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1.

From the following select the agent that acts as an importan From the following select the agent that acts as an important inhibitor of CYP3A4 A. St John s Wort B. Carbamazepine

C. Grapefruit juice
D. Phenytoin E. Barbiturates 1. Which of the following is not a side effect of tricyclic ant Which of the following is not a side effect of tricyclic antidepressants? A. Weight loss B. Postural hypotension C. Dry mouth D. Black tongue E. Reduced seizure threshold 1. Many of the side-effects of the tricyclic antidepressants ar Many of the side-effects of the tricyclic antidepressants are explained by: A. anti-muscarinic efficacy B. anti-dopamine efficacy C. anti-5-HT efficacy D. potentiation of 5-HT E. anti-adrenergic efficacy

Anti cholenergic

anti-muscarinic efficacy

Which of the following exerts its action by the reversible inhibition of cholinesterase? A. Moclobemide B. Topiramate C. Buproprion D. Memantine E. Rivastigmine 1

1. young boy is started on methylphenidate. Which of the foll A young boy is started on methylphenidate. Which of the following side effects must you warn him and his parents about? A.Sexual dysfunction B.Risk of suicide C.Constipation D.Growth restriction E.Tinnitus 1. Central nervous system stimulants such as methylphenidate an Central nervous system stimulants such as methylphenidate and the amphetamines are used in treating all of the following conditions EXCEPT (A) drug-induced respiratory depression (B) narcolepsy (C) attention deficit disorder (D) obesity (E) hyperkinetic syndrome in children 1. Sensory neurons of the central nervous system have what type Sensory neurons of the central nervous system have what type of receptive fields? a) Excitatory only b) Inhibitory only c) Excitatory and inhibitory d) None of the above 1. Toglial cells in the central nervous system? Which of the following statements appliesonly toglial cells in the central nervous system? A. The cell body contains ribosomes B. Is able to divide C. Conducts action potentials D. Is located in the ventral horn of the spinal cord E. The nucleus contains a nucleolus 1. Central nervous system defects An 8-year-old boy is brought to the emergency department because of vomiting and convulsions. His urine has a maple syrup odor and is found to contain an elevated level of ketone bodies and low levels of glucose. Neurologic studies show central nervous system defects. Despite intensive treatment, the boy dies after several days. The disease most likely resulted from which deficiency? A. arginase B. branched-chain -keto acid dehydrogenase complex C. cystathionine synthase 2

D. homogentisic acid oxidase E. phenylalanine hydroxylase 1. The autonomic nervous system is true? 2. Which of the following statements regarding the autonomic nervous system is true? 1- The heart will stop beating if it is denervated 2- Sympathetic innervation decreases the slope of the pacemaker potential 3- Sympathetic activity decreases membrane permeability to K+ 4- Parasympathetic activity increases membrane permeability to K+ 2.3. methylphenidate Q. A 28 yr old woman comes to the clinic for the first time with symptoms of major depression lasting several weeks. She requests mdications because apart from feeling low & tired, she feels distracted, forgetful, & unable to focus on her work. She reports she was diagnosed as a child with ADHD & dyslexia, & she had been given methylphenidate. She takes no medication at this time. Which of the following would be the most appropriate ttt? 1. Alprazolam [b]2. Bupropion [/b] 3. Lithuim 4. Olanzapine 5. Paroxetine Explanation : Buproprion is a very good antidepressant & is used in elderly or pts who suffer from sexual dusfc dt SSRI, the main side effect is that it decreases the seizure threshold so CI in epilept pt or if there is a hist of seizure 1. An anticancer chemotherapeutic agent that acts by first-orde An anticancer chemotherapeutic agent that acts by first-order kinetics would be expected to kill a A. constant number of cancer cells B. constant proportion of cancer cells C. variable number of cells depending on the half-life of the drug D. variable number of cells depending on the proportion of cells in S phase E. variable proportion of cells depending on the number of cells in the G0 phase

1. Chemotherapeutic agent causing SIADH is Chemotherapeutic agent causing SIADH is a- Cyclophosphamide b- Vincristine c- Visblastine d- D-carbazine 1. A person who has taken a sympathetic blocking agent What would the examining physician notice in the eye of a person who has taken a sympathetic blocking agent? a. Exophthalmos and dilated iris b. Enophthalmos and dry eye c. Dry eye and inability to accommodate for reading d. Wide open eyelids and loss of depth perception e. Ptosis and miosis (pin-point pupil) 1. A patient is administered a pharmacologic agent topically on Which of the following agents was administered: A patient is administered a pharmacologic agent topically onto the eye, resulting in mydriasis without cyclopegia. 1. 2. 3. 4. phenylephrine homatropine bethanechol neostigmine

1. Spermicidal agent acts through Spermicidal agent acts through 1. acrosomal enzyme 2. cervical enzyme alteration 3. glucose uptake inhibition by sperm 4. disruption of cell membrane Spermicides are composed of a spermicidal agent in a carrier that allows dispersion and retention of the agent in the vagina. Nonoxynol-9 is the most commonly used spermicidal agent, and it is the active component in most of the spermicide preparations available in Canada. Spermicides destroy the sperm cell membrane by altering the lipid layer. The sperm then become permeable to moisture resulting in swelling and break down of vital sperm cell membranes. 4

1. A middle-aged African-American male has advanced sarcoidosis A middle-aged African-American male has advanced sarcoidosis. His PaO2 is 55 on room air. The FEV1/FVC ratio is higher than normal. The diffusion capacity (DLCO) is only 20% of that which is predicted for his age, height, weight and sex. Why is the diffusion capacity so low? A. Enlarged lymph nodes from sarcoidosis compress the pulmonary arteries B. Airway obstruction prevents normal distribution of inhaled gases C. The pulmonary capillary bed is destroyed by the disease process D. Sarcoid causes interstitial thickening Answer - C: Remember that the DLCO measures how much carbon monoxide binds to pulmonary capillary blood, and that the thickened interstitium is not nearly the barrier to CO that it would be to oxygen. It is the loss of pulmonary capillary bed that lowers the DLCO. Lymph nodes and pulmonary artery compression is a bogus choice. The solubility of CO makes maldistribution of ventilation a nonissue.

1. AN INTRAVESICAL CHEMOTHERAPEUTIC AGENT WHICH ONE THE FOLLOWING IS NOT AN INTRAVESICAL CHEMOTHERAPEUTIC AGENT? 1.MITOMYCIN c 2.BCG 3.EPIRUBICIN 4.THITEPAN INTRAVESICAL CHEMOTHERAPEUTIC AGENTS have included BCG, mitomycin C, doxy- rubicin, thiotepa,epirubicin, and epidol so out of your list THITEPAN make no sense at all. A 23-year-old woman is scheduled to undergo surgical repair of an aortic malformation. A ganglionic blocking agent is administered before the procedure to decrease her blood pressure. The hypotension is achieved by binding of the drug at which of the following receptors? A) B) C) D) 1-Adrenergic 2-Adrenergic 1-Adrenergic 2 -Adrenergic

E ) Muscarinic F ) Nicotinic hexamethonium have no clinical usage. mecalamine is correct ans 5

1. The chemotherapeutic agent , most commonly administered by c The chemotherapeutic agent , most commonly administered by continuous infusion , is: 1) 2) 3) 4) ARA-C 5 -FU Cisplatin Etoposide.

read KDT 5th ed: pg 777 it says cisplatin is given by slow iv infusion. Harri mentions that 5 Fu is given by IV infusion at a few places...eg' pg 557 cervical cancer... 5 -FU 4 gm given by 96 hr infusion pg 531 GI tract cancer: here he mentions 5-FU is initially used a a bolus & then as an infusion for for 2 days harri pg 476 (16 ed) IV administration of 5-FU leads to bone marrow suppression after short infusions and stomatitis after prolonged infusions. [ what can we infer from this? i'm still confused] Immediately in the next para: For ara-C: Continuous infusion schedules allow maximum efficiency, with uptake maximal at 5 to 7 microM So can we conclude that its ara-C? for sure? I'm still a bit confused! See if this helps u.. from Cecil's: "Cytarabine is an S-phase-specific agent that is particularly useful in acute non-lymphocytic leukemia and, to a lesser extent, in other hematologic malignancies. Its active form, ara-CTP, competitively inhibits DNA polymerase, blocking DNA synthesis. Ara-C also blocks chain elongation and ligation of fragments into newly synthesized DNA. Ara-C is given intravenously and crosses the blood-brain barrier. It is administered either by continuous infusion or in bolus doses by the intravenous or subcutaneous route for 5 to 7 days. In an alternative schedule that exceeds the manufacturer's recommended maximum, high-dose ara-C is administered in doses of 1 to 3 g every 12 hours for 3 to 5 days and yields higher response rates. The duration of intracellular retention of ara-CTP appears to predict ara-C antileukemic effects, with best results in patients who have the longest ara-CTP retention times. Both standard and high-dose ara-C can produce severe myelosuppression." "Fluorouracil (5-FU) is an important anticancer agent used to treat a variety of solid tumors, including cancers of the head and neck, esophagus, breast, and colon. It acts synergistically with a variety of agents, including platinum compounds and radiation therapy. Studies indicate that "pulse" or bolus injections of 5-FU are cytotoxic mainly as a result of incorporation into RNA, whereas continuous infusions of this drug (2 or more days) kill cells by inhibiting DNA synthesis and producing "thymine-less death." 5FU is usually given intravenously by bolus or infusion schedules but can also be used in intra-arterial, intracavitary, and topical therapy. An optimal schedule for 5-FU administration is a 5-day continuous infusion at a dose rate of 1.0 g/m2 /day. " 6

It seems that ara-c is administered exclusively by infusion or bolus only, while 5fu has other routes... so why not take it arac as the answer?(this may sound foolish, but sometimes thinking like a simpleton helps breaking a deadlock!!!!! )

An anticancer chemotherapeutic agent that acts by first-order kinetics would be expected to kill a A. constant number of cancer cells B. constant proportion of cancer cells C. variable number of cells depending on the half-life of the drug D. variable number of cells depending on the proportion of cells in S phase E. variable proportion of cells depending on the number of cells in the G0 phase

The answer is B. First-order kinetics, when applied to the concept of cytotoxicity, means that the drug will kill a constant proportion of tumor cells (rather than a constant number, choice A). The log kill hypothesis refines this by stating that the magnitude of killing by a cytotoxic agent is a logarithmic function. Therefore, a drug producing a 3-log kill will reduce 1012 cells to 109, or will reduce 106 cells to 103 (three orders of magnitude in either case). This hypothesis accounts for the far better results observed with chemotherapy when the total tumor burden is low. The half-life of the drug (choice C) does not determine the number of cells killed, assuming an adequate dose is given. Choices D and E are both reflections of cell cycle specificity, the ability of a drug to specifically kill cells in a particular phase of the cell cycle (eg, S phase or G0 phase), and are unrelated to first-order kinetics.
1. An anticancer chemotherapeutic agent that acts by first-order kinetics would be expected to kill a:A. constant number of cancer cells B. constant proportion of cancer cells C. variable number of cells depending on the half-life of the drug D. variable number of cells depending on the proportion of cells in S phase E. variable proportion of cells depending on the number of cells in the G0 phase

Explanation: The correct answer is B. First-order kinetics, when applied to the concept of cytotoxicity, means that the drug will kill a constant proportion of tumor cells (rather than a constant number, choice A). The logkillhypothesis refines this by stating that the magnitude of killing by a cytotoxic agent is a logarithmic function. Therefore, a

drug producing a 3-log kill will reduce 1012 cells to 109, or will reduce 106 cells to 103 (three orders of magnitude in either case). This hypothesis accounts for the far better results observed with chemotherapywhen the total tumor burden is low. The half-life of the drug (choice C) does not determine the number of cells killed, assuming an adequate doseis given. Choices D and E are both reflections of cell cycle specificity, the ability of a drug to specifically kill cells in a particular phase of the cell cycle (eg, S phase or G0 phase), and are unrelated to first-order kinetics.
[b]estrogen acts on [/b] 1.nucleus 2mitochondria 3.cell membrane 4.cytoplasmic receptor Acetyl Co-A acts as a substrate for all the enzymes excepta- HMG-Co A synthase b- Malic enzyme c- Malonyl Co A synthetase d- Fatty acid synthetase 1. A 28 yr old african american male is given prophylactic medication and vaccination b4 travelling to africa 4 a business trip. 4 days later he comes back to physician with jaundice and dark urine. lab shows anemia, reticulocytosis and indirect hyperbilirubinemia. a peripheral smear shows RBC with dark inclusion when stained with crystal violet. his condition most likely has which of the following inheritance patterns? A autosomal dominant pattern B aut recessive C x linked recessive D x linked dominant E mitochondrial inheritance A 65-year-old African American male with a three- to four-day history of burning with urination and increased urgency presents to your clinic. His urinalysis is positive for white blood cells, leukocyte esterase, and nitrates. His CBC indicates that he is mildly anemic. The patient reports that his father and two brothers have anemia. To effectively treat his urinary tract infection while considering his family history, which of the following antibiotics would be the best choice? A. Ciprofloxacin B. Erythromycin C. Nitrofurantoin D. Penicillin E. Trimethoprim-sulfamethoxazole 1. DRUGS ARE USED FOR ENDOSCOPIC REMOVAL WITH INTRAVESICAL THER

THE FOLLOWING DRUGS ARE USED FOR ENDOSCOPIC REMOVAL WITH INTRAVESICAL THERAPHY IN SUPERFICIAL BLADDER TUMORS EXCEPT 1. 2. 3. 4. BCG IFN GEMCITABINE METHOTREXATE

2. GEMCITABINE--------answer

An anticancer chemotherapeutic agent that acts by first-order kinetics would be expected to kill a A. constant number of cancer cells B. constant proportion of cancer cells C. variable number of cells depending on the half-life of the drug D. variable number of cells depending on the proportion of cells in S phase E. variable proportion of cells depending on the number of cells in the G0 phase The answer is B. First-order kinetics, when applied to the concept of cytotoxicity, means that the drug will kill a constant proportion of tumor cells (rather than a constant number, choice A). The log kill hypothesis refines this by stating that the magnitude of killing by a cytotoxic agent is a logarithmic function. Therefore, a drug producing a 3-log kill will reduce 1012 cells to 109, or will reduce 106 cells to 103 (three orders of magnitude in either case). This hypothesis accounts for the far better results observed with chemotherapy when the total tumor burden is low. The half-life of the drug (choice C) does not determine the number of cells killed, assuming an adequate dose is given. Choices D and E are both reflections of cell cycle specificity, the ability of a drug to specifically kill cells in a particular phase of the cell cycle (eg, S phase or G0 phase), and are unrelated to first-order kinetics.

An anticancer chemotherapeutic agent that acts by first-order kinetics would be expected to kill a:A. constant number of cancer cells B. constant proportion of cancer cells C. variable number of cells depending on the half-life of the drug D. variable number of cells depending on the proportion of cells in S phase E. variable proportion of cells depending on the number of cells in the G0 phase Answer is b.since in 1st order kinetics clearance n t half remains constant.

Chemotherapeutic agent causing SIADH is a- Cyclophosphamide b- Vincristine c- Visblastine d- D-carbazine

The chemotherapeutic agent , most commonly administered by continuous infusion , is: 1) ARA-C 2) 5 -FU 3) Cisplatin 4) Etoposide.

read KDT 5th ed: pg 777 it says cisplatin is given by slow iv infusion. Harri mentions that 5 Fu is given by IV infusion at a few places...eg' pg 557 cervical cancer... 5 -FU 4 gm given by 96 hr infusion pg 531 GI tract cancer: here he mentions 5-FU is initially used a a bolus & then as an infusion for for 2 days

harri pg 476 (16 ed) IV administration of 5-FU leads to bone marrow suppression after short infusions and stomatitis after prolonged infusions. [ what can we infer from this? i'm still confused] Immediately in the next para: For ara-C: Continuous infusion schedules allow maximum efficiency, with uptake maximal at 5 to 7 microM

So can we conclude that its ara-C? for sure? I'm still a bit confused! See if this helps u.. from Cecil's: "Cytarabine is an S-phase-specific agent that is particularly useful in acute non-lymphocytic leukemia and, to a lesser extent, in other hematologic malignancies. Its active form, ara-CTP, competitively inhibits DNA polymerase, blocking DNA synthesis. Ara-C also blocks chain elongation and ligation of fragments into newly synthesized DNA. Ara-C is given intravenously and crosses the blood-brain barrier. It is administered either by continuous infusion or in bolus doses by the intravenous or subcutaneous route for 5 to 7 days. In an alternative schedule that exceeds the manufacturer's recommended maximum, high-dose ara-C is administered in doses of 1 to 3 g every 12 hours for 3 to 5 days and yields higher response rates. The duration of intracellular retention of ara-CTP appears to predict ara-C antileukemic effects, with best results in patients who have the longest ara-CTP retention times. Both standard and high-dose ara-C can produce severe myelosuppression." "Fluorouracil (5-FU) is an important anticancer agent used to treat a variety of solid tumors, including cancers of the head and neck, esophagus, breast, and colon. It acts synergistically with a variety of agents, including platinum compounds and radiation therapy. Studies indicate that "pulse" or bolus injections of 5-FU are cytotoxic mainly as a result of incorporation into RNA, whereas continuous infusions of this drug (2 or more days) kill cells by inhibiting DNA synthesis and producing "thymine-less death." 5FU is usually given intravenously by bolus or infusion schedules but can also be used in intra-arterial, intracavitary, and topical therapy. An optimal schedule for 5-FU administration is a 5-day continuous infusion at a dose rate of 1.0 g/m2 /day. " It seems that ara-c is administered exclusively by infusion or bolus only, while 5fu has other routes... so why not take it arac as the answer?(this may sound foolish, but sometimes thinking like a simpleton helps breaking a deadlock!!!!! ) 1. Which of the following inhibitis the activity of acetyl CoA Which of the following inhibitis the activity of acetyl CoA carboxylase? A Citrate B Glucagon C High carbohydrate, low fat diet D Insulin 1. Glutaryl CoA, Acetoacetyl CoA and Acetyl CoA are formed from Glutaryl CoA, Acetoacetyl CoA and Acetyl CoA are formed from A Tryptophan B L- Isoleucine C L- Valine D L-Leucine A Tryptophan 1. Which vitamin products cofactors that are involved in glycol

Which vitamin products cofactors that are involved in glycolysis, ketone body synthesis, and gluconeogenesis? A Niacin B Thiamine C Biotin D Riboflavin 1. Toxic ingestion 1-15-year-old teenage girl presents to the emergency department after her mother reports that her daughter has been having nausea and vomiting for the last 3 hours. The patient is scared and reports to taking a mouth full of acetaminophen. Her current blood level of acetaminophen is pending, but liver transaminases are elevated. What is the next most appropriate step in the treatment of this patient? 1. 2. 3. 4. Gastric lavage Administer activated charcoal Administer N-acetylcysteine (NAC) Psychiatric consulta

2-Gastric lavage is contraindicated in each of the following ingestions except: 1. 2. 3. 4. 5. Liquid plumber Gasoline Tricyclic Antidepressant (TCA) Clonidine patches None of the above

1. theophylline tab ingestion by a 4 yr old child You get a call from a mother who is panicked because her 4-year-old took some of her theophylline. She thinks it may have been as many as 10 pills but is not clear on the actual number. She is about 35 minutes from the hospital.Your advice to her is: ..?.... A) Give ipecac to promote stomach emptying and reduce theophylline absorption. B) Do not give ipecac and proceed directly to the hospital. C) Call poison control and then proceed to the hospital. D) None of the above 1. After alcohol ingestion, which of the following intermediate After alcohol ingestion, which of the following intermediates accumulates in liver that is not typical of glycolysis or the citric acid cycle? a. Acetyl CoA b. Lactate c. Acetaldehyde d. Citrate e. Oxaloacetate

1. 73-yr old woman has difficulty concentrating and demonstrate 73-yr old woman has difficulty concentrating and demonstrates some mild immediate-memory problems. She has a poor appetite and has lost 24 lbs in 6wks. She resists participation in recreational activities, and she wakes up at 4:00 AM everyday and is unable to get back to sleep. Her condition is worsening on a daily basis. Which of the following is the most likely diagnosis? a. alchohol-related delirium b. dementia of the alzheimer type c. hypothyroidism d. normal pressure hydrocephalus e. pseudodementia 1. The theophylline dose should be reduced in a patient with as To decrease the likelihood of drug toxicity, the theophylline dose should be reduced in a patient with asthma in which of the following circumstances? A) Active tobacco user B) Azithromycin use for Mycoplasma pneumonia C) Augmented use for recurrent otitis media D) Marijuana abuse E) Phenobarbital use for a seizure disorder 1. The answer is B. Although inhaled sympathomimetics are now considered the first-choice treatment for acute asthmatic attacks, methylxanthines such as theophylline are effective bronchodilators and continue to be used extensively in this disorder. The therapeutic plasma concentration is 10 to 20 g/mL, but the dose required to achieve these levels varies widely, depending on the clinical situation. The theophylline dose should be reduced in any condition in which the clearance of this drug is significantly impaired, such as in the very young, the elderly, and those with liver or cardiac dysfunction. Many drugs interfere with the metabolism of theophylline. Some commonly used agents, including allopurinol, propranolol, cimetidine, and erythromycin, interfere with theophylline clearance and thus lead to increased levels of this methylxanthine. Drugs that activate hepatic microsomal enzymes, such as cigarettes, marijuana, phenobarbital, and phenytoin, may lower theophylline levels. 2. An asthmatic patient is on theophylline suddenly developed i An asthmatic patient is on theophylline suddenly developed infection, which of the following antibiotic should not be given to prevent side effects of theophylline : One answer only. a) Ampicillin b) Erythromycin c) Cephalexin d) Sparfloxacin 1. Intermediate acting steroid Intermediate acting steroid is a) Betamethasone b) Paramethasone

c) Dexamethasone d)Methylprednisolone

1. Methotrexate exerts its antitumor effect by Methotrexate exerts its antitumor effect by (A) preventing absorption of folic acid (B) inhibiting dihydrofolate reductase (C) preventing formation of messenger RNA (D) forming a crytotoxic metabolite (E) preventing proper functioning of membrane ATPase 1. side effect of thiazids OPTIONS: a.hyponatremia b.hypernatremia c.hyperkalemia d.hypokalemia e.hypercalcemia 1. Guest side effect of Cysplatin : Which of the following is the side effect of Cysplatin :

a) Renal failure b) Acute tubular necrosis c) Thrombocytopenia d) Hemorrhagic cystitits 1. Side effect of neuroleptic drugs Commonest side effect of neuroleptic drugs is: a) EPSE b) Postural hypotension c) Sedation d) Constipation 1. ICH OF THE FOLLOWING AMINOGLYCOSIDES WHEN USED INTRAWHICH OF THE FOLLOWING AMINOGLYCOSIDES WHEN USED INTRAVITREOULY IS MOST RETINO-TOXIC

1.GENTAMYCIN. 2.TOBRAMYCIN. 3.AMIKACIN. 4.NEOMYCIN. IS IT GENTAMYCIN

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