DISCLAIMAER; The answers provided below were based completely on

the individual`s (B.O.A) understanding of the questions and may not

necessarily be the ideal solution to the question. In order words, the
answers were not endorsed by any lecturer or demonstrator as the
ideal solutions the following set of questions.
 DRUG DEPENDENCE, CNS DEPRESSANTS AND
PSYCHO-DEPRESSANTS

1. Drugs of abuse induce increased endogenous dopamine release at synaptic clefts in

the VTA BECAUSE drugs or activities with abuse potential target the mesolimbic
dopaminergic pathway. TT UR

2. In chronic substance exposure, pathways enhancing drug effects are increased to

regain equilibrium and avoid overstimulation BECAUSE in chronic substance
exposure, D1 and D5 receptors downregulation, reduction in dopamine
neurofilament size and decoupling of 2nd messenger relays occur. FT

3. A cocaine addict going through dysphoric withdrawal symptoms may need higher
doses of a benzodiazepine than in normal patients BECAUSE in a cocaine addict,
excitatory neuronal pathways are downregulated FT

4. In chronic substance abuse, positive reinforcements dominate over negative

reinforcement in the late phase of addiction BECAUSE in chronic substance abuse,
allostasis causes a maladaptive equilibrium state FT

5. The Nucleus Accumbens of a nicotine addict is smaller in size than in a non-addict

BECAUSE the Nucleus Accumbens diminishes in size in chronic substances abuse
FF
 SECTION B
MULTIPLE COMPLETION ITEMS
Each item in this section consists of either a question or an incomplete statement followed by three
alternative answers or completions, numbered (i), (ii) and (iii) of which one, two, or all three may be
correct. You are to select the alternatives which correctly answer the question or correctly complete the
opening statement. Use the following code to select the appropriate response.

A) if (i), (ii) and (iii) are correct

B) if (i) and (ii) only are correct
C) if (ii) and (iii) only are correct
D) if (i) only is correct
E) if (iii) only is correct

ANSWER CODE SUMMARY

A B C D E
i, ii, iii i, ii only ii, iii only i only iii only

1. The Diagnostic and Statistical Manual of Mental Disorders (DSM) V criteria for
drug addiction include;

(i) The substance is often taken in larger amounts or over a longer period
than was intended
(ii) There is a persistent desire or unsuccessful efforts to cutdown or control
substance use
(iii) Craving, or a strong desire or urge to use the substance A

2. All the following are neuroadaptive mechanisms that occur following a cocaine
use disorder

(i) Down regulation of D1, D2, D4 receptors C

(ii) Decoupling of cAMP 2nd messenger signalling pathway from dopamine
receptor activation
(iii) Endogenous synthesis of Gamma Amino Butyric Acid (GABA) increases

3. All the following statements are true concerning the sigma Receptor (σ1R) except

(i) Sigma Receptor antagonism is a possible target for possible substance

abuse reversal.
(ii) Sigma receptor activation is known to amplify the euphoric effects of
cocaine
(iii) Cocaine is a known antagonist of the sigma receptor E
 4. In the second stage of addiction or the compulsive disorder cycle, drug seeking
behavior is motivated by

(i) Obsession
(ii) Anxiety/ Stress
(iii) Pleasure B

5. A 33-year-old man was in his physician’s office because he started to perceive

flashes of colours and fleeting movements of strange objects as he entered a dark
room. This man who was an alcoholic and an occasional user of recreational
drugs, took two tablets of an illegal drug while at a party 2 months ago. Which of
the following drugs most likely accounted for the patient’s symptoms?
(i) Lysergic acid diethylamide
(ii) Phencyclidine withdrawal
(iii) Amphetamine-induced schizophrenic episode E

A 29-year-old man with a long history of drug abuse was brought unconscious to the
emergency department. Vital signs were blood pressure 190/110 mm Hg, pulse 150
beats/ min, rectal temperature 40°C. Pupils were mydriatic, and his skin was moist and
cold. Twenty minutes later he experienced a tonic-clonic seizure, his respiration became
shallow, and his systolic blood pressure fell to 50 mm Hg. Shortly afterward he died from
cardiovascular collapse and ventricular fibrillation.

6. Which of the following drug(s) is/are the likely cause of the patient’s death?

(i) Cocaine D
(ii) Tetrahydrocannabinol
(iii) Heroin

7. The substance(s) of abuse may exerts its action by;

(i) Increasing the reuptake of catecholaminergic neurotransmitters including
dopamine, noradrenaline and serotonin
(ii) Increasing the release of catecholaminergic neurotransmitters including
dopamine, noradrenaline and serotonin
(iii) Inhibiting the reuptake of catecholaminergic neurotransmitters including
dopamine, noradrenaline and serotonin C

8. Withdrawal symptoms from the substance(s) of abuse may include;

(i) Depression
(ii) Hypersomnolence
(iii) Sleep disturbances A

9. Possible therapy for withdrawal symptoms to facilitate abstinence include;

(i) Topiramate
(ii) Psychosocial treatment
(iii) Cognitive behavioural therapy A
10. Cocaine may cause;
(i) Spontaneous abortion during pregnancy
(ii) Powerful vasoconstrictive reactions resulting in myocardial infarction,
ischemic stroke
(iii) Multiple brain perfusion defects A

11. Overdoses of cocaine are usually rapidly fatal from

(i) Respiratory depression
(ii) Seizures
(iii) Arrhythmias A

12. Possible pharmacological therapy for relieving craving associated with

amphetamine and cocaine addiction include:
(i) Bromazepam
(ii) Baclofen
(iii) Topiramate C

13. Caffeine, a mild stimulant, is a most widely used psychoactive drug in the world.
It is present in soft drinks, coffee, tea, cocoa, chocolate, and over-the-counter
drugs. It is known to induce diuresis. The diuretic effect of caffeine is thought to
result from;
(i) Vasodilation of the afferent glomerular arteriole causing a decrease in
glomerular filtration rate
(ii) Vasodilation of the efferent glomerular arteriole causing an increase in
glomerular filtration rate
(iii) Vasodilation of the afferent glomerular arteriole causing an increase in
glomerular filtration rate E

14. Nevalack, a 28-year-old man was brought to the psychiatric clinic by the police
after he at tempted to assault a woman in the street. The man presented with
elevated mood, rapid speech, muscle twitching, and dilated pupils. He kept on
scratching himself repeatedly because he stated that “bugs are crawling under my
skin.” Vital signs were blood pressure 170/105mmHg, heart rate 120bpm,
respiratory rate 20 c/min. After a short time, stereotyped behavior developed
accompanied by paranoid delusions, but the man remained oriented and alert.
Which of the following drug(s) most likely caused the patient’s syndrome?
(i) Marijuana
(ii) Lysergic acid diethylamide
(iii) Cocaine E

15. A 33-year-old man was in his physician’s office because he started to perceive
flashes of colours and fleeting movements of strange objects as he entered a dark
room. This man who was an alcoholic and an occasional user of recreational
drugs, took two tablets of an illegal drug while at a party 2 months ago. Which of
the following drugs most likely accounted for the patient’s symptoms?
(i) Lysergic acid diethylamide
(ii) Phencyclidine withdrawal
(iii) Amphetamine-induced schizophrenic episode D
16. A 17-year-old girl who had never used drugs decided to join in with her friends
who were smoking drugged cigarettes. In the first 5 minutes, she experienced
euphoria, uncontrollable laughter, depersonalization, and sharpened vision. Her
concentration became difficult, and she noticed that her heart was “pounding.”
Her friends noted reddening of her conjunctiva but no change in pupil diameter.
Which of the following drug(s) most likely caused the girl’s symptoms?
(i) Cocaine
(ii) Heroin
(iii) Cannabis E

17. A 32-year-old man was brought to the emergency department after taking a large
amount of ecstasy at a rave party. Physical examination showed a confused and
agitated patient with profuse sweating, jaw clenching, muscle twitching and
rigidity, and temperature of 103.8°F (39.8°C). Vital signs were blood pressure
170/98 mg Hg, pulse 115 bpm, respirations 22/min. Blood analysis showed the
presence of methylenedioxymethamphetamine (MDMA). Which of the following
neurotransmitter(s) most likely mediate the effects of the drug in this patient?
(i) Serotonin
(ii) Norepinephrine
(iii) Dopamine A

18. Sikinya, a 27-year-old man was brought to the emergency department by police
for violent, combative behavior. Friends claimed he took some tablets of a
recreational drug at a party. The patient appeared agitated, diaphoretic, and
disoriented. His blood pressure was 170/100 mm Hg, pulse 130 bpm, and
temperature 38°C. His pupils were miotic, unreactive to light, and vertical and
horizontal nystagmus was noted. The patient’s signs and symptoms is likely
caused by;
(i) Lysergic acid
(ii) Marijuana
(iii) Phencyclidine D

19. The following may produce dissociative analgesia;

(i) Dextromethorphan
(ii) Ketamine
(iii) Phencyclidine C

20. Medicinal uses of cannabinoids include;

(i) Appetite suppression
(ii) Chemotherapy induced nausea and vomiting
(iii) Neuropathic pain C

21. Fetal alcohol syndrome may present with/as;

(i) Reduced cranial circumference
(ii) Retarded growth
(iii) Mental retardation and behavioural abnormalities A
 Use the preamble to answer questions 22-24

A 47-year-old woman suffered a generalized seizure and was taken to the emergency
department. On admission she was extremely anxious and agitated. She reported she had
no history of epilepsy. Further questioning revealed that she had a long history of drug
abuse, but the day before she decided to quit and ceased taking the abused drug.

22. Withdrawal from which of the following drug(s) most likely caused the patient’s
seizure?
(i) Alprazolam
(ii) Zolpidem
(iii) Methamphetamine B

23. Treatment objective(s) for withdrawal syndrome include the following;

(i) To prevent complications like seizures, development of amnesia and
encephalopathy
(ii) To correct fluid and electrolyte imbalance
(iii) To calm patient and promote agitation B

24. Intoxication of the likely drug(s) may be managed pharmacologically with;

(i) Nalmefene
(ii) Psychosocial treatment
(iii) Flumazenil E

25. Nhyira, a 3-year-old boy was brought to the emergency department with severe
vomiting after having ingested an antifreeze mixture containing ethylene glycol.
Vital signs were blood pressure 70/40, heart rate 115 bpm, respirations 22
breaths/min. Lab tests showed a plasma pH of 7.2 and oxalate crystals in the
urine. An intravenous solute ion of 10% ethanol was given. Which of the
following statements best explains the purpose of ethanol treatment in this
patient?
(i) It combines with ethylene glycol in blood, leading to an inert product
(ii) It speeds up the metabolism of ethylene glycol by the liver
(iii) It retards the oxidation of ethylene glycol to its toxic metabolites E
1. A 33-year-old Chinese man becomes flushed and light-headed after one glass of
wine. This reaction is likely due to
a) The rate he drank the glass of wine
b) Increased absorption of the alcohol
c) Inhibition of monoamine oxidase B
d) Decreased renal excretion of alcohol
e) A variant in aldehyde dehydrogenase
2. A 50-year-old woman with back pain is administered morphine suspension. After 2
weeks of therapy, she notices that she needs to increase the dose to get the same
analgesic effect. She is experiencing
a) Compulsive disorder
b) Addiction
c) Tolerance
d) Withdrawal
e) Drug-seeking behavior C

3. A patient in a rehab is a recreational user of cocaine. He is also a regular consumer

of alcohol. The effect of alcohol on cocaine metabolism is demonstrated by the
presence in the urine of
a) Benzoylecgonine
b) Methanol
c) Benzocaine
d) Cocaethylene D
e) Methylecgonine

4. A KNUST student is brought to the emergency room because of fearful

hallucinations and suicidal thoughts after consuming
methylenedioxymethamphetamine (MDMA). MDMA is thought to
a) act by inhibiting the release of monoamines primarily dopamine and
noradrenaline from nerve terminals in the brain
b) displace the catecholamines from vesicular storage and enhance
passive diffusion of neurotransmitters from nerve terminals into
synaptic cleft
c) increase reuptake of dopamine and noradrenaline by dopamine
transporters and noradrenaline transporters respectively
d) produce a decrease in blood pressure and stimulate gastrointestinal
motility
e) cause peripheral effects such as euphoria and excitement E

5. A male alcoholic complained of flushing, nausea, a throbbing headache, and

confusion after drinking a glass of Adonko bitters. The man was taking a drug as
part of his rehabilitation treatment for alcoholism. The symptoms of the patient are
most likely caused by the accumulation in the body of which of the following
substance?
a) Ethanol
b) Acetaldehyde
c) Methanol
d) Formaldehyde
e) Dopamine B
 6. Naltrexone is indicated in the management of alcohol use disorder because
a. Alcohol directly stimulates Mu-Opioid receptor
b. Alcohol directly inhibits GABA neurons
c. Alcohol induces the release of endogenous opioid peptides
d. Alcohol directly inhibits kappa receptors
e. Alcohol readily crosses the blood brain barrier C

SECTION D
CLASSIFICATION
Drugs of Abuse and their pharmacologic activities

A. Amphetamine
B. LSD
C. Caffeine
D. Cocaine
E. Phencyclidine

1. Visual effects are prominent with the use of this drug with colors becoming more
intense and shape altered B
2. This drug acts mainly by increasing non-vesicular release of dopamine from
dopaminergic neurons A
3. The basis of the local anesthetic action of this drug is the blockade of sodium ion
channels in neuronal membranes inhibiting conduction or action potentials D
4. Because of its hallucinogenic activity, it is no longer indicated in the induction of
anaesthesia in surgery E
5. A known inhibitor of catecholamine transporter in the synaptic cleft D

1, B 2. A 3. D 4. E 5. D

Opioid analgesics and antagonists

A) Buprenorphine
B) Ethanol
C) Loperamide
D) Methadone
E) Naloxone

1. The elimination of this drug follows mainly zero-order kinetics B

2. A long-acting µ (mu) opioid agonist that suppresses withdrawal symptoms and
controls the cravings for opioids in maintenance therapy D
3. A partial agonist at µ (mu) opioid receptors and antagonist at κ (kappa) opioid
receptors with partial agonist activity reducing craving while blocking or blunting
the euphoric effects of full agonist A
4. It is a competitive antagonist at µ, κ and δ opioid receptors which can precipitate
withdrawal symptoms in opioid abusers E
5. It is indicated in acute intoxication with a long acting opioid E
 PITUITARY PHARMACOLOGY
Choose the most appropriate

A 5-year-old boy has severe proportionate short stature. Bone age was delayed by
approximately 3 years. On examination, frontal bossing, sparse and thin scalp hair,
micrognathia, acromicria, and increased weight/height ratio were noted. An IGF-I
generation test did not result in a significant change in the IGF-I concentration (3.0 to
5.6 ng/mL, retrospectively before and after GH). The child further underwent GH
receptor sequencing, which showed he was homozygous for a previously reported
mutation of the GH receptor.

1. Which of the under listed medicines can induce clinical signs and symptoms
comparable to the 5-year-old boy’s present condition?
Ans; any drug that antagonizes growth hormone will present the boys current
condition.
Examples include; Pegvisomat, dopamine-receptor agonists (like Carbegoline) and
somatostatinergic agonist/Somatostatin receptor ligands (like Octreotide, lanreotide,
Pasireotide)

2. Which of the medicines below is the most appropriate for his current condition?
Ans; Mecasermin

3. Which of the following is an unexpected side effect during pharmacotherapy in this

patient?
Ans; look out for one of these side effects in the alternatives and choose as correct
answer; snoring, tonsillar hypertrophy, hypoacusis, lipohypertrophy, intracranial
hypertension, hypoglycaemia

A 17-year-old boy presented with persistent headaches, diplopia, acute esotropia and
occasional blurry vision in both eyes, seven weeks after being diagnosed with growth
hormone deficiency and treated with somatropin (Norditropin Flexpro) injections as
prescribed by his endocrinologist. He was diagnosed with growth hormone-related
idiopathic intracranial hypertension.

4. Which of the statements below is not true about effects of the somatropin injection
used in this patient?
Ans; Read on shortly on growth hormones (slide 25, 27 and maybe 28) to know how
growth hormones work thus their mechanism of action and their effects.

Suggested alternatives;
A. One molecule of Somatropin binds to two identical GH receptor.
B. 2 molecules of Somatropin binds two one GH receptor.
C. Somatropin brings the intracellular domain of the receptors to close proximity
D. Somatotropin activates cytosolic components. Ans; A
5. How does somatropin injection induce intracranial hypertension?
Ans; by acting on choroid plexus to produce cerebrospinal fluid

6. Medical treatment options considered in ICH patients with severe papilledema may
include all the following except:
Ans; except the following Somatropin, somatrem, Sermorelin, Mecasermin (all these
drugs can increase intracranial pressure and cause papilloedema hence not preferred)

A 76-year-old male hypertensive, diabetic patient was admitted due recurrent

episodes of hyponatremia. Upon examination, the patient met the criteria for
syndrome of inappropriate antidiuretic hormone (SIADH) and was initiated on
demeclocycline at 300 mg BD. Which of the statements about demeclocylcine is true?

Ans; Read on Demeclocydine (slide 81) to know everything about the drug

Suggestion;
A. Demeclocydine upregulate aquaporin gene expression and receptor number
B. Demeclocydine can be used to treat patients with hypernatremia
C. Demeclocydine increase urine volume and decrease urine osmolality Ans; C

7. A 29-year-old male with gross hematuria was diagnosed with Autosomal dominant
polycystic kidney disease at the Outpatient Department of our hospital, based on MRI
findings. Tolvaptan was started at 60 mg/day and then increased up to 120 mg/day.
Which of the statements about the effects of tolvaptan is true

Ans; Read on effects of Tolvaptan (slide 80)

A. Tolvaptan leads to increased endogenous levels of arginine vasopressin on
prolonged usage. Ans; A
B. Tolvaptan block both receptors.
C. Tolvaptan is preferred in congestive heart failure

8. An enuretic 10-year-old boy presented to the emergency department after

experiencing a brief generalized tonic-clonic seizure. The boy's mother reported that
he had been receiving 40 µg of intranasal desmopressin nightly for 3 weeks for
primary nocturnal enuresis and 500 mg/d of cefadroxil prescribed by his pediatrician.
Electrolyte levels, drawn prior to the initiation of intranasal desmopressin therapy,
were within reference ranges. There was no history of excessive fluid intake, diarrhea,
or fever prior to experiencing the seizure.
Which of the pharmacotherapeutic strategy below will likely improve his current
condition.
Ans; read on Desmopressin (slide 76)

Hint; nasal desmopressin was withdrawn as a treatment for nocturnal enuresis

because of a significantly higher incidence of symptomatic hyponatraemia than oral
desmopressin (from slide 76)
Suggestion; strategy is to switch to oral
9. Which of the class of medicines listed below are associated with impulse control
disorders and are known to precipitate pathological gambling, binge eating,
pornography, and hypersexuality.

Ans; Dopamine 2 receptor agonists (know some examples of drugs under these class
just in case he bring the examples instead)

10. Medicines that may be effective in the treatment of lactation insufficiency or

hypogalactia include;
Ans: any dopamine receptor antagonist (metoclopramide, domperidone, sulpiride),
oxytocin, thyroid releasing hormone and growth hormone (somatropin, somatrem,
Sermorelin etc.)

PHARMACOGENOMICS
1. Genome is ……………………..
A. how an organisms genotype is actually expressed
B. the segment of DNA sequence corresponding to a single polypeptide/protein
or set of protein variants
C. an organism's traits
D. the total genetic information embodied in DNA sequence

2. A man of European decent admitted to your clinic was found to poorly metabolize
warfarin. Genetic testing detected mutations possibly linked to the …………gene.
A. CYP2B6
B. CYP2C19
C. CYP2C9
D. CYP2D6

3. An African-American descent was found to poorly respond to increasing doses of

codeine. Genetic testing detected single nucleotide polymorphism possibly linked to
the…………… gene.
A. CYP2C19
B. CYP2B6
C. CYP2C9
D. CYP2D6

4. The BRCA gene is famously linked to………………….

A. Hodgkin’s lymphoma
B. Breast cancer
C. Leukemia
D. Cystic fibrosis

5. Phase II clinical trials primarily involves ……………….

A. determination of tolerable dose
B. therapeutic drug monitoring
C. use of healthy volunteers
D. determination of therapeutic dose
 6. Techniques used in genetic analysis include
i) DNA sequencing
ii) MassARRAY™
iii) Affimetrix

7. Conditions that may induce drug variability include

i) pathogenesis
ii) drug interactions
iii) Sex

8. An active drug is inactivated by metabolism. The following is true for a poor

metabolizer phenotype
i) Poor efficacy
ii) Accumulation of prodrug
iii) Good efficacy

9. Common variation in the genome most relevant to pharmacogenomics include

i) Insertions/deletions (small and large)
ii) Single nucleotide polymorphisms (SNPs)
iii) Copy Number Polymorphism

10. A drug must be metabolized for its therapeutic effect. The following is true for an
ultra-rapid metabolizer phenotype
i) Good efficacy
ii) Rapid effect
iii) Poor efficacy

ASSERTIONS

1. Genetic testing is encouraged in anticoagulant therapy BECAUSE genetic testing

provides better prediction of dose and response than clinical methods alone. TTR

2. P-glycoprotein polymorphism can affect drug response BECAUSE P-glycoprotein

can transport drugs across membranes. TTR

3. VKOR1C genetic screening is recommended for tamoxifen use in cancer BECAUSE

VKOR1C metabolises tamoxifen to the active drug. FF

4. Single Nucleotide Polymorphism (SNP) is not important in pharmacogenomics

BECAUSE SNP does not contribute in any way to interpatient variation in drug
response FF

4. HLA-B*5701 genetic screening is recommended for Abacavir use BECAUSE HLA-

B*5701 allele is strongly associated with hypersensitivity to Abacavir. TTR