MCQ Module (103)

Dr. Ahmed Abdelrahman

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1- Pharmacokinetics is the study of the kinetics of drug which include the following except:
A- Absorption B- Excretion C- Uses D- Metabolism E- Distribution.

2- All of the following statements concerning “simple diffusion” of drugs through lipid membranes are
true except:
A- It occurs along concentration gradient.
B- It does not require cellular energy.
C- Ionized drug is lipid soluble and diffusible.
D- It does not require energy.
E- The greater the lipid/ water partition coefficient, the greater the rate of diffusion.

3- All of the following are characteristics of active transport process except:

A- Moves drug molecules against a concentration gradient.
B- Is not inhibited by competitors.
C- Is a carrier-mediated transport system.
D- Requires energy.
E- Saturable.

4- Which of the following is false regarding highly lipid soluble drugs:

A- Have low lipid/ water partition coefficient.
B- Not readily absorbed from gut.
C- Are readily excreted without metabolism.
D- All of the above.
E- None of the above.

5- A weak acid drug with a pKa= 4 is placed in a solution which has a pH of 3, what is the ratio of
unionized to ionized drug:
A- 0.1 B- 1 C- 10 D- 100 E- 1000.

6- The following route of administration is not suitable for drugs with extensive hepatic first pass
metabolism:
A- Sublingual B- Oral C- Rectal D- Inhalation E- Parenteral.

7- The bioavailability of drugs after intravenous administration is:

A- 10% B- 25% C- 50% D- 70% E- 100%.

8- Which of the following is false regarding bioavailability:

A- It is calculated from comparison of the area under the plasma concentration-time curves after IV and
oral administration.
B- Usually less than 100% after oral route.
C- It is high for drugs undergoing extensive first pass hepatic metabolism.
D- May be altered by pharmaceutical formulation.
E- The pH of the absorption medium can affect it.

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9- The term bioavailability refers to the:
A- The relationship between the chemical and physical property of the drug and the systemic absorption
of the drug.
B- Measurement of the rate and amount of unchanged drug that reaches systemic circulation.
C- Movement of the drug into the body tissues over time.
D- Dissolution of the drug in the gastrointestinal tract.
E- Amount of drug destroyed by liver following systemic absorption from GIT.

10- The area under the plasma concentration curve (AUC) represents:
A- Biological half-life of the drug.
B- Amount of drug that is cleared by the kidney.
C- Amount of the drug in the original dosage form.
D- Amount of the drug absorbed.
E- Amount of the drug excreted.

11- A hypothetical drug X can be administered by all routes listed below. Which administration route is
guaranteed to provide complete (100%) bioavailability of that drug:
A- Intramuscular B- Intravenous C- Oral D- Rectal E- Subcutaneous.

12- Which of the following is correct as regards to drugs bound to plasma proteins:
A- Pharmacologically active.
B- Diffusible through capillary walls.
C- Excreted by glomerular filtration.
D- Promptly metabolized by hepatic microsomal enzymes.
E- A reservoir from which free drug can be dissociated.

13- Which of the following is incorrect regarding drug distribution:

A- It depends on blood flow and size of organ.
B- Depends on the solubility of the drug in tissues.
C- Is increased for drug which is less ionized.
D- Depends on concentration gradient between blood and tissue.
E- Is increased for drugs strongly bound to plasma proteins.

14- A patient with heart failure treated with digoxin at a target concentration of 1.5 ug/ L, Vd= 500 L, the
required IV loading dose is:
A- 0.5 mg B- 0.75 mg C- 1 mg D- 1.5 mg E- 2 mg.

15- Concerning the placental barrier, which of the following is correct:

A- Allow passage of hydrophilic drugs to the fetus.
B- Drugs crossing the placenta can be teratogenic.
C- Steroid can pass while aspirin cannot.
D- Acetaminophen cannot be used during pregnancy.
E- None of the above.

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16- Which of the following is the best definition of any drug that has a quaternary structure?
A- Absorbed very well, with oral bioavailability of or close to 100%.
B- Blocks both muscarinic and nicotinic receptors for acetylcholine (Ach).
C- Derived from a plant.
D- Inhibits synthesis of acetylcholine.
E- Ionized at physiological pH, can’t enter the CNS well, if at all.

17- X is a drug that is extensively bound to plasma proteins, if you give a therapeutic dose to a person
with severe hypoalbuminemia, which one of the following effects would you expect to occur?
A- A greater than normal (possibly toxic) response to the drug.
B- A longer duration of action.
C- A slower onset of action.
D- A drug effect that is completely different from what X normally would cause.
E- No effect of X at all.

18- All of the following are possible consequences of phase I (non-synthetic) biotransformation except:
A- Production of pharmacologically inactive metabolite.
B- Conversion of one pharmacologically active to another active substance.
C- Conversion of one pharmacologically inactive to an active substance.
D- Combination of a drug with an endogenous substance.
E- Production of a toxic metabolite.

19- Which of the following can inhibit hepatic microsomal enzymes:

A- Phenobarbitone B- Valproic acid C- Phenytoin D- Rifampicin E- Tobacco smoking.

20- Which of the following is phase II (synthetic, conjugation) reaction of drug metabolism:
A- Oxidation B- Hydrolysis C- Reduction D- Acetylation E- Deamination.

21- Regarding biotransformation of most of the drugs:

A- The general aim is to convert active lipid soluble drugs into inactive water soluble metabolites.
B- Phase I metabolism includes conjugation with glucuronic acid.
C- Always leads to inactivation of drugs.
D- Phase II metabolism includes hydrolysis.
E- Occurs only in the liver.

22- Which of the following is phase I biotransformation reaction:

A- Glucuronide conjugation with chloramphenicol.
B- Glycine conjugation with glycine.
C- Hydrolysis of acetylcholine.
D- Acetylation of sulfonamide.
E- Sulphate conjugation with phenols.

23- All of the following drugs cause enzyme induction except:

A- Androgens B- Phenobarbitone C- Rifampicin D- Cimetidine. E- Carbamazepine.

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24- Drug metabolism can result in one of the following:
A- Metabolites with greater water solubility than the parent compound.
B- Glucuronic conjugation.
C- Metabolites with greater pharmacological activity than the parent compound.
D- All of the above.
E- None of the above.

25- The term “prodrug” refers to:

A- Drug that has only pure antagonist activity.
B- Compound that liberates an active drug in the body.
C- Drug that has only prophylactic activity in the body.
D- Compound that may be pharmacologically active but still under trial.
E- Drug that is classified as being “probably effective”.

26- Metabolism of the following drug may generate a toxic metabolite:

A- Diazepam B- Captopril C- Phenobarbitone D- Paracetamol E- Propranolol.

27- Drug metabolism usually results in a product that is:

A- More likely to distribute intracellularly.
B- Less lipid soluble than the original drug.
C- More likely to be absorbed by kidney tubules.
D- Less polar than the parent drug.
E- More likely to produce side effects.

28- All the following are phase II biotransformation reactions except:

A- Hydrolysis B- Acetylation C- Methylation D- Glucuronidation E- Sulfate conjugation.

29- Cimetidine is one of the best examples of drugs that inhibit P450 system. This means it inhibits:
A- Absorption B- Distribution C- Metabolism D- Excretion E- Receptor binding.

30- Which of the following would be likely the result of a decrease in urinary pH:
A- Decreased urinary excretion of a weak base.
B- Increased urinary excretion of a weak acid.
C- Increased urinary excretion of a weak base.
D- Decreased urinary excretion of a nonionized drug.
E- Increased urinary excretion of a completely ionized drug.

31- Alkalinization of urine would be expected to increase renal excretion of:

A- Acidic drug.
B- Basic drug.
C- Both acidic and basic drugs.
D- Neither acidic nor basic drugs.
E- Water soluble drugs.

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32- Concerning renal excretion of drugs, which of the following is correct?
A- Protein-bound drugs are easily filtered through glomeruli.
B- Drugs with large volume of distribution have rapid clearance.
C- Acidification of urine increases excretion of alkaline drugs.
D- Alkalinization of urine decreases excretion of aspirin.
E- All of the above.

33- Concerning characteristics of “zero order kinetics” which of the following is correct?
A- The t1/2 is constant.
B- Log plasma concentration-time curve is linear.
C- The rate of the process is proportional to the concentration of the drug.
D- A constant amount of drug is eliminated per unit time.
E- The elimination process is non-saturable.

34- All of the following is correct regarding first order kinetics except:
A- Implies that rate of drug metabolism is proportional to drug concentration.
B- Is more common than zero order kinetics at therapeutic doses.
C- Is described by exponential process.
D- Log plasma concentration-time curve is non-linear.
E- Plasma half-life is constant.

35- Which of the statements is correct for a drug whose elimination from plasma obeys first order
kinetics:
A- t1/2 increases with the dose.
B- The elimination process can become saturable.
C- The rate of elimination is proportional to the plasma concentration.
D- A constant amount of the drug is eliminated in unit time.
E- None of the above.

36- Concerning first order kinetics, which of the following is incorrect?

A- The rate of the process is proportional to concentration of the drug.
B- Log plasma concentration-time curve is linear.
C- Digoxin follows this form of kinetics.
D- The half-life is constant irrespective of the dose.
E- A constant amount of the drug is eliminated per unit time.

37- Which of the following may follow zero order kinetics:

A- Diazepam B- Phenobarbitone C- Propranolol D- Phenytoin E- All of the above.

38- Digoxin is a drug still used in management of heart failure. The half-life of the drug is about 36 hours.
How long will it take for blood levels of the drug to reach a steady concentration (plateau):
A- 36 hours B- 3 days C- 7 days D- 14 days e- It depends on what the actual dose of the drug is.

39- The maximum effect (Emax) achieved by a drug is a measure of:

A- Therapeutic index B- Efficacy.
C- Potency D- Antagonist magnitude.
E- Safety margin.

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40- The phrase “ability to bind to a receptor” fits the definition of:
A- Affinity B- Agonist C- Antagonist D- Efficacy E- Potency.

41- Drug A has a greater efficacy than drug B, then drug A:

A- Is more toxic than drug B.
B- Has a greater affinity for the receptor than drug B.
C- Has a greater margin of safety than drug B.
D- Is capable of producing a greater maximum effect than drug B.
E- None of the above.

42- Pindolol alone causes an increase in heart rate, while in the presence of potent beta stimulant,
pindolol causes a decrease in heart rate. So, pindolol is:
A- Physiological antagonist.
B- Chemical antagonist.
C- Partial agonist.
D- Irreversible antagonist.
E- Pharmacokinetic antagonist.

43- A noncompetitive antagonist can produce:

A- Parallel shift of the dose-response curve of agonist to the right.
B- Decrease the maximal response of the drug.
C- Change in the mechanism of action of the agonist.
D- Its effect can be overcome by higher concentration of the agonist.
E- All of the above.

**44- Which of the following is an action of noncompetitive antagonist:

A- Alters the mechanism of action of the agonist.
B- Alters the potency of an agonist.
C- Shifts the dose-response curve of the agonist to the right.
D- Decreases the maximum response to an agonist.
E- All of the above.

45- Reversal of histamine-induced bronchospasm by adrenaline is regarded as:

A- Competitive antagonism.
B- Noncompetitive antagonism.
C- Chemical antagonism.
D- Physiological antagonism.
E- Antagonism by ion channel block.

46- Which drug should be taken for optimum emergency management of an anaphylactic reaction?
A- Albuterol B- atropine C- Epinephrine D- Propranolol. E- Physostigmine.

47- An exaggerated normal pharmacological response to usual dose of drug is termed:

A- Tolerance B- Supersensitivity C- Tachyphylaxis D- Idiosyncracy E- Hypersensitivity.

48- The ability of a drug to induce fetal malformation when given to a pregnant mother is termed:
A- Idiosyncracy B- Tachyphylaxis C- Hypersensitivity D- Teratogenicity E- Mutagenicity.

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49- Tolerance is:
A- Decreased response to a usual dose of a drug.
B- Increased response to a usual dose of a drug.
C- Abnormal response to a drug due to genetic or enzyme defect.
D- Inactivation of a drug by the kidney.
E- Immediate hypersensitivity reaction.

50- An abnormal reaction to a drug due to genetic abnormality is termed:

A- Tachyphylaxis B- Teratogenicity C- Idiosyncracy D- Hypersensitivity E- Tolerance.

51- Glucose -6- phosphate dehydrogenase deficiency is associated with:

A- Peripheral neuropathy.
B- Acute porphyria.
C- Hypoglycemia.
D- Hypercalcemia.
E- Hemolysis when subject ingests an oxidizing agent as aspirin.

52- Teratogenicity is:

A- Drug-induced disease.
B- Decreased response to the normal dose of the drug.
C- Abnormal response due to genetic abnormality.
D- The drug induces fetal malformation when given to pregnant women.
E- Hypersensitivity to drugs.

53- Aspirin-induced hemolytic anemia in G-6-P-D deficiency is termed:

A- Teratogenicity B- Drug dependence C- Idiosyncracy D- Hypersensitivity E- Intolerance.

**54- The therapeutic index of a drug is:

A- The ratio of lethal dose in 50% of animals to effective dose in 50% of animals.
B- The ratio of half the toxic dose to half the effective dose.
C- The ratio of the effective dose to the toxic dose.
D- A rough measure of safety of the drug.
E- all of the above.

**55- The margin of safety of a drug gives you information about the:
A- Number of drug interactions that are likely to be caused.
B- Relative ratio between a drug’s average lethal and average effective doses.
C- Number of indications for which it can be used.
D- Number of contraindications for which it should not be used.
E- Relative cost of a drug per dose (e.g. dollars per milligram).

56- Old patients aging more than 70 years need:

A- Larger dose than the adult dose.
B- Smaller dose than the adult dose.
C- Equal dose to that of the adult dose.
D- A dose that is equal to the infant dose.
E- Smaller dose than that of the infant dose.

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57- Reducing of which one pharmacokinetic factor does not account for more adverse effects in elderly:
A- Absorption B- distribution C- Hepatic metabolism
D- Renal excretion E- Decreased plasma proteins.

58- Two drugs with the same effect were given together, the net effect produced was greater than the
sum of their individual effects. This phenomenon is termed:
A- Potentiation B- Synergism C- Addition D- Cross tolerance E- Tachyphylaxis.

59- The following drug interactions are correct except:

A- Metoclopramide hastens the absorption of paracetamol.
B- Charcoal decreases the absorption of phenobarbitone.
C- Probenecid enhances renal excretion of penicillin.
D- Phenobarbitone reduces the pharmacological actions of warfarin.
E- Phenylbutazone displaces phenytoin from its plasma protein binding sites.

60- All of the following are drug interactions that affect absorption except:
A- Tetracycline-------milk.
B- Tetracyclines------antacids containing aluminum.
C- Tetracycline--------cimetidine.
D- Cholestyramine---cardiac glycosides.
E- Cholestyramine----thyroxine.

61- Synergism is considered to exist when the reaction to two drugs given in combination is:
A- Less than the sum of the individual actions of the two drugs.
B- Equal to the sum of the individual actions.
C- Greater than the sum of the individual actions.
D- Less than that of either of the individual actions.
E- Greater than that of either of the individual actions.

62- Mechanisms responsible for drug interactions include those related to:
A- Absorption.
B- Biotransformation and excretion.
C- Protein binding.
D- Receptor availability and receptor affinity.
E- All of the above.

63- Drug A increases blood pressure by 10 mmHg. Drug B increases pressure by 10 mmHg also. Giving
the two drugs together, each at their own right doses, increases blood pressure by 30 mmHg. This is an
example of:
A- Pharmacological antagonism B- Summation C- Potentiation
D- Synergism E- Pharmacological antagonism.

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64- The following statement is incorrect:
A- Drug metabolism can be affected by genetic variation.
B- Renal excretion of weak acid and/ or base is affected by urinary pH.
C- Partial agonists have no effect in the absence of agonists.
D- Drugs with first order kinetics reach their steady state concentration after regular administration for
4-5 half-lives.
E- Drugs with zero order kinetics have a non-linear disappearance curve.

65- Which of the following statements is incorrect:

A- The higher the therapeutic index, the safer the drug.
B- Ionized drugs of low lipid solubility can cross BBB.
C- Sublingual administration avoids first pass metabolism.
D- Intravenous administration provides 100% bioavailability.
E- Plasma t1/2 is the time it takes for plasma concentration to be reduced by one half.

66- Which of the following statements is correct?

A- Sublingual administration cannot avoid first pass metabolism.
B- The higher the therapeutic index, the safer the drug.
C- Alkalinization of urine enhances excretion of weak basic drugs.
D- Drug metabolism is slower in those who smoke than in those who do not.
E- Simple diffusion does not require energy but needs carrier.

**67- Allergic reactions to drugs can result in all of the following clinical manifestations except:
A- Angioneurotic edema B- Asthma C- Fever D- Peptic ulcer E- Photosensitivity.

ANSWERS:
1- C 2- C 3- B 4- D 5- C 6- B 7- E 8- C 9- B 10- D
11- B 12- E 13- E 14- B 15- B 16- E 17- A 18- D 19- B 20- D
21- A 22- C 23- D 24- D 25- B 26- D 27- B 28- A 29- C 30- C
31- A 32- C 33- D 34- D 35- C 36- E 37- D 38- C 39- B 40- A
41- D 42- C 43- B 44- BCD 45- D 46- C 47- B 48- D 49- A 50- C
51- E 52- D 53- C 54- A,D 55- B 56- B 57- A 58- B 59- C 60- C
61- C 62- E 63- D 64- C 65- B 66- B 67- D