Pharmacology solved MCQs

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chapter:   Analgesics-Toxicology

1. Regarding paraquat poisoning

a. The interval between ingestion and death is usually hours because of immediate pulmonary toxicity

B. Mechanism of action involves single electron oxidation of the herbicide to free radical species

c. Probable human lethal dosage is 50-500mg/kg

d. Oxygen high flow stops the pulmonary lesions occurring

e. Paraquat doesn’t affect hepatic or renal functions

2. Regarding NSAIDs

a. Piroxicam has a half life of >50 hours

B. Aspirin reversibly inhibits COX

c. Diclofenac is a selective COX1 inhibitor

d. Indomethacin is relatively free of adverse side effects

e. Ibuprofen is predominantly excreted unchanged in the urine

3. Regarding paracetamol (acetaminophen)

a. Less than 5% is excreted unchanged

B. Acetaminophen has no anti-inflammatory properties

c. The half life of paracetamol is 2-3 hours

d. Haemolytic anaemia has rarely been noted with paracetamol

e. All of the above are true

4. Regarding lead toxicity

a. Lead can induce an anaemia that is macrocytic

B. Young children absorb about 10% of ingested inorganic lead

c. Lead induced peripheral neuropathy often involves upper limb extensors resulting in wrist drop

d. High dose organic lead poisoning usually results in severe pneumonitis

e. All patients with elevated blood lead levels should have chelation treatment whether symptomatic or not

5. Regarding agents used to treat gout

a. As little as 8mg of colchicine taken over 24 hours may be fatal

B. Allopurinol is a xanthine oxidase stimulator

c. Probenecid is an organic alkaline substance

d. Colchicine may precipitate acute attacks of gout

e. Aspirin is effective against gout as it inhibits urate crystal phagocytosis

6. All of the following may be seen in organophosphate poisoning EXCEPT

a. Salivation

B. Tachycardia

c. Fibrillation of muscle fibres

d. Bronchospasm

e. Vomiting

7. Regarding aspirin

a. The average anti-inflammatory dose of aspirin is 0.6g up to 4 hourly

B. Aspirin’s main side effect at usual doses is rash

c. Aspirin’s antiplatelet effect lasts 8 – 10 days

d. At low toxic doses – respiratory acidosis may occur

e. Aspirin has a pka of 4.5

8. The main mechanism of action of colchicine is

a. Inhibition of polymorphonuclear leucocytes

B. Inhibition of synoviocyte phagocytosis

c. Reduced formation of leukotriene D4

d. Inhibition of mononuclear phagocytes

e. Decreasing the body pool of urate

9. Aspirin inhibits all of the following EXCEPT

a. Cyclo oxygenase

B. Recurrent miscarriages

c. Protacyclin synthesis

d. Kallikrein system

e. Lipo oxygenase

10. Acetaminophen (paracetamol) can undergo all of the following biotransformation reactions EXCEPT

a. Deamination

B. N-oxidation

c. Glucuronidation

d. Sulphation

e. Glutathione conjugation

11. Aspirin

a. Is hydrolysed to acetone and salicylate

B. Exhibits first order kinetics with elimination in low doses

c. Is mostly conjugated by the liver and excreted in the bile

d. Reversibly blocks the cyclooxygenase enzyme

e. Causes an immediate doubling of bleeding time

12. Regarding NSAIDs

a. At high doses diclofenac demonstrates zero order kinetics

B. Aspirin is a reversible inhibitor of cyclooxygenase

c. Aspirin at doses of <2g/day reduces uric acid levels

d. All NSAIDs can be found in synovial fluid after repeated dosing

e. Use of ibuprofen and aspirin together increases the anti inflammatory effect

13. The metabolic pathway of detoxification that becomes increasingly important in paracetamol toxicity is

a. Conjugation with glucuronide

B. Oxidation

c. Reduction

d. Cytochrome p-450 dependent glutathione conjugation

e. Methylation

14. Which of the following NSAIDs has a t1/2 of about 1 hour

a. Diclofenac

B. Naproxen

c. Piroxicam

d. Indomethacin

e. Ibuprofen

15. Which of the following symptoms of aspirin toxicity occurs at plasmasalicylate concentrations of 100mg/dl?

a. Tinnitus

B. Vasomotor collapse

c. Metabolic acidosis

d. Gastric intolerance

e. Renal failure

16. All of the following drugs can cause a wide anion gap metabolic acidosisEXCEPT

a. Lithium

B. Methanol

c. Cyanide

d. Salicylates

e. Isoniazid

17. Which of the following drug overdoses may be amenable to the elimination technique of haemodialysis

a. Calcium channel blockers

B. Benzodiazepines

c. Valproate

d. Quinidine

e. Opioids

18. Which of the following antidote – drug pairings is INCORRECT

a. Acetaminophen → n-acetyl cysteine

B. β blockers → glucagon

c. Opioids → naloxone

d. Benzodiazepines → Flumazenil

e. Tricyclic antidepressants → physostigmine

19. Regarding carbon monoxide poisoning

a. CO has an affinity for Hb that is about 2000 times that of oxygen

B. Hyperbaric oxygen is indicated as a treatment for all patients with CO Hb levels >20%

c. The average concentration of CO in the atmosphere is about 0.1ppm

d. With room air at 1atm the elimination half time of CO is about 80 minutes

e. The foetus is resistant to the effects of CO exposure

20. “Erethism” is seen in which of the following intoxications

a. Lead

B. Mercury

c. Arsine gas

d. Penicillamine

e. Arsenic

21. All of the following are NSAIDs EXCEPT

a. Sulindac

B. Piroxicam

c. Gemfibrozil

d. Ketorolac

e. Diflunisal

22. Drugs which enhance other drug metabolism include all of the following EXCEPT

a. Rifampicin

B. Ketoconazole

c. Phenobarbital

d. Griseofulvin

e. Phenytoin

23. Which of the following has a high extraction ratio

a. Trimethoprim

B. Valproic acid

c. Lignocaine

d. Metronidazole

e. Diazepam

24. Heparin and protamine used together is an example of

a. Physiologic antagonism

B. Chemical antagonism

c. Partial agonism

d. Irreversible antagonism

e. Agonal agonism

25. The half life of a drug with a Vd of 200ml/70kg and clearance of 10ℓ/hr/70kg is

a. 10 hours

B. 14 hours

c. 20 hours

d. 40 hours

e. Indeterminate

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