2. Agents that often cause vasoconstriction include all of the following except (a) Angiotensin II (b) Methysergide (c) PGF2a (d) Prostacyclin (e) Thromboxane
3. Inflammation is a complex tissue reaction that includes the release of cytokines, leukotrienes, prostaglandins, and peptides. Prostaglandins involved in inflammatory processes are produced from arachidonic acid by (a) Cyclooxygenase 1 (b) Cyclooxygenase 2 (c) Glutathione – S – transferase (d) Lipoxygenase (e) Phospholipase A2
4. A 60yearold woman has glaucoma following cataract surgery. Which of the following can be used to reduce intraocular pressure? (a) Leukotriene LTD4 or its analogs (b) Prostaglandin E2 or its analogs (c) Prostaglandin F2a or its analogs (d) Slowreacting substance of anaplylaxis (SRSA) (e) Thromboxane A2 or its analogs
5. Which of the following is a reversible inhibitor of platelet cyclooxygenase? (a) Alprostadil (b) Aspirin (c) Ibuprofen (d) LTC4 (e) Misoprostol
6. Vasodilation by prostaglandins involves (a) Arterioles (b) Precapillary sphincters (c) Postcapillary venules (d) All of the above
7. Fentanyl transdermal patches have been used postoperatively to provide transdermal analgesia. The most dangerous adverse effect of this mode of administration is (a) Cutaneous reactions (b) Diarrhea (c) Hypertension (d) Relaxation of skeletal muscle (e) Respiratory depression
8. Opioid analgesics are either contraindicated or must be used with extreme caution in several clinical situations. For morphine, such situations do not include (a) Aqueous diffusion (b) Aqueous hydrolysis (c) Lipid diffusion (d) Pinocytosis or endocytosis (e) Special carrier transport
9. Following is an example of paraaminophenol NSAID (a) Diclofenac (b) Acetaminophen (c) Piroxicam (d) Celecoxib
10. This drug, which does not activate opioid receptors, has been proposed as a maintenance drug in treatment programs for opioid addicts; a singly oral dose will block the effects of injected heroin for up to 48 hours (a) Amphetamine (b) Buprenorphine (c) Naloxone (d) Naltrexone (e) Propoxyphene
11. Which one of the following statements about dextromethorphan is accurate? (a) Activates kappa receptors (b) Analgesia equivalent to pentazocine (c) Highly effective antiemetic (d) Less constipation than codeine (e) Use requires a prescription
12. Which one of the following effects does not occur in salicylate intoxication ? (a) Hyperventilation (b) Hypothemia (c) Metabolic acidosis (d) Respiratory alkalosis (e) Tinnitus
13. Which one of the following drugs is not useful in dysmenorrhea? (a) Aspirin (b) Colchicine (c) Ibuprofen (d) Rofecoxib (e) Naproxen
14. Following gold compound is generally administered orally (a) Aurothioglucose (b) Auronafin (c) Gold sodium thiomalate (d) All of the above
15. The main advantage of ketorolac over aspirin is that ketorolac (a) Can be combined more safely with an opioid such as codeine (b) Can be obtained as an overthecounter agent (c) Does not prolong the bleeding time (d) Is available in a parenteral formulation that can be injected intramuscularly or intravenously (e) Is less likely to cause acute renal failure in patients with some preexisting degree of renal impairment
16. A 45yearold surgeon has developed symmetric early morning stiffness in her hands. She wishes to take a nonsteroidal antiinflammatory drug to relieve these symptoms and wants to avoid gastrointestinal side effects. Which one of the following drugs is most appropriate? (a) Aspirin (b) Celecoxib (c) Ibuprofen (d) Indomethacin (e) Piroxicam
17. Following is an example of preformed and not lipid derived mast cell mediator of inflammatory process (a) LTC4 (b) PGD2 (c) PAF (d) Histamine
18. The toxicity spectrum of aspirin does not include (a) Increased risk of encephalopathy in children with viral infections (b) Increased risk of peptic ulcers (c) Hyperprothrombinemia (d) Metabolic acidosis (e) Respiratory alkalosis
19. Accidental poisonings are common with both aspirin and ibuprofen, two OC drugs available in tasty chewable tablets. In cases of overdose, aspirin is more likely than ibuprofen to cause (a) Autonomic Instability (b) Hepatic necrosis (c) Metabolic acidosis (d) Thrombocytopenia (e) Ventricular arrhythmias
20. A drug that decreases blood pressure and has analgesic and spasmolytic effects when given intrathecally is (a) Atenolol (b) Clonidine (c) Morphine (d) Nitroprusside (e) Prazosin
21. Cyclooxygenase1 and –2 are responsible for (a) The synthesis of prostaglandins from arachidonate (b) The synthesis of leukotrienes from arachidonate (c) The conversion of ATP to cAMP (d) The metabolic degradation of cAMP (e) The conversion of GTP to cGMP
22. Following agent is generally used in allergic rhinitis (a) Beclomethasone (b) Fluticasone (c) Triamcinolone (d) All of the above
23. The primary objective for designing drugs that selectively inhibit COX – 2 is to (a) Decrease the risk of nephrotoxicity (b) Improve antiinflammatory effectiveness (c) Lower the risk of gastrointestinal toxicity (d) Reduce the cost of treatment of rheumatoid arthritis (e) Selectively decrease thromboxane A2 without effects on other eicosanoids
24. A newborn was diagnosed as having a congenital abnormality that resulted in transposition of her great arteries. While preparing the infant for surgery, the medical team needed to keep the ductus arteriosus open. They did this by infusing (a) Cortisol (b) Indomethacin (c) Ketorolac (d) Misoprostol (e) Tacrolimus
25. Acetyl salicylic acid is soluble in (a) An aqueous base (b) Water (c) An aqueous acid
26. Decomposition of the acetyl salicylic acid at room temperature most likely would occur by (a) Oxidation of the ester (b) Reduction of the carboxylic acid (c) Hydrolysis of the ester
27. Diamprit is an agonist of ______ receptors, except (a) H1 (b) H2 (c) H3 (d) All of the above
28. Which of the following enzymes is ultimately responsible for the production of prostaglandins associated with inflammatory reactions? (a) Phospholipase
(b) Lipoxygenase (c) CyclooxygenaseI (d) Cyclooxygenase II (e) Xanthine oxidase
29. Which of the following prostaglandin analogs is used specifically for the treatment of NSAID induced gastrointestinal ulcertation? (a) Alprostadil (b) Misoprostol (c) Carboprost (d) Dinoprostone (e) Epoprostenol
30. Which of the following compounds is most likely to lower circulating levels of leukotrienes? (a) Zileuton (b) Montelukast (c) Carprofen (d) Aspirin (e) Allopurinol
31. The action of aspirin that results in its greater efficacy as an antithrombotic (antiplatelet) drug is its ability to (a) Inhibit lipoxygenase as well as cyclooxygenase (b) Selectively inhibit cyclooxygenase I (c) Inhibit leukocyte migration (d) Promote uric acid excretion (e) Acetylate cyclooxygenase
32. Which of the following drugs may be effective in the treatment of gouty arthritis by acting by two separate and distinct mechanisms? (a) Allopurinol (b) Probenecid (c) Colchicine (d) Indomethacin (e) Sulfinpyrazone
33. Acute or chronic colchicine toxicity may be identified by which of the following signs/symptoms? (a) Alopecia (b) Blood dyscrasias (c) Severe gastrointestinal upset (d) All of the above (e) None of the above
34. Patients taking chronic doses of non-selective non-steroidal anti-inflammatory drugs (NSAIDs) should periodically be screened for which of the following toxicities? (a) Nephrotoxicity (b) Peripheral neuropathy (c) Cardiotoxicity (d) All of the above (e) None of the above
35. Which of the following medications would represent arthritis therapy that is least likely to cause gastric ulceration? (a) Aspirin (b) Acetaminophen (c) Piroxicam (d) Meclofenamate (e) Rofecoxib
36. In addition to their ability to decrease inflammatory prostaglandin synthesis, some nonsteroidal anti-inflammatory drugs (NSAIDs) may owe part of their effects to their ability to (a) Inhibit leukocyte migration (b) Inhibit leukotriene synthesis (c) Stabilize lysosmal membranes (d) All of the above (e) None of the above
37. The termination of heparin activity by protamine sulfate is due to (a) A chelating action (b) The inhibition of gastrointestinal absorption of heparin (c) The displacement of heparinplasma protein binding (d) An acidbase interaction (e) The prothrombinlike activity of protamine
38. In gastrointestinal tract, serotonin causes (a) Contraction of gastrointestinal muscles (b) Decreased muscle tone (c) Decreased peristalsis (d) All of the above
39. A FDA – approved ingredient for protection against painful sensitivity of the teeth due to cold, heat, acids, sweets or contact is (a) Dicalcium phosphate (b) Sodium lauryl sulfate (c) 5% potassium nitrate (d) Zinc chloride (e) Calcium carbonate
40. Which local anesthetic should be used to treat symptoms of pain, itching, burning, and disconfort in patients with an established lidocaine allergy? (a) Tetracaine (b) Dibucaine (c) Pramoxine (d) Benzocaine
41. What is the most commom sign/symptom of hemorrhoids? (a) Bleeding (b) Pain (c) Seepage (d) Pruritus
42. Which of the following agents is designated as a safe and effective analgesic, anesthetic and antipruritic by the Food and Drug Administration? (a) Witch hazel (b) Juniper tar (c) Hydrocortisone (d) Phenylephrine
43. A 65yearold is interested in taking ginkgo. Which of the following statements is correct regarding ginkgo? (a) Ginkgo is contraindicated in diabetes and pregnancy (b) There is a drugherb interaction between ginkgo and aspirin (c) Toxic effects include hypertension and cardiac arrest (d) There is a drugherb interaction between ginkgo and phenelzine (e) Ginkgo is contraindicated in patients with gallstone pain
44. All of the following medications should not be used routinely in pregnant patients during the third trimester except (a) Acetaminophen (b) Nonsteroidal antiinflammatory drugs (c) Warfarin (d) Lithium (e) Aspirin
45. Which of the following statements best describes the usual course of rheumatoid arthritis? (a) It is an acute exacerbation of joint pain treated with shortterm antiinflammatory therapy (b) It is a chronic disease characterized by acute changes within nonsynovial joints (c) It is an acute disease that is characterized by rapid synovial changes due to inflammation (d) It is a chronic disease characterized by acuteexacerbations followed by remissions with consequences associated with chronic inflammatory changes (e) It is a joint disease characterized by a marked loss of calcium from the bones and a resultant thinning of the bones
48. In the treatment of chronic inflammatory diseases, the most important limitation of aspirin is (a) Acid – base and electrolytc disturbances (b) Hypersensitivity and idiosyncratic reactions (c) Gastric mucosal damage (d) Salicylism
47. Generally the earliest manifestation of salicylism is (a) Visual disturbance (b) Excitement (c) Hyperventillation (d) Tinnitus
48. All of the following statements concerning an acute gouty arthritis attack are correct except (a) The diagonosis of gout is assured by a good therapeutic response to colchicines because no other form of arthritis responds to this drug (b) To be assured of the diagnosis, monosodium urate crystals must be identified in the synovial fluid of the affected joint (c) Attacks frequently occur in the middle of the night (d) An untreated attack may last up to 2 weeks (e) The first attack usually involves only one joint, most frequently the big toe (first metatarsophalangeal joint)
50. Potential adverse effects associated with aspirin include all of the following except (a) Gastrointestinal ulceration (b) Renal dysfunction (c) Enhanced methotrexate toxicity (d) Cardiac arrhythmias (e) Hypersensitivity asthma
51. All of the following facts are true about nonsteroidal antiinflammatory drugs (NSAIDs) except (a) They are antipyretic (b) There is a celling effect to their analgesia (c) They can cause tolerance (d) They do not cause dependence (e) They are antiinflammatory
52. Which of the following narcotics has the longest duration of effect? (a) Methadone (b) Controlledrelease morphine (c) Levorphanol (d) Transdermal fentanyl (e) Dihydromorphone
53. CylcoocygenaseII specific inhibitors block the following (a) Production of cytoprotective prostaglandins (b) Tumor necrosis factor a (c) Production of prostaglandins responsible for pain and inflammation
54. The emetic action of morphine is due to (a) Irritation of gastrointestinal tract (b) Stimulation of cerebral cortex (c) Stimulation of medullary vomiting center (d) Stimulation of emetic chemoreceptor trigger zone (e) None of the above
55. Colchicine is used mainly to treat (a) Gout (b) Arthiritis (c) Diabetes (d) Carcinomas (e) High blood pressure
56. Which type of patient is most likely to hypersensitive to aspirin? (a) Intrinsic asthamatic (b) Extrinsic asthamatic (c) Chronic bronchitic (d) Patient with viral injection (e) Both (c) and (d)
57. Codeine acts as a cough sedative by (a) Producing mild nausea (b) Depressing bronchiolar secretions (c) Depressing pulmonary action (d) Depressing cough center (e) Paralyzing sensory nerves of bronchi
58. The greatest threat from morphine poisoning is (a) Renal shutdown (b) Paralysis of spinal cord (c) Respiratory depression (d) Cardiovascular collapse (e) None of the above
59. A very common side effect of morphine is (a) Allergic response (b) Blood dyscrasias (c) Constipation (d) Liver damage (e) Visceral pain
60. Eicosanoids are a group of _____ carbon unsaturated fatty acids (a) 20 (b) 10 (c) 25 (d) 35
61. Which of the following durgs is a monamine oxidase inhibitor, but is used to treat hypertension? (a) Tranylcypromine (Parnate) (b) Reserpine (c) Propranolol (Inderal) (d) Pargyline (Eutonyl) (e) Imipramine (Tofranil)
62. Autacoids differ from hormones in that (a) Autacoids are involved only in the causation of pathological states (b) Autacoids do not have a specific cell/ tissue of origin (c) Autacoids generally act locally at the site of generation and release (d) Both (b) and (c)
63. Which of the following eicosanoids is generated through the lipozygenase pathway ? (a) Prostaglandin E2 (b) Thromboxane A2 (c) Prostacyclin (d) Leukotriene C4
64. The cyclooxygenase isoenzymes COX1 and COX2 differ from each other in that (a) They catalyse different pathways in prostanoid biosynthesis (b) COX–1 is inhibited by aspirin but not COX–2 (c) COX–2 is inhibited by ibuprofen but not COX–1 (d) COX–1 is constitutive while COX–2 is inducible
65. Which of the following is an irreversible inhibitor of cyclooxygenase ? (a) Aspirin (b) Phenylbutazone (c) Indomethacin (d) Piroxicam
66. The prostanoid that consistently constricts blood vessels is (a) Prostaglandin E2 (b) Prostaglandin F2a (c) Thromboxane A2 (d) Prostacyclin
67. The following prostanoid is a potent inducer of platelet aggregation (a) Prostacyclin (b) Prostaglandin E2 (c) Prostaglandin D2 (d) Thromboxane A2
(c) Platelets bind aspirin with high affinity (d) Platelet COX is inducible
69. The early pregnancy uterus is sensitive to the following oxytocic (a) Oxytocin (b) Methylergometrine (c) Prostaglandin F2a (d) Both (a) and (b)
70. Cervical priming with prostaglandin results in (a) Facilitation of sperm movement through cervical canal (b) Increased cervical tone (c) Softening of cervix (d) Increased cervical secretions
71. Corticosteroids exert antiinflammatory action by inhibiting the following enzyme (a) Cycloxygenase (b) Lipozygenase (c) Phospholipase A (d) Phosphodiesterase
72. Main effect of sulphinpyrazone in hyperuricaemia is (a) Suppress the symptoms (b) Promote the elimination of urate (c) prevent urate synthesis (d) All of the above
73. Which of the following glucocorticoids has significant mineralocorticoid activity also ? (a) Hydrocortisone (b) Triamcinolone (c) Dexamethasone (d) Betamethasone
74. Corticosteroid therapy is practically mandatory in the following condition. (a) Septic shock (b) Renal transplant (c) Rheumatoid arthritis (d) Ulcerative colitis
75. For limiting cerebral edema due to brain tumour, the preferred corticosteroids are betamenthasone/dexamethasone because (a) They do not cause Na+ and water retention (b) They are more potent (c) They can be administered intravenously (d) They inhibit brain tumours
76. Systemic corticosteroid therapy is not used routinely and is reserved only for severe cases of (a) Exfoliative dermatitis (b) Posterior uveitis (c) Acute rheumatic fever (d) Hodgkin’s disease
77. The following adverse effect of corticosteroids is due to their mineralocorticoid action (a) Osteoporosis (b) Rise in blood pressure (c) Moon face (d) Increased susceptibility to infection
78. Which of the following bones is affected more by glucocorticoid induced osteoporosis? (a) Femur (b) Humerus (c) Radius (d) Lumber vertebra
79. Morphine produces analgesia by acting at (a) Peripheral pain receptors (b) A spinal site (c) Suspraspinal sites (d) Both (b) and (c)
80. In man sedation caused by morphine is characterized by (a) Initial excitement (b) Little or no motor incoordination (c) Rise in seizure threshold (d) All of the above
81. Instead of depressing, morphine stimulates (a) Vasomotor centre (b) Edinger westphal nucleus (c) Temperature regulating centre (d) Cough centre
82. In a comatose patient suspected of poisoning, which of the following findings would be against the drug being morphine (a) Selegiline (b) Chlorgiline (c) Moclobemide (d) Tranylcypromine
83. Instead of being effective in hyperuricaemia following drug is contradictred in the treatment of gout (a) Indomethacin (b) Diclofenac (c) Piroxicam (d) Aspirin
84. Morphine dependence is characterized by (a) Marked drug seeking behavior (b) Physical dependence without psychic dependence (c) Physical as well as psychic dependence (d) Both (a) and (c)
85. Morphine is contraindicated in head injury because (a) It does not relieve the pain of head injury (b) It can raise intracranial tension (c) It can cause constipation (d) It is liable to cause addiction
86. Which of the following opioids is more potent than morphine ? (a) Pethidine (b) Fentanyl (c) Dextropropoxyphene (d) Tramadol
87. Which of the following opioid analgesics is similar to codeine in pharmacological profile but is less constipating ? (a) Methadone (b) Buprenorphine (c) Butorphanol (d) Dextropropoxyphene
88. Select the analgesic which acts through opioids as well as additional spinal monoaminergic mechanisms. (a) Tramadol (b) Ethoheptazine (c) Dextropropoxyphene (d) Alfentanil
89. An opioid analgesic is preferred over aspirin like analgesic in the following condition. (a) Acute gout (b) Burn (c) Toothache (d) Neuralgia
90. Morphine has high affinity for the following opioid receptor(s). (a) µ (Mu) (b) k (Kappa) (c) d (Delta) (d) All of these
91. Which of the following is an agonistantagonist type of opioid analgesic (a) Pethidine (b) Pentazocine (c) Fentanyl (d) Buprenorphine
92. Pentazocine differs from morphine in that (a) It is inactive by the oral route (b) It does not produce physical dependence (c) It has a lower ceiling of analgesic effect (d) Its action is not blocked by naloxone
93. Which action of morphine is incompletely reversed by naloxone ? (a) Analgesia (b) Respiratory depression (c) Sedation (d) Miosis
94. Lower dose of naloxone is required to (a) Antagonise the actions of nalorphine (b) Antagonise the actions of pentazocine (c) Precipitate withdrawal in mildly morphine dependent subjects (d) Precipitate withdrawal in highly morphine dependent subjects
95. Following mediators are involved in acute inflammation except (a) Histamine (b) Leukotrienes (c) Interferons (d) Bradykinin
96. The distinctive feature of the isoenzyme cyclooxygenase2 is (a) It is not inhibited by indomethacin (b) It is inducible (c) It generates cytoprotective prostagladins in gastric mucosa (d) It is found only in foetal tissues
97. Aspirin produces analgesia by (a) Preventing sensitization of peripheral pain receptors (b) Affecting gating of pain impulses at spinal level (c) Raising pain threshold at subcortical level (d) Both (a) and (b)
98. Aspirin reduces fever by (a) Decreasing heat production in the body (b) Enhancing cutaneous blood flow (c) Inducing sweating (d) Both (b) and (c)
