Pharmacokinetics / Pharmacodynamics MCQs May 2006

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Pharmacokinetics / Pharmacodynamics MCQsMay 20061.Which of the following is 90% bound to plasma proteins?a.b.c.d.e.2.Which of the following has the largest volume of inLithiumDigoxinWhich of the following is a phase one oquineTrimethoprimWhich of the following has the shortest half hylationSulphate conjugationClearance of which drug involves capacity limited nLithiumPhenytoin6.An example of drugs that undergo chemical antagonism isa. Insulin - glucagonb. Protamine - heparinc. Prednisone - glipizided. Morphine - naloxonee. Phenoxybenzamine - prazosin7.Regarding first order kinetics - all of the following are true EXCEPTa. First order kinetics means rate of reaction is proportional to concentrationb. First order kinetics is more common than zero order kineticsc. First order kinetics apply to exponential processesd. First order kinetics generally apply to high plasma concentrations ( 20 mg / 100 ml) of ethanole. First order kinetics result in steady state concentrations after multiple dosing.

8.Bioavailability isa. The difference between the amount of drug absorbed and the amount excretedb. The proportion of the drug in a formulation that is found in the systemic circulationc. The AUC relating plasma concentration of drug to time after administrationd. Always identical with different formulations of the same druge. A measure of the rate of absorption of a drug9.Which of the following drugs has a high extraction ratio?a. Diazepamb. Theophyllinec. Phenytoind. Warfarine. Propranolol10. What is the half life of a drug with a volume of distribution of 700l/70kg and clearance of 49l/hour/70kg?a. 5 hoursb. 7 hoursc. 10 hoursd. 12.5 hourse. 15 hours11. Regarding biotransformationa. Phase one reactions always precede phase two reactionsb. Skin is an organ involved in drug biotransformationc. Water conjugation is a phase one reactiond. CYP2D6 accounts for the majority of P450 activitye. Epoxidation is phase two biotransformation12. Which of the following receptor - ligand pathway is correct?a. Insulin - G protein receptorb. Mineralocorticoid - tyrosine kinase receptorc. Vitamin D - intracellular receptord. Adrenaline - ligand gated channel receptore. Platelet derived growth factor - cytokine receptor13. Age associated changes in pharmacokinetics includea. Reduction in creatinine clearance in 2/3 populationb. Decreased body fatc. Increase body waterd. A greater reduction in conjugation compared with oxidatione. A decreased absorption related to age alone14. The metabolic pathway of detoxification that become increasingly important in paracetamol toxicity isa. Conjugation with glucuronideb. Oxidationc. Reductiond. Methylatione. Cytochrome p450 dependent glutathione conjugation15. You are given a vial with 15 ml of 0.5% prilocaine to do an arm block. How many mg of prilocaine are you injecting?a. 7.5 mgb. 15 mgc. 30 mgd. 50 mge. 75 mg

16. Drugs that enhance other drug metabolism include all of the following EXCEPTa. Rifampicinb. Ketoconazolec. Phenobarbitald. Griseofulvine. Phenytoin17. Which is the safest to give in pregnancy?a. Lithiumb. Phenytoinc. Gentamycind. Heparine. ACE inhibitors18. Regarding pharmacology principlesa. Diffusion is directly proportional to thickness and inversely proportional to surface areab. LD50 - 50% of the dose that kills most peoplec. Efficacy is the maximum response produced by a drugd. A partial agonist is always less potent than a full agoniste. EC50 concentration of agonist that results in maximal response in 50% of patients19. Reports of cardiac arrhythmias caused by unusually high blood levels of 2 antihistamines (terfenadine and astemizole)are best explained bya. Concomitant treatment with phenobarbitalb. Use of these drugs by smokersc. Use of antihistamines by persons of Asian backgroundd. A genetic predisposition to metabolise succinylcholine slowlye. Treatment of these patients with ketoconazole20. Which of the following statements is correct?a. The half life is the time taken for a parameter to fall to 1/4 its original valueb. Partial agonists act at receptor sites to cause maximal pharmacological effect at high dosesc. Diazepam has a high extraction ratio and is thus subject to flow dependent eliminationd. Morphine and pethidine have the same potencye. A patient with oedema will have an increased volume of distribution of tobramycinAnswers: Pharmacokinetics / pharmacodynamics April 20041. B2. D3. C4. A5. E6. B7. D8. B9. E10. C11. B12. C13. A14. E15. E16. B17. D18. C19. E20. E

Antibiotics MCQsJan 041.All of the following are true regarding penicillins EXCEPTa. Most penicillins only cross the blood brain barrier when the meninges are inflamed.b. Penicillins don‟t require dosage adjustment in renal failurec. Penicillins inhibit cross linkage of peptidoglycans in the cell walld. Piperacillin is a penicillin active against pseudomonase. Only about 5 to 10% of people with a past history of penicillin allergy have a reaction on re exposure2.Ciprofloxacina. Is a defluorinated analogue of nalidixic acidb. Inhibits tropoisomerases 2 and 3c. Has no gram positive coverd. Has a bioavailability of 30%e. May cause an arthropathy3.Resistance to B lactamsa. Can be due to an efflux pumpb. Is most commonly due to modification of the target PBPsc. Does not involve penetration of drug to target PBPsd. Infers resistance only to penicillince. Can involve up to 5 different B lactamases4.Macrolidesa. Have enhanced activity at acidic pHb. Have little activity against legionellac. Have half lives which increase in patients with anuriad. Induce cytochrome p450 enzymese. Are contraindicated in neonates5.Flucloxacillina. Is ineffective against streptococcib. Is active against enterococci and anaerobesc. Blocks transpeptidation and inhibits peptidoglycan synthesisd. Is poorly absorbed orallye. Has excellent penetration into CNS and prostate6.All of the following inhibit nucleic acid synthesis EXCEPTa. Norfloxacillinb. Chloramphenicolc. Trimethoprimd. Rifampicine. Sulfasalazine7.Which of the following is a second generation cephalosporin?a. Cefaclorb. Ceftazidimec. Cephalexind. Cefotaximee. Cephalothin

8.Regarding the pharmacokinetics of the tetracyclinesa.b.c.d.e.9.Tetracyclines are 40 to 80 % bound by serum proteinsAbsorption is enhanced by coadministration of antacidsTetracyclines cross the blood brain barrier easilyDoxycycline is excreted predominantly by the kidneyDemeclocyline is a short acting tetracycline drugAll of the following are recognized adverse effects of isoniazid EXCEPTa.b.c.d.e.HepatitisPeripheral neuropathyRetrobulbar neuritisDecreased phenytoin metabolism – increased phenytoin blood levels / toxicityCNS toxicity10. Vancomycina.b.c.d.e.90% of vancomycin is excreted by glomerular filtrationInhibits proteinsynthesis in bacteriaIs bactericidal against gram negative bacilliIs well absorbed from the GITOne adverse reaction to infusions of vancomycin is the “blue man” syndrome11. Regarding mechanisms of antiviral drug actiona.b.c.d.e.blockage of viral uncoating is caused by rifampicinZidovudine is a protease inhibitorAmantidine blocks viral DNA packaging and assemblyIndinavir is a reverse transcriptase inhibitorAcyclovir inhibits viral DNA synthesis12. Regarding toxicity of antibioticsa.b.c.d.e.Enamel dysplasia is common with aminoglycosidesGray baby syndrome occurs with rifampicin useHaemolytic anaemias can occur with sulphonamide useNephritis is the most common adverse reaction with isoniazidDisulfiram like reaction can occur with macrolides13. Chloramphenicola.b.c.d.e.Does not penetrate the blood brain barrierMust be administered parenterallyCan be safely used in premature infantsCan cause depression of bone marrow functionCan cause discoloration of developing teeth when given to children14. Spironolactonea.b.c.d.e.Has a steroid structureIs a partial agonistPromotes sodium retentionIncreases potassium lossIs a loop diuretic

15. Which of the following drugs cause diuresis by the mechanisms indicated?a.b.c.d.e.Ethanol – by preventing the reabsorption of sodium from renal tubular fluidDigoxin – by inhibiting release of ADHDopamine – by inhibiting active transport of chloride over the entire length of the descending limb of theloop of HenleFrusemide – by inhibiting carbonic anhydraseChlorothiazide – by inhibiting active sodium transport in the ascending limb of the loop of HenleAntibiotics Pharmacology ACAECDAE

MCQs: Analgesia Toxicology and AntibioticsQ1: All of the following may cause seizures directly or indirectly except.A: TramadolB: M3GC: M6GD: HydromorphoneE: FlumazenilQ2: The following opiate with the least intrinsic activity is.A: PropoxypheneB: AlfentanilC: CodeineD: NefopamE: MeperidineQ3: Regarding spinal pain transmission and the opiates one is false.A: Pre-synaptic terminals have mu, delta and kappa receptors.B: Binding mu receptors on post-synaptic terminal opens K channels.C: Decrease in Ca influx pre-synaptically can be mediated by opiate binding.D: Opiates affect afferent pain transmission but also efferent pain modulation.E: NMDA blockade increases tolerance to opiates.Q4: Complications related to COX-2 inhibitors include.A: Gastrointestinal bleeding.B: Renal failure.C: Increase in adverse cardiovascular events.D: Sulphur allergy.E: All of the above.Q5: Medication with anti-inflammatory properties in gout include all except.A: PrednisoneB: ColchicineC: TolmetinD: IndomethacinE: CelecoxibQ6: Diet supplementation with fish eicosapentaenoic acidA: Decreases inflammation by elevating vitamin D levels.B: Is not as efficient as NSAIDs at reducing inflammation.C: Is a saturated fatty acid.D: Forms eicosanoids several orders less potent than usual.E: Effects have not been clinically studied.Q7: Regarding carbon monoxide one is false.A: It is readily formed by incomplete combustion of carbon.B: The fetus is protected by the maternal circulation from toxic effects.C: The hemoglobin affinity is 220 times that of oxygen.D: The half life is 5 hours and 20 mins breathing air.E: Smokers can exibit carboxyhemoglobin levels of 5-10 per cent.

Q8: Bio-accumulation is a feature of which substance.A: Carbamates.B: Organophosphates.C: Ozone.D: Mercury.E: None of the above.Q9: Chelation therapy for heavy metal poisoning.A: Chelation for lead has little compelling evidence in the asymptomatic individual.B: Deferoxamine therapy increases susceptibility to Yersinia enterocolitica infection.C: Chelation therapy is useful in cadmium intoxication.D: Peanut allergy is a contraindication to the use of intramuscular dimercaprol.E: L-Penicillamine frequently causes pyridoxine deficiency.Q10: A primarily bacteriostatic antibiotic is.A: MetronidazoleB: ChloramphenicolC: PenicillinD: VancomycinE: GentamicinQ11: If penicillin together with tetracycline is tested for synergy and is found in combination to achieve MIC at 3mg/L ofpenicillin and 3mg/L of tetracycline compared to a MIC of 0.5mg/L for each drug on its own then the FIC index is.A: 3B: 6C: 9D: 12E: 1/6Q12: For Question 11 one of the following statements is false.A: Damage to the bacteria at two sites simultaneously has not enhanced synergy.B: Antibiotics displaying indifference of effect approach a FIC index of 2.C: Antibiotics displaying similar action without synergy approach FIC index of 1.D: Synergy is an increase in expected effect above the sum of individual ABx effects had they been acting alone.E: Synergy is seen at greater than or equal to 4.Q13: Cefoxitin and Piperacillin interact in the following way to achieve antagonism.A: Induction of enzymatic inactivation by beta-lactamase for some species.B: Competitive inhibition at PBPs.C: Cidal inhibition by static agent.D: Achieve high levels of synergy.E: Are not available in Australasia and are irrelevant.Q14: All the penicillins need dose adjustment in renal failure except.A: Penicillin GB: DicloxacillinC: Amoxicillin/ ClavulanateD: TicarcillinE: Penicillin V

Q15: For cross reaction/ hypersensitivity one of the following is incorrect.A: Penicillins/ Monobactams no cross reactivity.B: Vancomycin: release of histamine.C: Penicillins/ Cephalosporin 20% cross reactivity.D: Penicillins/ Carbapenems 50% cross reactivity.E: Penicillin/ Erythromycin no cross reactivity.Q16: The best CSF penetration of the beta lactam containing antibiotics is achieved by.A: CefotaximeB: CeftriaxoneC: MeropenemD: Penicillin GE: AztreonamQ16: Chloramphenicol has the following features except one.A: In doses above 50mg/kg/d in infants may cause grey baby syndrome.B: It is an inhibiter of microsomal enzymes.C: It binds reversibly to the 50s subunit inhibiting protein synthesis.D: It penetrates virtually every tissue to near serum levels.E: Agranulocytosis is idiosyncratic, 1: 24-40,000 cases and tends to be reversible.Q18: A lactone ring is a feature of all the following drugs except:A: ErythromycinB: ClindamycinC: Amphotericin BD: ClarithromycinE: IvermectinQ19: MLS Resistance will give resistance to all the following antibiotics except.A: Quinupristin/ DalfopristinB: LinezolidC: RoxithromycinD: ClindamycinE: Lincomycin.Q20: Sulphonamide antibiotics.A: Do not affect mammalian cells as they rely on exogenous folate.B: Act as PABA analogues inhibiting Dihydrofolate reductase.C: Gain synergy from other folate metabolic pathway inhibitors acting at alternat sites.D: Have activity against protozoa, fungi and bacterial species.E: Share hypersensitivity with COX2 inhibitors/ carbonic anhydrase inhibitors/ loop diuretics and oral hypoglycaemicagents.Q21: Fluoroquinolones exibit all the following except.A: Risk of tendinitis and arthropathy.B: QTc prolongation worsened by erythromycin administration.C: Resistance arising with 1: 10 to the 7-9 due to point mutations.D: Act via inhibition of topoisomerase II and IVE: The newest agents including moxifloxacin have improved pseudomonal cover.

Q22: With the anti-Tubercular drugs the following associations are true except.A: Rifampcin: yellow staining of soft contact lenses.B: Pyrazinamide: taken up by phagocytes and more active in this acidic environment.C: Streptomycin: well tolerated orally and given as fourth agent pending sensitivity.D: Isoniazid: inhibition of mycolic acid production in cell wall.E: Ethambutol: red green colour blindness.Q23: One of the following is true for the imidazoles vs the triazoles.A: The triazoles are more specific for fungal p450B: The imidazoles are less toxic parenteral.C: Fluconazole has poor CSF penetration due to insolubility in water.D: Both these medications act to activate p450 digestion of fungal cell walls.E: Flucytosine is a close relative with similar action.Q24: The neucleotide-like antivirals include all except.A: acyclovirB: ganciclovirC: zidovudineD: lamivudineE: nevirapineQ25: The most generally active of the following antimicrobials is.A: Sodium hypochloriteB: PhenolsC: AlcoholsD: ChlorhexidineE: Sodium bicarbonateQ26: You are treating a patient with P.falciparum form rural Thailand and you are primarily worried about.A: The residency status of your patient.B: The risk of catching malaria.C: Mefloquine induced psychosis.D: Multi- drug resistance.E: Difficulty clearing the liver of hypnozoites.Q27: Agents used in the treatment of P jiroveci include all except.A: OxygenB: PentamidineC: Co-trimoxazoleD: AtovaquoneE: CiprofloxacinQ28: Albendazole shares a similar mechanism of action with.A: piperazinesB: opiatesC: colchicineD: ivermectinE: praziquantel

Answers from KatzungQ1: C page 500, 512, 360Q2: A page 499 note Nefopam non-opioid and not in KatzungQ3: E page 503, 500Q4: E page 582, 583, 584Q5: C page 583, 597Q6: D page 595Q7: B page 960Q8: D page 976Q9: C page 978. Others A-973; B-980; D-978; E-980Q10: B page 842Q11: D page 846Q12: E page 846Q13: A page 847Q14: B page 738Q15: C page 747 (5-10 per cent) note D from Guide to pathogens and AB treatmentQ16: A page 845Q17: E page 755Q18: B page 761 and 792 and 890Q19: B page 759 and 762Q20: B page 773 and 775Q21: E page 777Q22: C page 786Q23: A page 795Q24: E page 817Q25: A page 830Q26: debatable but probably D from page 864Q27: E page 880Q28: C page 886 and page 597

Antihypertensives, vasodilators, angina drugs, cardiac glycosides.June 021.Diureticsa.b.c.d.e.2.Methyl dopaa.b.c.d.e.3.Dilates veins but not arteriolesIs contraindicated in the treatment of preeclampsiaCan cause an SLE type syndrome in up to 10 – 20% of patientsCauses orthostatic hypotension in many casesIs extremely useful as a single agent in treatment of hypertensionWhich of the following drug‟s metabolism characteristics are bimodally distributed in the population?a.b.c.d.e.6.Is a B1 specific blockerCauses prominent postural hypotensionInhibits the stimulation of renin production by catecholaminesHas a half life of 12 hoursHas no effect on plasma lipidsHydralazinea.b.c.d.e.5.Lowers the heart rate and cardiac output more than clonidine doesCauses reduction in renal vascular resistanceHas minimal CNS side effectsHas 80% bioavailabilityUsual therapeutic dose is about 1 – 2 mg/dayPropranolola.b.c.d.e.4.Work to lower BP initially by decreasing peripheral vascular resistanceThiazide diuretics are potassium sparingAre effective in lowering Bp by 20 – 25 mmHg in most patientsBP response to thiazides continues to increase at doses greater than usual therapeutic dose.Diuretics may impair glucose toleranceSodium mineThe ACE inhibitorsa.b.c.d.e.Inhibit peptidyl dipeptidase thus preventing the inactivation of bradykininCaptopril is a prodrugAre to be used with caution in patients with IHD as reflex sympathetic activation occurs secondary to thehypotensive effects of the ACE inhibitorsHave no role in treating the normotensive diabetic patientsAre useful antihypertensive agents in late pregnancy

7.The following drugs when combined with ACE inhibitors may produce troublesome problems EXCEPTa.b.c.d.e.8.The nitratesa.b.c.d.e.9.DiclofenacPotassium supplementsSpironolactoneLithiumTheophyllineHave an antianginal effect via vasodilation of arterioles onlyServe to increase preloadHave a direct effect on cardiac muscle to cause a decrease in anginal symptomsAll have high oral bioavailabilityAre contraindicated in the presence of increased intracranial pressureRegarding Calcium channel blockersa.b.c.d.e.Calcium channel blockers are not bound to plasma proteinsNifedipine has less vascular potency than verapamilFelodipine has been shown to inhibit insulin release in humansDiltiazem has a plasma half life of 3 – 4 hoursVerapamil has high affinity for cerebral blood vessels thus decreasing vasospasm post subarachnoidhaemorrhage10. Which of the following calcium channel blockers is excreted predominantly in the dipineVerapamil11. Which of the following calcium channel blockers has the longest plasma half pineVerapamil12. The following include major actions of digoxin on cardiac electrical functions EXCEPTa.b.c.d.e.Decreased PR interval on ECGDecreased conduction velocity at the AV nodeIncreased automaticity of the atrial muscleDecreased effective refractory period in purkinje system/ventriclesBigeminy can be induced by digoxin13. Which of the following increases the risk of digoxin induced ypermagnesaemiaHyperuricaemiaHypernatraemia

14. Digoxina.b.c.d.e.Is poorly lipid solubleIs extensively metabolizedHas a half life in the body of 40 hoursHas minimal GI toxicityIs 80% bound to plasma proteins15. Drugs which may increase digoxin effect include all of the following EXCEPTa.b.c.d.e.AmiodaroneDiltiazemFrusemide

C: Ozone. D: Mercury. E: None of the above. Q9: Chelation therapy for heavy metal poisoning. A: Chelation for lead has little compelling evidence in the asymptomatic individual. B: Deferoxamine therapy increases susceptibility to Yersinia enterocolitica infection. C: Chelation therapy is useful in cadmium intoxication.

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