Clinical Pharmacy Department Clinical Pharmacy Modul 2. Clinical Pharmacy in gastroenterology, hepatology, hematology, endocrinology, allergology The drug of choice for treatment of anaphylactic shock is: A. Noradrenaline. B. Naphthyzine. C. Isadrine. D. Adrenaline. E. Anapriline. ANSWER: D Which of the following agents is a general tone-increasing drug of plant origin? A. Meridil B. Eleuterococci’s extract C. Pantocrin D. Caffeine E. T-activin ANSWER: B Which of the following drugs is related to anticoagulants and may be useful in disorders of cerebral circulation? A. Aspirin B. Trimetazidine C. Cinnarizine D. Nicergoline E. Heparin ANSWER: E Antiplatelets are used in disorders of brain circulation for: A. Stimulation of the metabolic processes in neurons B. Dilation of cerebral vessels C. Improving the microcirculation in cerebral tissue D. All the above E. None of the above ANSWER: C Immediate allergy reaction (type I allergic reaction) is: A. An allergic or immune response that begins within a period lasting from a few minutes to about an hour after exposure to an antigen to which the individual has been sensitized B. An allergic reaction that becomes apparent only hours after contact C. An allergic reaction that results from the formation of antigen-antibody complexes between a foreign antigen and IgM or IgG immunoglobulins. (It occurs during blood transfusion reactions and in hemolytic disease of the newborn) D. An allergic reaction that is due to the presence of elevated levels of antigenantibody complexes that cause tissue damage E. None of the above ANSWER: A Delayed allergy reaction (type IV allergic reaction) is: A. An allergic or immune response that begins within a period lasting from a few minutes to about an hour after exposure to an antigen to which the individual has been sensitized B. An allergic reaction that becomes apparent only hours after contact C. An allergic reaction that results from the formation of antigen-antibody complexes between a foreign antigen and IgM or IgG. (It occurs during blood transfusion reactions and in hemolytic disease of the newborn) D. An allergic reaction that is due to the presence of elevated levels of antigenantibody complexes that cause tissue damage E. All of the above ANSWER: B H1 histamine receptor subtype is distributed in: A. Smooth muscle, endothelium and brain B. Gastric mucosa, cardiac muscle, mast cells and brain C. Presynaptically in brain, mesenteric plexus and other neurons D. All of the above E. None of the above ANSWER: A H2 histamine receptor subtype is distributed in: A. Smooth muscle, endothelium and brain B. Gastric mucosa, cardiac muscle, mast cells and brain C. Presynaptically in brain, mesenteric plexus and other neurons D. All of the above E. None of the above ANSWER: B These categories of histamine H1 antagonists are noted for sedative effects, EXCEPT: A. Piperidines; i.e. Loratadine, Fexofenadine B. Ethanolamines (aminoalkyl ethers); i.e. Dimedrol, Clistin C. Ethylenediamines; i.e. Suprastine D. Phenothiazines; i.e. Diprazine, Promethazine E. All of the above is true ANSWER: A Which category of histamine H1 antagonists is recognized for as secondgeneration antihistamines? A. Alkylamines (propylamines); i.e. Brompheniramine B. Piperidines; i.e. Loratadine, Fexofenadine C. Ethylenediamines; i.e. Suprastine D. Phenothiazines; i.e. Promethazine E. None of the above ANSWER: B These histamine H1 antagonists are recognized for as second-generation antihistamines, EXCEPT: A. Astemizole B. desloratadine C. Loratadine (Claritin) D. Cetirizine (Zyrtec) E. Suprastine ANSWER: E Indication for administration of histamine H1 antagonists is: A. Prevention or treatment of the symptoms of allergic reactions (rhinitis, urticaria) B. Motion sickness and vestibular disturbances C. Nausea and vomiting in pregnancy (“morning sickness”) D. All of the above E. None of the above ANSWER: D Side effect of first-generation histamine H1 antagonists is: A. Aplastic anemia B. Vomiting, tinnitus, C. Decreased hearing D. Sedation E. Gastric ulcers and upper gastrointestinal bleeding ANSWER: D Immunosupressive effect of glucocorticoids is caused by A. Reducing concentration of lymphocytes (T and B cells) and inhibiting function of tissue macrophages and other antigen-presenting cells B. Suppression of cyclooxygenase II expression that results in reducing amount of an enzyme available to produce prostaglandins C. Activation of phospholipase A2 and reducing prostaglandin and leukotriene synthesis D. All of the above E. None of the above ANSWER: A Antiallergic effect of glucocorticoids is caused by: A. Suppression of leukocyte migration and stabilizing lysosomal membranes B. Reverse the capillary permeability associated with histamine release C. Suppression of the immune response by inhibiting antibody synthesis D. All of the above E. None of the above ANSWER: D The Immunosuppressive agent is: A. Corticosteroids B. Cyclosporine C. Tacrolimus (FK 506) D. All of the above E. None of the above ANSWER: D Class of cyclosporine A is: A. Interferons B. Immunosuppressive agents C. Monoclonal antibodies D. Immunoglobulins E. Glucocorticoids ANSWER: B Indication of cyclosporine A is: A. Secondary immunodeficiency B. None of the above C. Primary immunodeficiency D. Idiopathic nephrotic syndrome E. All of the above ANSWER: D The primary reason for a physician to prescribe human insulin is that: A. It has a faster onset of action than other insulins B. It has a shorter duration of action than other insulins C. It can be given to patients who have an allergy to animal insulins D. It is more effective in preventing the complications of diabetes than animal insulins E. All of the above ANSWER: C Diabetic coma is treated by the administration of: A. Insulin lente B. Glucose C. Crystalline insulin D. Oral anti-diabetic drugs. E. All of the above ANSWER: C Sulphonylureas act by: A. Reducing the absorption of carbohydrate from the gut B. Increasing the uptake of glucose in peripheral tissues C. Reducing the hepatic gluconeogenesis D. Stimulating the beta islet cells of pancreas to produce insulin E. All of the above ANSWER: D Thiazolidinediones act by: A. Diminishing insulin resistance by increasing glucose uptake and metabolism in muscle and adipose tissues B. Reducing the absorption of carbohydrate from the gut C. Stimulating the beta islet cells of pancreas to produce insulin D. All of the above E. None of the above ANSWER: A Alpha-glucosidase inhibitors act by: A. Diminishing insulin resistance by increasing glucose uptake and metabolism in muscle and adipose tissues B. Competitive inhibiting of intestinal alpha-ghucosidases and modulating the postprandial digestion and absorption of starch and disaccharides C. Reducing the absorption of carbohydrate from the gut D. Stimulating the beta islet cells of pancreas to produce insulin E. All of the above ANSWER: B The action of insulin is potentiated by: A. Sulphonylureas B. Glucagon C. Biguanides D. None of the above E. All of the above ANSWER: C Biguanides are used in the following conditions, EXCEPT: A. As a supplement to sulphonylurea, where it is insufficient to give good results B. In over weight diabetics C. To reduce insulin requirements D. In case of hyperglycemic shock E. All of the above ANSWER: D Main complications of insulin therapy include the following: A. Hypoglycemia B. Insulin allergy C. Lipodystrophy at an injection site D. All of the above E. None of the above ANSWER: D Tick the main approach of peptic ulcer treatment: A. Neutralization of gastric acid B. Eradication of Helicobacter pylori C. Inhibition of gastric acid secretion D. All the above E. None of the above ANSWER: D Indicate the drug belonging to proton pump inhibitors: A. Pirenzepine B. Ranitidine C. Omeprazole D. Trimethaphan E. Metoclopramid ANSWER: C Which of the following drugs is an agent of substitution therapy? A. Gastrin B. Hydrochloric acid C. Hystamine D. Carbonate mineral waters E. Bradikinin ANSWER: B Choose the drug which is a H2-receptor antagonist: A. Omeprazole B. Pirenzepine C. Carbenoxolone D. Ranitidine E. Loratadine ANSWER: D All of the following drugs are proton pump inhibitors EXCEPT: A. Pantoprozole B. Omeprazole C. Famotidine D. Rabeprazole E. Esomeprazole ANSWER: C Indicate the drug belonging to M1-cholinoblockers: A. Cimetidine B. Ranitidine C. Pirenzepin D. Omeprazole E. Pantoprazole ANSWER: C Tick the drug forming a physical barrier to HCL and Pepsin: A. Ranitidine B. Sucralfate C. Omeprazole D. Pirenzepine E. Loratadine ANSWER: B Which drug is an analog of prostaglandin E1? A. Misoprostol B. De-nol C. Sucralfate D. Omeprazole E. Ranitidine ANSWER: A Most of drugs are antacids EXCEPT: A. Misoprostol B. Maalox C. Mylanta D. Almagel E. Sodium bicarbonate ANSWER: A Indicate the drug that cause metabolic alkalosis: A. Sodium bicarbonate B. Cimetidine C. Pepto-Bismol D. Carbenoxolone E. Maalox ANSWER: A Choose the drug that causes constipation: A. Sodium bicarbonate B. Aluminium hydroxide C. Calcium carbonate D. Magnesium oxide E. None of the above ANSWER: B All of the following drugs stimulate appetite EXCEPT: A. Vitamins B. Bitters C. Fepranone D. Insulin E. Caffeine ANSWER: C All of the following drugs intensify gastrointestinal motility EXCEPT: A. Papaverine B. Metoclopramide C. Domperidone D. Cisapride E. Tegaserod ANSWER: A Select the emetic agent having a reflex action: A. Ipecacuanha derivatives B. Apomorphine hydroclorid C. Chlorpromazine D. Metoclopramide E. Ranitidine ANSWER: A Choose the drug affecting the biliary system and relaxing Oddy sphincter: A. Cholosas B. Oxaphenamide C. No-spa D. Cholenzyme E. Castor oil ANSWER: C The main mechanism of most drugs absorption in GI tract is: A. Active transport (carrier-mediated diffusion) B. Filtration (aqueous diffusion) C. Endocytosis and exocytosis D. Passive diffusion (lipid diffusion) E. None of the above ANSWER: D Which of the following antibiotics is most closely associated with the development of hepatitis? A. kanamycin B. penicillin G C. tetracycline D. isoniazid E. ethambutol ANSWER: D Isoniazid-induced liver damage: A. occurs primarily in patients under 30 years of age B. occurs with increased frequency in patients receiving concomitant ethambutol therapy C. is probably due to the formation of a toxic hydrazine metabolite that binds to liver protein D. is frequently associated with allergic manifestations such as eosinophilia, fever, and rash E. All of the above ANSWER: C Cromolyn, regarding its actions, is best described as: A. bronchodilator B. anticholinergic C. beta agonist D. inhibitor of mast cell degranulation E. glucocorticoid ANSWER: D The indications for prescribing of H2 – histamine blockers A. Hypoacidic gastritis B. Anorexia C. Acute cholecystitis D. The ulcerous disease of the stomach and duodenum E. Stomatitis ANSWER: D Which drug belongs to the laxatives? A. Pepsin B. Radicis Rhei C. Ranitidin D. Atropine sulfas E. Apomorphinum ANSWER: B One mechanism to reduce gastric acid secretion is by blocking the K+-Na+ATPase pump in the parietal cell. One drug that has this pharmacologic action is: A. misoprostol B. pirenzepine C. omeprazole D. serotonin E. isoniazid ANSWER: C The amount of sodium, phosphate or magnesium contained in an antacid should be assessed when selecting an antacid for patients with: A. renal insufficiency B. congestive heart failure C. ascitis D. All of the above E. None of the above ANSWER: D The concomitant administration of calcium and/or magnesium antacids to patients receiving one of the tetracycline drugs may have which of the following effects upon the action of the tetracycline: A. enhances the action B. causes no significant change C. decreases the action D. increases toxicity E. suppresses hypersensitivity reactions ANSWER: C In the treatment of acute diarrhea A. antibiotics are worst avoided in non-pathogenic diarrhea B. antibiotics are worst avoided in viral gastroenteritis C. oral rehydration should not be used for initial therapy D. electrolytes and glucose should not be supplemented for initial therapy E. oral rehydration and electrolytes supplementation are required particularly in children and in the elderly ANSWER: E Peptic ulcer disease A. is an acute disorder B. characterized by frequent recurrences C. comprises bones D. the incidence of duodenal ulcers is four to five times lower than that of gastric ulcer E. affects approximately 50% of the population ANSWER: B All these are major factors of known importance for the etiology of ulceration Except A. acid-pepsin secretion B. mucosal resistance to attack by acid and pepsin C. the age D. effects of non-steroidal anti-inflammatory drugs E. the presence of Helicobacter pylori ANSWER: C Antacids: A. react with gastric acid to form a neutral salt B. produce sweating C. are Ineffective at healing duodenal ulcer D. are very effective at healing gastric ulcers E. its effect on acid secretion lasts for long (5 hours) ANSWER: A Omeprazol A. is an irreversible stimulator of the proton pump B. can be used only for healing gastric ulcer C. Is for women only D. is taken once weekly E. degrades in the presence of moisture. Capsules are supplied in special containers ANSWER: E Constipation A. results from increased peristaltic activity in the intestinal tract. B. occurs only if one does not have a bowel movement at least once a day. C. leads to decreased salt and water absorption from the large intestine. D. symptoms can be artificially induced by increasing the volume of the large intestine. E. All of the above ANSWER: D Which of the following antibiotics is a tetracycline? A. Chloramphenicol B. Doxycycline C. Streptomycin D. Erythromycin E. None of the above ANSWER: B Correct statements about glucocorticoids include all of the following, EXCEPT: A. Effects of glucocorticoids are mediated by widely distributed glucocorticoid receptors that are members of the superfamily of nuclear receptors. B. Glucocorticoids have dose-related metabolic effects on carbohydrate, protein, and fat metabolism. C. Glucocorticoids have pro-inflammatory effects. D. Glucocorticoids have catabolic effects in lymphoid and connective tissue, muscle, fat, and skin. E. Glucocorticoids have antiallergic effects ANSWER: C A drug allergy occurs: A. When too much drug has accumulated in an individual B. When the body sees the drug as an antigen and an immune response is established against the drug C. An unwanted but predictable response to a drug D. None of the above E. All of the above ANSWER: B H. pylori is known to be a common cause of both duodenal and gastric ulcers, in a patient affected by H. pylori, the current regimen of choice is a two week course of triple therapy with Bismuth, Tetracycline and A. Loperamide B. Cimetidine C. Metronidazole D. Pirenzepine E. Sucralfate ANSWER: C Antibiotic's clearance from the body most likely influenced by severe hepatic disease: A. Penicillins B. clindamycin (Cleocin) C. rifampin (Rimactane) D. clindamycin & rifampin E. None of the above ANSWER: D Which of these diseases is associated with chronic diarrhea? A. Celiac disease B. Irritable bowel syndrome C. Diabetes D. Asthma E. Celiac disease & irritable bowel syndrome ANSWER: E Indication for glucocorticoids is: A. Chronic (Addison’s disease) and acute adrenocortical insufficiency B. Organ transplants (prevention and treatment of rejection – immunosuppression) C. Inflammatory conditions of bones and joints (arthritis, bursitis, tenosynovitis). D. All of the above E. None of the above ANSWER: D Diarrhea is defined as ____ or more loose stools per day A. 1 B. 2 C. 3 D. All of the above E. None of the above ANSWER: C The most common complication of diarrhea is _____. A. Intestinal perforation B. Dehydration C. Septicemia D. Seizures E. All of the above ANSWER: B Signs of dehydration are A. Sunken eyes B. Excessive thirst C. Reduced urination D. All of the above E. None of the above ANSWER: D Which of these are signs of anemia? A. Pale gums B. Dark circles under the eyes C. Bleeding D. Numbness in hands and feet E. All of the above ANSWER: A To note vitamin which stimulates hemopoesis. A. Tocoferolum. B. Ergocalciferolum. C. Cyanolocobalaminum. D. Retinolum. E. Riboflavin. ANSWER: C To name a vitamin drug, which is antagonist of indirect action anticoagulants. A. Vitamin К. B. Tocoferolum. C. Tiamin. D. Cyanolocobalaminum. E. Riboflavin. ANSWER: A Which drug is basic for the medical treatment of pernicious megaloblastic anaemia? A. Cyanocobalaminum. B. Folic acid. C. Fercoven. D. Coamid. E. Iron lactase. ANSWER: A Cyanocobalamin (vitamin B12) is indicated for the treatment of: A. Acute lymphocytic leukemia. B. Pernicious anemia. C. Bone marrow suppression. D. Optic nerve atrophy. E. All of the above. ANSWER: B What drug from the narcotic analgesic group does have the least ulcer action? A. Butadion. B. Voltaren. C. Indometacin. D. Meloxicam. E. Naproxen. ANSWER: D In oncologic patient the cellular immunity decreased after the radial therapy. Prescribe the proper drug. A. Prodigiosan. B. Interferon. C. Т-aktivin. D. Betaferon. E. Reaferon. ANSWER: C Immunodepressive action of prednisolon is due to: A. Activating a synthesis of inhibitors of proteases. B. Depression of collagen production. C. Decreasing of Т-lymphocytes level in the blood, limitation of cytotoxic influence of Т-lymphocytes (killers) on В-lymphocytes. D. Depression of synthesis of mucopolysacharides. E. Decreasing of activity of plasmin. ANSWER: C Nonsteroid anti-inflammatory drugs are effective in case of medical treatment of rheumatism thanks to their power to depress: A. Cyclooxygenase-2. B. Phospholipase-А2. C. Cyclooxygenase-1. D. Adenilatcyclase. E. Peroxydase. ANSWER: A Most nonsteroidal antiinflammatory drugs (NSAIDs) work by: A. Ameliorating pain perception. B. Increasing the supply of natural endorphins. C. Increasing blood flow to painful areas. D. Inhibiting prostaglandin production. E. Stimulate prostaglandin production. ANSWER: D The advantage of cyclooxygenase-2 (COX-2) inhibitors over other NSAIDs is that they: A. Have a longer duration of action. B. Are less likely to cause hepatic toxicity. C. Do not decrease the cytoprotective lining of the stomach. D. Have a more rapid onset of action. E. Decrease the cytoprotective lining of the stomach. ANSWER: C What agent is used for hemorrhagic diatheses treatment? A. Vit. A. B. Vit. C. C. Vit. E. D. Vit. K. E. Vit. D. ANSWER: D What drug belongs to antifibrinolytic? A. Acidum aminocapronicum. B. Pantothenic acid. C. Proserinum. D. Acidum salicylicum. E. Acidum nicotinicum. ANSWER: A Examples of autoimmune diseases A. rheumatoid arthritis B. insulin-dependent diabetes mellitus C. systemic lupus erythematosis D. none of the above E. all above ANSWER: E Glucocorticoid effects: A. inhibition of leukotriene production B. inhibition of prostaglandins C. increased chemotaxis D. inhibition of leukotriene production & inhibition of prostaglandins E. all of the above ANSWER: D Cytotoxic agents with immunosuppressive properties: A. cyclophosphamide (Cytoxan) B. vincristine (Oncovin) C. methotrexate D. cytarabine (ARA-C) E. all the above ANSWER: E Clinical uses of immunosuppressive drugs: A. organ transplantation B. hemolytic disease of the newborn C. autoimmune disorders D. none of the above E. all of the above ANSWER: E Which of the following drugs used in the treatment of gout acts by preventing the migration of granulocytes: A. Allopurinol B. Sulfinpyrazone C. Colchicine D. Indomethacin E. Cyclosporine ANSWER: C Indications for glucocorticoid administration (all answers are correct, except one): A. Shock B. Hypertensive disease C. Allergic diseases D. Inflammatory diseases E. Complicated intoxications ANSWER: B What pharmacological effect is not character for Prednisolone: A. Vasodilation B. Antiallergic C. Anti-inflammatory D. Immunosuppressant E. Antitoxic ANSWER: A A patient diagnosed with a deep venous thrombosis is begun on a heparin infusion of 1000 U/HR after a 5000 U Bolus. Duration of action of heparin is: A. 4 hours B. 10 hours C. 12 hours D. 24 hours E. None of the above ANSWER: A The direct-acting plasminogen activator and fibrinolitic drug is: A. streptomicine B. urokinase C. epsilon-aminocaproic acid D. vikasol E. heparin ANSWER: B The antithrombotic drug which inhibits cyclooxygenase enzymes is: A. prednisone B. dipyridamole C. ascorbic acid D. aspirin E. vikasol ANSWER: D Histamine-1 receptor antagonists include: A. ranitidine B. nizatidine C. famotidine D. terfenadine E. cimetidine ANSWER: D Agents for treatment of anaphylactic shock A. Anaprilin B. Adrenaline C. Morphine D. Codeine E. Analgine ANSWER: B Mechanism of antiallergic actions of antihistaminic preparations is A. Inactivation of histamine B. Block cholinoreceptor of peripheral ganglions C. Block of Н1-histamine receptors D. Activation of Н2-histamine receptors E. Diminish formation of antibodies ANSWER: C Agents, applied in therapy immediate allergic reactions are A. Analeptics B. Adrenomimetics C. Sympathomimetics D. Cholinomimetics E. NSAID ANSWER: B Hormonal preparation applied in case of immediate allergic reactions A. Insulin B. Tireoidine C. Vasopressine D. Dexametasone E. Cromoline sodium ANSWER: D Cromoline sodium mechanism of action A. Stabilization of mast cells membranes B. Block Н1-receptors C. Block Н2- receptors D. Bronchia dilative action E. Stimulation of adrenergic receptors ANSWER: A Indicate the adverse effect of antihistaminic preparations of I generation A. Excitation of the central nervous system B. Dryness in oral cavity C. Reduction of effect of sedative drugs D. Acceleration of psychiatry reactions E. Cramps ANSWER: B Heparin is A. Anticoagulant B. Analgesic C. Cardiac glycoside D. Antianginal medicine E. Drug for treatment of bronchial asthma ANSWER: A Drugs that disrupt the clotting cascade, thus inhibiting clot formation are A. Anticoagulants B. Nitrates C. Coagulants D. Antihypertensive drugs E. Cardiac glycosides ANSWER: A Antithyroid drugs (Mercazolil, Propilthyouracil): A. inhibit the effects of thyroid hormones in peripheral tissues B. inhibit the synthesis of thyroid hormones C. are used for treatment of hypothyroidism D. are used for treatment of congestive heart failure E. are used for treatment of glaucoma ANSWER: B Oxytocin… A. is a steroid hormone B. causes uterine contractions C. is used to prevent preterm delivery D. is used to prevent heart ischemia E. is used for depression ANSWER: B The clot aggregation blocker oppressing the Adenosine absorption and reducing its enzyme destruction A. Papaverine B. Propranolol C. Reserpine D. Dipiridamole E. Trental ANSWER: D Indicate the fibrinolitic drug which is direct-acting plasminogen activator: A. streptomicine B. urokinase C. epsilon-aminocaproic acid D. vikasol E. heparin ANSWER: B Loperamide, Imodium A. is used in the treatment of diarrhea B. is used for the treatment of constipation C. is a type I Cyclooxygenase inhibitor D. is a nonsteroidal anti-inflammatory drug E. inhibit H2 histamine receptors ANSWER: A The drugs whose generic name (international common name) ends in - glitazone like rosiglitazone, pioglitazone, are: A. antibiotics derived from fluoroquinolones B. antiepileptic drugs C. nonsteroidal anti-inflammatory drugs D. used as antidiabetics in the treatment of type II diabetes E. glucocorticoid ANSWER: D Nephrogenic diabetes insipidus is treated by: A. Thiazides B. Carbamazepine C. Vasopressin D. Cyclophosphamide E. Dopamine ANSWER: C Which drug can be used for local blood hemostasis? A. Fibrinogenum B. Spongia haemostatica C. Acidum aminicapronicum D. Protamine sulfas E. Vicasolum ANSWER: B What is the mechanism of the haemostatic effect of the aminicapronic acid? A. It increases the synthesis of prothrombine in the liver B. It increases the Ca2+ level in the blood C. It inhibits fibrinolysis D. It increases thrombocyte aggregation E. It increases vitamin K absorption ANSWER: C The anticoagulant of the direct action A. Thrombinum B. Neodicumarinum C. Phenylin D. Heparin E. Fibrinogenum ANSWER: D