Title: 1 Pharm BI-4

1. Which of the following drugs will produce a significantly higher concentration of

active metabolite in cells infected with the target virus?

a. Foscarnet
b. Oseltamivir
*c. Acyclovir
d. Lamivudine
e. Ribavirin

Title: 2 Pharm BI-4

2. A fixed dose of lopanivir and ritonavir is used in the US to treat HIV-positive patient.
Why is this combination effective?

a. Ritonavir and lopanivir have different mechanisms of action

*b. Ritonavir decreases the hepatic metabolism of lopanivir
c. Ritonavir decreases the excretion of lopanivir
d. Lopanivir inhibits development of viral resistance to ritonavir
e. Lopanivir facilitates the integration of the virus

Title: 3 Pharm BI-4

3. A person with HIV has continuously received acyclovir for treatment of recurrent
herpes simplex lesions. Lately the HSV strain has been found resistant to acyclovir. The
most likely explanation for this resistance is mutation of the viral

a. M2 ion channel
b. protease
*c. thymidine kinase
d. reverse transcriptase
e. RNA-dependent RNA polymerase

Title: 4 Pharm BI-4

4. A 25 year-old man is diagnosed with HIV and is initiated with the HAART (cART)
regimen. After the first week of therapy, he complains of nightmares, headaches and ill
temper. Which of the following HIV-antivirals most probably causes these symptoms?

*a. Efavirens
b. Lamivudine
c. Indinavir
d. Stavudine
e. Ritonavir

Title: 5 Pharm BI-4

5. A patient with HIV is receiving a combination of protease inhibitors as part of the
antiviral therapy. What is the most likely adverse effect of the protease inhibitors?

a. anemia and neutropenia

b. neuropathy
c. lactic acidosis
*d. hyperglycemia and hyperlipidemia

e. pancreatitis

Title: 6 Pharm BI-4

6. A patient that has been transplanted with a allograft kidney developed an acute CMV
infections characterized by fever, leukopenia, malaise, and arthralgia. Which of the
following drugs would be best to treat the cytomegalovirus infection?

*a. Ganciclovir
b. Rimantidine
c. Carbenicillin
d. Zidovudine
e. DIdeoxycitidine

Title: 7 Pharm BI-4

7. A 9-year-old was brought to the pediatrician with high fever and respiratory symptoms
and was diagnosed with influenza A virus subtype HIN5. Which of the following drugs
will be to be effective treating this infection?

a. Acyclovir
b. Amantidine
*c. Oseltamivir
d. Ganciclovir
e. Ritonavir

Title: 8 Pharm BI-4

8. Which of the following drugs is most likely to cause myelosuppression?

a. Famciclovir
b. Penciclovir
*c. Ganciclovir
d. Foscarnet
e. Amantidine

Title: 9 Pharm BI-4

9. Which of the following viral infections is suitable for the neuraminidase inhibitor
zanamivir?

a. HIV/AIDS
b. Respiratory syncytial virus
c. Herpes simplex type II
*d. Influenza
e. Herpes zoster

Title: 10 Pharm BI-4

10. PP, a 25-year-old carpenter was diagnosed with HIV four years ago. He recently has
started therapy with Tenofovir, Emcitritabine, ritonavir/ lopinavir. He should contact the
health care provider if he develops which of the following symptoms associated with
tenofovir?

a. Headache

b. Feeling unusually cold in the arms and legs associated with

*c. Problems urinating and increasing proteinuria
d. Hair Loss
e. Nasal allergy

Title: 11 Pharm BI-4

11. A woman who recently had bone marrow transplantation developed invasive
pulmonary aspergillosis while hospitalized. Which of the following antifungals did the
physician prescribe?

*a. Amphotericin B
b. Fluoconazole
c. 5-FU
d. Itraconazole
e. Griseofulvin

Title: 12 Pharm BI-4

12. Which of the following antiviral has as its mechanism of action the prevention of
viral uncoating after penetration into the host cell?

a. idoxuridine
b. vidarabine
c. acyclovir
d. ribavirin
*e. amantadine HCl

Title: 13 Pharm BI-4

13. Mr. Gonzalez was received at the emergency room with respiratory distress
characteristic of bronchial asthma and the attending decided to administer an adrenergic
drug. Which of the following agonists would be used for asthma patients?

a. alfa2-agonist
b. alfa1-agonist
c. beta3-agonist
*d. beta2-agonist
e. beta1-agonist

Title: 14 Pharm BI-4

14. During anesthesia for a dental procedure, epinephrine was added to the local
anesthetic. A few minutes after drug administration the patient developed tachycardia and
the dentist decided to call a physician. By which mechanism epinephrine caused
tachycardia?

a. Stimulation of alpha-1 receptor

b. Stimulation of alpha-2 receptor
*c. Stimulation of beta-1 receptor
d. Stimulation of beta-2 receptor
e. Stimulation of beta-3 receptor

Title: 15 Pharm BI-4

15. Patient was received at the Emergency Room with severe chest pain. You order an
electrocardiogram. The ECG comes back with acute ST-segment depression and you
diagnose a angina pectoris. You start giving oxygen, sublingual nitroglycerin for the pain.
You also gave another medication that you know recommend to prevent futures attacks.

a. alpha agonist
*b. beta-antagonist
c. muscarinic agonist
d. neuromuscular blocker
e. dopamine against

Title: 16 Pharm BI-4

16. The increase in strength of heart contraction caused by isoproterenol is related to:

a. Formation of cGMP
*b. Phosphorylation of calcium channels by protein kinase A
c. Phosphorylation of potassium channels
d. Increase of sodium permeability
e. Increase of ATP levels

Title: 17 Pharm BI-4

17. Patient male 68 years old was received at the emergency room of Cardiovascular Unit
referring strong chest pain. The electrocardiogram indicates an extensive anterior
myocardial infarction and within 2 hours the patient generated a cardiogenic shock with a
severe fall in blood pressure and peripheral resistance. To increase the peripheral
resistance which of the following drugs can be administered intravenously with caution?

a. Isoproterenol
b. Epinephrine
c. Guanetidine
*d. Norepinephrine
e. Prazosin

Title: 18 Pharm BI-4

18. A young female with history of bronchial asthma came to the cardiologist referring a
sensation that her heart is not well. The physical examination indicated an abnormality of
the heart beat and the electrocardiogram showed the presence of premature ventricular
beats (PVBs). The patient had no previous history of cardiac disease but a previous
laboratory analysis indicated elevation of the thyroid hormone. The cardiologist decided
to administer a drug to abolish the abnormal rhythm. Considering the evidence of
bronchial asthma which of the following drugs is recommended?

a. Propranolol
*b. Metoprolol
c. Lobetalol
d. Nadolol
e. Timolol

Title: 19 Pharm BI-4

19. Intravenous injection of epinephrine (1 ug/Kg) was administered to a patient male 48
years old causing changes in the strength of heart contractions, heart rate and arterial
systolic and diastolic blood pressure as shown below. Later on, a drug X was
administered intravenously and epinephrine was administered again, at the same dose, in
presence of drug X. According to the diagram drug X is:

a. guanetidine
b. phenylephrine
*c. propranolol
d. carbachol
e. ephedrine

Title: 20 Pharm BI-4

20. The graph showed below shows dose-response curves for isoproterenol (Control)
alone and in presence of one or the other of two beta receptor antagonists, drugs X and Y.
The responses are an increase in heart rate of a human subject and relaxation in vitro of
human bronchiolar muscle. Drug X is most likely:

a. propranolol
b. pindolol
c. timolol
*d. metoprolol
e. nadolol

Title: 21 Pharm BI-4

21. Miss Angulo has nasal mucosa stiffness and her physician prescribed phenylephrine
because it causes vasoconstriction. By which of the following effects phenylephrine
causes vasoconstriction?

a. blocking beta-adrenoreceptors
b. blocking nicotinic receptors
*c. stimulating alpha-adreneoreceptors
d. stimulating muscarinic cholinoreceptors
e. stimulating dopamine receptors

Title: 22 Pharm BI-4

22. A 6- year old boy is brought by his parents for complains of hyperactivity at school.
After a detailed interview the physician decides to give the boy amphetamine-containing
medication for presumed attention hyperactivity disorder. Amphetamine:

a. Inhibits epinephrine reuptake

*b. Indirectly acts on norepinephrine receptors
c. Blocks effects of norepinephrine
d. Directly acts on cholinoreceptors
e. Inhibits serotonin reuptake

Title: 23 Pharm BI-4

23. Mr. Gilbert 34 years old is normotensive but presented periodic hypertensive crisis
which are caused by a pheochromocytoma. Due to the severity of the crisis his physician
recommends him to remove the tumor. At the beginning of the surgery, the surgeon asked
the anesthesiologist to prevent the possible increase in blood pressure which is common
by manipulation of the tumor. Which of the drugs list below is appropriate to prevent the
increase in blood pressure during the tumor removal?

a. ephedrine
*b. phenoxybenzamine

c. atropine
d. phenylephrine
e. scopolamine

Title: 54 Pharm BI-4

54. Mr. Brooks arrived at the hospital and an ECG performed at the Emergency Room
showed AV block. Because he was taking a drug for his blood pressure the attending
concluded that this drug was the cause of the AV block. Which of the following drugs is
involved in the AV block?

a. atropine
*b. metoprolol
c. methyldopa
d. phenylephrine
e. phentolamine

Title: 55 Pharm BI-4

55. Acetylcholine is released from a presynaptic terminal and interacts with its receptor at
the neuromuscular junction. What happens to the acetylcholine molecule following
interaction with its interaction with the receptor on the skeletal muscle membrane?

a. Acetylcholine is transported back into the presynaptic membrane

b. Acetylcholine is internalized into the post-synaptic cell
c. Acetylcholine diffuses away and is eventually hydrolyzed in the plasma
d. Acetylcholine remains bound to its receptor for up to 15 minutes
*e. Acetylcholine is rapidly hydrolyzed to choline and acetate

Title: 56 Pharm BI-4

56. Acetylcholine causes vasodilation by stimulating the release of which of the
following substances from the endothelium?

a. Arachidonic acid
b. Calcium
c. Cyclic AMP
d. Histamine
*e. Nitric oxide

Title: 57 Pharm BI-4

57. When the sympathetic fight or flight response is activated, which neurotransmitter
is released from autonomic ganglion neurons onto cells in the adrenal medulla?

a. epinephrine
b. norepinephrine
c. dopamine
*d. acetylcholine
e. GABA

Title: 58 Pharm BI-4

58. A 40-year old woman is diagnosed with Sjogrens syndrome. Cevimeline is
prescribed. Which of the following best describes the intracellular effect of cevimeline?

*a. Stimulation of phospholipase C

b. Activation of adenylyl cyclase
c. Inhibition of adenylyl cyclase
d. Opens a G-protein regulated potassium channel in the cell membrane
e. Blocks a voltage-gated sodium channel in the cell membrane

Title: 59 Pharm BI-4

59. A three year old child is brought to the Emergency Department by her parents. They
found her with a wad of nicotine gum in her mouth. She had vomited in the car on the
way to the hospital. At arrival, she was hypertensive and tachycardic. One hour later she
had developed bradycardia, hypotension, and respiratory depression. She was intubated
and hospitalized in the PICU. What is the cause of the hypotension?

*a. block of autonomic ganglia

b. stimulation of autonomic ganglia
c. activation of the adrenal medulla
d. block of the neuromuscular junction
e. production of nitric oxide

Title: 60 Pharm BI-4

60. An 80 year-old man presents at the emergency room complaining of periorbital pain
and a severe unilateral headache. Careful evaluation reveals that the man has acute closed
angle glaucoma. Which of the following will be useful?

a. Atropine
b. Oxybutynin

*c. Pilocarpine
d. Pralidoxime
e. Tiotropium

Title: 61 Pharm BI-4

61. A 35 y/o agricultural field worker is brought to the Emergency Room by the field
foreman. He cannot work without support and has difficulty talking. He was cultivating
pineapples when a gust of wind carried parathion onto him from a nearby field where it
was being sprayed. He experienced difficulty breathing almost immediately and called
for help. Which of the following best describes why is he now experiencing difficulty
walking and talking?

*a. The muscle nicotinic receptor is desensitized

b. Activation of the nicotinic ganglionic receptor reduces acetycholine release from the
neuromuscular junction
c. Norepinephrine released by ganglionic stimulation is causing muscle weakness
d. Activation of acetylcholine receptors in the basal ganglia produces muscle weakness
e. Activation of presynaptic N-N receptors at the neuromuscular junction reduce
activation of the post-synaptic acetylcholine receptor

Title: 62 Pharm BI-4

62. A 25 year-old man who has been under treatment for myasthenia gravis for 6 months
presents with severe, generalized muscle weakness. The physician is uncertain is if he is
receiving too much or too little medication. Administration of which of the following will
help determine the diagnosis?

*a. edrophonium
b. pyridostigmine

c. oxybutynin
d. pilocarpine
e. propranolol

Title: 63 Pharm BI-4

63. The medical officer for troops stationed in Iraq is concerned about possible exposure
to organophosphate nerve gases. To improve protection when exposure is possible, she
recommends pre-treating combat soldiers with a drug that will largely prevent
organophosphate inactivation of acetylcholinesterase. Which of the following would be
most effective for this medication goal?

a. atropine
b. pralidoxime (2-PAM)
*c. pyridostigmine
d. edrophonium
e. pilocarpine

Title: 64 Pharm BI-4

64. Following eye surgery, the surgeon wants a drug to prevent the iris from adhering to
the lens. Which of the following would be effective?

*a. atropine
b. cevimeline
c. tubocurare
d. propranolol
e. physostigmine

Title: 65 Pharm BI-4

65. A 75 y/o man with sinus bradycardia (heart rate of 50 beats per minute) is scheduled
for prostate surgery with an inhalational anesthetic. Because of the irritating property of
the anesthetic, the anesthesiologist decides to add a drug to reduce airway secretions.
Which of the following will produce minimal or no bradycardia?

a. Atropine
*b. Glycopyrrolate
c. Scopolamine
d. Pyridostigmine
e. Bethanechol

Title: 66 Pharm BI-4

66. An 80 year-old woman presents to her health care provider with a complaint of
frequently feeling the urge to urinate. She sometimes has embarrassing accidents. She is
also being treated for hypertension with propranolol. Which of the following drugs would
reduce the problem of urge incontinence without increasing heart work?

a. atropine
*b. oxybutynin
c. cevimeline
d. albuterol
e. pyridostigmine

Title: 67 Pharm BI-4

67. A non-depolarizing neuromuscular blocker is used during anesthesia to maintain

muscle relaxation. Following the surgery, the anesthesiologist terminates the blocking
action by administering a drug. Which drug was administered?

a. atropine
*b. edrophonium
c. dantrolene
d. succinylcholine
e. pilocarpine

Title: 68 Pharm BI-4

68. Pancuronium is being used during surgery to maintain skeletal muscle relaxation. The
anesthesiologist regularly tests the degree of block with train-of-four stimuli and posttetanic potentiation. Which of the following best describes the origin of Fade in the
train-of-four test?

*a. block of presynaptic nicotinic autoreceptors

b. block of the acetylcholine NM receptor
c. block of presynaptic M1 receptors
d. desensitization of the acetylcholine receptor
e. block of sodium channels

Title: 69 Pharm BI-4

69. A paraplegic 35 year-old man who had been severely injured in a fall at his home was
brought by ambulance to the Emergency Department. He was belligerent despite his
paraplegia and life-threatening injuries, and needed an immediate CT scan. What
dangerous metabolic adverse effect might occur if succinylcholine is used for rapidsequence intubation?

*a. hyperkalcemia
b. hyperglycemia
c. hypoglycemia
d. hyponatremia
e. hypercalcemia

Title: 70 Pharm BI-4

70. A patient in the operating room has been anesthetized with halothane with
succinylcholine as an adjuvant drug. The anesthesiologist notices that the patients arm is
becoming stiff and his temperature has risen. He immediately notifies the surgeon. A drug
is administered to prevent further rise in temperature and skeletal muscle rigidity. Which
of the following best describes the drugs mechanism of action?

a. GABA-A agonist
b. GABA-B agonist
c. Potentiates GABA activity at the GABA-A ion channel
d. Alpha-2 agonist
*e. Blocks the ryanodine receptor

Title: 71 Pharm BI-4

71. A 26 year-old man with spinal cord damage has painful ankle flexion. He is treated
with a drug that effectively suppresses the hyperactive stretch response reflex by means
of a presynaptic alpha2 receptor. The drug acts by indirectly decreasing the release of
glutamate. Which of the following is being used in this patient?

a. baclofen

b. diazepam
*c. tizanidine
d. baclofen
e. botulinum toxin

Title: 72 Pharm BI-4

72. A 24 year old man with cerebral palsy is successfully treated with a drug that is nonsedating. It is a direct GABA agonist and enhances inhibitory tone in the stretch response
reflex. Which of the following is he being treated with?

a. tizandidine
b. diazepam
*c. baclofen
d. orphenadrine
e. botulinum toxin

Title: 73 Pharm BI-4

73. A 55 year-old Black male presented at the Emergency Department with sudden onset
of severe chest pain that he described as something tearing inside his chest. Acute
aortic dissection was diagnosed, and was corrected surgically. Which of the following
drug classes could be used to produce hypotension and block increased heart rate during
the critical repair?

*a. ganglionic NN blocker

b. neuromuscular NM blocker
c. alpha1blocker

d. beta1 blocker
e. M2 blocker

Title: 74 Pharm BI-4

74. An 8 year-old child is being treated with imipramine for management of bed-wetting.
Although it is usually used for treatment of depression, imipramine has useful antimuscarinic activity. Which of the following side effects is most likely to occur?

*a. dry mouth

b. reduced gastric acid secretion
c. miosis
d. tachycardia
e. hot, dry skin

Title: 75 Pharm BI-4

75. A patient is anesthetized for surgery with succinylcholine added to provide muscular
relaxation. After administration of succinylcholine, fine muscular fasciculations can be
observed in the patients skeletal muscles, which disappear a short time later. Why do the
fasicuclations end?

*a. inactivation of voltage-gated sodium channels at the edge of the end-plate

b. prolonged hyperpolarization at the muscle endplate
c. desensitization of the acetylcholine receptor
d. closed channel block of the acetylcholine receptor
e. open channel block of the acetylcholine receptor

Title: 76 Pharm BI-4

76. AK is a 25 year-old male patient was recently diagnosed with Hodgkin's disease. The
oncologist treats him with a drug regimen consisting of doxorubicin, mechlorethamine,
bleomycin, vinblastine and procarbazine. This morning, AK presents to the oncologist
office with the chief complaint of shortness of breath upon exertion and a dry cough. A
chest X-ray was taken and pulmonary infiltration is detected. Which of the drugs in this
patient's regimen is the most likely cause and must be discontinued?

a. Doxorubicin
b. Mechlorethamine
*c. Bleomycin
d. Vinblastine
e. Procarbazine

Title: 108 Pharm BI-4

108. Which of the following mechanisms most likely causes drug resistance by cancer
cells to multiple anticancer agents?

a. Amplification of metabolizing enzymes

b. Amplification of target enzymes
*c. Increased cellular efflux of drugs
d. Increased repair of DNA damage

Title: 109 Pharm BI-4

109. Cyclophosphamide is used with several anticancer agents in the treatment of
lymphomas, some forms of leukemia and some solid tumors. Which of the following
adverse effect you as oncologist should warn the patient as a serious toxicity of
cyclophosphamide?

a. alopecia
*b. myelosuppression
c. renal damage
d. hepatic failure
e. pulmonary fibrosis

Title: 110 Pharm BI-4

110. KB is a 71-year-old man farmer. He was recently diagnosed with carcinoma in situ
(CIS) of the bladder and his physician has placed him on the CMVB (cisplatin,
methotrexate, vincristine, bleomycin) regimen with radiotherapy. This therapy has
induced a significant amount of myelosuppression, which has made KB too tired to
work. Which of these drugs affects the mitotic spindle?

a. cisplatin
b. methotrexate
*c. vincristine
d. bleomycin
e. radiation

Title: 111 Pharm BI-4

111. A 15-year-old boy presents to his pediatrician with a chief complaint of a pain in his
right thigh. On evaluation of his right thigh is found to have a red swollen area. X-ray and
MRI of the thigh reveal extensive bony destruction and the presence of a bony tumor that
is diagnosed as an osteosarcoma. He is offered a limb salvage treatment that includes
neoadjuvant chemotherapy (methotrexate, cisplatin, doxorubicin and ifosfamide and
radiotherapy prior to tumor resection & bone grafting. He is also given leucovorin to
rescue normal cells from the toxicity of which of the following?

*a. methotrexate
b. cisplatin
c. doxorubicin
d. ifosfamide
e. Radiotherapy

Title: 112 Pharm BI-4

112. A 33-year old woman presents with tender swelling of the breast. A biopsy reveals
cells with an S phase fraction of 11% (for normal cells it should be ~1%). The cells are
estrogen and progesterone receptor negative, but overexpress Her2/neu . There is no
evidence for metastasis. The patient is initially treated with 4 courses of doxorubicin and
cyclophosphamide followed by a modified radical mastectomy. Two months after surgery
the patient was started with adjuvant therapy consisting of 4 cycles of paclitaxel. Besides
alopecia and nausea & vomiting, which additional adverse effect should you warn your
patient to look for since it is frequently associated with this type of adjuvant therapy?

a. Hemorrhagic cystitis
b. Nephrotoxicity
*c. Numb and tingling hands and feet
d. Pulmonary fibrosis
e. Thromboembolism

Title: 113 Pharm BI-4

113. Drug resistance represents a major obstacle to improving the overall response and
survival of cancer patients. Resistance of tumor cells to paclitaxel is the result of which
of the following?

a. Modification of DNA repair mechanism

b. Increased thiol content
c. Increased activity of glutathione transferase
*d. Mutation in the microtubule
e. Gene amplification

Title: 114 Pharm BI-4

114. Which of the following is a characteristic of Cytarabine (Ara-C) that makes it highly
useful in the treatment of acute myelogenous leukemia?

a. intercalate with DNA and produce double strand breakage

*b. interfere with synthesis of DNA
c. form interstrand cross-linkage with DNA
d. enhance T lymphocyte cytotoxicity
e. stops microtubule polymerization

Title: 115 Pharm BI-4

115. Mucositis (inflammation and necrosis of mucosal membranes) is a serious and
debilitating consequence of many cancer therapies. Which of the following anticancer
drugs, activated enzymatically to function as an alkylating agent, is characterized by
causing serious oral mucositis?

a. Doxorubicin
b. Paclitaxel
*c. Cyclophosphamide

d. Asparaginase
e. Cisplatin

Title: 116 Pharm BI-4

116. A 65-year-old man was diagnosed with advanced oropharyngeal cancer and is in
treatment with an anticancer drug and radiotherapy. He is treated with hydration to
prevent renal toxicity, a side effect of which of the following drugs?

*a. Cisplatin
b. Chlorambucil
c. Methotrexate
d. Tamoxifen
e. Gemcitabine

Title: 117 Pharm BI-4

117. A 42-year-old woman had breast cancer estrogen receptor positive. However tumor
cells were resistant to Tamoxifen most probably due to which of the following?

a. presence of an amplified P-glycoprotein

b. alteration in the tubulin structure
c. Increased DNA repair
*d. decreased affinity to estrogen receptor
e. Increased production of thiols

Title: 118 Pharm BI-4

118. A cancer patient develops severe, irreversible cardiomyopathy because the

cumulative dose of the anticancer drug exceeded the acceptable levels. Which of the
following drugs is most likely responsible for this complication?

a. Bleomycin
b. Cisplatin
*c. Doxorubicin
d. Vincristine
e. Cyclophosphamide

Title: 119 Pharm BI-4

119. Mr. Roman had an accident and was received at the trauma center and immediately
delivered to the operating room for urgency surgical procedure. The surgeon requested
the anesthesiologist to achieve an anesthesia at the surgical level, as soon as possible.
Which of the following statements is correct on selecting the appropriate general
anesthetic?

a. Decreasing the cardiac output will increase the onset of anesthesia

*b. Induction of general anesthesia is rapid with agents of low blood solubility
c. The effect of nitrous oxide is very slow
d. Induction of general anesthesia is accelerated by decreasing the inspired anesthetic gas
concentration
e. Halothane has a low blood/alveolar air coefficient

Title: 120 Pharm BI-4

120. In the patient described above the level of surgical anesthesia is achieved when?

a. The papillary reflex to light is still preserved

*b. Incision can be produced without changes in blood pressure
c. The corneal reflex is present
d. Respiration is rapid and superficial
e. The reticular formation is still active

Title: 121 Pharm BI-4

121. For a small surgical procedure thiopental was administered intravenously. Observing
the patient the resident was surprised that the effect of thiopental was of short duration.
How you explain the short duration of this drug?

a. Its rapid metabolism

b. Its fast renal excretion
*c. Its redistribution from brain to other tissues
d. Change of its chemical structure
e. Its binding to plasma proteins

Title: 122 Pharm BI-4

122. During a dental procedure lidocaine was injected parentherally and within minutes
local anesthesia was achieved. Which of the following explains the anesthetic action of
lidocaine?

a. blockade of chloride channels

b. blockade of potassium channels
*c. blockade of sodium channels

d. blockade of calcium channels

e. increase of bradikynin levels

Title: 123 Pharm BI-4

123. During a surgical procedure lidocaine was administered but it produced a small
effect due to severe inflammation of the tissue. How you explain the small effect of
lidocaine under these circumstances?

*a. acidosis reduced the penetration of lidocaine into axons

b. lidocaine is rapidly metabolized
c. lidocaine is diluted into the tissue fluids
d. the absorption of lidocaine is increased
e. lidocaine is transformed into a smaller anesthetic agent

Title: 124 Pharm BI-4

124. Due to the magnitude of the surgical procedure epinephrine was administered
together with lidocaine in order to prolong the anesthetic action of lidocaine. How
epinephrine prolongs the duration of anesthesia with lidocaine?

a. epinephrine increases the metabolism of lidocaine

b. the chemical structure of lidocaine is changed
*c. the absorption of lidocaine is reduced
d. epinephrine increases the penetration of lidocaine into axons
e. epinephrine reduces the bradikynin levels

Title: 125 Pharm BI-4

125. To extend the spectrum of some penicillins, clavulanic acid has been added to
certain preparations. What is the mechanism by which clavulanic acid extends this
spectrum?

a. Providing additional antimicrobial activity

b. Enhancing gastrointestinal absorption of the penicillin
c. Reducing allergic reactions to the penicillin
*d. Binding to and inactivating beta-lactamase
e. Facilitating entrance of penicillin in the bacterium

Title: 126 Pharm BI-4

126. Which of the following antimicrobials is most likely associated with aplastic
anemia?

a. Ciprofloxacin
b. Penicilln G
*c. Chloramphenicol
d. Amikasin
e. Sulfamethoxazole

Title: 127 Pharm BI-4

127. A 25 year-old woman come to your clinic complaining burning sensation during
urination, soreness, inflammation and discharge. Analysis shows a yeast infection. She
indicates that she is not using medications. Which drug is the appropriate choice of acute
treatment of the infection?

a. Amphotericin B
b. Griseofulvin
*c. Fluconazole
d. Nystatin
e. Econazole

Title: 128 Pharm BI-4

128. In terms of usable biochemical differences between host and infecting organisms,
what type of biochemical reaction is the best target for antibacterial chemotherapy?

a. Protein synthesis
b. DNA Synthesis
c. Folate synthesis
d. Sterol synthesis
*e. Cell wall synthesis

Title: 129 Pharm BI-4

129. A young woman complains of painful and frequent urination. She has no other
complaints and urinalysis shows some RBC, leucocytes, and bacteria. Which of the
following antimicrobials will be appropriate therapy for this patient?

a. Penicillin G
b. Nafcillin
*c. Trimethoprim-Sulfamethoxazole

d. Azithromycin
e. Chloramphenicol

Title: 130 Pharm BI-4

130. A 25 year-old man goes to the Medical Center with complaints of fever for the last
two days, chills, chest pain and rust colored sputum. When the sputum was analyzed it
was suggestive of Streptococcus pneumoniae. Until the blood culture results are available
which antibiotic would probably be the most effective and the least toxic?

a. Cefaclor
b. Penicillin G
*c. Levofloxacin
d. Clindamycin
e. Vancomycin