1ST SHIFTING MOCK EXAM PHARMA

A 65-year-old man was given 500 mg of an IV drug. Plasma concentration was measured at 10 mg/L. Which pharmacokinetic parameter is calculated by dose divided by plasma concentration?

A. Clearance

B. Half-life

C. Volume of distribution

D. Bioavailability

C. Volume of distribution

A drug has an effective dose of 50 mg and a toxic dose of 500 mg. Which statement is correct?

A. Therapeutic index is 5

B. Therapeutic index is 10

C. Drug has no receptor affinity

D. Drug has zero efficacy

B. Therapeutic index is 10

A patient taking phenytoin is started on rifampicin. After several days, the therapeutic effect of phenytoin decreases. What explains this interaction?

A. Enzyme inhibition

B. Plasma protein displacement

C. Competitive antagonism

D. Enzyme induction

D. Enzyme induction

Which phase of clinical trial is mainly post-marketing surveillance?

A. Phase I

B. Phase IV

C. Phase II

D. Phase III

B. Phase IV

A patient with opioid overdose presents with coma, pinpoint pupils, and respiratory depression. Which drug should be given immediately?

A. Naltrexone

B. Naloxone

C. Nalmefene

D. Flumazenil

B. Naloxone

A patient taking multiple antidepressants develops hyperthermia, diarrhea, tremor, mydriasis, clonus, and hyperactive bowel sounds. Which drug is used for treatment?

A. Dantrolene

B. Bromocriptine

C. Cyproheptadine

D. Diphenhydramine

C. Cyproheptadine

A farmer exposed to organophosphate insecticide presents with salivation, lacrimation, urination, diarrhea, bronchospasm, and seizures. Which drug is the best immediate muscarinic antidote?

A. Pralidoxime

B. Atropine

C. Bethanechol

D. Physostigmine

B. Atropine

A patient with early organophosphate poisoning is brought to the ER within 48 hours. Which drug regenerates acetylcholinesterase before aging occurs?

A. Neostigmine

B. Donepezil

C. Pralidoxime

D. Pilocarpine

C. Pralidoxime

A 70-year-old patient with Alzheimer disease is started on a once-daily acetylcholinesterase inhibitor with long half-life and less hepatotoxicity than tacrine. Which drug is this?

A. Rivastigmine

B. Galantamine

C. Memantine

D. Donepezil

D. Donepezil

A postoperative patient develops urinary retention and paralytic ileus. Which direct muscarinic agonist is the drug of choice?

A. Pilocarpine

B. Cevimeline

C. Bethanechol

D. Carbachol

C. Bethanechol

A patient with Sjögren syndrome complains of severe xerostomia. Which direct muscarinic agonist can increase salivary secretion?

A. Atropine

B. Cevimeline

C. Tolterodine

D. Ipratropium

B. Cevimeline

A glaucoma patient receives a drug that causes miosis by muscarinic stimulation. Which drug is most likely used?

A. Tropicamide

B. Timolol

C. Pilocarpine

D. Phenylephrine

C. Pilocarpine

A man develops dry mouth, blurred vision, urinary retention, tachycardia, flushing, and hallucinations after ingesting a plant extract. Which toxidrome is this?

A. Bethanechol toxicity

B. Neostigmine toxicity

C. Pyridostigmine toxicity

D. Atropine toxicity

D. Atropine toxicity

Which antimuscarinic is commonly used for motion sickness and has prominent CNS effects?

A. Scopolamine

B. Glycopyrrolate

C. Ipratropium

D. Tolterodine

A. Scopolamine

A COPD patient is prescribed an inhaled antimuscarinic. Which drug is short-acting compared with tiotropium, aclidinium, and umeclidinium?

A. Ipratropium

B. Glycopyrrolate

C. Darifenacin

D. Tolterodine

A. Ipratropium

A patient with adult urinary incontinence syndrome needs the academic drug of choice with minimal side effects. Which drug is preferred?

A. Oxybutynin

B. Tolterodine

C. Imipramine

D. Botulinum toxin A

B. Tolterodine

A 4-year-old child still wets the bed at night. Which drug is commonly used for pediatric enuresis?

A. Imipramine

B. Tolterodine

C. Darifenacin

D. Oxybutynin

A. Imipramine

A patient in cardiogenic shock needs inotropic support. Which drug is drug of choice because of β1 stimulation?

A. Dobutamine

B. Phenylephrine

C. Clonidine

D. Terbutaline

A. Dobutamine

A pregnant patient with hypertension due to preeclampsia needs treatment. Which sympatholytic is classically used?

A. Methyldopa

B. Clonidine

C. Prazosin

D. Midodrine

A. Methyldopa

A patient with anaphylactic shock needs immediate treatment. Which receptor profile is most useful?

A. α1 only

B. α1, α2, β1, β2

C. β1 only

D. β2 only

B. α1, α2, β1, β2

A man with neurogenic orthostatic hypotension is given a prodrug converted to norepinephrine. Which drug is this?

A. Clonidine

B. Midodrine

C. Droxidopa

D. Dobutamine

C. Droxidopa

A woman with overactive bladder is prescribed a β3 agonist. Which adverse effect should be monitored?

A. Ototoxicity

B. Mild hypertension

C. Kernicterus

D. Severe hypoglycemia

B. Mild hypertension

Which adrenergic receptor is coupled to Gq with increased IP3 and DAG?

A. α1

B. α2

C. β1

D. D2

A. α1

A student asks why norepinephrine is not used for bronchial asthma. Which is the best answer?

A. It has no β2 action

B. It has no α1 action

C. It has no β1 action

D. It has no α2 action

A. It has no β2 action

A patient with acute bronchospasm uses a rescue inhaler. Which is the most widely used SABA?

A. Albuterol/Salbutamol

B. Salmeterol

C. Formoterol

D. Montelukast

A. Albuterol/Salbutamol

Among SABAs, which drug is available for subcutaneous injection in status asthmaticus?

A. Pirbuterol

B. Terbutaline

C. Vilanterol

D. Salmeterol

B. Terbutaline

A patient on a β2 agonist develops tremor, tachycardia, and anxiety. These adverse effects are due to:

A. H1 blockade

B. Muscarinic stimulation

C. Dopamine blockade

D. β-receptor activation

D. β-receptor activation

An asthmatic patient with aspirin-exacerbated respiratory disease is given a drug that blocks LTD4 receptors. Which drug is this?

A. Zileuton

B. Omalizumab

C. Montelukast

D. Albuterol

C. Montelukast

Which leukotriene pathway drug inhibits 5-lipoxygenase?

A. Zafirlukast

B. Montelukast

C. Omalizumab

D. Zileuton

D. Zileuton

A child with asthma is placed on montelukast. Which serious warning should be remembered?

A. Ototoxicity

B. Neuropsychiatric events

C. Hemolysis

D. Nephrotoxicity

B. Neuropsychiatric events

A patient with severe allergic asthma receives a monoclonal antibody that binds IgE. Which drug is this?

A. Omalizumab

B. Mepolizumab

C. Reslizumab

D. Benralizumab

A. Omalizumab

Type I respiratory failure is defined as:

A. PaCO2 > 50 mmHg only

B. High PaO2 and high PaCO2

C. Normal PaO2 with metabolic acidosis

D. PaO2 < 60 mmHg with normal/low PaCO2

D. PaO2 < 60 mmHg with normal/low PaCO2

A patient with ARDS is hypoxic despite high-flow oxygen and has bilateral airspace shadowing. Which is the most common extrapulmonary cause?

A. Pneumonia

B. Near drowning

C. Smoke inhalation

D. Sepsis

D. Sepsis

Which pulmonary hypertension drug inhibits PDE5 and increases cGMP?

A. Bosentan

B. Riociguat

C. Epoprostenol

D. Sildenafil

D. Sildenafil

A patient with pulmonary arterial hypertension is given a competitive endothelin receptor antagonist. Which drug is this?

A. Sildenafil

B. Riociguat

C. Bosentan

D. Nitric oxide

C. Bosentan

A patient with allergic rhinitis wants a less-sedating antihistamine. Which is a second-generation H1 antagonist?

A. Loratadine

B. Diphenhydramine

C. Promethazine

D. Chlorpheniramine

A. Loratadine

A patient with Ménière syndrome complains of vertigo, tinnitus, and hearing loss. Which drug is the drug of choice?

A. Diphenhydramine

B. Ondansetron

C. Betahistine

D. Cimetidine

C. Betahistine

A man on anti-ulcer medication develops gynecomastia and antiandrogenic effects. Which drug is most likely responsible?

A. Cimetidine

B. Famotidine

C. Ranitidine

D. Nizatidine

A. Cimetidine

A patient receiving chemotherapy develops severe nausea and vomiting. Which 5-HT3 antagonist is prototypical?

A. Cyproheptadine

B. Ondansetron

C. Sumatriptan

D. Buspirone

B. Ondansetron

A migraine patient is given a 5-HT1B/1D agonist that causes cranial vasoconstriction. Which drug is this?

A. Sumatriptan

B. Ondansetron

C. Buspirone

D. Cyproheptadine

A. Sumatriptan

A patient with pheochromocytoma is prepared preoperatively with an irreversible α blocker. Which drug is used?

A. Phenoxybenzamine

B. Prazosin

C. Propranolol

D. Ketanserin

A. Phenoxybenzamine

A hypertensive diabetic patient develops dry cough and angioedema after starting a medication. Which drug class is most likely responsible?

A. ARBs

B. Calcium channel blockers

C. Thiazides

D. ACE inhibitors

D. ACE inhibitors

A patient on spironolactone develops gynecomastia. Which similar drug has less endocrine adverse effect?

A. Amiloride

B. Triamterene

C. Furosemide

D. Eplerenone

D. Eplerenone

A patient with pulmonary edema needs rapid diuresis. Which drug inhibits the Na-K-2Cl transporter in the thick ascending limb?

A. Furosemide

B. Hydrochlorothiazide

C. Acetazolamide

D. Spironolactone

A. Furosemide

A patient taking thiazide develops hyperuricemia. Which adverse effect is classic?

A. Hyperkalemia

B. Hypoglycemia

C. Gout

D. Hypercalciuria

C. Gout

A patient with hypertensive emergency receives sodium nitroprusside. Which toxicity should be monitored?

A. Hypercalcemia

B. Ototoxicity

C. Cyanide toxicity

D. Kernicterus

C. Cyanide toxicity

A patient with angina uses sublingual nitroglycerin. What is the primary hemodynamic effect?

A. Increased afterload

B. Decreased preload

C. Increased platelet aggregation

D. Increased renal sodium retention

B. Decreased preload

A heart failure patient on digoxin develops ventricular arrhythmia. Which antidote should be given?

A. Digoxin immune Fab

B. Protamine sulfate

C. Vitamin K

D. Naloxone

A. Digoxin immune Fab

A patient on heparin develops serious bleeding. Which antidote should be given?

A. Vitamin K

B. Idarucizumab

C. Deferoxamine

D. Protamine sulfate

D. Protamine sulfate

A patient on warfarin develops excessive bleeding. Which antidote reverses its mechanism?

A. Naloxone

B. Folic acid

C. Vitamin K

D. Pralidoxime

C. Vitamin K

A patient with peptic ulcer disease is prescribed an H2 blocker later withdrawn due to NDMA contamination. Which drug is this?

A. Famotidine

B. Nizatidine

C. Cimetidine

D. Ranitidine

D. Ranitidine

Long-term proton pump inhibitor therapy may cause which deficiency?

A. Vitamin C

B. Vitamin K

C. Vitamin B12

D. Vitamin B6

C. Vitamin B12

A patient with IBS constipation receives a drug that activates ClC-2 chloride channels. Which drug is this?

A. Lubiprostone

B. Loperamide

C. Alosetron

D. Diphenoxylate

A. Lubiprostone

Which antidiarrheal is combined with atropine to discourage abuse?

A. Loperamide

B. Diphenoxylate

C. Rifaximin

D. Bismuth subsalicylate

B. Diphenoxylate

A cirrhotic patient with hepatic encephalopathy is given a nonabsorbable disaccharide to trap ammonia. Which drug is used?

A. Rifaximin

B. Neomycin

C. Lactulose

D. Metoclopramide

C. Lactulose

A diabetic patient is started on metformin. Which adverse effect is most feared in renal failure?

A. Hypokalemia

B. Hypercalcemia

C. Ototoxicity

D. Lactic acidosis

D. Lactic acidosis

A patient with type 2 diabetes and obesity needs a drug that increases GLP-1 activity and promotes weight loss. Which drug fits best?

A. Acarbose

B. Pioglitazone

C. Semaglutide

D. Glipizide

C. Semaglutide

A diabetic patient on canagliflozin develops glycosuria. The mechanism is inhibition of:

A. SGLT2

B. DPP-4

C. α-glucosidase

D. KATP channel

A. SGLT2

A patient develops hypoglycemia after taking a drug that closes β-cell KATP channels and increases insulin release. Which class is responsible?

A. Biguanides

B. SGLT2 inhibitors

C. Thiazolidinediones

D. Sulfonylureas

D. Sulfonylureas

A patient with adrenal insufficiency needs mineralocorticoid replacement. Which drug is used?

A. Dexamethasone

B. Prednisone

C. Fludrocortisone

D. Mifepristone

C. Fludrocortisone

A pregnant patient with Cushing syndrome needs an adrenal steroid synthesis inhibitor. Which is the only adrenal-inhibiting drug usable in pregnancy?

A. Trilostane

B. Abiraterone

C. Mitotane

D. Metyrapone

D. Metyrapone

A patient with refractory prostate cancer is given a drug that blocks 17α-hydroxylase and 17,20-lyase. Which drug is this?

A. Mitotane

B. Ketoconazole

C. Mifepristone

D. Abiraterone

D. Abiraterone

Which drug is a glucocorticoid receptor antagonist with strong antiprogestin activity?

A. Fludrocortisone

B. Mitotane

C. Mifepristone

D. Etomidate

C. Mifepristone

A patient undergoing rapid IV induction of anesthesia has compromised myocardial contractility. Which drug is preferred for cardiovascular stability but suppresses adrenal steroid synthesis?

A. Etomidate

B. Propofol

C. Ketamine

D. Thiopental

A. Etomidate

A trauma patient receives an anesthetic causing dissociative anesthesia and analgesia. Which drug is this?

A. Propofol

B. Ketamine

C. Midazolam

D. Sevoflurane

B. Ketamine

A patient receiving propofol complains of pain on injection and later has rapid recovery. Which statement is TRUE?

A. It is a strong analgesic

B. It causes malignant hyperthermia

C. It is useful for rapid IV induction

D. It reverses neuromuscular blockade

C. It is useful for rapid IV induction

A patient on succinylcholine develops prolonged apnea due to abnormal hydrolysis. The enzyme involved is:

A. Pseudocholinesterase

B. Acetylcholinesterase

C. COMT

D. MAO

A. Pseudocholinesterase

A patient undergoing anesthesia develops muscle rigidity, hyperthermia, metabolic acidosis, and hyperkalemia. Which drug treats this condition?

A. Diazepam

B. Dantrolene

C. Atropine

D. Naloxone

B. Dantrolene

A benzodiazepine overdose patient has severe sedation. Which antagonist reverses it?

A. Naloxone

B. Naltrexone

C. Flumazenil

D. Physostigmine

C. Flumazenil

A patient with status epilepticus needs rapid seizure control. Which drug is commonly first-line?

A. Phenytoin

B. Valproate

C. Carbamazepine

D. Diazepam/Lorazepam

D. Diazepam/Lorazepam

A bipolar patient is started on lithium. Which toxicity requires monitoring?

A. Hepatic necrosis

B. Kernicterus

C. Pulmonary fibrosis

D. Nephrogenic diabetes insipidus

D. Nephrogenic diabetes insipidus

A patient on clozapine must undergo regular CBC monitoring because of:

A. Ototoxicity

B. Gingival hyperplasia

C. Agranulocytosis

D. Hyperuricemia

C. Agranulocytosis

A patient on an antipsychotic develops fever, rigidity, autonomic instability, and reduced bowel sounds. What is the diagnosis?

A. Neuroleptic malignant syndrome

B. Serotonin syndrome

C. Malignant hyperthermia

D. Anticholinergic poisoning

A. Neuroleptic malignant syndrome

A patient with alcohol use disorder is given a drug that causes an unpleasant acetaldehyde reaction when alcohol is consumed. Which drug is this?

A. Acamprosate

B. Naltrexone

C. Disulfiram

D. Fomepizole

C. Disulfiram

A chronic alcoholic patient arrives confused with ophthalmoplegia and ataxia. Which vitamin must be given stat before glucose?

A. Pyridoxine

B. Thiamine

C. Cyanocobalamin

D. Folic acid

B. Thiamine

A patient with methanol poisoning develops visual symptoms and metabolic acidosis. Which drug blocks alcohol dehydrogenase?

A. Ethanol only

B. Naloxone

C. Pralidoxime

D. Fomepizole

D. Fomepizole

A child exposed to a charcoal burner in a closed van develops coma and cherry-red skin. What is the ultimate management?

A. Hyperbaric oxygen

B. Sodium bicarbonate

C. Hydroxocobalamin

D. Methylene blue

A. Hyperbaric oxygen

A patient poisoned by cyanide from rodenticide develops cellular hypoxia and lactic acidosis. Which newer antidote is used?

A. Prussian blue

B. Ascorbic acid

C. Hydroxocobalamin

D. Deferoxamine

C. Hydroxocobalamin

A child with severe acute iron poisoning requires parenteral chelation. Which agent is classic?

A. Deferasirox

B. Succimer

C. D-penicillamine

D. Deferoxamine

D. Deferoxamine

Chronic inorganic arsenic poisoning presents with raindrop pigmentation, hyperkeratosis, and Mees lines. Which chelator is appropriate?

A. Succimer

B. Naloxone

C. Atropine

D. Vitamin K

A. Succimer

A patient with acetaminophen overdose is treated with a glutathione-restoring antidote. Which drug is used?

A. Fomepizole

B. Flumazenil

C. N-acetylcysteine

D. Pralidoxime

C. N-acetylcysteine

A patient with methemoglobinemia after oxidizing agent exposure receives the classic drug of choice. Which drug is this?

A. Methylene blue

B. Ascorbic acid

C. Hydroxocobalamin

D. Prussian blue

A. Methylene blue

A TB patient develops peripheral neuropathy while on isoniazid. Which vitamin prevents this adverse effect?

A. Thiamine

B. Pyridoxine

C. Niacin

D. Biotin

B. Pyridoxine

Among first-line anti-TB drugs, which causes optic neuritis and should be adjusted or avoided in renal failure?

A. Rifampicin

B. Isoniazid

C. Pyrazinamide

D. Ethambutol

D. Ethambutol

A TB patient develops orange-red urine and tears. Which drug causes this?

A. Rifampicin

B. Isoniazid

C. Ethambutol

D. Pyrazinamide

A. Rifampicin

Among first-line anti-TB drugs, which causes hyperuricemia and gout?

A. Ethambutol

B. Pyrazinamide

C. Rifampicin

D. Isoniazid

B. Pyrazinamide

A patient with newly diagnosed active drug-susceptible pulmonary TB needs standard initial therapy. Which regimen is correct?

A. INH alone

B. Rifampicin alone

C. HRZE intensive phase then continuation therapy

D. Ethambutol only

C. HRZE intensive phase then continuation therapy

A patient with Mycobacterium leprae is treated with the most bactericidal active drug. Which drug is this?

A. Dapsone

B. Clofazimine

C. Rifaximin

D. Rifampicin

D. Rifampicin

An immunocompromised patient with oral thrush is given treatment. Which is least appropriate?

A. Griseofulvin

B. Nystatin

C. Clotrimazole

D. Fluconazole

A. Griseofulvin

An antifungal forms pores by binding ergosterol and causes "shake and bake" infusion reaction. Which drug is this?

A. Caspofungin

B. Amphotericin B

C. Flucytosine

D. Terbinafine

B. Amphotericin B

A fungal meningitis patient needs a systemic azole with good CSF penetration. Which azole is best?

A. Itraconazole

B. Ketoconazole

C. Fluconazole

D. Efinaconazole

C. Fluconazole

Which antifungal inhibits β-(1,3)-D-glucan synthase?

A. Azoles

B. Polyenes

C. Allylamines

D. Echinocandins

D. Echinocandins

A patient taking prolonged voriconazole therapy should be monitored for which serious adverse effect?

A. Kernicterus

B. Photosensitivity and cutaneous squamous cell carcinoma

C. Fanconi syndrome

D. Orange discoloration of tears

B. Photosensitivity and cutaneous squamous cell carcinoma

Acyclovir requires initial phosphorylation by which enzyme?

A. Host thymidine kinase

B. Viral thymidine kinase

C. Host DNA polymerase

D. Viral protease

B. Viral thymidine kinase

Which anti-herpes drug does NOT require phosphorylation?

A. Acyclovir

B. Ganciclovir

C. Valganciclovir

D. Foscarnet

D. Foscarnet

A CMV patient develops neutropenia and thrombocytopenia during therapy. Which drug most likely caused this dose-limiting toxicity?

A. Ganciclovir

B. Acyclovir

C. Foscarnet

D. Oseltamivir

A. Ganciclovir

An HIV patient on ART develops Fanconi syndrome. Which drug is most likely responsible?

A. Zidovudine

B. Lamivudine

C. Tenofovir

D. Stavudine

C. Tenofovir

An HIV patient develops vivid dreams, insomnia, and CNS symptoms after starting ART. Which drug is most likely responsible?

A. Darunavir

B. Abacavir

C. Efavirenz

D. Tenofovir

C. Efavirenz

A patient with all forms of schistosomiasis is treated with the drug of choice. Which drug is used?

A. Albendazole

B. Praziquantel

C. Ivermectin

D. Diethylcarbamazine

B. Praziquantel

A Filipino herbal medicine question asks for the scientific name of Sambong, used as diuretic and anti-urolithiasis. Which is correct?

A. Mentha cordifolia

B. Corchorus olitorius

C. Bryophyllum pinnatum

D. Blumea balsamifera

D. Blumea balsamifera