PHARMACOLOGY COMPREHENSIVE EXAM 2022

1. The mechanism of action of atropine in the treatment of organophosphate poisoning

is:
A. It competes competitively with the organophosphate at the muscarinic
receptor
B. it can react directly with the organophosphate converting it into a harmless
compound
C. It can reactivate the inhibited cholinesterase both in blood and tissue
D. It competes with the organophosphate at the muscarinic and nicotinic
receptor site

2. Mr. Tukhang was rushed to the emergency room due to an overdose of

methamphetamine . The ER doctor immediately gives him an IV fluid and gives
nahco3 in order to increase the renal excretion of the drug. This type of antagonism
is called:
A. Competitive Antagonism
B. Chemical antagonism
C. Functional antagonism
D. Pharmacokinetic antagonism

3. Necrotizing arteritis is produced by which of the following drugs:

A. IsopropylalcohoL
B. Amphetamine
C. Ethylene glycol
D. Phenytoin

4. This drug is used in the management of adhd:

A. Pemoline
B. Methylphenidate
C. Both
D. Neither

5. These drugs may be used in the management of alcoholism except

A. Acamprosate
B. Disulfiram
C. Benzodiazepine
D. Daidzin

6. The following pharmacologic effects are true about ethanol except

A. Inhibition of platelet aggregation
B. Increased idl concentration
C. Increased gastric acid secretion
D. Vasodilation and hypothermia

7. Nikethamide as a respiratory stimulant produces its effects by:

A. Stimulating the respiratory center.
 B. Stimulating the carotid chemoreceptor.
C. Both
D. Neither

8. Which of the following best describe what the term tachyphylasis means?
A. There is a progressive rise in the intensity of drug response
B. There is an immediate hypersensitivity reaction to the drug
C. There is rapidly development of tolerance to the drug's effect
D. There is an increase in the toxic effect of the drug

9. The cholinergic effect of pilocarpine is due to:

A. Reversible inactivation of ache at the postganglionic synapse
B. Direct action upon the cholinergic receptor site
C. Stimulation of the release of acetylcholine from the nerve terminal
D. Inhibition of the release of acetylcholine esterase

10. Physostigmine the antidote in atropine poisoning acts by:

A. Increasing effects of ach by binding directly to muscarinic receptors
B. Noncompetitive antagonism
C. Increasing ach at the postsynaptic junction by binding reversibly with ache
D. Increasing ach at the postsynaptic junction by binding irreversibly with ache

11. The mechanism of action of pralidoxime in the treatment of organophosphate

poisoning is:
A. It can react directly with the organophosphate converting it into a harmless
compound
B. It can reactivate the inhibited cholinesterase both in blood and tissue
C. It competes with the organophosphate at the muscarinic receptor site
D. All of the above
E. Only a and b are correct

12. In 1995, members of the cult movement aum shinrikyo in japan went to the subway
and releases the gas sarin. The mechanism of action of this drug is
A. Reversibly inhibits the hydrolysis of acetylcholine
B. Binds irreversibly to acetylcholine
C. Binds directly to cholinergic receptor
D. Irreversibly inhibits the hydrolysis of acetylcholine esterase

13. A patient with Parkinson's was given a drug that will cross the ans to block the
activity of ACH in the basal ganglia. This drug is most likely.
A. Ipratropium bromide
B. Benztropine mesylate
C. Hyosamine n - butylbromide
D. Cyclopentolate

14. This neuromuscular blocking agent undergoes spontaneous breakdown in the

plasma to laudanosine (hofmann elimination),
A. Rocuronium
 B. Metocurine
C. Cisatracurium
D. Gallamine
E. Vecuronium

15. A hallucinogenic substance that comes from the venom of cane toad or cane frogs
A. Dimethyltryptamine
B. Mescaline
C. Psilocybin
D. Harmaline
E. Bufotenin

16. A group of party goers were taking a pink pill known as ecstasy. The active
substance of this drug is
A. 1,2 methylenedioxymethamphetamine
B. B. 2,4 deoxymethaphetamine
C. 3,4 methylenedioxymethamphetamine
D. 2,4 methamphetamine

17. The intensification of tactile sensation & feelings of intimacy of bonding & love for
others in pxs taking ecstasy is due to;
A. Increase of the blood levels of dopamine
B. Increase in the blood levels of oxytocin
C. Increase in the blood levels of acetylcholine
D. Increase in the blood levels of norepinephrine

18. Organ failure in ecstasy overdose is due to

A. Renal Failure
B. Seizure
C. Severe hyperthermia
D. Muscle rigidity

19. An epileptic patient who has been using phenobarbital for along period of time
complained that he had more occurrence of seizure attack. You shifted him to
phenytoin to control his seizures, however this drug seems to be not effective at all.
This phenomenon is called :
A. Tolerance due to receptor desensitisation
B. Idiosyncrasy
C. Supersensitivity
D. Tolerance due to induction

20. This barbiturate has the most rapid onset and the shortest duration of action.
A. Pentobarbital
B. Secobarbital
C. Thiopental
D. Phenobarbital

21. Which of the following benzodiazepine has the longest duration of action?
 A. Chlordiazepoxide
B. Alprazolam
C. Midazolam
D. Lorazepam

22. Benzodiazepines differ from barbiturates in that benzodiazepines ;

A. Have anticonvulsant activity
B. Facilitate action of gaba on neuronal chloride channel
C. Chronic use may lead to tolerance
D. Have a wider margin of safety than barbiturates

23. Mrs. Dora ratta, a 76 year old female was given the anti -depressant mirtazapine.
This agent has a distinctive ability to act as an antagonist of :
A. Alpha 2 adrenoceptor
B. Beta adrenoceptor
C. Dopamine receptor
D. Serotonin receptor

24. A 79 year old patient went to your clinic complainnig of feeling down, suicidal
thoughts & a feeling of unhappiness, you diagnose her as a case oddepression. She
wanted a natural product. The best natural remedy for her is.
A. Melatonin
B. St.john's wort
C. Valerian
D. Ramelton

25. The natural product of choice in the above case acts by inhibiting the re-uptake of
which chemical messenger?
A. Norepinephrine
B. Dopamine
C. Serotonin
D. Acetylcholine

26. A patient who was on antidepressant medication came in for complaints of

amenorrhea and galactorrhea. She also had resting hand tremors and a mask like
facies which antidepressant agent is the culprit ?
A. Bupropion
B. Venlafaxine
C. Mirtazapine
D. Amoxapine

27. A depressed retired general who was taking amitriptilline, a tca was admitted to the
hospital after he swallowed 20 pills for attempted suicide. which of the following is the
mechanism of action of the drug?
A. Reduce the active uptake of norepinephrine or serotonin into prejuctional
nerve endings
B. Directly stimulate postsynaptic adrenergic or serotonin (5ht) receptors
C. Inhibit the metabolism of norepinephrine or serotonin in the synapse
 D. Selectively inhibit the re-uptake of 5ht

28. Parasympathetic nerve stimulation due to a slow infusion of bethanechol will increase
A. Heart rate
B. Skeletal muscle tone
C. Urinary bladder tone
D. Urine formation
E. All of the above

29. A company wants to have a random drug test for it employees . if some employees
are taking methamphetamine, for how long will this drug be detected in the body
fluids such as urine in the addicts?
A. Within 12 to 24hrs after intake
B. Within 48 to 72 hrs after intake
C. After a week after intake
D. 30 hrs after intake

30. Which of the following best describe the mechanism of action of methylanthine such
as theophylline ?
A. Activation of adenosine receptors
B. Blockade of the enzyme phosphodiesterase
C. Decrease in the amount of cyclic amp in the different organs
D. Inhibits bronchial beta2 receptors

31. Conclusive evidence for the benefits of marijuana includes all except one :
A. Treatment of chronic pain
B. Treatment of spasticity in ms
C. As antiemetic for chemo-induced
D. Treatment of hiv neuropathic pain

32. A 60 year old chronic alcoholic abruptly stopped drinking alcohol .within a few hours
he become anxious and agitated and showed symptom of autonomic
hyperexcitability. He was admitted to the emergency room where he developed
seizures.Which of the following drug should be given inordeto control his seizure
activity ?
A. Oral acamprosate
B. I. V. Naloxone
C. I.v. thiamine
D. I.v diazepam

33. In potentiation:
A. Two drugs are given at half of each dose, are used simultanously and elicits
the same effect as the full dose of either drug use alone.
B. Two drugs are combined and the response is greater than that of the sum of
the full dose of the two drugs.
C. Two drugs are combined and the second drug which has no effect, increases
the effect of the first drug.
D. Occurs when two drugs has opposing actions.
34. Small amount of epinephrine is added to solutions of local anesthetic that will be
administered by infiltration. Which of the following is the reason for incorporating
epinephrine with local anaesthetic ?
A. To antagonise the intense hypertensive effect of the anaesthetic
B. To counteract cardiac depression cause by the local anaesthetic
C. To prevent anaphylaxis in patient allergic to local anaesthetic
D. To reduce the toxicity caused by systemic absorption of the local anesthetic

35. A drug was administered to an experimental animal which causes increase cardiac
rate and contractility , increased cardiac conduction, improves perfusion to the kidney
and induces natriuresis. Which of the following agent would cause this?
A. Isoproterenol
B. Epinephrine
C. Dopamine
D. Phenylephrine

36. A 65 year old man came into you clinic for complaints of nocturia urinary frequency
and inability to urinate forcefully. Following a complete work-up you prescribed
tamsulosin. Which of the following side effect should you forewarned the patient ?
A. Difficulty of breathing due to bronchoconstriction
B. Increase in blood pressure
C. Dizziness due to orthostatic hypotension
D. Blurring of vision

37. A patient was diagnosed with pheochromocytoma and has to undergo removal of the
catecholamine secreting tumour cells from the adrenal medulla .which of these agent
is the best to give prior to the operation in order to prevent a hypertensive crises.
A. Phentolamine
B. Phenoxybenzamine
C. Tamsulosin
D. Prazosin

38. Pindolol and acebutolol are classified as beta blockers with isa. This means that
A. They are partial agonist
B. They induce catecholamine synthesis
C. They potentiate the action of alpha adrenergic drugs
D. They are useful as agent or treat for glaucoma

39. A patient who developed a severe allergic reaction after eating peanut butter was
rushed to the hospital for difficulty of breathing due to severe bronchoconstriction his
BP was 40/10. The drug epinephrine was immediately administered. What is the
rationale of giving the epinephrine ?
A. Epinephrine will displace histamine from the h1 receptor sites
B. Epinephrine will binds with histamine and render inactive by precipitating it
C. Epinephrine act at a completely separate receptor initiating effects that are
functionally the opposite of histamine
 D. Epinephrine acts on the same receptor as histamine but produces an
opposite effect of that fromHistamine

40. In comparing metoprolol from propranolol, metoprolol

A. Is more effective in the treatment of migraine headache
B. Has greater selectivity to B2 receptors
C. Is more selective at the B1 receptors
D. Is more useful in patients with hyperthyroidism and hypertension

Questions 41-45= match each description to the most appropriate beta adrenergic blocking
agent
e. Timolol
A. Acebutolol
B. Labetalol
c. Carvedilol
d. Pindolol

41. Nonselective beta blocker used to treat glaucoma

- E
42. Nonselective beta blocker with alpha1 blocking activity, isa and msa
- B
43. Nonselective beta blocker with aplha adrenergic activity
- C
44. Beta blocker with stonger beta1 blocking effect than beta 2 blocking effect
- A
45. Nonselective beta blocker that lacks isa and msa
- E

46. The binding of antibiotics to albumin that increases the duration of the effects of the
antibiotic is considered:
A. Agonism
B. Antagonism
C. Chemical antagonism
D. Inert Binding

47. The presence of the antagonist at the receptor site will block access of agonists to
the receptor and prevent the usual agonist effect:
A. Inverse agonists
B. Chemical antagonists
C. Intrinsic antagonists
D. Neutral antagonists

48. Most important limiting factor for drug permeation

A. Aqueous diffusion
B. Lipid diffusion
C. Special carriers
D. Endocytosis
49. Dipole interactions
A. Covalent bonds
B. Electrostatic bonds
C. Hydrophobic bonds
D. Ionic bonds

50. One of the adverse effect of this diuretic is hypernatremia:

A. Hydrochlorothiazide
B. Furosemide
C. Spironolactone
D. Acetazolamide
E. Mannitol

51. The weakest of the diuretics with an effect of about 2%:

A. Thiazides
B. Loop
C. Potassium-sparing
D. Osmotic

52. Diuretic of choice for hepatic liver cirrhosis:

A. Thiazides
B. Loop diuretics
C. Potassium-sparing diuretics (spironolactone)
D. Osmotic diuretics
E. Carbonic-anhydrase inhibitors

53. Thiazide-like diuretic that can be used even in advanced kidney failure:
A. Furosemide
B. Chlorthalidone
C. Metolazone
D. Indapamide
E. Bumetanide-nil

54. Besides hypertension, Prazosin can also be used for the following disease:
A. Benign prostatic hyperplasia
B. Alopecia
C. Hyperthyroidism
D. Gynecomastia

55. Hydralazine is classified as:

A. Diuretic
B. Sympathoplegic agent
C. Direct vasodilator
D. Agents that block production or action of angiotensin

56. Decrease peripheral vascular resistance:

A. Furosemide
 B. Captopril
C. Metoprolol
D. Verapamil

57. One of the following drug does not affect the heart rate:
A. Atenolol
B. Methyldopa
C. Clonidine
D. Losartan

58. Prevents fatty acid oxidation:

A. Trimetazidine
B. Fenoldopam
C. Nitroprusside
D. Ivabradine

59. Nitrate derivative with bioavailability of 100%:

A. Nitroglycerin
B. Isosorbide mononitrate
C. Amyl Nitrite
D. Nitroprusside

60. Caution should be observed when using Beta blockers as an anti-angina on patients
with this respiratory disease
A. Cystic fibrosis
B. Pneumonia
C. Asthma
D. Lung cancer

61. Recommended for silent ischemia:

A. Nimodipine
B. Metoprolol
C. Allopurinol
D. Nitrates

62. One of the following drug may fail when given with omeprazole:
A. Aspirin
B. Prasugrel
C. Clopidogrel
D. Cilostazol

63. Which of the following anticoagulant is a direct inhibitor of thrombin?

A. Abciximab
B. Dabigatran
C. Rivaroxaban
D. Warfarin
E. Urokinase.
64. Antidote for warfarin:
A. Aminocaproic acid
B. Desmopressin
C. Factor VIll
D. Protamine
E. Vitamin K1

65. Third-generation cephalosporins can decrease the effectivity of this drug;

A. Clopidogrel
B. Aspirin
C. Warfarin
D. Rivaroxaban

66. Which drug is not considered as a first-line therapy for chronic heart failure:
A. Diuretics
B. ACE inhibitors
C. Beta blockers
D. Digoxin

67. Which beta blocker showed a reduction in mortality in patients with stable severe
heart failure:
A. Atenolol
B. Pindolol
C. Nebivolol
D. Esmolol

68. Which drug is not used for acute heart failure?

A. Beta blocker
B. Furosemide
C. Dobutamine
D. Isosorbide dinitrate

69. This inotropic drug decreases left ventricular filling pressure

A. Milrinone
B. Dobutamine
C. Digoxin
D. Furosemide

70. Is an isopropyl ester that is hydrolyzed completely in the intestine;

A. Niacin
B. Ezetimibe
C. Fenofibrate
D. Colestipol
E. Simvastatin

71. Rhabdomyolysis is common in:

A. HMG-CoA reductase inhibitors
B. Fibrates
 C. Niacin
D. Bile acid-binding resins
E. Intestinal sterol absorption inhibitors

72. The most effective agent for increasing HDL:

A. HMG-CoA reductase inhibitors
B. Fibrates
C. Niacin
D. Bile acid-binding resins
E. Intestinal sterol absorption inhibitors

73. Steatorrhea is the limiting factor for the use of this drug:
A. Niacin
B. Ezetimibe
C. Fenofibrate
D. Colestipol
E. Simvastatin

74. Prolongs the opening of the CI-channels:

A. Phenobarbital
B. Valproic acid
C. Ethosuximide
D. Acetazolamide

75. Reduces the aspartate content in the brain:

A. Valproic acid
B. Ethosuximide
C. Oxazolidinediones
D. Phenobarbital

76. Infants of pregnant patients taking this drug can lead to risk for spina bifida:
A. Phenobarbital
B. Valproic acid
C. Oxazolidinediones
D. Acetazolamide

77. Behavioral changes is not considered a side effect but rather an improvement when
taking this drug:
A. Phenobarbital
B. Ethosuximide
C. Oxazolidinediones
D. Acetazolamide

78. Opioids can cause hypothermia by:

A. Mu agonism (eg. morphine in the anterior hypothalamus produces
hyperthermia)
B. Delta agonism
C. Delta antagonism
 D. Kappa agonism

79. The concept of "opioid rotation' is done to prevent:

A. Tolerance
B. Dependence
C. Addiction
D. Withdrawal syndrome

80. A content of OTC "cold/cough® medications has been linked to increasing death in
children:
A. Codeine
B. Guaifenesin
C. Levopropoxyphene
D. Dextromethorphan

81. Side effect of Tramadol includes:

A. Respiratory depression
B. Tachycardia
C. Seizures
D. Neuropathic pain

82. True about the factors that affect local anesthetics;

A. Local aesthetics are weak acids.
B. The lower the pH the faster the onset of action.
C. Decrease in pH shifts equilibrium toward the ionized form.
D. The more ionized the local anesthetic agent is, the faster the onset of action.
E. The aromatic ring of the compound contributes to its slower onset of action.

83. True about vasoconstrictor:

A. leads to faster absorption and therefore increase in potency.
B. Is a substance that prolongs the effect of local anaesthetics
C. Norepinephrine can also be used as vasoconstrictor as adjunct to local
anesthetics
D. It can delay the metabolism and excretion of local anesthetic, hence the
shorter is its duration of action
E. More effective in Local aesthetics which are highly lipid soluble

84. True about Amide type of Local Anesthetics:

A. Contains metabolite that may also produce hypersensitivity reaction
B. Can have less likely systemic effect
C. Metabolized in the plasma by a pseudocholinesterase
D. Metabolized in the liver

85. Amide group of local anesthetic.

A. chloroprocaine
B. Procaine
C. Priocaine
D. Prilocaine
86. Causes of arrhythmia include the ff except:
A. Other cardiac sites other than SA node may show enhanced automaticity.
B. Abnormal automaticity - Myocardial cells damaged by hypoxia or potassium
imbalance.
C. Transmembrane potential difference
D. Reentry
E. None of the above

87. A 70-year-old male patient was diagnosed with acute pulmonary edema. What is the
best group of diuretics that you can prescribe for him? (loop diuretics)
A. Hydrochlorothiazide
B. Furosemide
C. Spironolactone
D. Mannitol
E. Ethacrynic acid

88. Based on the previous case, what is the mechanism of action of the drug?
A. Inhibits the NA/K/CI transport system in the luminal membrane of the thick
ascending limb of the loop of Henle.
B. Inhibits NaCI cotransporter in the luminal side of the distal convoluted tubule
C. Blocks sodium transport channels in the collecting tubule
D. Prevents the normal absorption of water by interposing a counteracting
gradient.

89. A 40-year-old male has a history of developing dizziness, headache, and nausea
while ascending Mount Apo. What is the best group of diuretics that you can
prescribe for this patient?
A. Mannitol
B. Bumetanide
C. Acetazolamide
D. Triamterene
E. Furosemide

90. The following are adverse effects of the above drug given to patient in number 4:
except(?) [Because all of these are adverse effects of acetazolamide except
metabolic alkalosis (should be hyperchloremic metabolic acidosis)]
A. Metabolic alkalosis,
B. potassium depletion,
C. renal stones
D. Drowsiness
E. paresthesia

91. A 60 year old man with congestive heart failure was taking furosemide regularly each
day. What electrolyte Is expected to be seen in the serum?
A. hypokalemia
B. hypermagnesemia
C. low bicarbonate level
 D. Decreased uric acid level

92. Which among these agents suppresses phase 4 depolarization?

A. Flecainide
B. Lidocaine
C. Propranolol
D. Amiodarone
E. Diltiazem

93. Expected adverse effect of spironolactone except:

A. Hyperkalemia
B. Hyperchloremic metabolic acidosis
C. Gynecomastia
D. Hypokalemic metabolic alkalosis

94. Which of the following statements best describes pharmacodynamics?

A. The study of how drugs are distributed into the various compartments of the
body.
B. The study of how drugs are excreted from the body
C. The study of how drug concentrations are achieved at the target site of action.
D. The study of how drugs alter physiologic and biochemical processes in the
body.

95. Which of the following statements best describes pharmacokinetics?

A. The study of the disposition of drugs from site of administration to site of
action.
B. The study of the mechanism of action of drugs.
C. The study of drug interaction with protein receptors in the body
D. The study of the structure-activity relationship characteristic of a drug

96. The movement of a drug from its site of administration into the central compartment
and the extent to which this occurs
A. Absorption
B. Distribution
C. Metabolism
D. Excretion

97. Predominant enzyme group responsible for Phase 1 metabolic transformation of

xenobiotics
A. Alcohol dehydrogenases
B. Cytochrome P450 enzymes
C. Glutathione-S-transferases
D. Epoxide hydrolases

98. Characteristic of Phase Il metabolic transformation:

A. Result to highly lipophilic substances
B. Generally results to loss of pharmacologic activity
C. Involves glucuronidation reactions
 D. Functionalization reactions

99. The principal organ for drug metabolism

A. Skin
B. Lungs
C. Liver
D. Kidneys

100. The time it takes for the concentration of a drug in the body to be reduced by
50%:
A. Clearance
B. Volume of distribution
C. Half-life
D. Bioavailability