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15. Menadione (vitamin K3):
A.
Can cause hemolysis in patients with G-6-PD
deficiency
B. Is given in large doses in patients with severe
liver disease
C. Is useful to prevent hemorrhagic disease of the
newborn
D. Is the preparation of choice to antagonize the
effect of warfarin overdose
16. Vitamin K promotes the hepatic biosynthesis of
following blood clotting factor
A.
Factor I B. Factor II
C. Factor VIII D. All of the above
17. Scurvy is:
A. A disease caused by deficiency of vitamin C
and characterized by spongy bleeding gums,
bleeding under the skin, and weakness
B. Excess dryness of the conjunctiva caused by a
disease localized in the eye
C. A disease caused by deficiency of niacin in
the diet and characterized by skin eruptions,
digestive and nervous system disturbances,
and eventual mental deterioration
D. All of the above
18. Beri-beri is caused by the deciency of:
A. Riboflavin B. Ascorbic acid
C. Nicotinic acid D. Thiamine
19. Vitamin-like compounds are:
A. Those nutritional requirements exist at specific
periods of development, particularly neonatal
development, and periods of rapid growth
phase
B. Inorganic nutrients required in small quantities
in body
C. Organic in nature and required in very large
quantities in body
D. Products of endocrine gland secretion
20. Which of the following factor(s) is/are required
for the absorption of vitamin B12 ingested in
physiological amounts?
A.
Gastric acid
B. Gastric intrinsic factor
C. Transcobalamine
D. Both A and B
21. Select a water-soluble vitamin:
A. Vitamin A B. Vitamin E
C. Vitamin D D. Vitamin B1
22. These substances are vitamin-like compounds,
except:
A.
Choline B. Vitamin PP
C. Orotate acid D. All of these
23. Select a fat-soluble vitamin:
A. Ascorbic acid B. Tocopherol
C. Thiamine D. Riboflavin
24. Choose one correct statement about vitamin C
function:
A.
Active functional form is pyridoxal
phosphate, which is an essential coenzyme for
transamination and decarboxylation
B. Necessary constituent of coenzyme A, the
important coenzyme for acyl transfer in the
TCA cycle
C. It is a carrier of one-carbon groups that are
added to, or removed from, metabolites
such as histidine, serine, methionine, and
purines
D. It has antioxidant properties and is necessary
for various hydroxylation reactions
25. Megaloblastic anaemia occurs in:
A. Vitamin B12 but not folic acid deficiency
B. Folic acid but not vitamin B
C. Either vitamin B
or folic acid deficiency
12
deficiency
12
D. Only combined vitamin B12 + folic acid
deficiency
26. The side effect which primarily limits acceptability
of oral iron therapy is:
A.
Epigastric pain and bowel upset
B. Black stools
C. Staining of teeth
D. Metallic taste
27. Which of the following vitamins resembles with
hormone?
A.
Vitamin K B. Vitamin A
C. Vitamin D D. Vitamin E
28. The percentage of elemental iron hydrated ferrous
sulfate is:
A.
5% B. 10%
C. 20% D. 33%
29. Vitamin K is indicated for the treatment of
bleeding occurring in patients:
A.
Being treated with heparin
B. Being treated with streptokinase
C. Of obstructive jaundice
D. Of peptic ulcer
30. Absorption of oral iron preparations can be
facilitated by co administering:
A.
Antacids B. Tetracyclines
C. Phosphates D. Ascorbic acid
31. Deciency symptom of vitamin A caused:
A. Night blindness
B. Xerophthalmia and keratomalacia
C. Decreased resistance to infective diseases
D. All of the above
32. Pellagra is:
A. A disease caused by a deficiency of niacin in
the diet and characterized by skin eruptions,
digestive and nervous system disturbances,
and eventual mental deterioration
Section 1 Pharmacology
129
B. Inflammation of several nerves at one time
caused by a deficiency of thiamin, marked by
paralysis, pain, and muscle wasting. Also called
multiple neuritis or polyneuritis
C. A type of anemia most often affecting elderly
adults, caused due to the incapability of
stomach to absorb vitamin B
. This anemia
12
is characterized by abnormal size RBCs, GIT
disturbances, and lesions of the spinal cord
D. All of the above
33. Succimer
A. Can significantly mobilize essential metals
B. Produces less toxicity than dimercaprol
C. Is ineffective orally
D. Is contraindicated in children
34. Beriberi is
A. Disease caused by deficiency of thiamine,
endemic in eastern and southern Asia, and
characterized by neurological symptoms,
cardiovascular abnormalities, and edema.
It is also called endemic neuritis
B. Corners of the mouth get inflamed due to
the deficiency of riboflavin, associated with a
wrinkled epithelium that does not involve the
mucosa
C. A disorder of the lips often due to riboflavin
deficiency and other B-complex vitamin
deficiencies and characterized by fissures
D. All of the above
35. The drug used for controlling tetany is:
A. Intravenous diazepam
B. Intramuscular vitamin D
C. Intravenous calcium gluconate
D. Intravenous calcitonin
36. Which vitamins from the following improve
megaloblast anemia but does not protect the
neurological manifestations of pernicious anemia?
Vitamin B12 B. Vitamin BC
A.
C. Vitamin PP D. Vitamin D
37. Keratomalacia is:
A. A illness characterized by spongy bleeding
gums, bleeding under the skin, and weakness
caused by vitamin C deficiency
B. A condition, usually occurs in children with
vitamin A deficiency as a resultant cornea get
soft, ulcerated and perforated
C. A visual defect marked by the inability to see
as clearly in bright light as in dim light
D. All of the above
Section 1 Pharmacology
38. Thiamine is vitamin:
130
A. B1 B. B
C. B6 D. B
2
12
39. Which of the following is required by a 5-year-old
boy with chronic renal in sufciency?
A.
Erythropoietin B. G-CSF
C. Interleukin - 11 D. Stem cell factor
40. Choose correct statement about iron therapy.
A. As compared with oral iron therapy,
intramuscular iron response for is faster
haemoglobin
B.
In all situation Iron must be given by oral route
except in pernicious anaemia
C.
Prophylactic iron therapy must be given in case
of pregnancy
D.
Infants on breast feeding do not require
medicinal iron
41. Deciency symptom of riboavin is:
A. Cheilitis
B. Cheilosis
C. Angular stomatitis
D. All of the above
42. Deciency of following vitamin is characterized
by loosening of teeth, gingivitis and hemorrhage:
A.
Vitamin K B. Vitamin 5
C. Vitamin B6 D. Vitamin C
43. Ingestion of polar bear liver may cause acute
poisoning of:
A.
Vitamin D B. Vitamin E
C. Vitamin A D. Vitamin C
44. Which of the following vitamins is given along
with isoniazid in the treatment of tuberculosis?
A.
Nicotinic acid B. Riboflavin
C. Pyridoxine D. Ascorbic acid
45. Megaloblastic anemia is caused by deciency of:
A. Iron B. Vitamin B12
C. Vitamin C D. All of the above
46. One of the following coenzymes is of vitamin
origin.
A.
Riboxine
B. Coenzyme Q10
C. Piridixal-5-phosphate
D. Lipoic acid
47. Following condition is characterized by dermatitis,
diarrhoea and dementia.
A.
Dry beriberi
B. Pyridoxine deficiency
C. Scurvy
D. Pellagra
48. Mega doses of which vitamin are sometime
benecial viral respiratory infections:
A.
Vitamin C B. Vitamin A
C. Vitamin K D. Vitamin PP
49. …………………..also known as an anti-sterility
factor.
A.
Vitamin E B. Vitamin B
5
C. Vitamin B1
50. Magnesium ion is necessary in:
A. Stimulating enzyme systems
B. Muscular contraction
C. Nerve conduction
D. All of the above
51. Which of the following statements concerning
biotin functions are true:
A. The active functional form is pyridoxal
phosphate
B. Necessary constituent of coenzyme A
C. An extremely important antioxidant, which
protects cell membrane lipids from peroxidation.
D. Coenzyme for several reactions involving CO2
fixation into various compounds
52. Which of the following drugs combination with
its clinical manifestation is correct?
Erythropoietin: Macrocytic anemia
A.
B. Iron dextran: Severe macrocytic anemia
C. Ferrous sulfate: Microcytic anemia of pregnancy
D. All of the above
53. Which of the following vitamin can be also
synthesized from a dietary precursor?
A. Vitamin C B. Vitamin A
C. Vitamin B3 D. Vitamin B
6
54. Xerophthalmia is:
A. Condition of extreme dryness of the conjunctiva
resulting from a disease localized in the eye or
from systemic deficiency of vitamin A
B. A condition caused by deficiency of vitamin C
and characterized by spongy bleeding gums,
bleeding under the skin, and weakness
C. A condition, usually occurs in children with
vitamin A deficiency as a resultant cornea get
soft, ulcerated and perforated
D. All of the above
55. …………………prevent vitamin B6 from exerting
its normal metabolic effects.
A. Isoniazid B. Ethanol
C. Carbamazepine D. All of these
56. ……………..prevent vitamin A from exerting its
typical metabolic effects?
A. Lipo-oxidase
B. Oral contraceptives
C. Antibiotics
D. All of these
ANSWER KEY
1. B 2. B 3. A 4. C 5. A 6. C 7. A 8. A 9. B 10. C 11. C 12. C 13. A 14. A
15. A 16. B 17. A 18. D 19. A 20. D 21. D 22. B 23. B 24. D 25. C 26. A 27. C 28. C
29. C 30. D 31. D 32. A 33. C 34. A 35. C 36. A 37. D 38. C 39. A 40. C 41. D 42. D
43. C 44. C 45. B 46. C 47. D 48. A 49. A 50. D 51. D 52. C 53. B 54. A 55. D 56. A
Section 1 Pharmacology
131
12. Hormones
1. Pituitary
z
Anterior pituitary- GH,
z
ACTH, TSH, FSH, LH, Prolactin.
z
Posterior pituitary- Oxytocin, ADH
2. Thyroid
z
Thyroxine T4
z
TriiodothyroxineT3
z
Calcitonin (ca decreases)
3. Parathyroid-
z
Parathormone (calcium increases)
4. Pancreas-
z
Insulin
z
Glucagon
5. Adrenal gland-
z
Cortex—glucocorticoid-hydrocortisone,
mineralocorticoid-aldosterone,
z
Sex steroid—testosterone, progesterone
z
Medula—adrenaline, epinephrine, noradrenaline
6. Gonad
z
Androgen: Testosteron
z
Oestrogen: Estradiol
z
Progesterone: Progestron
Insulin
Decreases Glucose level
Insulin is a hormone that causes maintenance of glucose
by oxidizing insulin is a polypeptide having 51 amino
acids with molecular weight of 6000.
A chain has 21 amino acids, B chain has 30 amino acids.
The A and B chains are held together by 2 disulphide
bonds.
Insulin is synthesized by β cells of pancreas.
Actions:
Inhibits gluconeogenesis
Increase glycogenesis
Decrease glycogenolysis
Increase glucose transport across cell membrane.
Skeletal muscle and fat are highly sensitive glucose entry
in liver brain RBC
WBC and renal cell is independent of insulin.
Normally acetyl coenzyme a is synthesized to fatty acid
and triglyceride but in diabetes acetyl coenzyme a is
converted to ketone bodies acetone (acetone acetate, beta
hydroxybutyrate) so ketonemia and ketonuria occurs.
Classification
1. Ultra-short acting
z
Lispro insulin
2. Short acting
z
Regular insulin
z
Prompt insulin
z
Section 1 Pharmacology
132
Zinc suspension
3. Intermediate
z
Insulin zinc suspension /lente
z
Natural protamine, isophane insulin.
4. Long active
z
Extended insulin
z
Zinc suspension/ultralente
z
protamine zinc insulin
Mechanism of action
1. The insulin act on specific receptors located on the cell
membrane of all cells, especially liver and fat cells are
very rich.
2. Insulin receptor is a heterotetrameric glycoprotein
consisting of two extracellular alpha and two
transmembrane beta subunits linked together by
disulfide bonds.
3. The alpha subunit carries insulin binding sites while
beta subunit has tyrosine protein kinase activity.
4. Binding of insulin to alpha subunits induced aggregation
and internalization of the receptors along with the
insulin molecule.
5. This activates tyrosine kinase activity of the beta subunit
to phosphorylate tyrosine residue of each other and then
of insulin receptor substrate protein (IRSPs).
6. In turn, a cascade of phosphorylation and dephosphorylation reaction is going on due to which there is
activation or inhibition of enzyme which involve in
rapid metabolic action of insulin.
7. Certain second messenger like phosphatidy linositol
tri-phosphate (PIP3) also mediate the action of insulin
on metabolic enzyme.
8. Through the phosphorylation cascade insulin activates
GLUT4 and promotes its translocation to the cell
membrane.
Pharmacological action
1. Carbohydrate metabolism:
z
Insulin decreased blood glucose level
z
Decreased glycogenolysis
z
Decreased gluconeogenesis
z
Promote glycogenesis in muscles
z
Liver and increase rate of utilisation of glucose.
2. Protein metabolism:
z
It promotes protein synthesis
z
Inhibit protein breakdown.
3. Fat metabolism:
z
Insulin promotes the synthesis of free fatty acid and
triglyceride and inhibit lipolysin.
4. It increases potassium entry into the cells.
5. It decreased urine output from liver.
Uses of insulin
a) In Juvenile diabetes it is essential.
b) In non-insulin dependent diabetes mellitus—it is
required when
z
Diabetes is not controlled by diet or exercise.
z
When oral hypoglycemic fail.
z
Infection, trauma, surgery, pregnancy, and labour.
z
Gangrene of extremities.
z
Ketoacidosis.
Preparation of insulin
1) Conventional insulin preparation
z
It is derived from beef and pork pancreas.
z
Zinc and protamine are added for slow absorption
and longer duration of action.
z
Commonly used preparation is:
a) Regular insulin: SC, IV, IM
b) Lenteinsulin: SC
c) Isophane insulin: SC.
z
Fate: Insulin is degraded in GIT and hence not given
orally.
2) Highly purified insulin preparation--
z
They are non-antigenic and are indicated in insulin
resistance, diabetes undergoing surgery and trauma
and infection
Types
A. Single peak insulin: It is purified by gel filtration and
repeated crystallization. They contain 50–200 ppm
proinsulin.
B. Mono component insulin: After gel filtration it is further
purified by ion exchange chromatography.
C. Human insulin: They were produced by recombinant
DNA technology in E.coli.
The side effect of insulin
1. Hypoglycaemia
z
It is due to counter regulatory sympathetic stimulation,
sweating, anxiety, palpitation, tremor is common and
also due to brain deprivation of its essential nutrient
glucose. So, dizziness, headache, visual disturbances,
hunger, fatigue, decrease in blood pressure occur.
z
If sugar gets less than 40 milligram percentage then
coma occurs.
Treatment
Oral glucose or IV adrenaline injection
Glucagon
Local reaction
Swelling, erythema, lipodystrophy at the injection site
after prolonged use
Allergy
Treatment
a) Insulin: When an insulin drip is given, blood glucose
level should fall by 10% per hour. Routine therapy with
subcutaneous insulin is instituted when a patient is fully
conscious.
b) IV fluids: To correct dehydration.
c) KCL upto 400 milligram % of k+ is lost in urine during
+
ketoacidosis. Serum, k
is usually normal due to exchange
with intracellular store. When insulin is substituted
+
ketosis subsides and K
is driving, so dangerous
hypokalaemia can occur. So KCl should be instituted with
+
IVF and infusion depending upon serum K
and ECG.
d) NaHCO3: It is not routinely used. if arterial blood pH
is less than 7.1 acidosis of blood is not correct so it is
added. Bicarbonate infusion is continuous still blood
pH greater than 7.2.
e) Phosphate use is controversial.
f) Antibiotic.
3. Hyperosmolar coma (nonketotic coma):
Uncontrolled glycosuria of diabetes mellitus, diuresis,
dehydration and haemoconcentration urine output
decrease and glucose accumulation in blood rapidly
>800 ml/dl
Plasma osmolarity >350 mg/dl can lead patients to coma
and death can occur.
Treatment: of it is the same as ketoacidosis expect it needs
faster replacement.
Alkali (NAHCO3) not required.
It may lead to thrombosis so prophylactic heparin
therapy is recommended.
4. Insulin along with glucose is given IV to treat cyclic
vomiting in children.
Hyperemesis gravidarium, acute alcoholic intoxication.
5. To test for completeness of vagotomy: If vagotomy is
complete, gastric secretion fails to increase in response
to insulin hypoglycaemia.
Hyperglycaemic agent
Glucagon, thiazide, diuretics, phenotoin, streptozocin and
somatostatin
Uses
1. Diabetes mellitus
Complication: Infection, ketoacidosis.
Long term: Cardiovascular, retinal, neurological, renal.
Indication-
Any complication of diabetes.
Temporally 2 to tide over infection, trauma, surgery,
pregnancy.
Failure of oral hypoglycemic drugs.
2. Diabetic ketoacidosis (coma diabetic):
It is due to precipitating factors that is infection, trauma,
stroke, stress full condition in adequate dose of insulin
diabetic coma is seen in insulin dependent
Diabetic coma is seen in insulin-dependent diabetes
mellitus and less seen in non-insulin dependent diabetes
mellitus.
Oral hypoglycaemic drug
Drugs lower blood glucose level are effective orally.
1. Sulphonyl urea:: is used only in diabetic patient for
sugar reduction.
First generation: Tolbutamide, chlorpropamide.
Second generation: Gliclazide, glibenclamide,
glimepiride, glipizide (drug of choice) is the most
common used drug.
2. Biguanide: They suppress gluconeogenesis in liver
promote peripheral uterus saturation of glucose &
decreases intestinal absorption of glucose and amino
acid.
Metformin
Phenformin.
3. Meglitinide/Phenylalnine Analogues
Repaglinide
Nateglinide.
Section 1 Pharmacology
133
4. Thiazolidinediones
Rosiglitazone
Pioglitazone.
a-glucosidase inhibitors
5.
Acarbose
Miglitol
Corticosteroids
Secreted by adrenal gland.
Adrenal cortex
Glomerulosa: Aldosterone
Fasciculata: Hydrocortisone
Reticularis: Dehydroepiandrosterone, testosterone
Adrenal medulla
Adrenaline
Corticosteroid, mineralocorticoid, Na
balance, glucocorticoid—carbohydrate, fat, protein
metabolism.
Action:
1. Carbohydrate—gluconeogenesis hyperglycaemia.
2. Protein—breakdown of proteins resulting in amino
acid formation amino acids taken up by liver for
gluconeogenesis.
3. Fat-it promotes lipolysis. It causes loss of fat in
extremities which gets deposited over face, neck and
shoulders result in moon-face, fish mouth, buffalo hump
(Cushing syndrome)
4. Calcium- inhibit calcium absorption from the intestine
and excretion so calcium decrease.
5. Water—increase excretion
6. CVS—hypertension
7. The stomach—increases gastric acid secretion.
8. Inflammation—it decreases inflammation but does not
remove the cause of inflammation.
9. Allergic reaction decreases
+
– K+ and fluid
Drugs
1. Glucocorticoids
Short acting <12 hr: Hydrocortisone, Cortisone.
Intermediate (12–36 hr): Prednisolone, Triamcilone.
Long acting >36 hr: Dexamethasone(8mg) :
betamethasone.
2. Mineralocorticoids
Deoxycorticosterone acetate.
Aldosterone.
Use of mineralocorticoids
Replacement therapy (for endocrine disorder)
a. Acute adrenal insufficiency
b. Chronic adrenal insufficiency—Addison’s disease.
Use of glucocorticoids (only use as a lifesaving drug)
1. Malignancy: All (acute: Lymphocytic leukaemia)
Hodgkin’s lymphoma.
2. Organ transplantation.
Section 1 Pharmacology
3. Others: Aspiration pneumonia, pulmonary edema
134
(given during pregnancy so cause lung maturity).
4. To test adrenal and pituitary axis function.
5. Arthritides: Rheumatoid, osteoarthritis, rheumatic
fever,gout.
6. Autoimmune disease: Autoimmune hemolytic
anaemia, thrombocytopenia, myasthenia gravis
7. Bronchial asthma: Chronic severe asthma—status
asthmaticus
8. Allergic reaction
9. Lung disease
10. Eye disease: Conjunctivitis, keratinitis.
11. Skin disease.
12. Intestinal disease: Ulcerative colitis.
13. Cerebral edema: Due to tumour
14. Shock.
Side effect
1) Mineralocorticoid: Sodium and potassium retentions
oedema occurs increase blood pressure.
2) Glucocorticoid
z
Delayed healing of wound.
z
Osteoporosis
z
Glaucoma
z
Growth retardation
z
Cushing habitus—fat deposition (moon face, buffalo
hump, fish mouth)
z
Hyperglycemia.
z
Infection—more common
z
Muscular weakness
z
Peptic ulceration.
z
Posterior subcapsular cataract.
z
Psychiatric disturbances.
z
Purple striae on abdomen and thighs.
Contraindication
TV and other infection
Osteoporosis
Peptic ulcer
Pregnancy
Psychiatric disturbances
Herpes simplex keratitis
Hypertension
Diabetes
Renal failure
Cardiac heart failure
Epilepsy
Uterine stimulant/Oxytocin/abortifacients
Uterine contraction
Posterior pituitary hormone: Oxytocin to cause labor
pain.
Ergot—ergotamine IV its given in PPM—postpartum
hemorrhage to contract uterus after delivery.
Prostaglandin—PG E2, PGF2 alpha, misoprostol (tablet
to contract uterus. 4 tablets in rectum)
Miscellaneous: Ethacridine, quine (Quinine is
contraindicated in pregnancy).
Uterine relaxant
These drugs have decreased uterine motility.
Delay or postpone labour.
Arrest threatened abortion.
Ritodrine
Ethyl alcohol
Salbutamol
Magnesium sulphate.
Isoxsuprime
PG synthesis inhibitor
Atosipan
Nifedipine (dilation of blood vessels, may decreases
blood pressure, given in mi)
Oral contraceptive pills
1. Barrier method
A. Physical—condoms and dumas cap
B. Chemical—spermicidal
2. IUD (intrauterine device) most common used because
of no hormone and problem
A. First generation: Lipper loop (non medicated)
B. Second generation: Copper T, progesterone
(medicated)
3. Hormone and preparation
A. OCP
B. Deport formation—injectable, subcutaneous
Oral contraceptive pills
1. Combined pills—combination of oestrogen and
progesterone on given in unsafe period.
2. progesterone only most common pills
3. Postcoital pills—within 72 hours unwanted 72.
4. Postconceptional method—menstrual regulation
5. Miscellaneous method.
Mechanism of action
1. Inhibition of ovulation
2. Change in endometrium
3. Change in cervical mucus
4. Change in fallopian tube motility
Uses
HRT: Hormonal replacement therapy is given after
Menopause
Osteoporosis
Ovulation
Dysmenorrhea pain during menses
Prevention of iron deficiency in anaemia
Polycystic ovarian disease PCOD
Acne and hirsutism
Amenorrhoea.
Benign breast disease
Cancer (ovarian or endometrial)
Cycle regulation.
Side effect
For oestrogen (cardiac problem)
Weight gain, pigmentation, migraine, jaundice, Lipid
profile disturb, cancer of cervix or benign breast disease.
For progesterone (metabolic problem)
BP increase, HDL decreased, atherogenesis insulin decrease
diabetes may precipitate
Contraindication
Absolute contraindication
Pregnancy, thromboembolic disease, migraine, cancer:
Breast or cervical
Relative contraindication
Diabetes, blood pressure, disturbances of lipid profile,
obesity, undiagnosed bleeding disorder.
MULTIPLE CHOICE QUESTIONS
1. The most serious adverse effect of antithyroid
drug, propylthiouracil is:
A.
Drug fever B. Agranulocytosis
C. Alopecia D. Nephritis
2. Glucocorticoids can _____________
A. Elevate the plasma concentration of glucagons
B. Produce deposition of glycogen in the liver
C. Produce peculiar alteration in fat distribution
D. All of the above
3. …………………………..agent can be used
diagnostically to distinguish between pseudo-
hypoparathyroidism and hypoparathyroidism?
A.
Calcitriol B. Calcitonin
C. P TH D. NaF
4. Correct statement(s) regarding thyroid- stimulating
hormone include(s)
A.
Stimulates the thyroid adenylcyclase
B. Enhances the production of diacylglycerol
C. Induces a rise in cytosolic calcium
D. All of the above
5. ________ is a 5-lipoxygenase inhibitor.
A. Zafirlukast B. Zileuton
C. Montelukast D. None of above
6. First-generation sulfonylureas include all the
following except:
Acetohexamide B. Glipizide
A.
C. Tolazamide D. Tolbutamide
7. Which one from the following does not play
any role in the enhancement of the action of
sulfonylureas?
Prednisolone B. Clofibrate
A.
C. Salicylates D. Ethanol
8. Cyanosis and potential cyanide poisoning are
possible with:
A. Nitroglycerin B. Nitroprusside
Nitrofurantoin D. Nitrous oxide
C.
9. Lack of ADH causes diabetes insipidus. Which
drug may be prescribed to combat the disorder?
Insulin B. Metformin
A.
C. Desmopressin D. Octreotide
Section 1 Pharmacology
135
10. Insulin preparations that contain a modifying
protein include I. lente insulin, II. regular insulin,
III. isophane insulin (NPH):
I only is correct B. III only is correct
A.
C. I and II are correct D. II and III are correct
11. Hormones that increase cyclic AMP in the larger
organ include all except:
Prolactin B. F S H
A.
C. LH D. Vasopressin
12. Which hormone is released at all postganglionic
sympathetic ber?
Adrenaline B. Noradrenaline
A.
C. Dopamine D. Acetylcholine
13. A drug that lacks the sulfonylurea moiety but
stimulates insulin secretion by blocking the
sulfonylurea receptor on KATP channels in
pancreatic β cells is:
Repaglinide
A.
B. Rosiglitazone
C. Glipizide
14. If glucocorticoids use for long duration which of
the following may be induced?
Psychosis B. Subcapsular cataracts
A.
C. Osteoporosis D. All of these
15. Which of the following insulins can be
administered intravenously?
Regular insulin
A.
B. Isophane insulin
C. Protamine zinc insulin
D. Semilente insulin
16. Which action related to antithyroid drugs
A. Block the action of thyroxine on peripheral
tissues
B. Block the action of thyroxine on pituitary
C. Block the action of TSH on thyroid
D. Inhibit thyroxine synthesis
17. Which of the following steroid is not a
mineralocorticoid?
Hydrocortisone B. Desoxycorticosterone
A.
C. Spirondactone D. Fludrocortisone
18. Choose preferred preparation for the maintenance
of replacement therapy?
Thyrotropin
A.
B. Thyroglobulin
C. Liothyronine sodium
D. None
19. Estrogen replacement therapy for postmenopausal
women is contraindicated in subjects with:
Leg vein thrombosis
A.
B. Undiagnosed vaginal bleeding
C. Migraine
D. All of these
20. Bromocriptine is used to treat amenorrhoea
Section 1 Pharmacology
136
because
It stimulates the ovary
A.
B. It stimulates the GRH release
C. It suppresses the prolactin release
D. It stimulates FSH release
21. Clomiphene is used to treat infertility because it:
A. Stimulates LH secretion
B. Stimulates follicular development
C. Stimulates ovulation
D. None of the above
22. The preferred estrogen for hormone replacement
therapy in menopausal women is:
Conjugated estrogens
A.
B. Ethinylestradiol
C. Estradiol benzoate
D. Diethylstilbestrol
23. The oral hypoglycemic agent which causes lactic
acidosis.
Tolbutamide B. Acetohexamide
A.
C. Tolazemide D. Phenformin
24. Activation of …………………….G protein coupled
receptor results in the generation of secondary
messengers IP3 and DAG
Gq coupled receptor
A.
B. Gi coupled receptor
C. Gb coupled receptor
D. Gs coupled receptor
25. Which side effect of the oral contraceptive
subsides after 3–4 cycles of continued use?
Glucose intolerance B. Rise in blood pressure
A.
C. Headache D. Fluid retention
26. Insulin preparation has the longest duration of
action:
Semilente B. Isophane
A.
C. Lente D. Protamine zinc
27. All of the following drugs bind to specific
receptors in the cytoplasm of sensitive cells except:
Cortisol B. Dexamethasone
A.
C. ACTH D. Triamcinolone
28. The principal source of oestrogen in
postmenopausal women is:
Placenta B. Ovary
A.
C. Adipose tissue D. Adrenal gland
29. Which drug may decrease iodide uptake by
thyroid?
Repaglinide B. Rosiglitazone
A.
C. Glipizide D. Tolbutamide
30. Hormones that are useful in the diagnosis of
endocrine insufciency include:
Corticotropin-releasing hormone
A.
B. Gonadotropin–releasing hormone
C. Thyrotropin–releasing hormone
D. All of the above
31. Which drugs increase ADH effect?
A. Lithium B. Colchicine
C. Vinca alkaloid D. All of the above
32. Effects of iodide salts given in large doses do not
include:
A.
Decreased size of the thyroid gland
B. Increased 131I uptake
C. Decreased vascularity of the thyroid gland
D. Decreased iodination of tyrosine
33. The binding of insulin to the insulin receptor
triggers:
A.
The interaction of the receptor with protein G
B. The activation of adenylcyclase
C. Tyrosine kinase activity
D. The activation of phospholipase C
34. Which drug from the following increases the tissue
sensitivity to insulin?
A.
Acarbose B. Gliclazide
C. Rosiglitazone D. Metformine
35. Which agents has been shown to interact with oral
thyroxine (T4) replacement therapy?
A.
Propylthiouracil B. Cholestyramine
C. Thyrotropin D. Levothyroxine
36. Example of IL-1 antagonist?
A. Auranofin B. Etanercept
C. Anakinra D. Prednisolone
37. The inactive derivative of progesterone is:
A. 17-a-hydroxyl progesterone
B. Hydroxy progesterone caproate
C. Medroxy progesterone
D. Chlormedione acetate
38. Which hormone is naturally occurring female
hormone?
A.
Estradiol B. Estriol
C. Mestranol D. Estrone
39. Oxytocin:
A. Is a ringed octapeptide
B. Has ADH-like effect
C. Effects on uterus antagonized by beta-agonists
D. None of above
40. Insulin can be administered by intravenous route:
A. Regular insulin
B. Isophane insulin
C. Protamine zinc insulin
D. Semilente insulin
41. Which of the following statement is incorrect?
A. Histamine injected means triple response
B. Beta histine H1 selective histamine analogue
C. Cetrizine is metabolite of hydroxyzine
D. Terfenadine open is the K+ rectifier channel
42. This G protein-coupled receptor acts to decrease
cAMP concentration intracellularly.
A.
Gs protein-coupled receptor
B. Gi protein-coupled receptor
C. Gq protein-coupled receptor
D. Gh protein-coupled receptor
43. Choose the pair of hormones that have agonistic
effects on blood sugar levels:
A.
Calcitonin and PTH
B. Adrenalin and glucagon
C. Glucagon and glucose
D. ADH and aldosterone
44. Which of the following is LOX inhibitor?
A. Zileuton B. Zafirlukast
C. Montelukast D. Both B & C
45. The essential feature in drug addiction is:
A. Physical dependence
B. Psychological dependence
C. Both (A) and (B)
D. Psychiatric abnormality
46. ………………… has potent antiandrogenic and
weak progestational activity?
A.
Digoxin B. Furosemide
C. Enalapril D. Amrinone
47. Which preparations is used to gain remission of
thyrotoxicosis?
A.
Propranolol
B. Liotrix
C. Levothyroxine
D. Propylthiouracil
48. Choose correct statement about peptide hormones
A. They make an entry into the cell through the
plasma membrane.
B. Firstly, hormone enters the cell then influences
the production of an enzyme
C. The hormone make complex with receptor then
binds to the DNA directly
D. They bind to a receptor site on the surface of
the cell.
49. Which of the following endocrine organs are
capable of secreting hormones that can enter the
cell because of their structure?
A.
Ovaries B. Testes
C. Adrenal glands D. All of the above
50. Which is the treatment of choice for
myxoedemacoma (emergency treatment)?
A.
Thyroxine B. Glucocorticoids
C. Liothyroxine D. Methimazole
51. Several actions of growth hormone are exerted
through the elaboration of:
A.
Insulin-like growth factor - 1
B. Cyclic AMP
C. Cyclic GMP
D. Somatostatin
52. In which of the following conditions estrogen is
not the primary drug but is added to progestin as
adjuvant?
A.
Dysfunctional uterine bleeding
B. Menopausal syndrome
C. Osteoporosis
D. Atrophic vaginitis
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137
53. All of the following conditions are causes of
hypothyroidism except:
A.
Endemic goiter
B. Surgical excision
C. Goitrin-induced iodine deficiency
D. Graves’s disease
54. The most important indication of mifepristone is:
A. Endometriosis
B. Cushing’s syndrome
C. First term abortion
D. Second term abortion
55. The mechanism of action of sulfonyl urea is that
they:
A.
Decrease degradation of glucose
B. Lower the blood glucose concentration by
producing insulin-like effect
C. Stimulate the release of insulin from B cells of
the pancreas
D. Increase glucose utilization in the periphery
56. Transdermal estradiol differs from oral estrogen
therapy in that it:
A.
FSH + LH obtained from the urine of
menstruating women
B. LH obtained from the urine of pregnant women
C. FSH + LH obtained from the urine of menopausal
women
D.
LH obtained from the serum of pregnant mare
57. Oestrogen act through …………………..receptor
A. Intracytoplasmic receptors
B. Nuclear receptor
C. Mitochondrial receptor
D. Cell membrane receptor
58. Who is least likely to be treated with somatropin?
A. A 4-year-old girl with an XO genetic genotype
B. A 4-year-old boy with chronic renal failure and
growth deficiency
C. A 10-year-old boy with polydipsia and polyuria
D. A 37-year-old AIDS patient who is 180 cm tall
and weights 52 kg
59. Which of the following compounds is incorrectly
matched with its mechanism of action?
A.
Flutamide: Competitively blocks the binding of
androgens to their receptor
B. Finasteride: Inhibits 5a-reductase
C. Miglitol: Inhibits a-glucosidase
D. Pioglitazone: Competitively blocks the binding
of estrogens to their receptor
60. Which of the following is true of anabolic steroids?
A. They are testosterone congeners having
anabolic but no androgenic activity
B. They are androgens with relatively selective
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138
anabolic activity
C. They are suitable for long-term therapy in
children
D. Both (B) and (C)
61. Which drug may be prescribed to treat
hypethroidism?
A.
Pegvisomant B. Insulin
C. Desmopressin D. Levothyroxine
62. When initiating thyroxine therapy for an elderly
patient with long-standing hypothyroidism, it is
important to begin with small doses to avoid?
A.
A flare of exophthalmos
B. Acute renal failure
C. Overstimulation of the heart
D. Hemolysis
63. What patient population should be screened for
thyroid disease?
A.
Hospitalized patients
B. Elderly hospitalized patients
C. College students
D. Women over 20 years old
64. Dantrolene sodium is used to treat:
A. Hypertension
B. Malignant hyperthermia
C. Malignant hypertension
D. Cancer
65. Which of the following substances when present
in urine is the most likely positive sign of
pregnancy?
A.
Thyroid-stimulating hormone (TSH)
B. Corticotropin
C. Human chronic gonadotropin (HCG)
D. Interstitial cell-stimulating hormone (ICSH)
66. Which hormone promotes the resorption of water
at the renal distal convoluted tubule?
A.
Testosterone B. Insulin
C. Corticotropin D. Vasopressin
67. All are produced from anterior lobe of the pituitary
gland except:
A.
Prolactin B. Luteinizing hormone
C. Growth hormone D. Antidiuretic hormone
68. Which antidiabetic agent is preferred in insulin-
dependent diabetic patients to control severe
ketoacidosis?
A.
Tolbutamide
B. Protamine zine insulin
C. Isophane
D. Crystalline zinc insulin
69. Choose a drug that is most likely to cause
hypoglycemia when used as monotherapy in the
treatment of type 2 diabetes?
A.
Acarbose B. Glyburide
C. Metformin D. Miglitol
70. Propylthiouracil is useful in the treatment of:
A. Derangement toxicosis
B. Hypothyroidism
C. Hypoparathyroidism
D. Hyperthyroidism