Acute hepatocellular necrosis can be caused by:
a. Penicillins
b. Aminoglycosides
c. Fusfomycin
d. Sulfonamides
e. Glycopeptides
Clinical endpoints are all listed except:
a. Survival
b. Disability
c. Change in blood pressure
d. Change in quality of life
Clinical endpoints typically focus on survival, disability, and quality of life rather than intermediate measures like blood pressure changes
Mydriasis, blurred vision, confusion, constipation, urinary retention, dryness of the mucous membranes are typical side effects of:
a. Cholinolytics
b. Beta-blockers
c. Alpha-blockers
d. Cholinomimetics
e. Benzodiazepines
The symptoms listed are classic anticholinergic side effects.
During pregnancy, hepatic metabolism is increased and clearance of drugs which elimination depends on the activity of liver isoenzyme CYP3A4, CYP2D6 and CYP2C9 is also increased.
a. True
b. False
During pregnancy, hepatic metabolism and the clearance of drugs metabolized by CYP3A4, CYP2D6, and CYP2C9 are generally increased
The WHO concept of “personal drug” includes the choice of:
a. Specific drug
b. Dosage form
c. Dosing regimen
d. Duration of treatment
e. All are correct answers
Discounting is a calculation method that estimates the present value of a future cost or benefit.
Which of the following pharmacotherapeutic problems is not specific to pediatric patients?
a. Growth retardation by corticosteroids.
b. Impaired dental development from tetracyclines.
c. Early closure of closure of the epiphyseal plate and impaired bone growth by estrogen and testosterone.
d. Cognitive impairment from anticholinergic drugs.
This issue is not unique to pediatric patients; it can occur in any age group
All of the following drugs are inhibitors of cytochrome P450 enzymes, EXCEPT:
a. Cimetidine
b. Clarithromycin
c. Fluconazole
d. Phenytoin
Phenytoin is an inducer, not an inhibitor, of cytochrome P450 enzymes
Drugs with a low extraction ratio (restrictive hepatic metabolism) are all listed EXCEPT:
a. Warfarin.
b. Digitoxine.
c. Theopbyllin.
d. Lidocaine.
e. Diazepam.
Lidocaine has a high extraction ratio, unlike the other drugs listed, which have low extraction ratios
The major aim of treatment of congestive heart failure is:
a. Reduction of dyspnea and swelling.
b. Improvement of survival.
c. Improvement of exercise intolerance.
d. Improvement of systolic function.
The major aim is to improve survival in heart failure treatment
Which of the following drugs is not usually used in anti-inflammatory doses for safety reasons?
a. Acetylsalicylic acid.
b. Ibuprofen.
c. Celecoxib.
d. Diclofenac.
ASA is typically not used in anti-inflammatory doses due to its safety profile, particularly its gastrointestinal and bleeding risks
Which of the following adverse drug reactions cannot be classified as serious?
a. Leading to death.
b. Life-threatening.
c. Leading to significant or permanent damage or congenital anomalies.
d. Requiring a hospitalization or emergency medical treatment to prevent complications.
e. Requiring a change in therapy, specific treatment, or prolongation of hospitalization for at least 1 day.
This is not classified as "serious" but rather as a moderate adverse drug reaction
Is it true that ACE inhibitors and angiotensin receptor blockers are contraindicated in pregnant women?
ACE inhibitors and ARBs are contraindicated in pregnancy due to the risk of fetal toxicity
Phase I of clinical trial of the drug is:
a. An extended clinical trial on a large group of patients.
b. Post-marketing surveillance (monitoring of efficacy and safety after authorization of the medicinal product).
c. The first administration of the biologically active substance to patients.
d. The first administration of the biologically active substance to healthy volunteers.
Which of the listed drug can cause prolongation of the QT interval and arrhythmia?
a. Sulfamethoxazole / trimethoprim
b Fosfomycin
c. Linezolid
d. Tetracyclines
e. Macrolides
f. Teicoplanin
Macrolides, like erythromycin, are associated with QT prolongation and arrhythmia risk
Bioavailability refers to the fraction and rate at which the administered dose of a drug is delivered by respective dosage form and reaches the systemic circulation.
Bioavailability describes the fraction and rate at which a drug reaches systemic circulation
Hepatic clearance is determined by these main parameters EXCEPT:
a. Hepatic blood flow, which reflects the delivery of the drug to the liver.
b. The fraction of drug in the blood that is free or not bound to plasma protein portion and capable of interacting with liver enzymes.
c. Internal hepatic clearance, which means the ability of the liver to metabolize drugs.
d. The apparent volume of distribution.
This parameter does not directly determine hepatic clearance
Long-term control of moderate persistent asthma is carried out with one of the following:
a. Combined forms of inhaled corticosteroids and long-acting beta-2 agonists
b. Short-acting beta-2 agonists
c. Oral corticosteroid
d. Systemic corticosteroid
This is the standard long-term treatment for moderate persistent asthma
Morphine:
a. Does not pass through placenta (diaplacentally).
b. Passes through the placenta (diaplacentally) and may cause fetal withdrawal syndrome.
c. Is indicated during pregnancy.
d. It is not excreted in breast milk and can be given to nursing mothers.
Crosses the placenta and can affect the fetus
In patients with chronic kidney disease, the use of the drugs with predominant extrarenal elimination is preferred.
In chronic kidney disease, drugs with extrarenal elimination are preferred to avoid accumulation.
Two medicinal products are considered bioequivalent if they have the same or close relative bioavailability (within established eligibility criteria), expressed by the ratio of their main pharmacokinetic parameters: AUC (area under the plasma concentration-time curve), Cmax (maximum plasma concentration) and Tmax (time to Cmax), of which AUC and Cmax are the leading.
Bioequivalence is determined by comparing AUC, Cmax, and Tmax within established criteria
There is no consensus that beta-blockers and ACE-inhibitors are complementary, and can be started together as soon as the diagnosis of heart failure with reduced ejection fraction is made.
b. Untruth
There is a consensus that beta-blockers and ACE inhibitors are complementary and can be started together for heart failure with reduced ejection fraction
Which one of the following methods of drug administration may result in significant oscillations of plasma concentrations (Cssmin, Cssmax) around the mean values of the equilibrium (Cssav) at steady-state?
a. Single intravenous bolus injection.
b. Single constant intravenous infusion.
c. Multiple (repeated) intermittent oral and intravenous administration.
d. None of the listed.
This can result in significant plasma concentration oscillations
Neuro-hormonal antagonists (ACE-inhibitors, ARBs, mineralocorticoid receptor antagonists, and beta-blockers) have been shown to improve survival in patients with heart failure with reduced ejection fraction.
Neuro-hormonal antagonists have been shown to improve survival in heart failure with reduced ejection fraction
The use of fluoroquinolones is restricted due to the following side effects:
a. Risk of ventricular arrhythmias
b. Allergic reactions, photodermatitis
c. Disorders of the central and peripheral nervous system
d. Risk of cartilage damage and tendon rupture
e. All of the listed
Fluoroquinolones are restricted due to the risks of ventricular arrhythmias, allergic reactions, photodermatitis, nervous system disorders, and cartilage damage/tendon rupture
Spironolactone or eplerenone are recommended in all symptomatic patients (despite treatment with an ACEI and a beta-blocker) with CHF with reduced ejection fraction, to reduce the mortality and hospitalization.
Spironolactone or eplerenone is recommended to reduce mortality and hospitalization in symptomatic patients with CHF despite ACEI and beta-blocker therapy
Research and analysis of costs and benefits of drug therapies aimed to help decision making for resource allocation in healthcare is subject of:
a. Clinical pharmacology.
b. Cohort studies.
c. Pharmacovigilance.
d. Pharmacoeconomics.
Pharmacoeconomics analyzes the costs and benefits of drug therapies to aid resource allocation in healthcare
Metoprolol has a pKa = 9.68 and propranolol has a 20-fold higher lipid solubility and pKa = 9.41. Which of the two drugs has more adverse reactions in the CNS?
a. Metoprolol.
b. There is no difference because they have similar pKa values.
c. Propranolol.
Propranolol, due to its higher lipid solubility, crosses the blood-brain barrier more easily and is associated with more CNS adverse effects
Phase II metabolic reactions include conjugation reactions and endogenous substrates such as glucuronic acid, acetyl-CoA, glutathione, etc., which further enhances the lipophilicity of the molecules and reduces their elimination.
Phase II reactions enhance hydrophilicity, not lipophilicity, to facilitate elimination
Select the incorrect statements about the physiological volumes of standard body fluids used as a guide for the apparent volume of drug distribution (Vd) for the average 70kg man.
A. Blood – 4–5.5L
B. Blood Plasma – 3L
C. Extracellular Fluid – 40L
D. Intracellular fluid – 27L
Extracellular fluid is around 14L, not 40L. Total body water is ~40L
Which of the following bioactive ingredients of popular nutrients does not inhibit cytochrome P450 isoenzymes?
A. Hyperforin in the St John’s wort herb
B. Curcumin in the rhizome of turmeric
C. Furanocoumarins in grapefruit juice
D. Cathechins in green tea leaves
Catechins generally do not inhibit P450 isoenzymes, unlike the other options
Usually, in multiple dosing, the blood sample is taken before the next dose to assess the peak concentration
A. True
B. False
To assess peak concentration, the blood sample is taken shortly after administration, not before the next dose
Increases atmospheric pressure exacerbates arthritis pain and may reduce the analgesic effect of NSAIDs
B. False (in datei A)
There is no conclusive evidence that increased atmospheric pressure exacerbates arthritis pain or reduces NSAID effectiveness
Chronopharmacological effects of drugs are expected to be more prominent in the beginning of therapy rather than after long term administration when Css plasma concentrations at steady-state are reached.
Chronopharmacological effects are more prominent at steady-state plasma concentrations rather than at the beginning of therapy
Which of the following statements about aminoglycosides is INCORRECT?
A. They are not absorbed because of their polar nature
B. Their major toxicities include drug-induced nephrotoxicity and ototoxicity
C. Their antibacterial action is concentration dependent
D. They are active against anaerobes
Aminoglycosides are not effective against anaerobic bacteria as they require oxygen-dependent transport to exert their effect
Drugs with a high excretion ration (>0.7) are those that are metabolised below 70% on their first passage through the liver.
Drugs with a high extraction ratio (>0.7) are metabolized extensively, meaning more than 70%, on their first passage through the liver.
Drugs for which presystemic (first-pass) elimination after oral administration is clinically significant include all of the following , EXCEPT:
a. Morphine.
b. Propranolol.
c. Nitroglycerin.
d. Diazepam.
Diazepam does not undergo significant first-pass metabolism compared to the other drugs listed
Phase 1 clinical trials of anticancer drug are performed on a limited number (usually up to 50) of healthy volunteers for moral and ethical reasons.
Phase 1 clinical trials for anticancer drugs are typically performed on patients with advanced cancer, not healthy volunteers, for ethical reasons
Metabolic and electrolyte disturbances are adverse drug reactions of:
A. Thiazide and loop diuretics
B. Betablockers
C. ACE inhibitors
D. Cardiac glycosides
These are known to cause metabolic and electrolyte disturbances such as hypokalemia and hyponatremia
Drugs with low molecular weight, high lipid solubility and low protein binding cannot easily cross the placenta and their use during pregnancy poses no risk to the foetus
Drugs with low molecular weight, high lipid solubility, and low protein binding can cross the placenta easily and may pose risks to the fetus
Total systemic clearance is a cumulative constant presented as a sum of all individual clearances (renal and non-renal) of the elim.. organs
Total systemic clearance is the sum of all individual clearances, including renal and non-renal clearance, from all elimination organs.
Cost-utility analysis is:
a. Type of economic analysis where competing interventions outcomes are identical and where decisions are based on cost comparison only
b. Type of economic analysis where competing alternative outcomes could differ in level and are measured in identical physiological and clinical units while costs are measured in monetary units
c. Type of economic analysis where competing interventions differ in outcomes both in terms of quantity and quality of life
d. Type of economic analysis where both costs and outcomes of the alternative interventions compared are measures in monetary units
Cost-utility analysis considers both quantity and quality of life, often using QALYs
In cumulative dosing regimens, treatment starts with maintenance doses of drugs and steady state plasma concentrations are reached after 4-5 elimination half-lives of the respective drug
In cumulative dosing regimens, steady-state plasma concentrations are reached after 4-5 elimination half-lives
Drugs that are completely or largely excreted by the kidneys or have active metabolites with renal excretion, in chronic kidney disease are used in:
A. Low initial dose and low maintenance dose
B. Normal initial dose and reduced maintenance dose
C. Normal initial dose and normal maintenance dose
D. Normal initial dose and higher maintenance dose
A. Low initial dose and low maintenance dose (in datei B)
In chronic kidney disease, drugs excreted by the kidneys require reduced doses to prevent toxicity
All of the listed drugs have high hepatic excretion ratio (>0.7) EXCEPT:
A. Diazepam
B. Morphine
C. Nitroglycerin
D. Verapamil
Diazepam has a low hepatic extraction ratio, unlike the others listed
Which of the following statements about Durogesic TTS (transdermal form of fentanyl) is NOT true?
A. Performs continuous analgesia for 72 hours
B. Provides a constant plasma concentration of fentanyl
C. At elevated temperature, transdermal resorption of fentanyl increases
D. Suitable for transient exacerbation of pain on the background of basic analgesic therapy
Durogesic TTS is not suitable for transient pain exacerbations due to its slow onset and long duration
Which of the following diseases exhibits circadian rhythms and is suitable for applying chronopharmacological approach in therapy?
A. Hypertension
B. Cancer
C. Pepticulcer
D. Rheumatoid arthritis
E. All of the listed
Diseases like hypertension, cancer, peptic ulcer, and rheumatoid arthritis exhibit circadian rhythms and can benefit from a chronopharmacological approach
IV admin of the opioid antagonist naloxone in the treatment of intoxication with narcotic analgesics may cause withdrawal symptoms
IV administration of naloxone in narcotic analgesic intoxication can precipitate withdrawal symptoms, especially in dependent individuals.
If an adverse reaction causes discomfort that makes it difficult to perform normal daily activities, this adverse reaction is:
A. Mild
B. Moderate
C. Serious
Adverse reactions that cause discomfort making it difficult to perform daily activities are classified as moderate
All of the listed gene-drug pairs are properly matched in terms of their relationship to genetically based individual changes in response EXCEPT:
A. CYP2D6 gene and fluoxetine
B. HER2 gene and codeine
C. Butrylcholinesterase gene and succinylcholine
D. CYP2C19 gene and clopidogrel
HER2 is not related to codeine metabolism; CYP2D6 is the relevant gene for codeine metabolism
Which of the listed factors has no influence on the degree of fluctuation of plasma concentrations around the mean values at steady state following intermittent administration of drugs?
A. Elimination half life
B. Dose
C. Dosinginterval
D. Rate of absorption
D. Rate of absorption (in datei B)
The rate of absorption does not significantly affect plasma concentration fluctuation at steady state with intermittent dosing.
In hypertensive patients with bronchial asthma, the following are not prescribed
A. ACE inhibitors
B. Alpha blockers
C. Calcium antagonists
D. Beta blockers
Beta blockers are contraindicated in hypertensive patients with bronchial asthma due to the risk of bronchospasm
All of the following antibacterial drugs are used in the treatment of MRSA infections except:
A. Azithromycin
B. Daptomycin
C. Linezolid
D. Vancomycin
Azithromycin is not effective against MRSA, while daptomycin, linezolid, and vancomycin are.
Which of the following statements about lincosamides is incorrect?
a. They are useful in treatment of osteomyelitis and septic arthritis due to clinically effective concentrations in the bone
b. They are active against gram negative bacteria
c. They are active against gram positive bacteria
d. They can be used for dental infections
Lincosamides are not effective against gram-negative bacteria; they target gram-positive bacteria and anaerobes
Clearance can be used to determine one of the following:
A. Maintenance dose size with non-cumulative dosing regimen
B. Loading dose size with non-cumulative dosing regimen
C. Course dose size with chronic treatment
D. None of the listed
Clearance is primarily used to calculate the maintenance dose for steady-state concentrations
Patient or society costs, such as production loss, income loss, absenteeism, reduced productivity etc are:
A. Direct costs
B. Indirect costs
C. Intangible costs
Costs such as production loss, absenteeism, and reduced productivity are categorized as indirect costs.
In patients with severe renal insufficiency, although the synthesis of 1,25 – dihydroxyergocalciferol is impaired, no replacement therapy is required:
In severe renal insufficiency, replacement therapy with active vitamin D metabolites is required due to impaired 1,25-dihydroxyergocalciferol synthesis
All of the listed drugs have limited placental transfer and their use in clinical indications during pregnancy is permissible except for
a. Enoxaparin
b. heparin
c. insulin
d. sodium valproate
Sodium valproate crosses the placenta and poses teratogenic risks, unlike enoxaparin, heparin, and insulin
Chloramphenicol induces gray baby syndrome in newborn infants because the metabolism of chloramphenicol from immature glucuronyltransferase to the inactive glucuronide metabolite is reduced
a) true
b) false
Chloramphenicol causes gray baby syndrome in newborns because of immature glucuronyltransferase enzyme activity
A diastolic blood pressure target of > 80 mmHg should be considered for all hypertensive patient independent of the level of risk and comorbidities
a. true
b. false
Blood pressure targets should consider individual risk and comorbidities, and diastolic BP targets may differ based on these factors
All of the following drugs are inducers of cytochrome p 450 enzymes except
a. carbamazepine
b. phenobarbital
c. rifampicin
d. erythromycin
Erythromycin is not a cytochrome P450 inducer; it is an inhibitor, unlike carbamazepine, phenobarbital, and rifampicin
The calculation of creatinine clearance according to Cocroft and Gault formula is based on:
a. amount of urine for 24 hours
b. urine creatinine concentration, amount of urine for 24 hours and serum creatinine
c. patient age in years, bodyweight, serum creatinine and correction factor
The Cockcroft-Gault formula estimates creatinine clearance using these parameters
Patient compliance in the treatment is an essential premise for effective therapy
Patient compliance is crucial for effective therapy, as it ensures proper medication use and adherence to the treatment plan
The risk of developing drug-related orthostatic hypotension, hypothermia or impaired homoeostatic control is comparable in adults and elderly patients
b.false
Elderly patients are more prone to orthostatic hypotension, hypothermia, and impaired homeostatic control due to physiological changes with age.
In “non-cumulative” dosing regimens loading doses of drugs are initially prescribed, after which therapy is continued with maintenance doses
In non-cumulative dosing regimens, loading doses are given to achieve therapeutic levels quickly, followed by maintenance doses
And impaired renal function such as interstitial nephritis can be caused by:
a. Cephalosporins
b. fosfomycin
c. macrolides
d. amphenicols
Cephalosporins can cause impaired renal function, such as interstitial nephritis
Which of the following antibiotics should not be given to children under age of eight due to the risk of drug position in the bones and teeth?
a. Azithromycin
b. Doxycycline
d. Quinupristin/ dalfopristin
Tetracyclines, including doxycycline, are contraindicated in children under 8 due to deposition in bones and teeth
Aspirin is contraindicated in children with viral infections due to an increased risk of:
a. asthma attack
b. thrombocytopenia
c. Fanconi syndrome
d. Reye’s syndrome
Aspirin use in children with viral infections increases the risk of Reye’s syndrome, a rare but serious condition
Orthostatic hypotension, tachycardia, vertigo and sexual dysfunction are typical side of:
a. cholinolytics
b. beta-blockers
c. alpha blockers
d. cholinomimetics
e. benzodiazepines
Orthostatic hypotension, tachycardia, vertigo, and sexual dysfunction are common side effects of alpha blockers
Which one of the following statements about the accumulation of drugs in the body is incorrect?
a. accumulation of drugs occurs with repeated administration
b. accumulation is not a natural property of drugs but a function of their half-life and the
c. applied dosing interval accumulation is lower when the dosing interval is shorter than the elimination half-life of a drug
d. accumulation is higher when the dosing interval is shorter than the elimination half-life of the drug
Chrono pharmacology studies the variations in the action and effects of drugs over biological timing, endogenous physiological rhythms and disease periodicities in the body
Chronopharmacology studies the effects of biological rhythms on drug actions and effects
Necrotic processes causing loss of liver parenchyma, significantly reduce the liver extraction ratio (E)
Necrotic liver processes reduce functional liver parenchyma, significantly decreasing the liver extraction ratio
The constellation of adverse effects associated with NSAIDs does not include the following
a. rashes
b. sedation and sleepiness
c. gastric irritation
d. fluid retention
NSAIDs are not associated with sedation and sleepiness; the other options are common adverse effects
The prokinetic effect due to interaction with motilin receptors and gastrointestinal discomfort are the most common side effects of:
a. glycopeptides
b. macrolides
c. aminoglycosides
d. quinolones
Macrolides cause a prokinetic effect through motilin receptor interaction and gastrointestinal discomfort
Rational pharmacotherapy requires that patients receive drugs appropriate to their clinical needs in doses that meet their requirements, for an adequate period and at the lowest cost
Rational pharmacotherapy ensures effective, safe, and cost-efficient drug use tailored to patient needs
The statement, “Statins are recommended in all patients with chronic coronary syndrome” has a level of evidence A and class of recommendation I for event prevention
Statins are strongly recommended in all patients with chronic coronary syndrome for event prevention
Can verapamil be both an alternative and an adjunct to metoprolol in the treatment of stable angina
she said this in her class: contraind. beta-blocker combined with verampil
Partitioning into fat can make the apparent volume of distribution larger in obese people
Pharmacoeconomics is:
a. A sub-discipline of health economics
b. evaluating the costs and effects of competing treatment alternatives
c. helping the optimal healthcare resource allocation in order to achieve maximization of therapeutic benefit
d. all answers are true
Pharmacoeconomics involves evaluating costs, effects, and resource allocation to maximize therapeutic outcomes
Which of the following drugs is contraindicated during pregnancy?
a. paracetamol
b. Famotidine
c. Ibuprofen
d. Misoprostol
Misoprostol is contraindicated during pregnancy as it can cause uterine contractions, leading to miscarriage or preterm labor.
(definitely CI)
Ibuprofen is contraindicated in the third trimester and should be avoided throughout pregnancy if possible, but it's not as universally contraindicated as misoprostol.
Which of the following drugs does not cause erectile dysfunction?
a. Propranolol
b. Nebivilol
c. Doxazosin
Nebivolol is a beta-blocker that has a lower incidence of erectile dysfunction compared to other beta-blockers like propranolol.
Diuretics are recommended to reduce the signs and symptoms of congestion in patients with CHF with reduced ejection fraction but there is no evidence for their effects on mortality and morbidity from clinical trials
Diuretics are useful for symptom relief in heart failure with reduced ejection fraction but don't significantly impact long-term mortality or morbidity.
Giving information, instructions and warnings about prescribed drugs is:
a. the primary responsibility of the pharmacist
b. the primary responsibility of the physician
c. the primary responsibility of the nurse
a. the primary responsibility of the pharmacist (in datei B)
In patients with low creatinine clearance ClCr or reduced GFR, the dose regimen of drugs with renal excretion should be adjusted either by reducing the dose or by increasing the dose interval or both
In patients with renal insufficiency, doses of renally-excreted drugs need to be adjusted to prevent toxicity
The number 0.693 (ln2) is a constant value obtained from the natural logarithm of the ratio of plasma concentrations (Cp) of the drug at the beginning and end of the half -life (t1/2) which by definition is 2 (100% divided by 50%)
chatgpt:
False (The number 0.693 is indeed the natural logarithm of 2, but it relates to the calculation of half-life. The half-life definition is not based on a ratio of plasma concentrations, but rather on the time it takes for the concentration to reduce by half.)
In patients with renal insufficiency although the synthesis of 1, 25 dihydroxyergocalciferol is impaired (an active form of vitamin D) no replacement therapy is required
In renal insufficiency, the synthesis of active vitamin D (1,25-dihydroxyergocalciferol) is impaired, and replacement therapy may be required
Whydoestheeffectoforalanticoagulantssignificantlyenhanceinpatientswithhepatic impairment?
a) Due to increased synthesis of coagulation factors
b) Due to reduced synthesis of coagulation factors
c) Due to increased oral bioavailability
d) Due to decreased half-life
In hepatic impairment, the liver's ability to synthesize coagulation factors is reduced, which can enhance the effects of oral anticoagulants
A one-month old baby has developed “grey baby syndrome’ . Which of the following antibiotics did the baby probably receive?
a) Linezolid
b) Chloramphenicol
c) Tobramycin
d) Erythromycin
Which of the following side effects are type C (chronic)?
a) Dose-dependent pharmacological effects, common, and predictable
b) Unexpected failure of therapy, usually due to drug interactions
c) Dose-independent, less common, not based on drug’s action, unpredictable
d) Dose- and time-dependent reactions due to dose accumulation or with prolonged use
e) Time-related reactions, ‘delayed’ reactions that become apparent sometime after the use of a drug
f) The undesired effects of ceasing the drugs (withdrawal reactions)
Type C adverse reactions are chronic, often related to dose accumulation or prolonged use of the drug
Which of the following statements about the treatment of cancer pain is true?
a) Dosing of the drug according to the patient’s complaints
b) Slow-release oral dosage forms, if possible
c) Application of analgesics “on-demand” and not at fixed intervals
d) Breakthrough pain on the background of basic analgesic therapy does not require therapy
In cancer pain management, long-acting analgesics like slow-release formulations are often used to provide consistent pain relief and avoid fluctuations in pain levels.
Cost-benefitanalysisis:
a) Type of economic analysis where competing interventions outcomes are identical and where decisions are based on costs comparison only
b) Type of economic analysis where outcomes of the competing alternatives could differ in level and are measured in identical physiological and clinical units while costs are measured in monetary units
c) Type of economic analysis where competing interventions differ in outcomes both in terms of quantity and quality of life
d) Type of economic analysis where both costs and outcomes of the alternative interventions compared are measured in monetary units
(in datei D)
Cost-benefit analysis compares the costs and benefits of competing interventions, including both the quantity and quality of life outcomes.
The 24 h rhythms in drug efficacy and toxicity are regulated by the circadian clock as the core source of rhythms
a) True
b) Untruth
Circadian rhythms regulate the efficacy and toxicity of drugs, meaning that the body's response to medications can vary depending on the time of day
No change in the starting dose (or loading dose) is required in patients with chronic kidney disease, as the volume of distribution in healthy patients and patients with renal impairment is almost the same
b) Untruth (in datei A)
In patients with chronic kidney disease, the volume of distribution can be altered due to changes in body composition and kidney function, so adjustments in dose or dosing interval may be required for certain drugs
Which of the following approaches help to ensure patient compliance in the therapy ?
a) Multiple-dose regimen
b) A large number of medicinal products
c) Lack of information from the doctor about the need for treatment
d) Single daily dose
A single daily dose is more convenient and can improve patient compliance, especially in chronic therapies.
During pregnancy, due to fluid retention and increased extracellular volume, it is necessary to increase the doses of:
a) Digoxin
b) Propranolol
c) Amoxicillin
d) Caffeine
e) Gentamicin
During pregnancy, due to increased extracellular volume and fluid retention, the doses of drugs like amoxicillin may need to be adjusted to account for these changes in pharmacokinetics
With long-term use of opioids develops a tolerance to:
a) Miosis
b) Constipation
c) Depression of the respiratory center
b) Constipation (in datei C)
With long-term opioid use, tolerance develops to most of the effects except constipation, which typically worsens over time
Depression of the respiratory center (c): Tolerance does not develop to respiratory depression, which is one of the most dangerous side effects of opioids. It remains a serious concern, especially with higher doses.
For most drugs, the systemic clearance remains constant even when the elimination pathways in a patient are altered by renal or hepatic dysfunction
Systemic clearance is often altered in patients with renal or hepatic dysfunction, so adjustments in dosing or dosing intervals are necessary to maintain appropriate drug levels
In myocardial ischaemia with tachycardia that has not responded sufficiently to treatment with a beta-blocker at the target dose (heart rate above 70 beats/mine), it is appropriate to add:
a) Verapamil
b) Molsidomine
c) Ivabradine
Ivabradine is used to lower heart rate in patients with myocardial ischemia and tachycardia, particularly if beta-blockers are not sufficiently controlling the heart rate
Which combination of antihypertensive drugs would you not use?
a) Verapamil and hydrochlorothiazide
b) Irbesartan and hydrochlorothiazide
c) Propranolol and verapamil
This combination should be avoided because both drugs can slow the heart rate and negatively affect cardiac conduction, increasing the risk of severe bradycardia or heart block
-> as she said Contraindication of use beta-blocker with verampil
Sulfation is well developed, but glucuronidation is immature in newborns. Paracetamol is indicated in infants over 3 months of age because:
a) Glucuronidation is impaired in infants, but this is partially compensated by the sulphation pathway
b) It is not glucuronidated
c) It is not metabolised by sulphation
d) It is not metabolised in the liver
In newborns, the glucuronidation pathway is immature, but sulfation is well developed, allowing for the metabolism of drugs like paracetamol
Drugs with renal clearance 50% (low renal excretion) are relatively safer even in anuria in patients with chronic kidney disease. select one
b. False (in datei A)
Drugs with low renal clearance (50%) are not necessarily safer in patients with anuria or chronic kidney disease. In fact, low renal clearance drugs may accumulate in such patients, requiring careful dose adjustments
Adequate communication skill with patients is essential to involve patients in treatment and increase the effectiveness and safety of the prescribed drugs
Effective communication with patients is essential for improving treatment outcomes and ensuring patient safety
The following adverse effect of corticosteroids is due to their mineralocorticoid action:
Select one:
A. Moon face.
B. Osteoporosis.
C. Increased susceptibility to infection.
D. Rise in blood pressure.
The mineralocorticoid effect of corticosteroids can cause fluid retention, leading to increased blood pressure
Aspirin is contraindicated in pregnant women around the delivery because:
A. The birth process can be delayed and prolonged.
B. Increase blood loss during childbirth.
C. Closure of the ductus arteriosus of the fetus prematurely.
D. All of the above are correct answers.
Aspirin is contraindicated in pregnant women around delivery due to risks such as delayed birth, increased blood loss, and premature closure of the ductus arteriosus
Relative bioavailability refers to the ratio between the area under the plasma concentration-time curve (AUC) of two medicinal products containing the same active substance but administered in a route other than intravascular (e.g., oral, subcutaneous, inhaled, rectal).
Relative bioavailability compares the AUC of two different formulations or routes of administration of the same active ingredient, excluding intravenous administration
Which of the following is contraindicated in liver damage:
A. Chloramphenicol
B. Rifampicin
C. Metronidazole
D. Tetracyclines
Chloramphenicol, rifampicin, metronidazole, and tetracyclines are all contraindicated in patients with liver damage due to their potential hepatotoxicity
There is no evidence favouring the initiation of treatment with a beta -blocker before an ACE- inhibitor has been started.
tbh answer is 50/50
in datei its a.true but chatgpt says its b. false -> There is evidence suggesting that in certain conditions, beta-blockers may be initiated before ACE inhibitors, but the timing depends on the specific clinical scenario.
For hypertension, beta-blockers are not always the first-line treatment, unless there are specific indications like ischemic heart disease, heart failure, or arrhythmias. The first-line agents for managing high blood pressure are typically:
ACE inhibitors (or Angiotensin II receptor blockers, ARBs)
Calcium channel blockers
Diuretics
Drug A has 100% oral bioavailability. If you administered the same dose of drug A as an oral solution rather than a tablet what do you expect would happen to the AUC and Cmax?
A. AUC is unchanged and Cmax goes up.
B. AUC goes up and Cmax is unchanged.
C. AUC is unchanged and Cmax goes down.
If the drug has 100% bioavailability, the AUC (area under the curve) would remain the same, but because the oral solution is absorbed more rapidly than a tablet, the peak plasma concentration (Cmax) will likely increase.
Which of the following drugs do not have renal excretion and/or nephrotoxicity, and no dose adjustment requires in patients with chronic kidney disease:
A. ACE inhibitors and angiotensin receptor blockers.
B. Digoxin.
C. Vancomycin.
D. Macrolides.
E. NSAIDs.
F. Fluoroquinolones.
For drugs with zero order kinetics, a constant amount (mass) of the drug is eliminated per unit time, regardless of the dose.
Zero-order kinetics means that the elimination rate of the drug is constant and does not depend on the concentration (dose), so the same amount of drug is eliminated per time interval, regardless of the dose.
Drugs with a high extraction ration (non-restrictive hepatic elimination) are all listed EXCEPT:
A. Lidocaine.
B. Diazepam.
C. Nitroglycerin.
D. Morphin.
E. Propranolol.
F. Verapamil.
Diazepam has a low hepatic extraction ratio (it's highly protein-bound and metabolized primarily by the liver), whereas drugs like lidocaine, propranolol, and nitroglycerin have high extraction ratios.
Cardiac glycosides improve the survival of patients with CHF with reduced ejection fraction, quality of life, and reduce hospitalizations.
b. False (in datei a.true)
While cardiac glycosides (e.g., digoxin) can help symptomatically manage heart failure by improving heart rate control and reducing symptoms of fluid overload, they do not significantly improve survival or reduce mortality in patients with chronic heart failure (CHF) and reduced ejection fraction (HFrEF).
ACE inhibitor plus angiotensin receptor blocker is a suitable combination for the treatment of hypertension.
Combining ACE inhibitors and ARBs is generally not recommended due to an increased risk of adverse effects such as hyperkalemia, hypotension, and renal impairment, without providing additional cardiovascular benefits.
Nimesulide:
A. Is a relatively selective COX-2 inhibitor.
B. The maximum duration of one course of treatment is 15 days. C. Have to avoid concomitant use with other potentially hepatotoxic substances.
D. Indicated for the treatment of acute pain, for the treatment of symptoms of painful osteoarthritis and menstrual pain.
E. All of the above is true.
Nimesulide is a relatively selective COX-2 inhibitor.
The maximum duration for one treatment course is typically 15 days to reduce the risk of hepatotoxicity.
It is contraindicated with other hepatotoxic substances.
It is indicated for acute pain, painful osteoarthritis symptoms, and menstrual pain.
Phase IV of the clinical trial of the drugs is:
A. An extended clinical trial on a large group of patients.
B. Post-marketing surveillance (monitoring of efficacy and safety after authorization of the drug product).
C. The first administration of the biologically active substance to patients.
D. The first administration of the biologically active substance to healthy volunteers.
Phase IV occurs after the drug is approved and marketed to monitor its long-term safety and efficacy in the general population.
Which of the following drugs is not nephrotoxic?
A. Vancomycin.
B. Enalapril.
C. Ibuprofen.
D. Methicillin.
E. Ampicillin.
F. Celecoxib.
In the treatment of osteoporosis, the surrogate markers are changes in bone mineral density and bone turnover markers, and the endpoint is the absence of bone fractures.
Surrogate markers like bone mineral density (BMD) and bone turnover markers are commonly used to monitor osteoporosis treatment, but the ultimate clinical endpoint is the reduction in bone fractures, which reflects improved bone strength.
There is a higher risk of rhabdomyolysis when combining fluoroquinolones with:
A. Statins
B. Benzodiazepines
C. Coumarin anticoagulants
D. Diuretics
Both fluoroquinolones and statins increase the risk of muscle toxicity, including rhabdomyolysis, when used together.
Gabapentin absorption is significantly higher in the light phase than in the dark phase of the diurnal pattern.
Gabapentin absorption is generally not influenced by the time of day, so there’s no significant difference in absorption between the light and dark phases.
Beta-blockers with intrinsic sympathomimetic activity (partial agonist) cause less resting bradycardia but may be less effective than full-dose antagonists in reducing heart rate during exercise.
Beta-blockers with intrinsic sympathomimetic activity (ISA) cause less resting bradycardia because they partially activate beta-receptors, but they are less effective at reducing heart rate during exercise compared to full beta-blockers (which block the receptors completely).
You initiate a patient on oral ibuprofen (400 mg bid) to treat a case of painful rheumatoid arthritis. Ibuprofen has an elimination half-life of 2 hours. How long will it take for the ibuprofen plasma level to reach 90% of its eventual steady state, assuming a one-compartment model?
A. 4 h
B. 8 h
C. 16 h
D. 2 h
It typically takes about 4-5 half-lives to reach 90% of the steady state. For ibuprofen with a half-life of 2 hours, it would take approximately 8-10 hours to reach 90% steady state.
Mild opioids such as hydrocodone and oxycodone can’t be combined with paracetamol or an NSAIDs.
Mild opioids like hydrocodone and oxycodone are commonly combined with paracetamol (acetaminophen) or NSAIDsto enhance analgesic effects.
Which of the following drugs is not contraindicated in pregnancy?
A. Ciprofloxacin.
B. Gliclazide.
C. Enalapril.
D. Methyldopa.
Which is the best description of a cross-over trial of a potential drug in phase III?
A. Cross-testing does not require randomization.
B. Participants receive each treatment (two or more drugs) in random order.
C. The second treatment period begins immediately after the end of the first treatment period.
D. People with the most severe illness are assigned to take the active drug first.
When both the researchers and participants know which drug (or other intervention) is given to participants, the clinical trial is:
A. An open study.
B. A single-blind study.
C. A double-blind study.
D. A placebo-controlled study.
Bacterial sinusitis with Haemophilus influenza etiology can be treated with:
A. Gentamicin
B. Amikacin
C. Co-amoxiclav
D. Metronidazole
Phase III of the clinical trial of the drugs is:
B. The first administration of the biologically active substance to patients.
C. The first administration of the biologically active substance to healthy volunteers.
D. Post-marketing surveillance (monitoring of efficacy and safety after authorizatio n of the medicinal product).
The renal toxicity of cisplatin is significantly reduced by evening administration.
Presystemic metabolism of drugs during their first pass through the liver does not influence the bioavailability of orally administered drugs.
Prescribing and use of generic drugs are examples of cost-minimization therapy.
One of the following drugs is a prodrug requiring metabolic activation by the cytochrome P450 2C19 isoenzyme (CYP2C19), which polymorphism CYP2C19*2 results in complete loss of enzyme function and no effect in homozygous carriers of the variant:
A. Morphine.
B. Clopidogrel.
C. Azithromycin.
D. Dabigatran.
First-line treatment of chronic coronary syndrome (IHD) is indicated with beta-blockers and/or CCBs to control heart rate and symptoms.
The ACE inhibitors and ARBs demonstrate significant reduction in asleep systolic/diastolic blood pressure with evening dosing.
Drug-induced induction or inhibition of cytochrome P450 enzymes most often occurs during the first days of drug administration and lasts up to 2-3 weeks after drug discontinuation.
Cost-effectiveness analysis is:
A. Type of economic analysis where competing interventions outcomes are identical and where decisions are based on costs comparison only.
B. Type of economic analysis where competing alternatives outcomes could differ in level and are measured in identical physiological and clinical units while costs are measured in monetary units.
C. Type of economic analysis where competing interventions differ in outcomes both in terms of quantity and quality of life.
D. Type of economic analysis where both costs and outcomes of the alternative interventions compared are measured in monetary units
Which of the following drugs is not usually subject to therapeutic drug monitoring?
a. Digoxin.
b. Phenytoin.
c. Theophylline.
d. Amoxicillin.
e. Gentamycin.
f. Lithium.
Changes in dose regimens in patients with chronic kidney disease can be determined through the use of formulas and nomograms, and in the case of drugs with a small therapeutic range or non-linear pharmacokinetics, through therapeutic drug monitoring.
The hypokalaemia produced by which drug increases toxicity of digoxin?
a. Hydrochlorothiazide.
b. Enalapril.
c. Valsartan.
d. Spironolactone.
What change in treatment regimen would reduce the risk of developing tolerance to isosorbide mononitrate?
a. Switching to its longer-acting precursor, isosorbide dinitrate.
b. Switching to a permanently applied transdermal patch with nitroglycerin.
c. Provide a period of low plasma concentrations of isosorbide mononitrate every day.
d. Administration of isosorbide mononitrate together with an β-adrenoceptor antagonist.
All of the listed drugs have low hepatic extraction ratio (E<0.3), EXCEPT:
a. Diazepam.
b. Theophylline.
c. Nitroglycerine.
d. Warfarin.
The hepatotoxicity of paracetamol oxidation product (NADQI) occurs due to:
a. Accumulation of sulfate products.
b. Accumulation of acetylation products.
c. Accumulation of glucuronidation products.
d. Depletion of glutathione.
What type of adverse reaction is bradycardia caused by beta-blockers?
a. Type A (augemented).
b. Type B (bizarre).
c. Type C (chronic).
d. Type D (delayed).
e. Type E (end-of-use).
f. Type F (failure).
A 24-year-old pregnant woman has been diagnosed with community-acquired pneumonia and will be treated on an outpatient basis. Which antibiotic is a suitable and safe option for this patient?
c. Nitrofurantoin
d. Gentamycin
Which of the following statements about the higher frequency of some drug effects in women compared to men is incorrect?
a. Higher incidence of drug-induced polymorphic ventricular tachycardia.
b. Higher sensitivity to alcohol and drugs acting on the CNS.
c. Higher incidence of drug-induced sexual dysfunction.
d. Higher risk of electrolyte imbalance with diuretics.
In recent years, the concern about COX-2 selective NSAIDs and, to a lesser extent, nonselective NSAIDs has centered on their cardiovascular adverse effects (i.e., stroke, myocardial infarction, and thrombus formation).
Which of the following statements about the use of medicines in the elderly is not correct?
a. Drugs acting on the central nervous system can provoke more pronounced than expected or qualitatively different or paradoxical effects.
b. Hypnotic drugs are associated with higher risk of respiratory depression with unpredictable prognosis.
c. Drug-induced electrolyte disturbances are uncommon and better tolerated.
d. Intensive antihypertensive treatment is associated with higher risk of severe hypertension, cardiovascular disturbance, falls and fractures.
Which of the following diuretics is useful in patients with renal insufficiency?
a. Hydrochlorothiazide
b. Chlorthalidone
c. Furosemide.
d. Acetazolamide
Drugs that act through active metabolites and drugs with irreversible action are not suitable for pharmacokinetic drug monitoring.
Medicinal products are commonly considered bioequivalent when the ratio of at least two of their main pharmacokinetic parameters (AUC and Cmax) are within a predetermined range (90% confidence interval 0.8-1.2) and do not differ by more than 20%.
For drugs with first-order kinetics, a constant fraction (%) of the drug is eliminated per unit time, the rate of elimination being proportional to the dose.
The loading dose can be predicted if the target concentration and the dru g apparent volume of distribution are known.
Costs referred to specific disease or medical intervention (consumables, drugs, equipment, personnel wages and salaries etc.) are:
a. Direct costs.
b. Indirect costs
c. Intangible costs
Which drug is not suitable for the treatment of Prinzmetal (vasospastic) angina?
a. Verapamil.
b. Isosorbide dinitrate.
c. Bisoprolol
d. Amlodipine.
What type of adverse effect is withdrawal syndrome?
a. Type A (augemented)
Losartan plus hydrochlorothiazide is a suitable combination for the treatment of hypertension.
Is it true that drugs of the first choice in the treatment of hypertension are ACE inhibitors, angiotensin receptor blockers, diuretics, calcium channel blockers, and vasodilators?
Which of the following does not apply to therapeutic drug monitoring?
a. To determine therapeutic failures – non compliance, subtherapeutic dose.
b. To choose an alternative therapy.
c. To adjust the dose and achieve the target drug concentration.
d. To diagnose poisoning, drug toxicity, and abuse.
e. To achieve optimal efficacy and avoid adverse reactions and toxicity.
The apparent volume distribution (Vd) is a hypothetical landmark for the amount of drug distributed outside the blood plasma and its values may vary significantly depending on the physiochemical properties of the drug and their binding to plasma and tissue proteins.
Medicines to relieve acute symptoms of bronchial asthma are:
a. Inhaled corticosteroids
b. Leukotriene receptor antagonists
c. Inhaled short-acting beta-2 agonists
d. Long-acting beta-2 agonists in combination with inhaled corticosteroids
e. Controlled-release theophylline formulations
The hepatic clearance of drugs with a higher degree of extraction during their first pass through the liver depends primarily on changes in the internal liver clearance and the degree of binding to plasma proteins.
The therapeutic plasma concentration range is:
a. Range between minimum effective and minimum toxic concentration.
b. The range between max.imum effection and minimum toxic concentration.
c. The range between minimum effective and maximum toxic concentration.
d. No correct answer is given.
During pregnancy, body fat increases on average by 4kg and can serve as a reservoir for lipid-soluble drugs.
Following repeated administration of drugs (multiple dosing), plasma concentrations at steady-state (Css) are always reached after 4-5 elimination half-lives (4-5 t1/2) of the respective drugs.
One of the following drugs is a prodrug that requires metabolic activation by the cytochrome P450 2D6 isoenzyme (CYP2D6), which genetic variants may lead to loss of enzyme function and no effect in some patients:
A. Codeine.
B. Ciprofloxacin.
D. Omeprazole.
Circadian changes in gastric pH, gastric emptying time, gastrointestinal mobility and blood flow may contribute to the time-dependent drug absorption.
A nonsteroidal anti-inflammatory drug in the treatment of arthritis with minimal gastrointestinal adverse effects is:
A. Aspirin.
B. Indomethacin.
C. Piroxicam.
D. Celecoxib.
E. Ibuprofen.
Which of the following effects is not an adverse reaction of the dihydropyridine calcium antagonist nifedipine?
A. Swelling of the ankles.
B. Redness.
C. Orthostatic hypotension.
D. Tachycardia.
A patient with a history of myocardial infarction has pain in the right thigh and discomfort when walking, dating from 6 months. Radiography shows osteoarthritis. Which is the most appropriate drug for pain relief?
A. Oxycodone.
B. Celecoxib.
C. Paracetamol.
D. Diclofenac.
Clonidine is a drug of choice for initial therapy of hypertension. Select one:
Which of the following is not related to clinical pharmacology?
A. Rational choice of drug therapy.
B. Chronic toxicity of the potential drug and testing for allergenicity, teratogenicity, mutagenicity, and carcinogenicity.
C. Optimization of drug therapy (individualization, economic aspects, drug safety).
D. Clinical trials of drugs.
In which disease is the placebo indicated in clinical trials?
A. Diabetes mellitus.
B. Neoplasms.
C. Peptic ulcer disease.
D. Infections.
E. Severe psychosis.
A patient with Zollinger-Ellison syndrome has been receiving high doses of cimetidine for 7 weeks. A frequent adverse effect of cimetidine is:
A. Hypertension.
B. Agranulocytosis.
C. Systemic lupus erythematosus.
D. Inhibition of hepatic metabolism of other drugs.
E. Antiestrogenic effects.
Which drug is not recommended in hypertension and accompanied by heart failure?
A. Bisoprolol.
B. Ramipril.
C. Valsartan.
D. Verapamil.
E. Hydrochlorothiazide.
Not recommended in patients with hypertension and heart failure because it can decrease myocardial contractility. This can worsen heart failure symptoms in patients with reduced ejection fraction.
Nonsteroidal antiinflammatory drugs can’t be useful for the treatment of acute pain associated with a prostaglandin-mediated activity, such as dysmenorrhea or osteoarthritis.
In the process of P-Drug selection, the criterion suitability includes:
A. Adverse drug reactions.
B. Contraindications and suitable dosage forms.
C. Adverse drug reactions and suitable dosage forms.
D. All are correct answers.
A patient with heart failure treated with ramipril, bisoprolol, and torasemide has atrial fibrillation with a rapid ventricular rate. Which drug may be useful to slow a rapid ventricular rate?
A. Diltiazem.
C. Spironolactone.
Select the correct statement about the inhaled anticholinergic drugs:
A. They are not used for relief of acute asthma attack
B. These are nicotine receptor blockers
C. They are used as alternative bronchodilators in patients with tachycardia and tremor
D. They are recommended for children asthma
The total area under the plasma concentration-time curve (AUC) allows assessing the extent to which the administered drug has reached the systemic circulation unchanged.
When the participants in the clinical trial do not know if they are receiving the placebo or the real treatment, the clinical trial is:
In a single-blind study, the participants do not know whether they are receiving the placebo or the real treatment, but the researchers do. This helps reduce bias in the participants' behavior or reporting.
The highest concentrations in the bronchial epithelium and alveolar macrophages can be achieved with:
A. Clarithromycin
B. Azithromycin
C. Midecamycin
D. Erythromycin
In patients with bilateral renal artery stenosis (fibromuscular tissue in young women or atheromatic disease in the elderly), GFR depends on angiotensin II-mediated vasoconstriction of efferent arterioles. The listed drugs are contraindicated in these individuals with the exception of:
A. ACE inhibitors.
B. Dihydropyridine derivatives.
C. Angitisen-receptor blockers.
Absolute bioavailability is the ratio of the area under the plasma concentration-time curve (AUC) of two medicinal products containing the same active drug, one administered extravascularly and the other intravenously.
Which of the following beta-lactams undergoes enterohepatic cycle, is partly eliminated with the faeces and may provoke maculopapular rash in patients with viral infection?
A. Carbenicillin
B. Ceftriaxone
C. Cefalexin
D. Ampicillin
Sedative-hypnotic drugs are well tolerated and indicated for routine treatment of elderly patients.
Fluoroquinolones are not antibacterial drugs of choice in the treatment of uncomplicated cystitis due to the unfavorable benefit/risk balance.
Gastrointestinal discomfort, liver damage, dizziness, deposition in bones and teeth, photosensitivity, damage to the fetus are side effects of:
A. Tetracyclines.
B. Benzodiazepines.
C. Aminoglycosides
D. Fluoroquinolones.
E. Cholinolytics.
Drugs with a low extraction ration (<0.3) are metabolized in less than 30% on their first passage through the liver and their metabolism is determined mainly by internal hepatic clearance and the degree of plasma protein binding.
Which of the following fluoroquinolones does not need dose reduction in patients with renal dysfunction?
A. Ofloxacin
B. Levofloxacin
C. Moxifloxacin
D. Ciprofloxacin
Simplified drug treatment algorithms with the preferred use of an ACE inhibitor or ARB, combined with a calcium channel blockers calcium channel blocker and/or a thiazide diuretic, as the core treatment strategy for most patients are recommended.
Chronotoxicity and chronoefficacy of drugs depend on a number of potential factors such as the rhythms in molecular targets, disease severity and circadian pharmacokinetics (including enzymes and transporters).
In patients with impaired hepatic function, the half-life of drugs with a low degree of extraction is extended (diazepam, lorazepam, barbiturates, theophylline, clindamycin and others). In such patients, these drugs should be administered with a prolonged dosing interval while maintaining a single dose.
Asymptomatic bacteriuria:
a. Is treated with aminoglycosides
b. Is not treated, except of in pregnant women and some patients with upcoming urological surgery
c. Is treated with nitrofurans
d. Is treated with fluoroquinolones
Costs that are difficult to measure and value, such as the value of pain, fear, suffering and discomfort associated with treatment are:
a. Direct costs
The effect of macrolide antibiotics on the activity of CYP3A4 is:
a. Inducers of CYP3A4
b. Inhibitors of CYP3A4
c. Do not affect the activity of CYP3A4
Is the following about cyclosporine correct: the patient’s non-compliance in the treatment can lead to rejection of the transplanted organ and high concentrations to worsening renal function?
All of the following drugs can readily cross the placenta, EXCEPT:
a. Insulin
b. Dexamethasone
c. Morphine
d. Warfarin
Fentanyl is:
a. A stronger analgesic than morphine
b. A morphine derivative with a long plasma half-life
c. Suitable for transient exacerbation of pain on the background of basic analgesic therapy
d. Not administered transdermally, buccally, nasally
In case of damage to the proximal tubules by nephrotoxic drugs (cephalosporins, aminoglycosides and radiographic contrast agents) there is a loss of glucose, phosphates, bicarbonates and amino acids in the urine
Long-term control of mild persistent asthma is carried out with one of the following:
a. Oral shorting-acting beta-2 agonists
b. Long-acting beta-2 agonists in combination with inhaled corticosteroilds
d. Low doses of inhaled corticosteroids
e. Long-acting theophylline
Drug of choice for the treatment of hypertension in pregnant women:
a. Thiazide diuretic
b. Alpha-methyldopa
c. Angiotensin receptor blockers
d. ACE inhibitor
All following are adverse drug reactions of aspirin EXCEPT:
a. Increased risk of encephalopathy in children with viral infections
b. Increased risk of peptic ulcers
c. Hyperprothrombinemia
d. Metabolic acidosis with respiratory alkalosis
e. Renal dysfunction
Select the incorrect statement about the process of drug elimination in childhood:
a. In young children, the liver and kidney capacity to eliminate some drugs may even exceed that of adults
b. The more premature the newborn, the lower the capacity of the liver and kidneys to eliminate drugs from the body
c. Liver and kidney functions to eliminate drugs are completely developed during the first week of the newborn's life
d. The major route of paracetamol metabolism in neonates and children under 12 is via sulphate conjugation while in adults predominating is glucuronidation
One of the following polymorphic genes may carry genetic variants which are subjects to pharmacogenetic testing for an increased risk of developing Stevens-Johnson syndrome and / or toxic epidermolysis during treatment with carbamezepine:
a. CYP2C19
b. ADH2
c. CYP3A4
d. HLA-B
The usual treatment for acute uncomplicated cystitis in women lasts:
a. 5 days
b. 3 days
c. 10 days
d. 7 days
The appropriate initial therapy for isolated systolic hypertension is a calcium antagonist or ACE inhibitor
A clinical trial is any investigation in humans intended to discover or verify clinical, pharmacokinetic, and pharmacodynamic effects of a medicinal product, as well as its efficacy and safety
What type of adverse effects are allergic reactions caused by beta-lactams?
a. Type c (chronic)
b. Type E (end-of-use)
c. Type A (augmented)
d. Type D (delayed)
e. Type B (bizarre)
Administration of beta-blockers in the morning more effectively lower the mean blood pressure compared to the evening dosing.
Indicate the Vd of propranolol knowing that after a single administration at a dose of 30 mg, its steady-state plasma concentration is 10 mg/l.
a. 3l
b. 300 l
c. 3000 l
Guidelines recommend sodium intake to be limited to approximately 5.0 g per day (equivalent to approximately 2.0 g salt per day) in the general population and to try to achieve this goal in all hypertensive patients.
Which of the following statements about vancomycin is not true?
a. Its dose should be adjusted in chronic kidney disease
b. It has a narrow antibacterial spectrum
c. Slow intravenous infusion is used for treating pseudomembranous colitis provoked by clostridium difficile
d. “Red man” syndrome can develop after fast intravenous infusion of the drug.
Which drug is an alternative to enalapril in heart failure and intolerance to the ACE inhibitor (cough)?
a. Losartan
b. Metoprolol
c. Ramipril
d. Digoxin
Only 20% of routinely administered drugs are at risk in pregnancy C (PRC C).
A suitable antipyretic in infants over 3 months of age is
a. Metamizole
b. Paracetamol
d. Celecoxib
The WHO pain relief ladder recommends a nonopiod such as paracetamol or a nonsteroidal anti-inflammatory drug for the initial management of pain.
In acute pulmonary oedema, the following diuretics are used:
A. Thiazide
B. Loop diuretics
C. Potassium-sparing diuretics
D. Xanthine derivatives
Calculations of areas under the plasma concentration-time curves (AUCs) after oral administration allows a comparison of the bioavailability of different pharmaceutical formulations of the same drug.
Clearance is the volume of fluid that is completely cleared of a given drug per unit time.
Simplified drug treatment algorithms with the preferred use of a beta blocker, combined with a calcium channel blocker and/or a thiazide, as the core treatment strategy for most patients arerecommended. ACEinhibitors are usedfor specificindications
Randomization is a method by which participants in a clinical trial are divided based on set criteria into two or more therapeutic alternatives.
Two types of transporters are involved in hepatic clearance: uptake transporters, which take and transport the drug to hepatocytes, and efflux transporters, which facilitate the elimination of metabolites and unchanged drugs in the bile.
Treatment of chronic pain requires: Select one:
A. Long-acting analgesics.
B. Optimal maintenance doses.
C. Drugs with minimal adverse effects.
D. Co-administration of adjuvant drugs to affect emotional problems or adverse effects.
E. All answers are correct
Acute cystitis in pregnant women is treated with : Select one:
A. Azlocillin
B. Ciprofloxacin
C. Amoxicillin
D. Clarithromycin
Drugs with a high extraction ratio (> 0.7) are those that are metabolized below 70% on their first passage through the liver.
The bioavailability of drugs with a high extraction ratio (> 0.7) is significantly increased in patients with diseases associated with reduced hepatic blood flow (eg in liver cirrhosis). Select one:
Which of the following drugs does not cause obstructive uropathy (crystal nephropathy): Select one:
A. Sulfadiazine (sulfonamides).
B. Methotrexate.
D. Acyclovir
The optimal duration of therapy for mild to moderate community-acquired pneumonia is: Select one:
A. 3 days
B. 5-7 days
C. 14 days
D. None of the listed is correct
In patients with angina and COPD, the following drugs should be avoided: Select one:
A. Non-selective beta-blockers
B. Inhaled steroids
C. Calcium channel blockers
D. Nitrates
If a drug B has a half-life of 15 h, how long will it take for the concentration in plasma to drop from 24 ng/ml to 3 ng/ml?
A. 45 h
B. 30 h
C. 15 h
In phenytoin therapy, therapeutic monitoring is performed due to its nonlinear pharmacokinetics (0 order) and the possible effect of its distribution in kidney or liver disease or pregnancy.
Efficacy means a better therapeutic benefit than the risk by a disease itself or the harm caused by the drug. It is evaluated in clinical trials
b) False
Erythromycin should be administered:
a) With food
b) After meals
c) On an empty stomach
d) Regardless of food intake
In patients with grade 2 or 3 hypertension, it is recommended that BP-lowering drug treatment should be initiated alongside lifestyle interventions:
The rare but characteristic adverse effect of HMGCoA reductase inhibitors (statins) is:
a) Myopathy
b) Onycholysis
c) Alopecia
d) Oculomucocutaneous syndrome
"Integrating the best available objective information (evidence) with individual clinical experience to make adequate decisions about the selection of rational therapy" is a definition of:
a) Pharmacotherapy
b) Evidence-based medicine
c) Personalised medicine
d) Precision medicine
Therapeutic drug monitoring is indicated in the following except:
a) Drugs with low therapeutic index
b) Co-medication and expected serious drug interactions
c) Optimization of replacement therapy (E.g. thyroxine)
d) Large interindividual variability in plasma concentrations of the drug at the same dose (e.g. phenytoin)
e) To select a P-drug
All of the following are adverse reactions to tetracyclines, except:
a. Photosensitivity
b. Tooth enamel dysplasia and impaired bone growth in young children
c. Hepatotoxicity
d. Aplastic anaemia
Which of the following statements about the WHO three-step analgesic ladder is not true:
a. Recommendations for the management of malignant pain in adults and children.
b. Initiation of analgesia with non-opioid analgesics or NSAIDs.
c. Recommendations for postoperative acute pain management.
d. The gradual incorporation of analgesics with increasing analgesic efficacy.
Which of the following is a group of choice for hypertension combined with diabetes?
a. Beta-blockers.
b. ACE inhibitors / angiotensin receptor blockers.
c. Calcium antagonists.
d. Diuretics.
All the following statements regarding the intrinsic clearance (CLint) are true, EXCEPT:
a. Intrinsic clearance CLint represents the ability of respective organs to extract and eliminate drug from incoming blood.
b. When Clint is much greater than organ blood flow Q, extraction ratio E is close to one.
c. When Clint is much smaller than organ blood flow Q (hepatic, renal), extraction ratio E is close to zero.
d. Extraction ratio E has nothing to do with the ability of the extraction organ to eliminate the drug.
The long-term therapeutic goals of antiasthmatic therapy include:
a) Achieving optimal control over the clinical symptoms of asthma
b) Improving the "quality" of life and the prognosis for the patient
c) Reducing the risk of complications and disability
d) Reducing mortality from bronchial asthma
e) All of the above are correct answers
Salicylate excretion is more rapid (reabsorption is milder) in the daytime when urine pH is more alkaline, and is slower (reabsorption is stronger) in the nighttime when urine pH is more acid.
Among human cytochrome P450 genes, the CYP2D6, CYP2E1, and CYP3A4 have been established as potential circadian genes that need further validation.
In intoxication with barbituric acid derivatives, their excretion can be enhanced by:
a) Alkalisation of urine, eg by the administration of sodium bicarbonate.
b) Alkalization of urine (by eating meat).
c) Acidification of urine (by acetazolamide).
d) Acidification of urine (by vegetable diet).
Cost-minimization analysis:
a) Type of economic analysis where competing interventions outcomes are identical and where decisions are based on costs comparison only.
b) Type of economic analysis where competing alternatives outcomes could differ in level and are measured in identical physiological and clinical units while costs are measured in monetary units.
c) Type of economic analysis where competing interventions differ in outcomes both in terms of quantity and quality of life.
d) Type of economic analysis where both costs and outcomes of the alternative interventions compared are measured in monetary units.
Which of the following is not an antihypertensive group of the first choice?
a) Alpha 1 blockers.
b) Beta-blockers.
c) Calcium antagonists.
d) Thiazide diuretics.
e) ACE inhibitors.
Sulfonamides may precipitate in the urine at acidic pH, causing crystalluria and hematuria. To prevent nephrotoxicity:
a) Patients need to be well hydrated.
b) Vit. C should be added.
c) A diuretic should be added.
The time required to demonstrate therapeutic efficacy often differs from the time required for a pharmacoeconomic study to demonstrate cost-effectiveness.
One choice is possible:
Cumulation occurs upon repeated administration of drugs into the body, the degree of accumulation being determined by the half-life (112) and the dosing interval (t) of the drug:
Which of the following drugs is not characterized by allergy to sun exposure (photodermatitis)?
B. Sulfonamides.
C. Penicillins.
E. Amiodarone.
Which drugs are suitable for the treatment of a patient with allergic shock:
a. Methylprednisolone.
b. Adrenaline.
c. Dexamethasone.
d. All answers are correct.
To achieve effective and safe therapy through therapeutic drug monitoring are used: One choice is possible:
a. Pharmacokinetic methods.
b. Pharmacodynamic methods.
c. Pharmacogenetic methods.
d. All of the above.
Which of the following statements about Fostomycin is not true:
a. Take 3 days in a dose of 3grams (in the evening, before bedtime, after emptying the bladder).
b. It is indicated for prophylaxis in surgical or diagnostic procedures of the lower urinary tract.
c. It is indicated for the treatment of uncomplicated lower urinary tract infections.
d. It is taken once in a dose of 3 grams (in the evening, before bedtime, after emptying the bladder).
e. It has a spectrum of antibacterial activity including the most common uropathogens.
The therapeutic result manifests itself more quickly over time, while a longer period of time is usually required for the manifestation of economic efficiency.
Therapy with selective COX-2 inhibitors is more gentle on: One choice is possible:
a. Damage to the gastrointestinal tract.
b. Impaired renal function.
c. Thrombotic events.
The individual dose of a drug can be adjusted based on body surface area according to the formula D = TP (m2) / 17 x Mean E for adults.
What are the possible side effects of low-dose inhaled glucocorticoid? One choice is possible:
a. Hypertension.
b. Steoporosis.
c. Nausea, vomiting.
d. Oral candidiasis.
A child with severe asthma is treated with high-dose corticosteroids. Which side effect should be considered?
a. Hirsutism.
b. Inhibition of growth.
c. Cushing's syndrome.
d. Hypoglycaemia.
The combination of nitrates and dihydropyridine calcium antagonists in the treatment of stable angina carries a risk OF:
A. Suppression of myocardial contractility
B. Sudden hypotension
C. Bradycardia.
Taking into account the fact that the human placenta passes lipid-soluble substances, but restricts the transfer of water-soluble compounds (especially those with MT over 600), indicate which of the drugs does not cross-placentally:
A. Warfarin.
B. Insulin.
C. Ciprofloxacin.
What is a placebo?
a. Allergic reaction to drugs.
b. Dosage form which does not contain a biologically active substance.
c. Drug tolerance.
d. Dosage form that contains another biologically active substance.
Evidence-based medicine requires compliance with these steps, with the exception of:
A. Application of the information obtained in clinical practice.
B. Conducting physical diagnostics of the patient.
C. Effective search for the best available objective information to answer the question posed.
D. Evaluation of the effect of the application of the information (monitoring).
E. Critical evaluation of the information found in terms of its quality, reliability and clinical applicability.
F. Turning the need for information into a structured and specific clinical issue.
NSAIDs can worsen:
A. Heart failure.
B. Diabetes.
C. Glaucoma.
D. Osteoporosis.
Anticoagulants are added to the therapy of patients with XCH, accompanied by:
A. Dyslipidemia.
B. Ischemic heart disease.
C. Atrial fibrillation.
The ultimate goal of treatment for coronary heart disease is:
A. Increasing the physical capacity of patients.
B. Prevent major cardiovascular events and increase life expectancy.
C. Reducing the frequency and intensity of angina attacks.
Right-sided pneumonia in a 50-year-old man with a proven penicillin allergy and creatinine clearance 45 ml / min. can be treated with:
A. Gentamicin.
B. Levofloxacin.
C. Ampicillin / sulbactam.
D. Clarithromycin.
What will you add to the therapy with ACE inhibitor and beta-blocker in CH II functional class with stagnation data?
A. Digoxin.
B. Spironolactone.
C. Furosemide.
Atypical pneumonia in a 32-year-old man with mycoplasmal etiology can be treated with:
A. Pefloxacin.
B. Ceftriaxone.
C. Clarithromycin.
D. Amoxicillin.
Theophylline clearance in smokers:
A. Increases.
B. Reduces.
C. It does not change.
Which of the following side effects are not provoked by sulfonamides?
a) Exfoliative dermatitis
b) Crystalluria and haematuria
c) Fanconi syndrome
d) Kernicterus in the newborn if they are used in the third trimester of pregnancy
Which of the following methods have the highest degree of scientific evidence?
a) Systematic reviews and metaanalysis
b) Expert opinions
c) Randomised controlled clinical trials
d) Pharmacoepidemiological studies (cohort and controlled cases)
In the treatment of chronic coronary syndrome, the dose of beta-blockers should be adjusted to limit the heart rate to 55-60 beats per minute at rest.
A suitable diuretic for hypertension with advanced chronic kidney disease is:
a) Indapamide.
b) Triamterene.
c) Hydrochlorothiazide.
d) Furosemide.
Hepatoxicity and nephrotoxicity of methotrexate are dependent on circadian dosing time and are more severe at 02:00 AM than at 02:00 PM.
Intrinsic clearance (CLint) represents the capacity of respective organs (liver, kidney) to extract and eliminate drug from incoming blood, regardless of the perfusion rate.
Which of the following drugs have been thoroughly investigated for circadian rhythm based chronoefficacy and chronotoxicity?
a) Simvastatin
b) Cisplatin
c) Methotrexate
d) Paracetamol
e) All of the listed
Which drug is recommended in patients with a history of myocardial infarction and asymptomatic LV systolic dysfunction to reduce the risk of death?
a) Ramipril
b) Digoxin
c) Metoprolol
d) Spironolactone
Which of the following statements are characteristic of category I recommendations I (indicated)?
a. Evidence or agreement that the given treatment is not useful or effective and, in some cases, may be harmful
b. Conflicting evidence and/or divergence of opinion about the usefulness or efficacy of the given treatment
c. Evidence or agreement that the given treatment is beneficial, useful, effective
What type of adverse reactions are hypokalaemia and hyperglycaemia caused by thiazide diuretics?
a) Type A (augmented)
b) Type B (bizarre)
c) Type C (chronic
d) Type D (delayed)
e) Type E (end of use)
f) Type F (failure)
Which of the following statements are characteristic of category III recommendations I (not recommended)?
Surrogate markers are all given except:
a) Blood pressure as an indicator of the risk of myocardial infarction
b) The number of CD4 cells as an indicator of AIDS progression
c) Mortality from a specific disease
d) Bone density as an indicator of the risk of fractures
Sacubitril/valsartan is recommended instead of an ACEi in patients with HF who remain symptomatic despite treatment with an ACEi, beta blocker, mineralocorticoid antagonist.
Examples of clinical endpoints are:
a) Arterial blood pressure: for MI, heart failure
b) Cholesterol levels: for atherosclerotic disease
c) CD4 count or viral load: for complications of HIV
d) Blood glucose/haemoglobin A1c: for diabetic complications
e) None
Which of the following drugs is most appropriate in the complex therapy of enterococcal endocarditis in a patient with a history of anaphylactic reaction to penicillin G?
a) Ceftriaxone
b) Aztreonam
c) Vancomycin
d) Piperacillin
What type of adverse drug reaction is neuroleptic parkinsonism caused by antipsychotic drugs?
c) Type C (chronic)
The detection, assessment, understanding and prevention of adverse drug reactions are subject to:
a) Pharmacokinetics
b) Pharmacovigilance
c) Clinical pharmacology
d) All are correct
Drugs with a high extraction ratio (> 0.7) should be administered in reduced oral doses in patients with liver cirrhosis (reduced hepatic blood flow), as the administration in standard doses is associated with an increased risk of relative dose.
Community-acquired pneumonia can be treated with:
a) Ampicillin
b) Amikacin
c) Co-amoxiclav
d) Teicoplanin
e) Vancomycin
Clopidogrel is a prodrug and is metabolised to its active form mainly by CYP2C19. Co- administered with the CYP2C19 inhibitors omeprazole and esomeprazole leads to:
a) Inhibition of clopidogrel metabolism and increase of its antiplatelet activity
b) Induction of clopidogrel metabolism and reduction of its antiplatelet activity
c) Inhibition of clopidogrel metabolism and reduction of its antiplatelet activity
The major of treatment of arterial hypertension is:
a) Lowering of blood pressure
b) Reducing the overall risk of cardiovascular morbidity and mortality
c) Improving the patient’s quality of life
From 10,000 newly synthesised molecules with potential biological activity to a clinical trial reach:
a) 10 of them
b) 100 of them
c) 1 of them
d) 50 of them
The risk of hyperkalaemia increases by the following combination:
a) ACE inhibitors and potassium sparing diuretics
b) Thiazide diuretics and potassium sparing diuretics
c) Calcium antagonists and potassium sparing diuretics
An informed consent statement which the participant should sign and date is a document certifying a wish to participate in a clinical trial of drugs with expected high toxicity.
Which of the following drugs has the largest volume of distribution (l/kg)?
a) Ciprofloxacin
b) Azithromycin
c) Erythromycin
d) Gentamicin
Daily nitrate-free interval is necessary to overcome the:
a. Headache
b. Hypotension
c. Nitrate tolerance caused by long-term nitrate therapy
In Prinzmetal (vasospastic) angina with tachycardia it is appropriate to use:
a. Nitrendipine
b. Verapamil
c. Amlodipine
Considering that low lipid solubility and/or increased plasma protein binding retain drugs in plasma and reduce the apparent volume of distribution Vd, which of the following drugs is expected to have a large Vd?
a) Heparin
b) Gentamicin
c) Amiodarone
d) Warfarin
Blood pressure lowering drugs may be considered for patients with high normal BP and established cardiovascular disease, especially coronary artery disease. In these patients, monotherapy may be sufficient.
In hypertension combined with a chronic arterial occlusive disease are contraindicated:
a) Alpha blockers
b) Calcium antagonists
c) Beta blockers
d) ACE inhibitors
Pharmacoeconomic analysis is a comparison of costs and side effects of two or more treatment alternatives.
Which of the following criteria is the most important in personal drug (P-drug) selection?
a) Efficacy
b) Safety
c) Suitability
d) Cost of treatment
Which of the following models of change in drug concentrations over time describes the elimination processes with two phases – fast phase of distribution (alpha phase) and slow phase of elimination (beta phase)?
a) One-compartment model
b) Two-compartment model
c) Multi-compartment model
d) None of the listed
More than 1000 intestinal microorganisms (intestinal microbiome) coexist in the human gastrointestinal tract including anaerobic bacteria and various yeasts that can alter the bioavailability and effects of orally administered drugs.
Paracetamol can cause:
a) Dose-dependent nephrotoxicity.
b) Cholestasis.
c) Dose-dependent hepatocellular damage.
d) Dose-independent hepatocellular damage.
What is a serious adverse drug reaction? Select one:
A. Requiring a change in therapy, specific treatment, prolongation of hospitalization for at least 1 day.
B. Does not require treatment.
C. Results in death, life-threatening, requires or prolongs hospitalization, or results in persistent or significant disability or incapacity.
D. No correct answer is given.
Controllers recommended to reduce exacerbation of bronchial asthma are: Select one:
A. Inhaled corticosteroids
B. Agents modifying the action of leukotrienes
C. Long-acting beta-2 agonists
D. Sustained release theophylline formulations
E. Mast cell inhibitors
F. All answers are correct
Is it true that nitric oxide donors (nitrates) should not be combined with phosphodiesterase 5 inhibitor sildenafil (Viagra)?
Intravenous administration of drugs is a “gold standard” for complete (100%) and immediate delivery of drugs into the systemic circulation.
Clearance is measured in units of volume per unit of time (ml/min, L/h). Select one:
All of the following drugs have anti-inflammatory action except: Select one:
A. Metamizole.
Effectiveness differs from efficacy in that it takes into account how well a drug works in real therapeutic practice. Select one:
Exacerbation of gout is possible in the treatment of hypertension with: Select one:
A. Calcium antagonists.
B. Thiazide diuretics.
C. Central sympatholytics.
D. ACE inhibitors/angiotensin receptor blockers.
Which of the following statements about pseudomembranous colitis is incorrect?
A. Meropenem is administered orally for eradication of C. difficile B. It is associated with overgrowth of Clostridium difficile
C. Use of antibiotics is a risk factor for its development
D. Common treatment is the oral administration of metronidazole or vancomyc
A. Meropenem is administered orally for eradication of C. difficile
Treatment of malignant pain requires: Select one:
A. Oral analgesics, if possible.
B. Slow-release dosage forms.
C. Taking into account the presence of concomitant diseases.
D. Administration of analgesics at fixed intervals (clockwise).
E. Co-administration of adjuvant drugs according to the patient's needs.
F. All answers are correct.
The uptake and accumulation of gentamicin in the renal cortical region are lower with a single daily dose than with a three-time daily dosing regimen because the receptor- mediated uptake of aminoglycoside is saturated.
What effect is expected from mineralocorticoid antagonists (spironolactone, eplerenone) in patients with heart failure?
A. Antianginal.
B. Diuretic.
C. Antifibrotic, anti-remodeling.
Beta-blockers should be initiated in clinically stable patients with heart failure at a low dose and gradually up-titrated to the maximum tolerated evidence-based dose.
What is a nocebo effect? Select one:
A. Allergic reaction to drugs.
B. Analgesic effect.
C. Adverse reaction to placebo.
D. CNS depression.
Hepatic clearance is "the volume of blood perfusing the liver that is completely cleared of a drug substance per unit of time"
Which of the following drugs has the lowest degree of plasma protein binding? Select one:
B. Warfarin.
C. Digoxin.
D. Phenytoin.
Administration of water-soluble drugs in standard adult doses to elderly patients is associated with an increased risk of overdose due to decreased total body water and reduced apparent volume of distribution (Vd). Select one:
Adverse effects of opioids include: Select one:
A. Nausea, vomiting, constipation.
B. Sedation, pruritus.
C. Urinary retention.
D. Respiratory depression.
E. All of the listed.
Adjuvant drugs (antidepressants, glucocorticoids, anticonvulsants, etc.) can be included as needed at any step of the pain relief ladder.
Patients with heart failure can be trained to self-adjust their diuretic dose based on monitoring of:
A. Heart rate and daily weight measurements.
B. Renal function and symptoms of congestion.
C. Blood pressure and daily weight measurements.
D. Symptoms / signs of congestion and daily weight measurements
Safety data are collected only during phases II and III of clinical trials in developing a new drug. Select one:
The clinical use of chloramphenicol is limited to the treatment of meningitis, plague, cholera and typhoid fever, because of one of the following:
A. May cause serious adverse reactions such as bone marrow depression and aplastic anaemia
B. It is a narrow-spectrum antibiotic
C. It is a potent inducer of cytochrome P450 isoforms CYP2C19 and CYP3A4
D. It is with limited absorption and low tissue distribution
The listed drugs are unsuitable for antihypertensive therapy in African Americans EXCEPT: Select one:
A. Beta-blockers.
B. Calcium antagonists.
C. ACE inhibitors.
Aspirin is recommended in patients with chronic coronary syndrome in a daily dose: Select one:
A. 1000 mg.
B. 6-8 g.
C. 75-100 mg.
D. 325-500 mg.
Relative bioavailability is most often used to compare newly developed medicinal products (test) with already authorized medicinal products (reference) and is calculated by the formula F = AUC Test x D Ref / AUC Ref x D Test .
If an adverse drug reaction causes symptoms that are easily tolerated, this adverse reaction is:
A. Mild.
B. Moderate.
Which of the following antibiotics and doses are used in the treatment of chlamydial urethritis? Select one:
a. Azithromycin in a single oral dose of 1.0-1.5 g
b. Doxycycline in a single oral dose of 1.0 g-1.5 g
c. Amoxicillin in a single dose of 1.0 g - 1.5 g
d. All of the listed are correct
Which of the following combinations of anti-angina drugs is not appropriate?
A. Beta-blockers + dihydropyridine calcium channel blocker.
B. Beta-blockers + non-dihydropyridine calcium channel blocker. C. Beta-blockers + nitrates.
B. Beta-blockers + non-dihydropyridine calcium channel blocker.
Non-dihydropyridine and dihydropyridine calcium antagonists are not included in the therapy of congestive heart failure.
Which of the following statements about the paracetamol is not true?
a. N- acetylcysteine is an antidote for paracetamol intoxication b. Hepatotoxic effect of paracetamol is not dose dependent c. Hepatotoxic effect of paracetamol is dose dependent
b. Hepatotoxic effect of paracetamol is not dose dependent
Placebo reactors are:
a. Patients experienced adverse reactions from a placebo
b. Patients showing a marked response to a placebo
c. Patients who have no response to a Placebo
d. no correct answer is given
Which drug is suitable for initial monotherapy in high normal blood pressure?
A. methyldopa
B. spironolactone
C. prazosin
D. Clonidine
E. Ramipril
Which of the following side effects are type B Bizarre?
a. Undesired effect of ceasing the drugs (withdrawal reactions)
b. Dose and time dependent reactions due to dose accumulation or with prolonged use
c. dose dependent pharmacological effects, and predictable
d. time related reaction is due to prolonged use of a drug that does not tend to accumulate
e. Dose independent, less common, not based on drug’s action, unpredictable
f. unexpected failure of therapy usually due to drug interactions
Pharmacogenetics studies the genetic basis of individual variation in drug response by evaluating the influence individual genetic factors (polymorphic candidate genes) on the pharmacokinetics and/or pharmacodynamics of drugs
Community acquired pneumonia can be treated with:
a. Ampicillin
b. Amikacin
c. Co-amoxiclav
d. Teicoplanin
e. V ancomycin
The major treatment of ischemic heart disease (chronic coronary syndrome) is:
A. Increasing exercise capacity of patients
B. Reducing the incidence and intensity of angina attacks
C. Prevention of major cardiovascular events (acute infarction, chronic heart failure, sudden cardiac death) and increase duration of life
In mammals, circadian rhythms are regulated by circadian clock system which central clock (pacemaker) is located in the suprachiasmatic nuclei (SCN) of the hypothalamus
Alpha 1 selective blockers are the drugs of choice in adult patients with hypertension
Which statement regarding the once-daily dosing of aminoglycosides is correct?
A. It is inconvenient and more costly for inpatient (hospital) treatment
B. The risk of nephrotoxicity is higher than with multiple dosing
C. The risk of ototoxicity is greatly reduced
D. Dose adjustment is important in renal dysfunction
A patient with peptic ulcer and a history of myocardial infarction takes clopidogrel, simvastatin and metoprolol. Which drug should be avoided in this patient?
A. Calcium citrate.
B. Famotidine.
C. Omeprazole.
D. Ranitidine
Which of the following statements are characteristic of category II recommemdations II (shoud/may be considered)?
A. Evidence or agreement that the given treatment is not useful/effective, and in some cases may be harmful.
B. Evidence and/or general agreement that a given treatment is beneficial, useful, effective.
C. Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the given treatment.
Short-acting nitrate for acute effort angina is administered:
A. Sublingually once in a supine position every 30 min until the pain disappears.
B. Sublingually in a sitting position every 5 min until the pain disappears, or up to 3 times within 15 min.
C. As iv bolus.
Which of the following statements about drug-induced toxic effects is not properly matched?
A. Hearing impairment with amikacin and kanamycin
B. Hepatotoxicity with streptomycin
C. Vestibular dysfunction with gentamicin and tobramycin
D. Acute tubular necrosis with aminoglycosides
Which subfamily of cytochrome P450 enzymes (CYP) is responsible for most of clinically significant drug interactions resulting from variations in drug metabolism?
A. CYP1A
B. CYP2A
C. CYP3A
D. CYP4A
A 65-year-old female patient with pneumonia was given antibacterial treatment with tobramycin at a dose of 150 mg intravenously. Twenty minutes after drug injection, a plasma concentration (Cp) of 3 mg / L was measured. Assuming that the drug is not eliminated in 20 minutes, what will be its apparent volume of distribution?
A. 0.1 L / min
B. 3 L
C. 50 L
D. 7 L
Which of the following medicines are suitable for the treatment of an acute asthma attack?
A. Glucocorticosteroids, by inhalation
B. Methylxanthines, orally
C. Beta-2 adrenomimetics, by inhalation
D. Mast cell protectors, by inhalation
The cardiovascular risk associated with NSAIDs is greater with greater COX-2 selectivity (celecoxib> diclofenac> ibuprofen> naproxen).
Which of the following macrolides does not inhibit liver CYP450 isoenzymes?
A. Erythromycin
B. Roxithromycin
C. Clarithromycin
D. Azithromycin
Which of the following diuretics is not useful in the therapy of congestive heart failure?
A. Mannitol.
B. Hydrochlorothiazide.
Calculate the loading dose of lidocaine to be administered intravenously over 2 minutes to a patient with ventricular tachycardia. The Vd of the drug is 0.5 l / kg / bw, its steady-state plasma concentration is 2 mg / l and patient body weight is 70 kg.
A. 70 mg
B. 300 mg
C. 1000 mg
Both ACE inhibitors and ARBs reduce albuminuria more than other BP-lowering drugs and are effective at delaying the progression of diabetic and non-diabetic chronic kidney diseases.
Chronic alcohol abuse induces drug metabolism and can decrease the action of many routinely used drugs.
In the process of rational choice of drugs, the therapeutic goal can be:
A. Healing.
B. Symptomatic treatment.
C. Replacement therapy
D. Prevention.
E. A combination of the listed objectives.
F. All are correct answers.
Induction of CYP2E1 (in chronic alcohol use and rifampicin) increases the risk of liver damage due to accumulation of the hepatotoxic metabolite of the paracetamol - NAPQI.
Determine the least accurate statement about antihypertensive drugs.
A. Thiazide diuretics increase the risk of diabetes.
B. Alpha-adrenoceptor antagonists are first-line therapy for hypertension.
C. Monotherapy does not always adequately lower blood pressure.
D. Angiotensin II receptor antagonists can be used as monotherapy.
E. Nifedipine is more likely to cause reflex tachycardia than amlodipine.
A long-acting beta-2 agonist with a rapid onset of action is :
A. Salbutamol
B. Formoterol
C. Clenbuterol
D. Hexoprenaline
E. Salmeterol
Amlodipine is a drug of first-line treatment of hypertension.
Determine the least exact statement about angina and myocardial infarction.
A. Isosorbide mononitrate is not metabolized at first pass.
B. Verapamil can lower blood pressure without causing reflex tachycardia.
C. Antiplatelet drugs may reduce the risk of myocardial infarction.
D. Lowering cholesterol is of little use in reducing the risk of recurrent myocardial infarction.
E. Nifedipine does not improve the prognosis after myocardial infarction.
Your patient with CHF with reduced ejection fraction receiving an ACE-inhibitor, a beta- blocker and an aldosterone antagonist MRA is unable to tolerate an ACE-inhibitor. Which group is recommended?
A. Non-dihydropyridine calcium-channel blockers.
B. Dihydropyridine calcium-channel blockers.
C. Diuretics.
D. Angiotensin receptor blockers.
A single-blind study is one in which neither the participants nor the experimenters know who is receiving a particular treatment.
A suitable drug for traveler's diarrhea is:
A. Aluminum hydroxide.
B. Loperamide.
C. Magnesium hydroxide.
D. Metoclopramide.
The main methods for recording adverse drug reactions are spontaneous reports (yellow card), the method of controlled drug use, and the method of controlled cases.
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