.
E.
Nitroglycerin
Nifedipine
Phentanyl
Morfin
A 54-year-old patient, who suffers from IHD, stable stenocardia II, heart insufficiency I, has an
attack of ventricular tachycardia, Ps 180/min, AP – 80/50 mm Hg. Choose a correct treatment:
Lidocain, potassium chloride
Mezaton, strofantin
Verapamil, potassium chloride
Digoxin
ATP, cordaron
A 55-year-old men has stenocardia on exertion II. Taking of nitroglycerin potentiate a sever
headache. Which of the following drugs is the most useful in this case?
Molsidomin
Amiodaron
Nifedipine
Propranolol
Verapamil
A 49-year-old patient has ischemic heart disease, angina on exertion, II functional class. What is the
drug of choice in treatment of acute attack?
No-spa IV
Aspirin
Digitalis IV
Nitroglycerin sublingually
Seduxenum orally
A patient of 42 year has arterial hypertension with bradyarrhythmia. Which of the following drugs is
necessary to administer?
Clonidine
Bisoprolol
Nifedipine
Diltiazem
Methyldopa
A 58-year-old women, who suffers from IHD, stenocardia on exertion II, heart insufficiency I, has an
attack of ventricular tachycardia, Ps 180/min, AP – 80/50 mm Hg. Choose a correct treatment:
Digoxin, mezaton
Lidocain, potassium chloride
Verapamil, potassium chloride
Digoxin
ATP, cordaron
A 55-year-old men has stenocardia on exertion II. Taking of nitroglycerin potentiate a sever
headache. Which of the following drugs is the most useful in this case?
Aspirin
Molsidomin
Captopril
Propranolol
Verapamil
38.
A.
B. *
C.
D.
E.
39.
A. *
B.
C.
D.
E.
40.
A. *
B.
C.
D.
E.
41.
A. *
B.
C.
D.
E.
42.
A.
B.
C.
D.
E. *
43.
A. *
B.
C.
D.
E.
A 6 month old patient who is in the ICU following cardiac surgery for a congenital defect develops
atrial flutter with an atrial rate of 300 beats/min and second degreee (2:1) AV node block. A 3rd year
medical student inadvertantly administers quinidine, instead of propranolol,and the patient's
ventricular rate skyrockets to 300 beats/min. The patient faints. This most likely occured because
quinidine is:
a partial beta agonist
antimuscarinic
a sodium channel blocker
a potassium channel blocker
able to increase vagal tone
A 45-year-old women with diagnosis: Paroxysmal arrhythmia. Arterial hypertension II. Drug of
choice for stopping attack:
Anaprilin
Nitroglycerin
Potassium chloride
Digoxin
Lidocain
A patient has arterial hypertension with bradyarrhythmia. Which of the following drugs is necessary
to administer?
Nifedipine
Klonidine.
Propranolol
Diltiazem
Methyldopa
A patient has bronchial asthma for a long time. Angina pectoris attacks have appeared recently
Which of the following drugs is contraindicated?
Propranolol
Nitroglycerin
Nifedipine
Lovastatin
Aspirin
A 64-year-old patient, who suffers from IHD, stable stenocardia II functional class, heart
insufficiency I, has an attack of ventricular tachycardia, Ps 180/min, AP – 80/50 mm Hg. Choose a
correct treatment:
ATP, cordaron
Mezaton, strofantin
Verapamil, potassium chloride
Digoxin
Lidocain, potassium chloride
A 45-year-old men with diagnosis: Paroxysmal arrhythmia. Arterial hypertension II. Drug of
choice for stopping attack:
Metoprolol
Nitroglycerin
Potassium chloride
Digoxin
Lidocain
44.
A.
B. *
C.
D.
E.
45.
A. *
B.
C.
D.
E.
46.
A.
B. *
C.
D.
E.
47.
A. *
B.
C.
D.
E.
48.
A.
B.
C. *
D.
E.
49.
A.
B.
C.
D. *
E.
50.
A.
B. *
A patient of 42 year has arterial hypertension with bradyarrhythmia. Which of the following drugs is
necessary to administer?
Clonidine
Nifedipine
Bisoprolol
Diltiazem
Methyldopa
A patient has bronchial asthma for a long time. Angina pectoris attacks have appeared recently.
Which of the following drugs is contraindicated?
Propranolol
Molsidomin
Nifedipine
Carvedilol
Aspirin
A 65-year-old woman with unstable angina pectoris fails to respond to heparin, nitroglycerin, beta
adrenegic blockers and calcium channel antagonists. What is the best treatment for this patient?
Intravenous strpetokinase
Coronary artery bypass grafting
Antihypertensive therapy
Aspirin, orally
Excercise testing
A 49-year-old women with diagnosis: Paroxysmal arrhythmia. Arterial hypertension II, heart
insufficiency 0. Introduce drug of choice for stopping attack:
Metoprolol
Nitroglycerin
Potassium chloride
Digoxin
Lidocain
A patient suffers from arterial hypertension with bradyarrhythmia. Which of the following drugs is
necessary to administer?
Atenolol
Furosemid.
Nifedipine
Diltiazem
Methyldopa
A patient has chronic obstructive pulmonary desease for a long time. Angina pectoris attacks have
appeared recently. Which of the following drugs is contraindicated?
Nifedipine
Isosorbide dinitrate
Lovastatin
Propranolol
Aspirin
A woman 56 years old with hypertension edema develops on lower extremities, moist wheezes in
the lower parts of lungs. What must be administered in the complex therapy of the patient?
Beta-adrenomimetics,
Diuretics,
C.
D.
E.
51.
A.
B. *
C.
D.
E.
52.
A.
B.
C.
D. *
E.
53.
A.
B.
C. *
D.
E.
54.
A.
B.
C.
D.
E. *
55.
A.
B. *
C.
D.
E.
56.
Glucocorticoids,
Preparations of calcium,
M-cholinolitics.
A woman 51 years old has arterial hypertension. Which group of drugs may be used for her
treatment?
Betaadrenomimetics,
Angiotensin-converting enzyme inhibitors,
Glucocorticoids,
Preparations of calcium,
M-cholinolitics.
A man 36, years old, has arterial hypertension. Which group of drugs may be used for her
treatment?
Beta-adrenomimetics
Preparations of calcium,
Glucocorticoids,
Calcium-channel inhibitors,
M-cholinolitics.
Patients suffering from congestive heart failure will show signs and symptoms of peripheral
vasoconstriction, moist skin, pale complextion because of:
Na and water retention
decreased renin release
increased sympathetic tone
decreased vagal tone
decreased aldosterone levels
A 67 year old patient with a history of heart disease presents to the ER with chronic atrial fibrillation,
an average ventricular rate of 120-140 beats/min, and an ejection fraction of 35 %. The best drug for
controlling his ventricular rate would be:
propranolol
quinidine
nifedipine
diltiazem
digoxin
A 76 year old patient being treated with digoxin, captopril and furosemide for systolic heart failure
and hypertension presents to the ER with complaints of dizziness and fatigue. The patient faints
immediately after an ECG recording indicates the presence of sinus bradycardia and intermittent 3rd
degree AV conduction block. The most likely explanation for this patient's rhythm disturbance is:
captopril overdose
increased vagal tone caused by digoxin
decreased vagal tone caused by furosemide
increased sympathetic tone caused by digoxin
hyperkalemia caused by furosemide
A 59 year old patient with a history of systolic heart failure arrives in the ER with complaints of chest
palpitations, nausea and GI upset. His chart indicates that he is currently taking digoxin, captopril,
metoprolol and furosemide. A 12 lead ECG is recorded and reveals the presence of frequent runs of
ventricular bigeminy. His echocardiogram indicates an ejection fraction of 40%. His blood tests
indicate a serum potassium level of 4.0 mM, and an elevated digoxin level of 2.2 ng/ml. The most
appropriate drug for treating this patient's arrhythmia would be:
A.
B.
C. *
D.
E.
57.
A.
B.
C.
D. *
E.
58.
A.
B. *
C.
D.
E.
59.
A.
B. *
C.
D.
E.
60.
A.
B.
C.
D.
E. *
61.
A.
B.
C. *
propranolol
quinidine
lidocaine
verapamil
atropine
A patient being treated for heart failure with digoxin and furosemide is discharged from the hospital
after being initiated on quinidine therapy to reduce the incidence of atrial tachyarrhythmias. The next
day the patient reappears in your office complaining of fatigue, visual difficulties and nausea. The
patient's ECG reveals a prolong PR interval, with occasional runs of bigeminy and 2nd degree
(Mobitz type I) AV conduction block. The most likely cause of these symptoms is:
furosemide induced hyperkalemia
an interaction between quinidine and furosemide
worsening heart failure
an interaction between quinidine and digoxin
quinidine toxicity
A patient who is experiencing progressive dyspnea of effort comes to your office for a physical
examination. The pulse is regular at 100 beats per minute, with a blood pressure of 126/84 mm Hg.
Auscultation of the lungs reveals inspiratory crackles at both bases. There is no peripheral edema,
and the cardiac apical impulse is not displaced. An echocardiogram reveals a left ventricular chamber
that is not dilated, with an estimated ejection fraction of 55%. You make the diagnosis of congestive
heart failure. Based on your observations, which of the following drugs would best address the
problem in this patient?
dopamine
verapamil
digoxin
hydralazine
furosemide
The 56 years old woman with hypertensive disease appealed to the doctor. Methyldopa was
prescribed to her. Indicate a mechanism of action of this drug.
Violation of noradrenalin synthesis
alpha-adrenoreceptors stimulator
Block of beta-adrenoreceptors
Depression of angiotensin converting enzyme activity
Increasing of acetylcholine synthesis
In the complex medical treatment of hypertensive disease a diuretic was prescribed to the patient. In a
few days the BP went down, but the signs of hypokaliaemia arose up. What drug could cause such
complication?
Triamterene
Clofeline
Enalapril
Spironolactone
Furosemide
The patient has cranial trauma. The brain edema threat developed in the postoperative period. To
prescribe drug for the removal of this complication.
Spironolactone
Papaverini hydrochloride
Furosemide
D.
E.
62.
A.
B. *
C.
D.
E.
63.
A. *
B.
C.
D.
E.
64.
A. *
B.
C.
D.
E.
65.
A.
B.
C.
D. *
E.
66.
A.
B. *
C.
D.
E.
67.
A.
B.
C.
D.
Dihlothiazid
Diacarb
In the patient with the considerable peripheral edema the by turns using of dihlothiazid, ethacrynic
acid and furosemide did not result in the considerable diuretic effect. The analysis of blood indicated
the considerable increasing of aldosteron level. Prescribe drug for treatment.
Mannitol
Spironolactone
Clopamid
Triamterene
Amiloride
To the 55 years old man for the medical treatment of gout was prescribed etamid. What is the
mechanism of uric actions of the drug?
Depression of reabsorbing of urinary acid
Increasing of secretion of urinary acid
Decreasing of production of urinary acid
Depression of activity of xantinoxydase
Production of easy soluble salts
At the 46 years old patient with blink arrhythmia the edema of lungs began. What drug is necessary
to inject in the first turn?
Furosemide
Triamterene
Verospirone
Amiloride
Euphylline
To the patient with edema of cardiac origin the doctor must prescribe diuretics. What drugs are
contraindicated in this situation?
Hypothiazide
Spironolactone
Furosemide
Mannitol
Diacarb
In the patient with the considerable peripheral edema using of dihlothiazid did not result in the
considerable diuretic effect. The analysis of blood indicated the considerable increasing of aldosteron
level. Prescribe drug for treatment in this situation.
Mannitol
Spironolactone
Ethacrynic acid
Furosemide
Diacarb
In the complex medical treatment of hypertensive disease a diuretic was prescribed to the patient. In a
few days the BP went down, but the signs of hypokaliaemia arose up. What drug could cause such
complication?
Triamterene
Clofeline
Enalapril
Spironolactone
E. *
68.
A.
B.
C. *
D.
E.
69.
A.
B.
C.
D.
E. *
70.
A.
B. *
C.
D.
E.
71.
A.
B.
C.
D. *
E.
72.
A.
B. *
C.
D.
E.
Furosemide
Patients suffering from congestive heart failure will show signs and symptoms of peripheral
vasoconstriction, moist skin, pale complextion because of:
Na and water retention
decreased renin release
increased sympathetic tone
decreased vagal tone
decreased aldosterone levels
A 67 year old patient with a history of heart disease presents to the ER with chronic atrial fibrillation,
an average ventricular rate of 120-140 beats/min, and an ejection fraction of 35%. The best drug for
controlling his ventricular rate would be:
verapamil
quinidine
nifedipine
diltiazem
digoxin
A 76 year old patient being treated with digoxin, captopril and furosemide for systolic heart failure
and hypertension presents to the ER with complaints of dizziness and fatigue. The patient faints
immediately after an ECG recording indicates the presence of sinus bradycardia and intermittent 3rd
degree AV conduction block. The most likely explanation for this patient's rhythm disturbance is:
captopril overdose
increased vagal tone caused by digoxin
decreased vagal tone caused by furosemide
increased sympathetic tone caused by digoxin
hyperkalemia caused by furosemide
A patient being treated for heart failure with digoxin and furosemide is discharged from the hospital
after being initiated on quinidine therapy to reduce the incidence of atrial tachyarrhythmias. The next
day the patient reappears in your office complaining of fatigue, visual difficulties and nausea. The
patient's ECG reveals a prolong PR interval, with occasional runs of bigeminy and 2nd degree
(Mobitz type I) AV conduction block. The most likely cause of these symptoms is:
furosemide induced hyperkalemia
an interaction between quinidine and furosemide
worsening heart failure
an interaction between quinidine and digoxin
quinidine toxicity
An elderly male patient has essential hypertension, congestive heart failure, and type I
insulin-dependent diabetes. His congestive failure developed secondary to coronary vascular disease
associated with hyperlipidemia. What antihypertensive drug(s) may be most appropriate for this
patient?
Chlorothiazide (Diuril)
captopril (Capoten)
propranolol (Inderal)
metoprolol (Lopressor)
furosemide
73.
A.
B. *
C.
D.
E.
74.
A.
B.
C.
D. *
E.
75.
A.
B.
C.
D.
E. *
76.
A.
B.
C.
D.
E. *
77.
A.
B.
An elderly male patient has essential hypertension, congestive heart failure, and type I
insulin-dependent diabetes. His congestive failure developed secondary to coronary vascular disease
associated with hyperlipidemia. What antihypertensive drug(s) may be most appropriate for this
patient?
chlorothiazide
lisinopril
propranolol
metoprolol
aspirin
A patient presents with a blood pressure of 160/110 mm Hg. The patient has a history of coronary
vascular disease, resulting in angina, but has no evidence of congestive heart failure. The patient also
has asthma and has been treated mainly using terbutaline (Brethine), by aerosol inhalation
Propranolol (Inderal) was prescribed to manage essential hypertension. Was this action appropriate?
Propranolol (Inderal) is appropriate because it will reduce heart rate and cardiac output. Negative
inotropism will help reduce the incidence of angina. It is an effective antihypertensive agent
Propranolol (Inderal) is inappropriate because it is only useful in mild hypertension; a better drug
would be minoxidil or hydralazine because they are more effective in lowering blood pressure
Propranolol (Inderal) is appropriate because it is an effective, low-cost antihypertensive. It will
augment the effects of terbutaline, an additional benefit
Propranolol (Inderal) is inappropriate because its use is contraindicated in a patient with asthma.
Popranolol (Inderal) is ineffective drag.
A 25-year-old woman complained of fatigue, hair loss, and brittle nails. On exam, pallor of skin, Ps
94/min, BP 110/70 mmHg. On blood cell count, Hb 90 g/L, RBC 3, 5 * 1012/L, color index of 0,7,
ESR of 20 mm/H. Serum iron level was 8,7 //mol/L. What treatment would you initiate?
Vitamin B12 intramuscularly
Packed RBCs transfusion
Iron dextrin injections
Blood transfusion
Ferrous sulfate orally
Which of the following are true regarding cephalosporins?
"third generation" cephalosporins are generally more active against gramnegative organisms;
cephalosporins may depress beta-lactamase in certain organisms; (Enterobacter, pseudomonas,
serratia) causing production of the enzyme to increase markedly; the enzyme in part B above binds to
the cephalosporin;
"third generation" cephalosporins are generally more active against gramnegative organisms; the
enzyme in part B above binds to the cephalosporin;
cephalosporins may depress beta-lactamase in certain organisms; (Enterobacter, pseudomonas,
serratia) causing production of the enzyme to increase markedly; enterococcus is never reliably
sensitive to any available cephalosporin.
enterococcus is never reliably sensitive to any available cephalosporin only
third generation" cephalosporins are generally more active against gramnegative organisms;
cephalosporins may depress beta-lactamase in certain organisms; (Enterobacter, pseudomonas,
serratia) causing production of the enzyme to increase markedly; enterococcus is never reliably
sensitive to any available cephalosporin
A 65-yr-old woman presents with anaemia. She is noted to have koilonychias and atrophic glossitis.
Her blood smear reveals microcytic, hypochromic blood cells.
Hereditary spherocytosis
Megaloblastic anaemia
C.
D. *
E.
78.
A.
B. *
C.
D.
E.
79.
A. *
B.
C.
D.
E.
80.
A. *
B.
C.
D.
E.
81.
A.
B.
C.
D.
E. *
82.
A.
B.
C.
D.
E. *
83.
A.
B.
C. *
Uraemia
Iron deficiency anaemia
Sickle cell anaemia
Aminoglycosides:
are very popular; are well absorbed from the gastrointestinal tract; do not penetrate pulmonary
secretions well
are very popular; do not penetrate pulmonary secretions well
are well absorbed from the gastrointestinal tract; do not appear in urine in high concentrations.
do not appear in urine in high concentrations only
are very popular; are well absorbed from the gastrointestinal tract only
The patient with severe allergic bronchial asthma has been treated by oral drug during 7 months.
Hypertension, “moon face”, obese trunk, oedema, insomnia occur. What drugs does he used?
Patient used one of orally used glucocorticoids, e.g. prednisolone.
Patient used one of beta-agonists.
Patient used cromolyne.
Patient used euphylline
Patient used furosemide.
Some potential barriers to successful treatment of an abscess-cavitary infection with an
aminoglycoside include:
inactivation of aminoglycoside by an acidic medium; binding of the drug by pus; decreased ability of
the drug to penetrate the abscess because of poor vascularity
inactivation of aminoglycoside by an acidic medium; decreased ability of the drug to penetrate the
abscess because of poor vascularity
binding of the drug by pus; inactivation of aminoglycoside by alkaline medium.
inactivation of aminoglycoside by alkaline medium only
binding of the drug by pus
A 41-year-old man was admitted to the surgical department with the symptoms of acute pancreatitis:
vomiting, diarrhea, bradycardia, hypotention, weakness, dehydration of the organism. What medicine
should be used first of all?
Etaperazine
No-spa
Platyphylline
Ephedrine
Contrycal
Cefazolin is generally preferred among the first-generation cephalosporins, because it:
has a favorable pharmacokinetic profile
has a longer half-life than comparable drugs
may be dosed every 8 hours
costs less for a hospital to utilize, since it may be given less frequently than comparable drugs
has a favorable pharmacokinetic profile, has a longer half-life than comparable drugs, may be dosed
every 8 hours, costs less for a hospital to utilize, since it may be given less frequently than
comparable drugs.
A patient receiving intravenous cimetidine for an acute ulcer problem needs to be monitored for
GI upset.
gynecomastia.
cardiac arrhythmias.
D.
E.
84.
A.
B.
C. *
D.
E.
85.
A. *
B.
C.
D.
E.
86.
A.
B.
C.
D.
E. *
87.
A. *
B.
C.
D.
E.
88.
A.
B.
C.
D.
E. *
89.
A.
B.
C. *
D.
E.
constipation.
Disbacteriosis
A nurse taking care of a patient who is receiving a proton pump inhibitor should teach the patient
to take the drug after every meal.
to chew or crush tablets to increase their absorption.
to swallow tablets or capsules whole.
to stop taking the drug after 3 weeks of therapy.
to take the drug in the first part of day
Chloramphenicol is associated with:
pancytopenia; gray-baby syndrome; reversible erythroid-suppression of bone marrow;
pancytopenia; gray-baby syndrome
reversible erythroid-suppression of bone marrow; renal failure
renal failure
pancytopenia
Cavalier use of antibiotics in the hospital setting may be associated with: increased cost; increased
toxicity; alteration of hospital flora; increased incidence of infections?
increased cost; increased toxicity;
increased cost; alteration of hospital flora;
alteration of hospital flora; increased incidence of infections
increased incidence of infections
increased cost; increased toxicity; alteration of hospital flora; increased incidence of infections,
Woman (60 years old), that suffers by arthritis of hip joint, took butadion for a long time. After blood
analysis the doctor abolished this drug. What complication did butadion cause?
Agranulocytosis.
Anemia.
Leukemia.
Tromboembolic syndrome.
Disturbance of hemocoagulation.
Imipenem is a beta-lactam antibiotic which is neither a penicillin nor a cephalosporin. Correct
statements regarding imipenem include:
it covers an extremely broad spectrum of microorganisms; it is very active against many
gramnegative rods
resistant pseudomonas may emerge during treatment
it is very active against many gramnegative rods
it should not be given to patients having a history of allergic reactions to penicillin
it covers an extremely broad spectrum of microorganisms; resistant pseudomonas may emerge during
treatment, it is very active against many gramnegative rods, it should not be given to patients having
a history of allergic reactions to penicillin
Patients having a history of a severe, immediate reaction to penicillin:
may be given a cephalosporin without concern; have a definite risk of reaction to any
cephalosporin;
may be given a cephalosporin without concern; have a low risk of having a reaction to a broad
spectrum antipseudomonal penicillin
have a definite risk of reaction to any cephalosporin; have a high risk of hypersensitivity to a broad
spectrum anti-pseudomonal penicillin
have a high risk of hypersensitivity to a broad spectrum anti-pseudomonal penicillin
may be given a cephalosporin without concern
90.
A.
B.
C. *
D.
E.
91.
A.
B.
C.
D. *
E.
92.
A.
B.
C.
D. *
E.
93.
A. *
B.
C.
D.
E.
94.
A.
B.
C.
D.
E. *
95.
A 34-year-old woman with severe erosive esophagitis is prescribed pantoprazole. One of the most
common adverse side effects of such therapy is which of the following?
Vomiting
Constipation
Headache
Heartburn
Paresthesias
A ninety two year-old female was brought to the emergency room following an episode of low blood
pressure and disorientation at the nursing home. She had been refusing food and drank little. She was
provided i.v glucose and was rehydrated. Over the next few days her condition worsened with
increasing periods of incoherence. She exhibited hyperventilation with respiratory alkalosis and
pulmonary congestion. Her body temperature was slightly subnormal and she was hypotensive (75/40
mm Hg) and tachycardic. Her pulmonary congestion worsened as did her blood gases. Digoxin was
administered. Blood cultures indicated the present of E. coli, leading to a definitive diagnosis of E.
coli septicemia. Which drug(s) would be appropriate to treat the septicemia?
cefotaxime (Claforan)
ceftriaxone (Rocephin)
aztreonam (Azactan)
cefotaxime, ceftriaxone, aztreonam
erythromycin
A 23 years old patient is pregnant with a history of severe (anaphylactic) penicillin allergy. To
prepare her for an upcoming tooth extraction you prescribe an antimicrobial medication that can be
taken prophlaxis 2 hrs prior to the procedure. This medication is:
Cefaclor
Doxycycline
Erythromycin base
Erythromycin stearate
Gentamycin
Mr.Antee Biatek, a 30 yr old woman is scheduled to undergo an exploration laparotomy to confirm
the diagnosis of an ectopic pregnancy. She has a history of several penicillin allergy. For prophylaxis
prior to her surgery you administer:
Chloramphenicol
Erythromycin stearate
Gentamycin + vancomycin i.v
Rifampin
Streptogramins A+B (synercid)
Amphotericin B is a very useful agent for treating fungal infections. Correct statements regarding
amphotericin include:
it is both hydrophilic and lipophilic; it binds to sterols in the fungal cell membrane;
it binds to sterols in the fungal cell membrane; nephrotoxicity may occur
it is both hydrophilic and lipophilic; a test dose should be administered before treatment begins;
nephrotoxicity may occur
it is both hydrophilic and lipophilic; it binds to sterols in the fungal cell membrane;nephrotoxicity
may occur, a test dose should be administered before treatment begins
Sulfonamides:
A.
B.
C.
D.
E. *
96.
A.
B.
C.
D.
E. *
97.
A.
B.
C.
D.
E. *
98.
A.
B.
C.
D. *
E.
99.
A. *
are competitive antagonists of PABA, and thereby decrease bacterial utilization of
para-aminobenzoic acid in the synthesis of folic acid; do not affect mammalian cells, since they
require pre-formed folic acid; are synergistic with trimethoprim, which inhibits dihydrofolate
reductase (which reduces dihydrofolate to tetrahydrofolate)
are competitive antagonists of PABA, and thereby decrease bacterial utilization of
para-aminobenzoic acid in the synthesis of folic acid; are synergistic with trimethoprim, which
inhibits dihydrofolate reductase (which reduces dihydrofolate to tetrahydrofolate)
do not affect mammalian cells, since they require pre-formed folic acid; can be antagonized by
PABA
can be antagonized by PABA only
are competitive antagonists of PABA, and thereby decrease bacterial utilization of
para-aminobenzoic acid in the synthesis of folic acid; do not affect mammalian cells, since they
require pre-formed folic acid; are synergistic with trimethoprim, which inhibits dihydrofolate
reductase (which reduces dihydrofolate to tetrahydrofolate); can be antagonized by PABA
Circumstances associated with allergy to penicillins may include:
maculopapular or urticarial rash
maculopapular or urticarial rash; anaphylactic reaction to penicillin skin-tests;
Anaphylaxis
exposure to penicillins in food
maculopapular or urticarial rash; anaphylaxis; anaphylactic reaction to penicillin skin-tests;
exposure to penicillins in food
Aminoglycosides:
must be dosed on the basis of renal function; are primarily active against gram-negative aerobes; are
not active against anaerobes
must be dosed on the basis of renal function; are not active against anaerobes
are primarily active against gram-negative aerobes; penicillin may be synergistic against
enterococcus
penicillin may be synergistic against enterococcus only
must be dosed on the basis of renal function; are primarily active against gram-negative aerobes; are
not active against anaerobes; penicillin may be synergistic against enterococcus
A week after initiating clindamycin therapy the patient develops signs of a potentially fatal infection
of the colon. His tests reveal that his infection is due to clostridium difficile, to treat this new
condition you should initiate drug therapy with
a higher dose of clindamycin
gentamicin i.v
linezolid
metronidazole
rifampin
True statement concerning the pharmacologic effects of salicylates include: salicylates are thought
to exert their activity at least partially by inhibiting prostaglandin synthetase; high-dose salicylate
therapy (more than 5 g /day) lowers the serum uric acid concentration; the effect of salicylates upon
platelet aggregation is irreversible unlike that of other non-steroidal anti-inflammatory drugs;
salicylate overdose is potentionally fatal, however, promt administration of acetylcystein will avert
this danger?
salicylates are thought to exert their activity at least partially by inhibiting prostaglandin synthetase;
high-dose salicylate therapy (more than 5 g /day) lowers the serum uric acid concentration; the
effect of salicylates upon platelet aggregation is irreversible unlike that of other non-steroidal
anti-inflammatory drugs
B.
C.
D.
E.
100.
A. *
B.
C.
D.
E.
101.
A. *
B.
C.
D.
E.
102.
A.
B.
C. *
D.
E.
103.
A.
B.
C.
D. *
E.
104.
A.
B. *
C.
D.
E.
salicylates are thought to exert their activity at least partially by inhibiting prostaglandin synthetase;
high-dose salicylate therapy (more than 5 g /day) lowers the serum uric acid concentration;
the effect of salicylates upon platelet aggregation is irreversible unlike that of other non-steroidal
anti-inflammatory drugs
salicylate overdose is potentionally fatal, however, promt administration of acetylcystein will avert
this danger
All above
A doctor is caring for a client with a diagnosis of rheumatoid arthritis who is receiving sulindac 150
mg po twice daily. Which finding would indicate to the doctor that the client is experiencing a side
effect related to the medication?
nausea
photophobia
fever
tingling in the extremities
couph
Angina pectoris is:
Severe constricting chest pain, often radiating from the precordium to the left shoulder and down the
arm, due to insufficient blood supply to the heart that is usually caused by coronary disease
An often fatal form of arrhythmia characterized by rapid, irregular fibrillar twitching of the ventricles
of the heart instead of normal contractions, resulting in a loss of pulse
The cardiovascular condition in which the heart ability to pump blood weakens
Severe constricting chest pain
An often fatal form of arrhythmia
All these drug groups useful in angina both decrease myocardial oxygen requirement (by decreasing
the determinations of oxygen demand) and increase myocardial oxygen delivery (by reversing
coronary arterial spasm), EXCEPT:
Nitrates and nitrite drugs (Nitroglycerin, Isosorbide dinitrate)
Calcium channel blockers (Nifedipine, Nimodipine)
Beta-adrenoceptor-blocking drugs (Atenolol, Metoprolol)
Potassium channel openers (Minoxidil)
(Nitroglycerin,
This drug group useful in angina decreases myocardial oxygen requirement (by decreasing the
determinations of oxygen demand) and does not increase myocardial oxygen delivery (by reversing
coronary arterial spasm):
Nitrates and nitrite drugs (Nitroglycerin, Isosorbide dinitrate)
Myotropic coronary dilators (Dipyridamole)
Potassium channel openers (Minoxidil)
Beta-adrenoceptor-blocking drugs (Atenolol, Mtoprolol)
Nitroglycerin group
This drug group useful in angina increase myocardial oxygen delivery (by reversing coronary arterial
spasm) and does not decrease myocardial oxygen requirement (by decreasing the determinations of
oxygen demand):
Beta-adrenoceptor-blocking drugs (Atenolol, Metoprolol):
Myotropic coronary dilators (Dipyridamole)
Calcium channel blockers (Nifedipine, Nimodipine)
Potassium channel openers (Minoxidil)
Nifedipine group
105.
A.
B.
C.
D. *
E.
106.
A.
B.
C.
D. *
E.
107.
A.
B.
C. *
D.
E.
108.
A. *
B.
C.
D.
E.
109.
A.
B.
C.
D.
E. *
110.
A.
B.
C. *
D.
E.
111.
Which of the following statements concerning nitrate mechanism of action is TRUE?
Therapeutically active agents in this group are capable of releasing nitric oxide (NO) in to vascular
smooth muscle target tissues
Nitric oxide (NO) is an effective activator of soluble guanylyl cyclase and probably acts mainly
through this mechanism
Nitrates useful in angina decrease myocardial oxygen requirement (by decreasing the determinations
of oxygen demand) and increase myocardial oxygen delivery (by reversing coronary arterial spasm)
Therapeutically active agents in this group are capable of releasing nitric oxide (NO) in to vascular
smooth muscle target tissues, (NO) is an effective activator of soluble guanylyl cyclase and probably
acts mainly through this mechanism, Nitrates useful in angina decrease myocardial oxygen
requirement (by decreasing the determinations of oxygen demand) and increase myocardial oxygen
delivery (by reversing coronary arterial spasm)
Nitrates useful in angina
Which of the following nitrates and nitrite drugs are long-acting?
Nitroglycerin, sublingual
Isosorbide dinitrate, sublingual (Isordil, Sorbitrate)
Amyl nitrite, inhalant (Aspirols, Vaporole)
Sustac
Molsidomine sublingual
Which of the following nitrates and nitrite drugs is a short-acting drug?
Nitroglycerin, 2% ointment (Nitrol)
Nitroglycerin, oral sustained-release (Nitrong)
Amyl nitrite, inhalant (Aspirols, Vaporole)
Sustac
Nitroglycerin, 2% ointment (Nitrol), Nitroglycerin, oral sustained-release (Nitrong)
Duration of nitroglycerin action (sublingual) is:
10-30 minutes
6-8 hours
3-5 minutes
1.5-2 hours
2-3 hours
The following statements concerning mechanism of nitrate beneficial clinical effect are true,
EXCEPT?
Decreased myocardial oxygen requirement
Relief of coronary artery spasm
Improved perfusion to ischemic myocardium
Diminishes preload (venous return to the heart)
Increased myocardial oxygen consumption
Side effect of nitrates and nitrite drugs are, EXCEPT:
Orthostatic hypotension,
Tachycardia
GI disturbance
Throbbing headache
Facial flushing
The following statements concerning mechanism of calcium channel blockers’ action are true,
EXCEPT:
A. *
B.
C.
D.
E.
112.
A.
B.
C.
D.
E. *
113.
A.
B.
C.
D. *
E.
114.
A.
B.
C.
D.
E. *
115.
A. *
B.
C.
D.
E.
116.
A.
B.
C. *
D.
E.
117.
A.
B.
C.
D. *
Therapeutically active agents in this group are capable of releasing nitric oxide (NO) in vascular
smooth muscle target tissues
Calcium channel blockers bind to L-type calcium channel sites
Calcium channel blockers useful in angina decrease myocardial oxygen requirement (by decreasing
the determinations of oxygen demand)
Calcium channel blockers increase myocardial oxygen delivery (by reversing coronary arterial
spasm)
Calcium channel blockers decrease transmembrane calcium current associated in smooth muscle with
long-lasting relaxation and in a cardiac muscle with a reduction in contractility
Which of the following antianginal agents is a calcium channel blocker?
Nitroglycerin
Lidocaine
Dipyridamole
Minoxidil
Nifedipine
Which of the following cardiovascular system effects refers to a calcium channel blocker?
The reduction of peripheral vascular resistance
The reduction of cardiac contractility and, in some cases, cardiac output
Relief of coronary artery spasm
The reduction of peripheral vascular resistance, The reduction of cardiac contractility and, in some
cases, cardiac output, Relief of coronary artery spasm
The increasing of cardiac contractility
Main clinical use of calcium channel blockers is:
Angina pectoris
Hypertension
Supraventricular tachyarrhythmias
Rheumatism
Angina pectoris, Hypertension, Supraventricular tachyarrhythmias
Which of the following antianginal agents is a myotropic coronary dilator:
Dipyridamole
Validol
Atenolol
Alinidine
Sotalol
Which of the following antianginal agents is a beta-adrenoceptor-blocking drug:
Dipyridamole
Validol
Metoprolol
Alinidine
Salmeterol
The following agents are cardioselective beta1-adrenoceptor-blocking drugs labeled for use in
angina, EXCEPT:
Metoprolol
Talinolol
Atenolol
Propranolol
E.
118.
A.
B. *
C.
D.
E.
119.
A.
B.
C.
D. *
E.
120.
A.
B.
C.
D. *
E.
121.
A. *
B.
C.
D.
E.
122.
A.
B.
C. *
D.
E.
Carvedilol
Which of the following antianginal agents refers to reflex coronary dilators:
Dipyridamole
Validol
Atenolol
Alinidine
Molsydomin
Which of the following statements concerning Validol is true:
Validol has a moderate reflex and vascular dilative action caused by the stimulation of sensitive
nerve endings
At sublingual administration the effect is produced in five minutes and 70 % of the preparation is
released in 3 minutes
It is used in cases of angina pectoris, motion sickness, nausea, vomiting when seasick or airsick and
headaches due to taking nitrates
Validol has a moderate reflex and vascular dilative action caused by the stimulation of sensitive
nerve endings, At sublingual administration the effect is produced in five minutes and 70 % of the
preparation is released in 3 minutes, It is used in cases of angina pectoris, motion sickness, nausea,
vomiting when seasick or airsick and headaches due to taking nitrates
Validol has a moderate expectorant effect
Which of the following antianginal agents is a potassium channel opener:
Dipyridamole
Validol
Atenolol
Minoxidil
Lisinopril
A man aged 74 has moderate hypertension controlled with hydrochlorothiazide 12.5 mg once daily
and losartan 50 mg once daily. He is prescribed rofecoxib 50 mg once daily to control osteoarthritis
pain. After 3 months of this therapy, his blood pressure begins to rise.This increase in blood pressure
is most likely due to
Inhibition of COX-2 by rofecoxib, which leads to decreased renal blood flow
Increased metabolism of losartan due to induction of CYP2C9 by rofecoxib
Increased excretion of hydrochlorothiazide due to increased renal blood flow caused by rofecoxib
Arteriolar contraction in the peripheral circulation caused by inhibition of COX-1 by rofecoxib
Weight gain caused by rofecoxib’s ability to decrease basal metabolic rate.
A 52-year-old woman with a history of eczema and heavy alcohol use begins taking ibuprofen to
control hip and knee pain due to osteoarthritis. Over the course of 6 months, as the pain worsens, she
increases her dosage to a high level (600 mg four times daily).What toxicity is most likely to occur,
and why?
Abnormal heart rhythms; alcohol induces cytochrome P450 isozymes that convert ibuprofen to a
cardiotoxic free radical metabolite
Necrotizing fasciitis; eczema predisposes an individual to this toxicity of ibuprofen
Gastric ulceration; heavy alcohol use increases the susceptibility of an individual to ibuprofeninduced
GI toxicity
Confusion and ataxia; these CNS toxicities of ibuprofen are additive with those of ethanol
Eosinophilia; this rare complication of ibuprofen therapy is exacerbated by the immunosuppression
frequently seen in alcoholics
123.
A.
B. *
C.
D.
E.
124.
A.
B. *
C.
D.
E.
125.
A.
B. *
C.
D.
E.
126.
A. *
B.
C.
D.
E.
127.
A.
B. *
C.
D.
E.
128.
A.
B. *
C.
D.
E.
A patient refuses to continue to take erythromycin because it makes him vomit.This is an example of
which patient–drug–pathogen interaction?
Pharmacokinetics
Pharmacodynamics
Immunity
Resistance
Selective toxicity
A 24-year-old AIDS patient is interested in starting chemoprophylaxis for Pneumocystis pneumonia
(PCP) and cerebral toxoplasmosis. He has no drug allergies.Which of the following prophylactic
agents is appropriate for the prevention of both PCP and cerebral toxoplasmosis?
Nitrofurantoin
Trimethoprim–sulfamethoxazole
Norfloxacin
Methenamine
Nalidixic acid
Urinalysis of a 38-year-old woman with recurrent UTIs revealed pH 6.8, 30 to 50 WBC per
highpower field, and gram-negative bacilli identified as Proteus mirabilis.Which of the following
produces a bacteriostatic urinary environment for P. mirabilis?
Urease enzyme
Hippuric acid
Catalase enzyme
Folic acid
Coagulase enzyme
A 3-day-old baby is given a presumptive diagnosis of kernicterus.Which of the following
mechanisms is involved in sulfonamide-induced kernicterus?
Competes for the bilirubin-binding sites on plasma proteins
Defective bilirubin hepatic conjugation and metabolism
Physiological jaundice due to destruction of fetal red blood mass
Pregnancy-induced hepatic congestion and cholestasis
Primary biliary cirrhosis of the liver
A 6-year-old relatively healthy boy is diagnosed with external otitis and was prescribed a 7-day
course of TMP-SMX.Which of the following is the basic mechanism of action of the sulfonamides?
Selective inhibition of incorporation of PABA into human cell folic acid synthesis.
Competitive inhibition of incorporation of PABA into microbial folic acid.
Inhibition of transpeptidation reaction in bacterial cell wall synthesis.
Changes in DNA gyrases and active efflux transport system resulting in decreased permeability of
drug.
Structural changes in dihydropteroate synthase and overproduction of PABA.
Evaluation of a yearly chest radiograph of a 73-year-old patient taking nitrofurantoin prophylactically
for recurrent UTIs revealed new findings of bilateral interstitial fibrosis. What is the possible
explanation for the patient’s pulmonary presentation and what is the next step?
Acute urosepsis; add a broad-spectrum antibiotic to nitrofurantoin.
Possible allergic reaction to nitrofurantoin; stop it immediately.
Nitrofurantoin-resistant E. coli infection; stop it immediately.
Acute community-acquired streptococcal pneumonia; treat accordingly.
Nitrofurantoin-induced hemolysis; requires permanent urinary catheter.
129.
A.
B. *
C.
D.
E.
130.
A.
B. *
C.
D.
E.
131.
A.
B.
C.
D. *
E.
132.
A. *
B.
C.
D.
E.
133.
A. *
B.
C.
D.
E.
134.
A.
B.
C. *
D.
E.
135.
A 16-year-old girl, a cystic fibrosis patient, is diagnosed with a ciprofloxacin-resistant Pseudomonas
aeruginosa lower respiratory tract infection. Bacteria acquire quinolone resistance by which of the
following mechanisms?
Overproduction of PABA
Changes in the synthesis of DNA gyrases
Plasmid-mediated changes in efflux transport system
Inhibition of synthesis of peptidoglycan subunits in bacterial cell walls
Inhibition of folic acid synthesis by blocking different steps
This drug can cause muscle damage, especially when used with any of several drugs including
erythromycin:
Cholestyramine (Questran)
Lovastatin (Mevacor)
Gemfibrozil (Loprol)
Probucol (Lorelco)
Clofibratum
This fibric acid derivative increases blood levels of high density lipoproteins (HDL):
Cholestyramine (Questran)
Lovastatin (Mevacor)
Atorvastatin
Gemfibrozil (Loprol)
Probucol (Lorelco)
Which of the following drugs used in the treatment of gout has as its primary effect the reduction of
uric acid synthesis
Allopurinol
Sulfinpyrazone
Colchicine
Indomethacin
Cyclosporine
Which of the following statements refers to 1,25-dihydroxyvitamin D3 (calcitriol):
The combined effect of calcitriol and all other vitamin D metabolites and analogs on both calcium
and phosphate makes careful monitoring of the level of these minerals especially important to avoid
ectopic calcification
Does not undergo enterohepatic circulation
Toxic to osteoclasts
Bioavailability increases with the administered dose
Bioavailability increases with IV administration
Correct statements about fluoride include all of the following, EXCEPT:
Fluoride is effective for the prophylaxis of dental caries
Fluoride is accumulated by bone and teeth, where it may stabilize the hydroxyapatite crystal
Subjects living in areas with naturally fluoridated water (1-2 ppm) had more dental caries and fewer
vertebral compression fractures than subjects living in nonfluoridated water areas
Chronic exposure to very high level of fluoride dust in the inspired air results in crippling fluorosis,
characterized by thickening of the cortex of long bones and bony exostoses.
Fluoride is accumulated by bone
While taking a NSAID for arthritis, a 65-year-old man developed a gastric ulcer. He was prescribed
ranitidine for 8 weeks. This drug binds a receptor located ___________?
A.
B.
C.
D. *
E.
136.
A.
B. *
C.
D.
E.
137.
A.
B.
C. *
D.
E.
138.
A.
B. *
C.
D.
E.
139.
A.
B.
C.
D. *
E.
140.
A. *
B.
C.
D.
E.
141.
A. *
Nucleus
Nucleolus
Cytoplasm
Cell membrane
Cell wall
A 20-year-old woman goes to the emergency department, stating that within the past hour she
ingested “a handful of sleeping pills.” She is still awake. Which of the following drugs can be given
to induce vomiting?
Metoclopramide
Ipecac
Morphine
Promethazine
Ondansetron
A 17-year-old boy with a history of sulfa allergy is diagnosed with left-side ulcerative colitis after a
3-week history of bloody diarrhea and tenesmus. On examination he is afebrile and has no abdominal
tenderness. The appropriate drug therapy to institute initially is which of the following?
Metronidazole
Sulfasalazine
Mesalamine
Cyclosporine
Prednisone
During assessment of a patient diagnosed with pheochromocytoma, the doctor reveales a blood
pressure of 210/110 mm Hg. The nurse would expect to administer which of the following
medications?
nadolol
phentolamine
dobutamine
verapamil
validolum
Patient with diagnosis of pheochromocytoma suffers from the high blood pressure which outgrows in
hypertensive crisis. What group of drugs will help in this situation?
Beta-adrenoblockers
Ganglionblockers
Sympatolitics
Alpha-adrenoblockers
Calciumchannels blockers
A 46-year-old patient has ischemic heart disease, angina on exertion, II functional class. What is the
drug of choice in treatment of acute attack?
Nitroglycerin sublingually
Platelet inhibiting agents (aspirin)
Spasmolitics (No-spa) IV
Digitalis IV
Sedative agents (Seduxenum) orally
A 52-year-old patient complains of intensive and prolonged retrosternal pains, decreased exercise
tolerance for 5 days. Which of the following groups is the most useful?
nitrates
B.
B.
dyslipidemic drugs
diuretics
ACE inhibitors
digitalis
A 55-year-old men has stenocardia on exertion II. Taking of nitroglycerin potentiate a sever
headache. Which of the following drugs is the most useful in this case?
Molsidomin
Amiodaron
Nifedipine
Propranolol
Verapamil
A 49-year-old patient has ischemic heart disease, angina on exertion, II functional class. What is the
drug of choice in treatment of acute attack?
No-spa IV
Aspirin
Nitroglycerin sublingually
Digitalis IV
Seduxenum orally
A patient of 42 year has arterial hypertension with bradyarrhythmia. Which of the following drugs is
necessary to administer?
Klonidine
Nifedipine
Bisoprolol
Diltiazem
Methyldopa
A 45-year-old women with diagnosis: Paroxysmal arrhythmia. Arterial hypertension II. Drug of
choice for stopping attack:
Metoprolol
Nitroglycerin
Potassium chloride
Digoxin
Lidocain
A woman 51 years old has arterial hypertension. Which group of drugs may be used for her
treatment?
Betaadrenomimetics,
Angiotensin-converting enzyme inhibitors,
Glucocorticoids,
Preparations of calcium,
M-cholinolitics.
A man 36, years old, has arterial hypertension. Which group of drugs may be used for treatment?
Betaadrenomimetics
Preparations of calcium,
C.
D. *
E.
Glucocorticoids,
Calcium_channel inhibitors,
M-cholinolitics.
C.
D.
E.
142.
A. *
B.
C.
D.
E.
143.
A.
B.
C. *
D.
E.
144.
A.
B. *
C.
D.
E.
145.
A. *
B.
C.
D.
E.
146.
A.
B. *
C.
D.
E.
147.
A.
148.
A.
B.
C.
D.
E. *
149.
A.
B.
C. *
D.
E.
150.
A.
B.
C.
D. *
E.
151.
A.
B.
C.
D.
E. *
152.
A.
B.
C.
D.
E. *
153.
A.
B.
C.
D. *
E.
154.
A.
B.
C. *
In the complex medical treatment of hypertensive disease a diuretic was prescribed to the patient. In a
few days the blood pressure went down, but the signs of hypokaliaemia arose up. What drug could
cause such complication?
Triamterene
Clofeline
Enalapril
Spironolactone
Furosemide
A 56-yr-old man wheezes and coughs. He has tried to give up smoking, but he finds it very difficult.
He is thin and healthy looking with a rounded chest. His breathing is noisy. His cough is
unproductive. What treatment has to be prescribed?
Amoxycillin
Prednisolone
Ipratropium
Salbutamol
Bronchial lavage
A 20-yr-old woman presents with a week's history of fever, rigors arid productive rusty cough. CXR
shows right lower lobe consolidation. Prescribe treatment
Erythromycin
Co-trimoxazole
Prednisolone
Amoxicillin
Salbutamol inhaler
All of the following antibiotics are associated with drug-induced deficiencies of vitamin K-dependent
factors EXCEPT:
Cefotaxime.
Trimethoprim.
Cefoperazone.
Moxalactam.
Cefamandole.
All of the following proteins require vitamin K to function properly EXCEPT:
Factor II (prothrombin).
Factor VII.
Factor IX.
Factor X.
Antithrombin III.
All of the following statements regarding fresh frozen plasma (FFP) are TRUE EXCEPT:
It contains all factors.
Intravenous administration can lead to volume overload.
Viral transmission is possible with transfusion.
It is a first-line treatment for uremic patients with bleeding.
It is a first-line treatment for bleeding patients with a coagulopathy.
All of the following statements concerning heparin therapy are TRUE EXCEPT:
It facilitates antithrombin III binding to activated factors II, IX, XI, and XII.
The most common complication is bleeding.
One milligram of protamine sulfate neutralizes 1000 units of heparin.
D.
E.
155.
A.
B.
C.
D.
E. *
156.
A.
B. *
C.
D.
E.
157.
A.
B.
C.
D. *
E.
158.
A.
B. *
C.
D.
E.
159.
A.
B.
C. *
D.
E.
160.
A.
B.
C.
D.
E. *
Thrombocytopenia is a common complication.
Co-use of cimetidine or NSAIDs increases bleeding risk.
All of the following statements regarding thrombocytopenia in the setting of heparin use are TRUE
EXCEPT:
The incidence is lower with low-molecular-weight heparin.
The most common form is transient and seldom lowers the platelet count below 100,000/µL.
The type with platelet antibody formation can be life threatening and may lower the platelet count
below 50,000/µL.
Arterial thromboses can occur in the more severe form.
Patients must have a previous exposure to heparin to develop anti-platelet antibodies.
Which of the following TCAs is capable of causing status epilepticus without QRS widening?
Nortriptyline
Amoxapine
Maprotiline
Desipramine
Amitriptyline
If sodium bicarbonate therapy is ineffective, which of the following antiarrhythmics may be used to
treat ventricular dysrhythmias associated with TCA overdose?
R-blockers
Calcium channel blockers
Phenytoin
Lidocaine
Class IA or IC antidysrhythmics
Which of the following statements about fluoxetine (Prozac) is FALSE?
It is the most frequently prescribed antidepressant in the United States
It is the most potent of the selective serotonin reuptake inhibitors (SSRIs)
Seizures occur in approximately 0.2 percent of patients taking fluoxetine
Fluoxetine is the most potent inhibitor of P-450 hepatic drug metabolism and may elevate TCA
levels 2- to 10-fold
The most common symptoms seen in fluoxetine overdose are sinus tachycardia, drowsiness, tremor,
and nausea/vomiting
All of the following statements concerning serotonin syndrome are TRUE EXCEPT:
It is characterized by alterations in cognitive-behavioral ability, autonomic nervous function, and
neuromuscular activity
It is usually seen when monoamine oxidase inhibitors or selective serotonin reuptake inhibitors are
combined with other serotonergic drugs
Morphine and fentanyl are contraindicated for treatment
Nneuromuscular symptoms are greatest in the lower extremities
Mandatory treatment includes discontinuation of all serotonergic medications
Which of the following drugs can be safely used in patients taking monoamine oxidase inhibitors
(MAOIs)?
Codeine
Dextromethorphan
Ketamine
Meperidine
Morphine
161.
A.
B.
C. *
D.
E.
162.
A.
B.
C.
D.
E. *
163.
A.
B.
C.
D. *
E.
164.
A. *
B.
C.
D.
E.
165.
A.
B. *
C.
D.
E.
166.
A.
B.
C.
D. *
E.
167.
Which of the following statements regarding adverse effects of neuroleptic medications is
INCORRECT?
Lower potency drugs such as chlorpromazine have greater anticholinergic, antiadrenergic, and
antihistaminic side effects, whereas the higher potency agents such as haloperidol have mainly
antidopaminergic side effects.
Dopamine antagonism accounts for adverse reactions, resulting in movement disorders.
Dystonic reactions are idiosyncratic, present early, and are seen more frequently in females
Akathisia and drug-induced parkinsonism are seen early and may be treated with benztropine or
amantadine.
Tardive dyskinesia is a late adverse effect and has no proven treatment
All of the following statements regarding thrombocytopenia in the setting of heparin use are TRUE
EXCEPT:
The incidence is lower with low-molecular-weight heparin.
The most common form is transient and seldom lowers the platelet count below 100,000/µL.
The type with platelet antibody formation can be life threatening and may lower the platelet count
below 50,000/µL.
Arterial thromboses can occur in the more severe form.
Patients must have a previous exposure to heparin to develop anti-platelet antibodies.
All of the following statements regarding thrombolytic drugs are TRUE EXCEPT:
They are contraindicated if the patient has a history of hemorrhagic stroke.
They cannot be used if the patient has active bleeding.
They must be avoided if aortic dissection is suspected.
They decrease pulmonary artery pressures, improve reperfusion, and increase survival after massive
pulmonary embolus.
They are indicated for treatment of acute myocardial infarction.
All of the following statements regarding factor VIII inhibitors are TRUE EXCEPT:
PTT is normal, but the PT is prolonged.
These inhibitors may develop in patients with previously normal hemostasis.
If present, mortality rate approaches 50 percent.
These inhibitors may develop in patients with underlying conditions such as pregnancy and
autoimmune or lymphoproliferative disorders.
These inhibitors can be seen in patients with congenital factor VIII deficiency (hemophilia A).
The pregnant woman (20 weeks of pregnancy) became ill on pneumonia. What drug is possible to
prescribe the woman without threat for fetus development?
Gentamicin.
Amoxycillin.
Sulphalen.
Levomicetin.
Ofloxacin.
Woman the 60 years take for a long time dexamethason for the medical treatment of arthritis of the
left knee-joint. What is the biochemical mechanism of anti-inflammatory action of this drug?
Blockade of folatsynthetase.
Blockade of cyclooxygenase 1.
Blockade of cyclooxygenase 2.
Blockade of phospholipase А2.
Blockade of folatreductase.
Woman the 48 years suffer on parandontosis. What antibacterial drug will be more effective in case
of introduction in gums tissues?
A.
B.
C. *
D.
E.
168.
A.
B.
C.
D. *
E.
169.
A. *
B.
C.
D.
E.
170.
A.
B. *
C.
D.
E.
171.
A.
B.
C.
D. *
E.
172.
A.
B.
C. *
D.
E.
Gentamicin.
Benzylpenicillin.
Linkomycin.
Oxacillin.
Dimexid.
It is necessary to prescribe an antibacterial drug of wide spectrum action to the child (4 years old) at
the intestinal infection. What antibacterial drug is not prescribed to the children in connection with
the harmful affecting a development of bone tissues?
Levomicetin.
Amoxicillin.
Ampicillin.
Doxycyclin.
Co-trimoxasol (biseptol).
The doctor prescribed an antibiotic stable to the destructive action of beta-lactamase to the child (10
years old) with the severe staphylococcus infection. Define this drug.
Oxacillin.
Benzylpenicillin-sodium salt.
Ampicillin.
Phenoximethylpenicillin.
Bicillin-1.
The antibiotic, that was prescribed for the etiologic medical treatment of chlamidiosis to the old man,
who follows a milk-vegetable diet, did not give a convalescence effect. What was a drug?
Oxacillin.
Tetracycline.
Methycillin.
Streptomycin.
Cefuroxim.
For the medical treatment of general form of salmonellosis was used an effective drug at old man.
However for the finished medical treatments the patient began to complain on decreasing of vision.
Indicate this drug.
Furamag
Furasolidon.
Ftalasol.
Levomicetin.
Biseptol.
You should assess a 75-year-old patient for nephrotoxicity and ototoxicity when administering which
of the following antimicrobials?
Cefazolin (cephalosporin antibiotic).
Clindamycin (lincosamide antibiotic).
Gentamicin (aminoglycoside antibiotic).
Erythromycin (macrolide antibiotic).
Tetracycline.