1 معهد البحوث الطبيةMedical Research Institute Pharmacology Department Semester: spring PhD Degree Academic year: 2019/2020 Course title: Clinical Pharmacology & therapeutics II Time allowed: 180 minutes Course code: 1704801 Date: 11 / 7/ 2020 Final Exam Total marks: 75 THE EXAM CONSISTS OF “2” QUESTIONS IN “26” PAGES Question no.1: (59 marks, 0.5 mark each) Select the ONE lettered answer that is BEST in each of the following statements: 1. In shock (a) Vasoconstriction of vital organs causes further increase in blood pressure (b) There is release of mediators like epinephrine and norepinephrin (c) Hypoperfusion of heart and brain leads to failure of these organs (d) Mortality is high even with optimal treatment 2. In shock: (a) Hypovolemia may be caused directly by bleeding (b) Hypovolemia may be caused indirectly by movement of extracellular fluid intracellularly (c) Various insults can be the underlying cause including fever and diabetes (d) Irradiation can be one case of precipitating shock 3. In class Ia antiarrhythmic drugs: (a) Quinidine and procainamide are the most drugs used in this class (b) Disopramide resembles quinidine including its atropine-like effect (c) Disopramide has more negative inotropic action than quinidine. (d) Disopramide is more likely to cause hypersensitivity reactions than quinidine 4. Class I antiarrhythmic drugs: (a) Activate sodium channels by binding to sites in the α-subunit
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معهد البحوث الطبية
Medical Research Institute
Pharmacology Department Semester: spring
PhD Degree Academic year: 2019/2020
Course title: Clinical Pharmacology & therapeutics II Time allowed: 180 minutes
Course code: 1704801 Date: 11 / 7/ 2020
Final Exam Total marks: 75
THE EXAM CONSISTS OF “2” QUESTIONS IN “26” PAGES
Question no.1: (59 marks, 0.5 mark each)
Select the ONE lettered answer that is BEST in each of the following statements:
1. In shock
(a) Vasoconstriction of vital organs causes further increase in blood pressure
(b) There is release of mediators like epinephrine and norepinephrin (c)
Hypoperfusion of heart and brain leads to failure of these organs (d)
Mortality is high even with optimal treatment
2. In shock:
(a) Hypovolemia may be caused directly by bleeding
(b) Hypovolemia may be caused indirectly by movement of extracellular fluid
intracellularly
(c) Various insults can be the underlying cause including fever and diabetes (d)
Irradiation can be one case of precipitating shock
3. In class Ia antiarrhythmic drugs:
(a) Quinidine and procainamide are the most drugs used in this class
(b) Disopramide resembles quinidine including its atropine-like effect (c)
Disopramide has more negative inotropic action than quinidine.
(d) Disopramide is more likely to cause hypersensitivity reactions than quinidine
4. Class I antiarrhythmic drugs:
(a) Activate sodium channels by binding to sites in the α-subunit
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(b) Increase the maximum rate of polarization in phase 0
(c) Bind to channels most strongly when they are either in the open or refractory state
(d) Activation of sodium cannels happens slowly
5. Emergency treatment of serious dysrhythmias includes:
(a) Propranolol
(b) Lidocaine
(c) Verapamil
(d) Electrical cardioversiom
6. Circulating drugs that may bring about cardiac arrhythmia include:
(a) Antiarrhythmics
(b) Parasympatholytics
(c) Anesthetics
(d) Opioids
7. Signs and symptoms of arrhythmia may include the following EXCEPT:
(a) Dizziness or collapse because of a poor blood supply to the brain
(b) Shortness of breath because of poor oxygenation
(c) Angina associated with a poor coronary circulation and/or
(d) Decreased cardiac workload arising from a bradycardia and weakness
8. Amiodarone as antiarrhythmic agent
(a) Has long t½ of 10 to 100 days and accumulates in the body during repeated dosing
(b) An i.v loading dose is usually given in a peripheral vein
(c) Causes phlebitis if given in a central vein
(d) Used mainly to treat bradyarrhthmias
9. Side defects of amiodarone include the following, except:
(a) Renal insufficiency
(b) Grey/bluish coloration of the skin
(c) Pulmonary fibrosis
(d) Thyroid abnormalities connected to high iodine content
10. Mechanism of action of mediators that promote smooth vasodilatation in shock
includes
(a) Activation of ATP-sensitive Ca++ channels in vascular muscles
(b) Relative increased secretion of antidiuretic hormone
(c) Increased synthesis of nitric oxide
(d) Relative deficiency of adrenalin secretion due to inhibition of synthesis by adrenal
gland
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11. The following are used to treat hypovolemic shock, except:
(a) Adrenaline can be life saving
(b) Blocking or neutralizing endotoxins , interleukins and tumor necrosis factor
(c) Supporting the circulation with vasoactive drugs designed to optimize flow to vital
organs (d) Volume replacement therapy by i.v. fluids to correct hypovolemia
12. Which of the following is not a property of the antiarrhythic Flicainamide? (a)
Is short acting antiarrhthnic administered i.v.
(b) May increase the incidence of sudden death after myocardial infarction
(c) Its main use of is in prophylaxis against paroxysmal atrial fibrillation (d)
Clinical uses include recurrent tachyarrythmias
13. Emergency treatment of serious dysrhythmias include:
(a) Propranolol
(b) Lidocaine
(c) Verapamil
(d) Electrical cardioversion
14. Which of the following conditions cannot cause shock?
(a) Hemorrhage
(b) Malignancy
(c) Anaphylaxis
(d) Myocardial infarction
15. In the physiological response to hypovolemia, which of the following is not correct?
(a) Vasodilatation of vital organs favors their perfusion
(b) Vasodilatation of certain organs causes reduction in blood pressure
(c) Tissue hypoxia is a serious problem
(d) Vasodilatation of vital organs prevents rapid deterioration of clinical condition
16. Which of the following is not true for patients with established shock?
(a) Have profound and inappropriate vasodilatation in non-essential organs
(b) Vasodilatation is non-essential organs could be easily corrected by vasoconstrictors
(c) Hypoperfusion leads to multiple organ failure
(d) Correcting hypotension is an essential step in treatment
17. Which of the following is not found in shock?
(a) There is release of mediators which promote hypotension
(b) The released mediators cause capillary dilatation
(c) There is leaking of blood in interstitial tissue
(d) The released mediators include histamine, nitric oxide and prostaglandins
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18. The mechanisms of action of mediators promoting vasodilatation in shock include the
following, except:
(a) Increased synthesis of nitric oxide
(b) Activation of ATP-sensitive Ca+2 channels in vascular smooth muscle
(c) Relative deficiency of antidiuretic hormone
(d) Increased synthesis of NO
19. Treatment of hypovolemic shock includes:
(a) Supporting the circulation with mixtures of vasoactive drugs
(b) Antagonists which block interleukins and inducible nitric oxide synthase
(c) Volume replacement is useful with hypovolemia
(d) Adrenaline can be life-saving
20. Propranolol as antiarrhythmic is not suitable for clinical use in:
(a) Reduction of mortality following myocardial infarction
(b) Prevention of recurrence of tachyarrhythmia provoked by increased sympathetic
activity
(c) Recommended for use in patients with bronchial asthma (d) Prevention of
paroxysmal fibrillation
21. Lidocaine in the treatment of dysrhythmia
(a) Is given by i.v. infusion immediately following MI to prevent ventricular dysrhythia
(b) In certain cases may be administered orally
(c) Its plasma t1/2 is 20 hours but may be accelerated if hepatic blood flow is increased
(d) Its main adverse effect is paralysis od respiratory muscles
22. Satolol has the following properties, except:
(a) More effective than amiodarone in preventing chronic malignant tachyarrhythmia
(b) Is valuable in patients whom β-adrenoceptor antagonists are not contraindicated
(c) Suppresses ventricular ectopic beats and short runs of ventricular tachycardia
(d) Prolongs the cardiac action potential and slows the outward potassium current
23. The following are properties of verapamil in the treatment of dysrhythmia, except
(a) Intravenous preparations are preferred
(b) Is subject to extensive first-pass if given orally
(c) Displaces digoxin from tissue binding sites and reduces its renal elimination if
coadministered
(d) Is ineffective and dangerous in ventricular dysrhythmias
24. The properties of adenosine as antiarrhythmic includes:
(a) It has largely replaced verapamil for this purpose because it is safer
(b) The effects of a bolus dose of adenosine last only 2-3 hours
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(c) The vasodilator and antiplatelet drug Dipyridamole blocks adenosine receptors and
inhibits the action of i.v. adenosine.
(d) Theophylline and other xanthine alkaloids potentiate adenosine and prolongs its
adverse effects
25. Digoxin has the following antiarrhhythmic properties except:
(a) Has a role in the management of atrial tachyarrhythmia., in the presence of congestive
heart failure
(b) Effects of digoxin are decreased by hyperkalemia, hypocalcemia and thyrotoxicosis
(c) Digoxin inhibits conduction through the AV node and thus protects the ventricles from
rapid atrial rhythms
(d) Non-cardiac side effects include anorexia, nausea & vomiting, fatigue, confusion,
abnormal color vision (excess yellow-green
26. A 63-year old man was admitted to the emergency department because of a 12-
hour history of dyspnea,and bradycardia.He was taking propranolol, captopril
furosemide, and amiloride because of previous myocardial infarction, as well as
ibuprofen for osteoarthritis.Physical examination showed the patient was in
respiratory distress with the following signs:blood pressure 150/86 mm Hg;
heart rate 40 bpm; respirations 20/min.Which of the following substances was
most likely increased in the patient’s serum?
(a) Sodium (b)
Calcium
(c) Glucose
(d) Potassium
27. All of the following agents may be associated with hypokalemia, EXCEPT:
(a) Hydrochlorothiazide
(b) Furosemide (c) Amiloride
(d) Indapamide
28. Diuretic that may be used to treat epilepsy, and open angle glaucoma
(a) Acetazolamide (Diamox)
(b) Chlorothiazide (Diuril)
(c) Bumetanide (Bumex)
(d) Metolazone (Zaroxolyn)
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29. Chlorothiazides can produce which one of the following actions :
(a) Hyperkalemia
(b) Hyperuricemia
(c) Hypoglycemia in diabetic patients
(d) Hypocalcemia
30. A 75-year-old woman with hypertension is being treated with a thiazide. Her blood
pressure was read at 120/75 mm Hg. After several months on the medication, she
complains of being tired and weak. An analysis of the blood indicates low values of
which of the following?
(a) Calcium
(b) Glucose
(c) Potassium
(d) Sodium
31. A 55-year –old male with kidney stones has been placed on a diuretic to decrease
calcium excretion. After a few weeks, he develops an attack of gout. Which diuretic
was he taking?
(a) Furosemide
(b) Hydrochlorothiazide
(c) Spironolactone
(d) Triamterine
32. A group of athletes is planning a mountain climbing trip. Which of the following drugs
would be appropriate for them to take to prevent mountain sickness?
(a) A thiazide diuretic
(b) An anticholinergic
(c) A carbonic anhydrase inhibitor
(d) A β- blocker
33. An alcoholic male with hepatic cirrhosis. To control ascites and oedema, he is
prescribed which one of the following?
(a) Hydrochlorothiazide
(b) Acetazolamide
(c) Spironolactone
(d) Mannitol
34. A 69-year old man was recently diagnosed with severe cardiac failure and the
physician started treatment with propranolol, captopril, and digoxin.Diuretic
therapy was also included.Which of the following pairs of diuretics would have been
most appropriate for this patient ?
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(a) Hydrochlorothiazide and spironolactone
(b) Furosemide and spironolactone
(c) Triamterene and acetazolamide
(d) Furosemide and mannitol
35. A 32-year-old woman suffering from idiopathic hypercalciuria was diagnosed with a
large stone in the right renal pelvis. She was scheduled for surgical removal of the
calculus. Which of the following drugs would be appropriate for the patient to
prevent new stone production
(a) Acetazolamide
(b) Furosemide
(c) Hydrochlorothiazide
(d) Triamterene
36. A 65-year-old patient was scheduled for surgery to remove a brain tumour. Which of
the following drugs would be given before and after surgery to prevent increased
intracranial pressure
(a) Hydrochlorothiazide
(b) Mannitol
(c) Triamterine
(d) Propranolol
37. A 64-year-old woman suffering from stage C heart failure had her diuretic
medication changed because of a serious allergic reaction to furosemide. Which of
the following diuretics was most likely prescribed?
(a) Spironolactone
(b) Triamterene
(c) Ethacrynic acid
(d) Indapamide
38. A 63-year-old woman was brought to the emergency department. Her past medical
history was significant for bone metastases from breast cancer.Her serum values
were Na 148 mEq/L (136-145 mEq/L); Ca 19.2 mg/dl (8.5-10.5 mg/dl).An IV saline
infusion was started and a diuretic was given. Which of the following diuretics was
most likely administered?
(a) Acetazolamide
(b) Hydroclorothiazide
(c) Furosemide
(d) Amiloride
39. A 60-year-old man was admitted to the hospital because of weakness, polydipsia
(excessive thirst), polyuria over the last 2 weeks. Blood pressure 136/95 mm Hg,