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  • CP Ca 01 2013

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    18 vues12 pages

    CP Ca 01 2013

    Transféré par

    Musa yohana
    Yes

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    © All Rights Reserved
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    Reg. No, ee — Program, MUHIMBIL{ UNIVERSITY OF HEALTH AND ALLIED SCIENCES SCHOOL OF MEDICINE DEPARTMENT OF CLiit!CAL PHARMACOLOGY SEMESTER 4 ML 200 MODULE 1 CONTINUOUS ASSESSMENT TEST FOR THE MD, DDS AND BSc.N PROGRAMS Date: 17" May 2013 Time 14:00 — 15:30 HRS ee ee INSTRUCTIONS 1, This paper is made upof 46 Multiple Choice Questions. You are required to answer all questionssBach question is followed by five options. chowse one hest-answer by shading the appropriate nubble (use the answer sheet provided One mark will be awarded deducted for wrong Jack ballpoint pen) on or each corrset response. No mark will be 3. Write your Program and registration number on EVERY PAGE. Program, 1. The figure depic expe aneil ee the effect of urine pi a eee ject. Based on the resate mare eof Drug X inan structure? cults in the figure, Drug X is most likely to have A. Non-ionizable compound B, Strong organic acid 9\ ©. Strong organic base {D.| Weak organic acid E. Weak organic base 2. Drug X has a half-life of 7 hours and is eliminated from the body by first-order kinetics ‘A single intravenous dose provides & therapeutic level of the drug for 14 hours. Douping the dose provides a therapeutic level for atotal of eA. 14 hours: e 21 hours "28 hours D. 35 hours E, 281035 hours ~ 3, A3S-year-old man is being treated for acquired immunodeficiency syndrome (alos). He experiences a significant weight loss caused by AIDS-related wasting syndrome and diarthea. Which pharmacokinetic parameter il likely main unchanged by ‘he presence of diarthea ard iterations inthe body mass and composition of this patient, with AIDS? A. Absorption B, Bioavailability First-pass metabolism 5 ee 1D. Steady-state plasma concentration e ho E_ Volume of distribution ac 2 2 Sere Reg. No. _ o 4. The table lists the pharmacokinetic Parameters of five drugs. Based on this information, which drug has the shoftest half-ife? Drug (Ampicilin [16.2 ‘Atenolol [10.2 e | [Diazepam (1.62 fe ( [Enalapri_ [9 {85 Labetalol [105 BS 2 C63 xv (Al Ampicnin “Ege 8 Bs Atenolol ae C. Diazepam D. Enalapril E. Labetalol 5. A 23-year-old man as a member of an experimental trial group was given an oral formulation of a new medication, The goal of the study was to evaluate the pharmacokinetic and pharmacedynamic properties of this new medication What property will most likely influenge the distribution of a drug in the body of this experimental subject? A. Bioavailability icacy ¢, First-pass metabolism Protein binding ‘Therapeutic index 6. A 78-year-old man is given an infusion of lidocaine for the control of ventricular tachycardia A dose adjustment 's required What parameter is the most important in selecting a new infusion rate that 1s therapeutically effective but nontoxic? A, Bioavailability Clearance C. Glomerular filtration rate (GFR) D. Plasma protein binding £. Volume of distribution 7. Many pharmacokinetic and pharmacodynamic changes occur in association with the process of aging. What metabolic function is likely to be best preserved ina woman? A. N-Dealkylation B. O-Dealkylation /E) Glucuronidation N-Hydroxylation E. S-Oxidation Sees O. F Program. 8. Drug A and Diug B an © both filtered but are neither a eiminated or clusively by the kidneys; both are &d nor reabsorbed, Drug A has no, whereas ‘ing I Drug A has a renal clearance of 100 Ctively secre 125 ml/min A B. +C. 75 mimin O. E. 250 ml/min 9. Which of the followin, soluble drugs:- ‘A. Absorption from the gastrointestinal tract “on ~ brtornGieedtts ig is most correct ‘roan ate eter properties of water ¢ B. Distribution is not restricted to extra cellular fluid) C. The drugs penetrate into CSF or brain ‘Substantial protein binding occurs that has elimination of the drug D. (E\ Binding to plasma proteins is not important eke n influence on the distribution and for some strong acids 10. Which of the following is most correct regarding acteristic features of drugs with intermediate solubility:- Distribution is not restricted to extra. ilar flue membrane and into the intracellular Binding to plasma protein is not important Elimination is predominantl; by excre [E) Absorption from the gut is adequate ie drugs penetrate through cell IDO m> \bolized drug in the urine but is often not compicte 11. In general, drugs which are highly lipid ‘A. Have low oillwater partition coeffic VIB) Have high apparent volume of distribu ‘C. Are mainly exereted unchanged in u D. Are readily excreted without being t E, Have very short elimination half tim ats Reg.No. Pegi its 12. Which of the following is most correct regarciny cMarastenistic features of acidic drugs’ A. Are mainly present as the chargeg acid «i pH 3 B. Generally in plasma the fraction of acid bolus! 1 protein is less than the fraction of base bound to protein €. The plasma clearance in direct proportion with the extent of re-absorption from the renal tubule D. Alpha acid glycoprotein is involvea in binding «cidic drugs In plasma, acidic drugs are present to a laige extent as the charged ions 13. Bioavailability of an agent is maximal when the drug has which of the following qualities? Highly lipid soluble B. More than 100 Daltons in molecular weight _ ©. Highly bound to plasma proteins D. Highly ionized E. Intermediate solubility 14. An agent is noted to have a very low calculated volume of distribution (V,) Which of the following is the best explanation? Ay, The agent's climnated by the kidneys, and the patient has renal insufficiency The agent is extensively bound to plasma proteins The agent 1s extensively seque: 1D. The agent's distntbution as ve: E The agent is clminated ty tered in ti ticled to ext 0 order kineti we cellular water 15 Which of the following terms descnbes the process by which the amount of active drug in the body is reduced after administration bu: be/ore entering the systemic circulation? i A. Excretion B. First-order elimination & First-pass elfect D. Metabolism . Pharmacokinetics 16. Oxidation of drugs in the hepatic endo A. S-adenosy! methionine B. Uridinediphosphate glucuronic a C. Acetyl co-enzyme A Reg. No Program, C. Is usually complete within 60 rr, Non-polar lipid soluble drugs drugs le drugs are alo jyaeh more readily than polar water-soluble E. Peptic y Ptides are well absorbed followin. oral administration 18. A patien i at Bee a or of episodic attack: «f eeughing, wheezing and shortness of euler oman e asthma clin. Several deug treatments with different apoutroteaeG '@ under consider tion Winch of the following statements trons rug administration is most .orrcet® pears often rise more slowly atter «:tramuscular injection than after oral {8) ue first-pass effect is the result of elimination of @ drug after administration and efore it enters the systemic circulation C. Administration of antiasthmatic drugs by inhaled aerosol is usually associated with more adverse effects than when administered orally D. Bioavailability of most drugs is greater with rectal administration than with sublingual administration A E, Administration of drug by transdermai patch is often faster but associated with. more “first-pass” metabolism than oral edministration 19. Botulinum toxin is a large protein molecule. Its action on cholinergic transmission depends on an intracellular action within naive endings, Which one of the following process is best suited for permeation of very large protien molecules? A. Aqueous diffusion B. Aqueous hydrolysis Endocytosis Lipid diffusion £. Special carrier transport 20 Which ststement about the distribution of drugs to specific tissties 1s most Cmte (2 A. Distribution to an organ is independent of blood flow B. Distribution is independent of the solubility of the drug in that tissue “| Distribution depend on the unbound drug concentration gradient between bioood and the tissue D. Distribution is increased for drugs that are strongly bound to plasma proteins E. Distribution has no effect on the half-life of the urug 21, Which of the following statements best describes the process by which piasma concentration of a drug declines with first-order kinetics? ‘A. There is only one metabolic path for drug elimination The half-life is the same regardless of the plasma concentration T. The drug is largely metabolised in the liver after oral administration and has low bioavailability ¥ D. The rate of elimination is proporticnal to the rate of administration at all times E. The drug is distributed to only one compartment outside the vascular system 22. A 55-year-old woman with heart failure isto be treated with a diuretic drug, Drugs X and Y have the same mechanism of diuretic action. Drug X in a dose of 5 mg produces the same magnitude of diuresis as 500 mg of drug Y. This suagests that (a) Drug Y is less effi ig ‘icacious than drug X fe) Dtlg is aout 100 times more ocraliaan arse (6) Toxicity of drug X is less than that of dw) ¥ ) Drug X is a safer drug than drug (e) Drug i X will have a shorter duration of actrwn tan drug Y because less of drug is present for a given effect 23. Dose-t si a Fesponse curves are used for drug evaliation in the animal laboratory and in the clinic. Quantal dose-response curves aru Lay Used for determining the therapeutic index of a drug (b) Used for determining the maximal efficacy ofa drug —gaced cloe reseese (c) More precisely quantitated than ordinary graded dose-response curves (4) Obtainable from the study of intact subjects but not from isolated tissue preparations (e) Used to determine the statistical variation (Standard deviation) of the maximal response to the drug 24, In the absence of other drugs, pindolol causes an increase in heart rate by activating beta adrenoceptors. In the presence of highly effective beta stimulants, however, pindolol causes a dose-dependent, reversible decrease in heart rate. Therefore, pindolol should be classified as:- (a) An irreversible antagonist (b) A physiologic antagonist (c) A chemical antagonist (GDA partial agonist (e) A spare receptor agonist 25, Which of the following statements about spare receptors is MOST correct? (a) Spare receptors, in the absence of drug, are sequestered in the cytoplasm Cee receptors may be detected by finding that the drug-receptor interaction longer than the intracell ees reas che tee t- receptors influence the maximal efficacy of the drug-receptor system (©) Spe es ‘ wee Reg Nog vouram. (d) Spare receptors activate thie!» machinery of for a drug Jey}spare receptors may be detects by tne nding ta the Kg for the agonist 26, Which of the following terms best dccribes a drug that blocks the action a ; epinephrine at its receptors by occupying those receptors without activating them’ ha] Pharmacologic antagonist (b) Partial agonist (c) Physiologic antagonist (d) Chemical antagonist (e) Noncomptetitive antagonist 27. Which of the following provides int... mation about the variation in sensitivity to a drug within the population studied? (a) Maximal efficacy (b) Therapeutic index (c) Drug potency (a) Graded dose-response curve ale MAX Mind POG, » (€)| Quanta! dose-response curve 28. Despite your careful adherence to basic pharmacokinetic principles, your patient on digoxin therapy has developed digitals toxicity. The plasma digoxin level is 4 ng/ml. Renal function is normal, and the plasmat,, for digoxin in this patient is 1.6 days. How long should you withhold digoxin in order to reach a safer yet probably therapeutic level of 1 I? (a) 1.6 days (0) 24 days * [[ol]2days - . © 48days (©) 8.4days isp ans phenytoin are both eimintedl fe jamil has a cleara inated fren BMEEE phecyioin hasia clearance <2 LIT". supronnnlely eGUe la ‘blood flow, 0.1 Umin, When these compounds are administered along with rifa rifampin, lenzymes, which of the following is most iad hepatic drug-metabolizing (a) The clearai nce of both verapamil and phenytoin will be increased ne body by metabolism in the: (b) The clearance of ) learance of both verapamil and phenytoinwill be decreased [i(c) The clearance of verapamil wll be unchanged, whereas the clearance of phenytoin will be increased (@) The clearance of phenytoin wil be unchanged, whereas the clearance of verapamil will be increased 30. A 60-year-old man enters the hospital with a myocardial infarction and a severe Ventricular arrhythmia. The antiarrhythmic drug éhosen has a narrow therapeutic \window: the minimum toxic plasma concentration'is 1.5 times the minimum therapeutic plasma concentration. The halflife 15 6 Itis essential to maintain the plasma concentration above the minimum therapeulle level to prevent a possibly Tethal arrhythmia Of the following, the most appropriate dosing regimen would be - (a) Once a day (b) Twice a day (c) Thre umes a day (d) Four times a day [oH{constant intravenous infusion 31. A 50-year-old woman with metastaligigiesst cance has elected to participate in the trial of a new chemotherapeutic agent Itis given by constant intravenous infusion of 8 mg/h. Plasma concentrations (Cp) are measured with the results shown in the table below. From these dala, itmay be concluded that: (a) Volume of distribution is 30 L Tp) clearance is2Uh ©) z (c) Elimination follows zero-order Kinetics we (6) Half-life is 8h (e) Doubling the rate of infusion would result in a plasma concentration of 16 mg/L at 40h o R eee Program____ [Time After Start | Plasma Time After Start | Plasma | of Infusion (h) Concentration of Infusion (h) Concentration (mg/l) 0.8 1.3 fener 20 3.0 6 32. 4 patient with systemic infection is being treated with an antibiotic whose elimination half-time (ty B) i$ 8 h. In order to maintain the Patient's total body store at 300 mg of the antibiotic, what the dosage be? (@) 100 mg every 8 hours 3 (b) 200 mg every 8 hours (©) 300 mg every 8 hours @ (d) 400 mg every 8 hours (e) 500 mg every 8 hours 33. Which of the following statements Concerning driq receptors is tie? (2) Gamaglobulin can find i> a drug and serve as a dry rev @ Lop drug cannot act unless itis fist bound to a receptor “(@) A.drug cannot act uniess iis frst released trom a receptor (4) Drug receptors play a role in tlc bioavailabilly of a drug 4~ (AJA drug can act as an antagonist even if it is bound to a drug receptor 34, Which of the following statements best characterizes potentiation? (@) Potentiation occurs if a drug lacking an effect of its own increases the effect of a seconf active drug (b) Potentiation occurs if two drugs with the same effect, when given together Produce an effect that is equal in magnitude to the sum of the effects when the drugs are given individually 10 entiation occurs. duce an effect that When the drugs are o ISS are given Pp P ith the er in magmite: » effect when given together, ; an the sum of the effects (a) P a (2) Potentiat prod une effect when given together «effect of each drug given- (€) None of the at terizes potentiation 36. The maximu: E mum effect (E max) achieved by a dig 1s a measure of: (a) Potency ~ oye oc ey veyuvef +e bing chat vl aoe opetficacy _ Waexctiune, Feb (c) The quantal response (4) Antagonist magnitude () The therapeutix mdex 36 Leukotricnes cata: bronchoconstaetion (mediated at leukotriene receptors) 1n a patient with asthma When albuterol (acting at B adrenoceptors) is given to the patient during an asthma attack, bronchoditation usually results. Which of the ne action of albuterol in this situation? following expressions best describes t (a) Chemical antagonist (b) Noncompetitive antagonist (c) Partial agonist ; (d) Pharmacologic antagonyst fe Physiologic antagonrst 37. Which of the following names describes an antagonist that interacts directly “vith the agonist and not at all, or only incidentally, with the receptor? [(@] Chemica! antagonist (b) Noncompetitive antagonist (c) Partial agonist (a) Pharmacologic antagonist (e) Physiologic antagonist 438. Drug metabolism in humans usually results ina product that is fa))Less lipid soluble than the original drug (6) More likely to distribute inracellulany (6) More likely to be reabsorbed by Kidney tubules ‘ (2) More lipid soluble than the original drus {@) Less water soluble than the original drug " < 1 Potentiation oc, Produce an effe; when the drugs ar th the s.0 ct : ib *~ lle when GBR aOR jagil«: 1" than the sum of the effects ually $ grea PPotentiat : Otentiation occurs if two NO drugs with the su magnitudh fect when given together effect of each drug given. t that is alone None of the above st nts correctly ot aswbterizes potentiation 35. The maxim naximum effect (E r (Emax) achieved by a ig is a measure of:- ney ~ oye e+ € ce pure) fe iy

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