1) A 45-year-old unemployed man was rushed to the hospital emergency room with symptoms of agitation, palpitations and profuse

sweating. Physical examination revealed mydriasis, increased heart rate and blood pressure. History suggestive of amphetamine abuse. Which among the following statements best explains the reason for an increase in the heart rate in this patient? A) B) C) D) E) Amphetamine directly increasing cAMP levels Amphetamine directly increasing IP3-DAG levels Amphetamine causing a reflex increasing the heart rate Amphetamine indirectly increasing cAMP levels Amphetamine indirectly increasing IP3-DAG levels

2) In the management of hypertension, if you want to choose a drug which would affect both the cardiac output and total peripheral resistance, which among the following drugs would you choose? A) B) C) D) E) Atenolol Propranolol Metoprolol Carvedilol Prazosin

3) An investigational drug is being tested for its effects on the blood pressure in an anesthetized mammal. The graph below shows the effect of drug administration on the blood pressure and the heart rate. The arrow mark on the graph corresponds to the time of drug administration. Which among the following drug Vs mechanism of action would be most similar to the actions of this investigational drug?

A) Ephedrine : Decreasing the IP3-DAG levels

B) C) D) E)

Phenylephrine : Increasing the IP3-DAG levels Prazosin : Decreasing the IP3-DAG levels Isoproterenol : Decreasing the cAMP levels Propranolol : Decreasing the cAMP levels

4) The graph below represents the action of norepinephrine (NE) alone (curve B) and norepinephrine (NE) in the presence of other drugs (curves A, C and D). Which among the following statements is true with regard to the graph shown below?

A) B) C) D) E)

Curve A represents NE in the presence of prazosin Curve A represents NE in the presence of phenoxybenzamine Curve C represents NE in the presence of Cocaine Curve D represents NE in the presence of Phenoxybenzamine Curve D represents NE in the presence of prazosin

5) The ED50 values for cardiac stimulation and vascular smooth muscle relaxation of a new adrenergic agonist and epinephrine is shown below. From the data in the table below identify the drug, which has the same characteristics as the new agonist?

A) B) C) D) E)

Isoproterenol Terbutaline Propranolol Amphetamine Xylometazoline

6) The following graph shows the phenomena of tachyphylaxis exhibited by frequent administration of ephedrine. Which among the following statements best explains the mechanism behind the reduction in the hypertensive response to repeated injections of ephedrine?

A) B) C) D) E)

Increased metabolism of ephedrine Increased availability of neurotransmitter in the synaptic cleft Downregulation of sympathetic receptors Upregulation of sympathetic receptors Depletion of neurotransmitter from the presynaptic nerve terminal

7) The following graph depicts the dose-response relationship of four different agonists namely W, X, Y and Z. All four drugs act on the same receptor to produce this response. With respect to the following graph, identify the TRUE statement among the following:

A) B) C) D) E)

Drug W has the highest ED50 Drug W has the highest Emax Drug Z has the lowest Emax Drug Y is a partial agonist Drugs W, X and Y have the same ED50

8) Drug X is given to a 25-year-old normal subject. This drug when given alone causes resting heart rate to increase from 62/min to 74/min. In the absence of the drug, the subjects heart rate increased to 150/min with vigorous exercise. After administration of drug X, the same intensity of vigorous exercise caused his heart rate to increase only to 98/min. Which among the following drugs was given to this individual? A) B) C) D) E) Pindolol Metoprolol Phenoxybenzamine Atenolol Prazosin

9) The following graph shows the effect of the drug administration on the end organs. The arrow mark corresponds to the time of drug administration. From the choices below identify the drug

A) B) C) D) E)

Phenylephrine : Isoproterenol Dopamine : Ephedrine : Norepinephrine :

10) A 30-year-old woman with depression and mild hypertension is on a Monoamine oxidase inhibitor (MAO-inhibitor). On the day of the event, in an office party, she had four big slices of pizza with extra cheese. Soon after the event she complained of severe palpitations and headache. She was rushed to the nearby hospital where her blood pressure was recorded as 180/100 mm Hg. What is the mechanism behind the increase in blood pressure in this patient? A) Activation of receptors by tyramine in cheese B) Activation of receptors by tyramine in cheese C) Displacement of norepinephrine from presynaptic nerve terminal D) Displacement of epinephrine from presynaptic nerve terminal E) Displacement of dopamine from presynaptic nerve terminal

11) A 45-year-old man is on propranolol for his hypertension. The following graph shows the effect of various antihypertensive drugs on serum lipid levels (Triglycerides, LDL and HDL respectively). Which among the following graphs would show the consequence of propranolol therapy in this patient? A) B) C) D) Graph A Graph B Graph C Graph D

12) The graph below shows the log dose responses with norepinephrine in the absence and presence of different drugs. If drug X is norepinephrine, then drug Y is A) Atropine B) Cocaine C) Neostigmine X+Y D) Prazosin E) None of the above
X+Z

13) A 56-year-old woman is rushed to the ER by her relatives, who claim that the woman had ingested 10 tablets of her antihypertensive medication. The woman seems to be fully conscious, but drowsy and exhausted. Her blood pressure is 60/40 mm Hg and her heart rate is 35 beats per minute. Which among the following drug was most likely taken by this patient? A) Prazosin

B) C) D) E)

Propranolol Losartan Enalapril Isoproterenol

14) The figure depicts the dose-response curve when norepinephrine is given alone and when it is given in the presence of a fixed dose of drug Y. Drug Y elicits no response when it is given alone. The experimental system is an organ bath that contains a piece of vascular smooth muscle. Drug Y in the figure is:

A) B) C) D) E)

Phenoxybenzamine binding irreversibly to receptors Prazosin binding irreversibly to receptors Isoproterenol binding reversibly to receptors Tamsulosin binding reversibly to receptors Phenoxybenzamine binding reversibly to receptors

15) You are considering isoproterenol for a patient with bronchial asthma to induce bronchodilation. Which among the following adverse effect will limit the use of isoproterenol in this otherwise healthy and non-pregnant patient? A) B) C) D) E) Severe hypertension Tachycardia Cycloplegia Excessive salivation Uterine relaxation

16) A 56-year-old man has been diagnosed with severe hypertension and is considered for treatment with prazosin. Which among the following major physiological factor is affected by prazosin? A) B) C) D) E) Central venous tone Peripheral vascular resistance Cardiac contractility Venous return Blood volume

17) A test drug enters the preclinical phase of drug trial and the safety of the drug is determined in lab animals. The ED50 of the drug is identified as 10 g and the LD50 is identified as 1.0 Mg. What would be the therapeutic index of the drug? A) B) C) D) E) 10 1 100 1000 0.001

18) A 49-year-old man was diagnosed with severe hypertension and is considered for treatment with clonidine. Which among the following mechanism of action of clonidine would be responsible for its hypotensive effect? A) B) C) D) E) Stimulation of 1 receptors and increasing the IP3-DAG Blockade of 1 receptors and decreasing the IP3-DAG Stimulation of 2 receptors and decreasing cAMP Blockade of 2 receptors and increasing cAMP Blockade of receptors and decreasing cAMP

25) A 35 year old known asthmatic patient after cholecystectomy couldnt pass flatus and stool for next 48 hours. To treat this paralytic ileus, pilocarpine was given. After some time patient developed severe bronchospasm and becomes breathless. Underlying mechanism for bronchospasm seen in this patient is A) B) C) D) E) Binding of Pilocarpine to M2 receptors Pilocarpine blocking beta-2 receptors Increase in adenylyl cyclase Increase in IP-3 and DAG Pilocarpine binding to a receptor coupled to Gs protein

26) A 20 year old woman has myasthenia gravis. She doesnt have any acute effects. She has visited your clinic for followups. Which of the following drugs is most appropriate for maintenance therapy? A) B) C) D) E) Bethanechol Edrophonium Pilocarpine Pralidoxime Pyridostigmine

27) If curve C represents the increase of motility of isolated stomach after acetylcholine was administered alone, which curve represents the effect of acetylcholine in a preparation pretreated with physostigmine?

A) B) C) D) E)

Curve A Curve C Curve D Curve E None of the above

28) A 48 year old farmer is brought to ER because of diarrhea , wheezing, agitation and dyspnea. On examination lacrimation, sweating, excess salivation, miosis and fasciculation of voluntary muscles was evident. Atropine and pralidoxime are administered to this patient. Which of the following statement is true about his therapy? A) B) C) D) E) Atropine is given to reverse the CNS effects Pralidoxime acts by inhibiting the enzyme Blockade of Muscarinic receptors most likely to benefit the patient Blocking of Nicotinic receptors benefits the patient Atropine acts by reactivating the enzyme

29) In tissue bath-1, a ring of normal arterial tissue is suspended. In tissue bath-2 another ring of arterial tissue after the endothelium is removed is suspended. Acetylcholine was added to both tissue baths. Arterial tension was reduced significantly with administration of acetylcholine in tissue bath -1 but not in tissue bath-2. The differential response to acetylcholine in the bath-1 and bath-2 is the action of which of the following substances? A) B) C) D) Bradykinin Endothelin Nitric oxide Nitorus oxide

E) Endothelin derived Contarcting factor 30) A migrant worker presents to the emergency room with respiratory distress. He had been spraying an organophosphorous insecticide in the fields for several days, and today he began to sweat a lot and felt dizzy. By the time he got to the hospital he was drooling, gasping, and became agitated. These symptoms are due to the inhibition of which of the following enzymes? A) B) C) D) E) Pseudocholinesterase Adenylyl cyclase Phospholipase Acetylcholinesterase CYP-450

31) A 70 year old man treated for glaucoma with pilocarpine. His vital signs before and after treatment are as follows: Before treatment: BP was 145/92 mmHg and heart rate was 99/minute After treatment: BP is 140/ 85 mmHg and heart rate is 49/minute Which among the following actions of pilocarpine is responsible for reduction of heart rate in this patient? A) B) C) D) E) Decrease in cyclic AMP Decrease in cyclic GMP Decreases in IP3 and DAG Increase in IP3 and DAG Increase in cGMP

32) A 48 year old farmer is brought to ER because of diarrhea , wheezing, and dyspnea. On examination lacrimation, sweating, excess salivation , miosis and fasciculations of voluntary muscles was evident. Treatment should include which of the following to reactivate the enzyme affected? A) B) C) D) E) Atropine Epinephrine Propronolol Pralidoxime Neostigmine

33) After undergoing a minor surgical procedure, A 71 year old man has difficulty in voiding urine.Which of the following is the most appropriate short term pharmacotherapy? A) B) C) D) Atropine Bethenochol Carbachol Neostigmine

E) Physostigmine

34) A 25 year old lady visits a cosmetologist for her facial wrinkles. Cosmetologist used botulinum toxin injection to reduce her facial frown lines. Which of the following mechanism best describes the action of botulinum injection? A) B) C) D) E) Prevents acetylcholine release Blocks T-type calcium channels Inhibits calcium release from sarcoplasmic reticulum of muscle Inhibits uptake of acetylcholine into motor neurons Inhibits reuptake of nor epinephrine into adrenergic neurons

35) With respect to their action on strip of bronchial smooth muscle in an isolated tissue bath, log dose response curves for Drug A and B are plotted in following graph. Drug B when given alone does not have any effect on its own. Which is true about Drug A and Drug B

Drug A +B

A) B) C) D) E)

Drug A is atropine and B is acetylcholine Drug A nor epinephrine and drug B is phenylephrine Drug A is epinephrine and B is Phenoxybenzamine Drug A is bethanochol and B is atropine Drug A is acetylcholine and B is Physostigmine

10

36) 10 year old boy diagnosed to have strabismus, for surgical correction, was anesthetized with halothane. Succinyl choline was administered to facilitate endotracheal intubation. Twenty minutes later masseter muscle tone remains increased so that his teeth compress the endotracheal tube. Even in other skeletal muscles muscle tone was found to be increased .His body temperature is 39 C (102.2 F), pulse is 125/minute and respiration rate is 20. Administration of a drug acting by which of the following mechanism is most appropriate next step to decrease muscle tone? A) B) C) D) E) Stimulation of GABA type B receptors Facilitating GABA mediated chloride channel opening Inhibiting membrane sodium channels Facilitating Calcium excretion in urine Inhibiting calcium release from sarcoplasmic reticulum

48) A 45-year-old man has an elevated blood pressure during a routine health check-up. All three consecutive readings are high (average: 150/100 mm Hg). History reveals that the patient is a chronic smoker and has some breathing difficulty. Which among the following drugs is best avoided in the management of hypertension in this particular patient? A) B) C) D) E) Propranolol Atenolol Metoprolol Betaxolol Acebutelol

49) Propranolol was given to a patient with mild hypertension. Which among the following adverse effects can be typically attributed to propranolol in this otherwise healthy patient? A) B) C) D) E) Palpitations Fine tremor Seizures Bradycardia Increased sexual drive

1. A 30 year old epileptic patient was treated with an antiepileptic drug orally. Even after 3 weeks there was no improvement. Serum drug concentration was found to be less than half the expected concentration. The same drug is then administered intravenously . In next few days drug achieved the expected plasma concentration and improvement in his disease (Reduced frequency of seizures). A difference in which of the following pharmacokinetic parameters is the most likely explanation for the differences in drug concentration in this patient with two different routes? A. Protein binding B. Clearance

11

C. Volume of distribution D. First pass effect E. Elimination half life 2. A 36-year-old man presents with signs of difficulty in breathing and cough. Preliminary diagnosis of bronchial asthma was made. Which among the following routes would be considered preferable to chronically administer drugs to this patient? A. B. C. D. E. Intravenous Intramuscular Oral Inhalation Sublingual

3. A 50 -year-old woman who is a chronic alcoholic complains of dyspepsia, itching and yellowish discoloration of skin. Liver function tests were found abnormal. She was prescribed a drug to control itching skin. She has a 50% increase in drug clearance because of a change in hepatic function. How are these changes expected to affect steady-state plasma concentration of the drug in her? A. B. C. D. E. Increase to 4 times its previous value Increase to 2 times its previous value Remain the same Decrease to one fourth of its previous value Decrease to one half of its previous value

4. An individual rapidly ingests 400 grams of ethanol. Two hour after ingestion, the blood ethanol concentration is 200 mg/L. Four hours after ingestion, the blood concentration is 150 mg/L. What is the blood concentration 6 hours after ingestion? A. B. C. D. E. 25 mg/L 37.5 mg/L 100 mg/ L 50 mg / L 75 mg / L

5. To prevent septicemia in a patient brought to ER, immediate antibiotic action was essential. You decide to administer an antibiotic (acidic in nature ) with a half life of 3 hours. In order to attain a desired therapeutic plasma concentration in short time, which of the following measures should be taken? A. B. C. D. Increase the rate of infusion Combine the drug with probenecid Administer the appropriate alkalinizing agent Administer the appropriate loading dose intravenously before you start infusion

12

E. Administer intravenous bolus injection every 3 hours 6. A 26-year-old woman is worried about her symptoms of motion sickness during her sea cruise. She is advised a skin patch of a drug, which would relieve her symptoms of sea sickness. Which among the following statements is TRUE about the skin patches? A. B. C. D. E. Has more bioavailabiolity than any other route Produces an immediate effect Produces effects only for a very short time Ensures uniform and almost constant blood levels of drug Has increased risk of adverse drug reactions

7. A 55-year-old man having congestive heart failure is on oral digoxin therapy. He is being considered for therapy with verapamil for his cardiac arrhythmias. Realizing the fact that verapamil can increase the risk of digoxin toxicity, verapamil is avoided. Which among the following explains the drug interaction between digoxin and verapamil? A. B. C. D. E. Verapamil inhibits the function of P-glycoproteins Verapamil induces the drug metabolizing enzymes Verapamil inhibits the drug metabolizing enzymes Verapamil increases the renal elimination of digoxin None of the above

8. Isoniazid, an antituberculosis drug is given in different doses in two individuals who weigh the same and are of same age. Both belong to different ethnic backgrounds. Which among the following statements best explains the reason for giving an excess dose in one among those patients? A. B. C. D. E. Enhanced metabolism of isoniazid Decreased metabolism of isoniazid Increased volume of distribution of isoniazid Decreased volume of distribution of isoniazid Delayed excretion of isoniazid

9. A 56-year-old man on cimetidine therapy for peptic ulcer is considered an oral anticoagulant for prevention of deep vein thrombosis. The specific agent considered is warfarin. Which among the following consequences would you expect if warfarin is prescribed to this patient? A. B. C. D. E. Action of warfarin will be decreased Increased risk of bleeding Enhanced excretion of cimetidine Decreased protein binding of warfarin Warfarin will be effective and safe as in any other individual

13

10. In phase-1 clinical trails setup, a new antibiotic being tested in an adult person has following pharmacokinetic parameters: Clearance= 100 L/hour Vd= 50L t1/2= 3 hours . If the drug has to be administered intravenously what dose should be given to quickly obtain a plasma concentration of 10mg/L? A. 5mg B. 25mg C. 100mg D. 500mg E. 1000mg 11. A 22-year-old lady, who is sexually active and is on oral contraceptives, is diagnosed with tuberculosis (TB). She is started on standard four drug regimen, which includes rifampin. Which among the following medical advices will you offer to this young lady? A. B. C. D. E. Stop rifampin therapy Increase the dose of rifampin Decrease the dose of rifampin Adopt an additional method of contraception Decrease the dose of oral contraceptives

12. A new drug is being tested against peptic ulcer. To begin with, the drug is being tested in 20 normal volunteers. Which of the following parameters of new drug is tested in this group of volunteers? A. B. C. D. E. Effectiveness Safety Cost effectiveness A very rare side effect Both effectiveness and safety

13. After animal studies a new molecule of test drug need to undergo various phases of clinical trials. Which of the following statement is most appropriate regarding new drug development? A. Phase -1 conducted in small number of patients to study the efficacy of the drug B. Phase-1 is conducted in large number of patients to study the efficacy of the drug C. Phase -3 is conducted in small number of patients to study the efficacy of the drug D. Phase -2 is conducted to study both the efficacy and safety of the drug E. Phase -4 is monitored by only licensed physicians to report the adverse effects observed after marketing the drug

14

14. Select the transmembrane transport mechanism it best defines the process of lipidsoluble drugs crossing the membrane at a rate proportional to the concentration gradient across the membrane A. B. C. D. E. Filtration Simple diffusion Facilitated diffusion Active transport Endocytosis

15. From the list of acidic compounds mentioned below,which one is best absorbed in the stomach? A. B. C. D. E. Ampicillin (pKa = 2.5) Aspirin (pKa = 3.0) Warfarin (pKa = 5.0) Phenobarbital (pKa = 7.4) Phenytoin (pKa = 9.4)

16. A patient with a history of episodic attacks of coughing, wheezing, and shortness of breath is being evaluated in the asthma clinic. Several drug treatments with different routes of administration are under consideration. Which of the following statements about routes of administration is most correct? A. Blood levels often rise more slowly after intramuscular injection than after oral dosing B. The "first-pass" effect is the result of metabolism of a drug after administration and before it enters the systemic circulation C. Administration of antiasthmatic drugs by inhaled aerosol is usually associated with more adverse effects than is administration of these drugs by mouth D. Bioavailability of most drugs is greater with rectal (suppository) administration than with sublingual administration E. Administration of a drug by transdermal patch is often faster but is associated with more first-pass metabolism than oral administration 17. A patient with abdominal stab injuries was admitted to hospital. An antibiotic with an elimination half life of 4 hours was continuously infused. What percentage of the steady state plasma drug concentration will be achieved in 16 hours?

15

A. B. C. D. E.

50% 75% 87% 93% 97%

18. A patient having severe sore throat infection has been given 400 mg of Doxycycline (an antibiotic). Plasma concentration of the Doxycycline measured at different time intervals is as shown in the table below. Wieght of the pateint is 70kg. Time Plasma concentration of Doxycycline in (mg/L of plasma) hours 0 72 2 55 4 46 5 36 8 25 10 18 To achieve 97% of Css , this drug requires how many hours ? A. B. C. D. E. 10 hours 20 hours 25 hours 16hour 40 hour

19. Absorption of the drug is most affected by which of the following factors? A. B. C. D. E. Plasma protein binding ability and Pka of the drug pKa of the drug and pH of medium Volume of distribution and pH of medium Half life and Clearance pH of the drug and pKa of the medium

combination of

20. Drug transport across the biological membrane depends upon whether a drug is acidic or basic , pKa and pH of the environment in which it is. Henderson hasselbach equation explains the relation of all these factors. Which of the following statement is most appropriate with respect to this equation? A. Acidic drugs are more ionized if pH-pKa is low B. Basic drugs are more ionized if pH-pKa is high

16

C. Acidic drugs are more unionized if pH-pKa is high D. Acidic drugs are more unionized if pH-pKa is low E. Basic drugs are more unionized if pH-pKa is low 21. The pKa of salicylic acid is 3.0. What percentage of the drug is likely to be excreted in the urine at pH of 5? A. B. C. D. E. 0.1% 50% 1% 90% 99%

22. A five year old boy has consumed accidentally 30 tablets of phenytoin (an acidic drug ). In this case which of the following statement is true? A. B. C. D. E. Acidification of urine facilitates renal excretion of the drug Drug is more absorbed in intestine than in stomach Drug absorption can be reduced by increasing the stoamch pH Drug absorption can be reduced by reducing the stoamch pH Drug absorption can be reduced by reducing the intestine pH

23. Most of the drugs after absorption distribute to various body compartments including plasma, bone, fat tissue and muscle. If the drug is following first order kinetics, which one of the following statement is true about protein binding and volume of distribution (Vd) A. A drug must have been restricted to vascular compartment if volume of distribution of this drug is more than 0.12 L/kg body weight B. In comparison to a 90 % plasma protein bound drug , A 5% plasma protein bound drug is likely to have more Vd C. A drug with highest Vd is generally seen in plasma than in tissues D. A drug known to have restricted its distribution to interstitial body fluids will have an approximate Vd of 42 L in an adult weighing 70kg. E. Protein binding and Vd of a drug vary with the dose of drug adminstered

24. A 3-year-old child is brought to the emergency department having just ingested a large overdose of Amphetamine, a weak base. It is capable of entering most tissues, including the brain. On physical examination, the heart rate is 100/min, blood pressure 140/100 mm Hg, and respiratory rate 20/minute.In this case of amphetamine overdose A. Urinary excretion would be accelerated by administration of NH4Cl B. Urinary excretion would be accelerated by giving NaHCO3 C. More of the drug would be ionized at blood pH than at stomach pH

17

D. Absorption of the drug would be faster from the stomach than from the intestine E. More of the drug is going to be tissue protein bound

small

25. After proven safety in human volunteers, several hospitals are participating in a study to test the efficacy of a newly developed drug prior to its release. This drug is designed to lower cholesterol levels. Of the one thousand patients that are involved in this study, half of the participants receive the drug and half receive a placebo. Neither the physicians in charge of the study nor the patients are permitted to know what the patients have received. Which of the following steps in the drug development process does this scenario most closely describe A. B. C. D. E. New Drug Application (NDA) Phase I Phase II Phase III Phase IV

26. Alkalanization of urine is justified in case of overdose of A. B. C. D. E. Sodium bicarbonate Morphine Amphetamine Barbiturate Atropine

27. Traditionally (until recently) to treat infections physcians were prescribing the combination of penicillin and probenacid .With this kind of combination of drugs which of the following parameters of penicillin is going to be affected A. B. C. D. E. Volume of distribution Glomerular filtration Bioavailability Biotransformation Duration of action

28. A patient who is taking probenacid is expected to have an increased excretion of which of the following? A. B. C. D. E. Warfarin Creatinine Penicillin Tetracycline Uric acid

18

29. A continuous IV infusion of a lidocaine is given to a 70 kg patient with cardiac arrythmias. The pharmacokinetic parameters of lidocaine are as follows: Clearance (Cl) : 0.9 L/hour Vd : 70L T1/2 : 2 hours How long will it take for drug levels to reach 93% of steady state ? A. 5 hours B. 6 hours C. 9 hours D. 8 hours E. 7 hours

30. Mr. X and Mr. Y who had similar body weight underwent toniselectomy and post operatively received ciprofloxacin (an antibiotic) . This antibiotic is known to undergo 50% clearance through liver and 50% clearance through kidney. Liver and renal function tests were done in both patients. Test results revealed that: Mr. X has 100 % functioning liver and kidney. Mr. Y is having 100% functioning liver and only 50% functioning kidney. For every 12 hour, 600 mg of ciprofloxacin was given to Mr. X. If the drug is metabolized by same pathways in both patients, which among the following maintenance regimens in Mr.Y would produce the same average concentration as observed with the Mr. X. A. 500 mg every 8 hours B. 500 mg every 12 hours C. 250 mg every 12 hours D. 450 mg every 12 hours E. 125 mg every 6 hours

1) A 54-year-old man is rushed to the emergency department with a blood pressure of 220/180 mm Hg and severe palpitation. Careful history from his relatives reveals that he skipped his antihypertensive pills for the past two days. He was on Propranolol (beta receptor antagonist/blocker) for the past six months. What could be the underlying cause of the latest complication in this patient? A) B) C) D) E) Upregulation of beta receptors Downregulation of beta receptors Impaired metabolism of epinephrine Enhanced renal clearance of propranolol Downregulation of -receptors

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2) A new drug is being tested on animals and the pharmacodynamics and pharmacokinetics are being evaluated. Following a series of lab studies in rats, quantal dose-response curves are constructed. This is: A) B) C) D) E) Invalid in the presence of inhibitors of the drug being studied Obtainable only from humans Used to determine the statistical variation (standard deviation) of the efficacy of the drug Done to determine the therapeutic index of a drug Done to determine the maximal efficacy of a drug

3) A 34-year-old man with congestive heart failure is being considered for a diuretic therapy. Drugs X and Y are considered. Drug X maximally increases the urine output by 80% at a dose of 50 mg/Kg. Drug Y maximally increases the urine output by 80% at a dose of 70 mg/Kg. Which of the following conclusions can be made with this available data? A) B) C) D) E) Drug X has a smaller volume of distribution than drug Y Drug X is more potent than drug Y Drug X is less efficacious than drug Y Drug X is less potent than drug Y Drug X has a lesser LD50 than drug Y

4) An agonist is known to bind to a G-protein coupled receptor coupled to a Gs protein. Which among the following physiological effects would you expect as a consequence of this drugreceptor interaction? A) Contraction of smooth muscle B) Reduction in the cardiac contractility C) Increase in the activity of phospholipase C D) Relaxation of the smooth muscle E) Decrease in the activity of adenylyl cyclase 5) The following graph depicts the dose-response relationship of four different agonists namely W, X, Y and Z. All four drugs act on the same receptor to produce this response. With respect to the following graph, identify the TRUE statement among the following:

20

A) B) C) D) E)

Drugs W, X, and Y are equally potent Drugs W is the most efficacious Drugs W is most potent Drug Z is a partial agonist and is most potent Drug Y is the most efficacious

6) A drug with a therapeutic index of 10 would have an: A) B) C) D) E) an LD50 of 300 mg/kg and an ED50 of 1 mg/kg an ED50 of 600 mg/kg and an LD50 of 20 mg/kg an LD50 of 90 mg/kg and a ED50 of 30 mg/kg an LD50 of 300 mg/kg and an ED50 of 30 mg/kg an LD50 of 300 mg/kg and a ED50 of 100 mg/kg

7) A 38-year-old woman on oral croticosteroids for over two months develops complains of polyuria and polydipsia (increased urine output and increased thirst). Her lab results revealed elevated blood glucose levels. Administration of subcutaneous insulin promptly reduced the glucose levels. What is the kind of antagonism involved in insulin reversing the hyperglycemic action of steroids? A) B) C) D) E) Physiological antagonism Competitive antagonism Non-competitive antagonism Chemical antagonism Physical antagonism

8) The graded dose response for norepinephrine (agonist) alone is shown in the graph B. The curve that best describes the response of norepinephrine in the presence of a competitive antagonist is:

A) B) C) D)

Curve A Curve C Curve D Curve E

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9) A competitive antagonist: A) B) C) D) E) Shifts the dose-response curve down and to the right Partially stimulates the receptor in the absence of an agonist Shifts the dose-response curve to the left and up Acts at the same site as the agonist Shifts the dose-response curve only at low concentrations of the compound

10) The graph with the continuous line shows the log dose response to epinephrine on beta receptors and the graph with the dotted line shows the log dose response to epinephrine with increasing concentrations of another drug. Which among the following best explains the characteristic of the second drug given?

% R e s p o n s e

100%

50%

Log dose
A) B) C) D) E) Has an intrinsic value of 0 Irreversibly binds to the adrenergic receptors Has a submaximal intrinsic activity It is safer than the agonist Has a longer duration of action than the agonist

11) Efficacy of a new analgesic drug is being tested and the results are plotted as a graph. Analyze the following graph and identify the approximate ED50 of the drug tested:

22

A) B) C) D) E)

15 mg 35 mg 20 mg 30 mg 5 mg

12) Minimal increment of drug dosage may or may not be associated with an increased magnitude of clinical response. This purely depends upon the nature of the drug. Which among the points in the graph below provides you the information in this regard? A) B) C) D) E) Point A Point B Point C Point D None of the above

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