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SECTION A:
Which of the following statements listed below are true or false?
1. In the treatment of anaemia
a. folic acid is used in the treatment of pernicious anaemia
b. iron supplementation is stopped as soon as an increase in heamoglobin levels is observed
c. calcium containing food increases the absorption of orally administered iron
d. the risk of anaphylactic reactions are increased with parenteral iron administration
e. iron supplementation is contraindicated in patients treated with erythropoietin

2. Type 1 diabetes
a. insulin detemir is administered intravenously in the treatment of ketoacidosis
b. insulin lispro is contraindicated during pregnancy
c. propranolol masks the symptoms of hypoglycaemia
d. insulin glargine has a more rapid onset of action than insulin glulisine
e. the basal bolus regimen is less likely cause hypoglycemia than the twice daily regimen

3. Oral hypoglycaemic agents

a. in combination therapy, metformin is used with gliclazide
b. pioglitazone inhibits the breakdown of complex carbohydrates in the small intestine
c. metformin decreases hepatic glucose production
d. acarbose stimulates insulin synthesis in β-pancreatic cells
e. sitagliptin causes peripheral oedema as an adverse effect

4. The following antipsychotics are correctly paired with their main mechanism of action:
a. haloperidol - inhibits dopamine D2 receptors
b. chlorpromazine - inhibits serotonin 5-HT2 receptors
c. risperidone - activates serotonin 5-HT2 receptors
d. clozapine - activates serotonin 5-HT2 receptors
e. quetiapine - inhibits dopamine D2 receptors

5. Drug-induced depression is associated with which of the following drugs

a. propranolol
b. clomipramine
c. prednisolone
d. methyldopa
e. diazepam

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6. The effects of benzodiazepines on GABA receptors

a. allosteric enhancement of chloride (Cl-) conduction
b. reduces the frequency of chloride (Cl-) channels opening
c. potentiates the actions of GABA neurotransmission
d. inhibits the post-synaptic glutamate transmission
e. promotes neuronal hyperpolarisation

7. Benzodiazepines are indicated for the following clinical conditions

a. Major Depressive Disorder (MDD)
b. epilepsy
c. insomnia
d. Attention Deficit Hyperactivity Disorder (ADHD)
e. acute alcohol withdrawal

8. The rationale behind using the combination Levodopa-Carbidopa therapy in

Parkinson’s disease are
a. to reduce the peripheral metabolism of levodopa
b. to increase the concentration of CNS carbidopa
c. to lower the dose of levodopa by 5 folds
d. to increase the concentration of CNS levodopa
e. to prevent the conversion of levodopa to norepinephrine

9. The following anticonvulsant agents are correctly paired with their adverse effects
a. carbamazepine - gingival hyperplasia
b. valproate - hepatotoxicity
c. vigabatrin - visual field loss
d. lamotrigine - Stevens-Johnson syndrome
e. pregabalin - weight reduction

10. The following antidepressant agents are correctly paired with their therapeutic classes
a. citalopram - serotonin 2 (5HT-2) receptor inhibitor
b. venlafaxine - serotonin-norepinephrine reuptake inhibitor
c. imipramine - tricyclic antidepressant
d. bupropion - dopamine-norepinephrine reuptake inhibitor
e. lithium - selective serotonin reuptake inhibitor

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11. Regarding valproate use in epilepsy

a. inhibits the GABA receptors activity
b. activates T-type calcium (Ca+) channels
c. contraindicated in absence seizure
d. is a potent hepatic enzymes inducer
e. indicated for generalized tonic-clonic seizures

12. The common clinical presentation of cocaine toxicity include:

a. agitation
b. hypothermia
c. bronchospasm
d. hypertension
e. convulsion

13. Halothane
a. is associated with dose-dependent hypotension
b. is associated with severe bronchospasm
c. is associated with upper respiratory tract irritation
d. compared to sevoflurane, is more nephrotoxic
e. increases the sensitivity of GABAA receptors

14. Regarding Intravenous General Anaesthetics

a. propofol changes the urine colour to green
b. thiopental elevates the diastolic blood pressure
c. diazepam promotes short anterograde amnesia
d. ketamine is a potent bronchodilator
e. etomidate is contraindicated in heart failure

15. Pharmacotherapy approved for the management of Obesity

a. atomoxetine
b. phentermine
c. orlistat
d. modafinil
e. methyldopa

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16. Antiviral agents

a. oseltamivir is effective against the Hepatitis C Virus (HCV)
b. zidovudine increases the myelosupressive effects of ganciclovir
c. oseltamivir decreases the release of progeny influenza virus from infected cells
d. ganciclovir is preferred to aciclovir in the treatment of CMV retinitis
e. aciclovir is inactivated by viral Herpes thymidine kinase

17. Antiretroviral agents

a. tenofovir is best avoided in patients with renal failure
b. emtricitabine is more likely than stavudine to cause peripheral neuropathy
c. ritonavir prolongs the plasma half-life of lopinavir
d. efavirenz is preferred to nevirapine in pregnant patients taking HAART (highly active
antiretroviral treatment)
e. efavirenz blocks the binding of the HIV outer envelope protein gp120 to the CCR5 chemokine
receptor

18. Antiretrovirals
a. tenofovir is associated with a higher incidence of lactic acidosis than didanosine
b. the use of stavudine and zidovudine in combination is synergistic
c. etravirine is preferred over efavirenz in patients with viral isolates of the K103N mutation
d. the combination of lopinavir/ritonavir is preferred to atazanavir/ritonavir in patients with
dyslipidemia
e. darunavir is contraindicated in patients with a doucmented history of anaphylaxis due to a
sulphur-containing drug

19. The anti-mycobacterial drug is correctly matched with its mechanism of action:
a. isoniazid - inhibits mycolic acid synthesis
b. rifampicin - inhibits DNA gyrase
c. pyrazinamide - inhibits pyrazinamidase
d. dapsone - inhibits dihydropteroate synthase
e. ethionamide - inhibits protein synthesis

20. The anti-mycobacterial agent is correctly paired with is adverse effect:

a. ethambutol - hyperuricaemia
b. clofazimine - skin discolouration
c. capreomycin - neurotoxicity
d. rifampicin - red-orange urine
e. dapsone - neonatal haemolysis in patient with a G-6PD
deficiency

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SECTION B

From the list below, select the most appropriate drug that matches the case or
scenario presented. Each option may NOT be used more than once.

a. abacavir k. liraglutide
b. acarbose l. lopinavir/ritonavir
c. acyclovir m. metformin
d. atazanavir/ritonavir n. nevirapine
e. didanosine o. oseltamivir
f. emtricitabine p. repaglimide
g. exenatide q. saxagliptin
h. gancyclovir r. stavudine
i. glibenclamide s tenefovir
j lamivudine t. valacyclovir

1) This medication is used as monotherapy or in combination with other agents for

optimal glycemic control in type 2 diabetes patients. The agent is administered orally
and works by inhibiting dipeptidyl peptidase 4 (DPP-4) enzymes.

2) A 30-year old male, recently diagnosed as HIV positive was started on a fixed dose
combination regimen of tenofovir/emtricitabine/efavirenz. After 2 months of taking his
ARV medications, he has developed an acute psychosis. His physician wants to
change the efavirenz in his regimen. What is the drug of choice that can be used as a
replacement for efavirenz given the patients acute psychosis?

3) A 40-year old HIV positive female patient was swopped over to a 2nd line regimen
after failing a Tenofovir-based 1st line regimen. She was placed on zidovudine,
lamivudine and lopinavir/ritonavir (LPV/r). A few weeks after starting this 2nd line
regimen, she has developed severe diarrhoea. Her physician decided to switch her
lopinavir/ritonavir to another drug. What is the most appropriate ARV agent that
safely replaces her LPV/r, and is associated with a low risk for diarrhoea?

4) A 28-year old male was seen by his GP complaining of an acute cough, sore throat,
rhinorrhea, congestion, body aches, headache, chills, tiredness, diarrhoea and
vomiting. His GP has informed him that his symptoms are possibly due to an
influenza virus, and has ordered nasal and throat swabs for testing. The swab
serology results came back positive for the H1N1 virus. What is antiviral of choice in
this patient to treat his H1N1 infection?

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From the list below, select the most appropriate drug that matches the case or
scenario presented. Each option may NOT be used more than once.

a. ethosuximide h. levodopa
b. flumazenil i. lorazepam
c. fluoxetine j. methamphetamine
d. haloperidol k. mirtazapine
e. halothane l. nitrous oxide
f. isoflurane m. phenytoin
g. ketamine n. zolpidem

5) A 22-year old university student known with a history of bipolar disorder was admitted
to the medical high care. He presented with: deteriorated levels of consciousness,
low blood pressure, slurred speech and a clinical picture of respiratory depression.
Toxicology screen reveals toxic plasma and urine levels of benzodiazepines. His
chronic medications include valproate and citalopram. What is the drug of choice to
reverse the respiratory complications?

6) A 35-year old female was seen by her plastic surgeon for elective breast implants.
The anesthetist has administered both succinylcholine and an inhaled anaesthetic
agent for her operation. Shortly after administering the combination, the patient’s
condition deteriorated, and her core body temperature became elevated (44°C).
What is the name of the general anaesthetic agent that is commonly associated with
this syndrome when used in combination with succinylcholine?

7) An 18-year old night club bodyguard was admitted to the medical high care unit
complaining of: high fever, severe tremor, increased heart rate, with altered mental
status. Patient profile reveals that he is suffering from depression and currently on
antidepressant medication. After recovery, the patient admitted abusing
methamphetamine and doubling the dose of his antidepressant in order to cope with
his workload. What is the name of the antidepressant drug that is commonly
associated with this clinical syndrome when used together with methamphetamine?

8) An 8-year old school girl was seen by her family physician. Her mother reported there
was something wrong with her daughter’s behaviour. Her daughter seemed
disconnected from reality with bizarre rapid eye-blinking and salivation that lasted for
less than 1 minute. Similar behaviour was noticed by her teacher at the school. An
electroencephalogram (EEG) was performed and she was diagnosed with absence
seizure. What is the anticonvulsant treatment of choice for her condition?

9) A 26-year old rugby player was on an international trip to Thailand. He joined a

beach party and aimed to get high. Later that night, he was seriously sick and
immediately rushed to the emergency room. On examination he was agitated,
hypertensive, and unable to breath due to acute crushing chest pain. His body
temperature was 42°C. A friend of his witnessed him injecting himself with cocaine a
few minute before he collapsed. What is the drug of choice to be used in order to
control his agitation and prevent convulsions?

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From the list below, select the most appropriate drug that matches the case or
scenario presented. Each option may NOT be used more than once.

a. clofazimine g. pyrazinamide
b. ethambutol h. pyridoxine
c. ethionamide i. rifampicin
d. folic acid j. vitamin A
e. moxifloxacin k. vitamin C
f. niacin l. vitamin K

10) A 56-year old male patient comes to the clinic complaining of a burning sensation in
his feet. Upon looking through his medical history his doctor discovers that he is on
the intensive phase of TB treatment. The doctor suspects isoniazid-induced
peripheral neuropathy. What is the drug of choice to treat the patient’s isoniazid-
induced peripheral neuropathy?

BPharm III 5th September 2016 Test 3