1- Patient has a relevant increase in his asthma symptoms due to environmental allergies. He is currently having salbutamol and fluticasone inhalers. What would you advise as an adjunct medication to treat his symptoms?
a) Oral corticosteroids
b) Higher dose of corticosteroid inhalers c) Salmeterol
d) Sodium cromoglycate e) Anticholinergic agents
2- Treatment of smoke withdrawal symptoms may include which of the following?
I- Nicorette II- Nicoderm III- Zyban a) I only b) III only c) I and II only d) II and III only e) All are correct
3- Which of the following vitamins is depleted in the blood by smoke?
a) Vitamin C b) Vitamin B c) Vitamin E d) Vitamin D e) Vitamin A
4- Condition characterized by a reversible form of airflow obstruction is known as:
a) Aneurism b) Emphesema c) Embolism d) Cirrhose e) Jaundice
5- Advantages of nasal route over oral route absorption of drugs may include:
I- Nasal route has a higher surface area II- Nasal route has more blood vessels III- Nasal route has a higher onset of absorption a) I only
b) III only c) I and II only d) II and III only e) All are correct
6- Which is not a drug used for smoke cessation?
a) Nicotine polacrilex
b) Transdermal nicotine patches c) Nicotine sublingual tablets d) Bupropion
e) Buspirone
7- Example of leukotriene antagonist drug include:
a) Salbutamol b) Ipratropium c) Zafirlukast d) Montelukast e) C and D are right
8- Which reaction can ozone cause in the lungs?
a) Oxidation b) Hydration c) Reduction d) Complexation e) Hydrolysis
9- Correct statements regarding glossitis include which of the following?
I- Inflammation of the tongue
II- Characterized by presence of pinkish-red central lesions on the dorsal surface of the tongue III- It can be a chronic condition of the tongue seen in pernicious anemia.
a) I only b) III only c) I and II only d) II and III only e) All are correct
10- Intal-Sodium cromoglycate is characterized by which of the following statements?
I- Non-steroidal drug with anti-inflammatory proprieties II- They can be used in prophylaxis of asthma and allergic rhinitis III Used in asthma only
a) I only b) III only c) I and II only d) II and III only e) All are correct
11- Drug of choice in the treatment of chronic obstructive pulmonary disease may include:
a) Salbutamol b) Ipratropium c) Salmereol
d) Sodium cromoglycate e) Fluticasone
12- Chronic progressive lower airway destruction causing reduced pulmonary inspiration and expiratory capacity is known as:
a) Asthma b) Bronchitis c) GERD d) COPD e) CHF
13- Asthma is a condition of respiratory tract that may be aggravated by:
a) Allergens b) Cold weather c) Execise d) Emotion e) All are correct
14- Which of the following is considered as the best treatment of asthma?
a) β2-agonists b) β-Blockers c) α-agonists
d) Anticholinergic drugs e) Cholinergic drugs
15- Which of the following agents or combinations may be appropriated to treat severe intermittent asthma?
a) High doses of inhaled corticosteroid b) Long acting β2-agonists
c) Short acting β2-agonists d) Oral corticosteroids
e) Combination of all the above medication
16- Examples of drug(s) that may precipitate asthma include all of the following, EXCEPT:
a) Aspirin b) β-Blockers c) Ipratropium d) NSAIDs e) Cholinergic drugs
17- All of the following are pathophysiologic characteristics of asthma, EXCEPT:
a) Airway obstruction and inflammation b) Destructive changes in the alveolar walls c) Thickened smooth muscle of airway d) Mucosal edema
e) Narrowed lumen of airway
18- The MOST well known characteristic symptom of asthma include:
a) Wheezing b) Mucosal edema c) Cough d) Chest tightness e) Tachycardia
19- Drug considered as the drug of choice in a specific asthma emergency treatment include:
a) Salmeterol b) Adrenaline c) Albuterol d) Cortisone e) Zafirlukst
20- Salbutamol is short acting β2-agonists that may be used in the treatment of which of the following asthma type?
a) Mild asthma b) Emergency asthma c) Severe intermittent asthma d) Moderate asthma e) All kind of asthma
21- All are correct concerning the action of corticosteroids in asthma status, EXCEPT:
a) Suppress the inflammatory response
b) Decrease production of inflammatory mediators c) Decrease airway responsiveness to inflammation d) Relieve brochocontriction
e) Increase β-agonist receptors response
22- All are examples of corticosteroids inhalers used in asthma, EXCEPT:
a) Beclometasone b) Sodium cromoglycate c) Flunisolide
d) Fluticasone e) Budesonide
23- All are examples of drugs used in the treatment of bronchoconstriction, EXCEPT:
a) β2-agonists b) Anticholinergic c) Methyl xanthenes d) Xanthine oxidase inhibitors e) Leukotriene modifiers
24- Best drug used in the prevention of exercise-induced asthma may include:
a) Long acting β2-agonists b) Short acting β2-agonists c) Anticholinergics d) Leukotriene modifiers e) Corticoids
25- All are β2-agonists used as brochodilators in the treatment of bronchospasm, EXCEPT:
a) Albuterol b) Salmeterol c) Terbutaline d) Pindolol e) Levalbuterol
26- Example of methyl xanthine used in the treatment of respiratory complications include:
a) Theophyllin b) Terbutaline c) Ipratropium d) Zafirlukast e) Salmeterol
27- Agents considered as precursor of leukotriene include:
a) Tyrosine b) Cyanide c) Arachidonic acid d) Prostaglandins e) Histamine
28- Indication of leukotrienes modifiers in the treatment of asthma includes which of the following?
I- Acute treatment II- Prophylaxis III- Chronic treatment a) I only
b) III only c) I and II only d) II and III only e) All are correct
29- Drug known as the new relative cromolyn like drug include:
a) Cromolyn sodium b) Cromoglycanate sodium c) Cromolyin disodium d) Disodium cromoglycanate e) Nedocromil sodium ANSWERS
1- D: Sodium cromoglycanate would be the best choice because it is a safe anti-inflammatory inhaler for children and very useful in treating environmental allergy and asthma prophylaxis.
2- C: Nicoret and nicoderm are nicotine replacement therapy for smoking cessation, so their use avoid the smoke withdrawal effect.
3- A: Smokers have more tendencies to vitamin C depletetion rather than other vitamins
4- B: Aneurysm is an abnormal dilatation of a blood vessel while embolism is an obstruction of airway by a mass transported in the circulation. Cirrhoses and jaundice are liver related complications.
5- D: Although nasal route has a smaller surface area than intestine drugs administrated by nasal route will have faster onset of action due to large quantity of blood vessels in the nasal route.
6- C: Buspirone is an atypical anxiolitic agent used to treat anxiety disorders.
7- E: Zafirlukast and montelukast are classics leukotriene antagonists used in the oral treatment of asthma
8- A: Ozone is a gas that may cause irritation and toxicity of pulmonary system. The main reaction of ozone in the body is oxidation.
9- E: Glossitis is an inflammatory disease of tongue of unknown etiology characterized by multiple annular areas of desquamation of the filiform papillae on the dorsal surface of the tongue. Usually presenting pinkish-red central lesions, normally seen in pernicious anemia 10- C: Sodium cromoglycanate is an anti-inflammatory, nonsteroid inhaler, mast cell stabilizer used in asthma prophylaxis and as antiallergic agent.
11- B: Ipratropium is a cholinergic antagonist used as the drug of choice in the treatment of COPD-Chronic Obstructive Pulmonary Disease by blocking the brochoconstriction caused by activation of the parasympathetic nervous system.
12- D: COPD-Chronic Obstructive Pulmonary Disease
13- E: Asthma is a chronic inflammatory disorder of the airway that may be induced by allergens, occupational exposure, exercise, emotion, weather, drugs and so on.
14- A: Inhalated short-acting β-agonists are the most effective drugs available for all the kinds of asthma treatment.
15- E: Severe intermittent asthma treatment is best done by short and long-acting β-agonists plus inhaled and oral corticosteroids.
16- C: Ipratropium is an anticholinergic drug that be used in adjunct treatment of asthma.
17- B: Destructive changes in the alveolar walls are characteristics of a respiratory complication called “Emphysema”
18- A: Mainly symptoms of asthma are: Wheezing, shortness of breathing, chest tightness, cough, tachycardia, tachypnea and pulses paradoxus.
19- C: Albuterol is the fastest acting β-agonist used in the treatment of bronchocostriction emergencies-asthma.
20- E: Salbutamol is a fast acting β-agonist and considered the drug of choice in all kind of asthma.
21- D: The use of corticosteroids in asthma suppresses the inflammatory response and decreases the airway hyperesponsiveness by decreasing the production of inflammatory mediators and mucus production.
22- B: Sodium cromoglycanate is an anti-inflammatory, antiallergenic and mast cell stabilizer drug.
23- B: Xanthine oxidase inhibitor is mainly used in the treatment of gout.
24- B: Salbutamol, a fast acting β-agonist, is the most effective drug in the prevention of exercise-induced asthma.
25- D: Pindolol is a β-blocker used mainly in the treatment of hypertension.
26- A: Ipratropium is an anticholinergic drug used in COPD as the drug of choice.
27- C: Cysteinyl leukotrienes are products of arachidonic acid metabolism. Leukotriene modifiers drugs inhibit leukotriene synthesis by inhibiting 5-lipoxygenase that catalyzes the conversion of arachidonic acid to leukotriene.
28- D: Leukotriene modifiers are approved for oral prophylaxis and chronic treatment of asthma.
29- E: Nedocromil sodium is the new relative cromolyn like drug acting in a very similar way as sodium cromoglycanate does.
TOXICOLOGY
1.Antidote for mercury may include a)Dimercaprol b)EDTA c)Detoroximine d)Naloxone e)succimer
2.Which of the ff is benzodiazepine antagonist a)naloxone
b)physostigmine c)flumazenil d)naltrexone e)penicillamine
3.What would be the best treatment for cyanide poisoning a)antivena
b)sodium thiosulfate c)acetylcycteine d)oxygen therapy e)sadium bicarbonate
4.carbon monoxide can be highly toxic because it can easily binds with I.hemoglobin
II.myoglobin III.cytochrome oxidase a)I only
b)III only c)I & II d)II & III e)All of the above
5.Acetaminophen toxicity most well known complication is a)cardiovascular failure
b)pulmonary edema c)CNS lethargy d)Liver necrosis e)Sedation
6.Salicylate poisoning treatment include which of the following I.Alkalinizaiton of urine with sadium bicarbonate
II.Decontamination with syrup of IPECAC until 30 mins overdose III.Charcoal every 6 hours
a) I only b)III only c)I & II d)II & III e)All of the above
7.Hyperphopotemia can be best treated with a)Magnesium Hydroxide b)Calcium Carbonate c)Aluminum Hydroxide d)Sodium bicarbonate e)Sodium phosphate
8.Correct statement regarding Ipecac may include
I.It has an emetic effect when large dose are administered II.It has an expectorant effect when small doses are administered III.Uses in decontamination procedure during toxic treatment.
Ans . All of the above
9.The organophosphate commonly found in insecticeds are thought to act by which mechanism a)Combining with acetylcholine
b)Potentiating the action of acethycholinesterase c)Forming a very stable complex with
d)Reaching at the cholinergic receptor
e)Preventing release of ecetylcholine from nerve ending
10.All of the ff. Can be recognised as Atropine poisoning except:
a)Dry skin b)Mydriasis c)Flushed appearance d)Diarrhea
e)Delirium
11.Antidote for Atropine poisoning include a)Physostigmine
b)Aminophylline c)Pralidoxine d)Flunazeril e)Dimercaprol
12.Poison ivy can be treated by which of the ff. Agents a)Topical antipruritic
b)Antihistamines c)Systemic corticosteroids
13.A patient is stabilized with heparin as . After 1 hr of administration he exhibited bleeding from his gums, while he was brushing his teeth. The pharmacist can advice him to take
a)Ascorbic Acid b)Vitamin K c)Protamine sulfate d)Quinolone
14.N-actyly cysteine may be the antidote of choice for which of the following agents a)Aspirin
b)Warfarin c)Digoxin d)Lead
e)Acetaminophen
15.Dimercaprol + mercury combination include
I.Dimercaprol best antidote forelemental mercury inhalation poisoning II.They form stable complex excreted renally
III.Penicillamine is alternative when mercury GI absorption Ans. All of the above
16.Naloxone is best antidote for which of the ff overdose agents a)opioid
b)heavy metal c)benzodiazepine
17.Management if toxicity of digoxin toxicity may include
I.May cause heart failure. Cardiac disrythmia, N, V, anorexia & confusion II.Treated by decontamination of supportive therapy
III.Treated with digoxin specific overdose known as FAB antibodies Ans: All of the above
18.Death due to cyanide poisoning
a)Cyanide - RBC complex formation b)Cyanide – HB complex formation c)Cyanide inhibiting cytochrome oxidase d)Cyanide increasing Hb levels e)Coronary vessel oclusion
19.The toxicity of methyl alcohol due to formation a)ketones
b)formaldehyde c)free alcohol radicals d)ethylene
e)aldehyde
20.Acetaminophen toxicity is due to a)oxidation stress b)active metabolite c)free radical chain d)reactive metabolite e)reduction of metabolite
21. Salicylate toxicity excessive respiration is due to I.Excessive production of CO2
II.Pulmonary inhalation
III.Central stimulation in the brain
22.Grayish mouth & loose of teeth are toxic symptoms of a)Fe salts poisoning
b)Cu poisoning c)Pb poisoning
23.Vomiting is contraindicated in poisoning is due to:
I.Bleaching II.Gasoline III.Light petroleum
24.Universal antidote is a mixture of a)Activated charcoal b)Mg Oxide c)Tannic Acid
25.Amphetamine overdose can be best treated with a)Salicylates
b)Benzodiazepines c)Barbiturates d)Naloxone e)Vit B & C
26.True statement regarding treatment of hyperkalemia
I.If change in ECG is detected give Ca to counteract the excess of K on heart II.Bicarbonate & insulin administration can shift K from extra to intracellular
III.Enema of kayexolate (exchange resin) as dialysis helps to remove excess of K from the body
27.Cardiovascular drug that overdose can cause cyanide intoxication include a)Nitrates
b)Nitroglycerin c)Nitroprusside d)Isosorbide e)Isosorbide dinitrate
28.Lead poisoning can be treated by a)BAL – Dimercaprol b)EDTA
c)Penicillamine
30.Atropine used as antidote for a)organophosphate b)heavy metals c)salicylates d)iron
31.Treatment of tricyclic antidepressant dose can be done by all of the ff except a)Control seizure & cardiotoxicity
b)Addition of phenytoin or benzodiazepine to control seizure c)Activated charcoal can be used
d)MAO antidepressant can help to overcome patient seizure e)Control acidosis with administration of sodium bicarbonate
32.Specific antidote for snake bites a)Detroxamine b)Aucord c)Antivenom d)Naloxone
33.Best treatment for carbon monoxide poisoning a)alkalinization of urine
b)Oxygen therapy c)Supportive therapy d)Acidification of urine e)Gastric lavage
34.Isoniazide antidote a)Vitamin A b)Vitamin B6 c)Vitamin B12 d)Folic acid e)Vitamin E
35.Warfarin antidote a)Vit K b)Heparin c)Protamine d)Vit E
36.Major first step in intoxication & poisoning in the supportive care treatment that involve a)Detoxification
b)Decontamination c)Hydration d)Toxicology lab test
e)Evaluation & support of vital treatment (airway, breath, circulation A,B,C)
37.management in treating patient with depressed mental status include I.Treat hypoglycemia with 50mL of dextrose 50%
II.Administration of thiamine 100mg IV push III.Administration of naloxone
38.Decontamination includes a)Gastric lavage b)Emesis
c)Administration of Activated charcoal d)Administration of adsorbant e)All of the above
39.Intravenous calcium administration is used in which situation a)verapamil overdose
b)cocaine overdose
c)verapamil overdose & kyperkalemia d)hyperkalemia
e)nifedipine overdose ANSWERS TOXICOLOGY
1A 2C 3B 4E 5D 6E 7C 8E 9C 10D 11A 12E 13C 14E 15E 16A 17E 18B 19B 20D 21A 22B 23E 24E 25E 26E 27C 28E 29B 30A 31D 32C 33B 34B 35A 36E 37E 38E 39C