MCQs in Medical Pharmacology

By Hamza Alhamad

This book contains 1774 comprehensive multiple-choice questions about different topics of medical pharmacology divided into eighteen parts. The first part contains multiple-choice questions about general concepts of medical pharmacology. The remaining seventeen parts cover the basic medical pharmacology of different body systems.
Pharmacology is the scientific branch of medicine that studies the effects of drugs and chemicals on living organisms, where a drug can be broadly defined as any chemical substance, natural or synthetic, that affects a biological system. Pharmacology is a bridge science that incorporates knowledge and skills from a number of basic science disciplines, including physiology, biochemistry, and cell and molecular biology.

 

• Language: English
• Publisher: Hamza Alhamad
• Release date: Jan 29, 2024
• ISBN: 9798224990023

Hamza Alhamad

I am Dr.  Hamza Alhamad; I obtained my Pharm D degree from JUST University in 2008 and received my MSc. in Clinical Pharmacy, International Practice and Policy (CPIPP) degree from the University of London/UK in 2011.  After that, I obtained my Ph.D. degree from the University of Reading/UK in Clinical Pharmacy and Pharmacy Practice in December 2017. In between getting my degrees, I worked as a clinical pharmacist in adult and pediatric ICUs in Tertiary Hospitals. I attended many conferences and published research articles that focused on; patient and healthcare professional experiences and practices related to deprescribing and optimizing medicine use processes supported by the application of social and psychological research methods, pharmacy education, OSCE exam implementation, and continuing professional development, and the impact of health information technology and electronic prescribing on antimicrobial stewardship and antibiotic use in hospitals. 

Book preview

Preface

This book contains 1774 comprehensive multiple-choice questions about different topics of medical pharmacology divided into eighteen parts. The first part contains multiple-choice questions about general concepts of medical pharmacology. The remaining seventeen parts cover the basic medical pharmacology of different body systems.

Pharmacology is the scientific branch of medicine that studies the effects of drugs and chemicals on living organisms, where a drug can be broadly defined as any chemical substance, natural or synthetic, that affects a biological system. Pharmacology is a bridge science that incorporates knowledge and skills from a number of basic science disciplines, including physiology, biochemistry, and cell and molecular biology.

This book is suitable for medical, dental, pharmacy, and nursing students who are studying pharmacology for their Bachelor's degree. Also, it helps clinicians and practitioners who want to refresh their medical and pharmacological information during their practice.

Copyright page

While every precaution has been taken in the preparation of this book, the publisher assumes no responsibility for errors or omissions, or for damages resulting from the use of the information contained herein.

MCQS IN MEDICAL PHARMACOLOGY

First edition. January 29, 2024.

Copyright © 2024 MedPharm Excellence.

ISBN: 979-8224990023

Written by MedPharm Experts.

Table of content

Preface

Copyright page

Part 1 Essentials of Basic Pharmacology

Part 2 Medical Pharmacology of Autonomic Nervous System, Adrenergic, and Cholinergic Drugs

Part 3 Medical Pharmacology of Cardiovascular Diseases (Hypertension)

Part 4 Medical Pharmacology of Cardiovascular Diseases (Arrhythmia)

Part 5 Medical Pharmacology of Cardiovascular Diseases (Angina)

Part 6 Medical Pharmacology of Cardiovascular Diseases (Heart Failure)

Part 7 Medical Pharmacology of Hyperlipidemia

Part 8 Medical Pharmacology of the Central Nervous System (Seddative hypnotic drugs)

Part 9 Pharmacology of Opioids

Part 10 Pharmacology of anesthesia

Part 11 Pharmacology of Antipsychotics

Part 12 Pharmacology of Antidepressants

Part 13 Pharmacology Parkinson's Disease

Part 14 Pharmacology of Epilespy

Part 15 Pharmacology of Respiratory System (Asthma, COPD, and Pulmonary Hypertension)

Part 16 Pharmacology of  Gastrointestinal System

Part 17 Pharmacology of Endocrine System (Diabetes)

Part 18 Pharmacology of Endocrine System (Thyroid Diseases)

Part 1 Essentials of Basic Pharmacology:

The most crucial factor influencing drug absorption rate following intramuscular injection:

Needle diameter.

Rate of administration.

Injection site blood flow.

Injection volume.

The most typical mechanism of drug permeation:

Endocytosis.

Carrier-mediated transport.

Active-transport.

Passive diffusion.

None of the statements is correct.

Pharmacological antagonists:

Cause receptor down-regulation.

Prevent binding of other molecules to the receptor by their binding to the receptor.

Atropine (blocks Acetylcholine action in the heart).

A & B.

B & C.

The term has to do with drug actions on the body:

Pharmacokinetics.

Pharmacodynamics.

Pharmacogenetics.

Placebo.

All of the statements are correct.

Dramatic decrease in the systemic availability of a drug following oral administration is most likely due to the following:

Extreme drug instability at stomach Ph.

Hepatic first-pass effect.

Drug metabolized by gut flora.

The tablet does not dissolve.

Patient non-compliance.

Drug-transport system described as energy requiring:

Glomerular filtration.

Facilitated diffusion.

Active transport.

B & C.

A, B & C.

Drugs with this ionization property are most likely to diffuse from the intestine (pH 8.4) to blood (pH 7.4):

Weak acid (pKa 7.4).

Weak base (pKa 8.4).

Weak acid (pKa 8.4).

Weak base (pKa 6.4).

Weak acid (pKa 6.4).

Example (s) of covalent drug-receptor interactions:

Activated phenoxybenzamine-receptor.

Anti-cancer DNA alkylating drugs, like cyclophosphamide (Cytoxan).

Norepinephrine.

A & B.

A, B & C.

Faster drug absorption:

Lung.

Stomach.

Bond type that is seen in some drug-receptor interactions and tends to be very strong, often nearly irreversible:

Hydrophobic.

Electrostatic.

Covalent.

A & C.

B & C.

Factors that influence the rate of passive movement of molecules down the concentration gradient (Fick's Law):

Concentration difference across the barrier.

The area across which diffusion occurs.

Drug mobility in the diffusion panel.

Thickness - length of the diffusion pass.

All of the statements are correct.

The binding of the activated form of phenoxybenzamine (alpha-receptor antagonist) with the alpha receptor is an example of this type of chemical force/bond:

Electrostatic.

Covalent.

Hydrophobic interactions.

Stereoselectivity and metabolism:

Enzymes typically exhibit stereoselectivity—a preference for one or the other enantiomeric form.

The duration of action of one enantiomer may be different from the other.

A & B.

None of the statements is correct.

Most common drug permeation mechanism:

Passive diffusion in aqueous or lipid medium.

Active transport.

Examples of enantiomeric differences significant in anesthesia:

Cardiotoxicity is probably associated with both enantiomers of bupivacaine.

Ropivacaine is less cardiotoxic compared to bupivacaine because it is metabolized faster.

Cisatracurium is an atracurium isomer that does not cause histamine release.

Both l- and d- morphine occur in nature.

Characteristics of aqueous diffusion:

Occurs within large intracellular and extracellular components.

Occurs across epithelial membrane tight junctions.

Occurs across endothelial blood vessel lining - often through pores.

A & C.

A, B & C.

Most likely to be transported into cells by endocytosis:

Propranolol.

Iron complex with its binding protein.

Erythromycin-macrolide antibiotic.

Phenylalanine.

Peptide.

Lipid solubility and drugs:

More weak acid drugs will be in the lipid-soluble form at alkaline pH.

More weak acid drugs will be in the lipid-soluble form at acid pH.

More of the weak base drugs will be in the lipid-soluble form at alkaline Ph.

A & C.

B & C.

Pentobarbital at a pH below its pKa will exhibit relatively:

Increased ionization.

Decreased ionization.

Therapeutic Index:

ED50/LD50.

Potency/selectivity.

EC50/LD50.

TD50/ED50.

ED50.

Elaboration of vesicular content (neurotransmitter) into the synaptic cleft is an example of:

Carrier transport.

Passive diffusion.

Endocytosis.

Exocytosis.

Lipid diffusion.

Ion-trapping in the kidney:

Weak acids are usually excreted slower in alkaline urine.

Weak bases are usually excreted faster in acidic urine.

All of the statements are correct.

None of the statements is correct.

Permanently charged amine:

Primary amine.

Secondary amine.

Tertiary amine.

Quaternary amine.

Which one(s) of the following statements is/are influence(s) of age on diazepam half-life?

Clearance changes with age.

The volume of distribution does not change with age.

All of the statements are correct.

None of the statements is correct.

Glucuronidation-type reactions are principally associated with which one of the following categories of drug-metabolizing systems?

Phase I.

Phase II.

Which one of the following represents the physical volume most closely approximating extracellular water?

0.07 L/kg.

0.4 L/kg.

0.5-0.7 L/kg.

0.2 L/kg.

Small changes in drug-bound fraction significantly influence free plasma concentration for which one(s) of the following drug(s)?

Warfarin.

Propranolol.

Phenytoin.

Diazepam.

All of the statements are correct.

Which of the following drugs exhibits a larger volume of distribution?

Digoxin.

Chloroquine.

The release of neurotransmitters at the presynaptic terminal is associated with a process that is called:

Endocytosis.

Exocytosis.

True or false: Plasma protein-bound drugs generally cannot permeate through aqueous pores.

True.

False.

The number of half-lives required to move from one steady-state drug level to 94% of another steady-state level is about:

One drug half-life.

Two drug half-lives.

Three drug half-lives.

Four drug half-lives.

Five drug half-lives.

Which one(s) of the following statement(s) correctly describes/describes factors In renal excretion?

The renal tubular urine flow rate will influence the renal tubular reabsorption rate.

The higher the fraction of free drug, the slower the excretion since the plasma protein-bound form of the drug is eliminated preferentially.

The glomerular filtration rate is usually an essential factor in renal excretion.

All of the statements are correct.

Example(s) of (an) agent(s) that may be administered by the transdermal route of administration:

Clonidine.

Fentanyl.

Scopolamine.

Nitroglycerin.

All of the statements are correct.

Which one of the following agents is significantly metabolized by phase II glucuronidation?

Dopamine.

Coumarin.

Clonazepam.

Morphine.

Ethacrynic acid.

Choose the week base(s) from the following agents:

Acetaminophen.

Ephedrine.

Phenobarbital.

Pentobarbital.

True or false: Definition: signal transduction: a process by which a drug-receptor interaction leads to intracellular effects that modulate cell physiology

True.

False.

Examples of biological second messengers:

Camp.

Calcium.

Phosphoinositide.

Cgmp.

All of the statements are correct.

Example of an agent that activates cytokine receptor:

Isoproterenol.

Norepinephrine.

Growth hormone.

Corticosteroids.

Vitamin D.

Associated with nicotinic cholinergic receptor activation:

Acetylcholine binding.

Activation of the ion channel.

Sodium enters the cell (down its concentration and electrical gradient).

Depolarization (EPSP).

All of the statements are correct.

True or false: Typically, the magnitude of drug effects is thought to be proportional to the number of occupied receptors:

True.

False.

Longer-lasting drug effects:

Drugs that act at surface receptors, such as beta-adrenergic receptors.

Drugs that act intracellularly through gene transcription.

Drug mixed-function oxidase (p450) mainly localized:

Mitochondrial fraction.

Cell membranes.

Golgi bodies.

Microsomal fraction.

Nucleolus.

The primary site for drug metabolism:

Stomach.

Muscle.

Kidney.

Small intestine.

Liver.

Most drugs are oxidized in one of the following ways:

Smooth endoplasmic reticulum.

Rough endoplasmic reticulum.

Smooth and rough about equally.

Nucleus.

None of the statements is correct.

Bioavailability < 100% following oral dose administration:

Incomplete absorption

First pass effect.

A AND B.

None of the statements is correct.

Drug biotransformation:

Mainly, but not exclusively, in the liver.

Products are usually less biologically active.

Biotransformation products can be toxic.

A & B.

A, B & C.

Cytochrome-P450 INDEPENDENT oxidation

Amine oxidase.

Epoxidation.

N-oxidation.

S-oxidation.

Deamination

The number of half-lives required to go from one steady state to another:

One.

Two.

Three.

Four.

Five.

Eight.

Absorption rate proportional to the drug concentration dissolved in the gastrointestinal tract:

First order.

Zero order.

A AND B.

None of the statements is correct.

Factor(s) influencing drug half-life:

Chronic renal failure.

Age.

Plasma protein binding.

A, B, and C.

None of the statements is correct.

Factor(s) influencing clearance (CL):

Elimination rate constant.

Volume of distribution.

A AND B.

None of the statements is correct.

First pass pulmonary uptake > 65% of the dose?

Lidocaine (Xylocaine).

Fentanyl (Sublimaze).

Propranolol (Inderal).

Alfentanil (Alfenta).

Meperidine (Demerol).

All of the statements are correct.

True or false: Biotransformation tends to convert a drug to a more hydrophobic (lipophilic) metabolite.

True.

False.

Drug mechanism/mechanisms that may increase the amount of cytochrome P450 enzyme:

Increased enzyme degradation rates.

Increase enzyme synthesis rate.

A AND B.

None of the statements is correct.

Principal organ for biotransformation of drugs:

Kidney.

Lung.

Liver.

Skin.

Localization of mixed function oxidase system:

Smooth endoplasmic reticulum membranes.

Rough endoplasmic reticulum membranes.

Drugs that exhibit clearances > 6 ml/min./kg is:

Diltiazem (Cardiazem).

Verapamil (Isoptin, Calan).

Lidocaine (Xylocaine).

Meperidine (Demerol)

Morphine.

All of the statements are correct.

Drug(s) with high extraction by the liver:

Imipramine (Tofranil).

Meperidine (Demerol).

Propranolol (Inderal).

Amitriptyline (Elavil, Endep).

Isoniazid (INH).

All of the statements are correct.

The most crucial organ for unchanged drug/drug metabolite elimination

Kidney.

Lung.

Liver.

Skin.

Factor(s) which may change intrinsic drug clearance:

Smoking.

Dietary considerations.

Age.

Genetic Factor.

All of the statements are correct.

Ion trapping:

The fetal pH is higher than the maternal pH.

In fetal distress, alkalosis contributes to local anesthetic accumulation.

Local anesthetics may tend to accumulate in the fetus.

A and C.

B and C.

Magnitude of first-pass hepatic effect:

Depends on hepatic blood flow (Q).

Depends on clearance.

A AND B.

None of the statements is correct.

Percentage of oral digoxin (Lanoxin, Lanoxicaps) dose likely to reach systemic circulation:

100%.

90%.

70%.

30%.

Renal pharmacology/pharmacokinetics:

Most drugs are not filtered by the glomerulus.

Lipid-soluble drugs are typically reabsorbed by passive diffusion after glomerular filtration.

Weak acids tend to be excreted faster in alkaline pH.

Weak bases tend to be excreted faster in alkaline pH.

B and C.

B and D.

Weak acid:

Morphine.

Chlordiazepoxide (Librium).

Phenobarbital (Luminal).

Cocaine.

Ephedrine

A 22-year-old woman who has asthma was prescribed albuterol by inhalation. Albuterol is a bronchodilator drug with a molecular weight of 239 daltons. Which of the following permeation processes most likely accounted for the transfer of the drug through the bronchial mucosa?

Aqueous diffusion.

Lipid diffusion.

Facilitated diffusion.

Endocytosis.

Active transport.

A 34-year-old man on vacation in Mexico was hospitalized because of vomiting, double vision, and muscular paralysis. The man reported eating some canned food from a local vendor the previous day. After a physical examination, a presumptive diagnosis of botulism was made. It is known that botulinum toxin causes paralysis by getting inside the axon terminals of motor nerves, where it inhibits the release of acetylcholine. Botulinum toxin is a protein with a molecular weight greater than 100,000 daltons. Which of the following permeation processes most likely accounts for the transfer of the toxin through the nerve cell membrane?

Aqueous diffusion.

Lipid diffusion.

Facilitated diffusion.

Endocytosis.

Filtration.

A 51-year-old woman suffering from hyperthyroidism was administered an oral solution of radioactive iodine to destroy her thyroid gland. Which of the following permeation processes most likely accounted for the transfer of the drug across the thyroid cell membrane?

Active transport.

Lipid diffusion.

Facilitated diffusion.

Endocytosis.

Aqueous diffusion.

A 12-year-old boy recently diagnosed with type 1 diabetes started therapy with two daily subcutaneous administrations of insulin. Which permeation processes best explain insulin absorption from the injection site?

Bulk flow transport.

Lipid diffusion.

Facilitated diffusion.

Endocytosis.

Active transport.

A 69-year-old woman was brought to a local hospital emergency department by her son, who reported that his mother had been found lethargic, disoriented, and combative a few hours earlier. Additional history revealed that she had ingested a large number of aspirin tablets during a suicide attempt. Appropriate therapy was instituted, including administering sodium bicarbonate to increase the elimination of salicylate. Which of the following best explains the mechanism of this increased elimination?

Decreased tubular active transport of salicylate.

Decreased renal biotransformation of salicylate.

Decreased bioavailability of salicylate.

Urinary ion trapping of salicylate.

Increased glomerular filtration of salicylate.

A 63-year-old man recently diagnosed with hypertension started therapy with hydrochlorothiazide, one tablet daily. Hydrochlorothiazide is an acidic drug with a pKa of about 9. Which of the following parts of the digestive tract most likely represent the drug’s main site of absorption drug?

Oral mucosa

Stomach

Small intestine

Colon

Rectum

A 44-year-old man took a large dose of acetaminophen in an aqueous solution to treat an excruciating headache. Two hours later, the pain was not diminished. Because acetaminophen should be effective in about 30 minutes after its oral administration, which of the following conditions most likely delayed the oral absorption of the drug in this patient?

A moderate increase in intestinal peristalsis.

The presence of strong pain.

The administration of the drug in an aqueous solution.

A large volume of distribution of the drug.

A very low clearance of the drug.

A 52-year-old woman with rheumatoid arthritis started a treatment that included infliximab, a monoclonal antibody against tumor necrosis factor-α (TNF-α). The drug has a volume of distribution of about 3 L. Which of the following is most likely the primary site of distribution of this drug?

Fat tissue.

Plasma.

Extracellular fluids.

Cell cytosol.

Total body water.

When studied in healthy volunteers, the oral bioavailability of a new drug turned out to be 20%. Knowing that, in this case, the entire administered drug reached the portal circulation, which of the following will be the drug's hepatic clearance (in mL/min)?

500

800

1200

1500

2000

A new drug was studied in a healthy volunteer during a phase 1 clinical trial. Urine and plasma samples were collected 1 hour after the intravenous administration of a test dose. Drug concentration was 40 mg/mL in urine and 1 mg/mL in plasma. The urine output of this subject was 1.44 L/d. Which of the following was most likely the renal clearance of the drug in mL/min?

40

30

20

50

60

10

A 10-mg dose of a new drug that follows first-order, one-compartment model kinetics was given intravenously to healthy subjects in a phase 1 clinical trial. The drug's volume of distribution (Vd) turned out to be 80 L. Which of the following would have been the volume of distribution of the drug (in liters) if the administered dose were 20 mg?

40

80

240

160

120

A 45-year-old man with epilepsy had been receiving carbamazepine, one tablet daily. The drug has a total clearance of 63 L/h and a hepatic clearance of 62 L/h. The man was recently diagnosed with a skin infection due to Mycobacterium marinum, and treatment with rifampin