Question 1 (1 point)

This is defined as any change from an organism's normal state which

is dependent upon the concentrfiion of active compound at the target site
for a sufficient time

(;‘\ Unnecessary effect

j Toxic effect

(:_‘ Adverse effect

() Deleterious effect

Question 2 (1 point)

The morphine metabolite that maybe responsible for most of

morphine's analgesic activity is:

( morphine sulfate

( N-acetylmorphine

O desmethylmorphine &

jj4 morphine-6-glucuronide
Question 3 (1 point)

Which one of the following is an established clinical use of

morphine?

(':1 Treatment of cough associated with use of

ACE inhibitors () Management of generalized
anxiety disorders

(") pulmonary congestion

() Relief of pain associated with biliary colic

Question 4 (1 point)

A 55 y/o man with a 40-pack year history of smoking develops agranulocytosis and
some leukemic features. His physical examination of the heart, lungs and abdomen
are within normal limits. Should this disease relate to a potential toxic
exposure, which of the following should be considered most likely?

) ethyl alcohol

( toluene () benzene

() methanol
Question 5 (1 point)

A 38 y/o woman presents to the ophthalmologist for a routine eye examination.

She is given intraocular pilocarpine. She was supposed to be administered to
drops in each to dilate the eyes for examination. Unfortunately, the eyedrops
administered by a new technician administered 10 drops of pilocarpine in each
eye. Which of the following agents should be immediately given to the patient?

() Donepezil
() Carbachol
( i ) Atropine

() Galantamine

Question 6 (1 point)

Which of the following is the antidote of Mercury

poisoning?

() dimercaprol
~ ) succimer PO

(") deferoxamine
() penicillamine
Question 7 (1 point)

A 45 year old factory worker with jaundice was assessed to have toxicity
from hydrocarbons used in the factory. He has been working at the
factory for the past 5 years. What kind of exposure does he likely have?

() Chronic exposure

(") Prolonged exposure

() Acute exposure

() Subacute exposure

Question 8 (1 point)

A 24 y/o woman presents to the pharmacy to pick up a prescription for the

management of her persistent cough. she was started on a medication that was
supposed to decrease sensitivity of the central cough center to peripheral
stimuli and decrease mucosal secretions. Which of the following
medications was prescribed?

() codeine
("f ) N-acetylcysteine

() guaifenesin
() benzonatate
Question 9 (1 point)

The following is true regarding Therapeutic

index

(") equals ED50/LD50

() The larger the ratio, the lesser the relative safety

(") the ratio of the doses of the toxic and the desired responses

() takes into account the slope of the

dose-response curves

Question 10 (1 point)

Which of the following is not true of tizanidine?

- It reduces muscle tone by activating GABAg receptors

() It is a clonidine congener used in spasticity

due to stroke or spinal injury

() It reduces muscle spasms without producing weakness

() It inhibits release of excitatory amino acids

in spinal interneurons
Question 11 (1 point)

What is the mechanism of action of

organophosphate poisoning?

‘.j:‘ Inhibition of acetylcholinesterase

() Inhibition of cytochrome P450 enzyme

(: ) Increase stimulation of acetylcholinesterase

() all are correct

Question 12 (1 point)

In using topical corticosteroid, you should start with less potent

then upgrade it to more potent preparation.

() True
Question 13 (1 point)

Full activation of the parasympathetic nerves is likely to

produce which of the following effects

() decreased intestinal motility

() bronchodilation

") increased thermoregulatory sweating

() increased pupillary constrictor tone (miosis)

Question 14 (1 point)

Which of the following skeletal muscle relaxant that acts as a

central a2 adrenergic agonist?

) tizanidine

() Chlormezanone

) Brimonidine

b
()\ Quinine
Question 15 (1 point)

A 28 y/o woman diagnosed with myasthenia gravis, She was prescribed with
pyridostigmine. Which of the following is a potential side effect of
this therapy?

() mydriasis

{'j tachycardia
) constipation | diaphoresis

Question 16 (1 point)

Several children at a summer camp were hospitalized with

symptoms thought to be

due to ingestion of food containing Which one of the

botulinum toxin. signs or symptoms is following botulinum
consistent with the diagnosis of poisoning?

() hyperventilation

O bronchospasm () diarrhea

() cycloplegia
Question 17 (1 point)

A bronchial smooth muscle contains?

() beta 2 receptor
() beta 1 receptor

(:w alpha 2 receptor

) alpha 1 receptor

Question 18 (1 point)

Which of the following ectoparacitides agent is not approved for

pregnancy and children?

() spinosad
( :, crotamiton lindane

() premethrin
Question 19 (1 point)

A 50 y/o man is brought to the emergency room due to seizures with

torsade de pointes. He initially experienced acute gastrointestinal
distress with garlic breath and rice water stools. He later on
developed skin pigmentation, alopecia. He complained of stocking glove
neuropathy. This man might be suffering from poisoning of which of the
following?

() lead
() arsenic

(:‘ iron

() mercury

Question 20 (1 point)

A 44 y/o man has been treated with opioid narcotic for his chronic back
pain. He has been suffering with constipation, initially managed with
increase fiber in his diet. What agent can be given to him to manage his
condition?

() lactulose
() methylnatrexone

() metoclopromide

() naltrexone
Question 21 (1 point)

Organophosphate can be absorbed through whichof the

following?

( all are correct () ingestion

(: | percutaneous

() inhalation

Question 22 (1 point)

A 48 y/o man is being treated with a long-acting opiate or pain

associated with terminal cancer. He is also prescribed a
transmucosal fentanyl formulation (lollipop) for "breakthrough"
pain. The transmucosal formulation is an effective analgesic
because it

) avoids nausea and vomiting that is associated with the systemic use of fentanyl ") avoids

first pass metabolism of fentanyl.

() avoids respiratory depression.

(") delivers fentanyl directly to opiate

receptors in the mouth.
Question 23 (1 point)

Which of the following topical corticosteroid

preparations has the highest potency?

() hydrocortisone
() clobetazole

() fluocinolone
() betamethasone

Question 24 (1 point)

Which vehicle to use for dry, scaly skin lesion?

( cream () tincture

() powder
Question 25 (1 point)

Which of the following alpha-adrenergic agonists would be

expected to have the strongest potency at the alpha-receptor?

() acetylcholine
; ) norepinephrine () epinephrine ©) metanephrine

Question 26 (1 point)

Which of the following antifungal agents are highly actives against

dermatophytes but not much against yeasts?

() clotrimazole

) terbinafine
() amphotericin B

() nystatin
Question 27 (1 point)

A man was found unconscious in the car park. You suspect that he was a case

of Carbon Monoxide poisoning. Which of the following is its mechanism of

action?

{\'j Inhibits acetylcholinesterase

) damages the lung infrastructure that produces the surfactant necessary to allow "~

smooth and low effort lung alveolar expansion

() Interfere with inactivation of the sodium channel in excitable membranes

—
(") It binds to hemoglobin which produces
carboxyhemoglobin leading to hypoxia

Question 28 (1 point)

Which of the following inhaled anesthetics is also

known as laughing gas?

() isoflurane

nitrous oxide

() desflurane
() sevoflurane
Question 29 (1 point)

Which of the following agents is used to accelerate recovery from

the sedative actions of intravenous benzodiazepines?

() flumazenil
() naloxone

() ketamine
() fomipezole

Question 30 (1 point)

Which of the following is NOT an important considerations in

choosing a vehicle for the agent?

:\ rate of release of the agent

(:‘j\ stability of the agent in the vehicle

’ the surface area of the site of application

() solubility of the agent to the vehicle
Question 31 (1 point)

A 47 y/o man is given atropine to decrease dental secretions

during a root canal procedure. This agent is likely to have
an effect on which of the following target organs/glands?

() lacrimation
() sweat glands

() pilomotor muscles

() salivary glands

Question 32 (1 point)

Which of the following inhaled anesthetic can cause

airway irritation?

() nitrous oxide

() halothane
() sevoflurane

() desflurane
Question 33 (1 point)

Commonalities of the sympathetic, parasympathetic and somatic nervous

systems involve which of the following neuroeffector transmitters?

7 acetylcholine i | epinephrine () norepinephrine @) dopamine

Question 34 (1 point)

A 15 y/o boy attempted suicide with a bottle of insecticide. He has

lost consciousness, his heart rate is 45 bpm and his blood pressure
is 80/40 mmHg. He is sweating and salivating profusely. What is the
most appropriate treatment for this patient?

() edrophonium

( physostigmine ) atropine

() norepinephrine
Question 35 (1 point)

What is the initial management of poisoned patient?

j:» Give antidote

() Do complete and physical examination

() Secure ABCD (airway, breathing,

circulation, dextrose line)

") Do gastric lavage

Question 36 (1 point)

Why is neuromuscular blocking drugs do not produce

central actions?

L:' They are sequestrated in the periphery by

tight binding to the skeletal muscles

() They do not cross the blood-brain barrier

() They do not ionize at the brain pH

Question 37 (1 point)

Which of the following is TRUE about dose response

relationship?

f\:w Lethal dose values cannot be derived from dose response data

() As the dose of a toxicant increases, so does the dose response

() Y axis represents the % of maximal

response () X axis represents the dose

Question 38 (1 point)

A 62 y/o retired small businessman has had slowly increasing intraocular

pressure bilaterally. You start him on a drug used to treat his open-
angle glaucoma, which happens to cross the blood brain barrier better
than other drugs in its class. Which of the following drugs is this?

() pyridostigmine

f’\ physostigmine

() echothiophate

() all are correct

Question 39 (1 point)

Which of the following ectoparacitides agent is not approved

for pregnancy and children?

() crotamion
() spinosad
() permethrin

() lindane

Question 40 (1 point)

Diazepam is used as a muscle relaxant for which

condition?

() tetanus
() myasthenia gravis

() tracheal intubation
() deep-intraabdominal surgery
Question 41 (1 point)

A 44 y/o man is found dead in his home by the police. Reports indicate
that the man was heating his one room apartment with kerosene space
heater. Other people in the apartment complex that he lives develop
headache, lethargy and confusion? What is the most likely explanation for
these findings?

7‘ carbon monoxide poisoning

( ’ ) mercury exposure () silica dust exposure

() cyanide exposure

Question 42 (1 point)

Which of the following topical corticosteroid preparations has

the lowest potency?

() fluocinolone
() hydrocortisone
() clobetazole
() betamethasone
Question 43 (1 point)

A 32 y/o woman presents to the ER with ptosis, diplopia and limited facial
expressions. Further examination leads to a diagnosis of myasthenia gravis.
Which of medication can help manage the patient's symptoms?

@) pyridostigmine

( tropicamide O atropine

" pralidoxime

Question 44 (1 point)

Indications of centrally acting muscle

relaxants include all of the following except:

() Balanced anesthesia

() Torticollis
(f\ Traumatic muscle spasms

() Electroconvulsive therapy
Question 45 (1 point)

Which of the following pesticides inhibit acetylcholinesterase by

carbamoylation of esteratic site?

() Organochlorines

() Organophosphates

(") Carbamates
() Botanical

Question 46 (1 point)

Which of the following is the most rapidly acting nondepolarizing

neuromuscular blocking agent which can be used as an alternative
to succinylcholine for tracheal intubation?

(") Rocuronium
() Pipecuronium

() Doxacurium

() Pancuronium
Question 47 (1 point)

Which of the following statements is NOT correct?

(") alpha agonist increase the production of aqueous humour

p
() alpha agonist causes mydriasis

;:J beta agonist decreaseproduction of

aqueous humour

(") alpha agonist causes miosis

Question 48 (1 point)

After norepinephrine is released, it binds to receptors on the target organs.

Then, it must be removed from the synaptic space. Which of the following
mechanism describes correct removal of norepinephrine from the synaptic
space?

() diffusion from the general circulation back into the

synaptic space

O pump system pumps norepinephrine out of the

neuron & () ATPase pump is stimulated by cocaine
(") metabolism to O-methylated derivatives in
the synaptic space
Question 49 (1 point)

A 3 y/o child has been admitted to the emergency department having swallowed contents of

3 bottles of nasal decongestant. The active ingredients of the medication is

phenylephrine, a potent selective alpha-adrenoceptor agonist drug. Which of the

following is a sign of alpha-receptor activation that may occur in this child?

() pupillary dilation (mydriasis)

() tachycardia
() bronchodilation
() vasodilator

Question 50 (1 point)

Which of the following is a nicotinic effect of

organophosphate poisoning?

() miosis

() diaphoresis
() muscle fasciculation

() bradycardia
Question 51 (1 point)

This term describes the ability of a chemical agent

to cause injury on people.

( :‘\ Hazard (){ Risk

Poison
) All of the above

Question 52 (1 point)

Which of the following topical antifungal drugs are highly active against
dermatophytes but not much with against yeasts?

) amphotericin B () terbinafine

clotrimazole

(’:3 nystatin
Question 53 (1 point)

A 72 y/o woman with Parkinson's disease is taking a medication that increases

release of dopamine, blockade of cholinergic receptors and inhibiting N-
methyl-D-aspartate receptor. This describes which of the following agents?

() tolcapone

) pramipexole

) bromocriptine () amantadine

Question 54 (1 point)

Dantrolene sodium reducesskeletal muscle tone by:

(’) Reducing acetylcholine release from motor nerve endings

(’) Reducing Ca2+ release from sarcoplasmic reticulum in the muscle

fiber g\) Inhibiting the generation of muscle action potential

() Suppressing spinal polysynaptic reflexes

Question 55 (1 point)

Which of the following antifungal is effective for Candida

albicans but not with dermatophytes?

( terbinafine () naftifine

(: nystatin

() tolnaftate

Question56 (1 point)

LD50 stands for

(3 doseat which 50% of population experiences toxicity

(’) dose at which 50% of population dies

(7\/\ dose at which 50% of population

therapeutically responds

(:’j dose at which 50% experience an adverse

effect
Question 57 (1 point)

A 50 y/o woman with back pain is administered an opiate agonist.

After 2 weeks of therapy, she notices that she needs to increase
the dose to get the same analgesic effect. She is experiencing:

) addiction
) withdrawal ) tolerance

Lj dependence

Question 58 (1 point)

It is considered as the major barrier to percutaneous absorption

and to the loss of water from the body

( ‘) subcutaneous layer

C) stratum spinosum () stratum corneum

() dermis
Question 59 (1 point)

Which vehicle to use for dry, scaly skin lesion?

() cream
() tincture
() ointment
U
() powder

Question 60 (1 point)

Which of the following topical imidazoles is used

for onychomycosis of the toenails

() miconazole
() clotrimazole