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  1. 1. A 25 y.o. patient is treated with parenteral Aminoglycoside for a Pseudomonas aeruginosa infection. They require immediate surgery. They are premedicated with Midazolam . Dithylinum ( Succinylcholine ) is administered for intubation, with skeletal muscle paralysis maintained during surgery with Pancuronium (Arduanum) . Anesthesia is maintained with N 2 O , Isoflurane . What is the most likely outcome of having the aminoglycoside in the perioperative setting along with all these other drugs? A. Acute hepatotoxicity from an Aminoglycoside-Isoflurane interaction B. Antagonism of Diazepam and sedative effects C. Increased or prolonged response to neuromuscular blockers D. Enhanced aminoglycoside toxicity to host cells E. Reduced risk of cardiac arrhythmias
  2. 2. A 37 y.o. patient, suffering an obliterating endarteritis of the legs, receives Phenylin in a dose of 60 mg/kg. Because of convulsion development (brain trauma is in anamnesis), Phenobarbital had been given, after the cancellation of which the nasal bleeding occurred at the patient. The given complication is connected with : A. Conjugation of phenylin with a glucuronic acid B. Inhibition by phenobarbital of enzymes microsomal oxidations in a liver C. Induction by phenobarbital of enzymes microsomal oxidations in a liver D. Oxidative deamination of phenylin E. Aliphatic hydroxylation of phenobarbital
  3. 3. <ul><li>For prevention remote relapses of 4-days malaria a 42 y.o. patient was given Primaquine . </li></ul><ul><li>On the 3-d day of the treatment with therapeutic doses of the drug patient experienced abdominal pain, cardiac pain, dyspepsia, generalized cyanosis. </li></ul><ul><li>What is the reason of these adverse effectss of the drug ? </li></ul><ul><li>A. Cumulation of the therapeutic agent </li></ul><ul><li>B . Slowing down of drug’s secretion with urine </li></ul><ul><li>C . Decreasing of activity of liver microsomal enzymes </li></ul><ul><li>D . Genetic deficiency of Glucose-6-phosphate dehydrogenase </li></ul><ul><li>E . Potentiation of the drug’s action by other therapeutic agent. </li></ul>
  4. 4. <ul><li>A 28 y.o. woman has just returned from a trip to Southeast Asia. Over the past 24 h she has developed shaking, rigors, and t o 40.5 o C. </li></ul><ul><li>A blood smear reveals Plasmodium vivax . </li></ul><ul><li>Which of the following agents should be used to eradicate the Extraerythrocytic Phase of the organism ? </li></ul><ul><li>A . Pyrimethamine (Chloridine) </li></ul><ul><li>B . Chloroquine </li></ul><ul><li>C . Primaquine </li></ul><ul><li>D. Tetracycline </li></ul><ul><li>E. Quinacrine (Acrichinum) </li></ul>
  5. 5. <ul><li>We give an ‘effective dose’ of atropine to a person who is poisoned with an acetylcholinesterase inhibitor . </li></ul><ul><li>Which structure will continue to be overacted by the excess acetylcholine after this drug is given ? </li></ul><ul><li>A. Airway smooth muscle </li></ul><ul><li>B. S-A node of the heart </li></ul><ul><li>C. Salivary and lacrimal glands </li></ul><ul><li>D. Skeletal muscle </li></ul><ul><li>E. Vascular smooth muscle </li></ul>
  6. 6. <ul><li>Pharmacokinetics includes all of </li></ul><ul><li>the following processes EXEPT : </li></ul><ul><ul><ul><ul><ul><li>A. Absorption </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>B . Distribution </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>C . Biotransformation </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>D. Elimination </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>E. Clinical use </li></ul></ul></ul></ul></ul>
  7. 7. <ul><li>The breadth of therapeutic action is a range of doses : </li></ul><ul><li>A . From average therapeutic dose to minimum toxic dose </li></ul><ul><li>B . From single dose to course dose </li></ul><ul><li>C . From minimum effective (threshold) dose to minimum toxic dose </li></ul><ul><li>D . From single dose to daily dose </li></ul><ul><li>E . From minimum effective dose to average toxic dose </li></ul>
  8. 8. <ul><li>The formation of a secondary mediator is obligatory in membrane-intracellular mechanism of hormone action. Point out the substance that is unable to be a secondary mediator : </li></ul><ul><li>A. Glycerol </li></ul><ul><li>B. Diacylglycerol </li></ul><ul><li>C. cAMP </li></ul><ul><li>D. Ca 2+ </li></ul><ul><li>E. Inositol-1,.4,5-triphosphate </li></ul>
  9. 9. <ul><li>If the drug substance or toxin inhibits synthesis of ATP , what mechanism of penetration through the cell membrane is blocked? </li></ul><ul><li>A. Pinocytosis </li></ul><ul><li>B. Passive diffusion </li></ul><ul><li>C. Filtration </li></ul><ul><li>D. Active transport </li></ul><ul><li>E. Simplified diffusion </li></ul>
  10. 10. <ul><li>How pharmacological activity of a drug with high affinity to plasma protein will be altered at hypoalbuminemia ? </li></ul><ul><li>A . Will greatly decrease </li></ul><ul><li>B. Will slightly decrease </li></ul><ul><li>C. Will increase </li></ul><ul><li>D. Will not change </li></ul><ul><li>E. Will disappear </li></ul>
  11. 11. <ul><li>How to explain the reduction of effects of euphyllinum in the interaction with Phenobarbital ? </li></ul><ul><li>A . Inhibition of enzymes of the liver </li></ul><ul><li>B . Antagonist effect </li></ul><ul><li>C . Tachyphylaxis </li></ul><ul><li>D . Idiosyncrasy </li></ul><ul><li>E . Activation of enzymes of the liver </li></ul>
  12. 12. <ul><li>A patient with increased sensitivity to sulfonamides needs tooth extraction. What local anesthetic has to be used? </li></ul><ul><li>A. Cocaine </li></ul><ul><li>B. Dicaine (tetracaine) </li></ul><ul><li>C. Anesthesine (benzocaine) </li></ul><ul><li>D. Lidocaine </li></ul><ul><li>E. Novocaine (procaine) </li></ul>
  13. 13. <ul><li>Which of the following drugs incorrectly matches a cholinergic agonist with a pharmacologic action ? </li></ul><ul><li>A. Physostigmine: stimulates atonic bladder </li></ul><ul><li>B. Carbachol: induces release of epinephrine from the adrenal medulla </li></ul><ul><li>C. Acetylcholine: decreases heart rate and cardiac output </li></ul><ul><li>D. Pilocarpine: reduces intraocular pressure </li></ul><ul><li>E. Proserine (Neostigmine): decreases intestinal motility </li></ul>
  14. 14. <ul><li>A 43 y.o. patient has been administered pentamine for hypertensive crisis. </li></ul><ul><li>What is the action mechanism of the drug? </li></ul><ul><li>A. Stimulation of M-cholinoceptors </li></ul><ul><li>B. Inhibition of M-cholinoceptors </li></ul><ul><li>C. Inhibition of M-,N-cholinoceptors </li></ul><ul><li>D. Stimulation of N-cholinoceptors </li></ul><ul><li>E. Inhibition of N-cholinoceptors </li></ul>
  15. 15. <ul><li>At complex narcosis (general anesthesia) protocol during stomach resection, a patient has got </li></ul><ul><li>an injection of tubocurarine chloride as </li></ul><ul><li>a myorelaxant (neuromuscular blocker). </li></ul><ul><li>What agent–antagonist should be administered to the patient for restoration of his self-driven respiration? </li></ul><ul><li>A. Etimizol </li></ul><ul><li>B. Dithyline (Succinylcholine) </li></ul><ul><li>C. Atropine </li></ul><ul><li>D. Proserine (Neostigmine) </li></ul><ul><li>E. Benzohexonium </li></ul>
  16. 16. <ul><li>During surgical operation a patient has developed symptoms of dithylin (succinylcholine) overdosage. </li></ul><ul><li>What treatment is necessary to provide to </li></ul><ul><li>the patient? </li></ul><ul><li>A. Blood transfusion </li></ul><ul><li>B. Norepinephrine </li></ul><ul><li>C . Proserine (Neostigmine) </li></ul><ul><li>D. Galantamine </li></ul><ul><li>E. Atropine sulfate </li></ul>
  17. 17. <ul><li>A patient had to go through an operation. Doctors introduced him dithylinum (listenone) and performed intubation. </li></ul><ul><li>After the end of operation and cessation of anesthesia the independent respiration wasn’t restored. Which enzyme deficit prolongs the action of muscle relaxant? </li></ul><ul><li>A. Succinate dehydrigenase </li></ul><ul><li>B. K-Na-adenosine triphosphatase </li></ul><ul><li>C. Carbanhydrase </li></ul><ul><li>D. Pseudocholinesterase </li></ul><ul><li>E. N-acetyltransferase </li></ul>
  18. 18. <ul><li>ANTIDOTES </li></ul><ul><li>Morphine - Naloxone </li></ul><ul><li>Nitroglycerine - Methylene blue </li></ul><ul><li>Paracetamole (Acetaminophen) - </li></ul><ul><li> Acetylcysteine (ACC) </li></ul><ul><li>Atropine – Physostigmine, </li></ul><ul><li>Proserine ( Neostigmine) </li></ul><ul><li>PHOS (Anticholinesterases) – </li></ul><ul><li> Atropine, Alloxime, Dipyroxime, Isonitrozine </li></ul><ul><li>Heparine - : Protamine sulfate </li></ul><ul><li>Neodicumarine - Vicasole (vitamine K) </li></ul><ul><li>Isoniazid - Pyridoxine ( Vitamine B6) </li></ul>
  19. 19. <ul><li>Symptoms of cardiac glycosides toxicity have been developed in a patient with chronic congestive heart failure. What agent should be administered to decrease adverse effects of cardiac glycosides? </li></ul><ul><li>A. Novocainamid </li></ul><ul><li>B. Dipiroxim </li></ul><ul><li>C. Ethimisol </li></ul><ul><li>D. Atropine sulfate </li></ul><ul><li>E. Potassium chloride </li></ul>
  20. 20. <ul><li>Which of the following drugs is appropriate and generally regarded as most effective for relieving and preventing ischemic episodes in patients with variant angina ? </li></ul><ul><li>A. Nifedipine </li></ul><ul><li>B. Lovastatine </li></ul><ul><li>C. Propranolol </li></ul><ul><li>D. Tramadol </li></ul><ul><li>E. Nitroglycerin </li></ul>
  21. 21. <ul><li>Which of the following drugs can relieve angina pectoris by decreasing myocardial work, but may precipitate congestive heart failure? </li></ul><ul><ul><ul><li>A. Phentolamine </li></ul></ul></ul><ul><ul><ul><li>B. Sthrophanthine </li></ul></ul></ul><ul><ul><ul><li>C. Metoprolol </li></ul></ul></ul><ul><ul><ul><li>D. Atropine </li></ul></ul></ul><ul><ul><ul><li>E. Enalapril </li></ul></ul></ul>
  22. 22. <ul><li>The advantages of metoprolol over propranolol include all of the following except : </li></ul><ul><li>A. Less likely to provoke bronchoconstriction </li></ul><ul><li>B. More likely to be effective </li></ul><ul><li>in sinus tachycardia </li></ul><ul><li>C. More likely to be effective in sinus bradycardia </li></ul><ul><li>D. Less likely to produce temporary rise in peripheral resistance at the start of therapy </li></ul><ul><li>E. Less likely to produce sudden rises in BP after physical exertion </li></ul>
  23. 23. <ul><li>A 27 y.o. male with angina pectoris was admitted to a cardiologic department. </li></ul><ul><li>A phosphodiesterase inhibitor was included to </li></ul><ul><li>the complex therapy of the patient. </li></ul><ul><li>Concentration of what substance will increase in the cardiac muscle? </li></ul><ul><ul><ul><li>A. Diacilglycerol </li></ul></ul></ul><ul><ul><ul><li>B . ATP </li></ul></ul></ul><ul><ul><ul><li>C . Cyclic-AMP </li></ul></ul></ul><ul><ul><ul><li>D . GMP </li></ul></ul></ul><ul><ul><ul><li>E . AMP </li></ul></ul></ul>
  24. 24. <ul><li>In a patient with hypertension at regular use of an antihypertensive agent , </li></ul><ul><li>cough has appeared. </li></ul><ul><li>What agent can cause the given adverse effect? </li></ul><ul><li>A. Prazosin </li></ul><ul><li>B. Verapamil </li></ul><ul><li>C. Clophelinum (Clonidinum) </li></ul><ul><li>D. Dichlothiasidum </li></ul><ul><li>E. Enalapril </li></ul>
  25. 25. <ul><li>A dentist prescribed an agent stimulating salivation to a patient with xerostomia . Indicate the drug: </li></ul><ul><li>A. Pilocarpine </li></ul><ul><li>B. Dithylinum (suxamethonium) </li></ul><ul><li>C. Armine </li></ul><ul><li>D. Scopolamine </li></ul><ul><li>E. Atropine </li></ul>
  26. 26. <ul><li>A 45 y. o. patient has been prescribed Digoxin to treat chronic heart failure. </li></ul><ul><li>What is the mechanism of action of Digitoxin ? </li></ul><ul><li>A. Stimulates production of cAMP </li></ul><ul><li>B. Decreases intracellular Na+ concentration </li></ul><ul><li>C. Increases the intracellular level of ATP </li></ul><ul><li>D. Inhibition of Na+/K+ ATPase </li></ul><ul><li>E. Decreases release of Ca2+ from the sarcoplasmic reticulum </li></ul>
  27. 27. <ul><li>A patient with a cardiac arrhythmia is being treated for a long time with Amiodarone . This drug can cause biochemical changes and clinical signs and symptoms that resemble those associate with which of the following disease ? </li></ul><ul><li>A. Hypothyroidism </li></ul><ul><li>B. Addisonian crisis </li></ul><ul><li>C. Parkinsonian syndrom </li></ul><ul><li>D. Stealing syndrome </li></ul><ul><li>E. Cushing’s syndrome </li></ul>
  28. 28. <ul><li>Indicate the mechanism of antiarrhythmical action of Amiodaronum ( Cordaronum ): </li></ul><ul><li>A . Blockade of alfa–adrenoceptors of </li></ul><ul><li>the myocardium </li></ul><ul><li>B . Blockade of Ca 2+ channels of </li></ul><ul><li>the cardiomyocyte membranes </li></ul><ul><li>C . Blockade of beta–adrenoceptors of </li></ul><ul><li>the myocardium </li></ul><ul><li>D . Blockade of K + channels of </li></ul><ul><li>the cardiomyocyte membranes </li></ul><ul><li>E . Blockade of Na + channels of the cardiomyocyte membranes </li></ul>
  29. 29. <ul><li>The half life of digoxin is : </li></ul><ul><li>A. 5 days </li></ul><ul><li>B. 24 hours </li></ul><ul><li>C. 36 hours </li></ul><ul><li>D. 12 hours </li></ul><ul><li>E. 8 hours </li></ul><ul><li>[ Digitoxin - 5 days </li></ul><ul><li>Strophanthine – 8 hours] </li></ul>
  30. 30. <ul><li>A 24 y.o. patient complains of unpleasant sensations in the heart region, and attacks of weakness and loss of consciousness. </li></ul><ul><li>Inspection of the patient’s ECG had revealed the presence of II degree AV block. </li></ul><ul><li>Specify a drug, which should be used in the situation: </li></ul><ul><li>A . Isadrinum </li></ul><ul><li>B . Lidocain </li></ul><ul><li>C . Nitroglycerine </li></ul><ul><li>D . Verapamil </li></ul><ul><li>E . Anaprilin </li></ul>
  31. 31. <ul><li>Digitoxin (1 tab tid) had been prescribed to a patient with chronic (congestive) heart failure. </li></ul><ul><li>In 15 days, the signs of intoxication developed in the patient – bradyarrhythmia, distrurbance of AV conduction, upset of colour vision. </li></ul><ul><li>What could cause the specified phenomena? </li></ul><ul><ul><li>A . Tolerance </li></ul></ul><ul><ul><li>B. Functional cumulation </li></ul></ul><ul><ul><li>C . Potentiation </li></ul></ul><ul><ul><li>D . Material cumulation </li></ul></ul><ul><ul><li>E . Summation </li></ul></ul>
  32. 32. <ul><li>In homozygous mice with defect of the gene-coding frame of a beta1—adrenoreceptors , it has been probed action of an agent on inotropic function of heart. What agent will lose the activity in these conditions? </li></ul><ul><ul><ul><li>A . Digoxin </li></ul></ul></ul><ul><ul><ul><li>B . Amrinone </li></ul></ul></ul><ul><ul><ul><li>C . Strophanthin </li></ul></ul></ul><ul><ul><ul><li>D . Propranolol </li></ul></ul></ul><ul><ul><ul><li>E. Dopamine </li></ul></ul></ul>
  33. 33. <ul><li>A patient has been administered Levodopa in complex therapy of Parkinson disease . </li></ul><ul><li>What changes does this drug produce </li></ul><ul><li>in the CNS ? </li></ul><ul><li>A. Blocks central cholinoreceptors </li></ul><ul><li>B. Decreases dopamine mediation </li></ul><ul><li>C. Stimulates dopamine receptors </li></ul><ul><li>D. Blocks dopamine receptors </li></ul><ul><li>E. Enhances dopamine mediation </li></ul>
  34. 34. <ul><li>A patient suffers from severe postoperative pseudomonades infection. What of the following antibiotics in this case? </li></ul><ul><li>A. Doxycycline </li></ul><ul><li>B. Benzylpenicillin </li></ul><ul><li>C. Erythromycin </li></ul><ul><li>D. Cephazolin </li></ul><ul><li>E. Amicacin sulfate </li></ul>
  35. 35. <ul><li>A patient requires an antibiotic that is the most effective against Pseudomonas aeruginosa . </li></ul><ul><li>Which drug is the quinolone of choice ? </li></ul><ul><li>A. Ciprofloxacin </li></ul><ul><li>B. Ofloxacin </li></ul><ul><li>C. Lomefloxacin </li></ul><ul><li>D. Norfloxacin </li></ul><ul><li>E. Enoxacin </li></ul>
  36. 36. <ul><li>A young boy presents the infestation with Taenia saginata (tapeworm). </li></ul><ul><li>Which drug is the most appropriate to administer ? </li></ul><ul><ul><li>A. Mebendazole </li></ul></ul><ul><ul><li>B. Praziquantel </li></ul></ul><ul><ul><li>C. Chloroquine </li></ul></ul><ul><ul><li>D. Tetracycline </li></ul></ul><ul><ul><li>E. Penicillin </li></ul></ul>
  37. 37. <ul><li>A 15 y.o. boy was admitted to the hospital with polytrauma in unconscious state, </li></ul><ul><li>BP 95/70 mm Hg, </li></ul><ul><li>HR 72/min, </li></ul><ul><li>RR 30/min, Superficial breathing </li></ul><ul><li>Choose the drug for general anaesthesia: </li></ul><ul><li>A. Phthorotanum (halothane) </li></ul><ul><li>B. Hexenalum (hexobarbital) </li></ul><ul><li>C. Propanidid </li></ul><ul><li>D. Thiopental natrium </li></ul><ul><li>E. Ketamine </li></ul>
  38. 38. <ul><li>A water-soluble cardiac glycoside has been prescribed to a patient. </li></ul><ul><li>What concomitant pathology can promote a cumulation of water-soluble cardiac glycosides? </li></ul><ul><li>A . Liver failure </li></ul><ul><li>B . Renal failure </li></ul><ul><li>C . Hyperacide gastritis </li></ul><ul><li>D . Hypoacidic gastritis </li></ul><ul><li>E . Hypothyroidusm </li></ul>
  39. 39. <ul><li>A patient with a severe arthritis will be placed on long-term therapy with Indomethacin . </li></ul><ul><li>Which of the following drugs is the most appropriate choice to administer as an add-on (adjunct ) to prevent gastric ulcers caused by this NSAID ? </li></ul><ul><ul><ul><li>A. Almagel </li></ul></ul></ul><ul><ul><ul><li>B. Celecoxib </li></ul></ul></ul><ul><ul><ul><li>C. Misoprostol </li></ul></ul></ul><ul><ul><ul><li>D. Omeprazole </li></ul></ul></ul><ul><ul><ul><li>E. Meloxicam </li></ul></ul></ul>
  40. 40. <ul><li>A liquidator of a breakdown at a nuclear power plant who was irradiated complained about vomiting that occurs all of a sudden. </li></ul><ul><li>What medication should be prescribed ? </li></ul><ul><ul><ul><li>A. Aeron </li></ul></ul></ul><ul><ul><ul><li>B. Contrical </li></ul></ul></ul><ul><ul><ul><li>C. Omeprazole </li></ul></ul></ul><ul><ul><ul><li>D. Atropine </li></ul></ul></ul><ul><ul><ul><li>E. Metoclopramid </li></ul></ul></ul>
  41. 41. <ul><li>Which one of the following actions can hydrochlorothiazide produce? </li></ul><ul><li>A. Hyperkalemia </li></ul><ul><li>B. Hypocalciemia </li></ul><ul><li>C. Hyperuricemia </li></ul><ul><li>D. Hypoglycemia in diabetic patients </li></ul><ul><li>E. Hypolipidemia </li></ul>
  42. 42. <ul><li>Which drug is primarily used in </li></ul><ul><li>Amebiasis and Leishmaniasis as well as Anaerobic Bacterial infections ? </li></ul><ul><li>A . Сo-Trimoxa z ol e (Biseptol) </li></ul><ul><li>B. Ciprofloxacin </li></ul><ul><li>C. Azithromycin </li></ul><ul><li>D . Metronidazole </li></ul><ul><li>E. Carbenicillin </li></ul>!
  43. 43. <ul><li>A doctor administered Allopurinol to a 37 y.o. man with the symptoms of gout . </li></ul><ul><li>What pharmacological action of Allopurinol ensures therapeutical effect ? </li></ul><ul><li>A. By inhibiting leukocyte migration into joint </li></ul><ul><li>B. By inhibiting uric acid synthesis </li></ul><ul><li>C. By increasing uric acid excretion </li></ul><ul><li>D. By inhibiting uric acid biotransformation </li></ul><ul><li>E. By general anti-inflammatory effect </li></ul>
  44. 44. <ul><li>There is a pregnant woman in a delivery room that on term of gestation should already have labors. The uterus cervix is not opened at inspection. </li></ul><ul><li>Indicate an agent for acceleration of uterus cervix ripening and for stimulation of parturition activity : </li></ul><ul><li>A. Prostin E2 (Dinoprostone) </li></ul><ul><li>B. Progesterone </li></ul><ul><li>C. Estrone </li></ul><ul><li>D. Testosterone </li></ul><ul><li>E. Ergometrine </li></ul>
  45. 45. <ul><li>Thank You for Listening! </li></ul>