Module 1. General Clinical Pharmacy.Clinical Pharmacy in cardiology, rheumatology, pulmonology,
nephrology.
Text test questions:
1. 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
2. The main principle of shock treatment is:
A. To increase the arterial pressure
B. To increase the peripheral vascular resistance
C. To increase the cardiac output
D. * To improve the peripheral blood flow
E. To improve the cardiac metabolism
3. Pick out the drug which increases cardiac output:
A. * Noradrenalin
B. Methyldopa
C. Phenylephrine
D. Angiotensinamide
E. Prazosine
4. Tick the synthetic vasoconstrictor having an adrenomimic effect:
A. Noradrenalin
B. Adrenalin
C. * Phenylephrine
D. Angiotensinamide
E. None of the above
5. Indicate the vasoconstrictor of endogenous origin:
A. Ephedrine
B. Phenylephrine
C. Xylomethazoline
D. * Angiotensinamide
E. None of the above
6. Which type of receptors can be activated by angiotensinamide:
A. Adrenergic receptors
B. Cholinergic receptors
C. Dopaminergic receptors
D. Hystamin receptors
E. * Angiotensin’s receptors
7. The clot aggregation blocker oppressing the adenosine absorption and reducing its enzyme destruction
A. Papaverine
B. Propranolol
C. Reserpine
D. Dipiridamole
E. * Trental
8. What group does Trimetazidine belong to?
A. Adrenomimetics
B. Cholinoblockers
C. * Cardioprotectors
D. Sympatholitics
E. Diuretics
9. The cardioselective beta-adrenoblocker is
A. * Atenolol
B. Adrenalin
C. Riboxinum
D. Enalapril
E. Nifedipine
10. The drug applied for the medical treatment of ischemic heart disease
A. sympatholitics
B. * beta-adrenoblockers
C. alpha-adrenoblockers
D. myorelaxants
E. M-cholinomimetics
11. Which drug belongs to the beta-adrenoblockers’ group?
A. Nitroglycerine
B. * Metoprolol
C. Captopril
D. Nifedipine
E. Furosemidum
12. The action of nitroglycerine and others organic nitrates is caused by
A. The blockade of potassium channels
B. The blockade of sodium channels
C. The blockade of calcium channels
D. * The release of nitrogen oxyde in the vessel walls
E. The excitation of beta2 -adrenoreceptors vessels
13. 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
14. Which drug belongs to the Calcium-channel blocker group?
A. Papaverinum
B. Atenolol
C. * Verapamil
D. Furosemidum
E. Anaprilinum
15. The drug applied for the medical treatment of ischemic heart disease
A. alpha-adrenoblockers
B. sympatholitics
C. diuretics
D. M-cholinomimetics
E. * nitrates
16. The basic principle of Nifedipine action
A. It rises the activity of potassium channels
B. It blockades beta2 -adrenoreceptors
C. The release of nitrogen oxide
D. * It blockades the calcium channels L-type
E. It blockades beta1 -adrenoreceptors
17. 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
18. At the case of anti- depolarizing myorelaxants overdose is used:
A. * Proserine.
B. Atropine.
C. Cytitone.
D. Аrmine.
E. Anapriline.
19. General unwanted effects of vasoconstrictors is:
A. Increase of arterial pressure
B. Increase of cardiac output
C. * Decrease of peripheral blood flow
D. Increase of blood volume
E. None of the above
20. For increasing blood pressure in case of low cardiac output the following agents must be used:
A. Ganglioblockers
B. Vasoconstrictors
C. * Positive inotropic drugs
D. Diuretics
E. Ca channel blockers
21. Tick the positive inotropic drug of glycoside structure:
A. Dopamine
B. * Digoxin
C. Dobutamine
D. Adrenalin
E. Amrinone
22. Tick the positive inotropic drug of non-glycoside structure:
A. Digitoxin
B. Digoxin
C. * Dobutamine
D. Strophanthin
E. None of the above
23. Dopamine at low doses influences mainly:
A. Alfa-adrenoreceptors (leads to peripheral vasoconstriction)
B. * Dopamine receptors (leads to vasodilation of renal and mesenterial vessels)
C. Beta-1 adrenoreceptors (leads to enhanced cardiac output)
D. All of the above
E. None of the above
24. Mechanism of ephedrine action:
A. Binding with adrenoreceptors.
B. Block of COMT.
C. * Increased quantity of neurotransmitter in the synaptic cleft.
D. Disturbance of noradrenaline synthesis.
E. Block of anticholinesterase.
25. The drug of choice for treatment of anaphylactic shock is:
A. Noradrenaline.
B. Naphthyzine.
C. Isadrine.
D. * Adrenaline.
E. Anapriline.
26. Main effect of ganglion- blockers is:
A. * Decrease of vessels’ tone.
B. Increase of vessels’ tone.
C. Decrease intraocular pressure.
D. Analeptic action.
E. Bronchial spasm.
27. Dopamine at medium doses influences mainly:
A. Alfa-adrenoreceptors (leads to peripheral vasoconstriction)
B. Dopamine receptors (leads to vasodilation of renal and mesenterial vessels)
C. * Beta-1 adrenoreceptors (leads to enhanced cardiac output)
D. All of the above
E. None of the above
28. Dopamine in high doses influences mainly the:
A. * Alfa-adrenoreceptors (leads to peripheral vasoconstriction)
B. Dopamine’s receptors (leads to vasodilation of renal and mesenterial vessels)
C. Beta-1 adrenoreceptors (leads to enhancing of cardiac output)
D. All of the above
E. None of the above
29. Tick the group of drugs for treatment of shock with hypovolaemia (reduced circulating blood volume):
A. Positive inotropic drugs
B. Vasoconstrictors
C. * Plasma Expanders
D. Analeptics
E. Tonics
30. Tick the group of drugs for chronic hypotension treatment:
A. Positive inotropic drugs
B. Vasoconstrictors
C. Plasmoexpanders
D. * Analeptics and tonics
E. All of the above
31. Which of the following is broncholytic from beta2–agonist group:
A. Ephedrine.
B. * Salbutamole.
C. Ipratropium.
D. Euphylline.
E. Adrenaline
32. What agent belongs to the alpha-adrenoblocker agents?
A. * Phentholamin.
B. Adrenalin.
C. Octadin.
D. Mezathon.
E. Anaprylin.
33. What is the way of noradrenalin using?
A. * Intravenous.
B. Intramuscular.
C. Per oral.
D. Subcutaneous.
E. Intracutaneous.
34. What is the effect of noradrenalin using?
A. Vasodilating.
B. * Vasoconstrictive.
C. Bronchodilating.
D. Bronchoconstrictive.
E. Analeptic.
35. Angina pectoris is:
A. * Severe constricting chest pain, often radiating to the left shoulder and down the arm, due to
insufficient blood supply to the heart that is usually caused by coronary disease
B. An often fatal form of arrhythmia characterized by rapid, irregular fibrillar twitching of the ventricles
of the heart instead of normal contractions, resulting in a loss of pulse
C. The cardiovascular condition in which the heart ability to pump blood weakens
D. All of the above
E. None of the above
36. The drug related to the group of calcium antagonists
A. Reserpine
B. Apressinum
C. * Nifedipine
D. Prazosinum
E. Papaverini hydrochloridum
37. Which drug decreases the demand in oxygen due to the blockade of the sympathetic innervation?
A. Molsidomin
B. * Atenolol
C. Pentoxiphylline
D. Papaverinum
E. Nitroglycerine
38. An efficiency of beta-adrenoblockers at angina pectoris is explained by
A. * The removal of the sympathetic influences on the heart because of the blockade of the betaadrenoreceptors
B. The expansion of the coronal vessels
C. The increase of sympathetic influences on the heart
D. The increase of cardiac abbreviations
E. The decline of thrombocyte aggregation
39. The drug, applied sublingually at the attack of angina pectoris
A. Isosorbide dinitrate
B. Riboxinum
C. Pentoxiphylline
D. Atenolol
E. * Nitroglycerinum
40. The drug of the group of nitrates with the prolonged action at the ischemic heart disease
A. Validolum
B. Losartan
C. * Sustac
D. Magnesium sulfate
E. Captopril
41. Which drug belongs to the group of beta-adrenoblockers
A. Nitroglycerine, Molsidomine
B. * Nebivolol, Atenolol
C. Pentoxiphylline, Papaverinum
D. Nifedipine, Verapamil
E. Captopril, Enalapril
42. Which drug belongs to the group of antagonists of calcium ions
A. Molsidomine, Nitroglycerine
B. Anaprilinum, Atenolol
C. Pentoxiphylline, Papaverinum
D. * Nifedipine, Verapamil
E. Captopril, Enalapril
43. Which drug belongs to the inhibitors of ACE
A. Nitroglycerine, Molsidomine
B. Anaprilinum, Atenolol
C. Pentoxiphylline, Papaverinum
D. Nifedipine, Verapamil
E. * Captopril, Enalapril
44. Indicate the antiarrhythmic drug
A. Nitroglycerin
B. Isosorbid dinitras
C. Sustac
D. Validolum
E. * Procainamide (Novocainamide)
45. Indicate the antiarrythmic drug which exerts membrane-stabilizing action.
A. * Quinidine sulfate
B. Isadrinum
C. Digoxin
D. Nitroglycerin
E. Atenolol
46. Indicate the antiarrytmic drug from of adrenoblockers group
A. Amiodaron
B. * Metoprolol
C. Verapamil
D. Asparcam
E. Nitroglycerin.
47. Indicate the peculiarities of the action of quinidine upon heart.
A. * Increase of the effective refractory period.
B. Decrease of the effective refractory period.
C. Increase of the conduction of myocardium.
D. Inhibition of the conduction of myocardium.
E. Increase of the cardic automatism.
48. Indicate the mechanism of verapamil action.
A. Blockade of beta-adrenoceptors of the heart.
B. * Blockade of calcium channels of the cardiomyocyte membranes.
C. Blockade of potasium channels of myocytes.
D. Inhibition of phosphodiesterase .
E. Inhibition cholinesterase.
49. Indicate the pharmacological effect of verapamil.
A. Cardiotonic effect.
B. Hypertensive effect.
C. * Antiarrhythmic effect.
D. Diuretic effect.
E. Antibacterial effect.
50. When does naphthysin used?
A. * Rhinitis, sinusitis.
B. Collapse.
C. Bronchial asthma.
D. For prolonged action of local anaesthetics.
E. Cardiac arrest.
51. Which of the following drugs is classified as selective alpha–1 antagonist?
A. * Prasozine
B. Anapryline
C. Epinephrine
D. Norepinephrine
E. Isadrine
52. Antianxiety agents have:
A. Hypnotic activity
B. Muscle relaxing and anticonvulsant effects
C. Amnesic properties
D. Exert a calming effect
E. * All of the above
53. Agents, stimulating CNS are all of the following except:
A. Fluoxetine
B. * Clozapine
C. Nootropil
D. Sydnocarb
E. Caffeine
54. Indicate the nootropic agent:
A. Sydnocarb
B. Eleuterococci extract
C. Fluoxetine
D. * Piracetam
E. Caffeine
55. Which of the following agents is a respiratory analeptic?
A. Piracetam
B. Sydnocarb
C. * Bemegride
D. Pantocrin
E. Morphine
56. Indicate the CNC stimulating drug, which belongs to adaptogens:
A. Amphetamine
B. * Eleuterococci extract
C. Caffeine
D. Sydnocarb
E. Nootropil
57. Adaptogens cause:
A. Improvement of efficiency using physical loads and acceleration of recovery after the load
B. Stimulation of respiratory and vasomotor centers
C. Temporary relief of the feeling of tiredness, facilitating the professional work and fighting
somnolence
D. * Increased resistance towards stress situations and adaptation to extreme conditions
E. None of the above
58. Which of the following agents is a general tone-increasing drug of plant origin?
A. Meridil
B. * Eleuterococci’s extract
C. Pantocrin
D. Caffeine
E. T-activin
59. Indicate a general tone-increasing drug, which is an agent of animal origin?
A. * Pantocrin
B. Amphetamine
C. Sydnocarb
D. Camphor
E. All of the above
60. Amphetamine:
A. Is a powerful stimulant of the CNS
B. Stimulates the medullar respiratory center and has an analeptic action
C. Increases motor and speech activity, mood
D. Decreases a sense of fatigue
E. * All of the above
61. Sydnocarb causes:
A. * Decreased sense of fatigue, it facilitates the professional work and fights somnolence
B. The feeling of prosperity, relaxation and euphoria
C. Influx of physical and mental forces, locomotive and speech excitation
D. Peripheral sympathomimetic action
E. None of the above
62. Indicate the psychostimulant, which is a methylxantine derivative:
A. * Caffeine
B. Sydnocarb
C. Amphetamine
D. Meridil
E. None of the above
63. Which of the following psychostimulants acts centrally mainly by blocking adenosine receptors?
A. Meridil
B. * Caffeine
C. Amphetamine
D. Sydnophen
E. None of the above
64. Caffeine can produce all of the following effects except:
A. Coronary vasodialation
B. Relaxation of bronchial tract smooth muscles
C. Relaxation of biliary tract smooth muscles
D. * Vasodialation of cerebral vessels
E. Reinforcement of the contractions and increase of the striaated muscle work
65. Therapeutic uses of caffeine include all of the following EXCEPT:
A. Cardiovascular collapse
B. Respiratory insufficiency
C. Migraine
D. Somnolence
E. * Gastric ulceration
66. Cordiamine is useful in the treatment of:
A. Hypotension
B. Coronary insufficiency
C. Respiratory insufficiency
D. * All of the above
E. None of the above
67. Which of the following CNS stimulants belongs to nootropics?
A. Camphor
B. Pantocrin
C. Sydnocarb
D. Caffeine
E. * Piracetam
68. Indicate the CNS stimulant, which is used in pediatric medicine, as it improves the communication with
the child, increases the ability to study and communication with peers, improves school-performance?
A. Meridil
B. * Piracetam
C. Bemegride
D. Amphetamine
E. Camphor
69. Which of the following CNS stimulants is used for the cerebral stroke treatment?
A. Pantocrin
B. Sydnocarb
C. * Piracetam
D. Caffeine
E. All of the above
70. Hypnotic drugs are used to treat:
A. Psychosis
B. * Sleep disorders
C. Narcolepsy
D. Parkinsonian disorders
E. All of the above
71. Hypnotic drugs should:
A. Reduce anxiety and exert a calming effect
B. Induce absence of sensation
C. * Produce drowsiness, encourage the onset and maintenance of sleep
D. Prevent mood swings in patients with bipolar affective disorders
E. Produce analgesia
72. Which of the following chemical agents are used in the treatment of insomnia?
A. Benzodiazepines
B. Imidazopyridines
C. Barbiturates
D. * All of the above
E. None of the above
73. Select a hypnotic drug, which is a benzodiazepine derivative:
A. Zolpidem
B. * Flurazepam
C. Secobarbital
D. Phenobarbitone
E. Thyopental
74. Tick a hypnotic agent – a barbituric acid derivative:
A. Flurazepam
B. Zaleplon
C. * Thyopental
D. Triazolam
E. Diazepam
75. Select a hypnotic drug, which is an imidazopyridine derivative:
A. Pentobarbital
B. Temazepam
C. * Zolpidem
D. Chloral hydrate
E. Thiopental
76. Which of the following hypnotic agents is absorbed slowly?
A. Phenobarbital
B. Flurazepam
C. Triazolam
D. Chloral hydrate
E. * Temazepam
77. Which of the following hypnotic drugs is more likely to cause cumulative and residual effects?
A. Zolpidem
B. Temazepam
C. * Phenobarbital
D. Triazolam
E. Zopiclon
78. Which of the following hypnotic drugs increases the activity of hepatic drug-metabolizing enzyme
systems?
A. * Phenobarbital
B. Zolpidem
C. Flurazepam
D. Zaleplon
E. Temazepam
79. Indicate the hypnotic drug, which does not change hepatic drug-metabolizing enzyme activity?
A. Flurazepam
B. Zaleplon
C. Triazolam
D. Temazepam
E. * All of the above
80. Which drug is used for ischemic heart disease, hypertension and cardiac arrhythmias?
A. * Bisoprolol
B. Sustac
C. Nitroglycerine
D. Novocainamidum
E. Validolum
81. Indicate the group of drugs influencing the cerebral flow:
A. Ca-channel blockers
B. Derivatives of GABA
C. Derivatives of Vinca minor plant
D. * All the above
E. None of the above
82. Tick the drug influencing the blood flow which is related to antiplatelet agents:
A. Heparin
B. * Aspirin
C. Pyracetam
D. Tanakan
E. Indometacin
83. Which of the following drugs is related to anticoagulants and may be useful in disorders of cerebral
circulation?
A. Aspirin
B. Trimetazidine
C. Cinnarizine
D. Nicergoline
E. * Heparin
84. Indicate the drugs which are Ca-channel blockers influencing the brain blood flow:
A. Aminalon, Picamilon
B. * Nimodipine, Cinnarizine
C. Heparin, Warfarin
D. Vinpocetine, Nicergoline
E. All of the above
85. Indicate the drugs influencing the blood flow in the brain - derivatives of GABA:
A. * Aminalon, Picamilon
B. Nimodipine, Cinnarizine
C. Heparin, Warfarin
D. Vinpocetine, Nicergoline
E. None of the above
86. Indicate the drug - Vinca minor alcaloid:
A. Nicergoline
B. Warfarin
C. Cinnarizine
D. * Vinpocetine
E. Nimodipine
87. Which of the following statements concerning nitrate mechanism of action is TRUE?
A. Therapeutically active agents in this group are capable of releasing nitric oxide (NO) in to vascular
smooth muscle target tissues
B. Nitric oxide (NO) is an effective activator of soluble guanylyl cyclase and probably acts mainly
through this mechanism
C. Nitrates useful in angina decrease myocardial oxygen requirement (by decreasing the determinations
of oxygen demand) and increase myocardial oxygen delivery (by reversing coronary arterial spasm)
D. * All of the above
E. None of the above
88. A concept «pharmacokinetics» includes
A. Kinds of actions of medicinal matters
B. Effects, caused medicinal matters
C. Localizations actions of medicinal matters
D. * Ways of use of medicinal matters
E. Mechanism of actions of medicinal matters
89. A concept «pharmacodynamics» includes
A. Biotransformation of medicinal matters
B. * Effects, caused medicinal matters
C. Pharmacokinetics of medicinal matters in an organism
D. Excretion of medicinal matters from an organism
E. Absorption of medicinal matters in an organism
90. To the parenteral ways of introduction of drugs
A. * Subcutaneous
B. Oral
C. Rectal
D. Sublingual
E. Intraduodenal
91. To the enteral ways of introduction of drugs
A. Intramuscular
B. * Rectal
C. Subcutaneous
D. Inhalation
E. Intravenous
92. Strengthening of action at the repeated introduction of medications is observed at
A. * Material accumulation
B. Tolerance
C. Physical dependence
D. Psychological dependence
E. Tachyphylaxis
93. Weakening of action at the repeated introduction of medications is observed at
A. Functinal accumulation
B. Physical dependece
C. Sensibility
D. * Tolerance
E. Idiosincrazia
94. Tolerance is characterized
A. Increasing of actions at the repeated application
B. * Decreasing of actions at repeated application
C. Tolerance
D. Sensibility
E. Fenomenom abolitions
95. Functinal accumulation is characterized
A. Action only at a reception into medication
B. By the «accumulation» of effect of medication
C. * Increasing of actions of medicinal agent
D. Endependes of increases of dose of medication
E. Decreasing of risk of origin of side and toxic effects
96. A type of co-operation of medications is in organism
A. * Sinergizm
B. Idiosincrazia
C. Tachyphylaxis
D. Accumulation
E. Tolerance
97. Etiotropic pharmacotherapy is directed on
A. Stop of undesirable symptoms
B. * Stop of reasons of disease
C. Stop of complications of disease
D. Stop of deficit of endogenous matters
E. Different links of pathogeny of illness
98. Rezorbtical action of medicinal matters shows up
A. Place of introduction of preparations
B. * After absorbtion of agents in blood
C. After leadingouts of medicinal matters from organism
D. Like answer for the irritation of sensible receptors
E. After application combined two and more medications
99. Signs, characteristic for medicinal dependence
A. Tachyphylaxis
B. Increasing of effect at the repeated introduction
C. * Aspiring to the repeated reception of medicine with the purpose of improvement of feel and
increase of mood
D. Sensibility
E. Material accumulation
100. Medicinal dependence shows up
A. Only intravenous introduction
B. Decreasing of actions at the repeated introduction
C. * Place of introduction of preparations
D. Increasing of actions at the repeated introduction
E. Functinal accumulation
101. Tachyphylaxis – it
A. Co-operations of medications
B. * the rapid development of tolerance on administration of closely spaced successive doses of a drug
or poison.
C. medicinal dependence
D. accumulation
E. allergic reaction of immediate type
102. The teratogenetic action of medications leads
A. * To birth of children with anomality
B. To the enhanceable sensitiveness to medications
C. To development of malignant tumours
D. To medicinal incompatibility
E. To the changes of genotype of posterity
103. Concept «Co-operation effect» two medicinal matters means
A. Decreasing of effects each of matters
B. Sensibility
C. Decreasing of durations of one action of matters
D. * Increasing of sums of effects both medicinal agents
E. Effects of medicinal dependence
104. Tick the drug – a derivative of ergot:
A. * Nicergoline
B. Warfarin
C. Cinnarizine
D. Vinpocetine
E. Heparin
105. Indicate the nootropic agent useful in disorders of brain circulation:
A. Aspirin
B. * Pyracetam
C. Warfarin
D. Ibuprofen
E. All the above
106. What is the main action of GABA derivatives in disorders of brain circulation?
A. Decrease of vessel permeability
B. * Stimulation of the metabolic processes in neurons
C. Brain vessel constriction
D. Intracranial pressure increase
E. Decrease of vessel permeability
107. Choose the appropriate mechanism of vinpocetine action:
A. * It dilates cerebral vessels and improves blood supply
B. It constricts cerebral vessels and decreases blood supply
C. It stimulates GABA-receptors and thus increases cerebral metabolic processes
D. It constricts peripheral vessels and increases blood pressure
E. None of the above
108. Antiplatelet drugs are used in disorders of brain circulation for:
A. Stimulation of the metabolic processes in neurons
B. Dilation of cerebral vessels
C. * Improving the microcirculation in cerebral tissue
D. All the above
E. None of the above
109. Migraine is a disorder connected with:
A. Thrombosis of cerebral vessels
B. Brain hemorrhage
C. * Dysfunction of regulation of cerebral vessel tonus
D. Malignant growth in brain
E. Inflammation in brain
110. The following Indol derivative is used for treatment of acute migraine attack:
A. Paracetamol
B. * Sumatriptan
C. Ergotamine
D. Metoclopramide
E. Dopamine
111. The following Ergot derivative is used for treatment of acute migraine attack:
A. Paracetamol
B. Sumatriptan
C. * Ergotamine
D. Metoclopramide
E. Dobutamine
112. The derivative of lysergic acid for migraine attack prevention is:
A. Metoclopramide
B. * Methysergide
C. Sumatriptan
D. Ergotamine
E. Tegaserod
113. Diltiazem is characterized by following:
A. It is a vasodilator
B. It has antiarrhythmic effect
C. Non-dihydropyridine Ca channel blocker
D. Block Ca channels in cardiac tissue & vascular smooth muscles
E. * All of the above
114. All of the following statements concerning the use of furosemide are true EXCEPT:
A. Loop-acting diuretic
B. Membrane ion transport inhibitor
C. Inhibits Na/K/2Cl cotransporter in ascending loop of Henle
D. Indicated in edema, heart failure, hypercalcemia
E. * Do not increase ototoxicity of aminoglycoside
115. Choose true statements concerning the use of methyldopa:
A. Antihypertensive drug
B. Adrenergic alpha 2 receptor agonist
C. Converted to active form methyl-norepinephrine which activates central alpha2 receptors
D. It is effective in pregnancy
E. * All of the above
116. Choose true statements concerning the use of losartan
A. Antihypertensives
B. Angiotensin receptor antagonist
C. Blocks AT II receptor in vascular smooth muscles & adrenal cortex
D. * All of the above
E. None of the above
117. Immunosupressive effect of glucocorticoids is caused by
A. * Reducing concentration of lymphocytes (T and B cells) and inhibiting function of tissue
macrophages and other antigen-presenting cells
B. Suppression of cyclooxygenase II expression that results in reducing amount of an enzyme available
to produce prostaglandins
C. Activation of phospholipase A2 and reducing prostaglandin and leukotriene synthesis
D. All of the above
E. None of the above
118. Antiallergic effect of glucocorticoids is caused by:
A. Suppression of leukocyte migration and stabilizing lysosomal membranes
B. Reverse the capillary permeability associated with histamine release
C. Suppression of the immune response by inhibiting antibody synthesis
D. * All of the above
E. None of the above
119. The Immunosuppressive agent is:
A. Corticosteroids
B. Cyclosporine
C. Tacrolimus (FK 506)
D. * All of the above
E. None of the above
120. Class of cyclosporine A is:
A. Interferons
B. * Immunosuppressive agents
C. Monoclonal antibodies
D. Immunoglobulins
E. Glucocorticoids
121. Side effect of cyclosporine A is:
A. Tremor
B. GI disturbance
C. Hepatotoxicity
D. * All of the above
E. None of the above
122. Side effect of cyclosporine A is:
A. * Tremor
B. Anorexia
C. Chills
D. Myalgia
E. All of the above
123. Side effect of cyclosporine A is:
A. Diarrhea
B. Headache
C. * GI disturbance
D. Immunosuppression
E. All of the above
124. Indication of cyclosporine A is:
A. Secondary immunodeficiency
B. Hairy cell leukemia
C. Primary immunodeficiency
D. * Idiopathic nephrotic syndrome
E. All of the above
125. Class of I.V. IgG preparation is:
A. Monoclonal antibodies
B. Immunosuppressive agents
C. Interferons
D. * Immunoglobulins
E. None of the above
126. Half-life of I.V. IgG preparation is:
A. 25-35 minutes
B. 19 hours
C. 4 - 16 hours
D. * 21 days
E. 3 days
127. Mechanism of action of I.V. IgG agent is:
A. Inhibits CD3 receptor
B. Inhibits calcineurin
C. Complement-mediated cytolysis of T lymphocytes
D. * Compete for Fc receptors with autoantibodies
E. None of the above
128. Indication for I.V. IgG agent administration is:
A. Kaposi's sarcoma
B. Acute rejection of organ transplant
C. Condyloma acuminatum
D. * Prophylaxis of certain infections
E. Viral hepatitis
129. Cytotoxic agents are the following EXCEPT:
A. Azathioprine
B. * Cyclosporine
C. Leflunomide
D. Cyclophosphamide
E. All of the above
130. Monoclonal antibodies is:
A. Trastuzumab
B. Rituximab
C. OKT-3
D. * All of the above
E. None of the above
131. Barbiturates increase the rate of metabolism of:
A. Anticoagulants
B. Digitalis compounds
C. Glucocorticoids
D. * All of the above
E. None of the above
132. Concept «Prolonging of effect» two medicinal matters means
A. Increasing of effect of both matters
B. * Increasing durations of action both agents
C. Decreasing of durations of action of both matters
D. Plus effects of both matters
E. Sensibility
133. Which of the following agents inhibits hepatic metabolism of hypnotics?
A. Flumasenil
B. * Cimetidin
C. Phenytoin
D. Theophylline
E. None of the above
134. Which of the following factors can influence the biodisposition of hypnotic agents?
A. Alterations in the hepatic function resulting from a disease
B. Old age
C. Drug-induced increases or decreases in microsomal enzyme activities
D. * All of the above
E. None of the above
135. Which of the following hypnotics is preferred for elderly patients?
A. Phenobarbital
B. Flurozepam
C. * Temazepam
D. Secobarbital
E. None of the above
136. Middle therapeutic dose of medication A. It is maximal amount of preparation, not causing a toxic action
B. * Necessary therapeutic action at majority of sick persons
C. Heavy poisoning
D. Therapeutic action at 50% patients
E. Poisoning at 50% of patients
137. Types of antagonism of two medicinal matters are in organism
A. * Inactive compound
B. Summarise effect
C. Pharmacephtical incompatibility
D. Potentiation of action
E. Etiotropical action
138. Types of transport of medicinal matters through a membrane
A. * Passiv difusion
B. Sublingual
C. Tachifilaxya
D. Inhibation of enzymes
E. Exocytosis
139. To indicate the possible side effect of Propranolol?
A. * Bronchial spasm
B. Tachycardia
C. Rise of АP
D. Ortostatic collapse
E. Development of tolerance
140. Why Novocainamide can’t inject intravenously quickly?
A. Cause tachycardia
B. * Cause decreasing of arterial pressure
C. Cause hypertension
D. Depress respiration
E. Have short acting period
141. What antiarrhythmic drug is paraaminobenzioc acid derevate?
A. * Novocainamidum
B. Chinidinum
C. Verapamilum
D. Xycainum
E. Dipheninum
142. What antiarrhythmic drug has local anaesthetic activity?
A. Novocainamidum
B. Chinidinum
C. Verapamilum
D. * Xycainum
E. Dipheninum
143. For treatment of what arrythmias Lidocaine is the most effective?
A. * Ventricular tachyarrhythmia
B. Atrium tachyarrhythmia
C. Atrio-ventrical block
D. Sino-auricular block
E. Chronic paroxismal arrhythmia
144. For treatmant of what kind of arrythmia cardiac glycosides are contraindicated?
A. * Ventricular tachyarrhythmia
B. Atrium tachyarrhythmia
C. Extrasystolia
D. Flutering of atrium
E. Chronic paroxismal arrhythmia
145. What medicine is a drug of choise for treatment of ventricular arrythmia?
A. Novocainamidum
B. Chinidinum
C. * Lidocaine
D. Dipheninum
E. Verapamilum
146. To indicate preparation of Nitroglycerine of prolong action
A. * Sustac
B. Amoidaronum
C. Molsidominum
D. Fenigidinum
E. Anaprilinum
147. Indicate the side effect of nitroglycerine
A. Itching of skin
B. Bradicardia
C. Rise of arterial pressure
D. * Headache
E. Intestine atony
148. Which antianginal drug provokes bronchial spasm?
A. Sustac
B. * Propranolol
C. Nitroglycerine
D. Fenigidinum
E. Molsidominum
149. 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
150. Indication to Sustac.
A. * Prophylaxis of attacks of angina pectoris
B. Removal of attacks of angina pectoris
C. Medical treatment of acute heart attack
D. Medical treatment of high blood pressure illness
E. Medical treatment of paroxismal tachycardia
151. Which preparation is drug of choice at attack of angina pectoris?
A. Sustac
B. Molsidominum
C. * Nitroglycerine
D. Anaprilinum
E. Fenigidinum
152. Which of the following hypnotics is preferred in patients with limited hepatic function?
A. * Zolpidem
B. Amobarbital
C. Flurozepam
D. Pentobarbital
E. Secobarbital
153. Indicate the mechanism of barbiturate action (at hypnotic doses):
A. * Increasing the duration of the GABA-gated Cl- channel openings
B. Directly activating the chloride channels
C. Increasing the frequency of Cl- channel opening events
D. All of the above
E. None of the above
154. Indicate a hypnotic drug - a selective agonist at the BZ1 receptor subtype:
A. Flurazepam
B. * Zolpidem
C. Triazolam
D. Flumazenil
E. Pentobarbital
155. Which of the following hypnotic agents is able to interact with both BZ1 and BZ2 receptor subtypes?
A. Zaleplon
B. Phenobarbital
C. * Flurazepam
D. Zolpidem
E. Flumazenil
156. Which of the following agents is preferred in the treatment of insomnia?
A. Barbiturates
B. * Hypnotic benzodiazepines
C. Ethanol
D. Phenothiazide
E. Ketanov
157. Barbiturates are being replaced by hypnotic benzodiazepines because of:
A. Low therapeutic index
B. Suppression in REM sleep
C. High potential of physical dependence and abuse
D. * All of the above
E. None of the above
158. Indicate the main claim for an ideal hypnotic agent:
A. Rapid onset of action
B. Sufficient duration of action
C. Minor effects on sleep patterns
D. Minimal “hangover” effects
E. * All of the above
159. Although the benzodiazepines continue to be the agents of choice for insomnia, they have:
A. The possibility of psychological and physiological dependence
B. Synergistic depression of CNS with other drugs (especially alcohol)
C. Residual drowsiness
D. Daytime sedation
E. * All of the above
160. Which one of the following hypnotic benzodiazepines is more likely to cause rebound insomnia?
A. * Triazolam
B. Flurazepam
C. Temazepam
D. All of the above
E. None of the above
161. Which of the following statements is correct for zolpidem?
A. Causes minor effects on sleep patterns
B. The risk of development of tolerance and dependence is less than with the use of hypnotic
benzodiazepines
C. Has minimal muscle relaxing effect
D. Has minimal muscle anticonvulsant effect
E. * All of the above
162. Which of the following hypnotic benzodiazepines is more likely to cause “hangover” effects such as
drowsiness, dysphoria, and mental or motor depression the following day?
A. Temazepam
B. Gidazepam
C. Triazolam
D. * Flurazepam
E. None of the above
163. Which agent exerts hypnotic activity with minimal muscle relaxing and anticonvulsant effects?
A. Flurazepam
B. Triazolam
C. * Zaleplon
D. None of the above
E. All of the above
164. Which of the following hypnotic drugs is used intravenously as anesthesia?
A. * Thiopental
B. Phenobarbital
C. Flurazepam
D. Zolpidem
E. Diazepam
165. Indicate the usual cause of death due to overdose of hypnotics:
A. * Depression of the medullar respiratory center
B. Hypothermia
C. Cerebral edema
D. Status epilepticus
E. All of the above
166. Toxic doses of hypnotics may cause a circulatory collapse as a result of:
A. Blocking alpa adrenergic receptors
B. Increasing vagal tone
C. * Action on the medullar vasomotor center
D. All of the above
E. None of the above
167. Local anesthetics produce:
A. Analgesia, loss of consciousness
B. Amnesia, loss of consciousness
C. * Blocking pain sensation without loss of consciousness
D. Alleviation of anxiety and pain with an altered level of consciousness
E. A stupor or somnolent state
168. Which from the antianginal preparations can be applying for the removal and for prophylaxis of attacks
of angina pectoris?
A. * Trinitrolong
B. Nitroglycerine
C. Sustac
D. Corvatonum
E. Validolum
169. Why is not it impossible to apply nitroglycerine in case of high intracranial pressure?
A. Increase АP
B. Causes bradycardia
C. * Increase intracranial pressure
D. Decrease intracranial pressure
E. Provoke angina pectoris
170. Which from preparations is used for ischemic heart disease and hypertension?
A. * Fenigidine
B. Sustac
C. Nitroglycerine
D. Novocainamaidum
E. Aspirine
171. To indicate preparation of nitroglycerine of prolong action
A. Fenigidinum
B. Amiodaronum
C. Molsidominum
D. * Sustac
E. Anaprilinum
172. Indicate possible side effect of propranolol?
A. Hypertension
B. Tachycardia
C. * Bradycardia
D. Оrtostatic collapse
E. Development of tolerance
173. The patient suffers by the ischemic heart disease. Which from the adopted antianginal drugs has
coronary dilation and antiplatelet action?
A. * Dipiridamolum
B. Acetylsalicylic acid
C. Validolum
D. Nitroglycerine
E. Molsidominum
174. After injection of medicines due to attack of angina pectoris patient noted a strong headache and
nausea. For what group of antianginal drugs is character such side effect?
A. Blockers of calcium channels
B. Beta – adrenergic blockers
C. * Nitrates
D. Vasodilators action on the coronal vessels
E. Beta – adrenergic stimulants
175. To note the drug for “controlled hypotension”
A. Reserpinum
B. Anaprilinum
C. Methyldopa
D. * Hygronium
E. Sibasonum
176. To indicate mechanism of Са2+ antagonists hypotensive action
A. Decrease the tonus of vasomotor centers
B. Block the postsynaptic beta-adrenoreceptors
C. Block the sympathetic ganglions
D. * Block the calcium channels
E. Stimulate the production of prostaglandins
177. Indicate the local anesthetic agent, which has a shorter duration of action:
A. Lidocaine
B. * Procaine
C. Bupivacaine
D. Ropivacaine
E. Novocainamid
178. For therapeutic application local anesthetics are usually made available as salts for the reasons of:
A. Less toxicity
B. Higher potency
C. Higher stability and greater lipid solubility
D. Less local tissue damage and more potency
E. * More stability and greater water solubility
179. Indicate the anesthetic agent of choice in patient with a liver disease:
A. Lidocaine
B. Bupivacaine
C. * Procaine
D. Etidocaine
E. Ultracaine
180. The primary mechanism of action of local anesthetics is:
A. Activation of ligand-gated potassium channels
B. * Blockade of voltage-gated sodium channels
C. Stimulation of voltage-gated N-type calcium channels
D. Blockade the GABA-gated chloride channels
E. None of the above
181. The more lipophylic drugs:
A. Are more potent
B. Have longer duration of action
C. Bind more extensively to proteins
D. * All of the above
E. None of the above
182. Indicate the function, which the last to be blocked:
A. Pain, temperature
B. Muscle spindles
C. * Motor function
D. Touch, pressure
E. Consciousness
183. Which of the following local anesthetics is an useful antiarrhythmic agent?
A. Cocaine
B. * Lidocaine
C. Bupivacaine
D. Ropivacaine
E. Ultracaine
184. Indicate the route of anesthetic administration, which is associated with instillation within epidural or
subarachnoid spaces:
A. Topical anesthesia
B. Infiltrative anesthesia
C. Regional anesthesia
D. * Spinal anesthesia
E. General anesthesia
185. The choice of a local anesthetic for specific procedures is usually based on:
A. The duration of action
B. Water solubility
C. Capability of rapid penetration through the skin or mucosa with limited tendency to diffuse away
from the site of application
D. * All of the above
E. None of the above
186. Indicate the drug belonging to M1-cholinoblockers:
A. Cimetidine
B. Ranitidine
C. * Pirenzepin
D. Omeprazole
E. Pantoprazole
187. Which of the following drugs may cause reversible gynecomastia?
A. Omeprazole
B. Pirenzepine
C. * Cimetidine
D. Sucralfate
E. Lansoprazole
188. Which of the following local anesthetics is a short-acting drug?
A. * Procaine
B. Tetracaine
C. Bupivacaine
D. Ropivacaine
E. All of the above
189. Indicate the local anesthetic, which is a long-acting agent:
A. Lidocaine
B. * Bupivacaine
C. Procaine
D. Mepivacaine
E. None of the above
190. The anesthetic effect of the agents of short and intermediate duration of action can be prolonged by
adding:
A. Epinephrine
B. Norepinephrine
C. Phenylephrine
D. * All of the above
E. None of the above
191. Which of the following local anesthetics is only used for surface or topical anesthesia?
A. * Cocaine
B. Tetracaine
C. Procaine
D. Bupivacaine
E. Lidocaine
192. Which of the following local anesthetics is used for infiltrative and regional anesthesia?
A. Procaine
B. Lidocaine
C. Mepivacaine
D. * All of the above
E. None of the above
193. Indicate the local anesthetic, which is used for spinal anesthesia:
A. * Tetracaine
B. Cocaine
C. Dibucaine
D. Bupivacaine
E. Propofol
194. Which of the following local anesthetics is called a universal anesthetic?
A. Procaine
B. Ropivacaine
C. * Lidocaine
D. Bupivacaine
E. Cocaine
195. Most serious toxic reaction to local anesthetics is:
A. Seizures
B. Cardiovascular collapse
C. Respiratory failure
D. * All of the above
E. None of the above
196. Correct statements concerning cocaine include all of the following EXCEPT:
A. Cocaine is often used for nose and throat procedures
B. Limited use because of abuse potential
C. * Myocardial depression and peripheral vasodilatation
D. Causes sympathetically mediated tachycardia
E. Causes vasoconstriction
197. Most local anesthetics can cause:
A. Depression of abnormal cardiac pacemaker activity, excitability, conduction
B. Depression of the strength of cardiac contraction
C. Cardiovascular collapse
D. * All of the above
E. None of the above
198. Which of the following opioid analgesics is used in the treatment of acute pulmonary edema?
A. * Morphine
B. Codeine
C. Fentanyl
D. Loperamide
E. Indapamide
199. The relief produced by intravenous morphine in dyspnea from pulmonary edema is associated with
reduced:
A. Perception of shortness of breath
B. Patient anxiety
C. Cardiac preload (reduced venous tone) and afterload (decreased peripheral resistance)
D. None of the above
E. * All of the above
200. The diagnostic triad of opioid overdosage is:
A. Mydriasis
B. * Coma, depressed respiration and miosis
C. Mydriasis, chills and abdominal cramps
D. Miosis, tremor and vomiting
E. Coma and hyperventilation
201. Which of the following opioid agents is used in the treatment of acute opioid overdose?
A. Pentazocine
B. Methadone
C. * Naloxone
D. Remifentanyl
E. Carbenoxolone
202. Indicate a partial mu receptor agonist, which has 20-60 times analgesic potency of morphine, and a
longer duration of action:
A. Pentazocine
B. * Buprenorphine
C. Nalbuphine
D. Naltrexone
E. Naloxone
203. Non-narcotic analgesics are mainly effective against pain associated with:
A. * Inflammation or tissue damage
B. Trauma
C. Myocardial infarction
D. Surgery
E. All of the above
204. Non-narcotic agents cause:
A. Respiratory depression
B. * Antipyretic effect
C. Euphoria
D. Physical dependence
E. Abstinence syndrome
205. Non-narcotic analgesics are all of the following drugs EXCEPT:
A. Paracetamol
B. Acetylsalicylic acid
C. * Butorphanol
D. Ketorolac
E. Ibuprofen
206. Select the non-narcotic drug, which is a paraaminophenol derivative:
A. Analgin
B. Aspirin
C. Baclophen
D. * Paracetamol
E. Ketoprofen
207. Which of the following non-narcotic agents is salicylic acid derivative?
A. Phenylbutazone
B. Ketamine
C. * Aspirin
D. Tramadol
E. Paracetamol
208. Tick pirazolone derivative:
A. Methylsalicylate
B. * Analgin
C. Paracetamol
D. Ketoralac
E. Indometacine
209. Which one of the following non-narcotic agents inhibits mainly cyclooxygenase (COX) in CNS?
A. * Paracetamol
B. Ketorolac
C. Acetylsalicylic acid
D. Ibuprofen
E. Naproxen
210. Most of non-narcotic analgesics have:
A. Anti-inflammatory effect
B. Analgesic effect
C. Antipyretic effect
D. * All of the above
E. None of the above
211. Correct statements concerning aspirin include all of the following EXCEPT:
A. It inhibits mainly peripheral COX
B. * It does not have an anti-inflammatory effect
C. It inhibits platelet aggregation
D. It stimulates respiration by a direct action on the respiratory center
E. It can produce ulceration
212. For which of the following conditions could aspirin be used prophylactically?
A. Noncardiogenic pulmonary edema
B. Peptic ulcers
C. * Thromboembolism
D. Metabolic acidosis
E. Glomerulonephritis
213. All of the following are undesirable effects of aspirin EXCEPT:
A. Gastritis with focal erosions
B. * Tolerance and physical addiction
C. Bleeding due to a decrease of platelet aggregation
D. Reversible renal insufficiency
E. None of the above
214. Characteristic findinds of salicylism include:
A. Headache, mental confusion and drowsiness
B. Tinnitus and difficulty in hearing
C. Hyperthermia, sweating, thirst, hyperventilation
D. vomiting and diarrhea
E. * All of the above
215. Methemoglobinemia is possible adverse effect of:
A. Aspirin
B. * Paracetamol
C. Analgin
D. Ketorolac
E. None of the above
216. Correct the statements concerning ketorolac include all of the following EXCEPT:
A. It inhibits COX
B. It is as effective as morphine for a short-term relief from moderate to severe pain
C. * It has a high potential for physical dependence and abuse
D. It does not produce respiratory depression
E. It does not produce constipation
217. Which of the following nonopioid agents is an antidepressant with analgesic activity?
A. Fluoxetine
B. Moclobemide
C. Tranylcypramine
D. * Amitriptyline
E. All of the above
218. Pharmacodynamics involves the study of following EXCEPT:
A. Biological effects of drugs
B. * Absorption and distribution of drugs
C. Mechanisms of drug action
D. Drug interactions
E. Therapeutic effects of drugs
219. Pharmacodynamics involves the study of following?
A. * Mechanisms of drug action
B. Biotransformation of drugs in the organism
C. Distribution of drugs in the organism
D. Excretion of drug from the organism
E. Binding to proteines
220. Pharmacodynamics involves the following?
A. Information about main mechanisms of drug absorption
B. * Information about unwanted effects
C. Information about biological barriers
D. Information about excretion of a drug from the organism
E. Information about biotransformation of drugs
221. Pick out the answer which is the most appropriate to the term “receptor”
A. All types of ion channels modulated by a drug
B. Enzymes of oxidizing-reducing reactions activated by a drug
C. * Active macromolecular components of a cell or an organism which a drug molecule has to combine
with in order to elicit its specific effect
D. Carriers activated by a drug
E. None of the above
222. What does “affinity” mean?
A. A measure of how tightly a drug binds to plasma proteins
B. * A measure of how tightly a drug binds to a receptor
C. A measure of inhibiting potency of a drug
D. A measure of bioavailability of a drug
E. A measure of biotransformation of a drug
223. Target proteins which a drug molecule binds are:
A. Only receptors
B. Only ion channels
C. Only carriers
D. * All of the above
E. None of the above
224. An agonist is a substance that:
A. Interacts with the receptor without producing any effect
B. * Interacts with the receptor and initiates changes in cell function, producing various effects
C. Increases concentration of another substance to produce effect
D. Interacts with plasma proteins and doesn’t produce any effect
E. All of the above
225. Narcotics analgesics should:
A. * Relieve severe pain
B. Induce loss of sensation
C. Reduce anxiety
D. Exert a calming effect
E. Induce a stupor or somnolent state
226. Chemical mediators in the nociceptive pathway are all of the following EXCEPT:
A. * Enkephalins
B. Kinins
C. Prostaglandins
D. Substance P
E. All of the above
227. Which of the following analgesics is a phenanthrene derivative?
A. Fentanyl
B. * Morphine
C. Methadone
D. Pentazocine
E. All of the above
228. Tick narcotic analgesic, which is a phenylpiperidine derivative:
A. Codeine
B. Dezocine
C. * Fentanyl
D. Buprenorphine
E. None of the above
229. Which of the following opioid analgesics is a strong mu receptor agonist?
A. Naloxone
B. * Morphine
C. Pentazocine
D. Buprenorphine
E. Ketanov
230. Indicate the narcotic analgesic, which is a natural agonist:
A. Meperidine
B. Fentanyl
C. * Morphine
D. Naloxone
E. Droperidol
231. Which of the following agents is a full antagonist of opioid receptors?
A. Meperidine
B. Buprenorphine
C. * Naloxone
D. Butorphanol
E. Morphine
232. The principal central nervous system effect of the opioid analgesics with affinity for a mu receptor is:
A. Analgesia
B. Respiratory depression
C. Euphoria
D. * All of the above
E. None of the above
233. Indicate the opioid analgesic, which has 80 times analgesic potency and respiratory depressant
properties of morphine, and is more effective than morphine in maintaining hemodynamic stability?
A. * Fentanyl
B. Pentazocine
C. Meperidine
D. Nalmefene
E. None of the above
234. Which of the following opioid analgesics is used in combination with droperidol in neuroleptanalgesia?
A. Morphine
B. Buprenorphine
C. * Fentanyl
D. Pentazocin
E. All of the above
235. Which of the following opioid analgesics can produce an increase in the pulmonary arterial pressure
and myocardial work?
A. Morphine
B. * Pentazocine
C. Meperidine
D. Methadone
E. Morphine & Pentazocine
236. Morphine causes the following effects EXCEPT:
A. Constipation
B. * Dilatation of the biliary duct
C. Urinary retention
D. Bronchiolar constriction
E. Myosis
237. Therapeutic doses of the opioid analgesics:
A. * Decrease body temperature
B. Increase body temperature
C. Decrease body heat loss
D. Do not affect body temperature
E. None of the above
238. If an agonist can produce maximal effects and has high efficacy it’s called:
A. Full antagonist
B. Partial agonist
C. Antagonist
D. Agonist-antagonist
E. * Full agonist
239. If an agonist can produce submaximal effects and has moderate efficacy it’s called:
A. * Partial agonist
B. Antagonist
C. Agonist-antagonist
D. Full agonist
E. None of the above
240. An antagonist is a substance that:
A. Binds to the receptors and initiates changes in cell function, producing maximal effect
B. Binds to the receptors and initiates changes in cell function, producing submaximal effect
C. Interacts with plasma proteins and doesn’t produce any effect
D. * Binds to the receptors without directly altering their functions
E. Interacts with plasma proteins and produce minimal effect
241. A competitive antagonist is a substance that:
A. Interacts with receptors and produces submaximal effect
B. * Binds to the same receptor site and progressively inhibits the agonist response
C. Binds to the nonspecific sites of tissue
D. Binds to one receptor subtype as an agonist and to another as an antagonist
E. Interacts with plasma proteins and doesn’t produce any effect
242. The substance binding to one receptor subtype as an agonist and to another as an antagonist is called:
A. Competitive antagonist
B. Irreversible antagonist
C. * Agonist-antagonist
D. Partial agonist
E. Partial antagonist
243. The increase of second messengers’ (cAMP, cGMP, Ca2+ etc.) concentration leads to:
A. Inhibition of intracellular protein kinases and protein phosphorylation
B. * Proteinkinases activation and protein phosphorylation
C. Blocking of interaction between a receptor and an effector
D. Antagonism with endogenous ligands
E. Activation of interaction between a receptor and an effector
244. Tick the substances whose mechanisms are based on interaction with ion channels
A. Sodium channel blockers
B. Calcium channel blockers
C. Potassium channels activators
D. * All of the above
E. None of the above
245. Give the definition for a therapeutical dose:
A. The amount of a substance to produce the minimal biological effect
B. The amount of a substance to produce effects hazardous for an organism
C. * The amount of a substance to produce the required effect in most patients
D. The amount of a substance to accelerate an increase of concentration of medicine in an organism
E. The amount of a substance to produce the minimal adverse effects
246. Pick out the correct definition of a toxic dose:
A. The amount of substance to produce the minimal biological effect
B. * The amount of substance to produce effects hazardous for an organism
C. The amount of substance to produce the necessary effect in most of patients
D. The amount of substance to fast creation of high concentration of medicine in an organism
E. The amount of a substance to produce the minimal adverse effects
247. Which effect may lead to toxic reactions when a drug is taken continuously or repeatedly?
A. Refractoriness
B. * Cumulative effect
C. Tolerance
D. Tachyphylaxis
E. Idiosyncrazy
248. What term is used to describe a more gradual decrease in responsiveness to a drug, taking days or
weeks to develop?
A. Refractoriness
B. Cumulative effect
C. * Tolerance
D. Tachyphylaxis
E. Idiosyncrazy
249. What term is used to describe a decrease in responsiveness to a drug which develops in a few minutes?
A. Refractoriness
B. Cumulative effect
C. Idiosyncrazy
D. Tolerance
E. * Tachyphylaxis
250. Tachyphylaxis is:
A. A drug interaction between two similar types of drugs
B. * Very rapidly developing tolerance
C. A decrease in responsiveness to a drug, taking days or weeks to develop
D. An unexpected reaction to a drug
E. None of the above
251. Tolerance and drug resistance can be a consequence of:
A. Drug dependence
B. * Increased metabolic degradation
C. Depressed renal drug excretion
D. Activation of a drug after hepatic first-pass
E. All of the above
252. Tolerance and drug resistance can be a consequence of:
A. * Change in receptors, loss of them or exhaustion of mediators
B. Increased receptor sensitivity
C. Decreased metabolic degradation
D. Decreased renal tubular secretion
E. Change in receptors
253. Dependence is often associated with
A. tolerance to a drug
B. a physical abstinence syndrome
C. psychological dependence (craving)
D. * All of the above
E. None of the above
254. The situation when failure to continue administering the drug results in serious psychological and
somatic disturbances is called?
A. Tachyphylaxis
B. Sensibilization
C. * Abstinence syndrome
D. Idiosyncrasy
E. None of the above
255. What is the type of drug-to-drug interaction which is connected with processes of absorption,
biotransformation, distribution and excretion?
A. Pharmacodynamic interaction
B. Physical interaction
C. Chemical interaction
D. Pharmaceutical interaction
E. * Pharmacokinetic interaction
256. What is the type of drug-to-drug interaction which is the result of interaction at receptor, cell, enzyme
or organ level?
A. * Pharmacodynamic interaction
B. Physical interaction
C. Pharmaceutical interaction
D. Pharmacokinetic interaction
E. Chemical interaction
257. What phenomenon can occur in case of using a combination of drugs?
A. Tolerance
B. Tachyphylaxis
C. Accumulation
D. * Synergism
E. Idiosyncrasy
258. If two drugs with the same effect, taken together, produce an effect that is equal in magnitude to the
sum of the effects of the drugs given individually, it is called as:
A. Antagonism
B. Potentiation
C. * Additive effect
D. None of the above
E. Cumulative effect
259. What does the term “potentiation” mean?
A. Cumulative ability of a drug
B. Hypersensitivity to a drug
C. Fast tolerance developing
D. Drug allergy
E. * Intensive increase of drug effects due to their combination
260. The types of antagonism are:
A. Summarized
B. Potentiated
C. Additive
D. Cumulative
E. * Competitive
261. The term “chemical antagonism” means that:
A. * two drugs combine with one another to form an inactive compound
B. two drugs combine with one another to form a more active compound
C. two drugs combine with one another to form a more water soluble compound
D. two drugs combine with one another to form a more fat soluble compound
E. none of the above
262. A teratogenic action is:
A. Toxic action on the liver
B. * Negative action on the fetus causing fetal malformation
C. Toxic action on blood system
D. Toxic action on kidneys
E. The ability of a substance to cause cancer
263. Characteristic unwanted reaction which isn’t related to a dose or to a pharmacodynamic property of a
drug is called:
A. Idiosyncrasy
B. * Hypersensitivity
C. Tolerance
D. Teratogenic action
E. Carcinogenicity
264. Idiosyncratic reaction of a drug is:
A. A type of hypersensitivity reaction
B. A type of drug antagonism
C. * Unpredictable, inherent, qualitatively abnormal reaction to a drug
D. Quantitatively exaggerated response
E. The ability of a substance to cause cancer
265. Therapeutic index (TI) is:
A. * A ratio used to evaluate the safety and usefulness of a drug for indication
B. A ratio used to evaluate the effectiveness of a drug
C. A ratio used to evaluate the bioavailability of a drug
D. A ratio used to evaluate the elimination of a drug
E. None of the above
266. All of the following are normally involved in the pathogenesis of heart failure EXCEPT:
A. A cardiac lesion that impairs cardiac output
B. An increase in peripheral vascular resistance
C. * A decrease in preload
D. An increase in sodium retention
E. An increase in water retention
267. All of the following are compensatory mechanisms that occur during the pathogenesis of congestive
heart failure EXCEPT:
A. An increase in ventricular end-diastolic volume
B. An increase in the concentration of plasma catecholamines
C. * An increase in vagal tone
D. Increased activity of the renin-angiotensin-aldosterone system
E. None of the above
268. All of the following are recommended at the initial stages of treating patients with heart failure
EXCEPT:
A. Reduced salt intake
B. * Verapamil
C. ACE inhibitors
D. Diuretics
E. Bea-blockers in low doses
269. All of the following agents belong to cardiac glycosides EXCEPT:
A. Digoxin
B. Strophantin K
C. * Amrinone
D. Digitoxin
E. Corglycon
270. The non-glycoside positive inotropic drug is:
A. Digoxin
B. Strophantin K
C. * Dobutamine
D. Digitoxin
E. Corglycon
271. Choose the derivative of the plant Foxglove (Digitalis):
A. * Digoxin
B. Strophantin K
C. Dobutamine
D. Amrinone
E. Mosydomin
272. All of the following statements regarding cardiac glycosides are true EXCEPT:
A. They inhibit the Na+/K+-ATPase and thereby increase intracellular Ca++ in myocardial cells
B. * They cause a decrease in vagal tone
C. Children tolerate higher doses of digitalis than do adults
D. The most frequent cause of digitalis intoxication is concurrent administration of diuretics that deplete
K+
E. None of the above
273. All of the following statements regarding cardiac glycosides are true EXCEPT:
A. They inhibit the activity of the Na+/K+-ATPase
B. * They decrease intracellular concentrations of calcium in myocytes
C. They increase vagal tone
D. They have a very low therapeutic index
E. None of the above
274. The most cardiac manifestation of glycosides intoxication is:
A. Atrioventricular junctional rhythm
B. Second-degree atrioventricular blockade
C. Ventricular tachycardia
D. * All the above
E. None of the above
275. The manifestations of glycosides intoxication are:
A. Visual changes
B. Ventricular tachyarrhythmias
C. Gastrointestinal disturbances
D. Second-degree atrioventricular blockade
E. * All the above
276. For digitalis-induced arrhythmias the following drug is favored:
A. Verapamil
B. Amiodarone
C. * Lidocaine
D. Propanolol
E. All the above
277. All of the following statements regarding cardiac glycoside-induced ventricular tachyarrhythmias are
true EXCEPT:
A. Lidocaine is a drug of choice in treatment
B. Digibind should be used in life-threatening cases
C. * They occur more frequently in patients with hyperkalemia than in those with hypokalemia
D. They are more likely to occur in patients with a severely damaged heart
E. Visual changes are the manifestation of glycosides intoxication
278. This drug is a selective beta-1 agonist:
A. Digoxin
B. * Dobutamine
C. Amrinone
D. Dopamine
E. Gastrocepine
279. This drug inhibits breakdown of cAMP in vascular smooth muscle:
A. Digoxin
B. Dobutamine
C. * Amrinone
D. Dopamine
E. Molsydomin
280. This drug is useful for treating heart failure because it increases the inotropic state and reduces
afterload:
A. Amiodarone
B. * Amrinone
C. Propanolol
D. Enalapril
E. Carvedilol
281. All of the following drugs are used in the treatment of severe congestive heart failure EXCEPT:
A. * Verapamil
B. Digoxin
C. Dobutamine
D. Dopamine
E. Spironolactone
282. Drugs most commonly used in chronic heart failure are:
A. Cardiac glycosides
B. Diuretics
C. Angiotensin-converting enzyme inhibitors
D. * All the above
E. None of the above
283. All of the following statements concerning angiotensin converting enzyme (ACE) inhibitors are true
EXCEPT:
A. * They act by inhibiting the ability of renin to convert angiotensinogen to angiotensin I.
B. Enalapril is a prodrug that is converted to an active metabolite
C. They reduce secretion of aldosterone
D. They can produce hyperkalemia in combination with a potassium-sparing diuretic
E. They have a vasodilating effect
284. All of the following effects of ACE inhibitors may be useful in treating heart failure EXCEPT:
A. They decrease afterload
B. * They increase circulating catecholamine levels
C. They reduce reactive myocardial hypertrophy
D. They increase myocardial beta-1 adrenergic receptor density
E. None of the above
285. All of the following statements concerning the use of angiotensin-converting enzyme (ACE) inhibitors
in the treatment of heart failure are true EXCEPT:
A. They improve hemodynamics by decreasing afterload
B. * They can increase plasma cholesterol levels
C. They may slow the progression of heart failure by preventing myocardial and vascular remodeling
D. They are effective first-line agents in the treatment of chronic heart failure
E. Enalapril is a prodrug that is converted to an active metabolite
286. Indicate the drug belonging to antitussives of narcotic type of action:
A. Glaucine hydrochloride
B. * Aethylmorphine hydrochloride
C. Tusuprex
D. Libexine
E. All of the above
287. Tick out the drug belonging to non-narcotic antitussives:
A. Libexine
B. * Tusuprex
C. Codeine
D. Aethylmorphine hydrochloride
E. None of the above
288. Indicate the expectorant with the reflex mechanism:
A. Sodium benzoate
B. * Derivatives of Ipecacucnha and Thermopsis
C. Trypsin
D. Ambroxol
E. Bromhexine
289. Tick the antitussive agent with a peripheral effect:
A. Codeine
B. Tusuprex
C. * Libexine
D. Glaucine hydrochloride
E. None of the above
290. This drug is a Class IC antiarrhythmic drug:
A. * Flecainide
B. Sotalol
C. Lidocaine
D. Amiodaron
E. Verapamil
291. This drug is a Class II antiarrhythmic drug:
A. Flecainide
B. * Propranolol
C. Lidocaine
D. Verapamil
E. Sotalol
292. This drug is a Class III antiarrhythmic drug:
A. Flecainide
B. * Sotalol
C. Lidocaine
D. Verapamil
E. Dilthiazem
293. This drug prolongs repolarization:
A. Flecainide
B. * Sotalol
C. Lidocaine
D. Verapamil
E. Dilthiazem
294. This drug is a Class IV antiarrhythmic drug:
A. Flecainide
B. Sotalol
C. Brethilium
D. Lidocaine
E. * Verapamil
295. This drug is used in treating supraventricular tachycardias:
A. * Digoxin
B. Dobutamine
C. Amrinone
D. Dopamine
E. Nitroglycerin
296. This drug has beta-adrenergic blocking activity:
A. Flecainide
B. * Sotalol
C. Lidocaine
D. Verapamil
E. Amiodaron
297. This is a drug of choice for acute treatment of ventricular tachycardias:
A. Flecainide
B. Sotalol
C. * Lidocaine
D. Verapamil
E. Dopamine
298. This drug is contraindicated in patients with moderate to severe heart failure:
A. Nifedipine
B. Lisinopril
C. * Verapamil
D. All of the above
E. None of the above
299. This drug is an effective bronchodilator:
A. Nifedipine
B. Verapamil
C. Sotalol
D. All of the above.
E. * None of the above
300. This drug is used intravenously to terminate supraventricular tachycardias:
A. Nifedipine
B. Molsidomine
C. * Verapamil
D. All of the above
E. None of the above
301. This drug has a little or no direct effect on chronotropy and dromotropy at normal doses
A. * Nifedipine
B. Diltiazem
C. Verapamil
D. All of the above
E. None of the above
302. All of the following calcium channel blockers are useful in the treatment of cardiac arrhythmias
EXCEPT:
A. Bepridil
B. Diltiazem
C. Verapamil
D. Digoxin
E. * Nifedipine
303. Tick the adverse reactions characteristic for lidocaine:
A. Agranulocytosis, leucopenia
B. Extrapyramidal disorders
C. * Hypotension, paresthesias, convulsions
D. Bronchospasm
E. Dyspepsia
304. All of the following are common adverse effects of calcium channel blockers EXCEPT:
A. * Skeletal muscle weakness
B. Dizziness
C. Headache
D. Flushing
E. Constipation
305. All of these drugs contain free sulfhydryl groups EXCEPT:
A. Acetylcysteine
B. Ambroxol
C. Bromhexin
D. Acetylcysteine&Ambroxol
E. * Trypsin
306. All of the following drugs destroy disulfide bonds of proteoglycans, which causes depolymerization
and reduction of viscosity of sputum, EXCEPT:
A. Acetylcysteine
B. Ambroxol
C. * Desoxiribonuclease
D. Bromhexin
E. None of the above
307. Which of these groups of drugs is used for asthma treatment?
A. Methylxanthines
B. M-cholinoblocking agents
C. Beta2 – agonists
D. Steroids
E. * All of the above
308. Tick the drug belonging to non-selective beta2-adrenomimics:
A. Salbutamol
B. * Isoprenaline
C. Salmeterol
D. Terbutaline
E. All of the above
309. Select the side effect characteristic for non-selective beta2-adrenomimics:
A. Depression of the breathing centre
B. * Tachycardia
C. Peripheral vasoconstriction
D. Dry mouth
E. All of the above
310. Pick out the bronchodilator drug related to xanthine:
A. Atropine
B. Ipratropium
C. Orciprenaline
D. Adrenaline
E. * Theophylline
311. Pick out the bronchodilator drug belonging to sympathomimics:
A. Isoprenaline
B. * Ephedrine
C. Atropine
D. Phormoterol
E. Salbutamol
312. The mechanism of methylxanthines action is:
A. * Inhibition of the enzyme phosphodiesterase
B. Beta2-adrenoreceptor stimulation
C. Inhibition of the production of inflammatory cytokines
D. Inhibition of M-cholinoreceptors
E. Inhibition of COX-oxygenase
313. Which of the following M-cholinoblocking agents is used especially as an anti-asthmatic?
A. Atropine
B. * Ipratropium
C. Platiphylline
D. Metacin
E. None of the above
314. Indicate the side effect of Theophylline:
A. Bradycardia
B. * Increased myocardial demands for oxygen
C. Depression of respiratory centre
D. Elevation of the arterial blood pressure
E. All of the above
315. All of the following drugs are inhaled glucocorticoids EXCEPT:
A. Triamcinolone
B. Beclometazone
C. * Sodium cromoglycate
D. Budesonide
E. Fluticazone
316. Choose the drug belonging to membrane stabilizing agents:
A. Zileutin
B. * Sodium cromoglycate
C. Zafirlucast
D. Montelucast
E. Budesonide
317. Indicate the drug which is a leucotriene receptor antagonist:
A. Sodium cromoglycate
B. * Zafirlucast
C. Zileutin
D. Triamcinolone
E. Zopiclon
318. To indicate side effect of Clophellinum (Clonidine)
A. Increasing of arterial pressure
B. Increasing of intraocular pressure
C. * Dryness in the mouth
D. Increasing of glands secretion
E. Increasing of intestine motility
319. To indicate the antihypertensive drug used for the medical treatment of hypertensive disease with
tachycardia and extrasystoles.
A. Methyldopa
B. Reserpinum
C. * Bisoprolol
D. Clophelinum
E. Dibazolum
320. What diuretic is used for the removal of hypertensive crisis?
A. * Furosemide
B. Mannitum
C. Triamteren
D. Dichlothiazide
E. Spironolactonum
321. To indicate the drug – blocker of angiotensin converting enzyme.
A. Anaprilinum
B. * Lisinopril
C. Methyldopa
D. Reserpinum
E. Dibazolum
322. To indicate– calcium channels blocker hypotensive drug
A. * Nifedepine
B. Captopril
C. Reserpinum
D. Anaprilinum
E. Dibazolum
323. Mechanism of enalapril action.
A. Blocks alpha-adrenoreceptors
B. * Blocks carboxypeptidase
C. Blocks M-cholinoreceptors
D. Has diuretic action
E. Has sympatholytic action
324. The patient suffers from hypertensive disease with bradiarrhythmia. What drug is necessary to
prescribe?
A. Platyphyllini hydrotartras
B. Ceftriaxone
C. Papaverinum
D. Paracetamol
E. * Methyldopa
325. The 45 years old patient has diagnosis Angina pectoris. Cardiosclerosis. Arrhythmia. Hypertensive
disease, Choose the drug for treatment?
A. * Nebivolol
B. Suprastine
C. Potassium chloride
D. Strophantine
E. Lidocaine
326. Indications of glucocorticoids are following, EXCEPT:
A. Gastrointestinal diseases (inflammatory bowel disease)
B. * Postmenopausal hormonal therapy
C. Inflammatory conditions of bones and joints (arthritis, bursitis, tenosynovitis)
D. Skin diseases (atopic dermatitis, dermatoses, localized neurodermatitis)
E. All of the above
327. What drug was prescribed to the patient with hypertensive disease (adrenotropic group). After some
time the pressure normalized, but developed bradycardia (50 beats on minute) and the atrio-ventricular
block.
A. * Propranolol
B. Papaverinum
C. Clophelinum
D. Mesatonum
E. Verapamilum
328. To indicate diuretic drug that is used for the removal of hypertensive crisis.
A. Oxytocine
B. Dichlothiazide
C. Triamteren
D. Spironolactonum
E. * Furosemide
329. What drug has been taking the patient with the hypertensive disease? The blood pressure normalized
but somnolence and dry cough developed.
A. Clophelinum
B. Prazosinum
C. * Enalapril
D. Aspirine
E. Adrenaline
330. The 56 years old woman with hypertensive disease appealed to the doctor. Methyldopa was prescribed
to her. Indicate a mechanism of action of this drug.
A. Violation of noradrenalin synthesis
B. Increasing of acetylcholine synthesis
C. Block of beta-adrenoreceptors
D. * Stimulating of alpha-adrenoreceptors
E. Depression of angiotensin converting enzyme activity
331. Patient with diagnosis of pheochromocytoma suffers from the high blood pressure which outgrows in
hypertensive crisis. What group of drugs will help in this situation?
A. Beta- adrenoblockers
B. Ganglionblockers
C. Sympatolitics
D. * alpha-adrenoblockers
E. Calcium channels blockers
332. To indicate what diuretics is used in the complex therapy of hypertensive crisis.
A. Spironolactonum
B. * Furosemide
C. Manit
D. Dichlothiazide
E. Triamterene
333. Nitrates relieve angina pain by reducing preload, which is:
A. Pressure within the heart
B. Pressure against which the heart must pump
C. Oxygen demand of the heart
D. * Blood volume within the heart
E. Contractility of the heart muscle
334. Which is a NOT a common side effect of nitroglycerin?
A. * Blurred vision
B. Flushing
C. Headache
D. Hypotension
E. Hypertension
335. Calcium channel blockers reduce myocardial oxygen demand by reducing afterload, which is:
A. Blood volume within the heart
B. Pressure within the heart
C. * Pressure against which the heart must pump
D. Contractility of the heart muscle
E. Oxygen demand of the heart
336. Which of the following nitrate agents 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
337. 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
338. Before administering isosorbide mononitrate (Imdur), a priority assessment would include:
A. Serum electrolytes
B. Blood urea nitrogen (BUN) and creatinine
C. * Blood pressure
D. Level of consciousness
E. Pressure within the heart
339. 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."
340. 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."
341. 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
342. An annoying side effect of ACE inhibitors that may be minimized by switching to an angiotensin
receptor blocking agent includes:
A. Orthostatic hypotension
B. * A dry, nonproductive cough
C. Fatigue
D. Hypokalemia
E. Hyperkalemia
343. Which of the following should not be taken concurrently with ACE inhibitors?
A. Lasix
B. Morphine
C. * Potassium
D. Natrium
E. Vicasolum
344. The doctor would plan to administer which of the following calcium channel blocking agents to a
patient with cerebral arterial spasms following a subarachnoid hemorrhage?
A. amlodipine (Norvasc)
B. diltiazem (Cardizem)
C. * nimodipine (Nimotop)
D. verapamil (Calan)
E. furosemidum
345. When explaining different medication regimens to treat hypertension during a community education
program, it would be accurate to state that African-Americans probably respond best to which
combination of medications?
A. ACE inhibitors and diuretics.
B. * Diuretics and calcium antagonists
C. Diuretics and beta-blockers
D. ACE inhibitors and beta-blockers
E. All of the above
346. Labetalol (Normodyne) and carvedilol (Coreg) are classified as:
A. Beta-blocking agents
B. Alpha1-blocking agents
C. * Combined alpha- and beta-blocking agents
D. Calcium channel blockers
E. Fibrinolytics
347. During assessment of a patient diagnosed with pheochromocytoma, the doctor auscultates a blood
pressure of 210/110 mm Hg. The nurse would expect to administer which of the following medications?
A. nadolol (Corgard)
B. * phentolamine (Regitine)
C. dobutamine (Dobutrex)
D. verapamil (Calan)
E. validolum
348. The pharmacist would monitor for reflex tachycardia in a patient receiving which classification of
antihypertensive agents?
A. Calcium channel blockers
B. Cardioselective beta-blockers
C. Nonselective beta-blockers
D. * Direct-acting vasodilators
E. Neuroleptics
349. ACE inhibitors and angiotensin receptor blockers both work to decrease blood pressure by:
A. Preventing the formation of angiotensin II
B. Enhancing sodium and water resorption
C. Increasing the breakdown of bradykinin
D. * Inhibiting aldosterone secretion
E. All of the above
350. All these drug groups useful in angina both decrease myocardial oxygen requirement (by decreasing
the determinations of oxygen demand) and increase myocardial oxygen delivery (by reversing coronary
arterial spasm), EXCEPT:
A. Nitrates and nitrite drugs (Nitroglycerin, Isosorbide dinitrate)
B. Calcium channel blockers (Nifedipine, Nimodipine)
C. * Beta-adrenoceptor-blocking drugs (Atenolol, Metoprolol)
D. Potassium channel openers (Minoxidil)
E. None of the above
351. This drug group useful in angina decreases myocardial oxygen requirement (by decreasing the
determinations of oxygen demand) and does not increase myocardial oxygen delivery (by reversing
coronary arterial spasm):
A. Nitrates and nitrite drugs (Nitroglycerin, Isosorbide dinitrate)
B. Myotropic coronary dilators (Dipyridamole)
C. Potassium channel openers (Minoxidil)
D. * Beta-adrenoceptor-blocking drugs (Atenolol, Mtoprolol)
E. None of the above
352. This drug group useful in angina increase myocardial oxygen delivery (by reversing coronary arterial
spasm) and does not decrease myocardial oxygen requirement (by decreasing the determinations of
oxygen demand):
A. Beta-adrenoceptor-blocking drugs (Atenolol, Metoprolol):
B. * Myotropic coronary dilators (Dipyridamole)
C. Calcium channel blockers (Nifedipine, Nimodipine)
D. Potassium channel openers (Minoxidil)
E. All of the above
353. Which of the following nitrates and nitrite drugs are long-acting?
A. Nitroglycerin, sublingual
B. Isosorbide dinitrate, sublingual (Isordil, Sorbitrate)
C. Amyl nitrite, inhalant (Aspirols, Vaporole)
D. * Sustac
E. All of the above
354. Which of the following nitrates and nitrite drugs is a short-acting drug?
A. Nitroglycerin, 2% ointment (Nitrol)
B. Nitroglycerin, oral sustained-release (Nitrong)
C. * Amyl nitrite, inhalant (Aspirols, Vaporole)
D. Sustac
E. None of the above
355. Which of the following nitrates and nitrite drugs is used for prevention of angina attack?
A. Nitroglycerin, 2% ointment (Nitrol)
B. Nitroglycerin, oral sustained-release (Nitrong)
C. Isosorbide mononitrate (Ismo)
D. * All of the above
E. None of the above
356. Duration of nitroglycerin action (sublingual) is:
A. * 10-30 minutes
B. 6-8 hours
C. 3-5 minutes
D. 1.5-2 hours
E. 2-3 hours
357. The following statements concerning mechanism of nitrate beneficial clinical effect are true, EXCEPT?
A. Decreased myocardial oxygen requirement
B. Relief of coronary artery spasm
C. Improved perfusion to ischemic myocardium
D. Diminishes preload (venous return to the heart)
E. * Increased myocardial oxygen consumption
358. Side effect of nitrates and nitrite drugs are, EXCEPT:
A. Orthostatic hypotension,
B. Tachycardia
C. * GI disturbance
D. Throbbing headache
E. Facial flushing
359. The following statements concerning mechanism of calcium channel blockers’ action are true,
EXCEPT:
A. * Therapeutically active agents in this group are capable of releasing nitric oxide (NO) in vascular
smooth muscle target tissues
B. Calcium channel blockers bind to L-type calcium channel sites
C. Calcium channel blockers useful in angina decrease myocardial oxygen requirement (by decreasing
the determinations of oxygen demand)
D. Calcium channel blockers increase myocardial oxygen delivery (by reversing coronary arterial
spasm)
E. Calcium channel blockers decrease transmembrane calcium current associated in smooth muscle with
long-lasting relaxation and in a cardiac muscle with a reduction in contractility
360. Which of the following antianginal agents is a calcium channel blocker?
A. Nitroglycerin
B. Lidocaine
C. Dipyridamole
D. Minoxidil
E. * Nifedipine
361. Which of the following cardiovascular system effects refers to a calcium channel blocker?
A. The reduction of peripheral vascular resistance
B. The reduction of cardiac contractility and, in some cases, cardiac output
C. Relief of coronary artery spasm
D. * All of the above
E. None of the above
362. Main clinical use of calcium channel blockers is:
A. Angina pectoris
B. Hypertension
C. Supraventricular tachyarrhythmias
D. None of the above
E. * All of the above
363. Which of the following antianginal agents is a myotropic coronary dilator:
A. * Dipyridamole
B. Validol
C. Atenolol
D. Alinidine
E. Sotalol
364. Which of the following antianginal agents is a beta-adrenoceptor-blocking drug:
A. Dipyridamole
B. Validol
C. * Metoprolol
D. Alinidine
E. Salmeterol
365. The following agents are cardioselective beta1-adrenoceptor-blocking drugs labeled for use in angina,
EXCEPT:
A. Metoprolol
B. Talinolol
C. Atenolol
D. * Propranolol
E. Carvedilol
366. Which of the following antianginal agents refers to reflex coronary dilators:
A. Dipyridamole
B. * Validol
C. Atenolol
D. Alinidine
E. Molsydomin
367. Which of the following statements concerning Validol is true:
A. Validol has a moderate reflex and vascular dilative action caused by the stimulation of sensitive nerve
endings
B. At sublingual administration the effect is produced in five minutes and 70 % of the preparation is
released in 3 minutes
C. It is used in cases of angina pectoris, motion sickness, nausea, vomiting when seasick or airsick and
headaches due to taking nitrates
D. * All of the above
E. None of the above
368. Which of the following antianginal agents is a potassium channel opener:
A. Dipyridamole
B. Validol
C. Atenolol
D. * Minoxidil
E. Lisinopril
369. This drug is a Class IA antiarrhythmic drug:
A. Sotalol
B. Propranolol
C. Verapamil
D. Amiodaron
E. * Quinidine
370. This drug is a Class IC antiarrhythmic drug:
A. Flecainide
B. Sotalol
C. Brethilium
D. * Lidocaine
E. Verapamil
371. Which of the following are the two modifying factors that contribute to why women have higher blood
peak concentrations of alcohol than men when consuming equivalent amounts?
A. Lower blood volume & increased hormones
B. Lower fat content & more gastric alcohol dehydrogenase (ADH)
C. Higher fat content & more gastric alcohol dehydrogenase (ADH)
D. Lower fat content & less gastric alcohol dehydrogenase (ADH)
E. * Higher fat content & less gastric alcohol dehydrogenase (ADH)
372. How much of morphine is metabolized on its first pass through the liver when administered orally?
A. * 90%
B. 70%
C. 50%
D. 30%
E. 10%
373. Which of the following is NOT a pharmacokinetic process?
A. Alteration of the drug by liver enzymes
B. Drug metabolites are removed in the urine
C. Movement of drug from the gut into general circulation
D. * The drug causes dilation of coronary vessels
E. The drug is readily deposited in fat tissue
374. 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
375. What organ is responsible for metabolism in the “first pass effect”?
A. Brain
B. Heart
C. Kidney
D. * Liver
E. Spleen
376. A patient presents with an overdose of acidic Aspirin. The drug ____ can be given to ____ the pH of
the urine and trap the Aspirin, preventing further metabolism.
A. * NaHCO3; Increase
B. NaHCO3; Decrease
C. NH4Cl; Increase
D. NH4Cl; Decrease
E. None of the above
377. A patient presents with an overdose of alkaline Codeine. The drug ____ can be given to ____ the pH of
the urine and trap the Codeine, preventing further metabolism.
A. NaHCO3; Increase
B. NaHCO3; Decrease
C. NH4Cl; Increase
D. * NH4Cl; Decrease
E. None of the above
378. Bioavailability (F) is the fraction or percentage of administered drug that reaches the systemic
circulation via a given route as compared to what route?
A. Oral
B. * IV (intravenous)
C. IO (intraosseous)
D. CSF (cerebrospinal fluid)
E. Whatever route attains the target drug concentration in plasma (CT)
379. Which of the following routers of administration is the most convenient, although may have a
bioavailability anywhere from 5-100%?
A. * PO (oral)
B. IV (intravenous)
C. IM (intramuscular)
D. SQ (subcutaneous)
E. Transdermal
380. Which of the following enteral administration routes has the largest first-pass effect?
A. SL (sublingual)
B. Buccal
C. Rectal
D. * Oral
E. None of the above
381. 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
382. Which of the following would receive drug slowly?
A. Liver
B. Brain
C. * Fat
D. Muscle
E. Kidney
383. What type of drugs can cross the blood-brain barrier?
A. Large and lipid-soluble
B. Large and lipid-insoluble
C. * Small and lipid-soluble
D. Small and lipid-insoluble
E. None of the above
384. Basic drugs, such as lidocaine, bind primarily to which of the following plasma proteins?
A. alpha-1-fetoprotein (AFP)
B. Gc-Globulin (GcG)
C. Albumin
D. * alpha 1-acid glycoprotein (AAG)
E. Transcortin
385. A decrease in drug-protein binding will lead to which of the following?
A. Decrease in the unbound drug concentration
B. Increase in free drug
C. * Increase in rate of drug elimination
D. Decrease in volume of distribution
E. None of the above
386. Which of the following locations can accumulate lipid-soluble drugs, has little or no receptors, and can
hold distributed drugs like barbiturates?
A. Liver
B. Kidney
C. Brain
D. * Fat
E. Fetus
387. Which of the following locations has high blood flow and is a site of excretion?
A. Liver
B. * Kidney
C. Brain
D. Fat
E. Fetus
388. What is the approximate lag time for equilibration between maternal blood and fetal tissues?
A. 20 mins
B. * 40 mins
C. 1 hour
D. 2 hours
E. 6 hours
389. Elderly patients often have ____ muscle mass and thus a(n) ____ Vd (volume of distribution).
A. More; Increased
B. More; Decreased
C. Less; Increased
D. * Less; Decreased
E. None of the above
390. 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
391. What is the goal of the P450 system (microsomes pinched off from endoplasmic reticulum)?
A. Metabolism of substances
B. Detoxification of substances
C. Increasing pH of compartments containing substances
D. Decreasing pH of compartments containing substances
E. * Metabolism of substances & Detoxification of substances
392. Pharmacokinetics is:
A. The study of biological and therapeutic effects of drugs
B. * The study of absorption, distribution, metabolism and excretion of drugs
C. The study of mechanisms of drug action
D. The study of methods of new drug development
E. All of the above
393. What does “pharmacokinetics” include?
A. Complications of drug therapy
B. * Drug biotransformation in the organism
C. Influence of drugs on metabolism processes
D. Influence of drugs on genes
E. All of the above
394. What does “pharmacokinetics” include?
A. Pharmacological effects of drugs
B. Unwanted effects of drugs
C. Chemical structure of a medicinal agent
D. * Distribution of drugs in the organism
E. All of the above
395. What does “pharmacokinetics” include?
A. Localization of drug action
B. Mechanisms of drug action
C. * Excretion of substances
D. Interaction of substances
E. All of the above
396. The main mechanism of most drugs absorption in GI tract is:
A. Active transport (carrier-mediated diffusion)
B. Filtration (aqueous diffusion)
C. Endocytosis and exocytosis
D. * Passive diffusion (lipid diffusion)
E. None of the above
397. A hydrophilic medicinal agent has the following property:
A. * Low ability to penetrate through the cell membrane lipids
B. Penetrate through membranes by means of endocytosis
C. Easy permeation through the blood-brain barrier
D. High reabsorption in renal tubules
E. None of the above
398. What does the term “bioavailability” mean?
A. Plasma protein binding degree of substance
B. Permeability through the brain-blood barrier
C. * Fraction of an uncharged drug reaching the systemic circulation following any route administration
D. Amount of a substance in urine relative to the initial doze
E. Amount of a substance obtained orally and quantity of intakes
399. The reasons determing bioavailability are:
A. Rheological parameters of blood
B. Amount of a substance obtained orally and quantity of intakes
C. * Extent of absorption and hepatic first-pass effect
D. Glomerular filtration rate
E. Permeability through the brain-blood barrier
400. Pick out the appropriate alimentary route of administration when passage of drugs through liver is
minimized:
A. Oral
B. Transdermal
C. * Rectal
D. Intraduodenal
E. All of the above
401. Which route of drug administration is most likely to lead to the first-pass effect?
A. Sublingual
B. * Oral
C. Intravenous
D. Intramuscular
E. Rectal
402. What is characteristic of the oral route?
A. Fast onset of effect
B. * Absorption depends on GI tract secretion and motor function
C. A drug reaches the blood passing the liver
D. The sterilization of medicinal forms is obligatory
E. All of the above
403. Tick the feature of the sublingual route:
A. * Pretty fast absorption
B. A drug is exposed to gastric secretion
C. A drug is exposed more prominent liver metabolism
D. A drug can be administrated in a variety of doses
E. All of the above
404. Pick out the parenteral route of medicinal agent administration:
A. Rectal
B. Oral
C. Sublingual
D. * Inhalation
E. None of the above
405. Parenteral administration:
A. Cannot be used with unconsciousness patients
B. Generally results in a less accurate dosage than oral administration
C. * Usually produces a more rapid response than oral administration
D. Is too slow for emergency use
E. All of the above
406. What is characteristic of the intramuscular route of drug administration?
A. Only water solutions can be injected
B. * Oily solutions can be injected
C. Opportunity of hypertonic solution injections
D. The action develops slower, than at oral administration
E. None of the above
407. Correct statements listing characteristics of a particular route of drug administration include all of the
following EXCEPT:
A. Intravenous administration provides a rapid response
B. Intramuscular administration requires a sterile technique
C. * Inhalation provides slow access to the general circulation
D. Subcutaneous administration may cause local irritation
E. None of the above
408. The volume of distribution (Vd) relates:
A. Single to a daily dose of an administrated drug
B. An administrated dose to a body weight
C. An uncharged drug reaching the systemic circulation
D. * The amount of a drug in the body to the concentration of a drug in plasma
E. An administrated dose to a body weight+ An uncharged drug reaching the systemic circulation
409. For the calculation of the volume of distribution (Vd) one must take into account:
A. * Concentration of a substance in plasma
B. Concentration of substance in urine
C. Therapeutical width of drug action
D. A daily dose of drug
E. All of the above
410. The term “biotransformation” includes the following:
A. Accumulation of substances in a fat tissue
B. Binding of substances with plasma proteins
C. Accumulation of substances in a tissue
D. * Process of physicochemical and biochemical alteration of a drug in the body
E. All of the above
411. Tick the drug type for which microsomal oxidation is the most prominent:
A. * Lipid soluble
B. Water soluble
C. Low molecular weight
D. High molecular weight
E. All of the above
412. Pick out the right statement:
A. Microsomal oxidation always results in inactivation of a compound
B. Microsomal oxidation results in a decrease of compound toxicity
C. * Microsomal oxidation results in an increase of ionization and water solubility of a drug
D. Microsomal oxidation results in an increase of lipid solubility of a drug thus its excretion from the
organism is facilitated
E. Microsomal oxidation results in an increase of water solubility of a drug
413. Stimulation of liver microsomal enzymes can:
A. * Require the dose increase of some drugs
B. Require the dose decrease of some drugs
C. Prolong the duration of the action of a drug
D. Intensify the unwanted reaction of a drug
E. All of the above
414. Metabolic transformation (phase 1) is:
A. Acetylation and methylation of substances
B. * Transformation of substances due to oxidation, reduction or hydrolysis
C. Glucuronide formation
D. Binding to plasma proteins
E. Glucuronide formation+ Binding to plasma proteins
415. Biotransformation of a medicinal substance results in:
A. * Faster urinary excretion
B. Slower urinary excretion
C. Easier distribution in organism
D. Higher binding to membranes
E. None of the above
416. Which of the following processes proceeds in the second phase of biotransformation?
A. * Acetylation
B. Reduction
C. Oxidation
D. Hydrolysis
E. Reduction+ oxidation
417. In case of liver disorders accompanied by a decline in microsomal enzyme activity the duration of
action of some drugs is:
A. Decreased
B. * Enlarged
C. Remained unchanged
D. Changed insignificantly
E. Remained unchanged or changed insignificantly
418. Half life (T 1/2) is the time required to:
A. * Change the amount of a drug in plasma by half during elimination
B. Metabolize a half of an introduced drug into the active metabolite
C. Absorb a half of an introduced drug
D. Bind a half of an introduced drug to plasma proteins
E. All of the above
419. Half life (T 1/2) doesn’t depend on:
A. Biotransformation
B. * Time of drug absorption
C. Concentration of a drug in plasma
D. Rate of drug elimination
E. Biotransformation and rate of drug elimination
420. Elimination is expressed as follows:
A. Rate of renal tubular reabsorption
B. Clearance speed of some volume of blood from substance
C. Time required to decrease the amount of drug in plasma by one-half
D. * Clearance of an organism from a xenobiotic
E. Time required to decrease the amount of drug in plasma by 80 %
421. Common adverse reactions of corticosteroidal therapy are:
A. bradycardia, mental dullness
B. anorexia, polyuria
C. tachycardia
D. * “moon face”, obese trunk
E. insomnia
422. The most specific agent for prevention of asthma is:
A. * Salbutamolum
B. Libexinum
C. Adrenalini hydrochloridum
D. Pertussinum
E. Mucaltinum
423. Proposed cellular mechanisms of theophylline's action include:
A. translocation of intracellular calcium
B. those mediated by increasing accumulation of intracellular cyclic AMP
C. those mediated by blockade of receptors for adenosine
D. * All of the above
E. None of the above
424. Theophylline clearance may be reduced by:
A. phenobarbital
B. warfarin
C. tobacco smoking
D. phenytoin
E. * ciprofloxacin
425. Factors which are important to consider in selecting a maintenance dose of theophylline in a patient
include all of the following EXCEPT:
A. smoking history
B. concomitant medication administration
C. presence of congestive heart failure or cor pulmonale
D. presence of hepatic failure
E. * presence of renal insufficiency
426. Manifestations of theophylline toxicity may include all of the following EXCEPT:
A. tremors
B. seizures
C. tachyarrhythmias
D. vomiting
E. * hyperkalemia
427. Regarding its actions, cromolyn is best described as:
A. bronchodilator
B. anticholinergic
C. beta agonist
D. * inhibitor of mast cell degranulation
E. glucocorticoid
428. Beta-2 selective adrenergic agonists include all EXCEPT:
A. terbutaline
B. albuterol
C. metaproterenol
D. * isoproterenol
E. pirbuterol
429. Adverse effects of beta-2 adrenergic bronchodilators include all of the following EXCEPT:
A. nervousness
B. headache
C. tachycardia
D. tremulousness
E. * lethargy
430. Which of the following work through cholinergic receptor antagonism?
A. theophylline
B. cromolyn
C. ephedrine
D. * ipratropium
E. salmeterol
431. Which of the following pharmacologic agents antagonize adenosine?
A. * theophylline
B. glucocorticoids
C. cromolyn sodium
D. propranolol
E. terbutaline
432. When comparing the relative adrenergic effects of the following drugs, the one which would have the
bronchodilative effect at normal doses is:
A. terbutaline
B. epinephrine
C. isoproterenol
D. isoetharine
E. * norepinephrine
433. Asthmatic patients could experience bronchoconstriction problems with which of the following agents?
A. * isoproterinol (Isuprel)
B. digoxin (Lanoxin)
C. pindolol (Visken) –
D. dextromethorphan
E. labetalol
434. What medical preparation is it necessary to prescribe to the patient with chronic non-obstructive
bronchitis, dry buzzling rales above all parts of the lungs, weakened vesicular breathing?
A. Diuretics;
B. Antitussive agents;
C. * Expectorants;
D. Broncholitics;
E. beta-blockers.
435. Which of the following can be administered orally and by inhalation?
A. Epinephrine
B. Albuterol
C. Pirbuterol
D. * Terbutaline
E. Isoproterenol
436. Which of the following is not true about Salmeterol?
A. administered by inhalation
B. long acting anti-asthmatic with a duration of 12 hours
C. * can lead to transient increase in PaO2, especially in poorly ventilated lung tissue
D. associated with improvement in patients homozygous for glycine at the B-16 locus of the betareceptor
E. none of the above
437. Which of the following is not true about Ipratropium bromide:
A. Anticholinergic agent administered by inhalation
B. better bronchodilator than Atropine
C. * better anti-asthmatic than Epinephrine
D. has no effect on mucocilliary clearance
E. none of the above
438. Which of the following asthma severity categories has a treatment including inhaled low-dose steroid,
cromolyn, nedocromil, zafirlukast or zileuton?
A. Mild intermittent asthma
B. * Mild persistent asthma
C. Moderated persistent asthma
D. Severe persistent asthma
E. Exercise-induced asthma
439. What is the first line drug for tuberculosis?
A. Rifampin
B. Rifabutin
C. Ethionamide
D. * Isoniazide
E. Ethambutol
440. Which of the following, along with Formoterol, is a long acting anti-asthmatic?
A. Albuterol
B. * Salmeterol
C. Metaproterenol
D. Terbutaline
E. Pirbuterol
441. Which of the following is a short acting leukotriene synthesis (5-lipoxygenase) inhibitor?
A. * Zileuton
B. Zafirlukast
C. Montelukast
D. Omalizumab
E. Theophyline
442. The following is true about Theophyline EXCEPT:
A. adenosine receptor agonist
B. causes tachycardia, jitterness and GIT irritation
C. take only orally and intravenously
D. used for long term control of asthma
E. * all of the above statements are true
443. The best drug choice to treat dyspnea in the dying patient is:
A. anti-cholinergic/anti-muscarinic (e.g. scopolamine)
B. anti-depressant (e.g. amitriptyline (Elavil))
C. anti-histamine (e.g. diphenhydramine (Benadryl))
D. local airway anesthetic (e.g. inhaled lidocaine)
E. * opioid analgesic (e.g. morphine)
444. Which one of the following drugs is a selective beta2-agonist?
A. Epinephrine
B. Norepinephrine
C. * Salbutamol
D. Isoproterenol
E. Dobutamine
445. The route by which isoniazid is usually administered is:
A. * oral
B. intramuscular injection of solution
C. intramuscular injection of suspension
D. subcutaneous injection of solution
E. intravenous
446. Rifampin is used mainly in the treatment of:
A. cholera
B. typhoid fever
C. * tuberculosis
D. rickettsial diseases
E. pseudomonas infections
447. An antitubercular agent which is associated with the development of ocular toxicity is:
A. rifampin
B. * ethambutol
C. isoniazid
D. streptomycin
E. para-aminosalicylic acid
448. Which of the following antitubercular agents is associated with the development of ototoxicity?
A. rifampin
B. ethambutol
C. isoniazid
D. * streptomycin
E. para-aminosalicylic acid
449. Which of the following antibiotics is most closely associated with the development of ocular toxicity?
A. * ethambutol
B. kanamycin
C. penicillin G
D. tetracycline
E. isoniazid
450. Which of the following antibiotics is most closely associated with the development of hepatitis?
A. kanamycin
B. penicillin G
C. * tetracycline
D. isoniazid
E. ethambutol
451. Which of the following antibiotics is most closely associated with the development of renal and
ototoxicity?
A. * kanamycin
B. penicillin G
C. tetracycline
D. isoniazid
E. ethambutol
452. Which of the following agents used in the treatment of pulmonary tuberculosis has a toxicity of
producing a lupus-like syndrome?
A. * isoniazid
B. rifampin
C. ethambutol
D. streptomycin
E. para-amino salicylic acid
453. Tubercule bacilli exist in tuberculous patients in three pools extracellular, intracellular, and necrotic
caseum. The only drug which is bactericidal for all three is:
A. isoniazid
B. ethambutol
C. pyrazinamide
D. * rifampin
E. streptomycin
454. Ethambutol has become a primary treatment drug in the therapy of tuberculosis because of its
infrequent side effects. The only significant toxic effect is:
A. bone marrow suppression
B. renal tubular damage
C. * retrobulbar neuritis
D. hepatitis
E. Stevens-Johnson Syndrome
455. Which of the following antitubercular drugs has hyperuricemia as one of its well-documented untoward
effects?
A. streptomycin
B. isoniazid
C. cycloserine
D. rifampin
E. * pyrazinamide
456. All of the following are considered primary drugs in the current therapeutic approaches to the treatment
of tuberculosis EXCEPT:
A. streptomycin
B. * para-aminosalicylic acid
C. isoniazid
D. rifampin
E. ethambutol
457. Which of the following agents used in the treatment of pulmonary tuberculosis has a toxicity of
producing a lupus-like syndrome?
A. * isoniazid
B. rifampin
C. ethambutol
D. streptomycin
E. para-amino salicylic acid
458. The route by which isoniazid is usually administered is:
A. * oral
B. intramuscular injection of solution
C. intramuscular injection of suspension
D. subcutaneous injection of solution
E. intravenous
459. Rifampin is used mainly in the treatment of:
A. cholera
B. typhoid fever
C. * tuberculosis
D. rickettsial diseases
E. pseudomonas infections
460. Impaired vision is an adverse effect of:
A. carbenicillin
B. * ethambutol
C. rifampin
D. colistin
E. cycloserine
461. Various drugs may induce vitamin deficient states as an undesirable side effect. Vitamine B6
(pyridoxine) deficiency may be related to taking:
A. estrogen-containing oral contraceptives
B. colchicine
C. * isoniazid
D. metotrexate
E. All of the above
462. Most adults who are at high risk of developing pulmonary tuberculosis should be treated with:
A. isoniazid 100 mg/day for 6 months
B. * isoniazid 300 mg/day for 12 months
C. ethambutol 400 mg/day for 12 months
D. rifampin 600 mg/day for 24 months
E. No treatment is necessary
463. An antitubercular agent which is associated with the development of ocular toxicity is:
A. rifampin
B. * ethambutol
C. isoniazid
D. streptomycin
E. para-aminosalicylic acid
464. Which of the following antitubercular agents is associated with the development of ototoxicity?
A. rifampin
B. ethambutol
C. isoniazid
D. * streptomycin
E. para-aminosalicylic acid
465. Which of the following antibiotics is most closely associated with the development of hepatitis?
A. kanamycin
B. penicillin G
C. tetracycline
D. * isoniazid
E. ethambutol
466. Which of the following antibiotics is most closely associated with the development of renal and
ototoxicity?
A. * kanamycin
B. penicillin G
C. tetracycline
D. isoniazid
E. ethambutol
467. Which of the following agents used in the treatment of pulmonary tuberculosis has the side effect of
loss of perception of the color green?
A. isoniazid
B. rifampin
C. * ethambutol
D. streptomycin
E. para-aminosalicylic acid
468. Isoniazid-induced liver damage:
A. occurs primarily in patients under 30 years of age
B. occurs with increased frequency in patients receiving concomitant ethambutol therapy
C. * is probably due to the formation of a toxic hydrazine metabolite that binds to liver protein
D. is frequently associated with allergic manifestations such as eosinophilia, fever, and rash
E. All of the above
469. The following structure is a protease inhibitor. What is the name of the structure?
A. * Ritonavir
B. Lopinavir
C. Saquinavir
D. Aciclovir
E. All of the above
470. Which of the following is a bactericidal antitubercular drug that has an inhibitory action on cell wall
synthesis?
A. * isoniazid
B. rifampin
C. ethambutol
D. streptomycin
E. para-aminosalicylic acid
471. A bacteriostatic antimicrobial that inhibits protein synthesis by blocking attachment of aminoacyi tRNA to the A site on the 30S bacterial ribosome
A. Aminoglycosides
B. Fluoroquinolones
C. Metronidazole
D. Sulfonamide
E. * Tetracycline
472. Serious side effects of glucocorticoids include the following, EXCEPT:
A. Acute peptic ulcers
B. Iatrogenic Cushing’s syndrome (rounding, puffiness, fat deposition and plethora alter the
appearance of the face – moon faces)
C. * Salicylism (vomiting, tinnitus, decreased hearing, and vertigo)
D. Hypomania or acute psychosis
E. None of the above
473. The main indications for Rifampicine is:
A. Cholera
B. Typhoid fever
C. * Tuberculosis
D. Rickettsial diseases
E. Pseudomonas infections
474. Mycobacterium avium prophylaxis in HIV patients
A. Rifabutin
B. dapsone/pyrimethamine
C. azithromycin
D. * Rifabutin & azithromycin
E. All of the above
475. The most specific agent for prevention of asthma is:
A. * Salbutamolum
B. Libexinum
C. Adrenalini hydrochloridum
D. Pertussinum
E. Mucaltinum
476. Proposed cellular mechanisms of theophylline's action include:
A. translocation of intracellular calcium
B. those mediated by increasing accumulation of intracellular cyclic AMP
C. those mediated by blockade of receptors for adenosine
D. * All of the above
E. None of the above
477. Theophylline clearance may be reduced by:
A. phenobarbital
B. warfarin
C. tobacco smoking
D. phenytoin
E. * ciprofloxacin
478. Manifestations of theophylline toxicity may include all of the following EXCEPT:
A. tremors
B. seizures
C. tachyarrhythmias
D. vomiting
E. hyperkalemia
479. Call factors which are important to consider in selecting a maintenance dose of theophylline in a patient
include all of the following EXCEPT:
A. smoking history
B. concomitant medication administration
C. presence of congestive heart failure or cor pulmonale
D. presence of hepatic failure
E. * presence of renal insufficiency
480. Cromolyn, regarding its actions, is best described as:
A. bronchodilator
B. anticholinergic
C. beta agonist
D. * inhibitor of mast cell degranulation
E. glucocorticoid
481. Beta-2 selective adrenergic agonists include all EXCEPT:
A. terbutaline
B. albuterol
C. metaproterenol
D. * isoproterenol
E. pirbuterol
482. Adverse effects of beta-2 adrenergic bronchodilators include all of the following EXCEPT:
A. nervousness
B. headache
C. tachycardia
D. tremulousness
E. * lethargy
483. Name, which of the following work through cholinergic receptor antagonism?
A. isoetharine
B. cromolyn
C. ephedrine
D. * ipratropium
E. salmeterol
484. Indicate, which of the following pharmacologic agents antagonize adenosine?
A. * theophylline
B. glucocorticoids
C. cromolyn sodium
D. propranolol
E. terbutaline
485. Bactericidal drugs that act by inhibiting DNA gyrase
A. Aminoglycoside
B. Fluoroquinolones
C. Macrolides
D. Rifamycins
E. Sulfonamides
486. Which of the following can be administered orally and by inhalation?
A. Epinephrine
B. Albuterol
C. Pirbuterol
D. * Terbutaline
E. Isoproterenol
487. Which of the following is not true about Salmeterol?
A. administered by inhalation
B. long acting anti-asthmatic with a duration of 12 hours
C. * can lead to transient increase in PaO2, especially in poorly ventilated lung tissue
D. associated with improvement in patients homozygous for glycine at the B-16 locus of the betareceptor
E. none of the above
488. Which of the following is not true about Ipratropium bromide:
A. Anticholinergic agent administered by inhalation
B. better bronchodilator than Atropine
C. * better antiasthmatic than Epinephrine
D. has no effect on mucocilliary clearance
E. none of the above
489. What is the first line drug for tuberculosis?
A. Rifampin
B. Rifabutin
C. Ethionamide
D. * Isoniazide
E. Ethambutol
490. Which of the following, along with Formoterol, is a long acting anti-asthmatic?
A. Albuterol
B. * Salmeterol
C. Metaproterenol
D. Terbutaline
E. Pirbuterol
491. Binds to the 50 s bacterial ribosome and prevents the translocation step in protein synthesis
A. Aminoglycosides
B. Daptomycin
C. Linezolid
D. * Macrolides
E. Metronidazole
492. Binds to the 30s bacterial ribosome and blocks the initiation step in protein synthesis. May cause
miscoding
A. * Aminoglycosides
B. Daptomysin
C. Linezolid
D. Metronidazole
E. Rifampin
493. Inhibits the formation of folic acid by competing with PABA for dihydropteroate synthase
A. Metronidazole
B. Rifampin
C. * Sulfamethoxazole
D. Trimethoprin
E. Linezolid
494. Binds to the D-Ala-D-Ala terminal end of peptidoglycan side chains, resulting in inhibition of
transglycosylation and disruption of cross-linking in the cell wall
A. Chloramphenicol
B. Clavulanic
C. Imipenem
D. * Vancomycin
E. Metronidazole
495. Combination of these two drugs would produce an antagonistic (undesirable) antimicrobial effect when
treating an infection
A. Amoxicillin+ gentamicin
B. Cephalexin+ gentamicin
C. Sulfamethoxazole+ trimethoprim
D. * Tetracycline+ amoxicillin
E. Vancomycin+ gentamicin
496. Which of the following antitubercular agents is associated with the development of ototoxicity?
A. rifampin
B. ethambutol
C. isoniazid
D. * streptomycin
E. para-aminosalicylic acid
497. Which form of resistance to the effect of antimicrobial drugs is specific to beta-lactam type antibiotics
A. Decreased drug uptake
B. Methylation of the antibiotic’s receptor
C. Decreased metabolic activation
D. Altered amount of drug receptor
E. * Increased enzymatic destruction of the antibiotic
498. 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
499. Bacterial resistance to this drug results from a plasmid mediated mechanism that results in an altered
ribosomal binding site within the bacteria
A. Ampicillin
B. * Azithromycin
C. Penicillin
D. Piperacillin
E. Vancomycin
500. Which of the following antimicrobial drugs is bactericidal
A. Azithromycin
B. Doxycycline
C. Erythromycin
D. * Gentamicin
E. Tetracycyline
501. Which of the following antinmicrobials is taken up into bacteria by an oxygen-dependent mechanim
and is therefore ineffective against anaerobic organisms
A. Cefoxitin
B. Clindamycin
C. * Gentamicin
D. Metronidazole
E. Ticarcillin
502. Ethambutol has become a primary treatment drug in the therapy of tuberculosis because of its
infrequent side effects. The only significant toxic effect is:
A. bone marrow suppression
B. renal tubular damage
C. * retrobulbar neuritis
D. hepatitis
E. Stevens-Johnson Syndrome
503. Which of the following antitubercular drugs has hyperuricemia as one of its well-documented untoward
effects?
A. streptomycin
B. isoniazid
C. cycloserine
D. rifampin
E. * pyrazinamide
504. All of the following are considered primary drugs in the current therapeutic approaches to the treatment
of tuberculosis EXCEPT:
A. streptomycin
B. * para-aminosalicylic acid
C. isoniazid
D. rifampin
E. ethambutol
505. Which of the following is the general mechanism of action for erythromycin?
A. Inhibition of a metabolic enzyme
B. Inhibition of cell wall synthesis
C. * Disruption of protein synthesis
D. Inhibition of nucleic acid transcription and replication
E. None of the above
506. The main route of administration of a drug to produce a local effect is:
A. * Topical
B. Oral
C. Parenteral
D. All of the above
E. None of the above
507. All these Drugs are cause obstipation Except:
A. Anticholinergic agents
B. Ca2+ channel antagonists
C. Opioids
D. Tricyclic antidepressants
E. * Muscarinic agonists
508. The drug of choice for Streptococcus pneumonia (pneumococcus) in a patient with no drug allergies is:
A. erythromycin
B. * penicillin
C. vancomycin
D. ceftriaxone
E. gentamicin
509. Which of the following is the general mechanism of action for fluoroquinolones?
A. Inhibition of a metabolic enzyme
B. Inhibition of cell wall synthesis
C. Disruption of protein synthesis
D. * Inhibition of nucleic acid transcription and replication
E. None of the above
510. 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
511. Which of the following statements is true regarding the properties of benzylpenicillin?
A. It is a bacteriostatic agent.
B. It is active over a wide range of bacterial species.
C. It is resistant to beta-lactamases.
D. * Certain individuals may have an allergic response to it.
E. All of the above
512. The following structure is a first generation cephalosporin. What is the name of the structure?
A. Cefazolin
B. Cefoxitin
C. Cefuroxime
D. * Cefalexin
E. All of the above
513. Pharmacokinetics considers:
A. * The way in which the body affects a drug by the processes of absorption, distribution, metabolism
and excretion
B. The effects of the drug on the body and the mode of drug action
C. The proportion of administered drug that is available to have an effect
D. The removal of the drug by the liver before it has become available for use
E. All of the above
514. The rate of drug absorption is greatest in:
A. * The small intestine
B. The large intestine
C. The stomach
D. All of the above
E. The small intestine & the large intestine
515. Which of the following antibiotics is a tetracycline?
A. Chloramphenicol
B. * Doxycycline
C. Streptomycin
D. Erythromycin
E. None of the above
516. Drug distribution may depend on tissue perfusion:
A. Highly vascular organs rapidly acquire a drug
B. Highly vascular organs acquire a drug slowly
C. Levels of a drug in bone may rise quickly due to its high vascularity
D. Levels of a drug in bone may rise slowly due to its reduced vascularity
E. * Highly vascular organs rapidly acquire a drug & levels of a drug in bone may rise slowly due to
its reduced vascularity
517. Correct statements about glucocorticoids include all of the following, EXCEPT:
A. Effects of glucocorticoids are mediated by widely distributed glucocorticoid receptors that are
members of the superfamily of nuclear receptors.
B. Glucocorticoids have dose-related metabolic effects on carbohydrate, protein, and fat metabolism.
C. * Glucocorticoids have pro-inflammatory effects.
D. Glucocorticoids have catabolic effects in lymphoid and connective tissue, muscle, fat, and skin.
E. Glucocorticoids have antiallergic effects
518. Most drugs and metabolites are excreted by:
A. * The kidneys
B. The bile
C. The lungs
D. Perspiration, saliva and tears
E. None of the above
519. Pharmacodynamics considers:
A. The way in which the body affects a drug
B. * The effects of the drug on the body and the mode of drug action
C. Drug metabolism
D. All of the above
E. None of the above
520. A drug that binds to a cell receptor and causes a response is called an:
A. * Agonist
B. Antagonist
C. Agonist-antagonist
D. Receptor blocker
E. None of the above
521. A drug allergy occurs:
A. When too much drug has accumulated in an individual
B. * When the body sees the drug as an antigen and an immune response is established against the
drug
C. An unwanted but predictable response to a drug
D. None of the above
E. All of the above
522. Factors affecting a client’s response to a drug include:
A. Body weight i.e. the larger the individual, the larger the area for drug distribution
B. Body fat – A loss of body fat stores means less drug available for activity
C. Body fat – An increase in body fat means greater sequestering in body fat and less drug activity
D. The presence of certain foods
E. * All are true EXCEPT: A loss of body fat stores means less drug available for activity
523. Choose the necessary component of therapy of pneumonia complicated by pleurisy with effusion:
A. Inhibitors of proteinases;
B. Diuretic;
C. * Pleurocentesis;
D. Antiviral therapy;
E. Cardiac glycosides.
524. Choose the necessary component of therapy of pneumonia complicated by pleurisy with effusion:
A. Inhibitors of proteinases;
B. Diuretic;
C. * Antibiotics;
D. Antiviral therapy;
E. Cardiac glycosides.
525. Rationale for antiviral treatment of acute HIV patients (initial viremia):
A. * reduction in rate of viral mutation
B. decrease severity of acute disease
C. both
D. neither
E. None of the above
526. Agents useful in treating mycobacterial infections in HIV patients:
A. clarithromycin (Biaxin)
B. ethambutol (Myambutol)
C. amikacin (Amikin)
D. * all of the above may be useful
E. None of the above
527. Properties of tetracycline (Achromycin):
A. inhibitor of bacterial cell wall synthesis
B. * drug of choice in treating typhus
C. cleared primarily by the liver
D. inhibitor of bacterial cell wall synthesis & drug of choice in treating typhus
E. None of the above
528. Suitable for treatment of bacterial meningitis caused by H. Influenzae:
A. * cefotaxime (Claforan)
B. cephalexin (Keflex)
C. cephalothin (Keflin)
D. cefadroxil (Duricef, Ultracef)
E. None of the above
529. More likely to cause polyneuritis in patients who are"slow acelators"; this antibiotic is inactivated by
the liver.
A. clindamycin (Cleocin)
B. * isoniazid (INH)
C. nafcillin (Nafcil, Unipen)
D. vancomycin (Vancocin)
E. None of the above
530. Alternative antimicrobial drug(s) for treating penicillin-resistant S. aureus:
A. * vancomycin (Vancocin)
B. nafcillin (Nafcil, Unipen)
C. methicillin (Staphcillin)
D. All of the above
E. None of the above
531. Antibiotic's clearance from the body most likely influenced by severe hepatic disease:
A. Penicillins
B. clindamycin (Cleocin)
C. rifampin (Rimactane)
D. * clindamycin & rifampin
E. None of the above
532. This antibiotic may cause hemolysis if prescribed to a patient with glucose-6-phosphate dehydrogenase
deficiency:
A. penicillin V (Pen-Vee K, Veetids)
B. neomycin
C. Augmentin ( amoxicillin (Amoxil Polymox) and clavulanic acid)
D. * sulfisoxazole (Gantrisin)
E. None of the above
533. Antibacterials regarded as generally safe to prescribe in pregnancy.
A. Clarythromycine
B. Cephalosporins
C. Tetracyclines
D. * Clarythromycine & Cephalosporins
E. All of the above
534. Ototoxicity and nephrotoxicity associated with this antibiotic:
A. cefotaxime (Claforan)
B. * amikacin (Amikin)
C. aztreonam (Azactan)
D. ceftriaxone (Rocephin)
E. All of the above
535. Inhibits bacterial cell wall synthesis:
A. Streptomycin
B. * vancomycin (Vancocin)
C. doxycycline (Vibramycin, Doryx)
D. gentamicin (Garamycin)
E. None of the above
536. Synergistic antimicrobial combination:
A. amoxicillin-clavulanate
B. ampicillin –streptomycin
C. * sulbactam-ampicillin
D. All of the above
E. None of the above
537. Combination of metronidazole (Flagyl) and penicillin in treating an abscess caused by beta-lactamase
producing bacteriodes and anaerobic streptococci is an example of:
A. synergistic drug treatment
B. antagonistic drug effects
C. * additive drug effects
D. none of the above
E. synergistic drug treatment & additive drug effects
538. Beta-lactamase inhibitor:
A. vancomycin (Vancocin)
B. sulbactam
C. clavulanate
D. * sulbactam & clavulanate
E. None of the above
539. Antifungal polyene macrolide that preferentially binds to fungal ergosterol which alters cellular
permeability.
A. Ketoconazole
B. * amphotericin B
C. Flucytosine
D. Grisefulvin
E. Clotrimazole
540. An azole most commonly used for topical treatment of candidiasis:
A. amphotericin B
B. * clotrimazole
C. Griseofulvin
D. Flucytosine
E. none of the above
541. Which of these diseases is associated with chronic diarrhea?
A. Celiac disease
B. Irritable bowel syndrome
C. Diabetes
D. Asthma
E. * Celiac disease & irritable bowel syndrome
542. Call the most potent of the presently available anti-fungal azoles:
A. Fluconazole
B. * itraconazole
C. Ketoconazole
D. All of the above
E. None of the above
543. Given by i.v. administration, the drug of choice for nearly all life-threatening mycotic infections-usually used as the initial induction regimen
A. Ketoconazole
B. Itraconazole
C. Flucytosine
D. * amphotericin B
E. nystatin
544. Which of the following statements concerning the anti-inflammatory effect of NSAIDs are TRUE?
A. * Anti-inflammatory effect of NSAIDs results from inhibition of cyclooxygenase
B. Anti-inflammatory effect of NSAIDs results from inhibition of phospholipase A2 and reducing
prostaglandin and leukotriene synthesis
C. Anti-inflammatory effect of NSAIDs results from induction of cyclooxygenase II expression which
results in reducing the amount of an enzyme available to produce prostaglandins
D. All of the above
E. none of the above
545. Suitable for treatment of bacterial meningitis caused by H. influenza:
A. * cefotaxime (Claforan)
B. cephalexin (Keflex)
C. cephalothin (Keflin)
D. cefadroxil (Duricef, Ultracef)
E. none of the above
546. More likely to cause polyneuritis in patients who are"slow acelators"; this antibiotic is inactivated by
the liver.
A. clindamycin (Cleocin)
B. * isoniazid (INH)
C. nafcillin (Nafcil, Unipen)
D. vancomycin (Vancocin)
E. none of the above
547. Name alternative antimicrobial drug(s) for treating penicillin-resistant S. aureus:
A. vancomycin (Vancocin)
B. nafcillin (Nafcil, Unipen)
C. methicillin (Staphcillin)
D. * All of the above
E. none of the above
548. Indication for glucocorticoids is:
A. Chronic (Addison’s disease) and acute adrenocortical insufficiency
B. Organ transplants (prevention and treatment of rejection – immunosuppression)
C. Inflammatory conditions of bones and joints (arthritis, bursitis, tenosynovitis).
D. * All of the above
E. None of the above
549. This antibiotic may cause hemolysis if prescribed to a patient with glucose-6-phosphate dehydrogenase
deficiency:
A. penicillin V (Pen-Vee K, Veetids)
B. neomycin
C. Augmentin ( amoxicillin (Amoxil Polymox) and clavulanic acid)
D. * sulfisoxazole (Gantrisin)
E. none of the above
550. 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
551. Name azole most likely to get into the cerebral spinal fluid (CSF):
A. ketoconazole
B. itraconazole
C. * fluconazole
D. all of the above
E. none of the above
552. The following structure is a protease inhibitor. What is the name of the structure?
A. * Ritonavir
B. Lopinavir
C. Saquinavir
D. Aciclovir
E. all of the above
553. A bacteriostatic antimicrobial that inhibits protein synthesis by blocking attachment of aminoacyi tRNA to the A site on the 30S bacterial ribosome
A. Aminoglycosides
B. Fluoroquinolones
C. Metronidazole
D. Sulfonamide
E. * Tetracycline
554. Bactericidal drugs that act by inhibiting DNA gyrase
A. Aminoglycoside
B. * Fluoroquinolones
C. Macrolides
D. Rifamycins
E. Sulfonamides
555. Inhibits the formation of folic acid by competing with PABA for dihydropteroate synthase
A. Metronidazole
B. Rifampin
C. * Sulfamethoxazole
D. Trimethoprim
E. Linezolid
556. Binds to specific receptors located in the bacterial cytoplasmic cell membrane and inhibits
transpeptidase enzymes, preventing cross linking of peptidoglycan chains in the cell wall
A. * Cephalosporins
B. Daptomycin
C. Linezolid
D. Metronidazole
E. Rifampin
557. Binds to the D-Ala-D-Ala terminal end of peptidoglycan side chains, resulting in inhibition of
transglycosylation and disruption of cross-linking in the cell wall
A. Chloramphenicol
B. Clavulanic
C. Imipenem
D. * Vancomycin
E. Metronidazole
558. Combination of these two drugs would produce an antagonistic (undesirable) antimicrobial effect when
treating an infection
A. Amoxicillin+ gentamicin
B. Cephalexin+ gentamicin
C. Sulfamethoxazole+ trimethoprim
D. * Tetracycline+ amoxicillin
E. Vancomycin+ gentamicin
559. Which form of resistance to the effect of antimicrobial drugs is specific to beta-lactam type antibiotics
A. Decreased drug uptake
B. Methylation of the antibiotic’s receptor
C. Decreased metabolic activation
D. Altered amount of drug receptor
E. * Increased enzymatic destruction of the antibiotic
560. 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
561. Bacterial resistance to this drug results from a plasmid mediated mechanism that results in an altered
ribosomal binding site within the bacteria
A. Ampicillin
B. * Azithromycin
C. Penicillin
D. Piperacillin
E. Vancomycin
562. Signs of dehydration are
A. Sunken eyes
B. Excessive thirst
C. Reduced urination
D. * All of the above
E. None of the above
563. Which of the following antinmicrobials is taken up into bacteria by an oxygen-dependent mechanim
and is therefore ineffective against anaerobic organisms
A. Cefoxitin
B. Clindamycin
C. * Gentamicin
D. Metronidazole
E. Ticarcillin
564. An anxiety disorder can be characterized by which of the following?
A. A sudden, uncontrollable attack of terror
B. An unfounded fear and dread of everyday situations
C. Repeated, unwanted thoughts that cause worry or nervousness
D. * Any of the above
E. None of the above
565. Which of the following is the general mechanism of action for erythromycin?
A. Inhibition of a metabolic enzyme
B. Inhibition of cell wall synthesis
C. * Disruption of protein synthesis
D. Inhibition of nucleic acid transcription and replication
E. None of the above
566. Which of the following is the general mechanism of action for fluoroquinolones?
A. Inhibition of a metabolic enzyme
B. Inhibition of cell wall synthesis
C. Disruption of protein synthesis
D. * Inhibition of nucleic acid transcription and replication
E. None of the above
567. 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
568. Which of the following statements is true regarding the properties of benzylpenicillin?
A. It is a bacteriostatic agent.
B. It is active over a wide range of bacterial species.
C. It is resistant to beta-lactamases.
D. * Certain individuals may have an allergic response to it.
E. All of the above
569. The following structure is a first generation cephalosporin. What is the name of the structure?
A. Cefazolin
B. Cefoxitin
C. Cefuroxime
D. * Cefalexin
E. All of the above
570. The structure is administered along with a penicillin in a preparation known as Tazocin or Zosyn.
Which penicillin is used?
A. Amoxicillin
B. * Piperacillin
C. Ampicillin
D. Methicillin
E. None of the above
571. Which of the following antibiotics is a macrolide?
A. Chloramphenicol
B. Doxycycline
C. * Spiramycin
D. Streptomycin
E. None of the above
572. Which of the following antibiotics is a tetracycline?
A. Chloramphenicol
B. * Doxycycline
C. Streptomycin
D. Erythromycin
E. None of the above
573. To mark a sulfonamide drug for the medical treatment of conjunctivitises.
A. * Sulfacylum-natium
B. Suptastine
C. Phthalazolum
D. Sulfadimetoxinum
E. Sulfapyridazinum
574. To indicate a sulfonamide drug, which is applied at the intestinal infections.
A. * Phthalazolum
B. Sulfadimezinum
C. Sulfadimetoxinum
D. Sulfacylum-natium
E. Sulfapyridazinum
575. To indicate combine sulfonamide drug
A. Sulfadimetoxinum
B. * Co-trimoxazole
C. Sulfadimezinum
D. Suprastine
E. Phthalazolum
576. To indicate marching 8-oxychinoline for the medical treatment of urinary infections.
A. Rifampine
B. * Nitroxoline
C. Co-trimoxazole
D. Ampicilline
E. Furosemide
577. To indicate quinolone derivated , which is used mainly at infections of urinary tract.
A. * Nalidixic Acid
B. Biseptol
C. Furosemide
D. Ethambutol
E. Aspirine
578. To name a mechanism of antibacterial action of sulfaniamides.
A. * Competition antagonism with PASA
B. Violation of synthesis of cellular wall of microorganisms
C. Change of permeability of cyotplasmic membranes
D. Violation of synthesis of phospholipids
E. Violation of synthesis of enzymes
579. Possible complications in case of purpose of sulfonamides drugs.
A. * Violation of function of kidneys by increasing of acetylation
B. Decrease of arterial pressure
C. Oppression of function of CNS
D. Оtotoxic action
E. Peripheral neuritis
580. Antituberculose drug from group of aminoglycosides
A. * Streptomicinum sulfate
B. Ethambutolum
C. PASA
D. Isoniasidum
E. Rifampicynum
581. Which antituberculose drug does paint organism (tears, saliva, urine, and others like that) liquids in the
red colour?
A. * Rifampicynum
B. Isoniasidum
C. PASA
D. Streptomicinum sulfate
E. Ethambutolum
582. To indicate a synthetic antituberculose drug, a day dose of which is 9-12 g
A. * PASA
B. Streptomicinum sulfate
C. Isoniasidum
D. Ethambutolum
E. Rifampicynum
583. The speed of bіоtransformation of which antituberculose drug depends on the genetic features of
organism?
A. * Isoniasidum
B. Ethambutolum
C. Rifampicynum
D. PASA
E. Streptomicinum of sulfate
584. After month of usage of antituberculose drugs patient began to mark the declination of hearing. Which
drug did patient apply?
A. * Streptomicinum sulfate
B. Isoniasidum
C. PASA
D. Rifampicynum
E. Ethambutolum
585. To define drug, which apply at spasms of vessels of extremities, kidneys, cerebrum, and for the decline
of arterial pressure.
A. Calcium pangamats.
B. Ascorbic acid.
C. Folic acid.
D. * Nicotine acid.
E. Lipoid Acid.
586. To mark drug from the group of steroid anti-inflammatory drugs.
A. Ibuprophen.
B. Ortophen.
C. Indometacin.
D. * Hydrocortisoni acetas.
E. Aspirin.
587. To mark drug from the group of nonsteroid anti-inflammatory drugs.
A. * Indometacin.
B. Prednisolon.
C. Dexametazon.
D. Hydrocortison.
E. Triamcinilon.
588. To mark drug from the group of nonsteroid anti-inflammatory drugs.
A. * Celecoxib.
B. Prednisolon.
C. Dexametazon.
D. Hydrocortison.
E. Triamcinilon.
589. To mark a side effect of nonsteroid anti-inflammatory drugs.
A. * Ulcer action.
B. Immunodepressive action.
C. Somnolent action.
D. Sedative effect.
E. Hypotensive action.
590. What drug from the narcotic analgesic group does have the least ulcer action?
A. Butadion.
B. Voltaren.
C. Indometacin.
D. * Meloxicam.
E. Naproxen.
591. Nonsteroid anti-inflammatory drugs are effective in case of medical treatment of rheumatism thanks to
their power to depress:
A. * Cyclooxygenase-2.
B. Phospholipase-А2.
C. Cyclooxygenase-1.
D. Adenilatcyclase.
E. Peroxydase.
592. Most nonsteroidal antiinflammatory drugs (NSAIDs) work by:
A. Ameliorating pain perception.
B. Increasing the supply of natural endorphins.
C. Increasing blood flow to painful areas.
D. * Inhibiting prostaglandin production.
E. Stimulate prostaglandin production.
593. When teaching a patient about potential side effects of NSAID therapy, the nurse will teach the patient
to report:
A. Dizziness.
B. Nonproductive cough.
C. * Black tarry stools.
D. Palpitations.
E. Headache.
594. The advantage of cyclooxygenase-2 (COX-2) inhibitors over other NSAIDs is that they:
A. Have a longer duration of action.
B. Are less likely to cause hepatic toxicity.
C. * Do not decrease the cytoprotective lining of the stomach.
D. Have a more rapid onset of action.
E. Decrease the cytoprotective lining of the stomach.
595. Which of the following NSAIDs would the nurse anticipate administering parenterally for the treatment
of acute postoperative pain?
A. allopurinol (Zyloprim).
B. indomethacin (Indocin)
C. aspirin.
D. rofecoxib (Vioxx).
E. * ketorolac.
596. True statement concerning the pharmacologic effects of salicylates include:
A. salicylates are thought to exert their activity at least partially by inhibiting prostaglandin synthetase
B. high-dose salicylate therapy (more than 5 g /day) lowers the serum uric acid concentration
C. the effect of salicylates upon platelet aggregation is irreversible unlike that of other non-steroidal
anti-inflammatory drugs
D. * All above
E. None of the above
597. Common adverse reactions of corticosteroidal therapy are:
A. bradycardia, mental dullness
B. anorexia, polyuria
C. tachycardia, insomnia
D. * “moon face”, obese trunk
E. All above
598. The chemotherapeutic agent also used orally for severe forms of arthritis is
A. 5-fluorouracil (5-FU)
B. * methotrexate (Mexate)
C. cyclophosphamide (Cytoxan)
D. cisplatin (Platinol)
E. chondroitin
599. 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
600. For a 6-year-old child with fever, what NSAIDs would be preferred?
A. aspirin
B. * acetaminophen
C. indomethacin
D. ibuprofen
E. prednisone
601. Cyclooxygenase isozyme responsible for prostaglandin synthesis by cells involvet in inflammation:
A. COX-I
B. * COX-II
C. H+K+ATP
D. All of the above
E. None of the above
602. Among these mediators: most significant increase in vascular permeability
A. prostaglandins
B. bradykinin
C. serotonin
D. * leukotrienes
E. all of the above produce similar increases in vascular permeability
603. Mediator in acute inflammation: pain
A. histamine
B. serotonin
C. leukotrienes
D. * bradykinin
E. none of the above
604. Mediator of chronic inflammation (for example rheumatoid arthritis)
A. histamine
B. * interleukin 1
C. bradykinin
D. neuropeptides
E. serotonin
605. Most nonsteroidal antiinflammatory drugs
A. * inhibit prostaglandin biosynthesis
B. probably increase production of free radicals
C. weak organic bases
D. mainly associated with guanylyl cyclase interactions
E. all the above
606. Initial drug of choice for treating most articular and musculoskeletal disorders (because of low-cost,
safety, and efficacy)
A. Glucocorticoids
B. aspirin
C. * diclofenac
D. indomethacin
E. phenylbutazone
607. Concerning salicylates:
A. sodium salicylate an aspirin: equally effective as anti-inflammatory agents
B. aspirin: maybe more effective for analgesia
C. aspirin: hydrolyzed to acetic acid plus salicylate by tissue and blood esterases
D. urine alkalinization: increases free salicylate excretion
E. * all of the above
608. Acute attacks of gouty arthritis may occur early in treatment with allopurinol (Zyloprim, Purinol)
because:
A. allopurinol (Zyloprim, Purinol) increases urate synthesis
B. * urate crystals move from tissue to plasma
C. allopurinol (Zyloprim, Purinol) increases release of chemotactic factors
D. all of the above
E. none of the above
609. Effective in management of mild to moderate pain, when anti-inflammatory action is not necessary
A. penicillamine
B. sulfasalazine
C. * acetaminophen
D. piroxicam
E. etodolac
610. Probably the initial step in acute gouty arthritis attack
A. polymorphonuclear leukocytes migration into the joint
B. increased numbers of mononuclear phagocytes (macrophages)
C. * urate crystals phagocytosis by synoviocytes
D. prostaglandin, lysosomal &, interleukin 1 release
E. None of the above
611. Reduces uric acid synthesis: uses for management of gout A. colchicine
B. sulfinpyrazone
C. probenecid
D. * allopurinol
E. oxaprozin
612. Manifestations of rheumatoid arthritis:
A. inflammatory synovitis
B. cartilage destruction
C. bone erosion
D. progressive, relentless polyarthritis with functional impairment
E. * All of the above
613. The major role in chronic management of arthritis:
A. glucocorticoids
B. * nonsteroidal antiinflammatory drugs
C. antibiotics
D. All of the above
E. None of the above
614. Advantages of other NSAIDs compared with aspirin:
A. generally less expensive
B. * less gastric irritation, potentially better compliance (e.g. naproxen, sulindac
C. easier to establish therapeutic range using blood levels
D. absence of acute renal failure/nephrotic syndrome
E. all above
615. Aspirin:
A. inhibits prostaglandin synthase
B. inhibits cyclooxygenase
C. decreases prostaglandin formation
D. decreases thromboxane A2 formation
E. * All above
616. Effective in managing acute gouty arthritis and ankylosing spondylitis; also accelerates closure of
patent ductus arteriosus in premature infants:
A. gold
B. ketorolac
C. phenylbutazone
D. methotrexate
E. * indomethacin
617. NSAID primarily promoted as an analgesic, not as an anti-inflammatory agent:
A. piroxicam
B. ibuprofen
C. naproxen
D. * ketorolac
E. sulindac
618. Drug associated with the hepatic/renal toxic metabolite: N-acetyl-p-benzoquinone
A. Diclofenac
B. meclofenamate
C. indomethacin
D. * acetaminophen
E. aspirin
619. Examples of autoimmune diseases
A. rheumatoid arthritis
B. insulin-dependent diabetes mellitus
C. systemic lupus erythematosis
D. none of the above
E. * all above
620. Glucocorticoid effects:
A. inhibition of leukotriene production
B. inhibition of prostaglandins
C. increased chemotaxis
D. * inhibition of leukotriene production & inhibition of prostaglandins
E. all of the above
621. Alkylating agent; destroys proliferating lymphoid cells; in low doses -- for effective against
autoimmune disorders including systemic lupus erythematosus
A. azathioprine (Imuran)
B. methotrexate
C. * cyclophosphamide (Cytoxan)
D. antilymphocyte globulin (ALG)
E. all the above
622. Cytotoxic agents with immunosuppressive properties:
A. cyclophosphamide (Cytoxan)
B. vincristine (Oncovin)
C. methotrexate
D. cytarabine (ARA-C)
E. * all the above
623. Structural analog/antimetabolite: cytotoxic immunosuppressive drug:
A. vincristine
B. cyclophosphamide
C. * azathioprine
D. none of the above
E. all of the above
624. Clinical uses of immunosuppressive drugs:
A. organ transplantation
B. hemolytic disease of the newborn
C. autoimmune disorders
D. none of the above
E. * all of the above
625. The following is not true about corticosteroids:
A. have anti-inflammatory activity
B. highly lipophillic
C. decrease the quantity and viscosity of mucus secretions
D. * decrease the synthesis of adrenergic mediators
E. decrease the transcription of genes coding for pro-inflammatory cytokines
626. The main principle of shock treatment is:
A. To increase the arterial pressure
B. To increase the peripheral vascular resistance
C. To increase the cardiac output
D. * To improve the peripheral blood flow
E. All of the above
627. Pick out the drug which increases cardiac output:
A. * Noradrenalin
B. Methyldopa
C. Phenylephrine
D. Angiotensinamide
E. Ipratropium
628. Tick the synthetic vasoconstrictor having an adrenomimic effect:
A. Noradrenalin
B. Adrenalin
C. * Phenylephrine
D. Angiotensinamide
E. Terbutalin
629. Indicate the vasoconstrictor of endogenous origin:
A. Ephedrine
B. Phenylephrine
C. Xylomethazoline
D. * Angiotensinamide
E. None of the above
630. General unwanted effects of vasoconstrictors is:
A. Increase of arterial pressure
B. Increase of cardiac output
C. * Decrease of peripheral blood flow
D. Increase of blood volume
E. Decrease of tone n.vagus
631. For increasing blood pressure in case of low cardiac output the following agents must be used:
A. Ganglioblockers
B. Vasoconstrictors
C. * Positive inotropic drugs
D. Diuretics
E. Beta-blockers
632. Tick the positive inotropic drug of glycoside structure:
A. Dopamine
B. * Digoxin
C. Dobutamine
D. Adrenalin
E. Milrinon
633. Tick the positive inotropic drug of non-glycoside structure:
A. Digitoxin
B. Digoxin
C. * Dobutamine
D. Strophanthin
E. None of the above
634. Lipoprotein is:
A. * A conjugated protein having a lipid component; the principal means for transporting lipids in the
blood
B. Any of various fat-soluble or water-soluble organic substances essential in minute amounts for
normal growth and activity of the body and obtained naturally from plant and animal foods
C. Product of endocrine gland secretion
D. Mediators of inflammatory process
E. None of the above
635. Very low density lipoprotein (VLDL) is:
A. * A lipoprotein containing a very large proportion of lipids to protein and carrying most cholesterol
from the liver to the tissues
B. A lipoprotein that contains relatively high amounts of cholesterol and is associated with an increased
risk of atherosclerosis and coronary artery disease. It is also called beta-lipoprotein
C. A lipoprotein that contains relatively small amounts of cholesterol and triglycerides and is associated
with a decreased risk of atherosclerosis and coronary artery disease. It is also called alpha-lipoprotein
D. Large lipoprotein particle that is created by the absorptive cells of the small intestine. It transports
lipids to adipose tissue where they are broken down by lipoprotein lipase
E. None of the above
636. Low-density lipoprotein (LDL) is:
A. * A lipoprotein that contains relatively high amounts of cholesterol and is associated with an
increased risk of atherosclerosis and coronary artery disease. It is also called beta-lipoprotein
B. A lipoprotein that contains relatively small amounts of cholesterol and triglycerides and is associated
with a decreased risk of atherosclerosis and coronary artery disease. It is also called alpha-lipoprotein
C. A lipoprotein containing a very large proportion of lipids to protein and carrying most cholesterol
from the liver to the tissues
D. Large lipoprotein particle that is created by the absorptive cells of the small intestine. It transports
lipids to adipose tissue where they are broken down by lipoprotein lipase
E. None of the above
637. High-density lipoprotein (HDL) is:
A. * A lipoprotein that contains relatively small amounts of cholesterol and triglycerides and is
associated with a decreased risk of atherosclerosis and coronary artery disease. It is also called alphalipoprotein
B. A lipoprotein containing a very large proportion of lipids to protein and carrying most cholesterol
from the liver to the tissues
C. A lipoprotein that contains relatively high amounts of cholesterol and is associated with an increased
risk of atherosclerosis and coronary artery disease. It is also called beta-lipoprotein
D. Large lipoprotein particle that is created by the absorptive cells of the small intestine. It transports
lipids to adipose tissue where they are broken down by lipoprotein lipase
E. None of the above
638. Hyperlipoproteinemia
A. * is a condition marked by an abnormally high level of lipoproteins in the blood.
B. Is high blood levels of triglycerides. It has been associated with atherosclerosis
C. is an abnormally high concentration of cholesterol in the blood.
D. is an abnormally high concentration of low-density lipoprotein in the blood
E. None of the above
639. All of the following statements concerning drugs which inhibit cholesterol synthesis are true, EXCEPT:
A. They work in part by increasing the rate of LDL clearance from the plasma
B. They are the most effective single agents for lowering LDL-cholesterol
C. When used with a bile-acid binding resin, they can lower LDL-cholesterol by 50% or more
D. * No special monitoring is required in patients receiving one of them
E. None of the above
640. All of the following statements concerning nicotinic acid (Niacin) are true, EXCEPT:
A. It reduces the rate of synthesis of VLDL(very low-density lipoprotein)
B. * Sustained-release preparations of this drug are largely free of side effects
C. Almost all patients taking the traditional dosage form of this drug experience uncomfortable flushing
D. It should not be used with antihypertensives
E. All of the above are true
641. All of the following statements concerning drugs which inhibit cholesterol synthesis are true, EXCEPT:
A. These drugs should not be used in pregnant women or children
B. These drugs often cause myopathy if used in combination with cyclosporine (Sandimmune)
C. Failure to discontinue the drug after myopathy has been detected can cause acute renal failure
D. * Several of these drugs tend to lengthen the sleep cycle
E. All of the above are true
642. All of the following statements concerning the general principles of therapy with lipid-lowering drugs
are true EXCEPT:
A. Therapy with a lipid-lowering drug should be always accompanied by an appropriate diet
B. * A lipid-lowering diet should be discontinued if it fails to decrease the levels of plasma LDL
cholesterol by at least 10%
C. Lipid-lowering drugs should only be administered after at least 3 months of prior dietary therapy
D. Some combinations of lipid-lowering drugs are synergistic
E. All of the above are true
643. This drug increases lipoprotein lipase (LPL) activity in adipose tissue:
A. Cholestyramine (Questran)
B. Lovastatin (Mevacor)
C. Nicotinic acid (Niacin)
D. * Gemfibrozil (Loprol)
E. Atorvastatin
644. This drug both inhibits an enzyme and indirectly enhances clearance of low density lipoproteins (LDL):
A. Cholestyramine (Questran)
B. * Lovastatin (Mevacor)
C. Nicotinic acid (niacin)
D. Probucol (Lorelco)
E. Misoprostol
645. This drug binds bile acids in the GI tract:
A. * Cholestyramine (Questran)
B. Nicotinic acid (niacin)
C. Gemfibrozil (Loprol)
D. Probucol (Lorelco)
E. Misoprostol
646. This drug may block oxidation of low density lipoproteins (LDL):
A. Lovastatin (Mevacor)
B. Nicotinic acid (niacin)
C. Gemfibrozil (Loprol)
D. * Probucol (Lorelco)
E. Misoprostol
647. This drug weakly stimulates synthesis of very low density lipoproteins (VLDL):
A. * Cholestyramine (Questran)
B. Lovastatin (Mevacor)
C. Gemfibrozil (Loprol)
D. Probucol (Lorelco)
E. Misoprostol
648. Flushing caused by this drug can be reduced by taking it after meals and/or by pretreatment with
aspirin:
A. Lovastatin (Mevacor)
B. * Nicotinic acid (niacin)
C. Gemfibrozil (Loprol)
D. Probucol (Lorelco)
E. Clofibratum
649. This drug can cause muscle damage, especially when used with any of several drugs including
erythromycin:
A. Cholestyramine (Questran)
B. * Lovastatin (Mevacor)
C. Gemfibrozil (Loprol)
D. Probucol (Lorelco)
E. Clofibratum
650. This fibric acid derivative increases blood levels of high density lipoproteins (HDL):
A. Cholestyramine (Questran)
B. Lovastatin (Mevacor)
C. Atorvastatin
D. * Gemfibrozil (Loprol)
E. Probucol (Lorelco)
651. Which of the following drugs is an uricosuric agent:
A. Allopurinol
B. * Sulfinpyrazone
C. Colchicine
D. Indomethacin
E. Cyclosporine
652. Uricosuric drugs are the following, EXCEPT:
A. Probenecid
B. Sulfinpyrazone
C. * Colchicine
D. Aspirin (at high dosages)
E. All of the above
653. Which of the following drugs used in the treatment of gout acts by preventing the migration of
granulocytes:
A. Allopurinol
B. Sulfinpyrazone
C. * Colchicine
D. Indomethacin
E. Cyclosporine
654. Which of the following drugs used in the treatment of gout has as its primary effect the reduction of
uric acid synthesis
A. * Allopurinol
B. Sulfinpyrazone
C. Colchicine
D. Indomethacin
E. Cyclosporine
655. Etanercept produces its antirheumatic effects by direct
A. Inhibition of cAMP phosphodiesterase in monocytic lineage leukocytes
B. Selective inhibition of COX-2
C. Enhancement of leukotriene synthesis at the expense of prostaglandin synthesis
D. * Reduction of circulating active TNF-alpha levels
E. Inhibition of the production of autoantibodies
656. An advantage of celecoxib over most otherNSAIDs is
A. * Less inhibition of PGE2 effects on the gastric mucosal
B. Less risk of bronchospasm and hypersensitivity reactions
C. Once-daily dosing allows the patient convenience
D. Less risk of harm to the developing fetus in the third trimester
E. Greater degree of efficacy in the treatment of rheumatoid arthritis
657. Status asthmaticus is best described by which of the following statements?
A. Status asthmaticus is well-controlled asthma.
B. * Status asthmaticus is a life-threatening exacerbation of asthma.
C. Status asthmaticus is best treated with inhaled controller medication, such as cromolyn sodium or a
leukotriene modulator.
D. Status asthmaticus always resolves without drug treatment.
E. Status asthmaticus occurs without warning in patients whose asthma symptoms are stable and well
controlled.
658. Which one of the following beta-adrenoceptor agonists has such a slow onset of action that it is not
indicated for the relief of acute asthma symptoms?
A. * Salmeterol
B. Albuterol
C. Epinephrine
D. Terbutaline
E. Isoproterenol
659. The standard treatment regimen for asthma is best described by which of the following?
A. Theophylline and exercise
B. Inhaled beta2-adrenoceptor agonists only
C. Inhaled corticosteroids only
D. * A combination of inhaled bronchodilators and inhaled corticosteroids
E. Oral corticosteroids
660. Symptoms typically produced by inhaled beta-adrenoceptor agonists include which of the following?
A. * Tachycardia, dizziness, and nervousness
B.
C.
D.
E.
Dysphonia, candidiasis, and sore throat
Dyspepsia and Churg-Strauss syndrome
Nausea, agitation, and convulsions
Muscle tremor, tachycardia, and palpitations
Situational tasks:
1. A 5-year-old child had an attack of palpitation with nausea, dizziness, generalized fatigue. On ECG:
2.
3.
4.
5.
6.
tachycardia with heartbeat rate of 220/min. Ventricle complexes are deformed and widened. P wave is
absent. What medication is to be prescribed to provide first aid?
A. * Lydocain
B. Seduxen
C. Novocainamides
D. Strophantin
E. Isoptin
A 46-year-old patient has ischemic heart disease, angina on exertion, II functional class. What is the drug
of choice in treatment of acute attack?
A. * Nitroglycerin sublingually
B. Platelet inhibiting agents (aspirin)
C. Spasmolitics (No-spa) IV
D. Digitalis IV
E. Sedative agents (Seduxenum) orally
The combination of hydralazine and nitrates has been shown to improve survival in patients of heart
failure. All of the following statements about this combination are true except:
A. The combination serves to decrease both afterload and preload.
B. * Prazosin is as effective as the combination in treatment of congestive heart failure.
C. The concept of afterload reduction is principally derived from patients of significant mitral
regurgitation.
D. The VA cooperative study was a landmark trial demonstrating the beneficial effect of hydralazine
and nitrate combination in patients of heart failure.
E. None of the above
A 52-year-old patient complains of intensive and prolonged retrosternal pains, decreased exercise
tolerance for 5 days. Which of the following groups is the most useful?
A. * nitrates
B. dyslipidemic drugs
C. diuretics
D. ACE inhibitors
E. digitalis
A 50-year-old patient was admitted to resusitation department with aqute myocardial infarction . Which
one of the following drugs is uneffective in this case?
A. Proranolol
B. Nitroglycerin
C. * Nifedipine
D. Phentanyl
E. Morfin
A 54-year-old patient, who suffers from ischemic heart disease, stable stenocardia II, heart insufficiency
I, has an attack of ventricular tachycardia, Ps 180/min, AP – 80/50 mm Hg. Choose a correct treatment:
A. * Lidocain, potassium chloride
B. Mezaton, strofantin
C. Verapamil, potassium chloride
D. Digoxin
ATP, cordaron
A 45-year-old woman has had recurrent episodes of atrial fibrillation. She is receiving phenytoin and
quinidine to control the atrial fibrillation. She is also taking a low dose of diazepam for insomnia and
estrogen replacement therapy.You learn today that she has been receiving ciprofloxacin for a urinary
track infection.The reason for her appointment today is that she has been having ringing in the ears,
headache, nausea, and blurred vision. She tells you that she is also having trouble hearing the television.
You suspect drug toxicity.The most likely agent is
A. Ciprofloxacin
B. Estrogen
C. Phenytoin
D. Diazepam
E. * Quinidine
You are asked to treat a 55-year-old patient for continuing ventricular arrhythmias.The patient is
receiving timolol drops for glaucoma, daily insulin injections for diabetes mellitus, and an ACE inhibitor
for hypertension.You decide to use phenytoin instead of procainamide because of what pharmacological
effect of procainamide?
A. The local anesthetic effect of procainamide would potentiate diabetes.
B. * The anticholinergic effect of procainamide would aggravate glaucoma.
C. The hypertensive effects of procainamide would aggravate the hypertension.
D. The local anesthetic effect of procainamide would aggravate the hypertension.
E. The cholinergic effects of procainamide would aggravate the diabetes.
Exercise-induced ventricular tachycardia in persons without overt cardiac disease is an example of
delayed after-depolarizations and is characterized by an increase in intracellular ionized calcium.This
type of arrhythmia is known to often respond well to which of the following combinations?
A. Beta-Blocker and ACE inhibitor
B. * Calcium channel antagonist and ACE inhibitor
C. Beta-blocker and ACE inhibitor
D. Beta-blocker and calcium channel antagonist
E. Alpa-blocker and calcium channel antagonist
Although most antiarrhythmic drugs (and indeed most drugs) are chemically synthesized, some
compounds that occur endogenously in humans are useful. Indicate which of the following agents occurs
endogenously and is a useful antiarrhythmic agent.
A. Phenytoin
B. Digoxin
C. * Adenosine
D. Quinine
E. Lidocaine
A patient comes to your office with effort-induced angina and resting tachycardia.You choose the
following drug to treat the patient because it slows heart rate by blocking L-type calcium channels in the
SA node:
A. * Verapamil
B. Propranolol
C. Nitroglycerin
D. Isosorbide dinitrate
E. Metoprolol
Which of the following hemodynamic effects of nitroglycerin are primarily responsible for the beneficial
results observed in patients with secondary angina?
A. Reduction in the force of myocardial contraction
B. Reduction in systemic vascular resistance (afterload)
C. Increased heart rate
D. * Reduction in venous capacitance (preload)
E. Increased blood flow to the subepicardium
A woman is prescribed a combination of drugs consisting of a nitroglycerin patch and a beta-blocker,
E.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
such as propranolol, to treat her attacks of secondary angina.Which effect of propranolol would
counteract an adverse effect of nitroglycerin?
A. A decrease in preload
B. A decrease in afterload
C. * A decrease in heart rate
D. An increase in myocardial contractile force
E. A reduction in coronary vasospasm
A patient who has been taking propranolol for a long period for secondary angina comes to your office
complaining of increased frequency of chest pains on exertion.You decide to stop the propranolol and
give him diltiazem because you suspect he has a mixture of secondary and primary angina. Why would
diltiazem be more likely to relieve the angina if your new diagnosis is accurate?
A. Diltiazem produces a decrease in heart rate.
B. * Diltiazem dilates coronary blood vessels in spasm.
C. Diltiazem produces AV blockade.
D. Diltiazem reduces myocardial contractility.
E. Diltiazem reduces afterload.
Metoprolol would produce which beneficial effect in a patient with secondary angina?
A. A decrease in preload
B. An increase in collateral blood flow
C. An increase in afterload
D. * An increase in diastolic filling time
E. An increase in blood flow through a concentric stenosis
An accurate statement regarding the actions of both ACE inhibitors and AT1 receptor antagonists is that
A. Both classes of drugs increase bradykinin.
B. Angiotensin II can act at the AT2 receptor with both classes of drugs.
C. * Both classes of drugs reduce total peripheral resistance.
D. Both classes of drugs decrease circulating angiotensin II levels.
E. Both classes of drugs are first-choice treatments for congestive heart failure.
Angiotensin II can:
A. * Increase the synthesis and release of aldosterone
B. Reduce the activity of the sympathetic nervous system
C. Be a potent positive inotropic at the heart
D. Relax vascular smooth muscle
E. Reduce the growth of cardiovascular cell types
The most potent vasoconstrictor known is
A. Bradykinin
B. Angiotensin II
C. Angiotensin IV
D. Natriuretic peptide
E. * Endothelin
The mechanism of action of captopril is
A. Angiotensin receptor antagonist
B. * ACE inhibitor
C. Aldosterone receptor antagonist
D. Bradykinin antagonist
E. None of the above
Which of the following statements most accurately characterize the cellular action of the calcium channel
blockers?
A. Their interaction with membrane phospholipids results in a nonselective decrease of ion transport.
B. They inhibit the Na+–Ca++ exchanger in cardiac and smooth muscle.
C. * They interact at three distinct sites at the L-type voltage-gated calcium channels.
D. Their interaction with the sodium pump results in an inhibition of calcium transport.
E. All of the above
21. Which of the following calcium channel blockers would be most likely to suppress atrial
22.
23.
24.
25.
26.
27.
28.
tachyarrhythmias involving the A-V node?
A. Nifedipine
B. * Verapamil
C. Nicardipine
D. Amlodipine
E. Nimodipine
A 55-year-old men has stenocardia on exertion II. Taking of nitroglycerin potentiate a sever headache.
Which of the following drugs is the most useful in this case?
A. * Molsidomin
B. Amiodaron
C. Nifedipine
D. Propranolol
E. Verapamil
A 49-year-old patient has ischemic heart disease, angina on exertion, II functional class. What is the drug
of choice in treatment of acute attack?
A. No-spa IV
B. Aspirin
C. * Nitroglycerin sublingually
D. Digitalis IV
E. Seduxenum orally
A patient of 42 year has arterial hypertension with bradyarrhythmia. Which of the following drugs is
necessary to administer?
A. Klonidine
B. * Nifedipine
C. Bisoprolol
D. Diltiazem
E. Methyldopa
A 45-year-old women with diagnosis: Paroxysmal arrhythmia. Arterial hypertension II. Drug of choice
for stopping attack:
A. * Metoprolol
B. Nitroglycerin
C. Potassium chloride
D. Digoxin
E. Lidocain
A woman 56 years old with hypertension edema develops on lower extremities, moist wheezes in the
lower parts of lungs. What must be administered in the complex therapy of the patient?
A. Betaadrenomimetics,
B. * Diuretics,
C. Glucocorticoids,
D. Preparations of calcium,
E. M-cholinolitics.
All of the following statements are applicable with regard to the systemic effects caused by nifedipine
EXCEPT:
A. It typically causes peripheral vasodilation.
B. It often elicits reflex tachycardia.
C. It causes coronary vasodilatation
D. It increases coronary blood flow.
E. * Its benefit in the management of angina is related to the reduction in preload that it induces.
A woman 51 years old has arterial hypertension. Which group of drugs may be used for her treatment?
A. Betaadrenomimetics,
B. * Angiotensin-converting enzyme inhibitors,
C. Glucocorticoids,
D. Preparations of calcium,
E. M-cholinolitics.
29. A man 36, years old, has arterial hypertension. Which group of drugs may be used for treatment?
A. Betaadrenomimetics
B. Preparations of calcium,
C. Glucocorticoids,
D. * Calcium_channel inhibitors,
E. M-cholinolitics.
30. All of the following statements regarding the pharmacokinetics of calcium channel blockers are correct
31.
32.
33.
34.
35.
EXCEPT
A. They are characterized by significant amount (~ 90%) of protein binding.
B. They undergo significant first-pass metabolism.
C. * Their half-life is not altered by hepatic cirrhosis.
D. They can be administered orally.
E. All of the above
Patients suffering from congestive heart failure will show signs and symptoms of peripheral
vasoconstriction, moist skin, pale complextion because of:
A. Na and water retention
B. decreased renin release
C. * increased sympathetic tone
D. decreased vagal tone
E. decreased aldosterone levels
The 56 years old woman with hypertensive disease appealed to the doctor. Methyldopa was prescribed to
her. Indicate a mechanism of action of this drug.
A. Violation of noradrenalin synthesis
B. * alpha-adrenoreceptors blockers
C. Block of beta-adrenoreceptors
D. Depression of angiotensin converting enzyme activity
E. Increasing of acetylcholine synthesis
A 59 year old patient with a history of systolic heart failure arrives in the ER with complaints of chest
palpitations, nausea and GI upset. His chart indicates that he is currently taking digoxin, captopril,
metoprolol and furosemide. A 12 lead ECG is recorded and reveals the presence of frequent runs of
ventricular bigeminy. His echocardiogram indicates an ejection fraction of 40%. His blood tests indicate
a serum potassium level of 4.0 mM, and an elevated digoxin level of 2.2 ng/ml. The most appropriate
drug for treating this patient's arrhythmia would be:
A. propranolol
B. quinidine
C. * lidocaine
D. verapamil
E. atropine
All of the following adverse effects are likely to occur with long-term use of calcium channel blockers
EXCEPT
A. * Skeletal muscle weakness
B. Flushing
C. Dizziness
D. Headache
E. None of the above
In the complex medical treatment of hypertensive disease a diuretic was prescribed to the patient. In a
few days the blood pressure went down, but the signs of hypokaliaemia arose up. What drug could cause
such complication?
A. Triamterene
B. Clofeline
C. Enalapril
D. Spironolactone
E. * Furosemide
36. The patient has cranial trauma. The brain edema threat developed in the postoperative period. To
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prescribe drug for the removal of this complication.
A. Spironolactone
B. Papaverini hydrochloride
C. * Furosemide
D. Dihlothiazid
E. Diacarb
A 55-year-old patient has been referred to you. She complains about a skin rash and a cough. In the
course of history taking, she tells you that she takes high blood pressure medication but she doesn’t
remember the name.You suspect a drug toxicity. Which of the following antihypertensive agents is the
patient most likely taking?
A. * Captopril
B. Nifedipine
C. Prazosin
D. Propanolol
E. Clonidine
In the patient with the considerable peripheral edema the by turns using of dihlothiazid, ethacrynic acid
and furosemide did not result in the considerable diuretic effect. The analysis of blood indicated the
considerable increasing of aldosteron level. Prescribe drug for treatment.
A. Mannitol
B. * Spironolactone
C. Clopamid
D. Triamterene
E. Amiloride
At the 46 years old patient with blink arrhythmia the edema of lungs began. What drug is necessary to
inject in the first turn?
A. * Furosemide
B. Triamterene
C. Verospirone
D. Amiloride
E. Euphylline
An elderly male patient has essential hypertension, congestive heart failure, and type I insulin-dependent
diabetes. His congestive failure developed secondary to coronary vascular disease associated with
hyperlipidemia. What antihypertensive drug(s) may be most appropriate for this patient?
A. Chlorothiazide (Diuril)
B. * captopril (Capoten)
C. propranolol (Inderal)
D. metoprolol (Lopressor)
E. none of the above
An elderly female patient has essential hypertension, congestive heart failure, and type I insulindependent diabetes. His congestive failure developed secondary to coronary vascular disease associated
with hyperlipidemia. What antihypertensive drug(s) may be most appropriate for this patient?
A. chlorothiazide
B. * lisinopril
C. propranolol
D. metoprolol
E. all of the above
Which of the following compounds depends least upon the release of EDRF (nitric oxide) from
endothelial cells to cause vasodilation?
A. Bradykinin
B. Histamine
C. * Minoxidil
D. Hydralazine
E. Acetylcholine
43. A patient presents with a blood pressure of 160/110 mm Hg. The patient has a history of coronary
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vascular disease, resulting in angina, but has no evidence of congestive heart failure. The patient also has
asthma and has been treated mainly using terbutaline, by aerosol inhalation Propranolol (Inderal) was
prescribed to manage essential hypertension. Was this action appropriate?
A. Propranolol (Inderal) is appropriate because it will reduce heart rate and cardiac output. Negative
inotropism will help reduce the incidence of angina. It is an effective antihypertensive agent
B. Propranolol (Inderal) is inappropriate because it is only useful in mild hypertension; a better drug
would be minoxidil or hydralazine because they are more effective in lowering blood pressure
C. * Propranolol (Inderal) is inappropriate because its use is contraindicated in a patient with asthma.
D. Propranolol (Inderal) is appropriate because it is an effective, low-cost antihypertensive. It will
augment the effects of terbutaline, an additional benefit
E. All of the above
The patient with severe allergic bronchial asthma has been treated by oral drug during 7 months.
Hypertension, “moon face”, obese trunk, oedema, insomnia occur. What drugs does he used?
A. * Patient used one of orally used glucocorticoids, e.g. prednisolonum.
B. Patient used one of beta-agonists.
C. Patient used cromolynum.
D. Patient used euphyllinum
E. Patient used all above.
Patient 65 years old suffers from bronchial asthma. Adrenergic receptor activator is used for treatment,
After two weeks of management a pain near heart, palpitation. How can these side effects be prevent? It
is necessary to prescribe
A. * selective beta2-adrenergic receptor stimulator, for example salbutamolum.
B. glucocorticoids.
C. theophylline.
D. anticholinergics
E. cromolyn sodium.
An 81-year-old female with arteriosclerotic heart disease and pulmonary emphysema was found to have
significant bronchospasm. Her physician prescribed theophylline 400 mg every 12 hours. All of the
following toxicities may be observed EXCEPT:
A. cardiac arrhythmias
B. nausea and vomiting
C. agitation
D. * sodium and water retention
E. tremulousness
Which of the following antihypertensive drugs is contraindicated in a hypertensive patient with a
pheochromocytoma?
A. Metyrosine
B. Labetalol
C. Prazosin
D. Phenoxybenzamine
E. * Guanethidine
Which of the following antihypertensive agents would decrease renin release?
A. Prazosin
B. Clonidine
C. * Captopril
D. Nitroprusside
E. Diazoxide
A patient complains of severe expiratory dyspnea, paroxysmal dry cough, general asthenia. This
condition lasts for 28 hours and is not benefite after usage of salbutamol. Data of examination: the patient
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is staying and leaning against window-still, diffuse cyanosis add swelling of neck veins are observed,
weezes are heard on the distance, by percussion bundbox sound is heard, by auscultation – weakened
wesicular breathing, elongated expiration, difuse dry rales. Which medical preparation is the most
important for the patient?
A. beta-agonists,
B. beta-blockers;
C. Expectorants:
D. M-cholinolithics,
E. * Parenteral administrations of corticosteroids.
Furosemide increases the excretion of all of the following EXCEPT:
A. Na+
B. K+
C. Ca++
D. Mg++
E. * Uric acid
During auscultation of patient P., 60 years old, with chronic non-obstructive bronchitis, dry buzzling
rales above all parts of the lungs were heard as well as weakened vesicular breathing. What medical
preparation is it necessary to prescribe to the patient?
A. Diuretics;
B. Antitussive agents;
C. * Expectorants;
D. Broncholitics;
E. beta-blockers.
When a patient is treated with a thiazide diuretic for hypertension, all of the following are likely
EXCEPT:
A. The fall of blood pressure that occurs in the first 2 weeks of therapy results from a decrease of
extracellular volume.
B. The sustained fall in blood pressure that occurs after several weeks of therapy is due to a decrease
of intravascular resistance.
C. After the blood pressure is reduced, hypokalemia remains a complication.
D. Hyperuricemia may occur.
E. * Hypoglycemia may occur.
A 56-yr-old man wheezes and coughs. He has tried to give up smoking, but he finds it very difficult. He
is thin and healthy looking with a rounded chest. His breathing is noisy. His cough is unproductive. What
treatment has to be prescribed?
A. Amoxycillin
B. Prednisolone
C. * Ipratropium
D. Salbutamol
E. Bronchial lavage
A 20-yr-old woman presents with a week's history of fever, rigors arid productive rusty cough. CXR
shows right lower lobe consolidation. Prescribe treatment
A. Erythromycin
B. Co-trimoxazole
C. Prednisolone
D. * Amoxicillin
E. Salbutamol inhaler
Which of the following drugs is an appropriate initial antihypertensive therapy in an otherwise healthy
adult with mild hypertension?
A. Bumetanide
B. Triamterene
C. * Hydrochlorothiazide
D. Aldactone
Furosemid
When furosemide is administered to a patient with pulmonary edema, there is often symptomatic relief
within 5 minutes of starting treatment.This relief is primarily due to:
A. A rapid diuretic effect
B. * An increase in venous capacitance
C. A direct effect on myocardial contractility
D. Psychological effects
E. All of the above
At 39 years old woman for the removal of high blood pressure crisis the solution of Pentamine was
injected. What is the mechanism of medicine action?
A. * Depression of N-cholinoreceptors
B. Depression of М-cholinoreceptors
C. Stimulation of М-, Н-cholinoreceptors
D. Stimulation of N-cholinoreceptors
E. Stimulation of М-cholinoreceptors
A patient with bronchial asthma had been taking tablets which caused insomnia, headache, increased
blood pressure. What medicine can cause such complications?
A. Izadrine
B. * Ephedrine
C. Chromohn sodium
D. Euphylme
E. Adrenaline
After dithyline injection (1 mg/kg) long-term muscle paralysis has been observed (for over 2 hours).
What cure must be used for this patient?
A. Adrenaline
B. * Blood transfusion
C. Proserine
D. Propranolol
E. Anaprilin
Man 65 years entered the neurological department of hospital with diagnosis of post-stroke syndrome.
Which medicine most expediently to choose to patient?
A. Isoniasidum
B. Phosphacolum
C. Dipiroxim
D. * Galantaminum
E. Aceclidinum
To patient with signs of poisoning by phosphor organic substance injected cholinesterase reactivators.
Indicate a mechanism of action of this group of drugs.
A. * Dephosphorilation of cholinesterase with renewal of its activity.
B. Inactivation of cholinesterase.
C. Blockade of cholinoreceptors.
D. Activate of cholinoreceptors.
E. Oppression of synthesis of acetylcholine.
Patient with the acute stomach-ache, vomit, heavy breathing, shortness of breath, delivers in intensive
therapy. At the review of patient - skin moisture, hypersalivation, myosis, bradycardia, muscular
fascilation. From anamnesis it is known, that patient – toxin abuse, used the aerosols to insects. To which
group of agents, the substance that caused poisoning, belong?
A. N-cholinomimetic
B. М-choliniblockers
C. Myorelaxants
D. Ganglion-blockers
E. * Anticholinesterase agents
Patient with the complaints to dizziness, nausea, salivation and spastic stomach-aches was delivered to
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the hospital. The diagnosis set: poisoning by the phosphor organic substance. What must be included to
the complex therapy?
A. * Atropine sulfate and Dipirixim
B. Tiosulfate sodium and Bemegridum
C. Tetacin-calcium and Unitiolum
D. Nalorphine hydrochloride and Bemegridum
E. Glucose and Bemegridum
To the patient with the after operation atony of intestine injected Proserinum. Which mechanism lies in
basis of action of this preparation?
A. Receptor
B. * Antienzymic
C. Physical and chemical co-operation
D. Affect ionic channels of cellular membranes
E. Affect the transport systems of cellular membranes
The woman of 63 years got the injections of galantaminum for renewal of functions of CNS after the
ischemic stroke of brain. State of patient considerably became better. What mechanism of action of this
drug?
A. Dopaminehydroxilase blockade
B. Blockade of cholinacetelase
C. Blockade of KOMT
D. * Blockade of cholinesterase
E. Blockade of monoaminooxidase
Patient with the complaints to dryness in the mouth, photophobia and violation of vision was delivered to
the hospital. The skin was hyperemic, dry, pupils were extended, tachycardia. After examination the
poisoning by alkaloids of Belladona was diagnosed. What medicine is the most expediently to choose to
patient?
A. Dipiroxime
B. Aceclidine
C. Pilocarpine
D. Armine
E. * Proserine
Patients can exhibit alterations in the rate and extent of drug absorption because of various factors. All of
the following factors might affect the rate and/or extent of drug absorption EXCEPT:
A. Gastric emptying time
B. Intestinal motility
C. The presence of food
D. The formulation of the drug
E. * A generic form of the drug
The body has developed defense mechanisms that reduce the amount of foreign chemicals, such as drugs,
that enter the body. One of the more prominent of these mechanisms is an efflux transport system that
pumps some drugs back into the intestinal lumen following absorption into the enterocytes and that is
responsible for the lack of complete absorption of some drugs. This efflux transport system is:
A. Facilitated diffusion
B. * P glycoprotein
C. Cytochrome P450 3A
D. Pinocytosis
E. All of the above
All of the following statements concerning the blood-brain barrier and the passage of drugs from the
systemic circulation into the cerebrospinal fluid are TRUE EXCEPT:
A. * Ionized drugs are more likely to cross into the CSF than un-ionized drugs.
B. The higher the lipid solubility of a drug, the more likely it will cross into the CSF.
C. Inflammation of the meninges improves the likelihood that drugs will cross the blood-brain
barrier as compared to the uninflamed state (i.e., normal condition).
D. P glycoprotein serves to pump drugs back into the systemic circulation from endothelial cells
lining the blood-brain barrier.
None of the above
Following oral administration, a drug is absorbed into the body, wherein it can exert its action. For a drug
given orally, the primary site of drug absorption is:
A. The esophagus
B. The stomach
C. * The upper portion of the small intestine
D. The large intestine
E. All of the above
Conjugation of a drug with glucuronic acid via the glucuronosyl transferases will result in all of the
following EXCEPT
A. Production of a more water-soluble moiety that is more easily excreted
B. A new compound that may also possess pharmacological activity
C. A drug molecule that may be more susceptible to biliary elimination
D. A drug molecule that may undergo enterohepatic recirculation and reintroduction into the
bloodstream
E. * A drug with a different pharmacological mechanism of action
Concerning the renal excretion of drugs:
A. Drugs that are ionized in the renal tubule are more likely to undergo passive reabsorption than
those that are unionized
B. Low-molecular-weight drugs are much more likely to be actively secreted than filtered.
C. * Only drug that is not bound to plasma proteins (i.e., free drug) is filtered by the glomerulus.
D. Decreasing renal tubular fluid pH will increase elimination of weakly acidic drugs.
E. None of the above
Organs such as the liver remove exogenous chemicals, such as drugs, from the body. For drugs such as
phenytoin, for which the difference between the minimum effective concentration and the minimum
toxic concentration is small, clinicians must calculate the rate at which a given individual removes drug
from the body.The volume of fluid from which drug can be completely removed per unit of time (rate of
drug removal) is termed:
A. Distribution
B. * Clearance
C. Metabolism
D. Excretion
E. Binding with proteins
For a drug such as piroxicam with a 40-hour halflife and being dosed once daily (i.e., every 24 hours),
steady state will be reached shortly following which DOSE (not which half-life)?
A. 1st dose
B. 3rd dose
C. 5th dose
D. * 8th dose
E. 12th dose
Volume of distribution (Vd), though not a physiological volume, helps a clinician to estimate drug
distribution in the body. Drugs distribute throughout the body to differing degrees depending on a
number of factors.Which of the following factors is TRUE concerning drug distribution?
A. * In general, a drug with a higher degree of plasma protein binding will have a lower volume of
distribution.
B. All drugs distribute to the same degree in all tissues.
C. The binding of drugs to tissues has no relationship to the distribution of drug in the body.
D. (D) In general, lipophilic drugs distribute to a lesser extent than hydrophilic drugs.
E. None of the above
A clinician must be concerned with the amount of a drug dose that reaches the systemic circulation, since
this will affect the plasma concentration and therapeutic effects observed.The fraction of a dose reaching
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the systemic circulation as unchanged drug (i.e., intact) is defined as:
A. Theoretical dose
B. Cmax
C. Bioavailability
D. Ideal dose
E. * Tmax
A 56-yr-old man wheezes and coughs. He has tried to give up smoking, but he finds it very difficult. He
is thin and healthy looking with a rounded chest. His breathing is noisy. His cough is unproductive. What
treatment has to be prescribed?
A. Amoxycillin
B. Prednisolone
C. * Ipratropium
D. Salbutamol
E. Bronchial lavage
A 20-yr-old woman presents with a week's history of fever, rigors arid productive rusty cough. CXR
shows right lower lobe consolidation. Prescribe treatment
A. Erythromycin
B. Co-trimoxazole
C. Prednisolone
D. * Amoxicillin
E. Salbutamol inhaler
Tubercle bacilli exist in tuberculous patients in three pools extracellular, intracellular, and necrotic
caseum. The only drug which is bactericidal for all three is:
A. isoniazid
B. ethambutol
C. pyrazinamide
D. * rifampin
E. streptomycin
During auscultation of patient P., 60 years old, with chronic non-obstructive bronchitis, dry buzzling
rales above all parts of the lungs were heard as well as weakened vesicular breathing. What medical
preparation is it necessary to prescribe to the patient?
A. Diuretics;
B. Antitussive agents;
C. * Expectorants;
D. Broncholitics;
E. beta-blockers.
A 20-yr-old woman presents with a week's history of fever, rigors arid productive rusty cough. CXR
shows right lower lobe consolidation. Prescribe treatment
A. Erythromycin
B. Co-trimoxazole
C. Prednisolone
D. * Amoxicillin
E. Salbutamol inhaler
A 56-yr-old man wheezes and coughs. He has tried to give up smoking, but he finds it very difficult. He
is thin and healthy looking with a rounded chest. His breathing is noisy. His cough is unproductive. What
treatment has to be prescribed?
A. Amoxycillin
B. Prednisolone
C. * Ipratropium
D. Salbutamol
E. Bronchial lavage
During auscultation of patient P., 60 years old, with chronic non-obstructive bronchitis, dry buzzling
rales above all parts of the lungs were heard as well as weakened vesicular breathing. What medical
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preparation is it necessary to prescribe to the patient?
A. Diuretics;
B. Antitussive agents;
C. * Expectorants;
D. Broncholitics;
E. beta-blockers.
Patient 65 years old suffers from bronchial asthma. Adrenergic receptor activator is used for treatment,
After two weeks of management a pain near heart, palpitation. How can these side effects be prevent? It
is necessary to prescribe
A. * selective beta2-adrenergic receptor stimulator, for example salbutamolum.
B. glucocorticoids.
C. theophylline.
D. anticholinergics
E. cromolyn sodium.
A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving
codeine when she does not have any pain. The nurse's response is based on knowledge that codeine also
has what effect?
A. Immunostimulant.
B. * Antitussive.
C. Expectorant.
D. Immunosuppressant.
E. Antihistamine.
Failure of first-line drugs in the initial treatment of apparent pulmonary tuberculosis may have several
causes including poor patient compliance and atypical mycobacterial infections, the latter usually
requiring use of second-line drugs. All of the following are first-line drugs EXCEPT:
A. streptomycin
B. rifampin
C. * ethionamide
D. ethambutol
E. isoniazid
A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse why she is receiving
codeine when she does not have any pain. The nurse's response is based on knowledge that codeine also
has what effect?
A. Immunostimulant.
B. * Antitussive.
C. Expectorant.
D. Immunosuppressant.
E. Antihistamine.
Mother, whose child suffered from dry cough that did not let her to sleep at night, consulted a
pediatrician. What preparation can’t be used in such case?
A. Libexyn.
B. Tusuprex.
C. * Codeine.
D. Bromhexyn.
E. Acetylcistein.
An 81-year-old female with arteriosclerotic heart disease and pulmonaryemphysema was found to have
significant bronchospasm. Her physician prescribedtheophylline 400 mg every 12 hours. All of the
following toxicities may beobserved EXCEPT:
A. cardiac arrhythmias
B. nausea and vomiting
C. agitation
D. * sodium and water retention
E. tremulousness
90. When comparing the relative adrenergic effects of the following drugs, the onewhich would have the
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least 2 (bronchodilatation) effect at normal doses is:
A. terbutaline
B. epinephrine
C. isoproterenol
D. isoetharine
E. * norepinephrine.
The alternate usage of dichlotiazide, etacrin acid and lasix did not cause marked diuretic effect in the
patient with marked peripheral edema. The aldosterone level in the blood is increased. Indicate which
medicine should be prescribed:
A. Mannit
B. Amilorid
C. Clopamid
D. Urea
E. * Spironolacton
The drug, administered at the intestine and urinary bladder atony, causing hypersecretion of the gastric
glands and at overdose it causes spasmodic pains in the abdominal region, bronchospasm
A. Atropine sulfas
B. Scopolaminum
C. * Proserinum
D. Hygronium
E. Platyphyllinum
The patient has cranial trauma. The brain edema developed in the postoperative period. To prescribe drug
for the removal of this complication.
A. Spironolactone
B. Papaverini hydrochloride
C. * Furosemide
D. Dihlothiazid
E. Diacarb
To the 55 years old man for the medical treatment of gout was prescribed Aethamidum. What is the
mechanism of uric actions of the drug?
A. * Depression of reabsorbing of urinary acid
B. Increasing of secretion of urinary acid
C. Decreasing of production of urinary acid
D. Depression of activity of ksantinoxydase
E. Production of easy soluble salts
At the 46 years old patient with blink arrhythmia the edema of lungs began. What drug is necessary to
inject in the first turn?
A. * Furosemide
B. Triamterene
C. Verospirone
D. Amiloride
E. Euphylline
To the patient with edema of cardiac origin the doctor must prescribe diuretics. What drugs are contraindicated in this situation?
A. Hypothiazid
B. Spironolactone
C. Furosemide
D. * Mannitol
E. Diacarb
At the 42 years old man with gout the concentration of urinary acid in the blood increased. For the
decline of level of urinary acid allopurinol was prescribed to him. What enzyme is allopurinol
competitive inhibitor of?
A.
B.
C.
D.
E.
* Xantinoxydase
Adeninphosphoriboziltransferase
Hypoxantinphosphoriboziltransferase
Guanindesaminase
Adenosindesaminase
98. In the complex medical treatment of hypertensive disease a diuretic was prescribed to the patient. In a
few days the BP went down, but the signs of hypokaliaemia arose up. What drug could cause such
complication?
A. Triamterene
B. Clofeline
C. Enalapril
D. Spironolactone
E. * Furosemide
99. Patient with acute rheumatism treated oneself by salicylates. After some time the insomnia appeared at
him. When the doctor prescribed Phenobarbital, the anti-inflammatory action of salicylates became weak.
How to explain weakening an action of salicylates in presence of Phenobarbital?
A. * Induction of liver enzymes.
B. Inhibition enzymes of liver.
C. Chemical antagonism.
D. Physiology antagonism.
E. Acceleration of selection of salicylates from organism.
100. In the patient of 55 years old with stomach ulcer on the 4-th day of medical treatment by indometacin
the gastric bleeding appeared. What is the mechanism of ulcer action of drug?
A. * Decreasing of production of prostaglandin Е1.
B. Decreasing of production of prostaglandin Е2.
C. Decreasing of production of leucotrienes.
D. Decreasing of production of cyclic endoperexes.
E. Decreasing of production of tromboxan.
101. The patient (60 years old) with diagnosis rheumatoid arthritis use nonsteroid anti-inflammatory drug
indometacin for a long time. What is the mechanism of action of this drug?
A. Blockade of lipooxygenase.
B. Blockade of acetylcholinesterase.
C. Blockade of phospholipase.
D. * Blockade of cyclooxygenase.
E. Blockade of phosphodiesterase.
102. Woman (40 years old) asked the doctor about her complaint on the pain in knee-joints. The doctor
found slight swelling, hyperaemia, hyperthermia in the area of these joints. The laboratory research
revealed positive rheumatic tests. What drugs did the doctor prescribe for treating such patient?
A. * Nonsteroid anti-inflammatory drugs.
B. Narcotic analgesics.
C. Antidepressants.
D. Antibiotics.
E. Sulfanilamides.
103. The patient with diagnosis rheumatoid arthritis use indometacin for a long time, and the symptoms of
gastropathies appeared. What action of this drug is possible to connect the mechanism of this
complication with?
A. Antichatecholamines.
B. Antihistamines.
C. Antiserotonines.
D. * Anticyclooxygenase.
E. Local irritative action.
104. Patient teaching for a patient receiving allopurinol (Zyloprim) should include which of the following
statements:
A.
B.
C.
D.
E.
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* "Do not take this medication during an acute attack of gout."
"Include salmon and organ meats in your diet on a weekly basis."
"Take the medication with an antacid to minimize GI distress."
"This medication may cause your urine to turn orange."
All of the above.
A doctor is caring for a client with a diagnosis of rheumatoid arthritis who is receiving sulindac
(Clinoril) 150 mg po twice daily. Which finding would indicate to the doctor that the client is
experiencing a side effect related to the medication?
A. * Nausea
B. Photophobia
C. Fever
D. tingling in the extremities
E. Hypertension
After the clinical and laboratory examinations the cholera was diagnosed in the patient. What antibiotic
must be used in this case?
A. * Tetracycline.
B. Levomicetin.
C. Oxacillin.
D. Cefalexin.
E. Gentamicin.
The patient was treated by antibiotic from the group of tetracycline. Doctor advised him to use not milk
products. Why did he recommend it?
A. The toxic of antibiotics increases.
B. Milk products do not absorb.
C. The risk of disbacteriosis increases.
D. * The absorption of antibiotics decreases.
E. The process of digestion decreases.
After the laboratory examinations Str. Pneumoniae was found in the patient with pneumonia, that was
sensible to beta-lactam antibiotics. What antibiotic must be used in this disease?
A. Gentamicin.
B. * Penicillin group
C. Azithromycin
D. Erythromycin.
E. Tetracycline.
The patient has rheumocarditis with frequent activation of disease. What antibiotic must be used for
prophylactic or medical treatment of activation?
A. Levomicetin.
B. Erythromycin.
C. * Bicillin-5.
D. Cefazolin.
E. Tetracycline.
An antibacterial therapy was prescribed to the patient with general form of salmonellosis. After some
time rethyculocytopenia and granulocytopenia, erythrocytopenia were founded in general blood
analysis of the patient. What antibiotic could cause such changes of blood?
A. Tetracycline.
B. Gentamicin sulphate.
C. * Levomicetin.
D. Polimyxin-В sulphate.
E. Amoxicillin.
An antibiotic was prescribed to the patient with tuberculosis in composition of complex therapy. The
injections of the antibiotic were painful; the skin rashes and eosinophylia in the blood appeared.
Introduction of the calcium pantotenat decreased the side effect of the antibiotic. What antibiotic was
prescribed?
Florimicin.
Bicillin.
Cefalexin.
Ampicillin.
* Streptomycin.
At woman with the post-natal sepsis in the bacteriological analysis of the blood Staphylococcus aureus
was founded; it was stable to the action of methycillin and others beta-lactam antibiotics. What drug is
necessary to prescribe to the patient for the combine antibacterial chemotherapy?
A. Oxacillin.
B. * Vancomycin.
C. Oletetryn.
D. Tetraolean.
E. Cefazolin.
Acute tracheobroncitis developed at pregnant woman. For the medical treatment of this infection the
antibiotic from penicillins was used. Define, what drug was prescribed to pregnant.
A. Streptomycin.
B. Gentamicin.
C. * Amoxicillin.
D. Tetracycline.
E. Furacilin.
Woman the 48 years suffer on parandontosis. What antibacterial drug will be more effective in case of
introduction in gums tissues?
A. Gentamicin.
B. Benzylpenicillin.
C. * Linkomycin.
D. Oxacillin.
E. Dimexid.
The pregnant woman (20 weeks of pregnancy) became ill on pneumonia. What drug is possible to
prescribe the woman without threat for fetus development?
A. Gentamicin.
B. * Amoxycillin.
C. Sulphalen.
D. Levomicetin.
E. Ofloxacin.
Woman the 60 years take for a long time dexamethason for the medical treatment of arthritis of the left
knee-joint. What is the biochemical mechanism of anti-inflammatory action of this drug?
A. Blockade of folatsynthetase.
B. Blockade of cyclooxygenase 1.
C. Blockade of cyclooxygenase 2.
D. * Blockade of phospholipase А2.
E. Blockade of folatreductase.
It is necessary to prescribe an antibacterial drug of wide spectrum action to the child (4 years old) at the
intestinal infection. What antibacterial drug is not prescribed to the children in connection with the
harmful affecting a development of bone tissues?
A. Levomicetin.
B. Amoxicillin.
C. Ampicillin.
D. * Doxycyclin.
E. Co-trimoxasol (biseptol).
The doctor prescribed an antibiotic stable to the destructive action of beta-lactamase to the child (10
years old) with the severe staphylococcus infection. Define this drug.
A. * Oxacillin.
B. Benzylpenicillin-sodium salt.
A.
B.
C.
D.
E.
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C. Ampicillin.
D. Phenoximethylpenicillin.
E. Bicillin-1.
119. The antibiotic, that was prescribed for the etiologic medical treatment of chlamidiosis to the old man,
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who follows a milk-vegetable diet, did not give a convalescence effect. What was a drug?
A. Oxacillin.
B. * Tetracycline.
C. Methycillin.
D. Streptomycin.
E. Cefuroxim.
For the medical treatment of general form of salmonellosis was used an effective drug at old man.
However for the finished medical treatments the patient began to complain on decreasing of vision.
Indicate this drug.
A. Etasol.
B. Furasolidon.
C. Ftalasol.
D. * Levomicetin.
E. Biseptol.
You should assess a 75-year-old patient for nephrotoxicity and ototoxicity when administering which
of the following antimicrobials?
A. Cefazolin (cephalosporin antibiotic).
B. Clindamycin (lincosamide antibiotic).
C. * Gentamicin (aminoglycoside antibiotic).
D. Erythromycin (macrolide antibiotic).
E. Tetracycline.
When teaching a patient being discharged on linezolid (Zyvox) to treat methicillin-resistant
Staphylococcus aureus (MRSA), the doctor must emphasize the importance of:
A. Reporting occurrence of constipation.
B. * Avoiding ingestion of food containing tyramine.
C. Stopping the drug as soon as he or she feels better.
D. Taking the medication with antacid to avoid GI upset.
E. Reporting occurrence of diarrhea.
A patient prescribed azithromycin (Zithromax) expresses concern regarding GI upset that he
experienced when taking erythromycin. The nurse's best response would be:
A. "I will call the doctor and ask for a different antibiotic."
B. * "This drug is like erythromycin but has less severe GI side effects."
C. "You need this medication and will just have to deal with the nausea."
D. "I will ask the doctor for a prescription for an antiemetic in case this drug makes you sick as
well."
E. Decreased free drug in blood.
A man aged 74 has moderate hypertension controlled with hydrochlorothiazide 12.5 mg once daily and
losartan 50 mg once daily. He is prescribed rofecoxib 50 mg once daily to control osteoarthritis pain.
After 3 months of this therapy, his blood pressure begins to rise.This increase in blood pressure is most
likely due to
A. * Inhibition of COX-2 by rofecoxib, which leads to decreased renal blood flow
B. Increased metabolism of losartan due to induction of CYP2C9 by rofecoxib
C. Increased excretion of hydrochlorothiazide due to increased renal blood flow caused by rofecoxib
D. Arteriolar contraction in the peripheral circulation caused by inhibition of COX-1 by rofecoxib
E. Weight gain caused by rofecoxib’s ability to decrease basal metabolic rate.
A 52-year-old woman with a history of eczema and heavy alcohol use begins taking ibuprofen to
control hip and knee pain due to osteoarthritis. Over the course of 6 months, as the pain worsens, she
increases her dosage to a high level (600 mg four times daily).What toxicity is most likely to occur, and
why?
A. Abnormal heart rhythms; alcohol induces cytochrome P450 isozymes that convert ibuprofen to a
cardiotoxic free radical metabolite
B. Necrotizing fasciitis; eczema predisposes an individual to this toxicity of ibuprofen
C. * Gastric ulceration; heavy alcohol use increases the susceptibility of an individual to
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ibuprofeninduced GI toxicity
D. Confusion and ataxia; these CNS toxicities of ibuprofen are additive with those of ethanol
E. Eosinophilia; this rare complication of ibuprofen therapy is exacerbated by the
immunosuppression frequently seen in alcoholics
A patient refuses to continue to take erythromycin because it makes him vomit.This is an example of
which patient–drug–pathogen interaction?
A. Pharmacokinetics
B. * Pharmacodynamics
C. Immunity
D. Resistance
E. Selective toxicity
A 24-year-old AIDS patient is interested in starting chemoprophylaxis for Pneumocystis pneumonia
(PCP) and cerebral toxoplasmosis. He has no drug allergies.Which of the following prophylactic agents
is appropriate for the prevention of both PCP and cerebral toxoplasmosis?
A. Nitrofurantoin
B. * Trimethoprim–sulfamethoxazole
C. Norfloxacin
D. Methenamine
E. Nalidixic acid
Urinalysis of a 38-year-old woman with recurrent UTIs revealed pH 6.8, 30 to 50 WBC per highpower
field, and gram-negative bacilli identified as Proteus mirabilis.Which of the following produces a
bacteriostatic urinary environment for P. mirabilis?
A. Urease enzyme
B. * Hippuric acid
C. Catalase enzyme
D. Folic acid
E. Coagulase enzyme
A 3-day-old baby is given a presumptive diagnosis of kernicterus.Which of the following mechanisms
is involved in sulfonamide-induced kernicterus?
A. * Competes for the bilirubin-binding sites on plasma proteins
B. Defective bilirubin hepatic conjugation and metabolism
C. Physiological jaundice due to destruction of fetal red blood mass
D. Pregnancy-induced hepatic congestion and cholestasis
E. Primary biliary cirrhosis of the liver
A 6-year-old relatively healthy boy is diagnosed with external otitis and was prescribed a 7-day course
of trimetoprim/sulfametoxazol.Which of the following is the basic mechanism of action of the
sulfonamides?
A. Selective inhibition of incorporation of PABA into human cell folic acid synthesis.
B. * Competitive inhibition of incorporation of PABA into microbial folic acid.
C. Inhibition of transpeptidation reaction in bacterial cell wall synthesis.
D. Changes in DNA gyrases and active efflux transport system resulting in decreased permeability of
drug.
E. Structural changes in dihydropteroate synthase and overproduction of PABA.
Evaluation of a yearly chest radiograph of a 73-year-old patient taking nitrofurantoin prophylactically
for recurrent UTIs revealed new findings of bilateral interstitial fibrosis. What is the possible
explanation for the patient’s pulmonary presentation and what is the next step?
A. Acute urosepsis; add a broad-spectrum antibiotic to nitrofurantoin.
B. * Possible allergic reaction to nitrofurantoin; stop it immediately.
C. Nitrofurantoin-resistant E. coli infection; stop it immediately.
D. Acute community-acquired streptococcal pneumonia; treat accordingly.
E. Nitrofurantoin-induced hemolysis; requires permanent urinary catheter.
132. A 16-year-old girl, a cystic fibrosis patient, is diagnosed with a ciprofloxacin-resistant Pseudomonas
aeruginosa lower respiratory tract infection. Bacteria acquire quinolone resistance by which of the
following mechanisms?
A. Overproduction of PABA
B. * Changes in the synthesis of DNA gyrases
C. Plasmid-mediated changes in efflux transport system
D. Inhibition of synthesis of peptidoglycan subunits in bacterial cell walls
E. Inhibition of folic acid synthesis by blocking different steps