CHOOSE THE MOST APPROPRIATE RESPONSE

• 1.1 ‘Essential drugs’ are:
  1. Life saving drugs
  2. Drugs that meet the priority health care needs of the population
  3. Drugs that must be present in the emergency bag of a doctor
  4. Drugs that are listed in the pharmacopoia of a country (p. 5)

• 1.2 An ‘orphan drug’ is:
  1. A very cheap drug
  2. A drug which has no therapeutic use
  3. A drug needed for treatment or prevention of a rare disease
  4. A drug which acts on Orphanin receptors (p. 5, 6)

• 1.3 Drug administered through the following route is most likely to be subjected to first-pass metabolism:
  1. Oral
  2. Sublingual
  3. Subcutaneous
  4. Rectal (p. 7, 8, 25)

1.1 B

1.2 C

1.3 A

• 1.4 Transdermal drug delivery systems offer the following advantages except:
  1. They produce high peak plasma concentration of the drug
  2. They produce smooth and nonfluctuating plasma concentration of the drug
  3. They minimise interindividual variations in the achieved plasma drug concentration
  4. They avoid hepatic first-pass metabolism of the drug (p. 8, 9)

• 1.5 In addition to slow intravenous infusion, which of the following routes of administration allows for titration of the dose of a drug with the response:
  1. Sublingual
  2. Transdermal
  3. Inhalational
  4. Nasal insufflation (p. 9)

• 1.6 Which of the following drugs is administered by intranasal spray/application for systemic action:
  1. Phenylephrine
  2. Desmopressin
  3. Azelastine
  4. Beclomethasone dipropionate (p. 9, 540)

• 1.7 Compared to subcutaneous injection, the intramuscular injection of drugs:
  1. Is more painful
  2. Produces faster response
  3. Is unsuitable for depot preparations
  4. Carries greater risk of anaphylactic reaction (p. 9, 10)

1.4 A

1.5 C

1.6 B

1.7 B

• 1.8 Select the route of administration which carries the highest risk of adversely affecting vital functions:
  1. Intra arterial injection
  2. Intrathecal injection
  3. Intravenous injection
  4. Intramuscular injection (p. 10)

• 2.1 Alkalinization of urine hastens the excretion of:
  1. Weakly basic drugs
  2. Weakly acidic drugs
  3. Strong electrolytes
  4. Nonpolar drugs (p. 13, 26)

• 2.2 Majority of drugs cross biological membranes primarily by:
  1. Passive diffusion
  2. Facilitated diffusion
  3. Active transport
  4. Pinocytosis (p. 12)

• 2.3 Diffusion of drugs across cell membrane:
  1. Is dependent upon metabolic activity of the cell
  2. Is competitively inhibited by chemically related drugs
  3. Is affected by extent of ionization of drug molecules
  4. Exhibits saturation kinetics (p. 12)

• 2.4 Which of the following drugs is most likely to be absorbed from the stomach:
  1. Morphine sulfate
  2. Diclofenac sodium
  3. Hyoscine hydrobromide
  4. Quinine dihydrochloride (p. 12)

1.8 C

2.1 B

2.2 A

2.3 C

2.4 B

• 2.5 Which of the following is a weakly acidic drug:
  1. Atropine sulfate
  2. Chloroquine phosphate
  3. Ephedrine hydrochloride
  4. Phenytoin sodium (p. 12)

• 2.6 The most important factor which governs diffusion of drugs across capillaries other than those in the brain is:
  1. Blood flow through the capillary
  2. Lipid solubility of the drug
  3. pKa value of the drug
  4. pH of the medium (p. 13)

• 2.7 Active transport of a substance across biological membranes has the following characteristics except:
  1. It is specific
  2. It is pH dependent
  3. It is saturable
  4. It requires metabolic energy (p. 13)

• 2.8 Tricyclic antidepressants can alter the oral absorption of many drugs by:
  1. Complexing with the other drug in the intesti-nal lumen
  2. Altering gut motility
  3. Altering gut flora
  4. Damaging gut mucosa (p. 14, 411)

• 2.9 Bioavailability of drug refers to:
  1. Percentage of administered dose that reaches systemic circulation in the unchanged form
  2. Ratio of oral to parenteral dose
  3. Ratio of orally administered drug to that excreted in the faeces
  4. Ratio of drug excreted unchanged in urine to that excreted as metabolites (p. 15)

2.5 D

2.6 A

2.7 B

2.8 B

2.9 A

• 2.10 Bioavailability differences among oral formulations of a drug are most likely to occur if the drug:
  1. Is freely water soluble
  2. Is completely absorbed
  3. Is incompletely absorbed
  4. Undergoes little first-pass metabolism (p. 16)

• 2.11 The most important factor governing absorption of a drug from intact skin is:
  1. Molecular weight of the drug
  2. Site of application
  3. Lipid solubility of the drug
  4. Nature of the base used in the formulation (p. 15)

• 2.12 If the total amount of a drug present in the body at a given moment is 2.0 g and its plasma concentration is 25 µg/ml, its volume of distribution is:
  1. 100 L
  2. 80 L
  3. 60 L
  4. 50 L (p. 17)

• 2.13 The following attribute of a drug tends to reduce its volume of distribution:
  1. High lipid solubility
  2. Low ionisation at physiological pH values
  3. High plasma protein binding
  4. High tissue binding (p. 17, 18)

• 2.14 Marked redistribution is a feature of:
  1. Highly lipid soluble drugs
  2. Poorly lipid soluble drugs
  3. Depot preparations
  4. Highly plasma protein bound drugs (p. 17)

2.10 C

2.11 C

2.12 B

2.13 C

2.14 A

• 2.15 A nonvolatile, highly lipid soluble drug is metabolized at a rate of 15% per hour. On intravenous injection it produces general anaesthesia for 10 min. Which process is responsible for termination of its action:
  1. Metabolism in liver
  2. Plasma protein binding
  3. Excretion by kidney
  4. Redistribution (p. 17, 342)

• 2.16 The blood-brain barrier, which restricts entry of many drugs into brain, is constituted by:
  1. P-glycoprotein efflux carriers in brain capillary cells
  2. Tight junctions between endothelial cells of brain capillaries
  3. Enzymes present in brain capillary walls
  4. All of the above (p. 17, 18)

• 2.17 Which of the following is not true of the blood-brain barrier:
  1. It is constituted by tight junctions between the endothelial cells of brain capillaries and the glial tissue
  2. It allows passage of lipid soluble drugs into the brain
  3. It limits entry of highly ionized drugs into the brain
  4. It regulates passage of substances from brain into blood (p. 17, 18)

• 2.18 Weakly acidic drugs:
  1. Are bound primarily to α₁ acid glycoprotein in plasma
  2. Are excreted faster in alkaline urine
  3. Are highly ionized in the gastric juice
  4. Do not cross blood-brain barrier (p. 18, 26)

2.15 D

2.16 D

2.17 D

2.18 B

• 2.19 High plasma protein binding:
  1. Increases volume of distribution of the drug
  2. Facilitates glomerular filtration of the drug
  3. Minimises drug interactions
  4. Generally makes the drug long acting (p. 18)

• 2.20 The plasma protein bound fraction of a drug:
  1. Contributes to the response at the given moment
  2. Remains constant irrespective of the total drug concentration
  3. Remains constant irrespective of the disease state
  4. Is not available for metabolism unless actively extracted by the liver (p. 18, 19)

• 2.21 Biotransformation of drugs is primarily directed to:
  1. Activate the drug
  2. Inactivate the drug
  3. Convert lipid soluble drugs into nonlipid solu-ble metabolites
  4. Convert nonlipid soluble drugs into lipid solu-ble metabolites (p. 20)

• 2.22 Which of the following is a prodrug:
  1. Hydralazine
  2. Clonidine
  3. Captopril
  4. Enalapril (p. 20)

• 2.23 A prodrug is:
  1. The prototype member of a class of drugs
  2. The oldest member of a class of drugs
  3. An inactive drug that is transformed in the body to an active metabolite
  4. A drug that is stored in body tissues and is then gradually released in the circulation (p. 20)

2.19 D

2.20 D

2.21 C

2.22 D

2.23 C

• 2.24 Which of the following cytochrome P450 isoenzymes is involved in the metabolism of largest number of drugs in human beings and has been implicated in some dangerous drug interactions:
  1. CYP 3A4
  2. CYP 2C9
  3. CYP 2E1
  4. CYP 1A2 (p. 21, 142)

• 2.25 The following is not true of the cytochrome P450 isoenzyme CYP2D6:
  1. It generates the hepatotoxic metabolite N-acetyl benzoquinone immine from paracetamol
  2. It is involved in demethylation of codeine into morphine
  3. Its altered form is responsible for poor capacity to hydroxylate many drugs including metoprolol
  4. It is inhibited by quinidine (p. 21, 23)

• 2.26 The most commonly occurring conjugation reaction for drugs and their metabolites is:
  1. Glucuronidation
  2. Acetylation
  3. Methylation
  4. Glutathione conjugation (p. 22)

• 2.27 Microsomal enzyme induction can be a cause of:
  1. Tolerance
  2. Physical dependence
  3. Psychological dependence
  4. Idiosyncrasy (p. 24)

• 2.28 The following drug metabolizing reaction is entirely nonmicrosomal:
  1. Glucuronide conjugation
  2. Acetylation
  3. Oxidation
  4. Reduction (p. 23)

2.24 A

2.25 A

2.26 A

2.27 A

2.28 B

• 2.29 Which of the following types of drug metabolizing enzymes are inducible:
  1. Microsomal enzymes
  2. Nonmicrosomal enzymes
  3. Both microsomal and nonmicrosomal enzymes
  4. Mitochondrial enzymes (p. 23, 24)

• 2.30 Induction of drug metabolizing enzymes involves:
  1. A conformational change in the enzyme protein to favour binding of substrate molecules
  2. Expression of enzyme molecules on the surface of hepatocytes
  3. Enhanced transport of substrate molecules into hepatocytes
  4. Increased synthesis of enzyme protein (p. 24)

• 2.31 Select the drug that undergoes extensive first-pass metabolism in the liver:
  1. Phenobarbitone
  2. Propranolol
  3. Phenylbutazone
  4. Theophylline (p. 25)

• 2.32 Drugs which undergo high degree of first-pass metabolism in liver:
  1. Have low oral bioavailability
  2. Are excreted primarily in bile
  3. Are contraindicated in liver disease
  4. Exhibit zero order kinetics of elimination (p. 25)

• 2.33 Glomerular filtration of a drug is affected by its:
  1. Lipid solubility
  2. Plasma protein binding
  3. Degree of ionization
  4. Rate of tubular secretion (p. 26)

2.29 A

2.30 D

2.31 B

2.32 A

2.33 B

• 2.34 If a drug undergoes net tubular secretion, its renal clearance will be:
  1. More than the glomerular filtration rate
  2. Equal to the glomerular filtration rate
  3. Less than the glomerular filtration rate
  4. Equal to the rate of urine formation (p. 27)

• 2.35 The plasma half life of penicillin-G is longer in the new born because their:
  1. Plasma protein level is low
  2. Drug metabolizing enzymes are immature
  3. Glomerular filtration rate is low
  4. Tubular transport mechanisms are not well developed (p. 27)

• 2.36 If a drug is excreted in urine at the rate of 10 mg/hr at a steady-state plasma concentration of 5 mg/L, then its renal clearance is:
  1. 0.5 L/hr
  2. 2.0 L/hr
  3. 5.0 L/hr
  4. 20 L/hr (p. 27)

• 2.37 Which of the following is not a primary/fundamental, but a derived pharmacokinetic parameter:
  1. Bioavailability
  2. Volume of distribution
  3. Clearance
  4. Plasma half life (p. 29)

• 2.38 If a drug is eliminated by first order kinetics:
  1. A constant amount of the drug will be elimi-nated per unit time
  2. Its clearance value will remain constant
  3. Its elimination half life will increase with dose
  4. It will be completely eliminated from the body in 2 half life period (p. 27–28)

2.34 A

2.35 D

2.36 B

2.37 D

2.38 B

• 2.39 If a drug has a constant bioavailability and first order elimination, its maintenance dose rate will be directly proportional to its:
  1. Volume of distribution
  2. Plasma protein binding
  3. Lipid solubility
  4. Total body clearance (p. 29)

• 2.40 If the clearance of a drug remains constant, doubling the dose rate will increase the steady-state plasma drug concentration by a factor of:
  1. 3
  2. 2
  3. 1.5
  4. 1.3 (p. 29)

• 2.41 When the same dose of a drug is repeated at half life intervals, the steady-state (plateau) plasma drug concentration is reached after:
  1. 2–3 half lives
  2. 4–5 half lives
  3. 6–7 half lives
  4. 8–10 half lives (p. 30)

• 2.42 The loading dose of a drug is governed by its:
  1. Renal clearance
  2. Plasma half life
  3. Volume of distribution
  4. Elimination rate constant (p. 30)

• 2.43 Monitoring of blood levels of diuretic drugs is not practised because:
  1. No sensitive methods for measuring blood levels of diuretics are available
  2. It is easier to measure the effect of these drugs
  3. Response to diuretics is not related to their blood levels
  4. Diuretics need activation in the body (p. 31)

2.39 D

2.40 B

2.41 B

2.42 C

2.43 B

• 2.44 Monitoring plasma drug concentration is useful while using:
  1. Antihypertensive drugs
  2. Levodopa
  3. Lithium carbonate
  4. MAO inhibitors (p. 31)

• 2.45 Sustained/controlled release oral dosage form is appropriate for the following type of drug:
  1. An antiarthritic with a plasma half life of 24 hr
  2. A sleep inducing hypnotic with a plasma half life of 2 hours
  3. An antihypertensive with a plasma half life of 3 hours
  4. An analgesic with a plasma half life of 6 hours used for relief of casual headache (p. 31)

• 2.46 Microsomal enzyme induction has one of the following features:
  1. Takes about one week to develop
  2. Results in increased affinity of the enzyme for the substrate
  3. It is irreversible
  4. Can be used to treat acute drug poisonings (p. 24, 34, 35)

• 3.1 Which of the following drugs acts by inhibiting an enzyme in the body:
  1. Atropine
  2. Allopurinol
  3. Levodopa
  4. Metoclopramide (p. 34)

• 3.2 The following is a competitive type of enzyme inhibitor:
  1. Acetazolamide
  2. Disulfiram
  3. Physostigmine
  4. Theophylline (p. 34, 35)

2.44 C

2.45 C

2.46 A

3.1 B

3.2 C

• 3.3 What is true in relation to drug receptors:
  1. All drugs act through specific receptors
  2. All drug receptors are located on the surface of the target cells
  3. Agonists induce a conformational change in the receptor
  4. Partial agonists have low affinity for the receptor (p. 35–37)

• 3.4 Drugs acting through receptors exhibit the following features except:
  1. Structural specificity
  2. High potency
  3. Competitive antagonism
  4. Dependence of action on lipophilicity (p. 45)

• 3.5 Study of drug-receptor interaction has now shown that:
  1. Maximal response occurs only when all receptors are occupied by the drug
  2. Drugs exert an ‘all or none’ action on a receptor
  3. Receptor and drugs acting on it have rigid complementary ‘lock and key’ structural features
  4. Properties of ‘affinity’ and ‘intrinsic activity’ are independently variable (p. 36–37)

• 3.6 A partial agonist can antagonise the effects of a full agonist because it has:
  1. High affinity but low intrinsic activity
  2. Low affinity but high intrinsic activity
  3. No affinity and low intrinsic activity
  4. High affinity but no intrinsic activity (p. 37)

• 3.7 Receptor agonists possess:
  1. Affinity but no intrinsic activity
  2. Intrinsic activity but no affinity
  3. Affinity and intrinsic activity with a + sign
  4. Affinity and intrinsic activity with a – sign (p. 37)

3.3 C

3.4 D

3.5 D

3.6 A

3.7 C

• 3.8 Agonists affect the receptor molecule in the following manner:
  1. Alter its amino acid sequence
  2. Denature the receptor protein
  3. Alter its folding or alignment of subunits
  4. Induce covalent bond formation (p. 38)

• 3.9 Receptors perform the following function/functions:
  1. Ligand recognition
  2. Signal transduction
  3. Both ligand recognition and signal transduction
  4. Disposal of agonists and antagonists (p. 45)

• 3.10 The following receptor type has 7 helical membrane spanning amino acid segments with 3 extracellular and 3 intracellular loops:
  1. Tyrosine protein kinase receptor
  2. Gene expression regulating receptor
  3. Intrinsic ion channel containing receptor
  4. G protein coupled receptor (p. 39–40)

• 3.11 Which of the following is a G protein coupled receptor:
  1. Muscarinic cholinergic receptor
  2. Nicotinic cholinergic receptor
  3. Glucocorticoid receptor
  4. Insulin receptor (p. 40, 42)

• 3.12 The following receptor has an intrinsic ion channel:
  1. Histamine H₁ receptor
  2. Histamine H₂ receptor
  3. Adrenergic alfa receptor
  4. GABA-benzodiazepine receptor (p. 42)

3.8 C

3.9 C

3.10 D

3.11 A

3.12 D

• 3.13 Select the receptor that is located intracellularly:
  1. Opioid µ receptor
  2. Steroid receptor
  3. Prostaglandin receptor
  4. Angiotensin receptor (p. 42, 43)

• 3.14 Agonist induced autophosphorylation, internalization and down regulation is a distinctive feature of:
  1. G-protein coupled receptors
  2. Intrinsic ion channel containing receptors
  3. Tyrosine protein kinase receptors
  4. Receptors regulating gene expression (p. 43)

• 3.15 All of the following subserve as intracellular second messengers in receptor mediated signal transduction except:
  1. Cyclic AMP
  2. Inositol trisphosphate
  3. Diacyl glycerols
  4. G proteins (p. 39–42)

• 3.16 The receptor transduction mechanism with the fastest time-course of response effectuation is:
  1. Adenylyl cyclase-cyclic AMP pathway
  2. Phospholipase C-IP₃: DAG pathway
  3. Intrinsic ion channel operation
  4. Protein synthesis modulation (p. 43)

• 3.17 A receptor which itself has enzymatic property is:
  1. Insulin receptor
  2. Progesterone receptor
  3. Thyroxine receptor
  4. Glucagon receptor (p. 43, 239)

3.13 B

3.14 C

3.15 D

3.16 C

3.17 A

• 3.18 Down regulation of receptors can occur as a consequence of:
  1. Continuous use of agonists
  2. Continuous use of antagonists
  3. Chronic use of CNS depressants
  4. Denervation (p. 43, 45)

• 3.19 The following statement is not true of log dose-response curve:
  1. It is almost linear except at the ends
  2. It is a rectangular hyperbola
  3. It facilitates comparison of different agonists
  4. It can help in discriminating between competitive and noncompetitive antagonists (p. 46)

• 3.20 When therapeutic effects decline both below and above a narrow range of doses, a drug is said to exhibit:
  1. Ceiling effect
  2. Desensitization
  3. Therapeutic window phenomenon
  4. Nonreceptor mediated action (p. 46)

• 3.21 Which of the following drugs exhibits ‘therapeutic window’ phenomenon:
  1. Captopril
  2. Furosemide
  3. Diazepam
  4. Imipramine (p. 46, 410)

3.18 A

3.19 B

3.20 C

3.21 D

• 3.22 The following statement is not true of ‘potency’ of a drug:
  1. Refers to the dose of the drug needed to produce a certain degree of response
  2. Can be related to that of its congeners by the relative position of its dose-response curve on the dose axis
  3. It is often not a major consideration in the choice of a drug
  4. It reflects the capacity of the drug to produce a drastic response (p. 47)

• 3.23 ‘Drug efficacy’ refers to:
  1. The range of diseases in which the drug is beneficial
  2. The maximal intensity of response that can be produced by the drug
  3. The dose of the drug needed to produce half maximal effect
  4. The dose of the drug needed to produce therapeutic effect (p. 47)

• 3.24 Which of the following is always true:
  1. A more potent drug is more efficacious
  2. A more potent drug is safer
  3. A more potent drug is clinically superior
  4. A more potent drug can produce the same response at lower doses (p. 47)

• 3.25 Higher efficacy of a drug necessarily confers:
  1. Greater safety
  2. Therapeutic superiority
  3. Capacity to produce more intense response
  4. Cost saving (p. 47)

3.22 D

3.23 B

3.24 D

3.25 C

• 3.26 If the dose-response curves of a drug for producing different actions are widely separated on the dose axis, the drug is:
  1. Highly potent
  2. Highly efficacious
  3. Highly toxic
  4. Highly selective (p. 47–48)

• 3.27 The therapeutic index of a drug is a measure of its:
  1. Safety
  2. Potency
  3. Efficacy
  4. Dose variability (p. 48)

• 3.28 Compared to the drug named within parenthesis, which of the following drugs has a higher potency but lower efficacy:
  1. Pethidine (morphine)
  2. Furosemide (hydrochlorothiazide)
  3. Diazepam (pentobarbitone)
  4. Enalapril (captopril) (p. 47)

• 3.29 If the effect of combination of two drugs is equal to the sum of their individual effects, the two drugs are exhibiting:
  1. Potentiation
  2. Synergism
  3. Cross tolerance
  4. Antagonism (p. 49)

• 3.30 The antagonism between adrenaline and histamine is called ‘physiological antagonism’ because:
  1. Both are physiologically present in the body
  2. They act on physiological receptors
  3. Both affect many physiological processes
  4. They have opposite physiological effects (p. 49)

3.26 D

3.27 A

3.28 C

3.29 B

3.30 D

• 3.31 The antidotal action of sodium nitrite in cyanide poisoning is based on:
  1. Physical antagonism
  2. Chemical antagonism
  3. Physiological antagonism
  4. Noncompetitive antagonism (p. 49, 492)

• 3.32 A drug ‘R’ producing no response by itself causes the log dose-response curve of another drug ‘S’ to shift to the right in a parallel manner without decreasing the maximal response: Drug ‘R’ is a:
  1. Partial agonist
  2. Inverse agonist
  3. Competitive antagonist
  4. Noncompetitive antagonist (p. 50)

• 3.33 A drug which does not produce any action by itself but decreases the slope of the log dose-response curve and suppresses the maximal response to another drug is a:
  1. Physiological antagonist
  2. Competitive antagonist
  3. Noncompetitive antagonist
  4. Partial agonist (p. 50)

• 3.34 The following is not a feature of competitive antagonists:
  1. Chemical resemblance with the agonist
  2. Parallel rightward shift of the agonist log dose-response curve
  3. Suppression of maximal agonist response
  4. Apparent reduction in agonist affinity for the receptor (p. 50)

• 3.35 The following is a competitive antagonist of GABA but a noncompetitive antagonist of diazepam:
  1. Picrotoxin
  2. Muscimol
  3. Flumazenil
  4. Bicuculline (p. 50, 364, 435)

3.31 B

3.32 C

3.33 C

3.34 C

3.35 D

• 3.36 The dose of the following class of drugs has to be adjusted by repeated measurement of the affected physiological parameter:
  1. Oral contraceptives
  2. Antiepileptics
  3. Antidepressants
  4. Oral anticoagulants (p. 51)

• 3.37 A drug which is generally administered in standard doses without the need for dose individualization is:
  1. Insulin
  2. Mebendazole
  3. Prednisolone
  4. Digoxin (p. 51)

• 3.38 Which of the following statements is not true of fixed dose combination formulations:
  1. They are more convenient
  2. Contraindication to one of the components does not contraindicate the formulation
  3. The dose of any one component cannot be independently adjusted
  4. The time course of action of the different components may not be identical (p. 51–52)

• 3.39 Fixed dose combination formulations are not necessarily appropriate for:
  1. Drugs administered in standard doses
  2. Drugs acting by the same mechanism
  3. Antitubercular drugs
  4. Antihypertensive drugs (p. 51, 515–17, 704)

• 3.40 A fixed dose combination preparation meant for internal use must not contain the following class of drug:
  1. Thiazide diuretic
  2. Fluoroquinolone antimicrobial
  3. Corticosteroid
  4. H₂ blocker (p. 52)

3.36 D

3.37 B

3.38 B

3.39 B

3.40 C

• 3.41 Interindividual variations in equieffective doses of a drug are most marked if it is disposed by:
  1. Glomerular filtration
  2. Tubular secretion
  3. Both glomerular filtration and tubular secretion
  4. Hepatic metabolism (p. 52)

• 3.42 The pharmacokinetics of drugs in the neonate differs from that in adults, because their:
  1. Intestinal transit is fast
  2. Drug metabolizing enzymes are overactive
  3. Tubular transport mechanisms are not well developed
  4. Glomerular filtration rate is high (p. 53)

• 3.43 Which adverse drug effect is more common in children than in adults:
  1. Isoniazid induced neuropathy
  2. Chlorpromazine induced muscle dystonia
  3. Digoxin induced cardiac arrhythmia
  4. Penicillin hypersensitivity (p. 53, 397)

• 3.44 The elderly patients are relatively intolerant to:
  1. Digoxin
  2. Salbutamol
  3. Propranolol
  4. Nifedipine (p. 54, 463)

• 3.45 The following drug adverse effect is specially noted in men compared to women:
  1. Tardive dyskinesia due to neuroleptics
  2. Levodopa induced abnormal movements
  3. Ampicillin induced loose motions
  4. Ketoconazole induced loss of libido (p. 54, 720)

3.41 D

3.42 C

3.43 B

3.44 A

3.45 D

• 3.46 Which racial difference in response to drugs has been mentioned incorrectly below:
  1. Africans require higher concentration of atropine to dilate pupils
  2. Black races are more responsive to antihypertensive action of beta blockers
  3. Japanese are more prone to develop SMON due to halogenated hydroxyquinolines
  4. Chloramphenicol induced aplastic anaemia is rare among Indians (p. 54)

• 3.47 Which of the following adverse drug reactions is due to a specific genetic abnormality:
  1. Tetracycline induced sunburn like skin lesions
  2. Quinidine induced thrombocytopenia
  3. Metoclopramide induced muscle dystonia
  4. Primaquine induced massive haemolysis (p. 54)

• 3.48 Drug metabolism can be induced by the following factors except:
  1. Cigarette smoking
  2. Acute alcohol ingestion
  3. Exposure to insecticides
  4. Consumption charcoal broiled meat (p. 55, 351)

• 3.49 A drug which produces qualitatively different actions when administered through different routes is:
  1. Phenytoin sodium
  2. Hydralazine
  3. Magnesium sulfate
  4. Nitroglycerine (p. 55)

• 3.50 Which of the following is true of ‘placebos’:
  1. Placebo is a dummy medication
  2. Placebo is the inert material added to the drug for making tablets
  3. Placebos do not produce any effect
  4. All patients respond to placebos (p. 55)

3.46 B

3.47 D

3.48 B

3.49 C

3.50 A

• 3.51 In patients of hepatic cirrhosis:
  1. The extent of change in pharmacokinetics of drugs can be predicted from the values of liver function tests
  2. High doses of furosemide can be safely used
  3. Metformin is the preferred oral hypoglycaemic
  4. Disposition of atenolol is not significantly affected (p. 56)

• 3.52 In patients with renal insufficiency the clearance of the following drug is reduced parallel to the reduction in creatinine clearance:
  1. Propranolol
  2. Digoxin
  3. Lignocaine
  4. Verapamil (p. 56)

• 3.53 The following statement is not correct for uremic patients:
  1. Attainment of steady-state plasma concentration of drugs eliminated through the kidney is hastened
  2. Pethidine can cause seizures
  3. Diazepam produces exaggerated CNS depression
  4. Tetracyclines further raise blood urea level (p. 56)

• 3.54 In congestive heart failure patients:
  1. Volume of distribution of all drugs is increased
  2. Hepatic clearance of drugs is unaffected
  3. Orally administered diuretics may not be effective, but the same may work parenterally
  4. Inotropic action of digoxin is attenuated (p. 56–57)

3.51 D

3.52 B

3.53 A

3.54 C

• 3.55 Interaction between the following pair of drugs can be avoided by making suitable adjustments:
  1. Levodopa and metoclopramide
  2. Furosemide and indomethacin
  3. Tetracyclines and ferrous sulfate
  4. Clonidine and chlorpromazine (p. 57, 670)

• 3.56 Drug cumulation is the basis of organ toxicity of the following drug when used for prolonged periods:
  1. Prednisolone
  2. Chloroquine
  3. Aspirin
  4. Hydralazine (p. 58, 740)

• 3.57 Tolerance is generally not acquired to:
  1. Antisecretory action of atropine
  2. Sedative action of chlorpromazine
  3. Emetic action of levodopa
  4. Vasodilator action of nitrates (p. 58, 384, 490)

• 3.58 Significant tolerance does not develop to the following action of morphine:
  1. Analgesia
  2. Euphoria
  3. Sedation
  4. Miosis (p. 58, 423)

• 3.59 In an anaesthetized dog, repeated intravenous injection of ephedrine shows the phenomenon of:
  1. Anaphylaxis
  2. Tachyphylaxis
  3. Idiosyncrasy
  4. Drug resistance (p. 59)

3.55 C

3.56 B

3.57 A

3.58 D

3.59 B

• 4.1 An undesirable effect of a drug that occurs at therapeutic doses and can be predicted from its pharmacological actions is called:
  1. Side effect
  2. Toxic effect
  3. Allergic reaction
  4. Idiosyncrasy (p. 61)

• 4.2 Which of the following is a type B (unpredictable) adverse drug reaction:
  1. Side effect
  2. Toxic effect
  3. Idiosyncrasy
  4. Physical dependence (p. 60, 62)

• 4.3 The side effect of a drug which has been used as a therapeutic effect in another condition is:
  1. Constipation caused by codeine
  2. Cough caused by captopril
  3. Uterine stimulation caused by quinine
  4. Diarrhoea caused by ampicillin (p. 61)

• 4.4 A ‘toxic effect’ differs from a ‘side effect’ in that:
  1. It is not a pharmacological effect of the drug
  2. It is a more intense pharmacological effect that occurs at high dose or after prolonged medication
  3. It must involve drug induced cellular injury
  4. It involves host defence mechanisms (p. 61)

• 4.5 The following statement is true in relation to ‘drug toxicity’ and ‘poisoning’:
  1. The two terms are synonymous
  2. When a toxic effect requires specific treatment, it is called poisoning
  3. A toxic effect which endangers life by markedly affecting vital functions is called poisoning
  4. Toxicity is caused by drugs while poisoning is caused by other harmful chemicals (p. 61, 62)

4.1 A

4.2 C

4.3 A

4.4 B

4.5 C

• 4.6 Use of an emetic to remove the ingested poison is contraindicated in following poisonings except that by:
  1. Strychnine
  2. Caustic soda
  3. Ferrous sulfate
  4. Kerosene (p. 62, 600)

• 4.7 Which of the following is an idiosyncratic adverse drug reaction:
  1. Muscle dystonia caused by triflupromazine
  2. Insomnia after taking pentobarbitone
  3. Precipitation of asthma by morphine
  4. Gum hyperplasia caused by phenytoin (p. 62)

• 4.8 An immunologically mediated reaction to a drug producing stereotyped symptoms unrelated to its pharmacodynamic actions is:
  1. Hypersensitivity
  2. Supersensitivity
  3. Intolerance
  4. Idiosyncrasy (p. 62, 63)

• 4.9 Drugs producing allergic reactions generally act as:
  1. Complete antigens
  2. Haptenes
  3. Antibodies
  4. Mediators (p. 63)

• 4.10 The following allergic drug reaction is caused by circulating antibodies:
  1. Serum sickness
  2. Anaphylactic shock
  3. Systemic lupus erythematosus
  4. Angioedema (p. 63)

4.6 C

4.7 B

4.8 A

4.9 B

4.10 A

• 4.11 Which of the following is the only life saving measure in case of anaphylactic shock:
  1. Intravenous hydrocortisone hemisuccinate
  2. Intravenous chlorpheniramine maleate
  3. Intramuscular adrenaline hydrochloride
  4. Intravenous glucose-saline (p. 63, 64)

• 4.12 The type II, type III and type IV hypersensitivity reactions can be suppressed by:
  1. Adrenaline
  2. Antihistaminics
  3. Corticosteroids
  4. Sod. cromoglycate (p. 64)

• 4.13 The most appropriate route of administration for adrenaline in a case of anaphylactic shock is:
  1. Intracardiac
  2. Intravenous
  3. Intramuscular
  4. Subcutaneous (p. 63)

• 4.14 Intradermal drug sensitivity tests can detect the presence of following type of hypersensitivity:
  1. Type I (anaphylactic)
  2. Type II (cytolytic)
  3. Type III (retarded)
  4. All of the above (p. 64)

• 4.15 An addicting drug which produces little or no physical dependence is:
  1. Diazepam
  2. Phenobarbitone
  3. Amphetamine
  4. Methadone (p. 65, 113)

4.11 C

4.12 C

4.13 C

4.14 A

4.15 C

• 4.16 The essential feature in drug addiction is:
  1. Physical dependence
  2. Psychological dependence
  3. Both physical and psychological dependence
  4. Psychiatric abnormality (p. 65)

• 4.17 Adaptive neurophysiological changes produced by repeated administration of a drug, which result in the appearance of characteristic withdrawal syndrome on discontinuation of the drug is called:
  1. Drug addiction
  2. Drug abuse
  3. Psychological dependence
  4. Physical dependence (p. 65)

• 4.18 Which of the following constitutes ‘drug abuse’:
  1. Physician prescribed use of penicillin G for the cure of viral fever
  2. Self administration of aspirin to relieve headache
  3. Repeated self administration of morphine to derive euphoria
  4. All of the above (p. 65)

• 4.19 ‘Addiction’ and ‘habituation’:
  1. Are fundamentally different phenomena
  2. Are produced by different set of drugs/substances
  3. Differ from one another by the presence or absence of physical dependence
  4. Differ from each other in the degree of attendant psychological dependence (p. 65)

4.16 B

4.17 D

4.18 C

4.19 D

• 4.20 Adverse consequences may follow sudden discontinuation of the following drug after chronic intake:
  1. Cocaine
  2. Cannabis
  3. Clonidine
  4. All of the above (p. 65, 510)

• 4.21 The most vulnerable period of pregnancy for the causation of foetal malformations due to drugs is:
  1. 18–55 days of gestation
  2. 56–84 days of gestation
  3. Second trimester
  4. 36 weeks onwards (p. 65)

• 4.22 The following is a proven human teratogen:
  1. Chloroquine
  2. Warfarin sodium
  3. Dicyclomine
  4. Methyldopa (p. 66, 517, 601, 740)

• 4.23 Select the drug which has been found to be a strong human teratogen:
  1. Isoniazid
  2. Isotretinoin
  3. Hydralazine
  4. Propylthiouracil (p. 66, 232, 512, 707, 801)

4.20 C

4.21 A

4.22 B

4.23 B