This document contains a series of multiple choice questions about clinical pharmacology. It addresses topics like the side effects of different drugs, their mechanisms of action, and drug interactions. For example, it asks about the common side effect of a drug class that works by inhibiting HMG CoA reductase (constipation), and notes that NSAIDs can decrease the effects of diuretics and ACE inhibitors by constricting blood flow to the kidneys. The document provides explanations and context for each question to help readers learn about various clinical pharmacology concepts.
2. Q1. The medication with the mode of action
shown is used to manage pruritus. The drug is?
a. Lovastatin
b. Cholestyramine
c. Gemfibrozil
d. Niacin
e. Diphenhydramine
Ng
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3. Q2. A very common side effect of the drug with
the mode of action shown below is?
a. Facial flushing
b. Liver dysfunction
c. Rash
d. Constipation
e. Dyspnea
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4. 1b,2d
1. Cholestyramine is an anion exchange resin binds to bile salts and prevents
absorption of the bile to the liver.
2. Lowering the bile aid concentration causes the liver to increase conversion of
cholesterol to bile salts, resulting in a replenished supply of these compounds.
3. Cholestyramine can also relieve pruritus caused by accumulation of bile salts in
patients with biliary obstruction. These anion resins can also interfere with
absorption of many drugs.
4. Cholestyramine is notorious for causing constipation
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5. Q1. The most common side effect of the drug class
with the mode of action shown below is:
a. Allergies
b. Gastrointestinal upset
c. Headache
d. Muscle pain
e. Skin rash
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6. Q2. Which of the following is a serious side effect
of the drug class with the mode of action shown
below?
a. Diabetes insipidus
b. Osteoporosis
c. Rhabdomyolysis
d. Rash
e. Pancreatitis
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7. 1b, 2c
1. The most common adverse affects are mild gastrointestinal disturbances. These
lessen as the therapy progresses.
The most important adverse side effects are muscle problems, an increased risk of
diabetes mellitus, and increased liver enzymes in the blood due to liver damage
In observational studies 10–15% of people who take statins experience muscle
problems; in most cases these consist of muscle pain.These rates, which are much
higher than those seen in randomized clinical trials have been the topic of
extensive debate and discussion.
Inhibition of HMG CoA Reductase is a mode of action of the statin drugs.
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8. Q. The agent with the mode of action shown
below is known to cause what adverse effect?
a. Diabetes mellitus
b. Osteoporosis
c. Cholelithiasis
d. Rash
e. Nephropathy
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9. c
Gemfibrozil causes a decrease in plasma triacylglycerol by stimulating lipoprotein
lipase levels, thereby hydrolyzing triacylglycerols in chlyomicrons and VLDL, and
thus hastening the removal of these particles from the plasma
Common side effects include headache, dizziness, feeling tired, and intestinal
upset.Serious side effects may include angioedema, gallstones, liver problems, and
muscle breakdown. Use in pregnancy and breastfeeding is of unclear safety. It
belongs to the fibrates group of medications and works by decreasing the
breakdown of lipids in fat cells.
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10. Q1. What is the antilipidemic agent that has the
mode of action shown below?
a. Niacin
b. Colestipol
c. Cholestyramine
d. Atorvastatin
e. Gemfibrozil
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11. Q2. The most common side effect of the antilipidemic drug with
the mode of action shown below is:
a. Diarrhea
b. Allergy
c. Flushing
d. Diabetes
e. Gout
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12. 1a,2c
1. The most common side effect of niacin therapy is an intense cutaneous flush
accompanied by a feeling of warmth and pruritus.
2. Administration of aspirin prior to taking niacin decreases the flushing, which is
mediated by prostaglandins.
3. Some patients may also experience nausea and abdominal pain. Nicotinic acid
inhibits tubular secretion of uric acid and thus predisposes to hyperuricemia.
Impaired glucose tolerance and hepatotoxicity have also been reported.
4. The figure shows the mode of action of niacin.
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13. 1. Niacin is a water-soluble vitamin and strongly inhibits lipolysis in adipose tissue-
the primary producer of circulating free fatty acids.
2. The liver normally utilizes these circulating fatty acids as a major precursor for
triacylglycerol synthesis. Thus, niacin causes a decrease in liver triacylglycerols
synthesis, which is required for very low-density lipoprotein production.
3. LDL is derived from VLDL. Further niacin increases HDL cholesterol and can boost
secretion of tissue plasminogen activator.
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14. Q. A patient with hypertension is started on a drug with the mode of
action shown. Which one class of medications can decrease the
antihypertensive effects of this class of drugs?
a. Corticosteroids
b. NSAIDs
c. Diuretics
d. Alpha-blockers
e. Beta-blockers
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15. B
1. Concurrent administration of indomethacin may decrease the antihypertensive
effects of furosemide, the thiazide diuretics, beta blocking agents and ACE
inhibitors
2.Concomitant use of ACE inhibitors with diuretic or non-steroidal anti-
inflammatory drugs (NSAIDs) is discouraged, as these combinations increase the
risk of kidney injury. NSAIDs constrict the blood vessels that supply the kidneys.
Similarly, diuretics reduce blood volume and decrease blood flow to the kidneys.
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16. Q. After taking a supplement to lower his lipid levels, an elderly male
quickly develops the following facial feature. What medication can you
use to stop this adverse effect?
a. Corticosteroid
b. Aspirin
c. Serotonin
d. Cromoglycate
e. PGE2
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17. b
• Flushing – a short-term dilatation of skin arterioles, causing reddish skin color – usually
lasts for about 15 to 30 minutes, although sometimes can persist for weeks. Typically, the
face is affected, but the reaction can extend to neck and upper chest. The cause is blood
vessel dilation due to elevation in prostaglandin GD2 (PGD2) and serotonin.
• Flushing was often thought to involve histamine, but histamine has been shown not to
be involved in the reaction. Flushing is sometimes accompanied by a prickly or itching
sensation, in particular, in areas covered by clothing.
• Prevention of flushing requires altering or blocking the prostaglandin-mediated pathway.
Aspirin taken half an hour before the niacin prevents flushing, as does ibuprofen. Taking
niacin with meals also helps reduce this side effect.
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18. Q. Which of the following medications is most commonly
prescribed for patients suffering from the following arrhythmia?
a. Lidocaine
b. Bretylium
c. Coumadin
d. Nifedipine
e. Adenosine
f. Aspirin
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19. C
ECG shows atrial fibrillation
The cornerstones of atrial fibrillation management are rate control and
anticoagulation and rhythm control for those symptomatically limited by AF.
The clinical decision to use a rhythm-control or rate-control strategy requires an
integrated consideration of several factors, including degree of symptoms,
likelihood of successful cardioversion, presence of comorbidities, and candidacy for
AF ablation (eg, pulmonary vein electric isolation or MAZE procedure).
No matter what drug is used to control rate, anticoagulation is mandatory for
chronic atrial fibrillation.
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20. Q. A 22 year old with a history of mental health issues was started on a
medication for symptom relief. He presents one month later with the
features shown. The most likely drug class he was started on is?
a. Typical antipsychotic
b. Tricyclic antidepressant
c. Anticonvulsant
d. SSRI
e. Benzodiazepine
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21. A
Hepatic cholestatic jaundice does occur after the use of phenothiazines but the
symptoms generally subside following discontinuance of the drug but cholestasis
may be prolonged.
Knowledge of antipsychotic-related hepatotoxicity is critical for the CL psychiatry
team, especially for drug selection in those with liver dysfunction.
The first aspect in clinical decision-making should be evaluation for any underlying
liver disease. If there is evidence of impairment, one should consider selecting an
antipsychotic with low risk to further exacerbate any underlying liver injury. Dosing
should be adjusted to account for pharmacokinetic changes seen in this population
with
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22. Q. A patient with a migraine receives IV chlorpromazine for symptom
relief. However, the nurse notes his BP -see below. Which of the
following treatments will not reverse his hemodynamics?
a. Norepinephrine
b. IV Normal saline 500 ml bolus
c. IV Ringers lactate 500 ml bolus
d. Trendelenburg position
e. Albumin 5% 150 ml drip
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23. A
1. Chlorpromazine may cause hypotension because of alpha blockade.
2. It should be used with caution in the elderly, alcoholics and in patients with
cardiovascular disease or in patients undergoing surgery.
3. The dosage of anesthetics and CNS depressants may have to be reduced in
the perioperative period.
4. Norepinephrine often does not work for chlorpromazine-induced
hypotension because of the alpha blockade induced by the antipsychotic
5. These patients are best managed with IV fluids. Once the electrolyte
imbalance and acidity is corrected with sodium bicarbonate, epinephrine can be
administered
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