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1.

A 35 year old HIV positive male patient comes to the OPD with complaint of
anorexia, nausea and vomiting and abdominal pain. His abdomen is tender in the
epigastric area. Laboratory results reveal a raised serum amylase activity and a
preliminary diagnosis is made of acute pancreatitis. Which of the following anti-retroviral
drugs has the patient most likely been taking?

a) Saquinavir
b) Zidovudine
c) Didanosine
d) Efavirenz
e) Enfuvirtide

2. A 40 year old HIV positive patient is receiving HAART regimen (Highly active anti-
retroviral therapy). Four weeks after initiating therapy, he comes to the emergency
department complaining of severe pain in the flank, nausea and frequent urination. Which
one of the following drugs is most likely the cause of his symptoms?
a) Zidovudine
b) Indinavir
c) Efavirenz
d) Nevirapine
e) Nelfinavir

3. A 30 year old man is recently diagnosed with HIV and therapy is started. After the
first week of therapy, the patient complains of headaches, irritability, and nightmares.
Which one of the following anti-retroviral drugs is most likely to be causing these
symptoms?
a) Efavirenz
b) Indinavir
c) Lamivudine
d) Nevirapine
e) Stavudine

4. A 35 year old woman is diagnosed with chronic hepatitis B infection and therapy is
initiated. Just after a few hours she comes to the emergency department complaining of
fever, chills and muscle aches. Which one of the following drugs most likely caused these
symptoms?
a) Lamivudine
b) Adefovir
c) Entecavir
d) Interferon alfa
e) Ribavirin

6. A 60 year old man with known history of Parkinson’s disease is to receive prophylaxis
against Influenza A virus. He is given a drug that is useful against Parkinson’s disease as
well for prophylaxis against influenza. The drug with which of the following mechanisms
of action is most likely to have been given?

a) It prevents entry and penetration of the virus


b) It prevents uncoating of the virus
c) It prevents replication of the virus
d) It prevents assembly of newly synthesized virus particles
e) It prevents release of the newly synthesized virus

Q7. Antimicrobial agent of choice for the outpatient treatment of infections due to animal
bite wound be:
a) Cefuroxime sodium
b) Amoxicillin/clavulanate potassium
c) Penicillin V
d) Ampicillin sodium/Salbactam sodium
e) Ticarcillin disodium/clavulanate potassium

Q8. An antibiotic is distributed in total body water and has an elimination half life of 45
minutes. Which one of the following statements is consistant with that observation?
a) The drug is stored in high concentration in fat
b) The rapid rate of disappearance rules out metabolism of the drug by the liver
c) The drug is actively transported into tubular urine
d) The drug cannot be bound to plasma proteins
e) The drug is eliminated only by glomerular filtration
Q9. Which one of the following is indicated for treatment of chlamydial urethritis during
pregnancy?
a) Amoxicillin (Amoxil)
b) Penicillin V
c) Erythromycin base
d) Doxycycline (Monodox)
e) Tetracycline
Q10. A 25-year-old male has a dental infection associated with facial swelling and
lymphadenopathy. Which one of the following is the most appropriate antibiotic?
a) Cephalexin
b) Tetracycline
c) Penicillin (note: watch an animation on penicillin mechanism of action)
d) Erythromycin
e) Gentamicin

Q11. A 16-year-old sexually active nulliparous white female complains of pelvic pain
and vaginal discharge. On examination she is found to have a temperature of 39.8° C
(102.0° F), pain with movement of the cervix, and tenderness and a mass in the right
adnexa. Which one of the following treatment would be appropriate?

a) Outpatient treatment with penicillin G procaine ,intramuscularly; probenecid


orally; plus doxycycline (Vibramycin) orally for 14 days and reexamination in 3
days
b) Outpatient treatment with ceftriaxone intramuscularly; probenecid orally; plus
doxycycline twice a day for 14 days and reexamination in 1 week
c) Outpatient treatment with cefoxitin intramuscularly; plus doxycycline twice a
day for 14 days and reexamination in 10 days
d) Hospitalization for treatment with cefoxitin intravenously and doxycycline
orally or intravenously, then doxycycline orally twice a day to complete 14 days
of treatment
e) Erythromycin 2 grams orally as a single dose

Q12. A drug that may cause nephrotoxicity, is:


a) Penicillin G
b) Erythrocin
c) Gentamycin
d) Cefuroxime
e) Penicillin V
Q13. Which one of the following is a common early side effect of Penicillin?
a) Constipation
b) Loss of appetite
c) Orthostatic hypotension
d) Atrioventricular block
e) Skin rash

Q14. Which of the following might be seen in patient of TB, who has regularly been
injecting intramuscular injection of streptomycin:
a) Depression
b) Sialorrhea
c) Increased serum alanine aminotransferase
d) Priapism
e) Deafness

Q15. Significant negative interaction has been known to occur between the following
drugs if given concurrently:
a) Penicillin G & Penicillin V
b) Penicillin & tetracycline
c) Penicillin & Gentamycin
d) Penicillin & Clavulanic acid
e) Ticarcillin & Clavulanic acid

Q16. Which of the following is NOT a recognized complication of ampicillin


toxicity:
a) Hemolytic anemia
b) Diarrhea
c) Nausea
d) Overgrowth of gram-positive organisms
e) Ventricular fibrillation

Q17. Doctor is wrong when he suggests his patient to get drug:


a) Streptomycin by IV route
b) Gentamycin by IV route
c) Neomycin by oral route
d) Penicillin V by oral route
e) Cefepime by IV route

Q18. Telithromycin:
a) Is structurally related to tetracycline
b) Is structurally related to beta lactam antibiotics
c) Is structurally related to aminoglycosides

d) Binds more tightly to ribosomes and so it is a poor substrate for bacterial efflux
pumps that mediate antibiotic resistance
e) Is used for UTI

Q19. Doxycycline is used:


a) for Pneumonia as drug of 1st choice
b) for the prevention of TB
c) for the prevention of malaria
d) for the prevention of leprosy
e) for the treatment of sexually transmitted diseases

Q20. Clindamycin:
a) is chemically related to macrolides
b) binds to 30S ribosomal subunit
c) is not recommended for oral route
d) cross-resistance may be observed between macrolides and Clindamycin
e) is excreted in breast milk

Q21. Which of the following statement is true:


a) nafcillin is beta-lactamase resistant antibiotic
b) cefazolin is second generation cephalosporin
c) tazobactam is used in gonorrhea mainly
d) penicillin G is contraindicated in infections caused by spirochetes
e) thrombocytosis is main side effect of Linezolid

Q22. All of the following statement is true, except:


a) chloramphenicol is broad spectrum protein synthesis inhibitor
b) linezolid and streptogramins are narrow spectrum protein synthesis inhibitors
c) mechanism of resistance to chloramphenicol is plasmid mediated and occurs through
the formation of acetyltransferases that inactivate the drug
d) tetracyclines are narrow spectrum protein synthesis inhibitors
e) susceptible organisms accumulate tetracyclines intracellularly via energy dependant
transport systems in their cell membranes

Q23. in a patient with culture-positive enterococcal endocarditis who has failed to


respond to vancomycin because of resistance, the treatment most likely to be effective is:
a) clarithromicin
b) erythromycin
c) linezolid
d) minocycline
e) Ticarcillin
Q24. A 24 year old male patient is suffering from peptic ulcer. He was advised anti-
peptic ulcer drugs including doxycycline. Which one of the following statements about
doxycycline is false?
a) it is bacteriostatic
b) it is excreted mainly in the feces
c) it is used in Lyme disease
d) it has a long elimination half-life
e) it is more active than tetracycline against H. Pylori

Q25. A 12 years old female patient came to pediatrician suffering from headache, high
grade fever, moderate chest pain, joint pain and drowsy. When doctor got history, he was
told to take diazepam 2.5 mg by patient 15 hours ago. Actually it was already a diagnosed
case of pneumonia and she was on drug treatment including streptogramin. Concerning
streptogramins, which one of the following statements is false:
a) they are active against methicillin-resistant staphylococci
b) they may cause a syndrome of arthralgia and myalgia
c) they are used in the management of infections caused by vancomycin-resistant
enterococci
d) they are associated with post antibiotic effect
e) they induce formation of hepatic drug-metabolizing enzymes

Q26. Telithromycin:
a) is cell wall synthesis inhibitor
b) is a ketolide structurally related to macrolides
c) it binds very loosely to ribosomes so it is good substrate for bacterial efflux pumps
that mediate resistance
d) is used in Lyme disease mainly
e) is used in pneumonia as drug of 1st choice

Q27. Which statement is true about tetracyclines?


a) resistance mechanisms include decreased activity of the uptake systems and, most
importantly, the development of mechanisms like efflux pumps for active extrusion of
tetracyclines
b) is contraindicated in gram-positive bacterial infections
c) is absolutely contraindicated in gram-negative bacterial infections
d) mechanism of action of tetracycline is same as Clindamycin
e) resistant organisms are killed when tetracycline is used in large doses
Q28. A 33 years old male patient has been diagnosed mycoplsma pneumoniae infection.
He was treated by one of the broad spectrum antibacterial drug group tetracycline 2 gram
TID for 21 days. What may be most appropriate toxicity?
a) anemia
b) hepatic necrosis
c) thrombocytosis
d) alopecia
e) sleeplessness

Q29. an elderly debilitated patient has a fever believed to be due to an infection. He has
extensive skin lesions, scrapings of which reveal the presence of large numbers of gram-
positive cocci. The most appropriate drug to use for treatment of this patient is:
a) amoxicillin
b) salbactam
c) cefoxitin
d) nafcillin
e) penicillin G

Q30. A 21 year old man was seen in a clinic with a complaint of dysuria and urethral
discharge of yellow pus. He has a painless clean-base ulcer on the penis and nontender
enlargement of the regional lymph nodes. Gram stain of the urethral exudates showed
gram negative diplococci within polymorphonucleocytes. The patient informed the clinic
staff that he was unemployed and had not eaten a meal for two days. The most
appropriate treatment of gonorrhea in this patient is:
a) amoxicillin orally for 7 days
b) vancomycin intramuscularly as a single dose
c) ceftriaxone intramuscularly as a single dose
d) tetracycline orally for 7 days
e) procaine penicillin G intramuscularly as a single dose plus one gram of probenecid

Q31. Eighty years old male patient having 73 Kg body weight was suffering from fever,
headache and lumbar pain since last 7 days. He was examined in clinic. Gram stain of the
smear of CSF revealed gram positive rods resembling diphtheroids. The antibiotic
regimen for empiric treatment would include:
a) Erythromycin
b) Ticarcillin
c) Cefotetan
d) Cefazolin
e) Ampicillin

Q32. A 25 year old male presents to the medical OPD with complaint of cough and low
grade fever since the last 3 months. Laboratory tests show sputum positive for acid fast
bacteria. Which of the following combination of drugs is most likely to be administered
at the start to this patient?
a) Streptomycin, Isoniazid, Rifampicin and Pyrazinamide
b) PAS, Pyrazinamide and Rifampicin
c) Pyrazinamide, Ethambutol and Isoniazid
d) Streptomycin and Rifampicin
e) Streptomycin alone

Q33. A 25 year old male has been given treatment for pulmonary tuberculosis for 2
months as initial phase. Now he comes to the OPD for medication for the continuation
phase. Which of the following drugs will he most likely be given for the continuation
phase?
a) Pyrazinamide and Isoniazid
b) Ethambutol and Streptomycin
c) Isoniazid and Rifampicin
d) Rifampicin and Streptomycin
e) Ethambutol and Pyrazinamide

Q34. A young man 26 years old is started treated for pulmonary tuberculosis. He comes
to the medical OPD after 1 week with complaint of orange red colored urine and sweat
and tears. Which of the following drugs is most likely causing these symptoms?
a) Streptomycin
b) Rifampicin
c) Ethambutol
d) Pyrazinamide
e) Thiacetazone

Q35. A 30 year old male with known TB infection and taking medication since 1 month
comes to the Eye OPD with complaint of visual disturbances including decreased
visibility and slight color blindness. If these symptoms are due to his drug treatment,
which one of the following drugs is most likely the cause of his symptoms?
a) Streptomycin
b) Ciprofloxacin
c) Ethambutol
d) Rifampicin
e) Isoniazid

Q36. A 35 year old male recently diagnosed with tuberculosis and is started on
medication. After a few days he comes to the emergency department a few hours after
taking a meal at McDonald’s with severe pain in the big toe. Blood tests show a very high
uric acid level. Which of the following drugs most likely caused these symptoms?
a) Streptomycin
b) Rifampicin
c) Isoniazid
d) Amikacin
e) Pyrazinamide
Q37. A 40 year old male taking medication for tuberculosis since the last 2 months comes
to the ENT OPD with complaint of hearing problems and ringing in the years. The drug
with which of the following mechanisms of action is most likely causing these
symptoms?
a) Binds to 30 S Ribosome subunit & inhibits initiation complex
b) Inhibits DNA Dependent RNA Polymerase
c) Inhibits synthesis of mycolic acid
d) Inhibits synthesis of arabinoglycan subunits
e) Inhibits DNA Gyrase

Q38. A 35 year old female taking medication for tuberculosis and oral contraceptives
comes to the Gynaecology OPD with complaint of amenorrhea. Laboratory test shows a
positive pregnancy test. Which one of the following drugs most likely caused her to
become pregnant?
a) Rifampicin
b) Pyrazinamide
c) Streptomycin
d) Ethambutol
e) Isoniazid

Q39. A 45 year old male with diagnosed chronic liver disease gets infected with the
tuberculosis. Which one of the following drugs would be most safe for this patient for the
treatment of tuberculosis?
a) Isoniazid
b) Rifampin
c) Pyrazinamide
d) Ethambutol
e) Ethionamide

Q40. A 48 year old male is diagnosed with tuberculosis and has been treated for 2 months
with isoniazid and rifampicin with good response. But the patient develops numbness and
paresthesias in the extremities. What will you most likely do next?
a) Add pyridoxine
b) Stop isoniazid
c) Add vitamin E
d) Replace rifampin with ethambutol
e) Replace isoniazid with streptomycin

Q41. A 30 year old male presents with history of fever occurring in a step-ladder fashion
for the last 10 days. He also feels abdominal pain after taking meals. Lab tests show
decreased TLC count and a positive Widal test. The drug which is most likely to be given
acts by which one of the following mechanisms?
a) Ciprofloxacin
b) Ampicillin
c) Cotrimoxazole
d) Cefixime
e) Azithromycin

Q42. A 35 year old pregnant woman presents to the gynecology department with
complaint of pain with rising fever since the last 5 days. Lab tests show gram negative
bacilli and widal test comes out positive. Which one of the following drugs will most
likely be administered?
a) Ciprofloxacin
b) Levofloxacin
c) Ofloxacin
d) Norfloxacin
e) Ampicillin

Q43. A 27 year old male football player gets injured in a match. He comes to the
emergency department with pain and swelling near the ankle. On examination, there is
small wound with a tender swelling near the ankle joint. Further tests reveal tendon
rupture with tendonitis setting in. Which one of the following antibiotics, if required, will
most probably not be given to this patient?
a) Ceftriaxone
b) Clarithromycin
c) Aminoglycoside
d) Ciprofloxacin
e) Amoxicillin

Q44. A 40 year old male comes to the medical OPD with symptoms of cough &
fever for the last few days. Sputum culture shows presence of gram positive cocci. Which
one of the following Fluoroquinolones is most likely to be administered to this patient?
a) Ciprofloxacin
b) Norfloxacin
c) Ofloxacin
d) Gatifloxacin
e) Levofloxacin

Q45. A 50 year old patient comes to the emergency department, a day after he has been
administered an antibiotic for an on-going infection, with complaint of palpitations. ECG
reveals prolonged QT interval. Which one of the following Fluoroquinolones most likely
caused this adverse effect?
a) Ciprofloxacin
b) Norfloxacin
c) Levofloxacin
d) Ofloxacin
e) Gatifloxacin

Q46. Disinfectants are:


a) Strong chemical agents that inhibit or kill micro-organisms
b) Agents with sufficient toxicity for host cells
c) They kill both vegetative cells and spores
d) A process intended to kill or remove all types of micro-organisms including spores and
include viruses
e) A process that kills non-sporulating microorganisms by hot water or steam at 65-100 C

Q47. A patient with watery stools is diagnosed as suffering from amebic dysentery. He is
given a drug that causes a metalic taste in the mouth which drug may be given.
a) Iodoquinol
b) Diloxanide furate
c) Metronidazole
d) Pentamiline
e) Emetine.

Q48. The reason for giving Metronidazole for oropharyngeal infection is due to its good
activity against:
a)Gram positive cocci
b)Gram Negative cocci
c)Gram positive bacilli
d)Gram negative bacilli
e)Anaerobes like B. fragilis

Q49. Patient comes to emergency with the complaints of marked visual and auditory
abnormities, vomiting diarrhea abdominal pain & skin rashes. From the history of
the patient it was revealed that he took some drug for the treatment of fever. What could
be probable diagnosis?
a)Cinchonism
b)Acute gastro enteritis
c)Cholera
d)Typhoid fever
e)Acid peptic disease

Q50. A 37 year old male is having repeated episodes of fever with chills with blood
smear positive for malaria since last one year. He was given chloroquine each time
& the fever subsided. Which of the following drugs would you add with chloroquine
this time?
a)Artemether
b)Mefloquine
c)Malarone
d)Primaquine

e)Halofantrine
Pharmacology (from old Usmle tests)

Q: Acetaminophen has what two clinical uses and lacks what one clinical use of the NSAIDs?
A: Acetaminophen has antipyretic and analgesic properties, but lacks anti-inflammatory properties.

Q: Can Heparin be used during pregnancy?


A: Yes, it does not cross the placenta.

Q: Can Warfarin be used during pregnancy?


A: No, warfarin, unlike heparin, can cross the placenta.

Q: Does Heparin have a long, medium, or short half life?


A: Short.

Q: Does Warfarin have a long, medium, or short half life?


A: Long.

Q: For Heparin what is the 1. Structure 2. Route of administration 3. Onset of action 4. Mechanism of
action
A: 1. Structure - Large anionic polymer, acidic
A: 2. Route of administration - Paranteral (IV, SC)
A: 3. Onset of action - Rapid (seconds)
A: 4. Mechanism of action - Activates antithrombin III

Q: Heparin continued: 5. Duration of action 6. Ability to inhibit coagulation in vitro 7. Treatment for
overdose 8. Lab value to monitor 9. Site of action
A: 5. Duration of action - Acute (hours)
A: 6. Ability to inhibit coagulation in vitro - Yes
A: 7. Treatment for overdose - Protamine sulfate
A: 8. Lab value to monitor - aPTT (intrinsic pathway)
A: 9. Site of action - Blood

Q: For Warfarin what is the 1. Structure 2. Route of administration 3. Onset of action 4. Mechanism of
action
A: 1. Structure - Small lipid-soluble molecule
A: 2. Route of administration -Oral
A: 3. Onset of action - Slow, limited by half lives of clotting factors
A: 4. Mechanism of action - Impairs the synthesis of vitamin K-dependent clotting factors

Q: Warfarin continued 5. Duration of action 6. Ability to inhibit coagulation in vitro 7. Treatment for
overdose 8. Lab value to monitor 9. Site of action
A: 5. Duration of action - Chronic (weeks or months)
A: 6. Ability to inhibit coagulation in vitro - No
A: 7. Treatment for overdose - IV vitamin K and fresh frozen plasma
A: 8. Lab value to monitor - PT
A: 9. Site of action - Liver

Q: Is toxicity rare or common whith Cromolyn used in Asthma prevention?


A: Rare.

Q: List five common glucocorticoids.


A: 1. Hydrocortisone
A: 2. Predisone
A: 3. Triamcinolone
A: 4. Dexamethasone
A: 5. Beclomethasone

Q: Of the following: 1. Antigen recognition, 2. Proliferation, 3. Differentiation synthesis,


Q: 5. Tissue injury; Which sites do each of the following act upon?
Q: 1. Prednisone 2. Cyclosporine 3. Azathioprine 4. Methotrexate
A: 1. Prednisone - 2. Proliferation, 5. Tissue injury
A: 2. Cyclosporine - 2. Proliferation, 3. Differentiation synthesis
A: 3. Azathioprine - 2. Proliferation
A: 4. Methotrexate - 2. Proliferation

Q: Sites continued: 5. Dactinomycin 6. Cyclophosphamide


A: 5. Dactinomycin - 2. Proliferation, 3. Differentiation synthesis
A: 6. Cyclophosphamide - 2. Proliferation

Q: Sites continued: 7. Antilymphocytic globulin and monoclonal anti-T-cell antibodies 8. Rh3(D) Immune
globulin 9. Tacrolimus
A: 7. Antilymphocytic globulin and monoclonal anti-T-cell antibodies - 1. Antigen recognition, 2.
Proliferation, 3. Differentiation synthesis
A: 8. Rh3(D) Immune globulin - 1. Antigen recognition
A: 9. Tacrolimus - 4. Cytokine secretion.

Q: Secretion of what drug is inhibited by Probenacid used to treat chronic gout?


A: Penicillin.

Q: The COX-2 inhibitors (celecoxib, rofecoxib) have similar side effects to the NSAIDs with what one
exception?
A: The COX-2 inhibitors should not have the corrosive effects of other NSAIDs on the gastrointestinal
lining.

Q: What are are the Sulfonylureas (general description) and what is their use?
A: Sulfonylureas are oral hypoglycemic agents, they are used to stimulate release of endogenous insulin in
NIDDM (type-2).

Q: What are five advantages of Oral Contraceptives (synthetic progestins, estrogen)?


A: 1. Reliable (<1% failure)
A: 2. Lowers risk of endometrial and ovarian cancer
A: 3. Decreased incidence of ectopic pregnancy
A: 4. Lower risk of pelvic infections
A: 5. Regulation of menses

Q: What are five disadvantages of Oral Contraceptives (synthetic progestins, estrogen)?


A: 1. Taken daily
A: 2. No protection against STDs
A: 3. Raises triglycerides
A: 4. Depression, weight gain, nausea, HTN
A: 5. Hypercoagulable state

Q: What are five possible toxic effects of Aspirin therapy?


A: 1. Gastric ulceration
A: 2. Bleeding
A: 3. Hyperventilation
A: 4. Reye's syndrome
A: 5. Tinnitus (CN VIII)
Q: What are five toxicities associated with Tacrolimus (FK506)?
A: 1. Significant: nephrotoxicity
A: 2. Peripheral neuropathy
A: 3. Hypertension
A: 4. Pleural effusion
A: 5. Hyperglycemia.

Q: What are four advantages of newer low-molecular-weight heparins (Enoxaparin)?


A: 1. Better bioavailability
A: 2. 2 to 4 times longer half life
A: 3. Can be administered subcutaneously
A: 4. Does not require laboratory monitoring

Q: What are four clinical activities of Aspirin?


A: 1. Antipyretic
A: 2. Analgesic
A: 3. Anti-inflammatory
A: 4. Antiplatelet drug.

Q: What are four clinical uses of glucocorticoids?


A: 1. Addison's disease
A: 2. Inflammation
A: 3. Immune suppression
A: 4. Asthma

Q: What are four conditions in which H2 Blockers are used clinically?


A: 1. Peptic ulcer
A: 2. Gastritis
A: 3. Esophageal reflux
A: 4. Zollinger-Ellison syndrome

Q: What are four H2 Blockers?


A: 1. Cimetadine
A: 2. Ranitidine
A: 3. Famotidine
A: 4. Nizatidine

Q: What are four Sulfonylureas?


A: 1. Tolbutamide
A: 2. Chlorpropamide
A: 3. Glyburide
A: 4. Glipizide

Q: What are four thrombolytics?


A: 1. Streptokinase
A: 2. Urokinase
A: 3. tPA (alteplase), APSAC (anistreplase)

Q: What are four unwanted effects of Clomiphene use?


A: 1. Hot flashes
A: 2. Ovarian enlargement
A: 3. Multiple simultaneous pregnancies
A: 4. Visual disturbances
Q: What are nine findings of Iatrogenic Cushing's syndrome caused by glucocorticoid therapy?
A: 1. Buffalo hump
A: 2. Moon facies
A: 3. Truncal obesity
A: 4. Muscle wasting
A: 5. Thin skin
A: 6. Easy bruisability
A: 7. Osteoporosis
A: 8. Adrenocortical atrophy
A: 9. Peptic ulcers

Q: What are signs of Sildenafil (Viagra) toxicity?


A: Headache, flushing , dyspepsia, blue-green color vision.

Q: What are the clinical uses for Ticlopidine, Clopidogrel?


A: Acute coronary syndrome; coronary stenting. Decreases the incidence or recurrence of thrombotic
stroke.

Q: What are the four conditions in which Omeprazole, Lansoprazole is used?


A: 1. Peptic ulcer
A: 2. Gastritis
A: 3. Esophageal reflux
A: 4. Zollinger-Ellison syndrome

Q: What are three clinical uses of the Leuprolide?


A: 1. Infertility (pulsatile)
A: 2. Prostate cancer (continuous: use with flutamide)
A: 3. Uterine fibroids

Q: What are three clinical uses of the NSAIDs?


A: 1. Antipyretic
A: 2. Analgesic
A: 3. Anti-inflammatory

Q: What are three common NSAIDS other than Aspirin?


A: Ibuprofen, Naproxen, and Indomethacin

Q: What are three complications of Warfarin usage?


A: 1. Bleeding
A: 2. Teratogenicity
A: 3. Drug-drug interactions

Q: What are three possible complications of Heparin therapy?


A: 1. Bleeding
A: 2. Thrombocytopenia
A: 3. Drug-drug interactions

Q: What are three possible toxicities of NSAID usage?


A: 1. Renal damage
A: 2. Aplastic anemia
A: 3. GI distress

Q: What are three toxicities of Leuprolied?


A: 1. Antiandrogen
A: 2. Nausea
A: 3. Vomiting
Q: What are three toxicities of Propylthiouracil?
A: 1. Skin rash
A: 2. Agranulocytosis (rare)
A: 3. Aplastic anemia

Q: What are three types of antacids and the problems that can result from their overuse?
A: 1. Aluminum hydroxide: constipation and hypophosphatemia
A: 2. Magnesium hydroxide: diarrhea
A: 3. Calcium carbonate: Hypercalcemia, rebound acid increase
A: - All may cause hypokalemia

Q: What are three unwanted effects of Mifepristone?


A: 1. Heavy bleeding
A: 2. GI effects (n/v, anorexia)
A: 3. Abdominal pain

Q: What are two Alpha-glucosidase inhibitors?


A: 1. Acarbose
A: 2. Miglitol

Q: What are two clinical uses of Azathioprine?


A: 1. Kidney transplantation
A: 2. Autoimmune disorders (including glomerulonephritis and hemolytic anemia)

Q: What are two conditions in which COX-2 inhibitors might be used?


A: Rheumatoid and osteoarthritis.

Q: What are two Glitazones?


A: 1. Pioglitazone
A: 2. Rosiglitazone.

Q: What are two mechanisms of action of Propythiouracil?


A: Inhibits organification and coupling of thyroid hormone synthesis. Also decreases peripheral conversion
of T4 to T3.

Q: What are two processes Corticosteroids inhibit leading to decreased inflammation?


A: 1. Phospholipase A2 is prevented from releasing arachidonic acid
A: 2. Decreases protein synthesis thus lowering amount of Cyclooxygenase enzymes

Q: What are two toxicities associated with Cyclosporine?


A: 1. Predisposes to viral infections and lymphoma
A: 2. Nephrotoxic (preventable with mannitol diuresis)

Q: What are two toxicities of the Glitazones?


A: 1. Weight gain
A: 2. Hepatotoxicity (troglitazone)

Q: What are two toxicities of the Sulfonylureas?


A: 1. Hypoglycemia (more common with 2nd-generation drugs: glyburide, glipizide)
A: 2. Disulfiram-like effects (not seen with 2nd-generation drugs).

Q: What are two types of drugs that interfere with the action of Sucralfate and why?
A: Sucralfate cannot work in the presence of antacids or H2 blockers because it requires an acidic
environment to polymerize.
Q: What can result due to antacid overuse?
A: Can affect absorption, bioavailability, or urinary excretion of other drugs by altering gastric and urinary
pH or by delaying gastric emptying.

Q: What enzyme does Zileuton inhibit?


A: Lipoxygenase

Q: What enzymes are inhibited by NSAIDs, acetaminophen and COX II inhibitors?


A: Cyclooxygenases (COX I, COX II).

Q: What is a common side effect of Colchicine used to treat acute gout, especially when given orally?
A: GI side effects. (Note: Indomethacin is less toxic, more commonly used.)

Q: What is a common side effect of Misoprostol?


A: Diarrhea

Q: What is a possible result of overdose of Acetaminophen?


A: Overdose produces hepatic necrosis; acetaminophen metablolite depletes glutathione and forms toxic
tissue adducts in liver.

Q: What is a possible toxicity of Alpha-glucosidase inhibitors used in type-2 diabetes?


A: GI disturbances.

Q: What is a possible toxicity of Ticlopidine, Clopidogrel usage?


A: Neutropenia (ticlopidine); reserved for those who cannot tolerate aspirin.

Q: What is a sign of toxicity with the use of thrombolytics?


A: Bleeding.

Q: What is action of insulin in the liver, in muscle, and in adipose tissue?


A: 1. In liver, increases storage of glucose as glycogen.
A: 2. In muscle, stimulates glycogen and protein synthesis, and K+ uptake.
A: 3. In adipose tissue, facilitates triglyceride storage.

Q: What is are two clinical uses of Cyclosporine?


A: 1. Suppresses organ rejection after transplantation
A: 2. Selected autoimmune disorders.

Q: What is the category and mechanism of action of Zafirlukast in Asthma treatment?


A: Antileukotriene; blocks leukotriene receptors.

Q: What is the category and mechanism of action of Zileuton in Asthma treatment?


A: Antileukotriene; blocks synthesis by lipoxygenase.

Q: What is the category of drug names ending in -ane (e.g. Halothane)


A: Inhalational general anesthetic.

Q: What is the category of drug names ending in -azepam (e.g. Diazepam)


A: Benzodiazepine.

Q: What is the category of drug names ending in -azine (e.g. Chlorpromazine)


A: Phenothiazine (neuroleptic, antiemetic).

Q: What is the category of drug names ending in -azol (e.g. Ketoconazole)


A: Antifungal.
Q: What is the category of drug names ending in -barbital (e.g. Phenobarbital)
A: Babiturate.

Q: What is the category of drug names ending in -caine (e.g. Lidocaine)


A: Local anesthetic.

Q: What is the category of drug names ending in -cillin (e.g. Methicillin)


A: Penicillin.

Q: What is the category of drug names ending in -cycline (e.g. Tetracycline)


A: Antibiotic, protein synthesis inhibitor.

Q: What is the category of drug names ending in -ipramine (e.g. Imipramine)


A: Tricyclic antidepressant.

Q: What is the category of drug names ending in -navir (e.g. Saquinavir)


A: Protease inhibitor.

Q: What is the category of drug names ending in -olol (e.g. Propranolol)


A: Beta antagonist.

Q: What is the category of drug names ending in -operidol (e.g. Haloperidol)


A: Butyrophenone (neuroleptic).

Q: What is the category of drug names ending in -oxin (e.g. Digoxin)


A: Cardiac glycoside (inotropic agent).

Q: What is the category of drug names ending in -phylline (e.g. Theophylline)


A: Methylxanthine.

Q: What is the category of drug names ending in -pril (e.g. Captopril)


A: ACE inhibitor.

Q: What is the category of drug names ending in -terol (e.g. Albuterol)


A: Beta-2 agonist.

Q: What is the category of drug names ending in -tidine (e.g. Cimetidine)


A: H2 antagonist

Q: What is the category of drug names ending in -triptyline (e.g. Amitriptyline)


A: Tricyclic antidepressant.

Q: What is the category of drug names ending in -tropin (e.g. Somatotropin)


A: Pituitary hormone.

Q: What is the category of drug names ending in -zosin (e.g. Prazosin)


A: Alpha-1 antagonist

Q: What is the category, desired effect, and adverse effect of Isoproterenol in the treatment of Asthma?
A: Nonspecific beta-agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Adverse
effect is tachycardia (Beta 1).

Q: What is the category, desired effect, and period of use of albuterol in the treatment of Asthma?
A: Beta 2 agonist; desired effect is the relaxation of bronchial smooth muscle (Beta 2). Use during acute
exacerbation.
Q: What is the category, desired effect, and possible mechanism of Theophylline in treating Asthma?
A: Methylzanthine; desired effect is bronchodilation, may cause bronchodilation by inhibiting
phosphodiesterase, enzyme involved in degrading cAMP (controversial).

Q: What is the category, mechanism of action, and effect of Ipratroprium in Asthma treatment?
A: Muscarinic antagonist; competatively blocks muscarinic receptors, preventing bronchoconstriction.

Q: What is the category, mechanism of action, and particular use of beclomethasone and prednisone in
Asthma treatment?
A: Corticosteroids; prevent production of leukotrienes from arachodonic acid by blocking phospholipase
A2. Drugs of choice in a patient with status asthmaticus (in combination with albuterol.)

Q: What is the category, method of use, and adverse effects of Salmeterol in Asthma treatment?
A: Beta 2 agonist; used as a long-acting agent for prophylaxis. Adverse effects are tremor and arrhythmia.

Q: What is the clincial use for Misoprostol?


A: Prevention of NSAID-induced peptic ulcers, maintains a PDA.

Q: What is the clinical use for Clomiphene?


A: Treatment of infertility.

Q: What is the clinical use for Heparin?


A: Immediate anticoagulation for PE, stroke, angina, MI, DVT.

Q: What is the clinical use for Sildenafil (Viagra)?


A: Erectile dysfunction.

Q: What is the clinical use for Sucralfate?


A: Peptic ulcer disease.

Q: What is the clinical use for Warfarin?


A: Chronic anticoagulation.

Q: What is the clinical use of Mifepristone (RU486)?


A: Abortifacient.

Q: What is the clinical use of Tacrolimus (FK506)?


A: Potent immunosuppressive used in organ transplant recipients.

Q: What is the effect of the Glitazones in diabetes treatment?


A: Increase target cell response to insulin.

Q: What is the enzyme inhibited, the effect of this inhibition, and the clinical use of the antiandrogren
Finasteride?
A: Finasteride inhibits 5 Alpha-reductase, this decreases the conversion of testosterone to
dihydrotestosterone, useful in BPH

Q: What is the lab value used to monitor the effectiveness of Heparin therapy?
A: The PTT.

Q: What is the lab value used to monitor the effectiveness of Warfarin therapy?
A: The PT.

Q: What is the main clinical use for the thrombolytics?


A: Early myocardial infarction.
Q: What is the mecanism of action of Sucralfate?
A: Aluminum sucrose sulfate polymerizes in the acid environment of the stomach and selectively binds
necrotic peptic ulcer tissue. Acts as a barrier to acid, pepsin, and bile.

Q: What is the mecanism of action of the COX-2 inhibitors (celecoxib, rofecoxib)?


A: Selectively inhibit cyclooxygenase (COX) isoform 2, which is found in inflammatory cells nad mediates
inflammation and pain; spares COX-1 which helps maintain the gastric mucosa.

Q: What is the mecanism of action, effective period, and ineffective period of use for Cromolyn in treating
Asthma?
A: Prevents release of mediators from mast cells. Effective only for the prophylaxis of asthma. Not
effective during an acute attack.

Q: What is the mechanism of action and clinical use of the antiandrogen Flutamide?
A: Flutamide is a nonsteroidal competitive inhibitor of androgens at the testosterone receptor, used in
prostate carcinoma.

Q: What is the mechanism of action and clinical use of the antiandrogens Ketoconazole and
Spironolactone?
A: Inhibit steroid synthesis, used in the treatment of polycystic ovarian syndrome to prevent hirsutism.

Q: What is the mechanism of action of Acetaminophen?


A: Reversibly inhibits cyclooxygenase, mostly in CNS. Inactivated peripherally.

Q: What is the mechanism of action of Allopurinol used to treat chronic gout?


A: Inhibits xanthine oxidase, decresing conversion of xanthine to uric acid.

Q: What is the mechanism of action of Aspirin?


A: Acetylates and irreversibly inhibits cyclooxygenase (COX I and COX II) to prevent the conversion of
arachidonic acid to prostaglandins.

Q: What is the mechanism of action of Clomiphene?


A: Clomiphene is a partial agonist at estrogen receptors in the pituitary gland. Prevents normal feedback
inhibition and increses release of LH and FSHfrom the pituitary, which stimulates ovulation.

Q: What is the mechanism of action of Colchicine used to treat acute gout?


A: Depolymerizes microtubules, impairing leukocyte chemotaxis and degranulation.

Q: What is the mechanism of action of Cyclosporine?


A: Binds to cyclophilins (peptidyl proline cis-trans isomerase), blocking the differentiation and activation
of T cells mainly by inhibiting the production of IL-2 and its receptor.

Q: What is the mechanism of action of Heparin?


A: Heparin catalyzes the activation of antithrombin III.

Q: What is the mechanism of action of Mifepristone (RU486)?


A: Competitive inibitor of progestins at progesterone receptors.

Q: What is the mechanism of action of Misoprostol?


A: Misoprostol is a PGE1 analog that increases the production and secretion of the gastic mucous barrier.

Q: What is the mechanism of action of NSAIDs other than Aspirin?


A: Reversibly inhibit cyclooxygenase (COX I and COX II). Block prostaglandin synthesis.
Q: What is the mechanism of action of Omeprazole, Lansoprazole?
A: Irreversibly inhibits H+/K+ ATPase in stomach parietal cells.

Q: What is the mechanism of action of Probenacid used to treat chronic gout?


A: Inhibits reabsorption of uric acid.

Q: What is the mechanism of action of Sildenafil (Viagra)?


A: Inhibits cGMP phosphodiesterase, casuing increased cGMP, smooth muscle relaxation in the corpus
cavernosum, increased blood flow, and penile erection.

Q: What is the mechanism of action of the Alpha-glucosidase inhibitors?


A: Inhibit intestinal bursh border Alpha-glucosidases; delayed hydrolysis of sugars and absorption of
sugars leading to decresed postprandial hyperglycemia.

Q: What is the mechanism of action of the glucocorticoids?


A: Decrease the production of leukotrienes and protaglandins by inhibiting phospholipase A2 and
expression of COX-2.

Q: What is the mechanism of action of the H2 Blockers?


A: Reversible block of histamine H2 receptors

Q: What is the mechanism of action of the Sulfonylureas?


A: Close K+ channels in Beta-cell membrane leading to cell depolarization causing insulin release
triggered by increase in Calcium ion influx.

Q: What is the mechanism of action of the thrombolytics?


A: Directly of indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots.
(It is claimed that tPA specifically converts fibrin-bound plasminogen to plasmin.)

Q: What is the mechanism of action of Ticlopidine, Clopidogrel


A: Inhibits platelet aggregation by irreversibly inhibiting the ADP pathway involved in the binding of
fibrinogen.

Q: What is the mechanism of action of Warfarin (Coumadin)?


A: Warfarin interferes with the normal synthesis and gamma-carboxylation of vitamin K-dependent
clotting factors II, VII, IX, and X, Protein C and S via vitamin K antagonism.

Q: What is the mechanism of Azathioprine?


A: Antimetabolite derivative of 6-mercaptopurine that interferes with the metablolism and synthesis of
nucleic acid.

Q: What is the mechanism of Leuprolide?


A: GnRH analog with agonist properties when used in pulsatile fashion and antagonist properties when
used in continuous fashion, causing a transient initial burst of LH and FSH

Q: What is the mechanism of Tacrolimus (FK506)?


A: Similar to cyclosporine; binds to FK-binding protein, inhibiting secretion of IL-2 and other cytokines.

Q: What is the memory key for the action of Sildenafil (Viagra)?


A: Sildenafil fills the penis

Q: What is the memory key for the effect of aluminum hydroxide overuse?
A: AluMINIMUM amount of feces.
Q: What is the memory key for the effect of magnesium hydroxide overuse?
A: Mg = Must go to the bathroom.

Q: What is the memory key to remember which pathway (extrinsic vs. intrinsic) and which lab value
Warfarin affects?
A: WEPT: Warfarin affects the Extrinsic pathway and prolongs the PT.

Q: What is the possible mechanism and effect of Metformin in treating diabetes?


A: Mechanism unknown; possibly inhibits gluconeogenesis and increases glycolysis; effect is to decrease
serum glucose levels

Q: What is the specific clinical use of Indomethacin in neonates?


A: Indomethacin is used to close a patent ductus arteriosus.

Q: What is used to reverse the action of Heparin?


A: Protamine Sulfate is used for rapid reversal of heparinization (positively charged molecule that binds to
negatively charged heparin).

Q: What patients are at risk for life threatening hypotension when taking Sildenafil (Viagra)?
A: Those patients who are taking nitrates.

Q: What process does Zafirlukast interfere with?


A: Leukotrienes increasing bronchial tone.

Q: What type of gout is treated with Allopurinol?


A: Chronic gout.

Q: What type of gout is treated with Colchicine?


A: Acute gout.

Q: What type of gout is treated with Probenacid?


A: Chronic gout.

Q: What type of patient should not take Misoprostol and why?


A: Misoprostol is contraindicated in women of childbearing potential because it is an abortifacient.

Q: Which H2 Blocker has the most toxic effects and what are they?
A: Cimetidine is a potent inhibitor of P450; it also has an antiandrogenic effect and decreases renal
excretion of creatinine. Other H2 blockers are relatively free of these effects.

Q: Why are the Sulfonylureas inactive in IDDM (type-1)?


A: Because they require some residual islet function.

Antiviral

CLASSIFICATION:
1. Anti-herpes virus: Idoxuridine, acyclovir, valacyclovir, famciclovir, ganciclovir, forscarnet
Except forscarnet which is an inhibitor of DNA polymerase and reverse transcriptase, others are purine and
pyrimidine anlaogues.

2. Anti-retrovirus:
a. Nucleoside reverse transcriptase inhibitors (NRTIs): Zidovudine (AZT), Didanosine, Zalcitabine,
Stavudine, Lamivudine, Abacavir
b. Non-nucleoside reverse transcriptase inhibitors (NNRTIs):Nevirapine, Efavirenz, Delaviridine
c. Protease inhibitors: Ritonavir, Indinavir, Nelfinavir, Saquinavir, Lopinavir

3. Anti-influenza virus: Amatidine, Rimantadine

4. Nonselective antiviral drugs: Ribavirin, Lamivudine, Interferon alpha

General Mechanism of Action of Nucleoside Analogues:


1. Taken up by cells
2. Converted by viral and cellualr enzymes to the triphosphate form
3. The triphosphate form inhibits:
a. DNA polymerase
b. Reverse transcriptase
c. RNA polymerase
4. Or it may get incorporated into growing DNA leading to abnormal proteins or breakage.

ANTI-HERPES VIRUS DRUGS:

1. Acyclovir and Valaciclovir: These are guanine analogues with antiviral activities against Herpes group
only.

Mechanism of action:

Acyclovir –viral thymidine kinase–> AcycloGMP –cellular kinases–> AcycloGTP


AcycloGTP performs 2 functions:
a. Inhibits viral DNA polymerase competitively
b. Termination of DNA synthesis by incorporation into DNA

Mechanism of resistance development:


a. Reduced activity of viral thymidine kinase
b. Altered DNA polymerase

Use:
The activity of acyclovir on herpes group:
Herpes simplex type I > Herpes simplex type II > (Varicella-zoster virus = Epstein-Barr virus)
Cytomegalovirus (CMV) are practically not affected.

a. Genital Herpes simplex (type II)


b. Mucocutaneous H. simplex (type I) : remains localized to lips and gums
c. H.simplex encephalitis (type I)
d. H. simplex (type I) keratitis : because of good corneal penetration
e. Herpes zoster
f. Chickenpox

Adverse effects:
a. Topical: stinging and burning sensation
b. Oral: headache, nausea, malaise
c. Intravenous: rashes, sweating, emesis and fall in BP
d. Other toxicities:
i. Renal insufficiency (normalization on discontinuation of drug)
ii. Encephalopathy : tremors, lethargy, disorientation, hallucinations, convulsions and coma
Valaciclovir is an ester prodrug of acyclovir with improved oral bioavailability. It is the drug of choice in
herpes zoster.

2. Famciclovir: It is used an alternative to acyclovir for genital or orolabial herpes and herpes zoster.

3. Ganciclovir:
a. Analogue of acyclovir
b. Active against all herpes viruses including CMV
c. CMV can develop ganciclovir resistance by mutation
d. Low oral bioavailability given I.V.
e. Drug of choice for CMV infection in immunosupressed patients (eg. AIDS) : pneumonia, colitis, retinitis

Adverse effects:
a. Bone marrow supression : leukopenia and thrombocytopenia
b. CNS effects: headache, behavioral psychosis, coma, convulsions
c. Rashes, fever, vomiting

4. Idoxuridine and Trifluridine:


a. Topical agent for Herpes keratitis
b. Triflurdine (also for CMV) is better for H.simplex II keratoconjunctivits

5. Forscarnet:
a. Direct inhibitor of DNA polymerase and reverse transcriptase
b. An inorganic pyrophosphate analogue

ADR:
a. Nephrotoxicity (Renal diabetes like condition, acute renal failure)
b. Hypocalcemia, hypokalemia and hypomagnesemia
c. Anemia
d. Tremor, convulsions
e. Phlebitis (administered i.v.)

Use:
a. CMV retinitis and other CMV infections resistant to gancyclovir
b. H.simplex and Varicella Zoster resistant to acyclovir
c. HIV

Read more ANTIVIRAL DRUGS: Classification and Anti-Herpes Virus drugs | Medchrome

IV. Classifications of Drugs


11. Special Circumstances and Drug Classifications
12. Nervous System Medications
13. Cardiovascular System Medications
14. Immunological System Medications
15. Integumentary System Medications
16. Respiratory System Medications
17. Gastrointestinal System Medications
18. Musculoskeletal System Medications
19. Endocrine System Medications
20. Reproductive and Urinary Systems Medications
21. Eye and Ear Medications
22. Herbs, Vitamins, and Minerals