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Practice exam week 13
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1

Which of the following drug classes produce their therapeutic action by inhibiting the function of an enzyme?

Bronchodilators

Lipid lowering drugs (statins)

Specific serotonin reuptake inhibitors

Benzodiazepines

Lipid lowering drugs (statins)

2

QUESTION 2

  1. Which of the following is the generic name of a drug? Nyquil Digoxin Prozac Imodium

Digoxin

3
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QUESTION 3

  1. The graph below shows two dose-response curves to the same agonist. What are the curves A and B most likely to represent?
  1. Curve A is agonist alone and curve B is non-competitive antagonist alone
  2. Curve A is competitive antagonist alone and curve B is non-competitive antagonist alone
  3. Curve A is agonist alone and curve B is agonist plus competitive antagonist
  4. Curve A is agonist alone and curve B is agonist plus non-competitive antagonist

Curve A is agonist alone and curve B is agonist plus non-competitive antagonist

4
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QUESTION 4

  1. The best example of a partial agonist on the graph below is:
  1. Drug A
  2. None of these drugs is behaving like a partial agonist
  3. Drug C
  4. Drug B

Drug B

5

QUESTION 5

  1. A patient needs to receive a medication and there are four possible drugs that can be used. Drug A has a therapeutic index of 4, drug B has a therapeutic index of 0.8 drug C has an index of 1.2 and drug D has an index of 0.2. The drugs are equivalent in all other respects. Which drug would be the best choice for the patient?
  1. Drug A
  2. Drug B
  3. Drug C
  4. Drug D

Drug A

6
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QUESTION 6

  1. According to the graph:
  1. Drug B has a greater efficacy than drug A
  2. Drug A is more potent than drug B
  3. Drug B has a narrower therapeutic index than drug A
  4. Drug A has a lower affinity than drug B

Drug A is more potent than drug B

7

QUESTION 7

  1. A competitive antagonist is a drug that:
  1. Binds to the same receptor site and competes with the agonist for occupation of the site
  2. Binds to one receptor subtype as an agonist and to another as an antagonist
  3. Binds to a different receptor, but produces an effect that opposes that of the agonist
  4. Interacts with receptors and produces a submaximal effect

Binds to the same receptor site and competes with the agonist for occupation of the site

8

QUESTION 8

  1. Which of the following will NOT have an impact on the amount of drug that reaches the systemic circulation after oral administration?
  1. the degree of first-pass metabolism of the drug
  2. the absorption of the drug across the gut wall
  3. the mechanism of action of the drug at the receptor level
  4. the stability of the drug in the gastrointestinal tract

the mechanism of action of the drug at the receptor level

9

QUESTION 9

  1. A drug which is a weak acid: would be likely to be better absorbed from the stomach than a weak base would be highly ionised in the stomach would not be highly ionised in the small intestine would be more ionised and therefore better absorbed from the small intestine

would be likely to be better absorbed from the stomach than a weak base

10

QUESTION 10

  1. The metabolism of drugs by the liver: always
  1. make them less toxic
  2. makes them more hydrophilic (water soluble)
  3. always increase their bioavailability
  4. makes them more lipophilic ( fat soluble)

makes them more hydrophilic (water soluble)

11

QUESTION 11

  1. Drugs that cross the cell membrane easily are more likely to be:
  1. polar
  2. ionised
  3. hydrophilic
  4. lipid-soluble

lipid-soluble

12

QUESTION 12

  1. After absorption of a drug, which of the following would you predict would be slowest to accumulate the drug?
  1. Liver
  2. Muscle
  3. Kidney
  4. Adipose tissue

Adipose tissue

13

QUESTION 13

  1. Weak acids are excreted faster in _____________ urine and weak bases are excreted faster in ___________ urine.
  1. Alkaline; acidic
  2. Acidic:alkaline
  3. Neutral;alkaline
  4. None of the above

Alkaline; acidic

14
card image

QUESTION 14

  1. What pharmacological action would the active ingredient in this preparation have?
  1. Increased nasal blood flow and reduced secretion due to muscarinic antagonist action
  2. Reduced nasal blood flow and secretion due to alpha-1 agonist action
  3. Reduced nasal secretion due to beta-2 antagonist action
  4. Reduced nasal blood flow and secretion due to muscarinic agonist action

Reduced nasal blood flow and secretion due to alpha-1 agonist action

15
card image

QUESTION 15

  1. What would this preparation be used for?
  1. To cause pupillary dilation
  2. To lubricate the eye
  3. To treat glaucoma
  4. To cause pupillary constriction

To treat glaucoma

16

QUESTION 16

  1. An agonist at which of these receptors would bring about bronchodilation?
  1. Alpha-1
  2. Beta-2
  3. Beta-1
  4. Muscarinic

Beta-2

17

QUESTION 17

  1. An agonist at which of these receptors would cause vasodilation?
  1. Beta-2
  2. Alpha-1
  3. Muscarinic
  4. Beta-1

Beta-2

18

QUESTION 18

  1. Which of the following drugs would be useful to reduce bronchial secretions?
  1. Muscarinic agonist
  2. Muscarinic antagonist
  3. Beta-2 agonist
  4. Beta-2 antagonist

Muscarinic antagonist

19

QUESTION 19

  1. A woman goes into labour prematurely, and on the way to hospital she is given salbutamol by inhalation. What effect might this have?
  1. The salbutamol, acting on beta-1 receptors, would help to reduce her blood pressure
  2. The salbutamol, acting on GABA receptors, would help to calm her down
  3. The salbutamol, acting on beta-2 receptors, would reduce the contractions of the uterus
  4. She must have asthma too, which is why she is being given the salbutamol

The salbutamol, acting on beta-2 receptors, would reduce the contractions of the uterus

20

QUESTION 20

  1. A patient with a cardiac arrhythmia is taking warfarin on a long term basis. Which of the following disorders is the patient likely to have?
  1. Heart block
  2. Ventricular tachycardia
  3. Atrial fibrillation
  4. None of the above

Atrial fibrillation

21

QUESTION 21

  1. A drug is an inhibitor of cholinesterase. From what you know about the action of this enzyme, which of the following conditions do you think could be successfully treated with this drug?
  1. Urinary retention
  2. Low blood pressure
  3. Vomiting and diarrhoea
  4. Asthma

Urinary retention

22

QUESTION 22

  1. Which of the following drugs is effective at reducing afterload on the heart and relieving an angina attack, but is taken sublinugally, as it is rapidly inactivated by first-pass metabolism in the liver?
  1. Glyceryl trinitrate
  2. Nicorandil Isosorbide
  3. dinitrate
  4. Atenolol

Glyceryl trinitrate

23

QUESTION 23

  1. Which of the following drugs may be used to treat the oedema associated with congestive heart failure and to treat hypertension?
  1. Cardiac glycosides
  2. Diuretics
  3. Alpha agonists
  4. Cholesterol lowering agents

Diuretics

24

QUESTION 24

  1. Which of the following is a life-threatening arrhythmia caused by electrical conduction disturbances in the heart?
  1. Premature ventricular contraction
  2. Atrial fibrillation
  3. Ventricular fibrillation
  4. Ectopic foci

Ventricular fibrillation

25

QUESTION 25

  1. What arises as a result of insufficient blood flow through coronary arteries?
  1. Angina pectoris
  2. Atherosclerosis
  3. Arteriosclerosis
  4. Supraventricular tachycardia

Angina pectoris

26

QUESTION 26

  1. What are the leading causes of congestive heart failure?
  1. Untreated hypertension, untreated diabetes and obesity
  2. Valvular defects, untreated hyperthyroidism, angina pectoris
  3. Coronary artery disease, myocardial infarction, untreated hypertension
  4. None of these are correct

Coronary artery disease, myocardial infarction, untreated hypertension

27

QUESTION 27

  1. How do beta blockers produce their antiarrhythmic effect?
  1. By slowing the pacemaker potential at the SA and AV nodes
  2. By blocking the initial influx of sodium ions to cardiac muscle cells during the cardiac action potential
  3. By blocking the influx of calcium ions to cardiac muscle cells during the cardiac action potential
  4. By slowing the repolarisation of ventricular muscle cells

By slowing the pacemaker potential at the SA and AV nodes

28

QUESTION 28

  1. A woman is taken ill and on admission to hospital, is found to have an arterial blood pressure of 185/120 mm Hg. Which of the following drugs would be most suitable for her immediately?
  1. Sodium nitroprusside
  2. Nifedipine
  3. Atenolol
  4. Minoxidil

Sodium nitroprusside

29

QUESTION 29

  1. A patient suffering from stroke due to a thrombus blocking a blood vessel in the brain is given clopidogrel and alteplase. What will these drugs do?
  1. They will both break up the thrombus that is blocking the blood vessel
  2. Both drugs will reduce the likelihood of more thrombi forming - only surgery can break up the existing thrombus
  3. Clopidogrel will reduce the likelihood of more thrombi forming and alteplase will break up the existing thrombus
  4. Alteplase will reduce the likelihood of more thrombi forming and clopidogrel will break up the existing thrombus

Clopidogrel will reduce the likelihood of more thrombi forming and alteplase will break up the existing thrombus

30

QUESTION 30

  1. A new drug, a renin antagonist, is made available on the market. What effect do you predict it would have and what disorder could it be used to treat?
  1. It would ultimately reduce sodium and fluid loss via the kidney. It could be used to treat hypotension.
  2. It would ultimately increase the release of aldosterone, thereby increasing sodium retention. It could be used to treat aldosterone deficiency.
  3. It would reduce the formation of angiotensinogen, thereby ultimately reducing blood volume. It could be used to treat hypertension.
  4. It would reduce the formation of angiotensin I from angiotensinogen, thereby ultimately reducing blood volume. It could be used to treat hypertension.

It would reduce the formation of angiotensin I from angiotensinogen, thereby ultimately reducing blood volume. It could be used to treat hypertension.

31

QUESTION 31

  1. What effect does the conversion of plasminogen to plasmin in the circulation have? It inhibits the clotting cascade It starts the clotting cascade It causes the breakdown of blood clots It creates a fibrous meshwork which traps platelets and clotted blood

It causes the breakdown of blood clots

32

QUESTION 32

  1. What would be the drug treatment of choice for the acute control of supraventricular tachycardia?
  1. Intravenous beta blockers
  2. Intravenous amiodarone
  3. Intravenous adenosine
  4. Oral glyceryl trinitrate

Intravenous adenosine

33

QUESTION 33

  1. Which of the following drug treatments would NOT be appropriate in the management of congestive heart failure?
  1. Diuretic
  2. ACE inhibitor
  3. Beta agonists
  4. Cardiac glycoside

Beta agonists

34

QUESTION 34

  1. Which of the following drugs is an angiotensin II antagonist?
  1. Amiloride
  2. Losartan
  3. Captopril
  4. Hydrochlorothiazide

Losartan

35

QUESTION 35

  1. Which of the following drugs work by inhibiting platelet aggregation?
  1. Heparin and Streptokinase
  2. Clopidogrel and Aspirin
  3. Tissue plasminogen activator and Aspirin
  4. Warfarin and Clopidogrel

Clopidogrel and Aspirin

36

QUESTION 36

  1. Which of the following indications are beta blockers mainly used for?
  1. Hypertension, anxiety, asthma
  2. Postural hypotension, high output cardiac failure and coronary artery disease
  3. Supraventricular tachycardia, exercise-induced arrhythmias, myocardial infarctions, congestive heart failure, stable angina
  4. None of these are the main clinical uses of beta-blockers

Supraventricular tachycardia, exercise-induced arrhythmias, myocardial infarctions, congestive heart failure, stable angina

37

QUESTION 37

  1. A man has an enlarged thyroid gland and high circulating levels of T3 and T4. He is given the thionamide drug propylthiouracil to treat the condition. How does this drug work?
  1. By preventing the uptake of iodine into the thyroid gland.
  2. By increasing the hepatic metabolism of T3 and T4
  3. By increasing the plasma protein binding of T3 and T4
  4. By inhibiting the iodination of the molecules during the production of thyroid hormones.

By inhibiting the iodination of the molecules during the production of thyroid hormones.

38

QUESTION 38

  1. In parts of the world where goitre is common, which would be the most useful treatment to reduce this incidence?
  1. Iodide
  2. Methimazole
  3. Propylthiouracil
  4. Any of these could be used

Iodide

39

QUESTION 39

  1. A patient is suffering from severe hyperthyroidism due to Grave's disease. Which of the following would be the quickest way to correct this problem?
  1. Administer a Thionamide, such as Carbimazole
  2. Administer radioiodide
  3. Surgically remove the pituitary gland
  4. Surgically remove the thyroid gland

Surgically remove the thyroid gland

40

QUESTION 40

  1. A post-menopausal woman with osteoporosis is given the drug alendronate. What will this drug do?
  1. Activate vitamin D, and increase calcium absorption from the gut.
  2. Increase the activity of osteoblasts in the bone
  3. Supply additional calcium, for bone building
  4. Reduce the activity of osteoclasts in the bone

Reduce the activity of osteoclasts in the bone

41

QUESTION 41

  1. An overweight woman with a history of type II diabetes and kidney disease is found in her home unconscious. Her blood glucose is found to be so low it does not register on the paramedic's test. She is taking the sulphonylurea, glibenclamide. Which of the following scenarios is the most likely explanation of what has happened?
  1. The woman has suffered a collapse due to her kidney condition, and the failure of the kidneys to reabsorb glucose. The glibenclamide should have improved her condition, but she must be taking too low a dose.
  2. The glibenclamide has been metabolised too quickly, due to the woman's increased weight, which has resulted in a reduced effect of the drug, which should have prevented her hypoglycaemia.
  3. The woman has suffered a severe hypoglycaemic episode, produced by glibenclamide. She may have reduced renal function, which would decrease the clearance of the drug metabolites from the body, and since glibencalmide has active metabolites, this would exacerbate the effect.
  4. The woman has suffered a severe hypoglycaemic episode, produced by her type II diabetes. Her condition has resulted in a failure to regulate glucose levels correctly, leading to an overload of glucose in cells, resulting in weight gain, which has been exacerbated by the drug and also causing low blood glucose levels.

The woman has suffered a severe hypoglycaemic episode, produced by glibenclamide. She may have reduced renal function, which would decrease the clearance of the drug metabolites from the body, and since glibencalmide has active metabolites, this would exacerbate the effect.

42

QUESTION 42

  1. Bert is a 79 year old man with congestive heart failure. He also has type II diabetes, and has been taking a Sulphonylurea for two years. During the time, he has suffered several hypoglycaemic episodes, so his doctor decides to change his medication and put him on a Glitazone instead, to reduce the risk of any more hypoglycaemia atttacks. Is this a good idea?
  2. No, it isn't. The Glitazone will be less likely to produce hypoglycaemic episodes, but it will cause fluid retention, and make his congestive heart failure worse.
  3. Yes, it is. The Glitazone will also improve his blood lipid levels, which will be a bonus.
  4. Yes it is. The Glitazone will increase his blood glucose level when combined with insulin.
  5. No, it isn't. The Glitazone will increase his insulin sensitivity, which will make him more prone to hypoglycaemia.

No, it isn't. The Glitazone will be less likely to produce hypoglycaemic episodes, but it will cause fluid retention, and make his congestive heart failure worse.

43

QUESTION 43

  1. Candice has been diagnosed with type II diabetes. She is very overweight, and is on an exercise and diet programme, which has not yet had much effect. Which of the following drugs would she be most likely to be given?
  1. Metformin
  2. Rosiglitazone
  3. Acarbose
  4. Glibenclamide

Metformin

44

QUESTION 44

  1. Tammy has been taking hydrocortisone orally for three weeks. Her doctor has told her to cut her dose down over the week, before she finishes the course of drugs. She can't see the point in doing that, so stops taking the drug abruptly. Which of the following might be likely to occur as a result of this?
  2. Tammy will have excessive levels of cortisol release after abruptly stopping the drug, due to adrenal rebound and might suffer from osteoporosis or devlelop a moon face
  3. Tammy will suffer a rebound supression of her immune system after stopping the drug, leaving her vulnerable to infections
  4. Tammy is likely to suffer symptoms of masculinisation after stopping the drug, as testosterone production will now be increased
  5. Tammy will have reduced cortisol release due to adrenal supression, and might suffer from hypoglycaemia, low sodium level and low blood pressure after stopping the drug

Tammy will have reduced cortisol release due to adrenal supression, and might suffer from hypoglycaemia, low sodium level and low blood pressure after stopping the drug

45

QUESTION 45

  1. COX-2 inhibitors produce:
  2. uterine contractions less clotting tendency because COX-2 is active in blood cells
  3. less gastric ulceration and bleeding because COX-2 is not found in the gastrointestinal tract
  4. less anti-inflammatory action because COX-2 is
  5. less active during the inflammatory response

less gastric ulceration and bleeding because COX-2 is not found in the gastrointestinal tract

46

QUESTION 46

  1. A patient has been diagnosed with rheumatoid arthritis. Which of the following drugs is she most likely to receive as the first line treatment?
  1. Methotrexate
  2. Prednisone
  3. Gold salts
  4. Hydroxychloroquine

Methotrexate

47

QUESTION 47

  1. Differentiate between paracetamol and the NSAIDs, and select the correct statement about their use.
  1. Paracetamol is suitable for chronic therapy of inflammatory conditions such as osteoarthritis and rheumatoid arthritis in patients who experience gastric bleeding with aspirin.
  2. Paracetamol is suitable for use in patients who experience gastric bleeding from aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs); however, it is not interchangeable with these drugs for chronic therapy of osteo- or rheumatoid arthritis.
  3. Paracetamol is beneficial when taken once a day, for reducing the risk of heart attack and strokes
  4. None of these are correct.

Paracetamol is suitable for use in patients who experience gastric bleeding from aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs); however, it is not interchangeable with these drugs for chronic therapy of osteo- or rheumatoid arthritis.

48

QUESTION 48

  1. Differentiate between the COX-2 inhibitors and other NSAIDs, and select the true statement about COX-2.
  1. The selective COX-2 inhibitors exhibit potentially less serious cardiac or renal adverse effects than other NSAIDs because they focus only on one group of enzymes.
  2. Selective COX-2 inhibitors do not have the antithrombotic (clot prevention) protective action of aspirin and other COX-1 inhibitors because platelet aggregation occurs predominately via the COX-1 pathway.
  3. NSAIDs and COX-2 inhibitor drugs do not promote sodium and water retention.
  4. All of these are correct.

Selective COX-2 inhibitors do not have the antithrombotic (clot prevention) protective action of aspirin and other COX-1 inhibitors because platelet aggregation occurs predominately via the COX-1 pathway.

49

QUESTION 49

  1. In the treatment of rheumatoid arthritis, disease-modifying antirheumatoid drugs (DMARDs)
  1. are exemplified by the anti-malarial drug hydroxychloroquine
  2. are usually preferred to non-steroidal anti-inflammatory drugs
  3. are second line drugs
  4. all produce a beneficial effect within days

are usually preferred to non-steroidal anti-inflammatory drugs

50

QUESTION 50

  1. People who are brought to hospital suffering from paracetamol overdose are given a compound known as N-acetylcysteine, either orally or intravenously to treat the overdose. From what you know about the effects of too much paracetamol, what do you think N-acetylcysteine does?
  1. Increases the production of cyclooxygenase, to counteract the effects of paracetamol
  2. Increases the activity of the CYP450 enzymes, so that more of the paracetamol can be metabolised by this route.
  3. Stimulates urination, to clear the drug faster
  4. Increases the production of glutathione by the liver, so that the toxic metabolite can be detoxified.

Increases the production of glutathione by the liver, so that the toxic metabolite can be detoxified.

51

QUESTION 51

  1. The oxicams (piroxicam, tenoxicam, and meloxicam) differ to drugs like aspirin and ibuprofen in that they: do not possess analgesic actions. do not possess anti-inflammatory actions. have fewer gastrointestinal side effects. do not possess antipyretic actions.

have fewer gastrointestinal side effects.

52

QUESTION 52

  1. Which of the following has the risk of Reye's syndrome if given when virus is present?
  1. Aspirin
  2. Beclamethasone
  3. Paracetamol
  4. Celecoxib

Aspirin

53

QUESTION 53

  1. Which adverse effect is the most common in patients receiving tumor necrosis factor (TNF) inhibitors?
  2. Peptic ulcers
  3. Rash
  4. Diarrhoea
  5. Infections with typical and atypical organisms

Infections with typical and atypical organisms

54

QUESTION 54

  1. A number of factors contribute to airway narrowing during an asthma attack. Which of the following is NOT involved?
  2. mucus hyper secretion
  3. bronchoconstriction
  4. airway oedema
  5. destruction of the lung tissue

destruction of the lung tissue

55

QUESTION 55

  1. COPD differs from asthma in the following respects:
  2. Use of drugs can only partially reverse airway obstruction at best
  3. Airway inflammation with many eosinophils makes COPD highly responsive to inhaled steroids
  4. COPD, unlike asthma, is largely preventable
  5. All of the above

Airway inflammation with many eosinophils makes COPD highly responsive to inhaled steroids

56

QUESTION 56

  1. Long term use of a drug such as prednisolone may produce the following adverse effects:
  2. Hypercalcaemia, muscle wasting and increased ACTH release
  3. Moon face, osteoporosis , hyperglycaemia and adrenal suppression
  4. Hyperkalaemia, diarrhoea, decreased body hair and tiredness
  5. Hypoglycaemia, osteroporosis, increased body hair and increased testosterone release

Moon face, osteoporosis , hyperglycaemia and adrenal suppression

57

QUESTION 57

  1. Mr Jones has a bad case of bronchitis and needs a bronchodilator to ease his breathing. Which of the following is the best bronchodilator for him and for which reason?
  2. A choliergic antagonist like iprotropium would be best in bronchitis, since it will produce both bronchodilation and reduction of airway mucus
  3. A corticosteroid like fluticasone would be best, since this is the most powerful at producing bronchodilation
  4. A biological agent like Omalizumab would be best to get a more natural bronchodilator effect that will not overstretch his airways
  5. An adrenergic agonist like salbutamol would be best, since it will also reduce blood flow to the lungs, reducing congestion.

A choliergic antagonist like iprotropium would be best in bronchitis, since it will produce both bronchodilation and reduction of airway mucus

58

QUESTION 58

  1. Omalizumab is: used to prevent asthma attacks, as it inhibits lymphocyte activation used to treat acute asthma attacks, as it is a histamine antagonist an antibody which prevents allergic asthma by binding to IgE given orally to reduce airway sensitivity, but can increase bleeding tendency

an antibody which prevents allergic asthma by binding to IgE

59

QUESTION 59

  1. What will happen to mast cells when an individual is first exposed to an allergen?
  2. IgE antibodies will be produced and attach to the surface of mast cells.
  3. Histamine release from mast cells will be immediately triggered
  4. Mast cells will produce antibodies.
  5. Histamine release from lymphocytes will take place.

IgE antibodies will be produced and attach to the surface of mast cells.

60

QUESTION 60

  1. Which of the following asthma patients would be likely to benefit from an inhaled corticosteroid?
  1. A person who has frequent attacks of asthma, and breathlessness between attacks
  2. A person who has a cat fur allergy which causes bronchospasm, but who avoids cats.
  3. A person who suffers exercise-induced asthma on cold mornings when taking his five km run
  4. A person who suffers hay fever in the spring, which leads to asthma attacks

A person who has frequent attacks of asthma, and breathlessness between attacks

61

QUESTION 61

  1. Which of the following drugs would be effective in helping to prevent asthma attacks?
  1. Salbutamol
  2. Salmeterol
  3. Nedocromil sodium
  4. Tiatropium

Nedocromil sodium

62

QUESTION 62

  1. Which of the following is the most likely adverse effect of the use of an inhaled steroid for asthma?
  1. osteoporosis
  2. growth suppression
  3. oral thrush
  4. Cushing's syndrome

oral thrush

63

QUESTION 63

  1. What effects does histamine have on blood vessels and bronchioles?
  1. Promotes constriction of blood vessels and dilation of bronchioles
  2. Promotes dilation of blood vessels and dilation of bronchioles
  3. Promotes constriction of the blood vessels and constriction of bronchioles
  4. Promotes dilation of blood vessels and constriction of bronchioles

Promotes dilation of blood vessels and constriction of bronchioles

64

QUESTION 64

  1. Patients who have symptoms of a peptic ulcer are often given a breath test for urease. This test would be useful for:
  2. detecting the presence of Helicobacter pylori
  3. detecting the products of abnormal digestion which occur in the presence of peptic ulcer
  4. detecting excess gastric acid secretion
  5. None of the above

detecting the presence of Helicobacter pylori

65

QUESTION 65

  1. Statins are drugs which are widely used to control plasma cholesterol levels. These drugs work by:
  2. Reducing the uptake of fats from the gastrointestinal tract
  3. Binding the cholesterol-containing bile acids up in the gastrointestinal tract, so they are excreted
  4. Stimulating lipoprotein lipase
  5. Inhibiting a cholesterol-synthesising enzyme

Inhibiting a cholesterol-synthesising enzyme

66

QUESTION 66

  1. Which of the following agents are considered to have a cytoprotective effect in the stomach?
  1. Misoprostol
  2. H2 antagonists
  3. Proton pump inhibitors
  4. All of the above

Misoprostol

67

QUESTION 67

  1. HMG-CoA reductase inhibitors can have which of the following side effects?
  2. hyperuricemia & gout
  3. flushing & pruritus
  4. constipation & impaction
  5. myositis & rhabdomyolysis

myositis & rhabdomyolysis

68

QUESTION 68

  1. The most effective triple therapy for treatment of peptic ulcers with H.pylori consists of:
  1. Clarithromycin, Amoxycillin and an H2 antagonist
  2. Clarithromycin, Metronidazole and a proton pump inhibitor
  3. Clarithromycin, Amoxycillin and a proton pump inhibitor
  4. Clarithromycin, Amoxycillin and Bismuth

Clarithromycin, Amoxycillin and a proton pump inhibitor

69

QUESTION 69

  1. Which of the following drugs would exert its therapeutic action by a direct inhibitory action on the proton pump?
  2. Rabeprazole
  3. Atropine
  4. Ibuprofen
  5. Ranitidine

Rabeprazole

70

QUESTION 70

  1. A proton pump inhibitor needs to be able to move into the acidic environment of the proton pumps on the acid-secreting cells and remain trapped there. What should these drugs be in order to ensure that this occurs?
  2. Strong acids
  3. Highly lipid soluble
  4. Weak bases
  5. Weak acids

Weak bases

71

QUESTION 71

  1. Which of the following provides a signal from adipose tissue that reduces food intake?
  2. Orlistat
  3. Phentermine
  4. Leptin
  5. Cholecystokinin

Leptin

72

QUESTION 72

  1. A man with class II obesity is taking a weight loss drug. He starts to suffer from palpitations and anxiety. Which of the following drugs would he be most likely to be taking?
  2. Phentermine
  3. Metformin
  4. Orlistat
  5. Leptin

Phentermine

73

QUESTION 73

  1. Which of the following drug combinations is most likely to be effective treatment for an obese person with metabolic syndrome?
  2. Orlistat and Metformin
  3. Orlistat and atorvastatin
  4. Phentermine and fish oil
  5. Phentermine and Meglitinide

Orlistat and Metformin

74

QUESTION 74

  1. Which of the following would be sufficient for a diagnosis of metabolic syndrome?
  2. Abdominal obesity, hypertension.
  3. Overweight, high HDL, low LDL
  4. Insulin resistance, low HDL, hypertension
  5. All of the above would be sufficient for a diagnosis of metabolic syndrome

Insulin resistance, low HDL, hypertension

75

QUESTION 75

  1. A man with obesity is taking a weight loss drug. After starting the drug, he starts to suffer from diarrhoea and flatulence Which of the following drugs would he be most likely to be taking?
  2. Leptin
  3. Phentermine
  4. Orlistat
  5. Adiponectin

Orlistat

76

QUESTION 76

  1. Mr. Smith was temporarily taken off chemotherapy despite responding very well to treatment. The reason for this would be:
  2. to prevent the development of bone marrow cancers to allow the immune system to fight off the tumour
  3. to allow recovery of the normal tissue.
  4. to allow medical staff time
  5. to test for remission.

to allow recovery of the normal tissue.

77

QUESTION 77

  1. Mr Smith is scheduled to receive six rounds of chemotherapy with a cytotoxic agent. There was a very good response to the first two rounds of chemotherapy, but the next rounds were not as effective. What is the likely reason for this, and what could be done about it?
  1. the patient's normal cells have resistance to the cytotoxic drug, which has reduced its effectiveness against the cancer cells. A more targeted therapy may need to be used.
  2. the remaining tumour cells have resistance to the cytotoxic drug. A cytotoxic drug with a different mechanism of action, or a combination of drugs, could be tried.
  3. the patient is metabolising and excreting the drug faster, as his body develops tolerance. A drug that inhibits metabolism of the cytotoxic agent might restore its effectiveness.
  4. None of the above are likely

the remaining tumour cells have resistance to the cytotoxic drug. A cytotoxic drug with a different mechanism of action, or a combination of drugs, could be tried.

78

QUESTION 78

  1. Which of the following is a promising product of current research on developing new targeted treatments for cancer? Monoclonal antibodies Alkylating drugs Antimetabolites Polyclonal antibodies

Monoclonal antibodies

79

QUESTION 79

  1. Why might a doctor prefer to prescribe a narrow-spectrum antibiotic?
  2. Because the use of broad-spectrum antibiotics gives more types of organisms a chance to develop resistance
  3. Because narrow-spectrum antibiotics are faster acting than broad-spectrum antibiotics
  4. Because the narrow-spectrum antibiotic are less likely to cause hypersensitivity
  5. Because broad-spectrum antibiotics are more expensive than narrow-spectrum antibiotics

Because the use of broad-spectrum antibiotics gives more types of organisms a chance to develop resistance

80

QUESTION 80

  1. A drug which is an antagonist at GABAA receptors would be expected to produce which of the following effects?
  1. Psychosis
  2. Seizures
  3. Drowsiness and sedation
  4. Hypertension

Seizures

81

QUESTION 81

  1. A patient with Parkinson's disease who is mobile one minute and immobile the next is probably experiencing:
  2. dyskinesias produced by dopamine agonists
  3. the on-off phenomenon with l-dopa
  4. an overdose of l-dopa
  5. an increased metabilism of l-dopa

the on-off phenomenon with l-dopa

82

QUESTION 82

  1. A person taking a second generation (atypical) antipsychotic medication might be expected to experience all of the following except:
  2. Increased blood lipid levels
  3. Anaemia
  4. Weight gain
  5. Insulin resistance

Anaemia

83

QUESTION 83

  1. A person taking medication for depression is taken ill after a meal of cold meats, cheeses and beer, topped off with roasted banana peel and custard. He develops a pounding headache, and feels unwell. One of his friends decides he must be having an allergic reaction, and administers an injection from his own epi-pen. A few minutes later, the man developes the symptoms of a stroke, and dies later in hospital. What are the likely events that led to this?
  1. The man was probably taking a monoamine oxidase inhibitor for his depression. The foods he ate were rich in tyramine, which would not have been metabolised in his gut because of the drug. The tyramine would hterefore have been absorbed and would have increased his blood pressure. The addition of the adrenaline from the epi-pen would further have increased his pressure, causing a blood vessel in the brain to burst.
  2. The man was probably taking a specific serotonin reuptake inhibitor for his depression. The foods he ate were rich in tryptophan, which would have increased the production of serotonin in his brain, causing serotonin syndrome. The addition of the adrenaline from the epi-pen would further have increased the serotonin production, producing extreme hyperthermia and failure of the CNS.
  3. The man was probably taking a tricyclic uptake inhibitor for his depression. The foods he ate would not have been a problem, but the alcohol in the beer would have inhibited the metabolism of the drug, increasing the levels of monoamines in his brain, and causing over-excitation. The addition of the adrenaline from the epi pen would have further increased monoamine levels and produced a seizure.
  4. The man was probably taking an antidepressant, but this was unlikely to be the problem. He was more likely to have been allergic to something in the food (probably the banana peel), but the epi pen was not sufficient to prevent him having a stroke as a result of the anaphylaxis.

The man was probably taking a monoamine oxidase inhibitor for his depression. The foods he ate were rich in tyramine, which would not have been metabolised in his gut because of the drug. The tyramine would hterefore have been absorbed and would have increased his blood pressure. The addition of the adrenaline from the epi-pen would further have increased his pressure, causing a blood vessel in the brain to burst.

84

QUESTION 84

  1. A person who suffers from schizophrenia is diagnosed with Parkinson's disease later in life, and prescribed a dopmine agonist. Which of the following is likely to occur?
  2. The dopamine agonist is unlikely to affect the antipsychotic medication the person is probably taking
  3. The dopamine agonist will increase the effect of the antipsychotic medication the person will be taking, which will lead to excess dopamine activity in the brain
  4. The dopamine agonist will interfere with the effect of the antipsychotic medication, and vice versa, since they will have opposing effects at the same receptors
  5. None of the above are true

The dopamine agonist will interfere with the effect of the antipsychotic medication, and vice versa, since they will have opposing effects at the same receptors

85

QUESTION 85

  1. What is the relationship between GABA and the sedative-hypnotic drugs? These agents:
  2. decrease the GABA receptor-mediated chloride influx into neurons, enhancing neuronal activity.
  3. increase the GABA receptor-mediated sodium influx into neurons, inhibiting neuronal activity.
  4. decrease the GABA receptor-mediated calcium influx into neurons, inhibiting neuronal activity
  5. increase the GABA receptor-mediated chloride influx into neurons, inhibiting neuronal activity.

increase the GABA receptor-mediated chloride influx into neurons, inhibiting neuronal activity.

86

QUESTION 86

  1. Which of the following drugs would a person with bipolar disorder be likely to take long term?
  2. Propranolol
  3. Haloperidol
  4. Folic acid
  5. Lithium

Lithium

87

QUESTION 87

  1. Which of the following effects would you NOT expect a benzodiazepine to produce?
  1. Memory loss
  2. Muscle weakness
  3. Hypertension
  4. Drowsiness

Hypertension

88

QUESTION 88

  1. Why is carbidopa given along with l-dopa in pateints with Parkinson's disease?
  2. It decreases the conversion of l-dopa to dopamine in the periphery, and reduces side effects
  3. It antagonises dopamine receptors in the periphery to block the production of side effects
  4. It increases the conversion of l-dopa to dopamine, increasing the effectiveness of l-dopa
  5. It crosses the blood-brain barrier and prevents the metabolism of l-dopa in the brain

It decreases the conversion of l-dopa to dopamine in the periphery, and reduces side effects

89

QUESTION 89

  1. A person suffering from an overdose of an opioid drug would show:
  1. Agitation, hyperventilation and dilated pupils.
  2. Coma, depressed respiration and pinpoint pupils.
  3. Coma, depressed respiration and dilated pupils.
  4. Coma, hyperventilation and pinpoint pupils.

Coma, depressed respiration and pinpoint pupils

90

QUESTION 90

  1. Which of these drugs, if taken with an opioid, would be likely to produce dangerous CNS depression?
  1. a bronchodilator such as salbutamol
  2. a benzodiazepine such as alprazolam
  3. an antidepressant such as fluoxetine
  4. a beta blocker such as propranolol

a benzodiazepine such as alprazolam