Question 1

Ganglion blocking drugs are used for the following emergencies EXCEPT?

Accepted Answer

Answer reason: Ganglionic blockers (e.g., trimethaphan) cause rapid vasodilation and are used for hypertensive crises and to induce controlled hypotension; they can reduce preload/afterload in acute pulmonary edema. They are contraindicated in cardiovascular collapse because they would worsen hypotension and shock.

Question 2

Which of the following neuromuscular blocking drugs is an intermediate-duration muscle relaxant?

Accepted Answer

Answer reason: Among nondepolarizing neuromuscular blockers, vecuronium is classified as intermediate-acting; tubocurarine and pancuronium are long-acting, and rapacuronium is short-acting.

Question 3

Which neuromuscular blocking agent has the potential to cause the greatest release of histamine?

Accepted Answer

Answer reason: Tubocurarine is well known to cause significant histamine release, leading to hypotension and bronchospasm. Succinylcholine, pancuronium, and rocuronium have minimal histamine release.

Question 4

Effects seen only with depolarizing blockade include all of the following EXCEPT?

Accepted Answer

Answer reason: Depolarizing neuromuscular blockers (e.g., succinylcholine) can cause hyperkalemia, increased intragastric pressure with risk of emesis, and postoperative muscle pain; they increase—not decrease—intraocular pressure. Thus a decrease in IOP is the exception.

Question 5

Distribution of alfa adrenoreceptor subtypes is associated with all of the following tissues except those of?

Accepted Answer

Answer reason: Alpha-adrenoceptor subtypes (e.g., α1A, α1B, α1D, α2) are classically distributed in vascular smooth muscle, the prostate, and the iris dilator muscle. The heart is primarily mediated by beta receptors; alpha subtype distribution is not a principal feature there.

Question 6

Beta adrenoreceptor subtypes is contained in all of the following tissues EXCEPT?

Accepted Answer

Answer reason: Beta receptors are present in bronchial smooth muscle (β2), heart (β1), and fat cells (β3). The pupillary dilator muscle is primarily mediated by α1 receptors, not beta, making it the exception.

Question 7

In which of the following tissues both alfa and beta1 adrenergic stimulation produces the same effect?

Accepted Answer

Answer reason: Both alpha and beta (notably beta1/beta) receptor activation reduce intestinal motility, leading to relaxation; in vessels, bronchi, and uterus alpha and beta receptor actions are opposite.

Question 8

The effects of sympathomimetics on blood pressure are associated with their effects on?

Accepted Answer

Answer reason: Sympathomimetics raise BP by increasing heart rate/contractility (β1), increasing peripheral vascular resistance via vasoconstriction (α1), and enhancing venous return through venoconstriction, so all listed mechanisms contribute.

Question 9

Which of the following drugs causes bronchodilation without significant cardiac stimulation?

Accepted Answer

Answer reason: Terbutaline is a selective beta-2 agonist producing bronchodilation with minimal beta-1 cardiac stimulation. Isoprenaline is nonselective beta agonist (more cardiac effects); xylometazoline and methoxamine are alpha agonists.

Question 10

Which of the following effects is associated with beta3-receptor stimulation?

Accepted Answer

Answer reason: Beta3 receptors are primarily located in adipose tissue and are Gs-coupled; activation increases cAMP and stimulates hormone-sensitive lipase, causing lipolysis. Bronchodilation is beta2, tachycardia is beta1, and platelet aggregation effects are not beta3-mediated.

Question 11

Epinephrine produces all of the following effects EXCEPT?

Accepted Answer

Answer reason: Epinephrine, a catecholamine, increases metabolic rate and oxygen consumption while causing bronchodilation, hyperglycemia, and mydriasis. Therefore the exception is a decrease in oxygen consumption.

Question 12

Isoproterenol is?

Accepted Answer

Answer reason: Isoproterenol stimulates both beta1 and beta2 receptors with minimal alpha activity, making it a nonselective beta agonist.

Question 13

Isoproterenol produces all of the following effects EXCEPT?

Accepted Answer

Answer reason: Isoproterenol is a nonselective beta-adrenergic agonist (β1, β2), which increases heart rate and cardiac output, lowers diastolic/mean arterial pressure via β2 vasodilation, and causes bronchodilation—not bronchoconstriction.

Question 14

Which of the following sympathomimetics is related to short-acting topical decongestant agents?

Accepted Answer

Answer reason: Phenylephrine is an alpha-1 agonist commonly used as a short-acting topical nasal decongestant (~4 hours). Xylometazoline is longer-acting, terbutaline is a beta-2 bronchodilator, and norepinephrine is not used as a topical decongestant.

Question 15

Indicate the sympathomimetic, which may be useful in the emergency management of cardiac arrest?

Accepted Answer

Answer reason: Epinephrine is the first-line vasopressor in cardiac arrest; its potent alpha-1 vasoconstriction improves coronary and cerebral perfusion during CPR. The others are primarily alpha agonists used for hypotension or as decongestants and are not recommended for cardiac arrest.

Question 16

The principal adverse effects of phentolamine include all of the following EXCEPT?

Accepted Answer

Answer reason: Phentolamine, a nonselective alpha-adrenergic blocker, commonly causes vasodilation with reflex tachycardia, arrhythmias, myocardial ischemia/angina, and GI hypermotility (diarrhea). Bradycardia is not a principal effect; reflex tachycardia is expected.

Question 17

Beta-receptor antagonists cause?

Accepted Answer

Answer reason: Beta-2 receptor activation promotes hepatic glycogenolysis; beta-receptor antagonists block this effect, inhibiting glycogenolysis. The other options describe effects that are stimulated by beta activation, not blockade.

Question 18

Propranolol is used in the treatment all of the following diseases EXCEPT?

Accepted Answer

Answer reason: Propranolol is a nonselective beta-blocker used for cardiovascular conditions, migraine prophylaxis, and symptomatic control in hyperthyroidism, but it is contraindicated in asthma because it can precipitate bronchospasm.

Question 19

Which of the following drugs has both alfa1-selective and beta-blocking effects?

Accepted Answer

Answer reason: Labetalol is a mixed adrenergic antagonist that blocks alpha1 receptors and beta receptors; the others are primarily selective or nonselective beta-blockers without alpha1 blockade.

Question 20

Hepatic microsomal drug-metabolizing enzyme induction leads to?

Accepted Answer

Answer reason: Enzyme induction increases hepatic metabolism, reducing drug levels and effect over time, producing metabolic tolerance (not accumulation, dependence, or hangover effects).

Question 21

Indicate the hypnotic drug, which does not change hepatic drug-metabolizing enzyme activity?

Accepted Answer

Answer reason: Benzodiazepines (flurazepam, triazolam) and Z-drugs (zaleplon) do not induce or inhibit hepatic microsomal enzymes; enzyme induction is characteristic of barbiturates. Therefore all listed do not change hepatic drug-metabolizing enzyme activity.

Question 22

Which of the following hypnotic agents is able to interact with both BZ1 and BZ2 receptor subtypes?

Accepted Answer

Answer reason: Benzodiazepines such as flurazepam bind nonselectively to benzodiazepine receptor subtypes BZ1 and BZ2 on GABA-A receptors. Zolpidem and zaleplon are selective for BZ1, and phenobarbital acts at the barbiturate site, not BZ receptors.

Question 23

Which of the following agents blocks the chloride channel directly?

Accepted Answer

Answer reason: Picrotoxin is a noncompetitive antagonist that directly blocks the GABA-A chloride channel pore; the others act at receptor sites without blocking the channel.

Question 24

Indicate the main claim for an ideal hypnotic agent?

Accepted Answer

Answer reason: An ideal hypnotic should act quickly with adequate duration, preserve normal sleep architecture, and avoid next-day hangover effects; therefore all listed features are desired.

Question 25

Which one of the following hypnotic benzodiazepines is more likely to cause rebound insomnia?

Accepted Answer

Answer reason: Triazolam is a short-acting benzodiazepine; its rapid offset commonly leads to rebound insomnia when discontinued, more than longer-acting agents like flurazepam or temazepam.

Question 26

Which agent exerts hypnotic activity with minimal muscle relaxing and anticonvulsant effects?

Accepted Answer

Answer reason: Zaleplon is a non-benzodiazepine hypnotic (a Z-drug) that selectively acts at the BZ1 subtype of the GABA-A receptor, producing sleep with minimal muscle-relaxant or anticonvulsant effects compared with benzodiazepines like flurazepam or triazolam.

Question 27

Which of the following hypnotic drugs is used intravenously as anesthesia?

Accepted Answer

Answer reason: Thiopental is an IV barbiturate used for induction of anesthesia; the others are mainly oral hypnotics or anticonvulsants, not used IV for anesthesia.

Question 28

Indicate the usual cause of death due to overdose of hypnotics?

Accepted Answer

Answer reason: Fatality from hypnotic overdose typically results from respiratory center depression leading to respiratory failure, not hypothermia, cerebral edema, or seizures.

Question 29

The antiseizure drug, which induces hepatic microsomal enzymes, is?

Accepted Answer

Answer reason: Phenytoin is a classic CYP450 (hepatic microsomal) enzyme inducer; lamotrigine is not an inducer and valproate is an inhibitor.

Question 30

The most dangerous effect of antiseizure drugs after large overdoses is?

Accepted Answer

Answer reason: Antiseizure drug overdose causes profound CNS depression, with life‑threatening respiratory depression being the most dangerous effect; the other options are less acute threats.

Question 31

Narcotics analgesics should?

Accepted Answer

Answer reason: Opioid (narcotic) analgesics are primarily indicated to relieve moderate to severe pain; the other options describe actions of anesthetics, anxiolytics, or hypnotics.

Question 32

The principal central nervous system effect of the opioid analgesics with affinity for a mu receptor is?

Accepted Answer

Answer reason: Mu opioid receptors mediate multiple CNS effects including supraspinal analgesia, respiratory depression, and euphoria; thus all listed effects apply.

Question 33

Which of the following opioid analgesics can produce dysphoria, anxiety and hallucinations?

Accepted Answer

Answer reason: Pentazocine is a kappa agonist and weak mu antagonist; kappa activation is associated with dysphoria and psychotomimetic effects such as anxiety and hallucinations.

Question 34

Which of the following opioid analgesics is used in combination with droperidol in neuroleptanalgesia?

Accepted Answer

Answer reason: Neuroleptanalgesia classically combines droperidol with fentanyl (e.g., Innovar) to provide sedation and potent analgesia.

Question 35

Therapeutic doses of the opioid analgesics?

Accepted Answer

Answer reason: Opioids at therapeutic doses have no significant antipyretic effect; body temperature is generally unchanged. Hypo- or hyperthermia can occur only with high doses/toxicity.

Question 36

Indicate the opioid analgesic, which is used for relieving the acute, severe pain of renal colic?

Accepted Answer

Answer reason: Meperidine (pethidine) is classically preferred for renal colic because it causes less smooth muscle spasm of the ureter; naloxone is an antagonist and methadone/morphine are not preferred for colicky spasm.

Question 37

For which of the following conditions could aspirin be used prophylactically?

Accepted Answer

Answer reason: Aspirin irreversibly inhibits platelet COX-1, reducing thromboxane A2 and platelet aggregation; it is used prophylactically to prevent thromboembolic events. It is not prophylactic for pulmonary edema, is contraindicated with peptic ulcers, and metabolic acidosis is an overdose effect, not an indication.

Question 38

Analgin usefulness is limited by?

Accepted Answer

Answer reason: Analgin (metamizole/dipyrone) is limited by the risk of potentially fatal agranulocytosis; GI bleeding is more typical of NSAIDs, hearing issues with salicylates, and methemoglobinemia is not the key limiting toxicity.

Question 39

Which of the following antipsychotic drugs has high affinity for D4 and 5-HT2 receptors?

Accepted Answer

Answer reason: Clozapine, an atypical antipsychotic, shows high affinity for D4 and 5-HT2 receptors, unlike typical agents (fluphenazine, thioridazine, haloperidol) which primarily target D2.

Question 40

Most phenothiazine derivatives have?

Accepted Answer

Answer reason: Phenothiazine antipsychotics block dopamine D2 receptors and also have muscarinic (anticholinergic) and H1 (antihistaminic) antagonism, producing typical side effects; therefore all listed activities apply.

Question 41

Orthostatic hypotension can occur as a result of?

Accepted Answer

Answer reason: Orthostatic hypotension commonly results from alpha-1 adrenergic blockade, which impairs reflex peripheral vasoconstriction on standing. Phenothiazines cause this via alpha blockade rather than their central action, and inhibition of norepinephrine reuptake typically increases sympathetic tone rather than causing orthostasis.

Question 42

The lithium mode of action is?

Accepted Answer

Answer reason: Lithium affects ion and electrolyte transport, modulates neurotransmitters, and interferes with second messenger systems (e.g., inositol monophosphatase), so all listed mechanisms apply.

Question 43

The most dangerous pharmacodynamic interaction is between MAO inhibitors and?

Accepted Answer

Answer reason: MAOIs have life‑threatening pharmacodynamic interactions with SSRIs (serotonin syndrome), tricyclics, and sympathomimetics (hypertensive crisis), so all listed are dangerous.

Question 44

Serotonin syndrome is a result of?

Accepted Answer

Answer reason: Serotonin syndrome arises from excessive serotonergic activity due to increased synaptic serotonin (e.g., with SSRIs/MAOIs), i.e., accumulation of amine neurotransmitters in the synapse. Increased presynaptic stores alone are not the cause; depletion is incorrect.

Question 45

Which of the following antidepressants may have latency period as short as 48 hours?

Accepted Answer

Answer reason: MAOIs like tranylcypromine can produce antidepressant effects rapidly, sometimes within 24–48 hours, whereas TCAs and SSRIs typically require 2–4 weeks.

Question 46

Which of the following antidepressants is used for treatment of eating disorders, especially bulimia?

Accepted Answer

Answer reason: Fluoxetine, an SSRI, is FDA-approved and commonly used for bulimia nervosa; the others (TCAs, MAOI) are not first-line for this indication.

Question 47

Which of the following anxiolytics is a partial agonist of brain 5-HT1A receptors?

Accepted Answer

Answer reason: Buspirone is an anxiolytic that acts as a partial agonist at brain 5-HT1A receptors; the others are benzodiazepines acting at GABA-A receptors.

Question 48

Indicate the anxiolytic agent, which relieves anxiety without causing marked sedative effects?

Accepted Answer

Answer reason: Buspirone is a non-benzodiazepine 5-HT1A partial agonist that reduces anxiety with minimal sedation, unlike benzodiazepines such as diazepam, chlordiazepoxide, and clorazepate.

Question 49

Indicate the inhaled anesthetic, which should be avoided in patients with a history of seizure disorders?

Accepted Answer

Answer reason: Enflurane lowers the seizure threshold and can provoke epileptiform activity, so it is contraindicated in patients with seizure disorders.

Question 50

Indicate the intravenous anesthetic, which causes minimal cardiovascular and respiratory depressant effects?

Accepted Answer

Answer reason: Etomidate maintains hemodynamic stability and has minimal cardiovascular and respiratory depression compared with propofol, thiopental, and midazolam.

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