MB1 M4

D. Pharmacologic Antagonism

Two drugs act on the same tissue or organ by binding to the same receptor site (or competing for it), where one drug prevents the binding or activates the opposite effect of the agonist. A classic example of this is Naloxone blocking Morphine at the mu-opioid receptors. This type of interaction is known as:

A. Physiologic Antagonism B. Functional Antagonism

C. Chemical Antagonism D. Pharmacologic Antagonism

C. X: Tolerance, Y: Dependence

A 45-year-old chronic pain patient has been taking sustained- release Oxycodone for severe osteoarthritis over the past six months. During a follow-up visit, the patient notes that the current dose no longer provides the same level of pain relief as it did initially, requiring a dose escalation (Phenomenon X). Furthermore, when they missed two consecutive doses due to a pharmacy delay, they experienced severe sweating, tremors, and abdominal cramping (Phenomenon Y). However, the patient strictly uses the medication to manage pain, has no compulsive cravings, and does not engage in risky behaviors to obtain the drug. Which of the following pairs correctly identifies Phenomenon X and Phenomenon Y?

A. X: Addiction, Y: Dependence

B. X: Tolerance, Y: Addiction

C. X: Tolerance, Y: Dependence

D. X: Hypersensitivity, Y: Tolerance

B. Concentration of the free drug at the target receptor site

While parameters like volume of distribution and protein binding dictate a drug’s pharmacokinetics, the ultimate intensity of its pharmacological action is most directly dependent on the:

A. Total concentration of the drug bound to plasma proteins

B. Concentration of the free drug at the target receptor site

C. Rate of drug distribution into peripheral tissues

D. Total volume of distribution at steady-state

C. Drug Y is more potent, but Drug X is more efficacious.

A clinical review board is comparing two novel analgesic agents for post-operative pain management. Drug X achieves maximum pain relief (100% pain reduction) at a dose of 50 mg. Drug Y achieves a maximum of 50% pain reduction, and increasing the dose beyond 5 mg does not provide any further pain relief. Which of the following statements correctly evaluates the relationship between these two drugs?

A. Drug Y is both more potent and more efficacious than Drug X.

B. Drug X is more potent, but Drug Y is more efficacious.

C. Drug Y is more potent, but Drug X is more efficacious.

D. Drug X is both more potent and more efficacious than Drug Y.

D. Activation of an intracellular nuclear receptor leading to gene transcription

Rationale: LGEN

I - Ligand

II - GPCR

III - Enzyme-linked

IV - Nuclear

Which of the following best describes the signaling process involved in eliciting the anti-inflammatory effects of a glucocorticoid like Hydrocortisone?

A. Activation of a G-protein coupled receptor leading to second messenger production

B. Direct opening of a ligand-gated ion channel to alter membrane potential

C. Binding to a transmembrane tyrosine kinase receptor to induce autophosphorylation

D. Activation of an intracellular nuclear receptor leading to gene transcription

C. I and III only

Consider the pharmacological profile of Bethanechol, a direct-acting muscarinic agonist frequently used to treat postoperative urinary retention. Which of the following combinations of statements accurately describes its receptor signaling mechanism?

I. It binds to a metabotropic receptor family.

II. It binds directly to a ligand-gated ionotropic receptor.

III. It couples primarily to the Gq protein subunit, activating phospholipase C.

IV. It couples primarily to the Gi protein subunit, inhibiting adenylyl cyclase.

A. I and IV only

B. II and III only

C. I and III only

D. II and IV only

D. Amoxicillin — Chemotherapeutic

Rationale:

• Salbutamol - Functional modifier

• Insulin glargine - Replenisher

• Barium sulfate - Diagnostics

A pharmacy student is sorting medications in the institutional pharmacy. They encounter four distinct agents: Insulin glargine, Salbutamol, Barium sulfate, and Amoxicillin.

A. Salbutamol — Replenisher

B. Insulin glargine — Functional Modifier

C. Barium sulfate — Chemotherapeutic

D. Amoxicillin — Chemotherapeutic

B. Ariëns and Stephenson’s Modified Occupancy Theory

Which receptor theory introduced the concept of intrinsic activity to explain why two drugs can occupy the exact same number of receptors, yet a full agonist produces a maximal biological response while a partial agonist only produces a submaximal response?

A. Clark’s Occupancy Theory

B. Ariëns and Stephenson’s Modified Occupancy Theory

C. Paton’s Rate Theory

D. Koshland’s Induced Fit Theory

C. Compound D — Inverse Agonist

A research pharmacist is plotting a log dose-response curve to analyze the intrinsic activity of four investigational ligands (Compounds A, B, C, and D) acting on a constitutively active neuroreceptor system. The baseline cellular response in the absence of any drug is measured at 20%. Based on the described graph below, which compound is correctly matched with its pharmacological classification

Compound A: Increases cellular response from 20% baseline up to a maximum plateau of 100%.

Compound B: Increases cellular response from 20% baseline up to a maximum plateau of 55%.

Compound C: Maintains the cellular response strictly at the 20% baseline, even at high concentrations, but blocks other ligands from binding.

Compound D: Decreases the baseline cellular response from 20% down to 0%.

A. Compound B — Full Agonist

B. Compound C — Inverse Agonist

C. Compound D — Inverse Agonist

D. Compound A — Partial Agonist

B. II and III only

Rationale: Aspirin + Warfarin = Synergistic (Risk for Hemorrhage)

Consider the following drug combinations and their resulting pharmacodynamic interactions:

I. Aspirin + Warfarin → Potentiation

II. Sulfamethoxazole + Trimethoprim → Synergism

III. Ibuprofen + Paracetamol → Addition.

Which of the following pairs is/are correct?

A. I only

B. II and III only

C. I and III only

D. I, II, and III

C. 80%-125%

In order to establish bioequivalence between drug formulations, both AUC and Cmax for the test product should be within ________ of the reference at a 90% confidence interval.

A. 80%-115%

B. 85%-115%

C. 80%-125%

D. 85%-125%

A. I

Rationale:

I - High High PaMella 1

II - Low High A2rvastatin

III - High Low Cime2dine, A3nolol??

IV - Low Low Bi4nazole

Metoprolol falls under which BCS class?

A. I

B. II

C. III

D. IV

D. Two of the choices (First-pass effect or Pre-systemic elimination)

This refers to the rapid metabolism of an orally administered drug before reaching the systemic circulation.

A. First-pass effect

B. Enterohepatic circulation

C. Pre-systemic elimination

D. Two of the choices

B. Exocytosis

Rationale:

• Passive diffusion - along

• Active transport - across

• Convective transport - aqueous pores

The transport of insulin from beta cells of the pancreas into the extracellular space involves which transport mechanism?

A. Passive diffusion
B. Exocytosis

C. Convective transport

D. Active transport

C. Unionized

Rationale: LUNAS

According to the pH partition theory, which form of a drug is most likely to diffuse across cell membranes?

A. Lipophobic B. Salt C. Unionized D. Protein-bound

A. The volume relating the concentration of a drug in the body to that in the plasma

Which of the following statements best describes the ‘apparent volume of distribution’ of a drug?

A. The volume relating the concentration of a drug in the body to that in the plasma

B. The volume of blood flowing through the renal vasculature per unit of time

C. The actual anatomical volume in which a drug is concentrated in the body

D. The volume of blood that is cleared of a drug per unit of time

B. 5

Rationale: 4-5 half lives

In clinical settings, approximately how many half-lives are required for the plasma drug concentration to be between 95% and 99% of the steady-state drug concentration? A. 3 B. 5 C. 7 D. 9

C. Only the free drug fraction is filtered

What is the effect of plasma protein binding on the renal glomerular filtration of a drug?

A. Protein binding increases the filtration rate

B. Only the bound drug fraction is filtered

C. Only the free drug fraction is filtered

D. Protein binding has no effect on the filtration rate

A. Extravascular

If a drug is determined to have a larger apparent volume of distribution, it implies that a greater amount of the drug is concentrated in the ________ space.

A. Extravascular

B. Interstitial

C. Extracellular

D. Intravascular

A. Membrane thickness

The diffusion of drugs across cellular membranes is governed by Fick’s law which is influenced by various factors. The following variables exhibit a directly proportional relationship with the rate of diffusion, except:

A. Membrane thickness

B. Diffusion coefficient

C. Surface area

D. Concentration gradient

C. 27.40 mL/min

Justin is a 47-year old male patient, weighing 70 kg, and has a measured serum creatinine of 3.3 mg/dL. He is to be administered with Amikacin for the treatment of a severe bacterial infection. Calculate the creatinine clearance in this patient using the Cockroft-Gault equation.

A. 23.29 mL/min

B. 13.85 mL/min

C. 27.40 mL/min

D. 11.77 mL/min

D. 15 L

A 67-year old female patient was administered 300 mg of Drug A. Immediately after administration, a blood sample was obtained and a plasma concentration of 0.02 mg/mL was measured. Calculate the volume of distribution.

A. 15000 L

B. 18.5 L

C. 23000 L

D. 15 L

D. Prolongation of prothrombin time

Rationale:

Warfarin - PT-INR

Enzyme Inhibitors (MEDVICKGAFS)

• Metronidazole, Erythromycin, Disulfiram, Verapamil, Isoniazid, Cimetidine, Ketoconazole, Grapefruit Juice, Acute Alcoholism, Fluconazole, Sulfonamides

Enzyme Inducers (CROPS GPS)

• Carbamazepine, Rifampicin, Omeprazole, Phenytoin, Smoking, Griseofulvin, Phenobarbital, St. John’s Wort

Mia presents to the clinic with complaints of persistent heartburn and regurgitation. After conducting appropriate symptom evaluation and physical examination, the physician arrived at a diagnosis of gastroesophageal reflux disease (GERD), hence, Mia was prescribed with Cimetidine to manage her condition. However, she forgot to inform the physician that she is currently under Warfarin therapy. Which of the following clinical findings will Mia most likely encounter?

A. Shortening of activated partial thromboplastin time

B. Prolongation of activated partial thromboplastin time

C. Shortening of prothrombin time

D. Prolongation of prothrombin time

D. No known interaction exists

Rationale: St. John’s bread is a chocolate substitute (AKA Carob, Locust bean)

Sassa is a 36-year old female patient with a history of hypertension. She has been compliantly taking Bisoprolol daily to manage her condition. However, there was a time when she forgot that she had consumed St. John’s bread a few minutes before taking the antihypertensive drug. What effect might this interaction most likely result in with regard to the metabolism of the drug?

A. Increased Bisoprolol half-life B. Decreased Bisoprolol elimination C. Increased Bisoprolol metabolism D. No known interaction exists

B. Digoxin toxicity due to increased intestinal absorption time

A patient treating congestive heart failure simultaneously takes Digoxin and the anticholinergic drug Dicyclomine to save time. What is the most likely consequence of taking these two drugs together?

A. Reduced Digoxin efficacy due to poor absorption

B. Digoxin toxicity due to increased intestinal absorption time

C. Dicyclomine toxicity due to enzyme inhibition

D. Severe hypokalemia due to a synergistic drug interaction

A. Only the first statement is correct.

Rationale: ↑ PO/W = lipophilic ↓ PO/W = hydrophilic

The partition coefficient is defined as a ratio of the drug concentration in the oil phase (octanol) to the drug concentration in the aqueous phase measured at equilibrium. Drugs with a low partition coefficient are highly lipophilic and tend to accumulate in lipid or adipose tissues.

A. Only the first statement is correct.

B. Only the second statement is correct.

C. Both statements are incorrect.

D. Both statements are correct.

C. 0.338

Rationale:

A new investigational drug was being developed and to further evaluate its bioavailability, it was tested in 20 participants.= Each participant was given either an oral tablet containing 500 mg of the drug, an oral solution containing 500 mg of the drug, or an IV bolus injection containing 75 mg of the drug. From the obtained data, calculate the absolute bioavailability of the drug in the tablet formulation.

A. 2.958 B. 0.067 C. 0.338 D. 1.043

C. The rate of elimination increases proportionally

Rationale: zero order: ↑ amount of drug = constant rate of drug elimination first order: ↑ amount of drug = ↑ rate of drug elimination

If a drug follows first-order elimination, what happens to the rate of drug elimination as the plasma drug concentration increases?

A. The elimination half-life increases

B. The elimination half-life decreases

C. The rate of elimination increases proportionally

D. The rate of elimination remains constant

D. IV

Rationale:

• Pharmaceutical Equivalents - same all aspects, different excipients

• Therapeutic Equivalents - bioequivalents, same safety and efficacy

• Pharmaceutical Alternatives - same API, different dose, different dosage form

• Therapeutic Alternatives - different API, samde drug class

The following statements are true, except:

I. Two drug formulations are considered pharmaceutical equivalents if they contain the same API, in the same dosage strength and dosage form.

II. Bioequivalence requires that there are no significant differences in the AUC and Cmax of drug absorption.

III. In bioequivalence, both parameters must fall within 80%-125% at a 90% confidence interval.

IV. Two bioequivalent drug formulations must always contain identical inactive excipients.

A. I and II

B. II and III

C. I, II, III

D. IV

C. Grapefruit juice acts as an irreversible inhibitor of metabolic enzymes, increasing drug concentrations.

Rationale:

• Enzyme Inducer - ↑ enzyme activity = ↑ metabolism = ↑ exit = ↓ retained = ↓ effect/conc.

• Enzyme Inhibitor - ↓ enzyme activity = ↓ metabolism = ↓ exit = ↑ retained = ↑ effect/conc.

Kelvin is a 23 year old male patient with a history of asthma, maintained on theophylline. Recently, a friend recommended him to drink 2 glasses of grapefruit juice everyday to boost his immune system. Eventually, he presented with nausea, palpitations, and tremors. What mechanism best explains this presentation?

A. Constituents in grapefruit juice displace the drug from receptor active sites, increasing the risk of toxicity.

B. Grapefruit juice activates intestinal transporters, resulting in a significant increase in drug levels.

C. Grapefruit juice acts as an irreversible inhibitor of metabolic enzymes, increasing drug concentrations.

D. Grapefruit juice decreases intestinal pH, thereby preventing the ionization of the drug.

B. The initial unbound plasma concentration will increase, resulting in a greater apparent volume of distribution.

Rationale: ↓ Albumin = ↓ Protein-bound, ↑ free/unbound = ↑ Vd

What would be the result if a highly protein-bound drug was administered through an intravenous bolus injection to a patient with severe hypoalbuminemia?

A. The apparent volume of distribution will decrease due to an increase in the concentration of bound drugs.

B. The initial unbound plasma concentration will increase, resulting in a greater apparent volume of distribution.

C. The apparent volume of distribution will decrease until it is equal to the plasma volume.

D. The drug will become unaffected by tissue distribution or elimination.

D. The fraction of unionized drug increases, favoring passive diffusion across the gastric mucosa.

Rationale: Basic + Basic = Unionized (LUNAS)

A patient was administered an oral formulation of a basic drug that is primarily absorbed through passive diffusion. If the patient was concurrently given an antacid that increases the gastric pH from 1.6 to 6.7, what would be its effect on the initial gastric absorption of the said drug?

A. The rate of passive diffusion decreases due to a decrease in the concentration gradient.

B. The drug becomes completely ionized, thereby preventing absorption across the gastric mucosa.

C. The absorption of the drug will be prevented as weakly basic drugs can only be absorbed in highly acidic environments.

D. The fraction of unionized drug increases, favoring passive diffusion across the gastric mucosa.

A. I only

The following are advantages of extended-release drug products, except:

I. Dose-dumping II. Improved patient compliance

III. Sustained therapeutic blood levels IV. Reduced adverse side effects

A. I only C. I, II, IV B. II and IV D. II, III, IV

B. I and IV

Rationale: ↓GER = ↑GET / ↑GER = ↓GET

A number of factors affect gastric emptying rate and time. If a patient consumed a high-fat meal and a cold beverage prior to the administration of a drug, this would most likely result to a/an:

I. Decreased gastric emptying rate II. Increased gastric emptying rate

III. Decreased gastric emptying time IV. Increased gastric emptying time

A. I and III C. II and III

B. I and IV D. II and IV

C. Both statements are correct.

Generally, transdermal drug products are used for systemic drug delivery. For transdermal drug administration, the drug may be incorporated into an ointment.

A. Only the first statement is correct. B. Only the second statement is correct.

C. Both statements are correct. D. Both statements are incorrect.

D. Both statements are incorrect.

Rationale: Dissolution is the rate-limiting step, Complete Disintegration is the second statement

For drugs with low water solubility, disintegration is often the rate-limiting step and therefore exerts a significant effect on drug bioavailability.

On the contrary, dissolution, as defined by the USP-NF, is “the process in which any residues of the tablet, except fragments of insoluble coating, remaining on the screen of the test apparatus in the soft mass have no palpably firm core”.

A. Only the first statement is correct. B. Only the second statement is correct.

C. Both statements are correct. D. Both statements are incorrect.

A. Only the first statement is correct.

Polymorphism refers to the arrangement of a drug in various crystal forms. Generally, a drug that exists as a crystalline form dissolves more rapidly than the same drug in an amorphous form.

A. Only the first statement is correct.

B. Only the second statement is correct.

C. Both statements are correct.

D. Both statements are incorrect.

D. II and IV Rationale: sloWEST, fastEAST

Historically, studies have shown that there are variabilities between populations in terms of therapeutic response and drug metabolism. Specifically, the following populations are considered as slow acetylators, except:

I. Caucasians III. Egyptians

II. Eskimos IV. Filipinos

A. II only C. II and III

B. I and III D. II and IV

D. Clonidine

The mechanism of action of the drug Methyldopa most closely resembles which of the following agents?

A. Phentolamine C. Midodrine

B. Metoprolol D. Clonidine

C. I, II, III

Which of the following drugs has/have anticholinergic actions? I

. Dicyclomine III. Cyclopentolate

II. Oxybutynin IV. Cevimeline

A. I only C. I, II, III

B. I and II D. I, II, III, IV

B. Norepinephrine

Rationale:

• Nor, ayoko mag amoy septic tank

• Epinephrine - anaphylactic shock

• Dobutamine - cardiogenic shock

Which of the following adrenergic agents is considered the first-line drug of choice for the management of septic shock due to its potent vasoconscriptive effects that effectively restore systemic vascular resistance?

A. Epinephrine C. Dopamine

B. Norepinephrine D. Dobutamine

B. Acetylcholinesterase

A farmer was rushed to the emergency department (ED) after an acute overdose of an organophosphate insecticide. Upon evaluation, it was found that he presented with miosis, lacrimation, salivation, and urination. The toxicity described above is due to the inhibition of which of the following enzymes?

A. Cytochrome Oxidase B. Acetylcholinesterase

C. Catechol-O-Methyltransferase D. Monoamine Oxidase

A. I only

Rationale:

• Pilocarpine - Cholinergic AGONIST

• Ipratropium - Cholinergic ANTAGONIST

Consider the following drug-to-class classifications:

I. Tamsulosin — Adrenergic Antagonist II. Pilocarpine — Cholinergic Antagonist

III. Ipratropium —Cholinergic Agonist Which of the following pairs is/are correct?

A. I only C. I and III only

B. II only D. II and III only

C. I, II, and IV only

Rationale:

Physostigmine - Indirect-Acting Parasympathomimetic

Consider the following classifications of autonomic nervous system drugs:

I. Neostigmine — Indirect-Acting Parasympathomimetic II. Epinephrine — Direct-Acting Sympathomimetic

III. Physostigmine — Direct-Acting Parasympathomimetic IV. Amphetamine — Indirect-Acting Sympathomimetic Which of the following combinations of drug-to-class matchings is/are correct?

A. I and II only B. II and IV only

C. I, II, and IV only D. I, II, III, and IV

D. Pyridostigmine

Rationale: Pyridostigmine is a quaternary ammonium compound and is used for the treatment of Myasthenia gravis

The following medications are acetylcholinesterase inhibitors clinically indicated for the symptomatic management of cognitive decline in Alzheimer’s disease (AD), EXCEPT:

A. Donepezil C. Rivastigmine

B. Galantamine D. Pyridostigmine

C. Non-selective antagonist at B1 and B2 receptors, with additional selective A1 antagonist activity

A 62-year-old patient with chronic heart failure and hypertension is prescribed Carvedilol to reduce cardiac workload and decrease systemic vascular resistance. Which of the following correctly describes the specific receptor-binding profile of this medication?

A. Selective antagonist at A1 receptors only

B. Non-selective agonist at B1 and B2 receptors

C. Non-selective antagonist at B1 and B2 receptors, with additional selective A1 antagonist activity

D. Selective A2 receptor agonist that decreases central sympathetic outflow

B. Relaxation of the detrusor muscle in the urinary bladder

Which of the following physiological responses is a direct result of increased sympathetic nervous system innervation (activation) to the target organ?

A. Constriction of the pupils B. Relaxation of the detrusor muscle in the urinary bladder

C. Constriction of bronchial smooth muscle D. Increased gastrointestinal motility and secretions

C. I and III only

Rationale: Phenoxybenzamine - IRREVERSIBLE, non-competitive non-selective alpha blocker - Pheochromocytoma

Consider the following drug classifications and profiles:

I. Mirabegron — Selective B3 Adrenergic Agonist — Overactive bladder

II. Phenoxybenzamine — Reversible Alpha 1 Adrenergic Antagonist — Raynaud’s phenomenon

III. Oxybutynin — Non-selective Muscarinic Antagonist — Overactive bladder Which of the following pairs is/are correct?

A. I only C. I and III only

B. I and II only D. I, II, and III

C. It causes a profound, life-threatening drop in serum potassium levels (severe hypokalemia) in patients with massive burns.

Rationale:

Succinylcholine causes HYPERkalemia Antidote for malignant hyperthermia: Dantrolene

The following statements regarding the neuromuscular blocking agent Succinylcholine are correct, EXCEPT:

A. It is classified as a depolarizing neuromuscular blocker that acts as an agonist at nicotinic receptors.

B. It is clinically indicated to facilitate rapid sequence intubation (RSI) due to its quick onset and short duration of action.

C. It causes a profound, life-threatening drop in serum potassium levels (severe hypokalemia) in patients with massive burns.

D. A serious potential adverse drug reaction associated with its use is malignant hyperthermia, especially when combined with volatile anesthetics.

B. Baclofen

Which of the following muscle relaxants acts centrally as a GABA-B receptor agonist to alleviate severe spasticity associated with spinal cord injuries or multiple sclerosis?

A. Orphenadrine C. Rocuronium

B. Baclofen D. Succinylcholine

D. Trihexyphenidyl

Rationale: Drugs used for the mgt of Parkinson’s Disease - TriBiBe

• Trihecyphenidyl

• Biperidine

• Benztropine

Trifluoperazine is an anti-psychotic drug and not for Parkinson’s disease

Entacapone is a COMT inhibitor

Pramipexole is a D2 receptor agonist

Which of the following drugs used in the management of Parkinson’s disease acts by blocking acetylcholine receptors? A. Trifluoperazine C. Entacapone B. Pramipexole D. Trihexyphenidyl

D. Phenobarbital

Which of the following drugs is absolutely contraindicated in patients with a history of acute intermittent porphyria?

A. Valproic Acid C. Levetiracetam

B. Lorazepam D. Phenobarbital

D. I, II, III, IV

Rationale: ester type dapat, walang ether type teh

The following are ether type local anesthetics, except:

I. Procaine II. Bupivacaine III. Tetracaine IV. Xylocaine (Lidocaine)

A. II only C. II and IV

B. I and III D. I, II, III, IV

C. Haloperidol

Several antipsychotic drugs contain chemical structures which have been correlated with their pharmacologic property. Which of the following antipsychotic agents is butyrophenone derivative?

A. Risperidone C. Haloperidol

B. Fluphenazine D. Thiothixene

D. Sodium Bicarbonate

Which of the following agents acts as the antidote to treat cardiotoxicity caused by an overdose of tricyclic antidepressants (TCAs)?

A. Dimercaprol C. Protamine Sulfate

B. Calcium Edetate D. Sodium Bicarbonate

C. Selective Serotonin Reuptake Inhibitors (SSRIs)

A 28-year-old female patient is diagnosed with Generalized Anxiety Disorder (GAD). She has no other comorbid psychiatric conditions or history of substance abuse. Which of the following classes of medications is considered the first-line pharmacological treatment for the long-term management of her condition?

A. Benzodiazepines B. Barbiturates

C. Selective Serotonin Reuptake Inhibitors (SSRIs) D. Beta-blockers

B. Levetiracetam (referred to as Keppa rage)

A 24-year-old male patient with a history of focal-onset seizures has been taking an antiseizure medication for the past six months. During a routine follow-up visit, he reports experiencing significant mood changes, including increased irritability, unprovoked anger, and intermittent bouts of anxiety. His family confirms these behavioral changes. Which of the following antiseizure medications is most notoriously associated with this?

A. Phenytoin C. Valproic Acid

B. Levetiracetam D. Carbamazepine

B. Concurrent antagonism of serotonin 5HT2 and dopamine D2 receptors

Which of the following pharmacological mechanisms distinguishes second-generation (atypical) antipsychotics from first-generation (typical) antipsychotics, contributing to their lower risk of extrapyramidal symptoms (EPS)?

A. Strong and selective antagonism of dopamine -D2 receptors

B. Concurrent antagonism of serotonin 5HT2 and dopamine D2 receptors

C. Selective inhibition of the vesicular monoamine transporter 2 (VMAT2)

D. Potent agonism of central GABA receptors

A. Duloxetine

Which of the following antidepressants is classified as a Selective Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)?

A. Duloxetine C. Phenelzine

B. Sertraline D. Amitriptyline

B. St. John’s Wort

A 34-year-old patient diagnosed with Major Depressive Disorder (MDD) is prescribed sertraline. During a medication reconciliation, the patient mentions they have been taking an over-the-counter herbal supplement to help lift their mood. The pharmacist warns the patient to discontinue the herbal supplement immediately due to a severe risk of triggering Serotonin Syndrome. Which herbal supplement is the patient most likely taking?

A. Ginkgo biloba C. Valerian Root

B. St. John’s Wort D. Kava Kava

A. I only (hyperGLUC)

The following are manifestations associated with the use of thiazide diuretics, except:

I. Hypocalcemia III. Hypokalemia

II. Hyperglycemia IV. Hyperuricemia

A. I only C. II, III, IV

B. I and II D. I, II, III, IV

C. Mexiletine

Rationale:

• Class IA - prolong AP (DQP)

• Class IB - shorten AP (LMTP)

• Class IC - no effect (MFP)

• Class II - beta-blockers

• Class III - K channel blockers (BIDAS)

• Class IV - Ca channel blockers

The action of this antiarrhythmic agent is described as the blockade of sodium channels with the shortening of the action potential. Which of the following drugs is most likely referred to?

A. Bretylium C. Mexiletine

B. Moricizine D. Disopyramide

A. Abciximab

Rationale: Adalimumab, Infliximab, and Golimumab is a Tumor Necrosis Factor (TNF) Alpha Blocker

The following are not used as antithrombotic agents, except:

A. Abciximab C. Infliximab

B. Adalimumab D. Golimumab

A. Gemfibrozil

Rationale:

• hypertriglyceridemia - fibrates

• hypercholesterolemia - statins

After obtaining his laboratory test results, it was found out that Mimi has an elevated level of VLDL, which is strongly indicative of hypertriglyceridemia. Hence, he was prescribed a drug which can help manage his condition. Which of the following medications is most likely being referred to?

A. Gemfibrozil C. Rosuvastatin

B. Ezetimibe D. Colestipol

C. Amlodipine – Calcium Channel Blocker (CCB)

Rationale:

• Losartan - ARBs (-sartan)

• Metoprolol - Beta-blockers (-olol)

• Lisinopril - ACEIs (-pril)

• *CCBs (-dipines)

Which of the following antihypertensive medications is correctly paired with its pharmacologic class?

A. Losartan – Calcium Channel Blocker (CCB)

B. Metoprolol – Angiotensin-Converting Enzyme (ACE) Inhibitor

C. Amlodipine – Calcium Channel Blocker (CCB)

D. Lisinopril – Angiotensin II Receptor Blocker (ARB)

D. Doxazosin – First-dose orthostatic hypotension

Which of the following antihypertensive medications is correctly paired with its characteristic adverse drug reaction (ADR)?

A. Clonidine – Reflex tachycardia and drug-induced lupus erythematosus

B. Verapamil – Severe hypertrichosis and pericardial effusion

C. Hydralazine – Rebound hypertension upon abrupt withdrawal

D. Doxazosin – First-dose orthostatic hypotension

B. Metoprolol

A 62-year-old female with a history of chronic stable angina presents to the clinic complaining of an increased frequency of chest pain episodes during her daily morning walks. Her current medication regimen consists of low-dose aspirin and lisinopril. Her vitals reveal a blood pressure of 132/82 mmHg and a heart rate of 84 beats per minute. Which of the following is the most appropriate agent to add to her chronic regimen to prevent these exertional angina episodes?

A. Sublingual Nitroglycerin

B. Metoprolol

C. Nifedipine (Immediate-Release)

D. Isosorbide mononitrate

B. Carvedilol

A 58-year-old male with Heart Failure with Reduced Ejection Fraction (HFrEF, LVEF 32%) is taking an ACE inhibitor and a loop diuretic. Which of the following medications should be added to his regimen specifically to reduce mortality and prolong survival?

A. Digoxin C. Furosemide

B. Carvedilol D. Ivabradine

A. Diltiazem

A 65-year-old male is admitted to the emergency department with acute atrial fibrillation accompanied by a rapid, racing heart rate. He is hemodynamically stable. Which of the following intravenous medications is a first-line drug of choice to rapidly slow down his heart rate?

A. Diltiazem C. Digoxin

B. Amiodarone D. Nitroglycerin

A. Significant reduction in the risk of cardiovascular mortality and slowing the progression of chronic kidney disease

A 62-year-old female patient with a history of Type 2 Diabetes Mellitus and chronic kidney disease (eGFR 42 mL/min/1.73m}) is being evaluated for her glycemic control. Her current regimen includes metformin. Her provider decides to add empagliflozin to her therapy. Aside from lowering blood glucose, which of the following clinical benefits is a primary reason for selecting an SGLT2 inhibitor (“flozin”) in this patient?

A. Significant reduction in the risk of cardiovascular mortality and slowing the progression of chronic kidney disease

B. Acute reversal of diabetic ketoacidosis (DKA) symptoms

C. Rapid weight gain to counteract cachexia

D. Direct prevention of calcium oxalate nephrolithiasis (kidney stones)

C. Chlorpropamide

Which of the following drugs is classified as an oral hypoglycemic agent?

A. Chlorthalidone C. Chlorpropamide

B. Chlorpromazine D. Chlordiazepoxide

B. An aromatase inhibitor

What is Exemestane?

A. A C-C chemokine receptor 5 antagonist

B. An aromatase inhibitor

C. A tyrosine kinase inhibitor

D. A HER2 blocker

C. III only

The following statements correctly describes thiazolidinediones:

I. The primary action of thiazolidinediones is to increase insulin release from the pancreas.

II. These are ligands of peroxisome proliferator-activated receptor-alpha.

III. Such drugs include Pioglitazone and Rosiglitazone.

IV. Compared to Pioglitazone, Rosiglitazone appears to exhibit more nephrotoxic risk than the former.

A. I only C. III only

B. II and III D. II, III, IV

C. I, II, III

Which of the following drugs has/have an established clinical application in the treatment of osteoporosis?

I. Raloxifene III. Denosumab

II. Zolendronate IV. Cholestyramine

A. I only C. I, II, III

B. I and II D. I, II, III, IV

C. Thyroid-stimulating hormone (TSH)

Rationale: POV - Posterior, Oxytocin, Vasopressin (ADH)

Which of the following hormones is secreted by the anterior pituitary gland?

A. Oxytocin

B. Antidiuretic hormone (ADH)

C. Thyroid-stimulating hormone (TSH)

D. Epinephrine

D. Propylthiouracil (PTU)

A 29-year-old female in her first trimester of pregnancy is diagnosed with Graves’ disease presenting with severe hyperthyroidism. Which of the following antithyroid medications is considered the first-line drug of choice for this patient during her first trimester?

A. Methimazole C. Radioactive Iodine

B. Potassium iodide D. Propylthiouracil (PTU)

B. I and III only

Systemic corticosteroid therapy (such as long-term prednisone) requires careful monitoring due to its broad physiological effects. Consider the following adverse drug reactions (ADRs):

I. Osteoporosis and increased fracture risk

II. Hyperkalemia and metabolic acidosis

III. Hyperglycemia and impaired glucose tolerance

Which of the choices correctly identifies the common adverse effects associated with chronic systemic steroid use?

A. I and II only C. II and III only

B. I and III only D. I, II, and III

A. Clomiphene

Rationale:

• Mifeprostone - abortifacient

• Levonorgestrel - hormonal contraceptive, inhibit ovulation

*Addtnl info: Finasteride - BPH, Flutamide - prostate cancer (Fluta may cancer)

A 31-year-old female patient is being treated for infertility due to anovulation (failure to ovulate). Her provider prescribes an oral medication that blocks estrogen receptors in the hypothalamus, removing negative feedback and leading to an increase in LH and FSH secretion to stimulate ovulation. Which of the following drugs is used for this purpose to increase the chances of pregnancy?

A. Clomiphene C. Finasteride

B. Mifepristone D. Levonorgestrel

C. If a patient experiences vomiting or severe diarrhea within 2 to 4 hours of taking an active pill, it should be treated as a missed dose.

Which of the following is true regarding the practical application and physiological management of combined oral contraceptive pills (OCPs)?

A. Missing a single active pill requires the immediate initiation of a back-up contraceptive method (such as condoms) for the next 14 days.

B. Placebo pills (the last 7 days of a standard 28-day pack) contain a low dose of estrogen to prevent sudden breakthrough bleeding.

C. If a patient experiences vomiting or severe diarrhea within 2 to 4 hours of taking an active pill, it should be treated as a missed dose.

D. Setting a consistent daily alarm is unnecessary because the contraceptive efficacy of combined OCPs remains unchanged regardless of the time of day they are ingested.

C. Tolvaptan

A patient with lung cancer is diagnosed with SIADH (Syndrome of Inappropriate Antidiuretic Hormone), which is causing dangerously low blood sodium levels due to excessive water retention. Which of the following medications treats this condition by directly blocking the vasopressin V2 receptors in the kidneys?

A. Hydrochlorothiazide C. Tolvaptan

B. Desmopressin D. Fludrocortisone

A. Dimenhydrinate

Rationale:

• Pyrilamine - ethylenediamines

• Brompheniramine - alkylamine

• Cyproheptadine - piperidine

Which of the following agents is an ethanolamine derivative antihistamine? A. Dimenhydrinate C. Cyproheptadine B. Pyrilamine D. Brompheniramine

D. Phenylbutazone

Which of the following NSAIDs is classified as a pyrazolone derivative? A. Oxaprozin C. Tolmetin B. Nabumetone D. Phenylbutazone

D. Two of the choices (Cyclosporine & Tacrolimus)

Which of the following immunosuppressive agents inhibit calcineurin, which is necessary for the activation of a T-cell- specific transcription factor? A. Cyclosporine C. Tacrolimus B. Mycophenolate D. Two of the choices

B. Salmeterol Rationale: (1st line for acute rescue) SABA - Salbutamol (Alt) SAMA - Ipratropium (1st line for chronic maintenance) ICs - “son” (1st line preferred add-on) LABA - Salmeterol (2nd line/alt) LTRA - Montelukast, Mast Cell Stabilizer - Cromolyn (Last resort Add-on) MX - Theophylline

The following drugs are short acting beta agonists, except: A. Albuterol C. Pirbuterol B. Salmeterol D. Terbutaline

A. I and II

Rationale:

• Epoprosternol - PGI2

• Misoprostol - PGE1

• Dinoprostone - PGE2 (di-2)

• Carboprost - PGF2a

The following synthetic analogs are correctly matched with their corresponding prostaglandins, except:

I. Epoprostenol: PGE1 III. Dinoprostone: PGE2

II. Misoprostol: PGI2 IV. Carboprost: PGF2α

A. I and II C. II and IV

B. I and III D. NOTA

D. Ethanol (Fetal Alcohol Syndrome)

Rationale:

• Thalidomide - Phocomelia

• Carbamazepine/Valproic acid - Spina bifida

• Tetracycline - Bone Growth Syndrome

Which of the following teratogens most commonly causes craniofacial dysmorphism and retarded intellectual development?

A. Thalidomide C. Tetracycline

B. Carbamazepine D. Ethanol

C. Osmotic

Lactulose

A. Bulk-forming C. Osmotic

B. Stool-softening D. Stimulant

B. Levorphanol

Rationale:

• Mild-Moderate Full - “cod”

• Partial - Bu, Penta

• Antagonist - “Nal” except Nalbuphine (Partial)

Which of the following opioids is a strong full agonist?

A. Pentazocine C. Nalbuphine

B. Levorphanol D. Buprenorphine

B. It increases fluid secretion into the intestines to soften stool and speed up transit.

A patient with chronic Irritable Bowel Syndrome with Constipation (IBS-C) is prescribed linaclotide after lifestyle changes fail to work. Which of the following options best describes how this medication works to relieve constipation?

A. It blocks serotonin receptors to slow down bowel movements.

B. It increases fluid secretion into the intestines to soften stool and speed up transit.

C. It acts as an antibiotic to destroy harmful gut bacteria.

D. It coats the stomach lining to prevent acid reflux.

B. Rheumatoid Arthritis (RA)

Rationale:

• OA - Degenerative “wear and tear”

• RA - Systemic autoimmune disease

• GA - Crystal deposition

Which of the following joint disorders is a chronic, systemic autoimmune disease characterized by symmetrical joint inflammation and morning stiffness that typically lasts for more than an hour?

A. Osteoarthritis (OA) C. Gouty Arthritis (GA)

B. Rheumatoid Arthritis (RA) D. Septic Arthritis

C. G2

Rationale:

• G1 - Asparaginase

• S - AntiMetabolites (SAM)

• G2 - Bleomycin, Etoposide (2BEG)

• M - Taxanes, Vinka Alkaloids (MagTANIM)

Bleomycin is an antineoplastic drug that exerts its action on cells traversing the cell cycle, hence it is classified as a cell cycle-specific (CCS) drug. Specifically, which stage of the cell cycle does this agent primarily target?

A. G1 C. G2

B. S D. M

D. II and IV

Which of the following drugs are used in combination as a second line treatment of malaria?

I. Pyrilamine III. Sulfadiazine

II. Pyrimethamine IV. Sulfadoxine

A. I and III C. II and III

B. I and IV D. II and IV

D. I and IV

Rationale:

• Usual 4-6 months TB Regimen: RIPE

• Rifaximin - tx for traveller’s diarrhea

• Cyclosporin - immunosuppressant

The following are second line drugs for the treatment of tuberculosis:

I. Ethionamide III. Cyclosporine

II. Rifaximin IV. Para-Aminosalicylic Acid

A. I and II C. I and III

B. II and IV D. I and IV

A. I and II

Which of the following drugs are co-administered in a once-daily, fixed-dose combination formulation where it was found out to be effective as a pre-exposure prophylaxis, thereby reducing HIV acquisition among individuals.

I. Tenofovir III. Zalcitabine

II. Emtricitabine IV. Delavirdine

A. I and II C. III and IV

B. II and III D. I, III and IV

A. Cephradine

Rationale:

• 1st - fa, pha

• 2nd - fox, fur, tan, L

• 3rd - time, money

• 4th - pi

• 5th - rol

The following drugs are second generation cephalosporins, except:

A. Cephradine C. Cefuroxime

B. Cefotetan D. Loracarbef

D. Aflatoxin

Rationale:

Amanitoxin & Phallotoxin - Death Cap (Amanita phalloides)

Clupeotoxin - Plankton-feeding fish

What toxin is commonly found in legumes contaminated with Aspergillus species?

A. Amanitoxin C. Phallotoxin

B. Clupeotoxin D. Aflatoxin

D. Category B

What pregnancy risk category implies that animal studies have not shown an adverse effect on the fetus, but there are no adequate clinical studies in pregnant women?

A. Category C C. Category D

B. Category X D. Category B

D. Fomepizole (Ethylene Glycol)

Rationale:

• Flumazenil - Benzodiazepines

• Deferasirox - Iron

A patient presents with severe metabolic acidosis and an altered mental status after ingesting an unknown substance. 

Based on the obtained laboratory results, high concentrations of oxalic acid crystals were found in the urine, indicating renal failure. Which of the following antidotes should be administered to inhibit the production of these toxic metabolites?

A. Flumazenil C. Deferasirox

B. Disulfiram D. Fomepizole

B. Toxin B (LD50 = 0.0005 mg/kg)

Rationale: ↓ LD50 = ↑ Potency = ↑ Toxicity

Five milligrams of one of the following toxins was administered to 4 identical test animals. Which toxin has the highest probability of causing fatality when administered to an experimental animal?

A. Toxin A (LD50 = 5 mg/kg)

B. Toxin B (LD50 = 0.0005 mg/kg)

C. Toxin C (LD50 = 50 mg/kg)

D. Toxin D (LD50 = 5000 mg/kg)

C. Sodium nitrate

Rationale:

Cyanide poisoning antidote

• Hydroxocobalamine

• Amyl nitrite

• Sodium nitrite

• Sodium thiosulfate (Photographer’s hypo)

The following are used as antidotes for patients with cyanide poisoning, except:

A. Amyl nitrite C. Sodium nitrate

B. Photographer’s hypo D. Hydroxocobalamine