PHARMACOLOGY
General Pharmacology
1.
2.
3.
4.
5.
6.
7.
Which has a half life of 6 hours
a)
Aspirin – non linear kinetics, T1/2 varies with dose – high dose = antipyretic / NSAID, low dose antiplatelet
b)
Digoxin – elimination half life 30 hours..
c)
Atenolol – elimination half life 6-9 hours
d)
diazepam – elimination half life 20-40 hours,
Irreversible antagonists; which is correct
a)
requires regeneration of receptors for further agonist action – this – e.g. PPIs,
b)
can be displaced by increasing concentration of agonist
c)
can be displaced by increasing potency of agonist
d)
can be displaced by increasing efficacy of agonist
Calculate a phenytoin loading dose for a 70 kg male; Target concentration 10 mg/L, Vd 0.5 L/kg
a)
350 mg- Vd = 35litre, X 10mg/L = 350mg required…
b)
300 mg
c)
400 mg
d)
3500 mg
Which of the following is a phase I reaction? (p54)
a)
Sulphation – is a conjugation reaction – phase 2
b)
glucuronidation – this is conjugation – a phase 2 reaction
c)
hydration – this one, along with oxidation, reduction, hydrolysis, cyclization, and decyclization
d)
acetylation – also a phase 2 reaction
15) How many mg in 2ml of a 0.5% weight per volume solution?
a)
10mg – 1% = 10mg per ml. therefore 0.5% = 5mg per ml
b)
1 mg
c)
100mg
d)
0.1 mg
e)
5mg
The volume of distribution
a)
is calculated by dividing the amount of drug by it’s clearance – amount of drug in body / conc in plasma
b)
if high suggests homogeneous distribution throughout tissues – no – not homogenous
c)
if low suggests homogeneous distribution throughout tissues – no, mostly in plasma
d)
of aspirin is greater than pethidine – aspirin 9L, pethidine 4L/kg (therefore peth greater)
e)
of midazolam is greater than warfarin – midaz Vd = 0.8-1.5l/kg, warfarin = 0.1-0.16l/kg
The volume of distribution
a)
is proportional to half life – no
b)
is inversely proportional to clearance – no
c)
is used to work out maintenance dose – yes
d)
is measured in mg/L – L/kg or L per 70kg
e)
is high in warfarin – no
8.
Calculate the half life of digoxin in a patient with a renal clearance of 8.4L/min and Vd of digoxin of 5 L/Kg in a 70 Kg man
(0.7 x Vd) / Clearance
9.
- (0.7 x 5 x 70) / 8.4 = 29.2
a)
8 hours –
b)
14 hours –
c)
29 hours – this one
d)
36 hours –
e)
44 hours –
The half life of lignocaine is
a)
1 minute
b)
5 minutes
c)
10 minutes
d)
30 minutes
e)
120 minutes – 90-110 minutes
10. The volume of distribution
a)
is less than 70 L for fluoxeteine – 2500l/70kg = 35 l/kg. FALSE
b)
is calculated by dividing rate of elimination by concentration –divide amount of drug in body, by concentration of drug in
plasma
c)
is inversely proportional to half life – nothing to do with half life
d)
is about 5L/kg for pethidine – true
e)
is effected by the route of drug administration – no
11. The bioavaliability of a drug – defined as fraction of unchanged drug reaching systemic circulation after any route of administration.
a)
must be 100% if given by inhalation – anywhere from 5-<100
b)
is typically 75 % if given intravenously – by definition – 100% if given iv
c)
is high if the drug is hydrophillic – generally low as not absorbed well if hydrophilic (lipid cell walls)
d)
is equal to 1 – the extraction ratio – bioavailability = absorption x (1-extraction ratio)
e)
is 70% for orally administered digoxin – 60-90%
12. Type 1 biotransformation reactions include
a)
methylation – phase 2
b)
acetylation – phase 2
c)
oxidation – this is phase 1
d)
glucuronidation – phase 2
e)
sulphonation – phase 2
13. The half life of narcan is
a)
1-2 minutes
b)
2-4 minutes
c)
40-60 minutes
d)
60-90 minutes – this one
e)
more than 2 hours
14. 5 ml of 2% wv is equal to
a)
10 mg
b)
100 mg – this one
c)
200 mg
d)
20 mg
e)
40 mg
15. With regard to a drug
a)
LD50 is 50 % of the dose necessary to kill experimental animals – dose necessary to kill 50% of animals
b)
Efficacy is the maximum response produced by a drug – yes
c)
Spare receptors are present if Kc 50 is the same as EC 50 – ???
d)
Potency is the same as affinity – no
e)
TD50 is the concentration of a drug necessary to produce toxic effects 50 % of the time – in 50% of population
16. Half life – 0.7 x Vd x clearance
a)
t1/2 may not be a good indication of clearance – true
b)
does not increase with age – false, can increase with age
c)
not dependant on Vd – see formula above
17. 2ml of 0.5% wv is equal to
a)
1 mg
b)
10 mg – this one
c)
100 mg
d)
20 mg
18. What is an example of a phase II biotransformation – glucoronidation, acetylation, sulphonation, methylation
a)
oxidation
b)
reduction
c)
glycolysis
19. What is the half life a drug given: clearance = 8.4l/min; weight = 70 kg; Vd = 5 l/kg – 29hours
a)
24 hrs
b)
12 hrs
c)
30+ hrs
20. Regarding t ½
a)
Can be poor predictor of clearance – this one
b)
Is not affected by age
c)
Is not related to Vd
d)
Is related to volume of distribution and protein binding
21. Regarding efficacy
a)
It cannot be zero – false
b)
It is regardless of route of administration – true
c)
It refers to dose that has effect in 50% of population – false, this is EC50
d)
It refers to effect at 50% of dose – false
e)
Relates effect to amount of receptor occupancy – false
22. Clearance
a)
Is proportional to liver blood flow
23. Regarding PK's/PD's
a)
Diffusion is inversely proportionate to S.A. and directly proportionate to thickness – other way round
b)
The LD50 is 50% of the dose that kills most people – dose that kills 50% of people
c)
The LD50 is 50% of the dose at which toxicity occurs
d)
Efficacy is the maximum response produced by a drug – twoo
24. 42. Regarding bioavailability
a)
PR drugs have no first pass – false – about 50% go through portal blood, 50% through systemic
b)
Transdermal drugs have first pass – false
c)
IV drugs undergo first pass – false
25. 2 ml of 0.5% wv is equal to
a)
1mg
b)
10mg – this one
c)
100mg
d)
20mg
26. 10 ml of 1% wv is equal to
a)
1 mg
b)
10 mg
c)
100 mg – this one
d)
1000 mg
27. Regarding therapeutic index, which is correct – book says TD50, (wiki says LD50) / ED50
a)
It equals ratio ED50/LD50
b)
It equals LD50/ED50
c)
High therapeutic index means a drug is dangerous – false
d)
Potent drugs are more likely to have a high therapeutic index – not necessarily
28. A 70 kg male patient has the following pharmokinetic parameters; VD: 5liter/kg, clearance 8.4 litre per hour
What is the half life of digoxin if the bioavailability is 0.70?. – 0.7 x Vd / clearance = 29hours = 1750minutes
a)
~1800 minutes – this one
b)
~2300 minutes
c)
~2900 minutes
d)
~3400 minutes
29. Regarding pharmacokinetics
a)
Potency is maximal drug effect – no efficacy
b)
Potency is dose of maximal effect – efficacy
c)
Efficacy is maximal drug effect – yes
d)
Efficacy is measured by gram-for-gram effect
30. Regarding enzyme induction
a)
It is irreversible – false
b)
It takes 4 months to develop – false
c)
Causes increase in smooth endoplasmic reticulum – true
d)
Causes increase in rough endoplasmic reticulum – false
Respiratory System
1.
Theophylline; which is incorrect
a.
antidiuretic action – this is incorrect.
Theophylline has a diuretic effect, also causes bronchodilatation and
stabilizes mast cells
2.
Salbutamol; which is correct
a.
low pO2 initially – yes – as increase in perfusion to poorly ventilated lung.
Given clinically with oxygen, so
not a problem.
b.
half life of 12 hours
– no, this will be salmeterol / formoterol – short acting ones work in 15 mins, last 3-
4hrs.
3.
4.
5.
Which of the following do not possess bronchodilator activity
a.
sodium cromoglycate – mast cell stabilizer – no effect on bronchial smooth muscle.
b.
theophylline – no
c.
atropine – inhibits parasymp bronchoconstriction.
d.
salbutamol – no
e.
adrenaline – no
Theophylline; which is not an overdose effect
a.
seizures – this is an effect in overdose.
b.
hypokalaemia – secondary to diuresis
c.
hyperglycaemia – NO IDEA
d.
hypocalcaemia – inteferes with ca influx – smooth muscle at high doses (>100umol/l)
e.
tachycardia – does
Salbutamol
a.
6.
7.
it decreases the PaO2 briefly – yes
Regarding theophylline
– yes
a.
it is a diuretic
b.
it blocks adenosine receptors – yes
Theophyline
a.
is a positive chronotrope – yes
b.
reduces GFR
c.
is thought to increase blood viscosity– ???
d.
is less potent than aminophlline– no
e.
has a Vd of 10L/kg– no – 35
– no
8.
9.
The Beta 2 sympathomimetic with the longest duration of action is
a.
salbutanol– 3-4 hrs
b.
salmeterol– 12 hrs
c.
sotalol– 12 hr t1/2
d.
terbutaline– longest of the short acting
e.
isoprotenerol– minutes
Which is an effect of methylxanthines
a.
weak anti-diuresis– no
b.
increased strength of muscle contraction– yes
c.
negative inotropic effect– positive
d.
medullary depression– no.
e.
stimulation of cell surface adenosine receptors– no – adenosine receptor antagonism
10. All of the following cause DIRECT bronchodilation EXCEPT
a.
atropine
b.
adrenaline
c.
salbutamol
d.
theophylline
e.
disodium cromoglycate– has NO effect on muscle
11. Salbutamol may cause all except
a.
Hyperkalemia – reduces serum potassium
b.
decreased PO2 initially
c.
skeletal muscle tremor
d.
nervousness
e.
weakness
12. Ipratropium – atropine derivative which competitively inhibits at Ach receptors
a.
causes miosis – no, would cause mydriasis – on topical application to eye.
b.
is well absorbed orally – 3%
c.
inhibits mast cells– no
d.
readily enters the CNS– not able to cross BBB
e.
onset of effect within 10 minutes–??
13. Cromolyn reduces bronchial reactivity chiefly by
a.
relaxing smooth muscle cells– no
b.
inhibiting eosinophil chemotactic factor –??
c.
direct bronchodilation– no
d.
inhibiting IgE mediated mast cell degranulation– yes
e.
inhibiting basophil mediator release – no
14. Regarding ipratropium bromide
a.
peak onset is 10 mins post inhalation – probably.
b.
gives rise to tolerance
c.
has CNS effects – no
d.
may precipitate narrow angle glaucoma– if you put it in your eye
15. Regarding theophylline, which is CORRECT
a.
causes increased K+ – no – decreased 2o diuresis
b.
Seizures may not have warning neurological signs
c.
Overdose of slow release tablets will give a peak serum level in 6 hrs
16. Regarding theophylline
a.
Vd is 2L/kg – 0.5
b.
Diuretic – true
17. Which causes bronchodilation?
a.
Cromoglycate – no
b.
Propranol – no
c.
Prednisone –
d.
Histamine – no.
18. Salbutamol
a.
gives a low PO2 initially – true
b.
beta-1 mimetic agent – no, beta 2
c.
gives bradycardia – no
19. Oxygen toxicity
a.
Lung effects more related to FiO2 than PiO2 – no – more related to pressure than fraction???
b.
Occurs when breathing 50% oxygen for more than 16 hours – risk begins to increase (worse if greater than sea
level pressure)
c.
Has an effect on the retina in children – neonates - ? this one?
d.
rarely gives central nervous system effects – not rare…
20. Sodium Cromoglycate
a.
main route of administration is orally – no, inhaled aerosol
b.
increases airway sensitivity long term – no.
c.
inhibits IgE mediated mast cell degranulation – true
21. 21. Regarding cromolyn, which is incorrect?
a.
It inhibits IgG mediated mast cell degranulation – no - IgE
Cardiovascular System
1
Thrombosis/coagulation
1.
2.
3.
4.
5.
6.
7.
What drugs do not effect warfarin metabolism
a.
phenobarbitone – enzyme inducer
b.
rifampicin – enzyme inducer
c.
cimetidine – enzyme inhibitor
d.
benzodiazepines – this, everything else does
Which does not interact with warfarin
a.
phenobarbitone – enzyme inducer
b.
loop diuretics – chlortahlidone (thiazide) and spiro (K-sparing) do. Unsure about loops???
c.
benzodiazepines – this doesn’t
d.
cephalosporins – affects Vit K producing enzyme in gut
Heparin; which is correct
a.
causes alopecia – true
b.
is a homogenous mixture
c.
is contraindicated in pregnancy
d.
can be given intramuscularly
e.
protamine blocks its receptor effects
Which of the following statements is correct
a.
aspirin makes platelets sticky – false
b.
ticlopidine inhibits the ADP pathway – true – in same class as clopidogrel
c.
aspirin versus diclofenac (? Comparing some properties) – both non-selective. Diclofenac longer half-life.
Fibrinolytics; which is correct
a.
urokinase is cheap – expensive compared to streptokinase
b.
streptokinase is a human product – streptokinase
c.
aminocaproic acid is an inhibitor of fibrinolysis – yes – competitively inhibits plasminogen activation
d.
gastrointestinal bleed within 12 months is a contraindication –???
e.
TIMI trial shows that GI haemorrhage is the most common adverse effect –???
What is true of heparin?
a.
it is a mix of complex mucopolysaccharides? – sounds right
b.
it causes alopecia – it does
Regarding fibrinolytics
a.
all thrombolytics act to convert free plasminogen to plasmin – some plasminogen bound to fibrin
b.
urokinase is a human product – yes
c.
tPA and APSAC lack the streptococcal antigen –APSAC does contain it
d.
tPA does not occur naturally – it does
e.
reactions to tPA and antistrepalase are preparation related
8.
9.
In a patient on warfarin which of the following drugs cause an increased INR
a.
cholestyramine – decreases absorption
b.
barbituates – enzyme inducer
c.
benzodiazepines – no effect
d.
rifampicin – enzyme inducer
e.
amiodorone – enzyme inhibitor
Which is not true of warfarin
a.
it has 100% bioavailability
b.
it is reversed by FFP
c.
it is 99% protein bound
d.
it affects vitamin K synthesis – inhibits reduction of oxidized vit k
e.
Half life is 6 hours – 36 hours
10. Streptokinase
a.
is a complex lipopolysaccharide – no, protein
b.
is synthesised by the human kidney – urokinase is
c.
binds to the proactivator plasminogen – apparently so
d.
activates the plasminogen that is bound to fibrin – tPA
e.
is more dangerous than tPA in those over 75 years of age – no
11. Heparin induced mild thrombocytopenia is caused by – glycosaminoglycan produced by macrophages and mast cells
a.
release of lipoprotein lipase – not sure
b.
platelet aggregation – probably this one
c.
thrombosis – is an effect of HITT
d.
anti-platelet antibodies
e.
none of the above
12. With respect to the pharmacokinetics of warfarin. All the following cause altered INR EXCEPT
a.
cephalosporins – increase INR
b.
benzodiazepines – no effect
c.
barbituates – decrease INR
13. All of the following are known to potentiate the effects of oral anticoagulants EXCEPT
a.
cimetidine – enzyme inhibitor
b.
ceftriaxone – stops vit k uptake, increase INR
c.
rifampicin – enzyme inducer – THIS ONE
d.
metronidazole – enzyme inhibitor
e.
trimethoprim – enzyme inhibitor
14. Heparin – activates antithrombin III – inactivates IX, X, XI, XII
a.
decrease the rate of conversion of VII to VIIa – antithrombin affects intrinsic. VII is extrinsic
b.
decreases the rate of fibrinogen to fibrin – not directly
c.
slows the rate of prothrombin to thrombin – yes, by inhibiting factor X
d.
inhibits the action of antithrombin III – activates it
e.
inhibits the action of protein C – no, activates it
15. Regarding heparin
a.
dose reduction is necessary in the elderly
b.
LMW fractions have more effect on thrombin than HMW fractions
c.
It may cause alopecia
d.
It inhibits antithrombin III
e.
Protamine is a competitive antagonist of heparin
16. Ticlodipine
a.
inhibits ADP induced platelet aggregation
17. Warfarin
a.
is completely broken down in the duodenum
b.
decreases levels of thromboplastins
18. Regarding fibrinolytics
a.
TIMI trial showed increased incidence of GI bleed as the major side effect of administration
b.
Aminocaproic acid inhibits fibrinolysis
19. Regarding fibrinolytics
a.
urokinase is cheap but less selective
b.
streptokinase comes from human cells
c.
HIMA says GIT haemorrhage is most common haemorrhagic complication
d.
GIT haemorrhage within 12 months is a contraindication
e.
Actriylitic acid is a potent fibrinolytic inhibitor
20. Which is CORRECT regarding warfarin
a.
broken down in GIT
b.
added to transfused blood
c.
decreases thromboplastins
21. Regarding warfarin (terrible question)
a.
Works by affecting metabolism of VitK dependant clotting factors
b.
75% protein bound
c.
half-life 6 hours
d.
increases levels of protein C early on
22. Regarding ticlodipine (repeat)
a.
Works by antagonising ADP binding of platelets
b.
Something about platelet acuity
23. concerning heparin
a.
low molecular weight variety work by binding to ATIII – bind to ATIII, work as anti-factorXa, do not inhibit thrombin formation
directly - ?badly remembered question?
b.
comes in preparations of standadised units against a bioassay – yes
c.
LWH more potent than heparin – no
d.
Nothing about alopecia
e.
Another wordy option
24. Heparin induced severe thrombocytopenia is caused by
a.
release of lipoprotein lipase
b.
aggregation – mild form
c.
antiplatelet antibodies – antibodies vs platelet factor 4?
d.
all of the above
25. Heparin
a.
Inhibits antithrombin III – activates it
b.
Causes alopecia – yes
c.
Decreases rate conversion prothrombin to thrombin – inactivates thrombin
d.
Decreases rate conversion fibrinogen to fibrin – not directly
e.
Decreases rate conversion VII to VIIa – extrinsic not heparin
26. The following drugs increase warfarin’s action, except
a.
metronidazole
b.
amiodarone
c.
disulfiram
d.
phenobarbitone – this one. Others are enzyme inhibitors
27. Regarding heparin, which is correct
a.
causes alopecia – yes
b.
is not a racemic mixture
c.
is contra indicated in pregancy
d.
can be given IM
e.
protamine blocks heparin receptors
28. Ticlopidine:
2
a.
Decreases platelet aggregation by inhibiting the ADP pathway of platelets – yes
b.
Has no GI side effects
c.
Inhibits prostaglandin metabolism
Antiarrhythmics
1.
Which shortens the refractory period in normal cells
a.
amiodarone – inc
b.
sotalol – inc
c.
quinidine – inc
d.
lignocaine – this one, also propranolol
e.
procainamide – inc
2.
3.
Digoxin; which is correct
a.
is a negative inotrope – +ve intotrope
b.
has atropine like effects on heart acetylcholine receptors – atropine blocks early dig effects, so no
c.
inhibits central vagal effects – potentiates central vagal activity
d.
increases ventricular excitability – must be. RMP closer to zero by blocking Na/K exchange
e.
increases conduction through Bundle of His – decreases conduction due to vagal activity
Digoxin
a.
4.
5.
6.
7.
8.
is a positive inotrope
All of the following may increase the effect of digoxin EXCEPT
a.
amiodorone – reduces dig excretion
b.
frusemide – K depletion
c.
carbamazepine – this one
d.
verapamil – increases plasma levels
e.
quinidine – reduces dig excretion
Coronary artery dilation occurs with
a.
adenosine – this one, and dihydropyridines
b.
high potassium – constrictor?
c.
propranolol – no
d.
enalapril – no
e.
none of the above
Regarding adenosine
a.
its receptors are ion channels – GProteins
b.
it increases AV nodal conduction – slows
c.
it enhances potassium conductance – it does
d.
it is the drug of choice in VT – SVT
e.
it has a half life of 2 minutes – 10secs
Which does not prolong the refractory period of normal cells
a.
amiodorone
b.
lignocaine – this one shortens
c.
quinidine
d.
sotalol
e.
procainamide
Verapamil – decreases output and contractility. Blocks activated and inactivated ca channels, relaxes smooth mm, prolongs AV
conductance and refractory period
a.
is a positive inotrope – negative inotrope
b.
inhibits activated and inactivated sodium channels – Calcium
c.
is a dihydropyridone – no
9.
The calcium channel blocker with the most rapid onset of action when given orally is
a.
diltiazem
b.
nifedipine – this one hence use in hypertensive emergencies (Amlodipine slow)
c.
verapamil
d.
felodopine
e.
nicardipine
10. Adenosine
a.
has a half life of only minutes
b.
is drug of choice in VT
c.
decreases SA nodal conduction
d.
enhances K+ conductance – this one
11. Digitalis
a.
is positive inotrope
12. Adenosine
a.
opens K+ channel
b.
opens Cl- channel
c.
half like of 10 mins
d.
profoundly blocks SA node
e.
blocks Ca++ dependant action potential – this one
13. Which is an example of a Class IV antiarrhythmic – ca channel blockers
14. Verapamil
3
a.
increases myocardial contractility
b.
is a positive inotrope
c.
causes skeletal muscle weakness
d.
blocks active and inactive Ca++ channels – this one
Antihypertensives
1.
Coronary artery dilation occurs with
a.
adenosine – this one does
- not sure
c. propranolol - not this one
d. enalapril - this one does
b.
high potassium
e.
none of the above
2.
Prazosin; which is correct
a.
b.
c.
d.
e.
3.
4.
- alpha-1 selective
reduces afterload and preload – alpha-1 cause vasoconstriction, therefore inhibiting lowers systemic BP
half life is 18 hours - 2-3hours
alters lipid levels - ??
causes lupus like syndrome - don’t think so
it is non-selective
Diuretics; which is the correct drug-MOA pairing
a.
thiazides – proximal DCT - true
b.
triamterene – ascending loop of Henle – no, DCT and collecting duct (aldosterone antagonist)
c.
spironolactone – loop of Henle – no, DCT and collecting duct
d.
frusemide – collecting duct - no, loop of henle
e.
acetazolamide – DCT - PCT
GTN; which is correct
- yes
b. moderate incidence of MetHb - not moderate incidence
a.
works via NO and cGMP
- no
d. tolerance is due to ? consumption of sulfhydryl groups - maybe thiol compounds depleted?
c.
5.
works well to increase coronary blood flow in atherosclerosis
Calcium channel blockers; which is correct
a.
verapamil slows AV conduction
- yes
- no nifedipine
c. causes postural hypotension - no effect on sympathetic reflex
b.
6.
diltiazem is the prototypical dihydropyridine
Propranolol; which is correct
- think so
b. is beta 1 selective - non-selective
a.
has Na+ blocking activity
- no
d. is poorly lipid soluble - massive Vd, high lipid solubility
c.
7.
has intrinsic sympathomimetic activity
Which does not cause vasoconstriction
a.
lactate – must be this one
- when released from platelets to aid coagulation
c. adrenaline - duh
d. angiotensin 2 - cause vasoconstriction
e. antidiuretic hormone - aka vasopressin
b.
8.
serotonin
regarding Simvastatin
a.
it has a half life of between 5 and 8 hours
b.
bioavailability is…
c.
NO option about rhabdomyolysis
- low – 5%
- 3hours
9.
Ace Inhibitors
a.
cause angioedema
- commonest cause of drug induced angioedema
10. An old lady has a K+ of 6.7 mmol/L, she was previously stable on Lithium. Which drug is most likely to have done this?
a.
a thiazide
- surely not. Thiazide decreases K+
11. Regarding nitrates, which is true?
a.
tolerance is due to sulphydral groups in tissue
- yes
- erm…
c. they cause significant Methaemaglobinaemia - not significant
d. they relieve spasm - ?
e. they cause an increase in LVED volume - decrease by lowering preload
b.
increased collateral flow even if there is a fixed constriction
12. Regarding Calcium channel blockers, all are true EXCEPT:
- highly protein bound.
b. verapamil blocks sodium channels c. they have a high first pass metabolism a.
they have low protein binding
13. Diazoxide. Which of the following is NOT true ?
a.
is used to treat severe hypertension – yes, acts within 5 minutes, lasts 4-12 hrs. dilates arterioles.
b.
acts by direct smooth muscle relaxation – prevents vasc smooth muscle contraction by opening potassium channels,
stabilizing membrane potential at resting level.
c.
causes salt and water retention – true
d.
is a thiazide derivative – not really derivative, is structurally related though.
14. Hydralazine – dilates arterioles but not veins. Can cause lupus-like syndrome
a.
Causes an abrupt but transient fall in blood pressure – no, vascular effect lasts longer than the half life due to tissue binding
b.
Displays a biphasic blood pressure response – bimodal – fast or slow acetylators.
15. The most lipid soluble beta blocker is
a.
propranolol – very lipid soluble, massive Vd
b.
atenolol
c.
metopralol
d.
pindolol
e.
sotalol
16. Propranolol
a.
is a highly selective beta receptor antagonist
b.
is poorly lipid soluble
c.
has sodium channel blocking action – this
d.
has intrinsic sympathomimetic activity
e.
has an oral bioavaliability of > 50 %
17. Nitrates
a.
increase collateral blood flow
b.
demonstrate tolerance – yes
c.
demonstrate physical dependence
18. The CAST trial highlighted the adverse effects of
a.
metoprolol
b.
verapamil
c.
sotalol
d.
flecanide – this
e.
bretylium
19. Losartan differs from enalapril in:
a.
its selective action on angiotensin type one receptors – yes
b.
its enhanced effect on bradykinin metabolism
c.
its prolonged half life – only 2 hrs
d.
its higher incidence of drug related angioedema
e.
its increased incidence of cough
20. All of the following anti-hypertensives act directly on vascular smooth muscle EXCEPT
a.
felodipine
b.
nitroprusside
c.
indapamide - diuretic, related to thiazides
d.
prazosin
e.
hydralazine
21. Which of the following is an aldosterone antagonist
a.
Spironolactone - true
22. An example of an ADH antagonist is
a.
ethanol
b.
amiloride
c.
lithium - this one
d.
aldosterone
e.
triamterene
23. Carbonic anhydrase inhibitors
a.
were developed from early antibiotics - true
b.
are closely related to thiazide diuretics - true
c.
cause metabolic acidosis - true
d.
decrease the pH of CSF - true
e.
all of the above - this one
24. Which is NOT true of diuretics
a.
loop diretics can be used to treat hypercalcemia - true, in conjunction with saline infusions
b.
frusemide is used in the prophylaxis of acute mountain sickness – false - acetazolamide
c.
cirrhotic patients respond to spironolactone - true
d.
they may enhance the effect of ACE inhibitors - true, often combined in one tablet
e.
hydrochlorothiazide is useful in treating diabetes insipidus – yes, nephrogenic
25. Which is not the correct site of action
a.
Spironolactone and the collecting duct – this is correct
b.
Triamterene and the ascending loop of Henle – this one is incorrect. Acts on collecting duct
c.
Thiazides and the proximal part of the distal tubule – this is correct
d.
Acetazolamide and the collecting tubule – wrong – acts on prox convoluted tubule
e.
Frusemide and the ascending loop of Henle – true - correct
26. Sodium nitroprusside
a.
increases cGMP by release of nitric oxide – this one
b.
decreases vascular resistance but increases blood pressure
c.
is a complex of calcium and cyanide groups
d.
is predominantly an arteriodilator
e.
has its onset of action in 10-15 minutes
27. Methyldopa
a.
is a potent vasoconstrictor
b.
can cause Coombs positive test after prolonged use – this one
28. ACE inhibitors
a.
cause a concomitant reduction in bradykinin
b.
directly inhibit angiotensin receptors
c.
work predominantly by venodilation
d.
can cause angioneurotic oedema – yes
e.
are only available intravenously
29. Hydralazine
a.
classically has a biphasic response in BP control
b.
should not be used in eclampsia
c.
causes significant post hypotension
d.
predominantly a vasodilator – this one
30. Diazoxide
a.
can be used in a hypertensive emergency - true
b.
structurally related to thiazide - no
31. ACE inhibitors
a.
can be used in second and third trimesters
b.
have been associated with angiooedema – yes
32. Regarding hydralazine
a.
Works by direct vasodilation – yes
b.
Shows biphasic blood pressure response
c.
Causes postural hypotension
33. Regarding simvastation
a.
Low bioavailability – yes
b.
Half life 5 – 8 hours – 1-3hrs
34. Adenosine (repeat)
a.
Half life 10 mins – secs
35. Which is an inhibitor of aldosterone (repeat) – spironolactone, epleronone, triamterene (blocks ENaCs)
36. Regarding frusemide
a.
Is more potent than trimeterne -???
b.
Has no effect on digoxin function –low K
c.
Causes hyperkalaemia - no
d.
Causes hypercalcaemia - no
37. Regarding nitrates –
a.
Direct activity is coronary artery vasodilation
b.
Cause water and sodium retention – this one
38. Regarding nitrates, they do not
a.
Increase collateral coronary blood flow – NO.
b.
Demonstrate tachyphylaxis/tolerance
c.
Demonstrate physical dependance – no – they don’t do this.
39. Regarding propranolol
a.
Is a highly selective B receptor antagonist
b.
Is poorly lipid soluble
c.
Has sodium channel blocking activity – this one
40. A 42 year old male with typical ischaemic chest pain. Further investigation leads to diagnosis of "vasospasm". Which is most likely to
cause this?
a.
Adrenaline
41. Prazosin
a.
is non-selective
b.
worsens lipid levels
c.
causes SLE like syndrome
d.
reduces BP by affecting both resistance + capacitance vessels – this one – alpha.
42. Regarding nitrates
a.
increase coronary blood flow
b.
rarely demonstrate tolerance
c.
decrease myocardial contractility
d.
give relief of coronary spasm – this one
43. ACE inhibitors
a.
are safe in pregancy
b.
can cause angioedema – this
c.
do not interact with NSAID
d.
have no effect on bradykinin
44. Mannitol
a.
Inhibits H2O absorption in proximal tubule, loop of henle and collecting tubule – this one, certainly PCT and desc limb.
Oppose action of ADH in collecting tubule
b.
Is metabolised to glycerol – not metabolized in man
c.
Decreases TBW and total body cation content equally – no – get hypernatraemia and hyperkalaemic if used in excess
d.
Is of no value when renal haemodynamics are compromised
45. Female patient on ACE inhibitor, which is most likely to impair hypotensive effects
a.
Prostaglandin inhibitor (Indomethacin)
46. Prazosin
a.
Has a half life of 18 hours
b.
Adversely affects lipid profiles
c.
Produces a reflex bradycardia
d.
Has a first dose hypotensive effect
e.
Can increase CO by decreasing preload and leaving afterload unchanged
Nervous System
1.
2.
3.
Dantrolene in malignant hyperthermia; which is the correct MOA
a.
it antagonises the effects of suxamethonium – not this
b.
it inhibits prostaglandin formation – not this
c.
it decreases calcium release from skeletal muscle sarcoplasmic reticulum – this one
Which agent has a pure beta agonist effect in the circulation
a.
adrenaline
b.
noradrenaline
c.
isoprenaline – this one
Methyldopa; which is correct
a.
4.
5.
6.
7.
Propofol; which is correct
a.
accumulates in the body – metabolized rapidly by the liver
b.
can produce abnormal muscle movements – myoclonic movements common
c.
has minimal effects on the CVS - no
Carbamazepine; which is correct
a.
overdose causes seizures – yes
b.
is an enzyme inhibitor – enzyme activator (P450)
c.
metabolises to non-active metabolites – non-active and active metabolites
d.
has antihistamine properties – no
L-dopa; which is correct
a.
abrupt stop can increase tremour – causes rebound hypertension
b.
precursor to dopamine – yes, by L amino acid decarboxylase
c.
? 25% reaches the brain – 1-3% only
Ergot
a.
8.
causes a positive Coombs test with prolonged use – in 10-20% after 12 months
In overdose produces hypertension and severe vasospasm which is treated with an alpha antagonist – acts as serotonin,
noradrenaline and dopamine receptors
Ergotamine; which is incorrect
a.
can be given parenterally – orally / nasally / IV
b.
causes vasoconstriction – yes it does
c.
causes GI haemmorhage – NO splanchnic vasoconstriction
d.
good early in acute migraine – yes
e.
can cause nausea and vomiting – yep
9.
Drugs used to treat glaucoma; which is correct drug-MOA pairing
a.
pilocarpine – ciliary muscle contraction – THIS ONE pupillary constriction by circular iris muscle and ciliary mm constriction
b.
timolol – ciliary muscle contraction – reduces aqueous production
c.
acetazolamide – increased aqueous production – reduces aqueous production
d.
latanoprost – increased aqueous production – increases outflow
e.
dipivefrine – decreased outflow – adrenaline prodrug – decreases production, increases outflow
alpha= vasoconstriction, beta= vasodilation, therefore adrenaline (acting on alpha recs) and B-blocker do effectively same thing in the eye
10. Neuromuscular junction blockers; which is incorrect
a.
vecuronium is predominantly kidney excreted – THIS ONE 25% urine, 75% liver
b.
atracurium is inactivated by Hofmann elimination – yes – spontaneous breakdown
c.
pancuronium has a longer duration of action than vecuronium – yes 120 mins vs 30 mins
d.
pancuronium and vecuronium have the same structure – yes
11. Which is true of local anaesthetics?
a.
they act on the most rapidly firing neurons – yes
b.
they act on th biggest diameter neurons first – no smaller first
c.
they work from the outside fibres to the inside ones – yes
12. Carbamezapine
a.
induces enzymes – yes P450
b.
has active metabolites – yes
13. Match these eye drugs with their mechanism of action
a.
pilocarpine and ciliary contraction – yes
b.
prostaglandins and decreased aqueous production – increases outflow
c.
b-blockers and increased outflow – reduces production by ciliary epithelium
14. Which drug decreases the effect of neuromuscular blockade?
a.
Atropine –???? Used in reversal but why?
b.
Tubocurarine – inhibits phase 1 sux, enhances phase 2 sux
c.
gentamicin – enhances blockade
15. Which statement is true regarding recovery from irreversible neuromuscular blockade?
a.
it relies on receptor turnover – yes
16. Ergotamine
a.
overdose can be treated with alpha blockers – yes ish
b.
is a partial alpha 1 agonist – yes
17. Regarding flumazenil, which is INCORRECT?
a.
it can cause hypertension – yes (N+V, headache, flushing, dysrrythmia, anxiety)
b.
it has a half life of 4 hours – 1hour
18. A young male punter comes in with a high blood pressure, mydriasis and a high temperature. Which drug has he most likely taken?
a.
Atropine – no effect on BP, tachycardia. Mydriasis only if put directly into eye
b.
Adrenaline – increases BMR. Mydriasis ?only if applied topically
c.
Aspirin – no effect on BP or eye. ?temp effect?
d.
Naloxone – inc BP, ?effect on eye
e.
Cocaine – yes, yes, yes
19. regarding Valproate, what is true?
a.
it’s VD is…..a number – 0.1-0.4L/Kg
b.
it is lipid soluble – ?true
c.
it has high FPM – no, bioavailability 80-100%
20. What is true of L-Dopa?
a.
33% reaches the CNS – 1-3%
b.
it is the precursor of dopamine – true
c.
suddenly stopping it will cause tremor – rigidity
d.
it’s half life is about 5 hours – 1 hour
e.
40% less is required if it is given with a peripheral carboxylase inhibitor – up to 75%
21. Regarding Phenytoin, what is true?
a.
it demonstrates autoinduction – not AUTOinduction
b.
low doses exhibit 1st order kinetics – yes also
22. The most common adverse effect of procainamide is
a.
bradycardia
b.
pulmonary infiltrates
c.
fever
d.
hypotension – this one, also lupus like syndrome
e.
anaphylaxis
23. A patient complains of pain post-operatively. This is most likely to be due to
a.
propfol – at injection site in 28%
b.
isoflurane –??
c.
suxamethonium – myalgia is ‘common’
d.
atracurium –??
e.
ketamine –??
24. The muscle relaxant with the longest duration of action is
a.
atracurium – 20-35mins
b.
mivacurium – 10-20mins
c.
pancuronium – 35mins+ this one
d.
vecuronium – 20-35mins
e.
rocuronium –20-35mins
25. The MAC is greatest for – MAC minimal alveolar concentration (% needed to stop response to nociceptive stimulus in 50% of subjects)
a.
nitrous oxide – >100%
b.
halothane – 0.75%
c.
isoflurane – 1.4%
d.
methoxyflurane – 0.16%
e.
ketamine – cannot be given as an inhaled gas surely?
26. All the following are anaesthetic agents EXCEPT
a.
midazolam
b.
glycopyrolate – only works peripherally on muscarinic receptors
c.
propofol
d.
fentanyl
e.
etomidate
27. Prochlorperazine
a.
can cause neuroleptic malignant syndrome – yes (same as chlorpromazine)
28. Local anaesthetics
a.
act on the most rapidly firing neurones – yes
b.
have an increased effect on large fibre diameter – no, on smaller diameter fibres
29. The muscle relaxant most commonly associated with tachycardia is low dose
a.
Suxamethonium – ?bradycardia?
b.
Atracurium – hypotension
c.
Vecuronium – no effect on CVS
d.
Pancuronium – this one
e.
Tubocurare – hypotension
30. All of the following are amide local anaesthetics EXCEPT –(amides contain letter ‘ i ’ in name before –caine suffix)
a.
lignocaine
b.
bupivicaine
c.
benzocaine – this one
d.
prilocaine
e.
etidocaine
31. Which is an ester local anaesthetic
a.
tetracaine – this one - see above
b.
lignocaine
c.
bupivicaine
d.
etidocaine
e.
prilocaine
32. Which of the following statements are FALSE regarding vecuronium
a.
it has minimal cardiovascular effects – true
b.
it is predominantly renally excreted – false, liver
c.
it has a significantly longer duration of action than pancuronium – false, slightly lower
33. Which is true of neuromuscular blockers
a.
atracurium causes hypotension in volume depleted patients
b.
pancuronium causes histamine release – tubocurarine, atracurium, sux
c.
vecuronium is an isoquinolone derivative
d.
gallium is eliminated by the liver– ?gallamine? -
e.
gentamicin increases their efficacy – this is true
Panc and vec are same structure – steroid derivative – no histamine release. Panc causes tachy
Atrac tubo – isoquinoline derivatives – histamine release as well as sux
34. The cholinesterase inhibitor with the shortest duration of action is – phonium < stigmines < thions
a.
physostigmine
b.
edrophonium – this one
c.
neostigmine
d.
parathion
e.
malathion
35. Which of the following is a direct serotonin agonist
a.
fluoxeteine – SSRI
b.
amitryptiline – TCA inhibit reuptake of DA, NA and 5-HT
c.
moclobemide – MAOI (inc levels NA, DA, 5-HT
d.
ondansotron – 5-HT antagonist
e.
sumatriptan – this one – similar in structure to 5-HT
36. Regarding SSRI’s
a.
they are preferred in the treatment of obsessive compulsive disorders over TCA’s – true indeed
37. Barbituates act by
a.
opening GABA chloride ion channels – yes – bind at site that is different to benzo site. Potentiate effect of GABA
38. Which of the following regarding carbemazepine is FALSE
a.
it is greater than 50 % protein bound – 75%
b.
it has active metabolites – yes
c.
it induces p450 liver cytochromes – yes
39. Carbemazepine is closely related to
a.
vigabatrin
b.
quinidine
c.
sodium valproate
d.
metoprolol
e.
imipramine – this one
40. The drug that acts by MAO inhibition is
a.
paroxetine – SSRI
b.
sertraline – SSRI
c.
trazodone – random
d.
moclobemide – this one
e.
clomipramine – TCA
41. The most dangerous drug in overdose is
a.
imipramine – TCA – this one
b.
moclobenide – MAOI – unlikely lethal
c.
sertraline – SSRI unlikely dangerous OD
d.
trazodone – ‘rarely lethal’
e.
paroxeteine – SSRI unlikely dangerous OD
42. Fluoxeteine
a.
has minimal drug interactions – nonsense
b.
is associated with seretonin syndrome with muscle weakness, hyperpyrexia and confusion – yes
c.
induces hepatic p450 enzymes – inhibit p450
43. Patient on phenytoin is found to have a low blood phenytoin level. Which of the following is LEAST likely to cause this
a.
Carbemazepime – quite likely, this is an enzyme inducer, which can reduce phenytoin blood levels
b.
non-compliance – quite likely
c.
disulfiram – inhibits p450???this one because pt more likely to be on erythromycin?
d.
erythromycin – inhibits p450???
e.
hypoalbuminemia – quite likely
44. Carbemazepime
a.
enhances sodium channel conductance – no blocks channels
b.
causes seizures in overdose – yes, acc to hypertox, not in Katzung
c.
inhibits cytochrome p450 – no, induces p450
d.
has active metabolites – yes
e.
is not a tricyclic – false, it is a tricyclic
45. Regarding SSRI
a.
They are safe in OD due to minimal drug interactions – no, only dangerous when other drugs taken
b.
Can cause malignant hyperpyrexia – neuroleptic malignant syndrome and serotonin syndrome
c.
Are readily removed by dialysis – no, due to high Vd
d.
May cause seizures in OD – actually yes
e.
May be associated with seretonin syndrome with muscle weakness, hyperpyrexia and confusion – yes, if muscle twitching not
weakness
46. The opiate associated with seizures when given in high dose to patients with renal failure is
a.
morphine
b.
pethidine – norpethidine is convulsant. This SE is one of the major reasons why pethidine is not used any more
c.
methadone
d.
fentanyl
e.
codeine
47. Regarding neurotransmitters in the brain
a.
strychnine stimulates glycine receptors – antagonizes glycine receptors
b.
atropine antagonises GABA receptors – antagonize muscarinic receptors
c.
butyrophenones stimulate dopamine receptors – antagonize DA receptors
d.
ondansotron antagonises seretonin receptors – YES
e.
atenolol stimulates noradrenaline receptors – erm….no
48. Buspirone relieves anxiety without sedation by:
a.
direct GABA stimulation
b.
indirect GABA stimulation
c.
direct noradrenaline receptor stimulation
d.
indirect noradrenaline stimulation
e.
none of the above – this one, serotonin agonist
49. The most potent sedative is
a.
diazepam
b.
midazolam – this one
c.
temazepam
d.
phenobarbitone
e.
chloral hydrate
50. The drug used as an antipsychotic most likely to cause extrapyramidal effects is
a.
chlorpromazine
b.
lorazepam
c.
risperidone
d.
haloperidol – this one –known to be common with haloperidol
e.
clozapine
51. A man presents with dilated pupils, confusion, hyperpyrexia. Which of the following drugs would not account for this
a.
atropine OD – could well be this one
b.
morphine – this one
c.
datura – ???
52. A healthy young man recieves a normal dose of a drug which induces midriasis and increased systolic blood pressure . The drug could
be
a.
adrenaline – this one
b.
acetylcholine
53. Characteristics of propranolol include all EXCEPT
a.
lipid solubility
b.
local anaesthetic action
c.
half life of 3-6 hours
d.
bioavaliability of 30 %
e.
beta sympathetic selectivity – NON selective
54. A patient arrives in the DEM staggering, agitated, hyperthermic with dilated pupils. Which is least likely to produce this effect
a.
atropine OD – cause all the above
b.
amphetamine OD – cause agitation, staggering
c.
aspirin OD – causes hyperpyrexia, agitation
d.
tricyclic OD – doesn’t cause these – seizures + arrythmias
e.
angels trumpet – aka datura – contains atropine
55. A young man is injected with an iv drug. He shows a resultant tachycardia, midriasis, normal blood pressure and reduced sweating.
The most likely drug is
a.
nicotinic antagonist – no – would have muscular symptoms
b.
muscarinic antagonist – this one – eg atropine
c.
cholinomimitic – would be miosis, decreased HR, increased sweating
d.
adrenergic agonist – would raise BP, and increase sweating
e.
adrenergic antagonist – would be bradycardic
56. A woman is hypertensive with a potassium of 6.7. which of the following is LEAST likely to cause this
a.
potassium supplements
b.
frusemide – this one
c.
ACE inhibitor – secondary to renal failure… RAS
d.
Suxamethonium – K+ release…
e.
Spironalactone – does reserve K+
57. The major side effect of benztropine is – centrally acting antocholinergic
a.
miosis – mydriasis
b.
confusion – this one
c.
diarrohea – constipation
d.
GIT haemorrhage – unlikely
e.
Bronchorrhea – dry mouth etc..
58. Stemetil
a.
useful in tardive dyskinesia – causes TD
b.
can cause neuroleptic malignant syndrome – yes
c.
has antiemetic effect via 5-HT antagonist activity – this is ondansetron. Anti-emetic through DA and Muscarinic receptors
59. Alpha –methly- dopa
a.
can cause a positive Coombes test – 10-20% after 12months
60. Termination of irreversible neuromuscular block involves
a.
regeneration of receptors –this one
b.
increase in end plate Ach
61. Regarding antidepressants
a.
fluoxetine is more sedating than tricyclics – TCAs sedating
b.
SSRI’s are more effective in OCD – true
62. Carbamazepine
a.
is metabolised to active metabolites – yes (metabolite?)
b.
in overdose causes seizures – yes
c.
is an enzyme inhibitor – inducer
63. What has pure beta agonist effect in the circulation
a.
adrenalin
b.
noradrenalin
c.
isoprenalin – this one
64. Regarding the treatment of Parkinsons, which is INCORRECT
a.
L-dopa is contraindicated in acute psychoses – true
b.
Bromocriptine has less CNS effects than L-dopa – FALSE more CNS effects
c.
Administration of L-dopa with a dopa decarboxylase inhibitor decreases side effects – yes indeedy
65. GABA receptor
a.
barbituates increase the time GABA opens – true (benzos increase frequency of opening [benZo – hZ])
b.
barbituates do not effect warfarin metabolism – false – is P450 inducer therefore increases warfarin metabolism
66. In TCA overdose
67. Regarding the treatment of glaucoma, which of these decreases aqueous outflow?
a.
Timolol – decrease production
b.
Lantanoprost – increases outflow
c.
Carbechol – causes miosis and increased outflow
d.
Adrenaline – this one decreases production, but may cause mydriasis
e.
Acetazolamide – decreases production
68. Regarding sedatives
a.
Barbiturates increased the time of GABA channel opening – yes
b.
Carbamazepine has no active metabolites – false
c.
Phenytoin has low plasma protein binding – 80%+
69. Which causes methaemaglobinaemia (repeat)
a.
Prilocaine – yes
70. How does pralidoxime work? (repeat) – reactivates cholinesterase after organophosphate binding / inhibition
71. Regarding St Johns Wort
a.
It is more effective than placebo – true
b.
It has a side effect profile comparable/same as placebo – no
c.
Can cause hyperthermic/hypertensive reaction – true, but only with MAOIs or SSRIs
d.
It has more side effects than placebo – true, photosensitization, enzyme inducer
72. What is the correct order of catecholamine synthesis?
a.
Tryptophan – dopa – dopamine – adrenaline – noradrenaline – no
b.
Tysosine - dopa- dopamine – adrenaline – noradrenaine
c.
Tyrosine – dopa – dopamine – noradrenaline – adrenaline – yes
d.
Tyrosine – dopamine – dopa – noradrenaline – adrenaline
e.
Tyrosine – dopamine – dopa – adrenaline – noradrenaline
73. A young man presents with dilated pupils, confusion and hyperpyrexia. Which of the following could not account for these effects.
a.
Atropine
b.
Datura
c.
Morphine – this one
74. Pralidoxime acts to
a.
Inhibit presynaptic ACh release
b.
Cleave acetylcholinesterase – takes organophosphates off cholinesterase
c.
Regenerate Ach – ‘regenerates acetylcholinesterase’
75. Vecuronium, all of the following are true except
a.
Has minimal CVS effects
b.
Is predominantly renally excreted – no, liver excretion
c.
Has a significantly longer duration of action than pancuronium – no, panc longer
76. In the treatment of parkinsons disease
a.
Antimuscarinics are better for the treatment of (?) tremor than dopamine agonists – less effective
b.
Administration of L-dopa with a dopa decarboxylase inhibitor decreases side effects – true
77. Dantrolene is a good choice in treatment of malignant hyperpyrexia because
a.
It antagonises the effects of suxemethonium
b.
It inhibits prostaglandin formation
c.
It decreases calcium release from sarcoplasmic reticulum in skeletal muscle – this one
78. Atracurium
a.
Has a longer duration of action than vecuronium – no
b.
Is not associated with histamine release – is associated
c.
Is a steroid derivative – isoquinolone
d.
Is eliminated by non renal/liver dependant mechanisms – Hoffman degradation
79. Regarding pancuronium - which is incorrect?
a.
It is a steroid – correct
b.
It does not release histamine – correct
c.
It is renally excreted – correct
d.
It has a shorter duration of action than vecuronium – incorrect, longer duration
80. Phenytoin
a.
Is lowly protein bound – 80%+
b.
Causes agranulocytosis in 5% of patients – exceedingly rare
c.
Can cause abnormalities of vitamin D metabolism – true
81. Match the drug and effect - which is wrong?
a.
Phenytoin - gum hypertrophy – correct
b.
Carbamazepine - blood dyscrasias – correct
c.
Phenobarbitone – porphyria?
d.
Ethosuximate - hirsutism – correct
82. Which local anaesthetic causes methaemaglobinaemia?
a.
Lignocaine
b.
Tetracaine
c.
Bupivacaine
d.
Procaine
e.
Prilocaine – this one
83. Benztropine causes
a.
Miosis – mydriasis
b.
Diarrhoea – constipation
c.
Confusion – this one
d.
Bronchorroea – dries up secretions
e.
GIT haemorrhage – don’t think so
84. A patient on phenytoin has a seizure and is found to have a low level, which is least likely to cause this?
a.
Phenobarbitone – quite likely as enzyme inducer as displaces from plasma protein
b.
Non-compliance – quite likely
c.
Hypoalbuminaemia – quite likely
d.
Disulfiram – enzyme inhibitor – more likely high level
e.
Erythromycin – enzyme inhibitor also
85. Diazepam
a.
Does not engender psychological dependance
b.
Is metabolized to oxazepam – all metabolized to oxazepam (except lorazepam and alprazolam)
86. Regarding fluoxetine
a.
Seretonin syndrome = muscle weakness,hyperpyrexia and confusion – not muscle weakness
b.
It is removed by dialysis – not, large Vd
c.
Can cause malignant hyperpyrexia – no, NMS and SS
d.
Is an enzyme inhibitor – yes
e.
Is safe in overdose due to minimal drug interactions – dangerous with other drugs, esp MAOIs
87. Dobutamine
a.
Results in ATP -> AMP – activates adenylyl cyclase ATP -> cAMP
b.
Can decrease systemic vascular resistance / afterload – yes, mild only
88. All prolong refractory period in normal cells, except
a.
amiodarone – does
b.
lignocaine – reduces refractory period
c.
quinine –?quinidine does
d.
pracainamide – does
e.
sotalol – does
89. Propofol
a.
Does accumulate – yes
b.
Can produce abnormal muscle movements – yes
c.
Has minimal effects on the CVS – common SE on CVS
90. Benztropin
a.
causes confusion – yes
b.
causes diarrhoea
c.
causes GI hemorrhage
d.
causes miosis
91. Barbiturates
a.
Only Phenobarbital is excreted unchanged by the kidney – true (20% vs 0%)
b.
stimulates the medullary vasomotor center – surely depressors of CNS, via GABA
c.
have more benign side-effect spectrum than benzodiazepine – false, death by barbiturate OD
92. L-Dopa
a.
1-3% reaches the brain – true
b.
Precursor to tyrosine – no, both precursor to dopamine
c.
abrupt stop can increase tremor – no rigidity
d.
rarely needs increase in dose once effective – needs to keep increasing hence dose holidays
93. Stemetil
a.
can cause neuroleptic malignant syndrome – yes
b.
can cause malignant hyperthermia – no
c.
can cause serotonin syndrome – no
d.
never causes tardive dyskinesia – false
e.
has anti-emetic effect through serotonin antagonism – through DA receptors
94. Treatment of glaucoma does not include
a.
alpha blocker – alpha stimulation
b.
beta blocker – timolol
c.
carbonic anhydrase inhibitor – acetazolamide
d.
cholino-mimetic agents – pilocarpine
95. Praloxidime
a.
regenerates acetylcholine
b.
regenerates acetylcholine receptors
c.
regenerates acetylcholinesterase – this one
d.
regenerates succinylcholine
96. SSRI’s
a.
Have more pronounced side effects than TCA’s – no, fewer
b.
are the treatment of choice in bipolar disease – no
c.
usually have short half-lives – no, days
d.
are effective in obsessive compulsive disorders – yes
97. Diazepam
a.
is metabolised to lorazepam – no
b.
is metabolised to oxazepam – yes
c.
has a half life of 4 hours – 20hours
d.
should not be used in convulsions of unknown origin – no
98. Which local anaesthetic causes methemoglobinemia?
a.
lignocaine
b.
prilocaine – this one
c.
bupivacaine
d.
procaine
99. Cisapride – used for GORD
a.
Has a half life of 6-8 hours – about 10hours
b.
Decreases lower oesophageal sphincter pressure – increases pressure
c.
Is well absorbed orally – not really
100. Sumatriptan
a.
Is a partial alpha 1 agonist – no idea
101. A young patient is given a normal dose of a drug in the emergency department. They develop tachycardia, increase BP and dilated
pupils. The drug is most likely to be
a.
Adrenaline – yes
b.
Atropine – no effect on blood pressure
102. Dantrolene is used in malignant hyperthermia. It’s mechanism of action is:
a.
Succinylcholine antagonist
b.
decrease in calcium release from sarcoplasmatic reticulum – this one
c.
hypothermia through muscle relaxation
d.
antipyretic through prostaglandin inhibition
Antimicrobial Agents
1.
2.
3.
4.
5.
6.
7.
8.
Sulphonamides are a structural analogue of
a.
PABA – p-aminobenzoic acid - true
b.
Dihydrofolate
c.
Tetrahydrofolate
d.
Folic acid
Interferons; which is incorrect
a.
has virus specific antiviral activity – specific to RNA viruses
b.
antiviral to all viruses
Amphotericin B; which is correct
a.
can be given orally to treat systemic illness – no only for oral candidiasis or GIT stuff
b.
can cause fever, headache and confusion – ?confusion
c.
dose needs to be reduced in renal impairment – no, causes renal impairment
d.
can cause liver toxicity/damage/problems (unsure of exact statement) – yes
Antibiotic resistance; which pair is incorrect – none
a.
vancomycin – alteration in D-ALA-D-ALA – true
b.
penicillin – beta lactamase – true
c.
gentamicin - ? penetration into cell – true
d.
erythromycin - ? esterase – true (3 methods - reduced permeability of cell membrane, production of esterases that hydolyse
macrolides, modification of ribosomal binding site)
e.
fluoroquinolones - ? binding sites – true (3 methods - efflux pump, protective proteins, mutation binding site)
Zidovudine (AZT); which is correct
a.
has a short half life – 1 hr
b.
blocks thymidine kinase – no… reverse transcriptase
c.
not used to treat retroviruses – false
d.
similar mechanism of action to amantadine – nucleoside-nucleotide reverse transcriptase inhibitor – very different action to
amantadine which blocks m2 proton ion channel – inhibiting uncoating of mRNA.
Cephalosporins; which is incorrect
a.
ceftazadime has activity against pseudomonas – true
b.
cefaclor is second generation – true
c.
third generation have greater gram negative spectrum than first generation – yes
d.
not as sensitive to beta-lactamase as penicillins (giving a wider spectrum) – true
Norfloxacin
a.
has increased concentration in tubular fluid when given with probenecid – increases plasma concentration.
b.
something to do with nucleic acid synthesis – does inhibit DNA synthesis
Sulphonamides
a.
are structurally related to PABA – true
9.
Gentamicin
a.
is an oxygen dependant antibiotic – true, not able to cross cell membrane in low pH (anaerobic conditions)
10. Which is true of penicillin-V?
a.
it can be used for eyes
b.
it should be given on an empty stomach – true – absorption impaired by food
11. regarding AZT
a.
it has a short half life – true – 1 hr
12. Regarding metronidazole
a.
it is indicated for trichomonas – true
b.
it is NOT indicated for gardnerella – false
c.
it inhibits aldehyde dehydrogenase – has a disulfiram like reaction…???
13. Which is the correct combo of AB and mechanism of resistance? – incorrect?
a.
Gentamicin and ?cell entry – true – deleted porins
b.
erythromycin and esterase production – true (minor effect), also reduced permeability, modification of binding sites
c.
quinolones and point mutation – yes – mutation of binding sites of DNA gyrase / tropoisomerase
d.
vancomycin and ALA-ALA-ALA repeat – no, D-ALA-D-ALA
e.
penicillin and esterase production – no – beta lactamase
14. A patient with impetigo would be most likely to respond to
a.
streptomycin – better for gram negative aerobes
b.
kanamycin – as for a.
c.
metronidazole – won’t work well.
d.
cephalexin – this one - would cover strep and staph
e.
phenoxymethylpenicillin – won’t cover staph
15. Which of the following is a live virus vaccine
a.
typhoid – live bacteria
b.
tetanus – no - toxoid
c.
HBV – viral antigen only
d.
Rabies – inactivated
e.
Measles – this one, also influenza, mumps, rubella, varicella, yellow fever
16. Which skin antiseptic is commonly used
a.
ethyl alcohol 70% – this one – effective 60-90%
b.
ethanol 30% – not strong enough
c.
isopropyl alcohol 10% – 70-80%
d.
formaldehyde – no
e.
boric acid – no (suppositories for yeast vaginal infections)
17. Macrolide antibiotics
a.
are usually active against neisseria species – yes.
b.
are bacteriostatic but not bactericidal – bactericidal at higher concentrations
c.
bind at the 30 s ribosome sub-unit – no – 50s – gent = 30s
d.
are unaffected by plasmid mediated resistance – no.
e.
enhance metabolism by cytochrome pathways – no – inhibitors of cytochrome pathways
18. Which of the following is a second generation cephalosporin
a.
cefaclor – this one
b.
ceftazidime – 3rd
c.
cephalexin – 1st
d.
cefotaxime – 3rd
e.
cephalothin – 1st (ph)
19. The cephalosporin with the highest activity against G +ve bacteria is:
a.
cefuroxime
b.
cefotaxime
c.
cefaclor
d.
cefipime –
e.
cephalothin – this one – the first generation were the best
20. Which of the following antibiotics does not possess a beta-lactam ring
a.
penicillins
b.
cephalosporins
c.
fluoroquinolones – this one
d.
carbapenems
e.
monobactams
21. Which of the following drugs does not exert its action by inhibiting cell wall synthesis
a.
vancomycin
b.
erythromycin – this one
c.
penicillin
d.
ceftriaxone
e.
imipenem
22. Erythromycin
a.
has a large cross-reactivity with the penicillins – no
b.
is bacteriostatic only – no
c.
is ineffective against G +ve organisms – no
d.
is inactivated by beta-lactamases – no
e.
binds to the 50 s sub-unit of the bacterial ribosome – true
23. Erythromycin
a.
is effective against campylobacter jejuni – true
24. Metronidazole
a.
inhibits alcohol dehydrogenase – no - aldehyde
b.
is effective for vaginal trichomoniasis – true
c.
does not cause a metallic taste in the mouth – false – it does
d.
turns urine green – no
25. Penicillins reach high concentrations in
a.
vitreous humour – poor penetration into eye, CNS, prostate
b.
CSF with normal meninges – no
c.
Proximal tubular fluid in kidneys – yes.
26. Zidovudine ( AZT)
a.
has a short half life – this one
b.
inhibits viral thymidine kinase
c.
has no activity against retroviruses – false
27. The antiviral drug which acts on reverse transcriptase is:
a.
Acyclovir – inhibits DNA polymerase
b.
zidovudine – this one
c.
ganciclovir – inhibits DNA polymerase
d.
vidarabine –substrate and inhibitor for DNA polymerase
e.
all of the above
28. Regarding metronidazole which is not true
a.
it is used to treat giardiasis
b.
it inhibits alcohol dehydrogenase – this one – aldehyde dehydrogenase
c.
it causes a metallic taste in the mouth
d.
it is used to treat gardenella
e.
it is useful against trichomonas vaginalis
29. Acyclovir is active against all the following EXCEPT
a.
HSV
b.
CMV – some activity against CMV. But comparatively weak
c.
HZV
d.
Varicella
e.
None of the above
30. Acyclovir
a.
is commonly given in doses of 10-20 mg TDS – no, 400mg…
b.
is used to treat CMV – no - ganciclovir
c.
is a guanosine analogue –yes
d.
acts to inhibit viral entry into cells – no, inhibits synthesis within cells
e.
is only available intravenously – no
31. Amantadine
a.
is an antiviral drug
b.
produces insomnia not sedation
c.
causes acute psychosis
d.
potentiates dopaminergic function
e.
all of the above – this one
32. Doxycycline
a.
acts to inhibit nucleic acid synthesis – inhibits protein synthesis – same as aminoglycosides – 30s subunit
b.
may cause photosensitivity – this one
33. Metronidazole
a.
may cause a disulfiram-like reaction – true
b.
is only available intravenously – false
34. All of the following inhibit nucleic acid synthesis except
a.
norfloxacin – inhibits DNA gyrase
b.
trimethoprim – inhibits DHF reductase - so inhibiting DNA synthesis
c.
rifampicin – prevents transcription of mRNA
d.
sulfasalazine – inhibits DHF-synthase
e.
chloramphenicol – binds 50s ribosomal subunit – inhibits protein synthesis
35. Gentamicin
a.
is not nephrotoxic – BS
b.
increases the effect of neuromuscular junction blocking drugs
36. Gentamicin
a.
may be given orally – no
b.
enters cells by an oxygen dependent influx – true
c.
has a large theraputic index – no
37. Which of the following is not true of trimethoprim
a.
it is useful in the treatment of UTI
b.
it is bactericidal – bacteristatic
c.
it is an anti-folate anti-metabolite drug – true
38. Regarding trimethoprim, which is INCORRECT
a.
synergistic with sulphonamides
b.
folate synthesis disruption
c.
less toxic to humans than bacteria
d.
is bacteriocidal – bacteristatic
39. Aminoglycosides
a.
resistance is plasmid mediated – true
b.
does not cross species
40. Which is INCORRECT
a.
disinfectants clean non-living fields
b.
antiseptics clean living fields
c.
antiseptics in low dose can promote bacterial growth
d.
alcohol kills all bacteria and spores
41. Aciclovir
a.
dose is 10-20 mg five times daily
b.
does not work on viruses with thymidine kinase
c.
does not work on CMV
d.
is a guanasine analogue
42. Metronidazole
a.
shown to be teratogenic in humans
b.
causes a disulfram like reaction
c.
inhibits alcohol dehydrogenase
d.
is recommended as a single dose for Giardiasis
43. Which of the following is a cell wall inhibitor
a.
cephalosporin
b.
tetracyclin
c.
ciprofloxacin
44. Tetracyclin
a.
may cause photosensitivity
b.
does not cause enamel discolouration
45. Gentamicin
a.
is water soluble but unstable in solution
b.
is an antibiotic which is O2 dependant
46. Which antibiotic is resistant to beta – lactamase
a.
piperacillin
b.
cloxacillin
c.
amoxicillin
d.
penicillin
47. Regarding penicillins
a.
Doesn’t cause hypernatremia
b.
Can cause seizures
c.
50% of people with previous reaction will have another reaction
d.
foods treated with tetracycline can cause reaction
48. Erythromicin
a.
Treats campylobacter jejuni
49. Which of these is INCORRECT?
a.
Disinfectants clean non-living fields
b.
Antiseptics clean tissue
c.
Alcohol kills fungi and spores
50. Which of these inhibit cell membrane function?
a.
Amikicin
b.
Erythromycin
c.
Vancomycin
d.
Amphotericin B
51. Regarding cephalosporins, which is INCORRECT
a.
Cefaclor is a second generation
b.
2nd generation have greater gram negative activity than first
c.
ceftriaxone has anti-pseudomonal activity
d.
3rd generation has good cover for penicillin resistant strep
e.
Generally have wider spectrum of activity compared to pencillins due to beta-lactmase resistance
52. Regarding erythromycin (repeat)
a.
Affects 30S subunit
b.
Is bactericidal
c.
Effective against Campylobacter jejuni
53. Penicillins reach high concentrations in
a.
Vitreous humour
b.
CSF with normal meninges
c.
Proximal tubular fluid in kidneys
54. Which antibiotic is a cell wall inhibitor?
a.
erythromycin
b.
streptomycin
c.
vancomycin
d.
gentamycin
55. Pentamidine
a.
Is an antiretroviral agent
b.
is a protease inhibitor
c.
can cause iatrogenic diabetes
d.
should be avoided in HIV patients
56. Pentamidine
a.
Is toxic to pancreatic B cells
57. Interferons;
a.
Are directly antiviral
b.
Exert virus-specific anti-viral activities
c.
Can be used to treat Kaposi"s sarcoma
58. Zidovudine;
a.
Is a protease inhibitor
b.
Has a short serum half life
c.
Has no activity against retroviruses
d.
Inhibits viral thymidine kinase
59. Penicillin G
a.
Hypernatraemia is not reported
b.
Has good penetration to the eye
c.
100 000u intrathecally can cause seizures
d.
50% of people who claim allergy will have an allergic reaction on further exposure
60. Which causes hypoprothrombinaemia & bleeding disorders?
a.
Cefuroxime
b.
Cephalexin
c.
Cefaclor
d.
Cefotetan
e.
Ceftazidime
61. Which antiseptic is commonly used in medical practice/
a.
Ethyl alcohol 70%
b.
Ethanol 30%
c.
Formaldehyde
d.
Isopropyl alcohol 10%
e.
All of the above
62. Metronidazole
a.
Commonly causes constipation
b.
Inhibits alcohol dehydrogenase
c.
Is useful in treatment of urogenital trichomonas
63. Erythromycin
d.
Is predominantly renally excreted
e.
Is a cell wall inhibitor
f.
Is bacteriostatic only
g.
Is effective against Campylobacter jejuni
64. sulphonamides are a structural analogue of
h.
Folate
i.
Vit B12
j.
PABA
k.
penicillin
65. Acyclovir is active against all except;
a.
CMV
b.
VZV
c.
HSV
d.
EBV
Autocoids
1.
2.
3.
4.
On administration of an anti-histamine which of the following effects are caused by receptors other than histamine receptors
a.
sedation
b.
postural hypotension
c.
nausea and vomiting
d.
LA
e.
All of the above
Antihistamines have significant effects at which other receptors? (only definite option I could remember was alpha and probably
dopamine. The other ones may be confabulatory)
a.
Dopamine
b.
Alpha adrenergic
c.
Muscurinie
d.
Nicotinic
e.
Serotonin
Histamine
a.
decreases smooth muscle spasm
b.
gives vasoconstriction and therefore hypertension
c.
increase myocardial contractility
d.
has no effect on local edema
Histamine when injected locally could be expected to produce all of the following except
a.
Increase contractility of GI smooth muscle
b.
Decrease systemic vascular resistance
c.
Decrease myocardial contractility
Endocrine System
1.
2.
3.
4.
5.
6.
7.
Which of these has a different mode of action
a.
insulin – tyrosine kinase A
b.
glucagon – cAMP
c.
ACTH – cAMP
d.
PTH – cAMP
e.
All of the above – cAMP
Glucocorticoids; which is correct
a.
prednisolone is 5 times more potent than hydrocortisone – yes
b.
fludrocortisone can only be given intravenously - oral
c.
methylprednisolone has mineralocorticoid effects – none at all
d.
dexamethasone has a short half life – long
With regard to the mechanism of action of steroids - ???
a.
they cause bronchodilation – vasoconstriction, inhibit complement, macrophages and leucocytes, reduce cytokine formation
and histamine release (reduce capillary permeability)
b.
something to do with interferons – inhibits formation of interferon gamma
Regarding thyroid hormones
a.
the half life of T3 is greater than that of T4 – no, shorter
b.
other options to do with endogenous vs man-made hormones – levothyroxine (syntheticT4) same efficacy, liothyronine
(synT3) – more potent, short half-life, more cardiotoxic
With regard to oral hypoglycaemics
a.
tolbutamide and glipizide are sulphonylureas – true
b.
chlorpropramide has a half life of 4-6 hours – no really long – 32 hrs
c.
metformin is more effective once weight is controlled – no, used in overweight pts
d.
glipizide has one of the longest half lives – no - chlorpropramide
e.
lactic acidosis is more common with metformin than phenformin – no phenformin withdrawn because of lactic acidosis
The most potent mineralocorticoid, is fludrocortisone
a.
hydrocortisone – this one
b.
prednisolone
c.
methylprednisolone
d.
dexamethasone
e.
betamethasone
Metformin
a.
does not require functioning pancreatic beta cells for its action – true
8.
9.
Which is most potent - ?glucocorticoid
a.
cortisol – this one
b.
cortisone –x 0.8
c.
aldosterone - mineralocorticoid
d.
corticosterone - ?
e.
deoxycorticosterone – no glucocorticoid activity
Which action of glucagon is INCORRECT – none of these.
a.
Smooth muscle relaxant
b.
Positive inotrope
c.
Positive chronotrope
d.
Stimulates gluconeogenesis
10. Insulin does not cause
a.
Decrease glycogenolysis in the liver – does cause this
b.
Increase glycogen synthesis in the liver – does cause this
c.
Increase lipolysis in the liver – no, inhibits lipolysis
11. Metformin
a.
Is a sulphonylurea – no - biguanide
b.
Can cause a significant lactic acidosis (?)– yes…
c.
Is similar to chlorpropamide – no
d.
Their action is (or is not - can't remember exact option) dependant on insulin – action is not dependent on insulin
e.
Does not require functioning pancreatic B cells for its action – true
12. Insulin causes
a.
Decrease lipolysis in liver – decrease lipolysis in adipose tissue
b.
Decrease glycogenesis in liver – no, increases glycogenesis
c.
Increase glycogen synthesis in liver – yes
d.
Decrease lipolysis in skeletal muscle – in adipose tissue
Gastrointestinal Tract
1.
2.
3.
4.
Cisapride; which is correct
a.
is a serotonin antagonist – serotonin receptor agonist
b.
is a dopamine antagonist
c.
slows colonic motility - reverse
d.
atropine opposes its effects – true – stimulates Ach release from enteric nervous system
Antiemetics; which is incorrect
a.
diphenoxylate – opioid agonist – antidiarrhoeal – not antiemetic.
b.
dexamethasone – augments antiemetic effects of eg ondansetron
c.
THC - also antiemetic.
d.
Ondansetron - serotonin receptor antagonist
e.
Diphenhydramine – antihistamine – motion sickness, used for extrapyamidal sx etc
Metoclopramide; which is correct
a.
decreases lower oesophageal sphincter tone - increases
b.
increases antral contractility - yes
c.
decreases ileal peristalsis – no effect on small intestine motility
d.
is a dopamine agonist – receptor blocker
Regarding Cisapride, what is true?
a.
5.
6.
7.
Cisapride
a.
slows gastric emptying - increases
b.
delays oesophageal clearance -?
c.
raises lower oesophageal sphincter pressure - probably
d.
increases pancreatic secretions
e.
increases gastric secretions
Regarding cisapride, which is CORRECT
a.
80% oral bioavailability
b.
potent anti-dopamine agent – nothing to do with dopamine
c.
needs to be reduced in renal failure
d.
decreases colonic motility - increases
Regarding antiulcer/antireflux drugs
a.
8.
it makes Parkinson’s disease worse – serotonin receptor agonist – parasympathomimetic… no Dopamine effect
Oral antiacids completely safe in people with renal failure – no – can cause alkalosis.
Metoclopramide
a.
Increases antral contractility - yes
9.
Cimitidine
a.
blocks both H1 and H2 receptors - no – specific for H2
b.
t1/2 is 22 hours – 6-10hours
c.
inhibits cytochrome P450 - yes
d.
never causes gynaecomastia – false – as increases oestradiol and prolactin levels.
10. regarding antiemetics
a.
metoclopramide increased lower oesophageal sphincter tone
b.
metoclopramide is a dopamine agonist
c.
THC works at the chemoceptor trigger zone
Analgesics & NSAIDs
1.
2.
Which pathway produces the toxic metabolite in ol overdose
a.
N-hydroxylation – this one
b.
Glucoronidation
c.
Sulfation
d.
Conjugation with glutathione
Opiates; which is correct
a.
3.
morphine acts as a mu, kappa and delta agonist – true
Aspirin; which is correct
a.
has a pKa of 6.5
- pKa 3.5
- ??‘still larger doses cause hyperpnoea’ ?moderate
c. high doses cause alkalosis - ??according to Katsung, toxic doses initially cause respiratory alkalosis
d. reversible inhibitor of cyclo-oxygenase - irreversible
e. alkalinising the urine will decrease excretion - no increases excretion
b.
4.
5.
moderate doses increase respiratory rate
Ketamine; which is correct out of the following options
a.
cardiovascular stimulant via a central mechanism
b.
increases respiratory rate initially
- this one
Ketamine
- think not
b. decreases the brains oxygen use/requirement - increases blood flow and oxygen requirements
c. is a negative ionotrope - no, symp stimulant
a.
6.
has a brief period of increased resp rate
Tolerance to morphine involves all of these features EXCEPT
a.
miosis and resp depression – no tolerance to miosis, yes to resp depression.
Also no tolerance develops to
constipation and convulsions
b. euphoria– yes
c. analgesia– yes
d. cough suppression– yes
7.
8.
Which is true of aspirin?
- 3.5
a.
it has a pKa of 6.5
b.
causes cutaneous vasodilation
- indirectly, by acting on the hypothalamus
what is correct regarding salicylates?
a.
they demonstrate capacity limited clearance at low doses - yes
b.
they have a pKa of 6.5 – aspirin 3.5
c.
they cause platelets to have a half life of 2 days
- don’t change half-life of platelets at all
9.
In an overdose of paracetamol
a.
metabolism of paracetamol requires glutathione
- yes in form of NAC
10. Paracetamol
- no significant anti-inflam properties
b. is highly protein bound - 0-5% protein bound
a.
has anti-inflammatory properties
11. Dextropropoxyphene
a.
is structurally related to methadone– yes. Very similar
12. Ketamine is closely chemically related to
a.
phencyclidine
b.
LSD
c.
Propofol
d.
Thiopentone
e.
Enflurane
- this one
13. A high degree of tolerance can be expected to all these effects of morphine EXCEPT
a.
miosis– this one
b.
nausea
c.
cough supression
d.
analgesia
e.
respiratory depression
– long T1/2, slow tolerance development
it does not produce constipation – must. It is a mu agonist
it is a phenylpiperadine class narcotic agonist – no, phenylheptylamine
it produces a short withdrawal when ceased – no, longer withdrawal, although milder.
it produces predictable effects when given orally – true
it is a less efficacious analgesic than morphine – false, also blocks NMDA
14. Methadone is used in the treatment of narcotic addiction because.
a.
b.
c.
d.
e.
15. What do kappa receptors mediate
a.
supraspinal analgesia and euphoria – not euphoria – that is mu and delta receptors.
b.
truncal rigidity – ????
c.
hallucinations and dysphoria – true
d.
respiratory depression and dependence– true, although dependence is also mu.
e.
spinal analgesia and miosis – true
16. Allopurinol
a.
metabolised by xanthine oxidase
- false
c. useful in acute gout - false
d. low oral bioavailability - flase
b.
has no side effects
- inhibits xanthine oxidase, and metabolized by it
17. Regarding paracetamol toxicity
a.
toxicity is related to glutothione consumption
- yes (NAPQI is active metabolite in OD that requires metabolism
by glutathione)
b.
enhanced with cimetidine
c.
toxic metabolite is due to sulphanation
- due to P450 which oxidates
18. Paracetamol
- no, rectal
b. highly protein bound - low preotein binding
c. doesn’t cause hyperuricaemia - guess its this one
a.
is only given orally
19. Dextropropoxyphene
a.
when combined with paracetamol is a strong anti inflammatory – no, s’rubbish
b.
overdose causes death from hepatotoxicity –no, seizure, arrythmia
c.
structurally related to methadone – true
20. Regarding paracetamol
a.
It has significant anti-inflammatory effects
b.
No effect on uric acid levels
- no
- think not
21. Regarding Aspirin
- no
b. High does cause metabolic alkalosis - no acidosis, respiratory alkalosis
c. Reversibly inhibits COX - no, irreversibly
a.
Low doses causes hypoventilation
22. Regarding ibuprofen
a.
- less frequently than with aspirin
More gastric side effects than aspirin
- false, high
c. Irreversibly inhibits COX - reversible. Aspirin irreversible
b.
Low bioavailability
23. Naloxone
-
a.
Has a half life of over 4 hours
b.
Has a half life of less than one hour
-
d. Has a half life of between 1 and 2 hours – 1-2 hrs.
e. Has a half life of between 3 and 4 hours c.
Has a half life of between 2 and 3 hours
24. Pethidine
a.
Causes raised CSF pressure – in all opiates. resp depression raises CO2 – cerebral vasodilation, increase
ICP… ?anything to do with CSF.
25. Dextropropoxyphene
a.
should never be used in combination with paracetamol – false.
b.
should be avoided in renal failure – no mention.
c.
is structurally similar to methadone – true
26. Allopurinol
a.
metabolised by xanthine oxidase
- yes, and inhibits it
- no
c. low bioavailability - no
b.
used in acute gout
27. Ketamine
- bronchodilator
e. increases respiratory rate initially - don’t think so
f. has no cardiovascular effects - cardiovascular stimulant
g. can cause agitation and ‘emergence’ in children - true
d.
is a bronchoconstrictor
Toxicology
1.
Ethylene glycol overdose; which is correct
a.
toxicity is due to polycyclic hydrocarbon ring structure – no – due to metabolites – glycoaldehydes, glycolic acid
etc.
b.
causes formic acid crystals in urine – one of the metabolites – oxalic acid, reacts with calcium – calcium
oxalate stones.
c.
causes metabolic alkalosis– no – metabolic acidosis
d.
……… (some drug) is the antidote (NOT ethanol, may have been fomepizole?) – antidotes are ethanol and
fomepizole (works by inhibiting alcohol dehydrogenase – preventing formation of toxic metabolites)
2.
Cocaine; which is incorrect
a.
inhibits monoamine oxidase – no, serotonin and dopamine reuptake inhibitor.
(esp dopamine) – at noradrenergic synapses
c. enhances dopamine activity – true - inhibits dopamine reuptake…
d. has central and peripheral effects – true
e. has local anaesthetic effects – true
b.
3.
4.
5.
Yet another overdose rocks up to your ED. You examine them and find them to have: blurred vision, urinary retention, dilated pupils
and to be very agitated. What have they taken?
a.
cocaine
b.
TCAs – This one - antimuscarinic effects.
c.
morphine
Another dodgy young male has had an overdose of a drug….he is hyperthermic, agitated and has rhabdomyolsis…which drug has he
taken to excess?
a.
Cocaine – possible
b.
MDMA – likely.
c.
Aspirin – no (no rhabdo)
repeat question regarding ethyl alcohol PhK and PhD
a.
6.
blocks uptake of catecholamines – true
is excreted unchanged by the lungs – 10% excreted unchanged by lungs – 90% metabolized in liver
– forms formic acid in liver – damages optic nerve
is partly due to inhibition of aldehyde dehydrogenase – ?lack of this is responsible for asians flushing…
is due to formation of oxalic acid – no – this is from ethylene glycol metabolism
is treated in part with activated charcoal – no. (doesn’t bind alcohols or cyanide well)
produces renal damage due to crystal formation – no – again this is ethylene glycol
can be treated with 4 methylpyrazole – true – otherwise known as fomepizole
Methanol intoxication
a.
b.
c.
d.
e.
7.
8.
9.
Cannabinoids
a.
produce tachycardia – true
b.
have an antipsychotic action – no.
c.
act on a number of non-specific receptors – no – specific cannabinoid recptors in brain
d.
constrict the pupils – no -
e.
all of the above
Regarding ethyl-alcohol
a.
excreted unchanged in the lungs – yes
b.
causes CNS excitation then depression – no – just depressant
regarding marijuana
a.
it causes miosis – no
b.
hydroponic indoor-grown varieties are no more potent than soil grown – false.
c.
it causes conjunctival hyperaemia and tachycardia – true
10. A 30 year old male patient presents with an acute myocardial infarction. Which drug has most likely caused this?
a.
alpha-1 effect of cocaine – must be this one…. Surely?
b.
increased adrenalin production due to heroin – opioids - no major cardiac effects, except pethidine (tachy,
seizures)
c.
increased serotonin due to fluoxetine – increased risk of suicide, prolonged QT and torsades, serotonin
syndrome
d.
monoamineoxidase inhibition by amphetamine derivative – don’t think so.
11. Regarding ethanol metabolism
a.
The MEOS system is the main pathway – no – alcohol dehydrogenase
b.
The alcohol dehydrogenase pathway is inducible – no – the MEOS system (P450) is inducible
c.
Obeys first order kinetics – no – zero order
d.
Most alcohol dehydrogenase is found in the stomach– soluble cytolplasmic enzyme confined mainly to liver cells
(significant amount in men in the stomach, but most is in liver)
12. The metabolism of paracetamol to its toxic metabolite – NAPQI - is via which reaction
a.
Glucuronidation – no - safe
b.
Sulphation – no - safe
c.
Hydroxylation – yes – by P450. must then be conjugated with glutathione to be cleared.
Extremes of Age & Pregnancy
1.
2.
3.
4.
5.
6.
7.
Drug toxicity and the foetus; which is correct
a.
ACE inhibitors – renal failure/damage
b.
Thalidomide – neural tube defects
c.
Alcohol – Ebstein’s anomaly
Which of the following drugs is safest in pregnancy?
a.
heparin
b.
warfarin
c.
enoxaparin
Which is the correct combo of agent and teratogenic effect?
a.
Lithium – Epstein Barr anomaly
b.
ACE inhibitors – hydronephrosis
Which of the following drugs is the most safe to give in pregnancy
a.
heparin
b.
lithium
c.
phenytoin
d.
captopril
e.
gentamicin
Regarding drugs in the elderly
a.
the dose of lithium should be increased
b.
phase II biotransformation is much poorer
c.
they have an increased lean body mass
d.
side effects are proportional to the amount of medication
e.
they have higher serum albumin
Which is safest to give in pregnancy
a.
Lithium
b.
Phenytoin
c.
Warfarin
d.
ACE inhibitor
e.
Heparin
Neonates have
a.
increased total body water
b.
decreased bioavailability
c.
increased clearance of drugs by glomerular filtration
d.
increased hepatic enzymes
e.
increased protein binding
8.
Elderly people have reduced hepatic clearance of
a.
ethanol
b.
warfarin
c.
prazosin
d.
tolbutamide
e.
salicylate
Miscellaneous Agents
1.
2.
3.
Which agent does not cause constipation
a.
verapamil – does, almost always
b.
digoxin – diarrhoea
c.
warfarin – not sure
Allopurinol; which is correct
a.
metabolised by xanthine oxidase – yes
b.
has no side effects – rash, ATN, bone marrow issues
c.
useful in acute gout – no
d.
low oral bioavailability – 90%
Hyperkalaemia; which drug is unlikely to have caused
a.
methyldopa – this one – increases renal blood flow (CNS depressant, coombs test +ve, hemolytic anemia,
hepatitis)
4.
5.
6.
b.
potassium supplement – erm..
c.
spironolactone – K sparing
d.
ACE inhibitor – RF
e.
Naproxen – RF
Drug interactions; which pairing is correct
a.
Rifampicin induces warfarin metabolism – potent inducer of P450
b.
Carbamazepine inhibits ………..
Which drug has a half life of 6 hours?
a.
Atenolol – 6hours
b.
aspirin – variable
c.
lignocaine – 1.5hours
d.
adenosine – 10 seconds
Regarding drugs that affect thyroid function, which is true?
– blocks conversion T4-T3, large source of iodine, hypo / hyper thyroidism
b. Lithium inhibits T4 absorption – causes hypothyroidism ?mechanism.
c. Iodide decreases the amount of TBG – decreases release of TH from gland
d. phenytoin alters T3 and T4 metabolism – yes, displaces it from TBG, enzyme inducer
a.
amiodarone…..mech
7.
8.
9.
With regard to the side effects of N-Acetyl Cysteine, all are true EXCEPT:
– ???
a.
bronchoconstriction – yes
b.
increased endogenous histamine production and release – yes, common anaphylaxis
c.
it causes glutathione regeneration – almost true
d.
it inhibits P450 enzymes –
e.
cimetidine increases its toxicity –
– does not? - has its metabolism inhibited by limiting liver blood flow –
a. verapamil – flow-limited
b. lignocaine – flow-limited
c. labetalol – flow-limited
Which of the following
d.
trimethoprim
e.
propoxyphene – flow-limited
Allopurinol
a.
is metabolised by xanthine oxidase – yes
10. Which of the following drugs causes methaemaglobinemia
a.
lignocaine
b.
prilocaine – this one
c.
bupivicaine
d.
benzocaine
e.
cocaine
11. Which of the following drugs can cause alopecia
a.
warfarin
b.
heparin – this one
c.
verapamil
d.
ticlodopine
e.
digoxin
12. Which of the following drugs DOES NOT cause constipation
a.
verapamil
b.
digoxin – diarrhoea
c.
imipramine
d.
codeine
e.
chlorpromazine
13. Which of the following drugs can cause hypothrombinemia – methylthiotetrazole group – cefanmandole, otetan, metazole,
operazone
a.
Cefuroxime – 2nd gen
b.
cefotetan – this one – 2nd
c.
cefazolin – 1st
d.
cefaclor – 2nd
e.
ceftriaxone – 3rd
14. Which of the following drugs does not cause the same effect
a.
muscarine
b.
acetylcholine
c.
hyoscine – all the rest are cholinergics, this is antagonist
d.
carbachol
e.
methacholine
15. Which of the following side effects for given drugs is wrong
a.
phenytoin and gum hypertrophy – true
b.
phenobarbitol and enzyme induction – true
c.
carbemazepine and ataxia – true
d.
ethosuximate and hirsutism – true according to wiki and every other website. But not according to book.
e.
valpraote and idiosyncratic hepatic toxicity – true
16. Which of these has a different mode of action
a.
insulin – Tyrosine kinase
b.
glucagon – cAMP
c.
ACTH –cAMP
d.
PTH –cAMP
e.
All of the above
17. Chose the odd one out
a.
muscarine
b.
Ach
c.
Hyoscine – easy, ha
d.
Bethanachol
18. Which drug does not interact with warfarin
a.
phenobarbitone – enzyme inducer
b.
loop diuretic – decrease PT
c.
benzodiazepine – no effect on warfarin
d.
cepholosporins – increase PT
19. Which agent does not cause constipation
a.
verapamil
b.
digoxin – this one
c.
warfarin
20. Fosamax working mechanism: – inhibits osteoclasts
a.
increasing hydroxyappatite – this one
b.
increasing calcium resorbtion – inhibits resorption
c.
decrease in phosphate excretion – ?no effect on excretion
21. Which applies to Simvastatin
a.
half life is 5-8 hours – 3hours (atorvastatin and rosuvastatin longer – 15-20hours)
b.
has a low bioavailability – 5%
c.
is associated with peptic ulcer disease – no
d.
is not known to give rhabdomyolysis – it is known to give rhabdo
Genito-urinary Agents
1.
2.
3.
Which raises the pH of the urine the most
a.
frusemide – inhibits Na/K/Cl cotransporter in ascending LoH
b.
acetazolamide – this one
c.
chlorothiazide – reduces sodium resorption
d.
phenobarbitone
Ph of urine is increased mostly by
a.
acetazolamide – this one
b.
furesemide
c.
chloorthiazide
d.
spironolacton
Which raises the pH of the urine the most
a.
Acetazolamide – this one
b.
Frusemide
c.
Chlorthiaziade