Para sa ating lucky 52 na mag-reremove on Monday, I hope this helps

Thanks to everyone na nag-contribute ng questions, answers, tips ^_^

We werent so sure if some of the questions here were actually in our Final exam, pero nilagay na rin namin dito just in
case.
If there are any corrections, pakisabi nalang agad
Reminder: Doc Alvero said that her 45 questions that were multiple choice nung Finals are all going to be matching type
for the Removals. Some of her topics last year were (if you know any of her other topics last year na wala dito, please let
us know):
- Principles of Pharmacokinetics
- Principles of Chemotherapy
- Tx of Asthma
- Antimicrobials
- Tx of Acid Peptic Diseases
- Adrenal Steroids
- Anti-Epileptic drugs
We can doooo this!
- Aly

MULTIPLE CHOICE
1) Components of Pharmacokinetics include:
a. Absorption, distribution, metabolism, excretion
b. Mechanism of action, spectrum of activity, mode of activity
c. Adverse effects, drug interactions, contraindications
d. All of the above
2) Gynecomastia is a side effect of [Spirinolactone?] because:
- Cant remember the exact answer in the exam. Just remember that a lot of drugs metabolized in the liver has
gynecomastia as a side effect, since the liver metabolizes estrogen (which causes gynecomastia). So since the liver is
busy metabolizing other drugs, estrogen accumulates.

3) Majority of drugs enter the cell through:

Simple diffusion
10) Which of the following drugs is given to treat the SYMPTOMS of vertigo & motion sickness?
a. Dimenhydrinate
b. Meclizine
c. Scopolamine
d. all of the above
e. A & B

Anticholinergic drugs, especially the muscarinic receptor antagonist, scopolamine, and H1receptor antagonists, such as dimenhydrinate, meclizine, and cyclizine, are very useful in
motion sickness. They are anti-emetics that are useful in preventing vomiting due to vertigo.

15) A bronchodilator useful in COPD the answer should be either a beta-2 adrenergic agonist or an
anticholinergic agonist

A. Cromolyn Sodium
B. Ipratropium Bromide
C. Terbutaline
D. Theophylline
Note for this table: those with * is the protoype drug
A question in our exam was: Which of the anti-tussives is centrally-acting?
PERIPHALLY acting anti-tussives

H1-receptor inhibitors
Anti-histamines

also used as Anti-allergy

- Diphenhydramine hydrochloride*

Added to cough and cold remedies as both antitussives and

- Fenspiride
to treat the nasal congestion.

Do not have any direct antitussive effect but may act

indirectly by reducing postnasal drip
Expectorants
- Glyceryl guaiacolate*
- Syrup of Ipepac
- NH4Cl
- KCl

Mucolytics
- Bromhexine*
- Acetylcysteine
- Carboxymethylcysteine
- Ambroxol Hydrochoride

Aim to stimulate bronchial mucous production, making

the secretions easier to remove by cough or by ciliary
transport

Alter the viscosity of bronchial secretions

stimulates mucociliary action and clears the air passages in
the respiratory tract
Crosses the BBB & small amounts cross the placenta

Bronchodilators
Ephedrine, Theophylline, Terbutaline
Demulcents
- Syrup of Acacia
- Olive oil
- Glycerin
- Licorice
- Honey

Local Anesthetics
- Benzocaine
- Benzonatate

Narcotic (Opioids)
- Codeine
Non-Narcotic
- Dextrometorphan hydrobromide*
- Butamirate citrate
- Dimethoxanate
- Pipazethate

is an agent that forms a soothing film over a mucous

membrane, relieving minor pain and inflammation of the
membrane.

Soothes irritation
Component of throat lozenges
Lozenges are medicated candies that dissolves slowly
in the mouth and soothes the irritated throat
CENTRALLY acting anti-tussives

Both used as analgesic and respiratory depressant

acts centrally to elevate the threshold for coughing

Has no analgesic or addictive properties

17) Why is Penicillin V for minor infections (**Laryngitis, bronchitis, tonsillitis, otitis media, dental
abscesses, pneumonia, and soft tissue and skin infections caused by susceptible bacteria) only?
a. Bacterial resistance
b. Needed for frequent dosing
c. Relative poor bioavailability
d. Narrow spectrum
e. All of the above ?
Penicillin V is a natural penicillin. It has a spectrum similar to that of penicillin G, but it is not used for treatment of
bacteremia because of its higher minimum bactericidal concentration (the minimum amount of the drug needed to
eliminate the infection)
Criteria

Penicillin G

Penicillin V

Route of Administration

Parenteral

Oral

Gastric Acid Stability

Degraded

Stable

Penicillinase-resistant

NO

NO

Renal Clearance

Rapid

Rapid

26) Which is not an adverse effect of Corticosteroids?

a. Osteoperosis
b. Growth suprression
c. Cataract
d. Hypoglycemia (This should be HYPERglycemia)
Other side effects of Corticosteroids are:
weight gain
swelling and edema
high blood pressure
diabetes
black and blue marks
slowed healing of wounds
acne
muscle weakness

thinning of the skin

increased susceptibility to infection
stomach ulcers
increased sweating
mood swings
psychological problems such as
depression
adrenal suppression and crisis

31) Opioid analgesics work on which type of receptors?

A. Motor
B. Sensory
C. (Autonomic?)
D. Nociceptive
*NOTES FROM OUR TRANX: No autonomic, sensory, or motor blockade. Opioid analgesic effects are specific to nociceptive
(injury perceiving) neurons; Nociceptive afferents are unaffected, and normal sensation of pressure, touch and temperature are
preserved.

40) Why is Nitroglycerin given sublingulally? In order to bypass the first-pass effect
42) What is the most common effect of nitrate?
a. Headache because Nitrate causes vasodilation
b. Tremors
c. Hypertension dapat hypotension
d. Hypersensitivity
60) Adrenergic agonist with a comparable affinity to alpha 1, beta 1, beta 2 receptors?
a. Norepinephrine
b. Epinephrine
c. Ephedrine
d. ALL OF THE ABOVE
e. B & C
69?) Hepatic injury secondary to Acetaminophen causes this type of reaction:
a. Genotoxic
c. Phenotoxic
b. Phototoxic
d. Pharmacotoxic

69) Symptoms of Organophosphate poisoning: (to make things simple, isipin mo nalang na nagkakaroon dito ng
excess accumulation of ACh, thus the following symptoms)

a. convulsions
b. difficulty breathing
c. miosis
d. all of the above
e. A & C
Signs and symptoms of organophosphate poisoning can be divided into 3 broad categories, including (1) muscarinic
effects, (2) nicotinic effects, and (3) CNS effects.
Mnemonic for muscarinic effects=
- SLUDGE (salivation, lacrimation, urination, diarrhea, GI upset, emesis) and
- DUMBBBELS (diaphoresis and diarrhea; urination; miosis; bradycardia, bronchospasm, bronchorrhea; emesis; excess
lacrimation; and salivation).
Muscarinic effects by organ systems include the following:
Cardiovascular - Bradycardia, hypotension
Respiratory - Rhinorrhea, bronchorrhea, bronchospasm, cough, severe respiratory distress
Gastrointestinal - Hypersalivation, nausea and vomiting, abdominal pain, diarrhea, fecal incontinence
Genitourinary - Incontinence
Ocular - Blurred vision, miosis
Glands - Increased lacrimation, diaphoresis
Nicotinic signs and symptoms= muscle fasciculations, cramping, weakness, and diaphragmatic failure.
CNS effects include anxiety, emotional lability, restlessness, confusion, ataxia, tremors, seizures, & coma.
**Remember!: Atropine & Pralidoxeme are given to patients in cases of organophosphate poisoning

80) Which is a macrolide with 15-C ring?

*hindi maalala yung choices for this question, but I looked it up sa internet and Azithromycin is a 15membered ring macrolide. Here are some additional notes on macrolides:

Macrolides are one of the groups under protein synthesis inhibitors. The macrolides are a group of antibiotics with a macrocyclic lactone
structure to which one or more deoxy sugars are attached. Erythromycin was the first of these drugs to find clinical application, both as a
drug of first choice and as an alternative to penicillin in individuals who are allergic.The newer members of this family, clarithromycin (a
methylated form of erythromycin) and azithromycin (having a larger lactone ring), have some features in common with, and others that
improve on, erythromycin. Telithromycin , a semisynthetic derivative of erythromycin, is the first ketolide antimicrobial agent that has been
approved and is now in clinical use. Ketolides and macrolides have very similar antimicrobial coverage. However, the ketolides are active
against many macrolide-resistant gram-positive strains.
Erythromycin: This drug is effective against many of the same organisms as penicillin G; therefore, it is used in patients who are allergic
to the penicillins.
Clarithromycin: This antibiotic has a spectrum of antibacterial activity similar to that of erythromycin, but it is also effective against
Haemophilus influenzae. Its activity against intracellular pathogens, such as Chlamydia, Legionella, Moraxella, and Ureaplasma species
and Helicobacter pylori, is higher than that of erythromycin.
Azithromycin: Although less active against streptococci and staphylococci than erythromycin, azithromycin is far more active against
respiratory infections due to H. influenzae and Moraxella catarrhalis. Azithromycin is now the preferred therapy for urethritis caused by
Chlamydia trachomatis. It also has activity against Mycobacterium avium-intracellulare complex in patients with acquired
immunodeficiency syndrome and disseminated infections.

89) Gentamicin (pwede ring Streptomycin) combined with ____

organisms:
a. Imipinem
b. Vancomycin [or a -lactam (ex. Penicillin G)]

is the treatment for gram (+)

* Cant remember the other choices

90) Aminoglycoside which is applied only topically:

a. Streptomycin (LEAST nephrotoxic)
b. Gentamycin
c. Kanamycin
d. Neomycin (due to its association to severe nephrotoxicity)
All Aminoglycosides are nephrotoxic, but Neomycin is the MOST nephrotoxic

Aminoglycosides had been the mainstays for treatment of serious infections due to aerobic gram-negative bacilli
(ex. P. aureginosa)
End either in mycin or -micin
Inhibit bacterial protein synthesis (30s)
Disrupt cell wall synthesis
Are bacteriCIDAL

MOST ototoxic= NAK (Neomycin, Amikacin, Kanamicin)

LEAST ototoxic= Netilmicin

93) Anti-fungal Antibiotic with the broadest spectrum?

Answer = Amphotericin B
99) For Trichomoniasis in a single, non-gravid female, with a history of multiple sex partners, the
treatment is a single dose of:
a. Chloramphenicole
b. Metronidazole
c. Ketoconazole
d. Fluconazole
100) Primary pharmakokinetic property that determines DURATION of local anesthetics, EXCEPT?
a. Nerve & fiber type
b. Size & health of patient
c. Duration of anesthetic required
d. Duration of injury
103) Succinylcholine is hydrolyzed to succinate ? by:
Answer = Plasma cholinesterase
Normally, the duration of action of succinylcholine is extremely short, because this drug is rapidly broken
down by plasma cholinesterase

110) For the Tx of sleep disorders, the drug selected should be one which
a. Has sufficient duration
b. Decrease sleep latency
c. Has minimal hangover effects
d. All of the above ?
111) All of the following are side effects of Diazepam EXCEPT:
a. Sedation, confusion, lethargy
b. Impaired mental & psychomotor function
c. Delayed reaction time
d. Anterograde amnesia (remember that this is a side effect of Midazolam)
#?) Which of the following is the MOA for H1 Receptor Blockers?
A. Prevent histamine release
B. Reverse effects of histamine
C. Prevents further histamine release
D. All of the above

ANESTHETICS
Drug/s used to reverse and (?) competitive or nondepolarizing neuromuscular blockers
A. Neostigmine
B. Edrophonium
C. Physostigmine
D. All of the above
E. A and C only
Anesthetic that causes dissociative amnesia? Ketamine
What drug is used in surgeries with an anterograde amnesia side effect? Midazolam
What is the benefit of Paracetamol (Acetaminophen) over Aspirin? (not sure kung ito talaga yung question
nung finals natin)

It does not cause gastric irritation, so you can prescribe it to patients with ulcers
**ALSO REMEMBER THAT PARACETAMOL LACKS THE ANTI-INFLAMMATORY PROPERTIES OF NSAIDS

There was a question that included Midazolam, Bupivacaine and endotracheal intubation
Midazolam (general anesthetic) is used as an adjunct to endotracheal intubation, it induces respiratory
relaxation.
Bupivacaine (local anesthetic) is administered for airway management.
Tracheal intubation is performed by practitioners in various medical conditions, such as when a patient
is under general anesthesia. In anesthetized patients spontaneous respiration may be decreased or
absent due to the effect of anesthetics, opioids, or muscle relaxants. To enable mechanical ventilation,
an endotracheal tube is often used.
**These are notes from SDLS & the internet

ANTIEPILEPTICS
Which of the anti-epileptics and 1st gen at 2nd generations...
1st gen (3PC): Phenytoin, Carbamazepine, Phenobarbital, Primidone
2nd gen (Lusty Girl Friend): Lamotrigine, Gabapentin, Felbamate
Which anti-epileptic causes Stevens Johnson Syndrome?
Accorrding to notes from last year, the answer = PHENYTOIN
According to wikipedia: SJS could be caused daw by Phenobarbs, Phenytoin, Lamotrigine,
Ethosuximide, Carbamazepine

Which among PD meds act on the Dopamine 2 receptor?

Answer = PRAMIPEXOLE
What drug is used to treat Restless leg syndrome (RLS) ?
Answer = Bromocriptine or Pramipexole These are Dopamine Recptor Agonists
Which of the following drugs cause orthostatic hypotension?
*cant remember what the choices were, so notes nalang:
-

Nitrovasodilators (Nitroglycerin, Amyl Nitrite, Isosorbide)

Calcium-channel blockers (F.A.N.-pine)
Levodopa (due to side effect of Dopamine)
COMT inhibitors (Tolcapone, Entacapone) drugs that inhibit Dopamine metabolism
Dopamine receptor agonists (Pramipexole, Bromocriptine)
BASTA MGA DRUGS THAT DOPAMINE, & INHIBIT ALPHA-1 ADRENERGIC RECEPTORS!!!

SEDATIVE HYPNOTICS
Which part of the BNZ causes the sedative effect? di ko sure ung questioin... basta pag structure:
Substition of halo or nitro group in GROUP 7 POSITION

DIURETICS
Which diuretic inhibits the Na-Cl Symport?
THIAZIDE DIURETICS (Remember: Hydrochlorthiazide)

CANCER
The following drugs are stage-specific EXCEPT:
Correct Answer: i forgot ung right answer but i remember eliminating:
Methotrexate --- S-phase
Vincristine ---- Metaphase
Paclitaxel-- -- Metaphase
Cell-cycle SPECIFIC
Anti-metabolites (Methotrexate)

Cell-cycle NON-SPECIFIC
Alkylating agents (Cyclophosphamide)

Anti-biotic (Bleomycin)

Antibiotics (Doxorubicin)

Vinca alkaloids (Vincristine)

Cisplatin

Etoposide

Nitrosureas
CCDN
MEBV

The following are anti-metabolites except:

Correct Answer: either Vincristine or Paclitaxel both are mitotic inhibitors
Anti-metabolites:
Folic Acid analogs
Methotrexate
Pyrimidine analogs
5-Fluorouracil
Purine analogs
Mercaptopurine

Doxorubicin is a Topoisomerase inhibitor and its MOA and the choices had something to do with
the action of topoisomerase II, it went something like:
A) topoisomerase II .
B) topoisomerase IV? .
C) DNA Gyrase.
D) A and C only
MOA of Doxorubicin:
1. Intercalation in the DNA: The drugs insert nonspecifically between adjacent base pairs and bind to the sugar-phosphate
backbone of DNA. This causes local uncoiling and, thus, blocks DNA and RNA synthesis. Intercalation can interfere with
the Topoisomerase II catalyzed breakage/reunion reaction of supercoiled DNA strands, causing irreparable breaks.
2. Binding to cell membranes: This action alters the function of transport processes coupled to phosphatidylinositol
activation.
3. Generation of oxygen radicals: Cytochrome P450 reductase (present in cell nuclear membranes) catalyzes reduction of
the anthracyclines to semiquinone free radicals. These in turn reduce molecular O 2, producing superoxide ions and
hydrogen peroxide, which mediate single-strand scission of DNA

Which drug has the same mechanism of action as CYCLOSPORINE?

Answer = TACROLIMUS

PUD DRUGS
Used for stress ulcers: Ranitidine

ANTI-MALARIAL
Which anti-malarial drugs needs cardiac monitoring? Most probably the answer = Chloroquine
Adverse effects = Hypertension, vasodilation, suppressed myocardial function, cardiac arrythmia
Prolonged use = widening of QRS interval, P wave abnormalities
**Note: Artemisinin has an adverse effect of increased QT interval

What kind of Adverse drug effect is gingival hyperplasia due to Phenytoin?

Adverse Drug
Reaction

Description

Examples

Predictable, dose dependent

1.

Extension Effect

An exaggeration of the therapeutic effect

Hypoglycemia
Gastropathy
Priapism

Oral Hypglycemic Agents

NSAID induced
Sildenafil

2.

Side Effect

Effect different from desired effect

Drowsiness
Depression

AntiHistamines
Methyldopa

B Bizarre

Unpredictable
Effect is not related to the usual pharmacologic effects
Idiosyncrasy

Hypersensitivity reaction or Allergy (Cutaneous Allergic Reaction

with Penicillin)
Stevens-Johnsons Syndrome Sulfonamides
Aplastic Anemia
Chloramphenicol
Malignant Hyperthermia
Succinylcholine

C Continuous

Occurs on long term use of drug

Related to dose and duration of treatment

Osteoporosis
Nephropathy
Gynecomastia
Gingival Hyperplasia

Heparin
Analgesic-induced
Cimetidine
Phenytoin

Occurs after a longer time

May affect offspring of mother who took the drug during
pregnancy

Phocomelia
Vaginal Adenocarcinoma

Thalidomide
Diethylstilbestrol

Occur when drug is suddenly stopped and withdrawal

symptoms set in

Acute Adrenal Insufficiency

Rebound Hypertension
Rebound Insomnia

Prednisone
Clonidine
Diazepam

Resistance or tolerance to drug effects

Penicillin G
Antibacterial Drugs

Staphylococcal Infection
Viral Infections

A Augmented

D Delayed

E Ending of Use

F Failure of
Treatment

ANTI-ACNE PREPARATIONS
a.

Retinoic Acid (Tretinoin)

Normalize maturation of follicular epithelium, and has immunomodulatory properties and efficacy
against the inflammatory component of acne.
Used as first line therapy for most cases of mild to moderate inflammatory acne and preferred agent
for maintenance therapy
Approved for the treatment of acne vulgaris and as adjunct in the treatment of sun damaged skin
Topical application for acne treatment is unlikely to produce systemic drug levels

b.

Isotretinoin
Has been a life-threatening medication for many patients
Decreases Priopionibacterium acnes
Absorption is enhanced with a high fat meal

Treatment for Severe Recalcitrant Nodular Acne (looked it up sa net )

Oral isotretinoin remains the most effective treatment for acne, BUT is reserved for severe cases
Absolute Contraindication: Pregnancy (Teratogenic)

SULFONYLUREAS
A group of oral hypoglycemics that promote insulin release from the 2 cells of the pancreas. The primary
drugs used today are:
- tolbutamide has shortest duration of action
- glyburide
- glipizide
- glimepiride
MOA:
1) Stimulation of insulin release from the 2 cells of the pancreas by blocking the ATP-sensitive K+
channels, resulting in depolarization and Ca2+ influx;
2) in hepatic glucose production
3) in peripheral insulin sensitivity
Pharmacokinetics: Given orally, these drugs bind to serum proteins, are metabolized by the liver, and
are excreted by the liver or kidney.
Adverse effects:
- Weight gain
- Hyperinsulinemia
- Hypoglycemia.
- Should be used with caution in patients with hepatic or renal insufficiency

ANTI-HYPERLIPIDEMICS
HMG-CoA Reductase Inhibitors (-statins)
MECHANISM OF ACTION

EFFECTS

PHARMACOKINETICS

Competitive inhibitor of HMG-CoA reductase.

Induce an increase in high-affinity LDL receptors leading to

Useful alone or in combination with

- Well absorbed from the GIT (40%-75%)

- High first-pass extraction by the liver
- absorption enhanced by food except
Pravastatin
- Protein binding:
Most statins = 90%
Pravastatin = 50%
- CYP3A4 metabolizes most statins
- excretion primarily in the bile and feces
except for Pravastatin w/c is renal
excretion
- plasma half-life = 1-3 hours

increase fractional catabolism of LDL and livers extraction of

LDL precursors from the blood, thus reducing LDL.

Best given in the evening wherein synthesis of cholesterol

occurs except Atorvastatin which can be given anytime due
to long half life.

resins, niacin, ezetimibe

Lowers LDL (20-40%)
In Heterozygous familial
hypercholesterolemia (20-30%
reduction of LDL)
DOC for HFH Atorvastatin (5060% reduction)
- Increases HDL (5-15%)
- Decreases triglycerides
- Antiproliferation effect on smooth
muscle cells
-Antioxidant and anti inflammatory

10mg Simvastatin = 20mg

Lovastatin/Pravastatin = 80mg
Fluvastatin

 Which antidiabetic drugs do not have hypoglycemia as a side effect?

-Glucosidase inhibitors glucose absorption
Acarbose
Miglitol
Biguanides hepatic production of glucose
Metformin
Thiazolidinediones insulin resistance
Pioglitazone
Rosiglitazone
DPP-IV inhibitors - glucose dependent insulin release; glucagon secretion
Sitaglipitin
**Sulfonylureas & Meglitinides have hypoglycemia as an SE

All of the following are contraceptives, EXCEPT:

a.
b.
c.
d.
e.
f.
g.

Estradiol
Estrone
Estriol
Ethinyl estradiol
Diethyllstilbesterol
Progesterone
Clomiphene (an anti-estrogen; another anti-estrogen is Tamoxifene)

*Not sure what the exact choices were * Note: Anti-estrogens are Tx for infertility

Coumadin (Warfarin) and Vitamin K reaction

Warfarin antagonizes Vitamin K. It interferes in the synthesis of Vitamin K dependent clotting factors (2, 7,
9, 10) by inhibiting the enzyme Epoxide reductase

What iron supplement is BEST for pregnant patients?

Ferrous gluconate (contains the least amount of elemental iron)
Ferrous fumarate (contains the greatest amount of elemental iron)
* I remember there being a choice na Ferric something

What anti-gout drug is also used for ?

Allopurinol Hematologic cancers
Indomethacin Closing PDA

Which anti-gout drug has anti-mitotic properties?

- Colchicine binds to protein tubulin, prevent polymerization into microtubules and inhibits phagocytosis of uric acid;
blocks release of chemotactic factor.

Topical Corticosteroids
Class 1 Highest Potency
Clobetasol propionate
Betamethasone dipropionate
Class 2 High Potency
Fluocinonide
Betamethasone dipropionate
Class 3, 4, 5 Intermediate Potency
Betamethasone dipropionate
Flucinoloneacetonide
Hydrocortisone valerate
Class 6 Low Potency
Fluocinolone acetonide
Class 7 Lowest Potency
Hydrocortisone

PRESCRIPTION WRITING
- Morphine sulphate has a dispense No. up to 3 ONLY and not 10
- Do not forget about the S2 drugs!

a) VIOLATIVE PRESCRIPTIONS
- Generic name is not written
- Generic name is not legible and a Brand name which is legible is written
- Brand name is indicated & instructions added (ex. No substitution) which tends to obstruct, hinder or
prevent proper generic dispensing
What to do:
- Shall NOT be filled
- Shall be kept & reported by the pharmacist to the nearest DOH office for appropriate action
- The Pharmacist shall advise the prescribe of the problem / instruct the customer to get the proper
description

b) ERRONEOUS PRESCRIPTIONS
- Brand name precedes the generic name
- Generic name is the one in the parenthesis
- Brand name is not in the parenthesis
What to do:
- Shall be filled
- The prescription will be kept and reported

c) IMPOSSIBLE PRESCRIPTIONS
-

Only generic name is written, but is not legible

Generic names does not correspond to the brand name
Both generic name & brand name are not legible
Drug product prescribed is not registerd with the BFAD

What to do:
- Shall NOT be filled
- Prescription will be kept & reported
- Pharmacist shall advise the prescriber of the problem / Insruct the customer to get the proper prescription

STUDY THE FOLLOWING

Basic concepts regarding the passage of drugs through a lipid membrane (polar or non-polar drugs, ionized or
unionized)
Can EASILY pass through = Non-Polar, Non-ionized (lipid soluble)
Cant easily pass through = Polar, Ionized (water soluble)
MOAs for the CVS drugs
Review functions of NSAIDS (if anti-inflammatory only or also anti-pain, and anti-pyretic)