Question 1

The state of "general anesthesia" usually includes?

Accepted Answer

Answer reason: General anesthesia produces unconsciousness, analgesia, amnesia, and suppression of sensory/autonomic reflexes; therefore all listed effects apply.

Question 2

Which of the following inhaled anesthetics increases cerebral blood flow least of all?

Accepted Answer

Answer reason: Among commonly used inhaled agents, sevoflurane causes the smallest increase in cerebral blood flow and intracranial pressure; nitrous oxide and isoflurane/desflurane increase CBF more.

Question 3

Indicate the intravenous anesthetic, which is an ultra-short-acting barbiturate?

Accepted Answer

Answer reason: Thiopental is an ultra–short-acting barbiturate used for IV induction; fentanyl is an opioid, midazolam is a benzodiazepine, and ketamine is an NMDA antagonist.

Question 4

Indicate the intravenous anesthetic, which produces dissociative anesthesia?

Accepted Answer

Answer reason: Ketamine is the IV anesthetic known for producing dissociative anesthesia with analgesia and amnesia.

Question 5

The mechanism of Cytiton action is?

Accepted Answer

Answer reason: Cytiton (cytisine) is a respiratory stimulant that activates carotid body chemoreceptors, increasing respiration via a reflex pathway to the respiratory center rather than direct stimulation.

Question 6

Indicate the expectorant with the reflex mechanism?

Accepted Answer

Answer reason: Ipecacuanha and Thermopsis are classic reflex expectorants that irritate the gastric mucosa and via vagal reflex increase bronchial secretions. Trypsin and Ambroxol are mucolytics, and sodium benzoate is not a reflex expectorant.

Question 7

Which of these groups of drugs is used for asthma treatment?

Accepted Answer

Answer reason: Asthma therapy includes methylxanthines (e.g., theophylline), antimuscarinics (M-cholinoblockers like ipratropium), and beta2-agonists; therefore all listed groups are used.

Question 8

Which of the following M-cholinoblocking agents is used especially as an anti-asthmatic?

Accepted Answer

Answer reason: Ipratropium is an inhaled antimuscarinic bronchodilator specifically used for asthma/COPD. Atropine and others are antimuscarinics but not used primarily as inhaled anti-asthmatics.

Question 9

All of the following drugs are inhaled glucocorticoids EXCEPT?

Accepted Answer

Answer reason: Triamcinolone, beclometazone, and budesonide are inhaled corticosteroids; sodium cromoglycate is a mast cell stabilizer, not a glucocorticoid.

Question 10

Which of the following drugs is an agent of substitution therapy?

Accepted Answer

Answer reason: Substitution therapy replaces a deficient endogenous substance. Exogenous hydrochloric acid directly replaces gastric acid in hypochlorhydria/achlorhydria, unlike gastrin or histamine which only stimulate secretion.

Question 11

Which of the following drugs may cause reversible gynecomastia?

Accepted Answer

Answer reason: Cimetidine has antiandrogenic effects and can cause reversible gynecomastia; the other listed GI drugs are not commonly associated with this effect.

Question 12

Choose the drug that causes constipation?

Accepted Answer

Answer reason: Among antacid salts, aluminum compounds commonly cause constipation, whereas magnesium salts cause diarrhea. Therefore aluminium hydroxide is the classic constipating agent.

Question 13

Select an anorexigenic agent affecting serotoninergic system?

Accepted Answer

Answer reason: Fenfluramine is an appetite suppressant that acts via the serotonergic system by increasing serotonin release and inhibiting reuptake. The other listed agents primarily act through noradrenergic/dopaminergic mechanisms.

Question 14

All of the following drugs intensify gastrointestinal motility EXCEPT?

Accepted Answer

Answer reason: Metoclopramide, domperidone, and cisapride are prokinetic agents that increase GI motility. Papaverine is a smooth muscle relaxant/antispasmodic that decreases motility, so it is the exception.

Question 15

All of these drugs reduce intestinal peristalsis EXCEPT?

Accepted Answer

Answer reason: Cisapride is a prokinetic 5-HT4 agonist that increases gastrointestinal motility, whereas loperamide and adsorbent/bulk agents like methyl cellulose and magnesium aluminium silicate decrease motility or reduce diarrhea.

Question 16

Which of the following drugs belongs to coumarin derivatives?

Accepted Answer

Answer reason: Warfarin is a coumarin derivative (vitamin K antagonist). Heparin, enoxaparin, and dalteparin are heparins/LMWHs, not coumarins.

Question 17

Which of the following drugs is an inhibitor of platelet glycoprotein IIb/IIIa receptors?

Accepted Answer

Answer reason: Abciximab is a monoclonal antibody that blocks platelet glycoprotein IIb/IIIa receptors; the others inhibit COX-1 (aspirin) or P2Y12 ADP receptors (clopidogrel, ticlopidine).

Question 18

The most cardiac manifestation of glycosides intoxication is?

Accepted Answer

Answer reason: Digoxin (cardiac glycosides) toxicity commonly produces AV nodal suppression with enhanced junctional automaticity, leading to an AV junctional rhythm; AV block and VT can occur but are less characteristic/common.

Question 19

This drug is contraindicated in patients with moderate to severe heart failure?

Accepted Answer

Answer reason: Verapamil (a non‑dihydropyridine calcium channel blocker) has negative inotropic effects and can worsen systolic heart failure, so it is contraindicated. Nifedipine is not an absolute contraindication in HF.

Question 20

This drug acts by inhibiting slow calcium channels in the SA and AV nodes?

Accepted Answer

Answer reason: Diltiazem is a non-dihydropyridine calcium channel blocker that inhibits L-type calcium channels in SA/AV nodal tissue, slowing conduction. Quinidine and flecainide are sodium channel blockers; adenosine acts via A1 receptors to increase K+ efflux.

Question 21

Main clinical use of calcium channel blockers is?

Accepted Answer

Answer reason: Calcium channel blockers are used to treat angina, hypertension, and certain supraventricular tachyarrhythmias, so all listed uses are correct.

Question 22

All of the following are central acting antihypertensive drugs EXCEPT?

Accepted Answer

Answer reason: Methyldopa, clonidine, and moxonidine act centrally (alpha-2/imidazoline receptor agonists). Minoxidil is a peripheral direct arteriolar vasodilator, not a centrally acting antihypertensive.

Question 23

30 year old patient has developed pseudomembranous collitis due to high dose moxiflaxaccin so now what should be the choice of drug for the pseudomembranous collitis?

Accepted Answer

Answer reason: Pseudomembranous colitis from antibiotics is treated with oral vancomycin or fidaxomicin (metronidazole as alternative). Penicillins (ampicillin, amoxycillin, nafcillin) and nalidixic acid are not indicated and can precipitate or worsen C. difficile infection.

Question 24

In an old house a 60 year old man is suffering from rheumatoid fever what should be the choice of drug for him?

Accepted Answer

Answer reason: Benzathine penicillin G (long-acting IM) is the drug of choice for rheumatic fever eradication/prophylaxis of group A streptococci; procaine penicillin G or oral penicillin V are not preferred, so not both.

Question 25

Chemical interaction between which of the following drug and cell membrane components can result in the formation of pores lined by hydrophilic groups present in the drug molecule?

Accepted Answer

Answer reason: Nystatin is a polyene antifungal that binds ergosterol in fungal membranes and aggregates to form transmembrane pores; the hydrophilic portions of the drug line the pore. Fluconazole inhibits ergosterol synthesis and does not form pores.

Question 26

A patient is being treated with auopurinol to control hyperuricemia resulting from chemotherapy which of the following would have its doses reduced to prevent toxicity?

Accepted Answer

Answer reason: Allopurinol inhibits xanthine oxidase, which metabolizes 6‑mercaptopurine. Concomitant use increases 6‑MP levels and toxicity, so its dose must be reduced. 5‑FU, 6‑TG, and cytarabine are not affected.

Question 27

Which statment is accurate for pharmkodynamics?

Accepted Answer

Answer reason: Pharmacodynamics describes what a drug does to the body (effects, mechanisms, dose–response). Option B states this, whereas option A defines pharmacokinetics.

Question 28

Which drug class isn't used to treat GERD?

Accepted Answer

Answer reason: GERD is treated with acid-suppressing agents such as antacids, H2 receptor antagonists, and proton pump inhibitors; beta blockers are not GERD therapies.

Question 29

What does “pharmacokinetics” include?

Accepted Answer

Answer reason: Pharmacokinetics describes what the body does to a drug—absorption, distribution, metabolism (biotransformation), and excretion. The other options relate to effects on the body or adverse effects, not kinetics.

Question 30

The main mechanism of most drugs absorption in GI tract is?

Accepted Answer

Answer reason: Most drugs are absorbed by passive processes. Among the given choices, only filtration (aqueous diffusion) represents a passive mechanism and is more common than carrier-mediated transport or endocytosis.

Question 31

A small amount of the volume of distribution is common for lipophilic substances easy penetrating through barriers and widely distributing in plasma, interstitial and cell fluids?

Accepted Answer

Answer reason: Lipophilic drugs cross membranes easily and distribute widely into tissues, resulting in a large volume of distribution, not a small one.

Question 32

Tick the drug type for which microsomal oxidation is the most prominent?

Accepted Answer

Answer reason: Microsomal (CYP450) oxidation in the liver primarily acts on lipophilic drugs to convert them into more polar metabolites for excretion; water-soluble drugs usually need little metabolism.

Question 33

Biotransformation of a medicinal substance results in?

Accepted Answer

Answer reason: Drug metabolism increases polarity and decreases lipid solubility, making compounds more water-soluble and easier to eliminate via the kidneys, thus speeding urinary excretion.

Question 34

Half life (t 1/2) doesn't depend on?

Accepted Answer

Answer reason: Drug half-life is determined by clearance and volume of distribution (rate of elimination), not by how quickly it is absorbed. Therefore, time of drug absorption does not affect t1/2.

Question 35

Which effect may lead to toxic reactions when a drug is taken continuously or repeatedly?

Accepted Answer

Answer reason: Repeated dosing can exceed the body’s elimination capacity, causing drug accumulation and toxicity—i.e., a cumulative effect. Tolerance and tachyphylaxis decrease response; refractoriness is lack of response.

Question 36

A teratogenic action is?

Accepted Answer

Answer reason: Teratogenicity refers to drug effects that disrupt embryonic or fetal development, leading to congenital malformations.

Question 37

A good local anesthetic agent shouldn’t cause?

Accepted Answer

Answer reason: An ideal local anesthetic has minimal systemic toxicity; low toxicity is a core desired property. Fast onset and long duration are desirable, whereas local irritation and vasodilatation are undesirable but systemic toxicity is the key effect it should not cause.

Question 38

Which one of the following groups is responsible for the duration of the local anesthetic action?

Accepted Answer

Answer reason: Duration is largely determined by the intermediate linkage (ester vs amide), which dictates metabolism rate; amides are metabolized more slowly and last longer. The lipophilic group mainly affects potency, and the ionizable group mainly affects onset (pKa).

Question 39

Which of the following local anesthetics is preferable in patient with pseudocholinesterase deficiency?

Accepted Answer

Answer reason: Ester local anesthetics (procaine, tetracaine, benzocaine) are hydrolyzed by plasma pseudocholinesterase, so deficiency causes prolonged effect/toxicity. Ropivacaine is an amide anesthetic metabolized hepatically and is preferred.

Question 40

The anesthetic effect of the agents of short and intermediate duration of action can not be prolonged by adding?

Accepted Answer

Answer reason: Vasoconstrictors such as epinephrine, norepinephrine, and phenylephrine reduce local anesthetic systemic absorption and prolong action. Dopamine is not used as a vasoconstrictor adjunct for local anesthetics and does not prolong their effect.

Question 41

A vasoconstrictor does not?

Accepted Answer

Answer reason: Vasoconstrictors reduce blood flow at the injection site, delaying drug removal, lowering systemic blood levels and toxicity risk, and prolonging action. They do not reduce local anesthetic uptake by the nerve; if anything, they enhance it by keeping more drug near the nerve.

Question 42

Muscarinic receptors are located in?

Accepted Answer

Answer reason: Muscarinic cholinergic receptors are found on parasympathetic effector organs (smooth muscle, cardiac muscle, glands). Autonomic ganglia and skeletal neuromuscular junctions use nicotinic receptors, and the carotid sinus baroreceptor is a mechanoreceptor, not muscarinic.

Question 43

Acetylcholine is not used in clinical practice because?

Accepted Answer

Answer reason: Acetylcholine is rapidly broken down by acetylcholinesterase and plasma cholinesterases, giving it an extremely short duration of action and poor clinical utility.

Question 44

Which of the following direct-acting cholinomimetics is mainly muscarinic in action?

Accepted Answer

Answer reason: Bethanechol is a direct muscarinic agonist with negligible nicotinic activity, whereas carbachol and acetylcholine act on both muscarinic and nicotinic receptors.

Question 45

Indicate the reversible cholinesterase inhibitor, which penetrates the blood-brain barrier?

Accepted Answer

Answer reason: Physostigmine is a tertiary amine anticholinesterase that crosses the blood–brain barrier; edrophonium, neostigmine, and pyridostigmine are quaternary ammonium compounds and do not.

Question 46

Which of the following drugs is used for acute toxic effects of organophosphate cholinesterase inhibitors?

Accepted Answer

Answer reason: Pralidoxime reactivates acetylcholinesterase inhibited by organophosphates, treating the cause of toxicity; atropine only counters muscarinic symptoms.

Question 47

The group of nicotinic receptor-blocking drugs consists of?

Accepted Answer

Answer reason: Nicotinic receptors are located at autonomic ganglia (NN) and the neuromuscular junction (NM). Antagonists that block these sites are ganglion blockers and neuromuscular junction blockers; atropine-like drugs block muscarinic receptors, not nicotinic.

Question 48

The tissues most sensitive to atropine are?

Accepted Answer

Answer reason: Secretory glands are the most sensitive tissues to muscarinic blockade; atropine reduces salivary, bronchial and sweat secretions at low doses. Cardiac and smooth muscle effects require higher doses, and gastric parietal cells are least sensitive.

Question 49

All of the following parts of the heart are very sensitive to muscarinic receptor blockade except?

Accepted Answer

Answer reason: Muscarinic (vagal) M2 receptors are concentrated in the SA node, AV node, and atria; ventricular myocardium has minimal cholinergic innervation and is relatively insensitive to muscarinic blockade.

Question 50

Contraindications to the use of antimuscarinic drugs are all of the following except?

Accepted Answer

Answer reason: Antimuscarinics are contraindicated in angle-closure glaucoma (↑IOP), myasthenia gravis (worsens neuromuscular weakness), and paralytic ileus/urinary retention (↓GI/GU motility). They are not contraindicated in asthma; in fact agents like ipratropium are used for bronchospasm.

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