Clinical Pharmacy Department
Clinical Pharmacy
Modul 3. Pharmaceutical care during dispensing OTC medications
The drug applied at the case of hypersusceptibility to nitroglycerine for removing
attack of angina pectoris
A. Aspirin
B. Atropine
C. Piracetame
D. Papaverine
E. Molsidomine
ANSWER: E
All of the following statements concerning nitroglycerin are correct EXCEPT:
A. It causes an elevation of intracellular cGMP.
B. It undergoes significant first-pass metabolism in the liver.
C. It may cause significant reflex tachycardia.
D. It significantly decrease AV conduction.
E. It can cause postural hypotension.
ANSWER: D
What group does Trimetazidine belong to?
A. Adrenomimetics
B. Cholinoblockers
C. Cardioprotectors
D. Sympatholitics
E. Diuretics
ANSWER: C
The cardioselective beta-adrenoblocker
A. Bisoprolol
B. Adrenalin
C. Riboxinum
D. Enalapril
E. Nifedipine
ANSWER: A
The drug applied for the medical treatment of ischemic heart disease
A. Sympatholitics
B. beta-adrenoblockers
C. alpha-adrenoblockers
D. Myorelaxants
E. M-cholinomimetics
ANSWER: B
Which of the following adverse effects is associated with nitroglycerin?
A. Hypertension
B. Throbbing headache
C. Bradycardia
D. Sexual dysfunction.
E. Anemia.
ANSWER: B
Which drug belongs to the beta-adrenoblockers’ group?
A. Nitroglycerine
B. Metoprolol
C. Captopril
D. Nifedipine
E. Furosemidum
ANSWER: B
The efficiency of Nifedipine at arterial hypertension is caused by
A. The dilation of vessels
B. The rise of myocardium contractility
C. The decline of renine production
D. The decline of diuresis
E. The rise of diuresis
ANSWER: A
The drug applied for the medical treatment of ischemic heart disease
A. alpha-adrenoblockers
B. Sympatholitics
C. Diuretics
D. M-cholinomimetics
E. Nitrates
ANSWER: E
The basic effect of nitroglycerine
A. Strengthening diuresis
B. Dilation of arterioles and venules
C. Oppression of heart contraction
D. Anti-inflammatory action
E. Rise of myocardium contractility
ANSWER: B
Which antianginal drug provokes bronchial spasm?
A. Sustac
B. Propranolol
C. Nitroglycerine
D. Fenigidinum
E. Molsidominum
ANSWER: B
Why during attack of angina pectoris Sustac is not prescribed orally?
A. Brief action
B. Causes tachycardia
C. Long latent period
D. Causes hypotension
E. Causes tolerance
ANSWER: C
Agents which may lower circulating plasma lipids include:
A. Clofibrate
B. Nicotinic acid
C. Cholestyramine
D. Dextrothyroxine
E. All are correct
ANSWER: E
Which medication is drug of choice at attack of angina pectoris?
A. Sustac
B. Molsidominum
C. Nitroglycerine
D. Anaprilinum
E. Fenigidinum
ANSWER: C
Which of the following nitrate preparations or dosage forms has the longest
duration of action?
A. Sublingual nitroglycerin
B. Sublingual isosorbide dinitrate
C. Oral isosorbide dinitrate
D. Transdermal nitroglycerin patch
E. Validolum
ANSWER: D
In order to prevent the development of tolerance, the pharmacist instructs the
patient to:
A. Apply the nitroglycerin patch every other day
B. Switch to sublingual nitroglycerin when the patient's systolic blood pressure
elevates to >140 mm Hg>
C. Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at
night
D. Use the nitroglycerin patch for acute episodes of angina only
E. Apply the nitroglycerin patch 2 times per day
ANSWER: C
The patient asks how nitroglycerin should be stored while traveling. The
pharmacist's best response would be:
A. "You can protect it from heat by placing the bottle in an ice chest."
B. "It's best to keep it in its original container away from heat and light."
C. "You can put a few tablets in a resealable bag and carry in your pant's pocket."
D. "It's best to lock them in the glove compartment of your car to keep them away
from heat and light."
E. "Keep the tablets locked in a safe place until you need them."
ANSWER: B
Patient teaching regarding sublingual nitroglycerin should include which of the
following statements:
A. "You can take up to five doses every 3 minutes for chest pain."
B. "Chew the tablet for the quickest effect."
C. "Keep the tablets locked in a safe place until you need them."
D. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness."
E. "You can protect it from heat by placing the bottle in an ice chest."
ANSWER: D
What is the best way to prevent tolerance to nitrates when using the transdermal
patches?
A. Leave the old patch on for 2 hours when applying a new patch
B. Apply a new patch off for 24 hours once a week
C. Leave the patch off for 24 hours once a week
D. Remove the patch at night for 8 hours, and then apply a new patch in the
morning
E. Leave the patch off for 12 hours once a week
ANSWER: D
GI problems—nausea, vomiting, flatulence, constipation or diarrhea, abdominal
discomfort are the most common adverse effects of:
A. dyslipidemic drugs
B. calcium channel blockers
C. beta-adrenergic blocking agents
D. nitrates
E. all of the above
ANSWER: A
Special concerns in using antimicrobials in newborns and young children:
A. Sulfonamides can be safely given to newborns
B. Tetracyclines should not be administered to children betlow the age of eight
C. Newborns should not be given chloramphenical because they are unable to
metabolize the drug adequately.
D. Tetracyclines should not be administered to children betlow the age of eight &
Newborns should not be given chloramphenical because they are unable to
metabolize the drug adequately
E. None of the above
ANSWER: D
Antibacterials regarded as generally safe to prescribe in pregnancy.
A. Erythromycins
B. Cephalosporins
C. Tetracyclines
D. Erythromycins & Cephalosporins
E. All of the above
ANSWER: D
An azole most commonly used for topical treatment of candidiasis:
A. amphotericin B
B. clotrimazole
C. Griseofulvin
D. Flucytosine
E. none of the above
ANSWER: B
Most potent of the presently available anti-fungal azoles:
A. Fluconazole
B. Itraconazole
C. Ketoconazole
D. Both Fluconazole & Ketoconazole
E. None of the above
ANSWER: B
Females often complaine: odorless, white or yellow cheesy discharge with itching
A. Chalymida
B. Syphilis
C. Chalmdyia
D. Candidias
E. none of the above
ANSWER: D
The combination of sulfamethoxazole and trimethoprim is a useful drug for
treating urinary tract infections. Bacterial resistance to trimethoprim occurs
primarily by
A. Acetylation of trimethoprim
B. Acetylation of the drug receptor
C. Decreased bacterial uptake
D. Upregulation of dihydrofolate reductase
E. Upregulation of beta-lactamase
ANSWER: D
Trimethoprim is often administered alongside a sulfonamide as a preparation
known as co-trimoxazole. Which of the following sulfonamides is used?
A. Sulfamethoxazole
B. Sulfathiazole
C. Sulfadoxine
D. Sulfadiazine
E. None of the above
ANSWER: A
What drugs are present in the preparation Augmentin?
A. Ticarcillin and clavulanic acid
B. Ampicillin and sulbactam
C. Ampicillin and clavulanic acid
D. Amoxicillin and clavulanic acid
E. None of the above
ANSWER: D
Which of the following antibiotics is a macrolide?
A. Chloramphenicol
B. Doxycycline
C. Erythromycin
D. Streptomycin
E. None of the above
ANSWER: C
Which of the following antibiotics is a tetracycline?
A. Chloramphenicol
B. Doxycycline
C. Streptomycin
D. Erythromycin
E. None of the above
ANSWER: B
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
The drug of choice for the treatment of anaphylactic shock is:
A. Epinephrine
B. Norepinephrine
C. Isoproterenol
D. Orciprenaline
E. Atropine
ANSWER: A
Aspirin may be fatal in taken in sufficient quantity. The syndrome of fatal salicyate
overdose in children is characterized by
A. marked hypotermia secondary to an antipyretic effect
B. fever, tinnitus
C. peripheral oedema
D. None of the above
E. All of the above
ANSWER: B
Common adverse reactions of corticosteroidal therapy are:
A. bradycardia, mental dullness
B. anorexia, polyuria
C. tachycardia, insomnia
D. “moon face”, obese trunk
E. All of the above
ANSWER: D
What adverse effects are associated with chronic use of systemic corticosteroids?
A. Candidosis
B. Gastrointestinal complications
C. Hypotension
D. Hypoglycemia
E. All of the above
ANSWER: B
For a 6-year-old child with fever, what NSAIDs would be preferred?
A. aspirin
B. acetaminophen
C. indomethacin
D. ibuprofen
E. All of the above
ANSWER: B
Symptoms of salicylism:
A. Tinnitus
B. decreased hearing
C. vertigo
D. None of the above
E. All of the above
ANSWER: E
Most nonsteroidal antiinflammatory drugs:
A. inhibit prostaglandin biosynthesis
B. weak organic bases
C. probably increase production of free radicals
D. mainly associated with guanylyl cyclase interactions
E. all the above
ANSWER: A
Initial drug of choice for treating most articular and musculoskeletal disorders
(because of low-cost, safety, and efficacy)
A. Aspirin
B. Diclofenac
C. Indomethacin
D. Phenylbutazone
E. Glucocorticoids
ANSWER: A
Effective in management of mild to moderate pain, when anti-inflammatory action
is not necessary
A. penicillamine (Cuprimine)
B. sulfasalazine (Azulfidine)
C. acetaminophen (Tylenol, Panadol)
D. etodolac (Lodine)
E. piroxicam (Feldene)
ANSWER: C
Aspirin mechanism of action: anti-platelet effects:
A. promotes platelet aggregation
B. activates thromboxane synthesis
C. snhibits thromboxane synthesis
D. all of the above
E. none of the above
ANSWER: C
Aspirin and antipyresis:
A. aspirin -- best available drug for reducing fever (in the absence of
contraindications to its use recurrent
B. aspirin -- more effective in lowering elevated temperature than normal body
temperature
C. aspirin-induced temperature reduction is caused by vasodilation
D. All of the above
E. None of the above
ANSWER: D
Advantages of other NSAIDs compared with aspirin:
A. generally less expensive
B. less gastric irritation
C. potentially better compliance (e.g. naproxen, sulindac)
D. generally less expensive & less gastric irritation
E. less gastric irritation & potentially better compliance (e.g. naproxen, sulindac)
ANSWER: E
NSAID primarily promoted as an analgesic, not as an anti-inflammatory agent:
A. Piroxicam
B. Ibuprofen
C. Naproxen
D. Ketorolac
E. Sulindac
ANSWER: D
Drug associated with the hepatic/renal toxic metabolite: N-acetyl-p-benzoquinone
A. Diclofenac
B. Meclofenamate
C. Indomethacin
D. Acetaminophen
E. Aspirin
ANSWER: D
If a drug is 80% bound to blood elements or plasma proteins, what part is
considered the free form?
A. 20%
B. 40%
C. 50%
D. 80%
E. 100%
ANSWER: A
If a patient misses three doses of their daily drug, which of the following (in
general) is the best solution?
A. Take a 4x dose at the next dose time
B. Wait 3 more days (week total) then return to normal regimen
C. Do nothing and continue normal regimen
D. Setup an appointment to have the patient evaluated
E. Prescribe a higher dosage pill so missed doses will have less effect
ANSWER: C
Which of the following is NOT needed for drug bioequivalence?
A. Same active ingredients
B. Same strength or concentration
C. Same dosage form
D. Same route of administration
E. Same side effects
ANSWER: E
Which of the following can produce a therapeutic response? A drug that is:
A. Bound to plasma albumin
B. Concentrated in the bile
C. Concentrated in the urine
D. Not absorbed from the GI tract
E. Unbound to plasma proteins
ANSWER: E
What organ is responsible for metabolism in the “first pass effect”?
A. Brain
B. Heart
C. Kidney
D. Liver
E. Spleen
ANSWER: D
Which of the following is NOT an advantage of prolonged release medications?
A. Less frequent administration
B. Therapeutic effect overnight
C. Lower incidence of side effects
D. Patient compliance
E. More fluctuation in plasma concentration
ANSWER: E
Most drugs are active in their ____ form and inactive in their ____ form.
A. Non-polar; Polar
B. Polar; Non-polar
C. Water-soluble; Lipid-soluble
D. Lipid-insoluble; Water-insoluble
E. Neutral; Neutral
ANSWER: A
Iron deficiency anemia leads to:
A. pallor
B. fatigue
C. dizziness
D. exertional dyspnea
E. All of the above
ANSWER: E
Indicate the drug which increases absorption of iron from intestine:
A. Cyanocobalamin
B. Folic acid
C. Ascorbic acid
D. Erythropoetin
E. All of the above
ANSWER: C
Pernicious anemia is developed due to deficiency of:
A. Erythropoetin
B. Vitamin B12
C. Iron
D. Vitamin B6
E. Vitamin C
ANSWER: B
An adverse effect of oral iron therapy is:
A. Anemia
B. Thrombocytopenia
C. Headache
D. Constipation
E. Hypertension
ANSWER: D
Folic acid is recommended for treatment of:
A. Megaloblastic anemia
B. Shock
C. Hypertension
D. Leukemia
E. None of the above
ANSWER: A
Appropriate indications for and/or uses of laxatives include:
A. prevent straining at the stool in patients with cardiovascular disease
B. bulk forming agents for diverticular disease
C. treatment of drug overdose
D. All of the above
E. None of the above
ANSWER: D
Which of the following substances is most likely to cause systemic alkalosis?
A. sodium bicarbonate
B. methylcellulose
C. sodium phosphate
D. castor oil
E. mineral oil
ANSWER: A
Saline cathartics, such as sodium sulfate or magnesium sulfate:
A. are safe in patients with renal failure
B. are readily absorbed from the gastrointestinal tract
C. are slower acting than bulk-forming laxatives
D. act by increasing intestinal volume, hence stimulating peristaltic action
E. lower the surface tension of the feces to facilitate fecal hydration
ANSWER: D
Adverse effect(s) of laxatives:
A. electrolyte disturbances (hypernatremia, hypokalemia)
B. dehydration
C. spastic colitis with stimulant laxatives
D. gastrointestinal obstruction with bulk forming agents
E. All of the above
ANSWER: E
Drug which exerts anti-peptic ulcer effects through histamine-2 receptor
antagonism:
A. sucralfate
B. ranitidine
C. metoclopramide
D. omeprazole
E. misoprostol
ANSWER: D
The substance which is principally an emollient laxative is:
A. bran
B. methylcellulose
C. magnesium hydroxide
D. phenolphthalein
E. mineral oil
ANSWER: E
Agents of potential use in peptic ulcer disease include:
A. muscarinic antagonists
B. proton pump inhibitors
C. antacids
D. prostaglandins
E. All of the above
ANSWER: E
Possible drug interactions: Aluminium hydroxide antacids tend to interfere with
the gastrointestinal absorption of:
A. cephalexin
B. penicillin G
C. erythromycin
D. chloramphenicol
E. tetracycline
ANSWER: E
An agent which promotes defecation without increasing peristalsis is:
A. castor oil
B. phenolphthalein
C. docusate sodium
D. cascara
E. milk of magnesia
ANSWER: C
Antacids having a relatively non-systemic effect include:
A. aluminum hydroxide
B. sodium bicarbonate
C. calcium carbonate
D. all of the above
E. aluminum hydroxide and calcium carbonate
ANSWER: E
Which of the following substances has its major activity as an stimulant cathartic?
A. sodium bicarbonate
B. methylcellulose
C. sodium citrate
D. castor oil
E. mineral oil
ANSWER: D
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 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 general, mechanisms of laxation include
A. adding bulk to the stool
B. increasing peristaltic activity
C. emulsifuing aqenons and fatty substances with stool
D. lubricating the passage of stool
E. all of the above
ANSWER: E
Drug which exerts anti-peptic effects through histamine-2 receptor antagonism:
A. Denol
B. Ranitidine
C. Omeprasole
D. Aluminium hydroxide
E. All of above
ANSWER: B
For treatment of heartburn patient regularly used some powder. After a week of
drug using vomiting, nausea, abdomen pain, fibrillation, shallow and slow
breathing, alkalosis. What drug used patient?
A. Natrii hydrocarbonas
B. Aluminium hydroxide
C. Magnesium sulfate
D. Omeprasole
E. Calcium carbonate
ANSWER: A
Plant fiber (a laxative, purgative)
A. Decrease the bulk of the stools
B. increases the bowel transit time
C. slowly distends the wall of the colon
D. increases the effective caloric content of the diet
E. takes down water and swells
ANSWER: C
Senna alcaloids (anthraquinones, the sennosides A and B)
A. act directly on the intramucosal plexus of the gut wall
B. take about 8 minutes to produce an effect
C. should be given to pregnant women
D. should be given to nursing mothers
E. can not induce diarrhea with excessive loss of water and electrolytes
ANSWER: A
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
Osteoporosis:
A. causes an elevation of the serum calcium concentration
B. typically causes elevation of the alkaline phosphatase activity
C. causes pain in the bones
D. improves during bed rest
E. the response to calcium substitution therapy is usually positive
ANSWER: C
Possible initial symptoms of diabetes mellitus include:
A. polydipsia
B. polyuria
C. severe pruritus
D. all of the above
E. none of the above
ANSWER: D
Decrease in numbers of red blood cells or hemoglobin within red blood cells:
A. Anemia
B. Erythrocytosis
C. Thrombocytosis
D. Leukemia
E. Leukocytosis
ANSWER: A
The pregnant women (duration of 10 weeks) with essential hypertension asked the
doctor. Which agent the most safe in this situation?
A. Methyldopa
B. Propranolol
C. Captopril
D. Losartan
E. Hydralazine
ANSWER: A
In patient 36 years revealed atypical hospital pneumonia, which is caused by
Chlamydia trachomatis. Which antibiotic to recommend in this case?
A. Roxithromycin
B. Ampicillin
C. Penicillin
D. Cefuroxime
E. Vancomycin
ANSWER: A
In elderly patients diagnosed hospital pneumonia. Treated with gentamicin. What
side effects most commonly encountered in the use of antibiotics in this group?
A. Ototoxicity
B. Hematotoxicity
C. Pseudomembranous colitis
D. Hepatic Impairment
E. Thrombophlebitis
ANSWER: A
In asthma attack can be effective all drugs, except for:
A. Ketotifen
B. Adrenaline hydrochloride
C. Izadrin
D. Berotek
E. Aminophylline
ANSWER: A
Please select a non-characteristic symptom for hypertensive crisis:
A. Painful urination
B. Nausea
C. Vomiting
D. Flickering of flies before the eyes
E. Headache
ANSWER: A
Select from the listed diseases that may be treated with OTC drugs, with a
pharmacist consultation.
A. Acute respiratory infection
B. Lung Cancer
C. Pleural effusion
D. Asthma
E. Pneumonia
ANSWER: A
A young woman wants to purchase antipyretic drug in the pharmacy. The
pharmacist saw on his face reddening in the form of a butterfly. What kind of
disease does this mean?
A. Systemic lupus erythematosus
B. Rheumatism
C. Gout
D. Rheumatoid Arthritis
E. Osteoporosis
ANSWER: A
A pregnant woman with fever asked for agent in the pharmacy. Advise the safest
medication:
A. Paracetamol
B. Diclofenac
C. Aspirin
D. Ibuprofen
E. Indomethacin
ANSWER: A
Sympathomimetics for the treatment of rhinitis is prescribed with caution in:
A. Hypertension
B. Diarrhea
C. Gastritis
D. Hypotension
E. Myxedema
ANSWER: A
A young woman with migraine asked in the pharmacy. What kind of drug you
recommend for the relief of an attack?
A. Sumatriptan
B. Piracetam
C. Amitriptyline
D. Furosemide
E. Phenazepam
ANSWER: A
A patient with hypertension asked to the pharmacist, doctor has prescribed
captopril to him. What is the mechanism of action of this drug?
A. Inhibition of angiotensin converting enzyme activity
B. Beta-adrenoceptor blockade
C. alpha-adrenoceptor blockade
D. blockade of angiotensin II
E. Diuretic action
ANSWER: A
In the patient after the exercise chest pain radiating to the left hand appeared.
Which drug should be appointed for the relief of pain attack?
A. Nitroglycerin
B. Isosorbide 5-mononitrate
C. Nifedipine
D. Metoprolol
E. Diltiazem
ANSWER: A
A patient with peptic ulcer disease with mild clinical manifestations appealed to
the pharmacy. From history we know that he has identified Helicobacter
pylori.Which group of drugs should be the base of treatment?
A. Antimicrobial drugs
B. Antacids
C. Antisecretory drugs
D. Correction of motor function
E. Sedative drugs
ANSWER: A
A pregnant woman ill with severe pneumonia. Which of the following antibiotics
it is expedient to appoint:
A. Cefotaxime
B. Gentamicin Sulfate
C. Tetracycline hydrochloride
D. Ofloxacin
E. Biseptol
ANSWER: A
One of the main indicators of drugs elimination from the human body is:
A. The half-life
B. The volume of distribution
C. Bioavailability
D. Bioequivalence
E. Maximum concentration in blood
ANSWER: A
Which of these drugs are useful in patients with collapse and shock in order to
increase blood pressure?
A. Mezaton
B. Corglikon
C. Propranolol
D. Dobutamine
E. Eufillin
ANSWER: A
The following statements about the treatment of hypertension are true:
A. The goal of treatment is to stabilize the blood pressure at 140/90 mm Hg.
B. The goal of treatment is to stabilize the blood pressure at 160/95 mm Hg.
C. is particularly urgent need to reduce blood pressure for older people
D. treatment is not carried out at asymptomatic course
E. canceling the drug in case low blood pressure
ANSWER: A
For the angina is not typical:
A. Stitching character of pain
B. Retrosternal localization of pain
C. Relationship to physical activity
D. Duration of pain for 5-10 minutes
E. effecticity of nitroglycerin for the relief
ANSWER: A
Asthma is not characterized by:
A. high temperature
B. attacks of breathlessness
C. wheezes
D. viscous and difficult expectorated sputum
E. eosinophilia
ANSWER: A
Which drug is indicated for the treatment of status asthmaticus?
A. Prednisolone
B. Atropine
C. Salbutamol
D. Intal
E. Fenoterol
ANSWER: A
What antibiotic groups are undesirable in elderly patients:
A. aminoglycosides
B. Penicillin
C. Macrolides
D. Cephalosporins
E. carbapenems
ANSWER: A
Drugs, contributing to the development of diarrhea include all, except:
A. Aluminum-containing antacids
B. magnesium antacids
C. preparations of potassium
D. antibacterials
E. anticoagulants
ANSWER: A