BASIC PRINCIPLES – PHARMA **Answer: A.

Synergism**
Rationale: Synergism occurs when two drugs produce
1. Which of the following is NOT a route of drug a combined effect greater than the sum of their
administration? individual effects.
A. Intravenous
B. Intramuscular 6. The study of how genetic variations affect individual
C. Subcutaneous responses to drugs is known as:
D. Intradermal A. Pharmacodynamics
E. None of the above B. Pharmacokinetics
C. Pharmacogenetics
**Answer: E. None of the above** D. Pharmacotherapy
Rationale: All options (A-D) are routes of drug
administration. **Answer: C. Pharmacogenetics**
Rationale: Pharmacogenetics focuses on the influence
2. What term describes the study of drug absorption, of genetic variation on drug response.
distribution, metabolism, and excretion?
A. Pharmacodynamics 7. Which of the following terms describes the range of
B. Pharmacokinetics plasma drug concentrations that result in therapeutic
C. Pharmacogenetics effects without toxicity?
D. Pharmacology A. Therapeutic index
E. None of the above B. Therapeutic window
C. Half-life
**Answer: B. Pharmacokinetics** D. Steady-state concentration
Rationale: Pharmacokinetics refers to the study of
drug movement within the body. **Answer: B. Therapeutic window**
Rationale: The therapeutic window is the range of
3. Which of the following routes of drug administration drug concentrations that produce therapeutic effects
has the first-pass effect? without causing toxicity.
A. Oral
B. Intravenous 8. The time required for the plasma concentration of a
C. Intramuscular drug to decrease by half is known as:
D. Subcutaneous A. Absorption
E. Topical B. Distribution
C. Metabolism
4. What is the term used to describe the relationship D. Half-life
between the dose of a drug and its effects?
A. Potency **Answer: D. Half-life**
B. Efficacy Rationale: Half-life is a pharmacokinetic parameter
C. Toxicity that describes the rate of drug elimination.
D. Half-life
9. What term describes the reduction in drug
**Answer: A. Potency** responsiveness over time with continuous drug
Rationale: Potency refers to the dose of a drug administration?
required to produce a certain effect. A. Tolerance
B. Dependence
5. Which of the following drug interactions occurs when C. Withdrawal
the effect of two drugs together is greater than the sum D. Tachyphylaxis
of their individual effects?
A. Synergism **Answer: A. Tolerance**
B. Antagonism Rationale: Tolerance refers to the decreased response
C. Additive effect to a drug following repeated administration.
D. Idiosyncratic reaction
10. The process by which a drug binds to its target administration, requiring higher doses to achieve the
receptor and produces a physiological effect is known same effect?
as: A. Tolerance
A. Absorption B. Dependence
B. Distribution C. Addiction
C. Metabolism D. Withdrawal
D. Pharmacodynamics
**Answer: A. Tolerance**
**Answer: D. Pharmacodynamics** Rationale: Tolerance refers to the decreased response
Rationale: Pharmacodynamics is the study of the to a drug following repeated administration,
biochemical and physiological effects of drugs and their necessitating higher doses to produce the same effect.
mechanisms of action.
15. Which of the following factors can affect drug
11. Which of the following terms describes the study of absorption?
the biochemical and physiological effects of drugs and A. Gastric emptying time
their mechanisms of action? B. pH of the gastrointestinal tract
A. Pharmacokinetics C. Presence of food in the stomach
B. Pharmacodynamics D. All of the above
C. Pharmacogenomics
D. Pharmacoeconomics **Answer: D. All of the above**
Rationale: Gastric emptying time, pH of the
**Answer: B. Pharmacodynamics** gastrointestinal tract, and presence of food can all
Rationale: Pharmacodynamics is the study of drug influence drug absorption.
effects on the body and their mechanisms of action.
16. What is the term used to describe the process by
12. Which of the following statements about agonists is which a drug is transported from its site of
true? administration to the bloodstream?
A. Agonists bind to receptors but do not produce a A. Absorption
response. B. Distribution
B. Agonists bind to receptors and produce a maximal C. Metabolism
response. D. Excretion
C. Agonists bind to receptors and inhibit their activity.
D. Agonists have no affinity for receptors. **Answer: A. Absorption**
Rationale: Absorption is the process by which a drug
**Answer: B. Agonists bind to receptors and produce enters the bloodstream from its site of administration.
a maximal response.**
Rationale: Agonists are drugs that bind to receptors 17. Which of the following factors can affect drug
and activate them, producing a response. distribution within the body?
A. Blood flow to tissues
13. Which of the following routes of drug administration B. Protein binding
is suitable for drugs with poor oral bioavailability? C. Tissue permeability
A. Oral D. All of the above
B. Sublingual
C. Intravenous **Answer: D. All of the above**
D. Intramuscular Rationale: Blood flow to tissues, protein binding, and
tissue permeability are all factors that can influence
**Answer: C. Intravenous** drug distribution.
Rationale: Intravenous administration bypasses the
gastrointestinal tract and is suitable for drugs with poor 18. Which of the following routes of drug administration
oral bioavailability. has the fastest onset of action?
A. Oral
14. What term describes the phenomenon where a B. Intravenous
drug's effect is reduced as a result of repeated C. Subcutaneous
 D. Topical
**Answer: A. Naloxone**
**Answer: B. Intravenous** Rationale: Naloxone is a competitive opioid receptor
Rationale: Intravenous administration delivers drugs antagonist used for the reversal of opioid overdose.
directly into the bloodstream, resulting in rapid onset of
action. 23. A pregnant woman with epilepsy requires
antiepileptic medication to control seizures. Which of
19. Which of the following terms describes the study of the following factors should be considered when
the biochemical transformation of drugs within the selecting the appropriate antiepileptic drug for this
body? patient?
A. Absorption A. Risk of teratogenicity
B. Distribution B. Maternal weight
C. Metabolism C. History of allergies
D. Excretion D. Blood type

**Answer: C. Metabolism** **Answer: A. Risk of teratogenicity**

Rationale: Metabolism refers to the chemical Rationale: Antiepileptic drugs have varying risks of
alteration of drugs by enzymes within the body. teratogenic effects, which must be considered when
prescribing for pregnant women.
20. Which of the following organs is primarily
responsible for drug metabolism? 24. A patient is prescribed a medication that undergoes
A. Liver significant first-pass metabolism. Which of the following
B. Kidneys routes of administration would be most appropriate to
C. Lungs bypass first-pass metabolism?
D. Spleen A. Oral
B. Intramuscular
**Answer: A. Liver** C. Sublingual
Rationale: The liver is the primary site of drug D. Transdermal
metabolism, where enzymes catalyze the
biotransformation of drugs. **Answer: D. Transdermal**
Rationale: Transdermal administration bypasses the
21. A 65-year-old patient with a history of liver disease liver and first-pass metabolism, making it suitable for
is prescribed a medication with a narrow therapeutic drugs susceptible to significant hepatic metabolism.
index. Which of the following pharmacokinetic
parameters is likely to be affected in this patient? 25. A patient receiving long-term corticosteroid therapy
A. Volume of distribution develops osteoporosis. Which of the following
B. Bioavailability pharmacological agents is most appropriate for
C. Clearance preventing corticosteroid-induced osteoporosis?
D. Half-life A. Bisphosphonates
B. Nonsteroidal anti-inflammatory drugs (NSAIDs)
**Answer: C. Clearance** C. Calcium channel blockers
Rationale: Liver disease can impair drug metabolism, D. Antibiotics
leading to reduced clearance of drugs with a narrow
therapeutic index. **Answer: A. Bisphosphonates**
Rationale: Bisphosphonates are commonly used to
22. A patient presents to the emergency department prevent and treat corticosteroid-induced osteoporosis
with signs of opioid overdose. Which of the following by inhibiting bone resorption.
medications is most appropriate for immediate reversal
of opioid effects? 26. A patient with a history of heart failure and
A. Naloxone hypertension is prescribed a medication that inhibits
B. Diazepam the renin-angiotensin-aldosterone system. Which of the
C. Atropine following medications is most likely to be prescribed?
D. Flumazenil A. Lisinopril
 B. Metoprolol
C. Amlodipine
D. Furosemide
**Answer: A. Lisinopril**
Rationale: Lisinopril is an angiotensin-converting
enzyme (ACE) inhibitor commonly used in the
management of heart failure and hypertension.
27. A patient with rheumatoid arthritis is prescribed a
disease-modifying antirheumatic drug (DMARD). Which
of the following DMARDs requires regular monitoring of
liver function tests due to the risk of hepatotoxicity?
A. Methotrexate
B. Hydroxychloroquine
C. Sulfasalazine
D. Etanercept
**Answer: A. Methotrexate**
Rationale: Methotrexate, a commonly used DMARD,
can cause hepatotoxicity and requires regular
monitoring of liver function tests.
28. A patient is prescribed a medication with a narrow
therapeutic index. Which of the following strategies can
help minimize the risk of toxicity associated with this
medication?
A. Administering a higher dose
B. Monitoring drug levels regularly
C. Prescribing a different medication
D. Increasing the dosing frequency
**Answer: B. Monitoring drug levels regularly**
Rationale: Regular monitoring of drug levels can help
ensure therapeutic efficacy while minimizing the risk of
toxicity, especially for drugs with a narrow therapeutic
index.
29. A patient with chronic obstructive pulmonary
disease (COPD) requires bronchodilator therapy. Which
of the following bronchodilators is a long-acting
muscarinic antagonist (LAMA)?
A. Albuterol
B. Formoterol
C. Ipratropium
D. Tiotropium
**Answer: D. Tiotropium**
Rationale: Tiotropium is a long-acting muscarinic
antagonist (LAMA) commonly used in the management
of COPD.
30. A patient is prescribed a medication that undergoes
significant hepatic metabolism via the cytochrome P450
enzyme system. Which of the following factors can
potentially affect the metabolism of this medication?
A. Genetic polymorphisms
B. Renal function
C. Age
D. Gender
**Answer: A. Genetic polymorphisms**
Rationale: Genetic polymorphisms in cytochrome
P450 enzymes can lead to variability in drug
metabolism, affecting drug efficacy and toxicity.
31. A 55-year-old patient with a history of type 2
diabetes mellitus presents with signs of diabetic
nephropathy. Which of the following medications is
most appropriate for slowing the progression of renal
disease in this patient?
A. Metformin
B. Lisinopril
C. Insulin glargine
D. Sitagliptin
**Answer: B. Lisinopril**
Rationale: Lisinopril, an ACE inhibitor, is commonly
used to slow the progression of diabetic nephropathy by
reducing intraglomerular pressure and proteinuria.
32. A patient with depression is prescribed an
antidepressant medication. After starting treatment, the
patient experiences significant weight gain and
sedation. Which class of antidepressants is most likely
to be responsible for these adverse effects?
A. Selective serotonin reuptake inhibitors (SSRIs)
B. Tricyclic antidepressants (TCAs)
C. Monoamine oxidase inhibitors (MAOIs)
D. Atypical antidepressants
**Answer: B. Tricyclic antidepressants (TCAs)**
Rationale: Tricyclic antidepressants are associated
with significant anticholinergic effects, sedation, and
weight gain, compared to other classes of
antidepressants.
33. A 70-year-old patient with a history of atrial
fibrillation is prescribed a direct oral anticoagulant
(DOAC) for stroke prevention. Which of the following
DOACs is contraindicated in patients with severe renal
impairment (creatinine clearance < 15 mL/min)?
A. Apixaban
B. Rivaroxaban
C. Dabigatran
 D. Edoxaban
**Answer: C. Dabigatran**
Rationale: Dabigatran, a direct thrombin inhibitor, is
contraindicated in patients with severe renal
impairment due to the risk of drug accumulation and
bleeding.
34. A patient with hypertension is prescribed a diuretic
medication as initial therapy. Which of the following
diuretics is classified as a thiazide diuretic?
A. Furosemide
B. Hydrochlorothiazide
C. Spironolactone
D. Acetazolamide
**Answer: B. Hydrochlorothiazide**
Rationale: Hydrochlorothiazide is a thiazide diuretic
commonly used in the treatment of hypertension and
edema.
35. A patient with chronic pain is prescribed an opioid
medication for pain management. Which of the
following opioids is associated with a reduced risk of
respiratory depression and constipation due to its
unique mechanism of action?
A. Morphine
B. Fentanyl
C. Tramadol
D. Methadone
**Answer: C. Tramadol**
Rationale: Tramadol is a synthetic opioid with dual
mechanisms of action, including weak mu-opioid
receptor agonism and inhibition of serotonin and
norepinephrine reuptake, which reduces the risk of
respiratory depression and constipation.
36. A patient with rheumatoid arthritis develops a
hypersensitivity reaction to methotrexate. Which of the
following biologic agents targets tumor necrosis factor-
alpha (TNF-α) and is an alternative treatment option for
this patient?
A. Rituximab
B. Adalimumab
C. Abatacept
D. Tocilizumab
**Answer: B. Adalimumab**
Rationale: Adalimumab is a TNF-α inhibitor indicated
for the treatment of rheumatoid arthritis and other
autoimmune conditions.
37. A patient with schizophrenia experiences
extrapyramidal symptoms (EPS) such as akathisia and
dystonia while receiving antipsychotic medication.
Which of the following atypical antipsychotics is least
likely to cause EPS due to its low affinity for dopamine
D2 receptors?
A. Olanzapine
B. Risperidone
C. Quetiapine
D. Aripiprazole
**Answer: D. Aripiprazole**
Rationale: Aripiprazole is a partial dopamine D2
receptor agonist with lower propensity to cause EPS
compared to other antipsychotic medications.
38. A patient with chronic obstructive pulmonary
disease (COPD) requires bronchodilator therapy. Which
of the following combinations of bronchodilators
provides additive bronchodilator effects and is
recommended as maintenance therapy for COPD?
A. Albuterol and ipratropium
B. Formoterol and salmeterol
C. Tiotropium and aclidinium
D. Salmeterol and aclidinium
**Answer: C. Tiotropium and aclidinium**
Rationale: Tiotropium (a long-acting muscarinic
antagonist) and aclidinium (another long-acting
muscarinic antagonist) are often used together for
additive bronchodilator effects in COPD.
39. A patient is prescribed a medication that is known to
prolong the QT interval. Which of the following
medications, if co-administered, increases the risk of QT
prolongation and torsades de pointes?
A. Metoprolol
B. Fluoxetine
C. Furosemide
D. Digoxin
**Answer: B. Fluoxetine**
Rationale: Fluoxetine, a selective serotonin reuptake
inhibitor (SSRI), can prolong the QT interval and
increase the risk of torsades de pointes when co-
administered with other QT-prolonging medications.
40. A patient with severe pain due to metastatic cancer
is prescribed an opioid analgesic. Which of the following
opioids is preferred for managing severe cancer pain
due to its rapid onset and short duration of action?
A. Morphine
B. Oxycodone
 C. Hydromorphone
D. Fentanyl
**Answer: D. Fentanyl**
Rationale: Fentanyl, a potent synthetic opioid, is
preferred for managing severe cancer pain due to its
rapid onset of action and short duration, making it
suitable for breakthrough pain episodes.
Match the drug interaction mechanism with the correct
example:
A. Pharmacokinetic interaction
B. Pharmacodynamic interaction
C. Combined effect interaction
1. **Inhibition of Cytochrome P450 enzymes**
A. Warfarin and aspirin
B. Ketoconazole and simvastatin
C. Quinidine and digoxin
2. **Potentiation of central nervous system
depression**
A. Alcohol and benzodiazepines
B. Digoxin and spironolactone
C. Metoprolol and albuterol
3. **Additive effect leading to increased bleeding risk**
A. NSAIDs and warfarin
B. Metformin and cimetidine
C. Phenytoin and phenobarbital
4. **Reduced therapeutic effect due to chelation**
A. Calcium supplements and levothyroxine
B. Tetracycline and antacids
C. ACE inhibitors and potassium-sparing diuretics
5. **Increased risk of serotonin syndrome**
A. Sertraline and tramadol
B. Fluoxetine and sumatriptan
C. Ondansetron and metoclopramide
6. **Decreased bioavailability due to altered gastric
pH**
A. Omeprazole and clopidogrel
B. Ferrous sulfate and antacids
C. Aspirin and ibuprofen
7. **Increased risk of hypotension and bradycardia**
A. Verapamil and atenolol
B. Amiodarone and simvastatin
C. Lisinopril and potassium supplements
8. **Antagonism of anticoagulant effect**
A. Warfarin and vitamin K-rich foods
B. Heparin and enoxaparin
C. Aspirin and clopidogrel
9. **Additive effect on serum potassium levels**
A. Loop diuretics and ACE inhibitors
B. Calcium channel blockers and beta-blockers
C. Oral contraceptives and rifampin
10. **Prolongation of QT interval leading to
arrhythmias**
A. Amiodarone and quinidine
B. Azithromycin and ondansetron
C. Ciprofloxacin and fluoxetine
Answers:
1. A - B. Ketoconazole and simvastatin
2. B - A. Alcohol and benzodiazepines
3. C - A. NSAIDs and warfarin
4. C - B. Tetracycline and antacids
5. B - A. Sertraline and tramadol
6. A - B. Omeprazole and clopidogrel
7. C - A. Lisinopril and potassium supplements
8. C - A. Aspirin and clopidogrel
9. A - A. Loop diuretics and ACE inhibitors
10. B - C. Ciprofloxacin and fluoxetine
1. **A patient with chronic obstructive pulmonary
disease (COPD) is prescribed a beta2-adrenergic agonist
for bronchodilation. Which of the following adverse
effects is most likely to occur due to prolonged use of
this medication?**
A. Hypokalemia
B. Hypoglycemia
C. Hypercalcemia
D. Hyperkalemia
- **Correct Answer: A. Hypokalemia**
- Rationale: Beta2-adrenergic agonists such as
albuterol can stimulate beta2 receptors in skeletal
muscle, leading to potassium intracellular shift and
subsequent hypokalemia, especially with prolonged use.
2. **A patient receiving long-term therapy with a loop
diuretic develops hearing loss and tinnitus. Which of the
following loop diuretics is most commonly associated
with ototoxicity?**
A. Furosemide
B. Hydrochlorothiazide
C. Bumetanide
D. Spironolactone
- **Correct Answer: A. Furosemide**
 - Rationale: Furosemide, a loop diuretic, is known to
cause ototoxicity, characterized by hearing loss and
tinnitus, especially with high doses or prolonged use.
3. **A patient with heart failure is prescribed digoxin to
improve cardiac function. Which of the following
electrolyte imbalances increases the risk of digoxin
toxicity?**
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypernatremia
- **Correct Answer: B. Hypokalemia**
- Rationale: Hypokalemia increases the risk of digoxin
toxicity by enhancing the binding of digoxin to its target
receptor on cardiac myocytes, leading to exaggerated
effects on cardiac contractility.
4. **A patient receiving chemotherapy for cancer
develops neutropenia. Which of the following
medications is most appropriate for stimulating the
production of neutrophils in this patient?**
A. Filgrastim
B. Epoetin alfa
C. Oprelvekin
D. Romiplostim
- **Correct Answer: A. Filgrastim**
- Rationale: Filgrastim is a granulocyte colony-
stimulating factor (G-CSF) that stimulates the
production of neutrophils in bone marrow and is
commonly used to treat neutropenia associated with
chemotherapy.
5. **A patient with type 1 diabetes mellitus experiences
hypoglycemia and is unable to consume oral glucose.
Which of the following medications should be
administered to rapidly increase blood glucose levels in
this situation?**
A. Metformin
B. Glipizide
C. Glucagon
D. Pioglitazone
- **Correct Answer: C. Glucagon**
- Rationale: Glucagon is a hormone that stimulates
glycogenolysis and gluconeogenesis in the liver, leading
to an increase in blood glucose levels and is used to
treat severe hypoglycemia when the patient cannot
consume oral glucose.
6. **A patient receiving long-term therapy with a
proton pump inhibitor (PPI) develops osteoporosis.
Which of the following mechanisms contributes to the
increased risk of osteoporosis associated with PPI use?
**
A. Inhibition of vitamin D absorption
B. Inhibition of calcium absorption
C. Inhibition of gastric acid secretion
D. Inhibition of bone resorption
- **Correct Answer: B. Inhibition of calcium
absorption**
- Rationale: PPIs can inhibit calcium absorption in the
intestines, leading to decreased calcium levels in the
body and an increased risk of osteoporosis over time.
7. **A patient with a history of atrial fibrillation is
prescribed rivaroxaban, a direct oral anticoagulant
(DOAC), for stroke prevention. Which of the following
laboratory tests should be monitored to assess the
anticoagulant effect of rivaroxaban?**
A. Prothrombin time (PT)
B. Activated partial thromboplastin time (aPTT)
C. International normalized ratio (INR)
D. Platelet count
- **Correct Answer: A. Prothrombin time (PT)**
- Rationale: Prothrombin time (PT) is commonly used
to monitor the anticoagulant effect of warfarin but is
less reliable for DOACs like rivaroxaban. However, it can
still provide some information about anticoagulation
status.
8. **A patient receiving treatment for depression
develops serotonin syndrome. Which of the following
medication classes is most likely responsible for this
adverse reaction?**
A. Selective serotonin reuptake inhibitors (SSRIs)
B. Tricyclic antidepressants (TCAs)
C. Monoamine oxidase inhibitors (MAOIs)
D. Atypical antidepressants
- **Correct Answer: A. Selective serotonin reuptake
inhibitors (SSRIs)**
- Rationale: Serotonin syndrome is most commonly
associated with the use of serotonergic medications
such as SSRIs, which increase serotonin levels in the
brain and can lead to excessive stimulation of serotonin
receptors.
9. **A patient with hypertension is prescribed a calcium
channel blocker. Which of the following adverse effects
is most commonly associated with calcium channel
blocker therapy?**
A. Bradycardia
B. Hypertension
C. Peripheral edema
D. Hyperglycemia
- **Correct Answer: C. Peripheral edema**
 - Rationale: Peripheral edema is a common adverse
effect of calcium channel blockers due to their
vasodilatory effects, especially in the lower extremities.

10. **A patient receiving chemotherapy develops

alopecia. Which of the following chemotherapy agents
is most commonly associated with hair loss as an
adverse effect?**
A. Cyclophosphamide
B. Doxorubicin
C. Methotrexate
D. Vinblastine
- **Correct Answer: B. Doxorubicin**
- Rationale: Doxorubicin, an anthracycline
chemotherapy agent, is commonly associated with
alopecia as an adverse effect due to its cytotoxic effects
on rapidly dividing cells, including hair follicles.