Font size
WorksheetsKSMP STATE LEVEL QUIZ — Pharmacology
Total questions: 66
Worksheet time: 50mins
Which adverse effect is most characteristic of amphotericin B therapy?
Nephrotoxicity and infusion-related chills/fever
Ototoxicity mainly
Severe hepatotoxicity primarily
Pulmonary fibrosis
Which cancer chemotherapy agent causes peripheral neuropathy predominantly by microtubule stabilization?
Cisplatin (neurotoxicity by other mechanisms)
Paclitaxel (taxanes: microtubule stabilization causing neuropathy)
Doxorubicin
Methotrexate
Which neuroleptic has the lowest risk of extrapyramidal side effects but higher metabolic adverse effects?
Haloperidol
Clozapine
Olanzapine
Fluphenazine
Which drug pair poses the highest risk of serotonin syndrome?
A. Amitriptyline + warfarin
B. Fluoxetine + metoprolol
C. Sertraline + tramadol
D. Citalopram + calcium channel blocker
Which pharmacologic strategy is most appropriate to prevent methotrexate toxicity in high-dose chemotherapy?
Give folic acid concurrently at full dose (reduces anti-cancer efficacy)
Leucovorin (folinic acid) rescue after high-dose methotrexate to allow normal cells to recover
No rescue required
Increase methotrexate dose further
A neonate develops apnea after maternal administration of an analgesic during labour. Which drug is most likely responsible?
Meperidine (pethidine)
Ibuprofen
Paracetamol
Amoxicillin
Which targeted cancer therapy is a BCR-ABL tyrosine kinase inhibitor?
Imatinib
Erlotinib
Trastuzumab
Bevacizumab
Which target is inhibited by monoclonal antibody pembrolizumab used in oncology?
VEGF
PD-1 immune checkpoint receptor
HER2 receptor
EGFR
Which antibiotic’s absorption is markedly reduced by concurrent oral iron therapy?
Ciprofloxacin
Azithromycin
Cefixime
Doxycycline
Which antibiotic requires therapeutic monitoring of peak and trough levels to avoid nephro- and ototoxicity?
Vancomycin and aminoglycosides (e.g., gentamicin) — monitor levels
Azithromycin
Tetracycline
Cephalexin
In elderly patients, which pharmacokinetic change commonly increases drug sensitivity?
Increased renal clearance
Increased Vd for hydrophilic drugs
Decreased hepatic metabolism and reduced clearance
Faster gastric emptying
Which opioid is a partial agonist at μ receptor and has ceiling effect for respiratory depression?
Morphine
Buprenorphine
Fentanyl
Methadone
Which pharmacodynamic property explains why naloxone precipitates opioid withdrawal?
Naloxone is an opioid antagonist that displaces agonists from receptors abruptly
Naloxone is a partial agonist producing withdrawal
Naloxone is a long-acting opioid agonist
Naloxone increases opioid receptor synthesis
Which anti-cancer drug’s cardiotoxicity is mediated by free radical generation and is dose-limited?
Cisplatin
Doxorubicin
Vincristine
Methotrexate
Which statin has the least CYP3A4-mediated interactions and is preferred with potent CYP3A4 inhibitors?
Simvastatin
Atorvastatin
Rosuvastatin or pravastatin (less CYP3A4 metabolism)
Lovastatin
Which drug is most likely to cause drug-induced lupus?
Isoniazid
Hydralazine
Doxycycline
Omeprazole
Which drug is a mechanism-based (suicide) inhibitor of CYP450 and can cause long-lasting interactions?
(a)
Which drug is associated with severe hepatotoxicity and pancreatitis and is contraindicated in pregnancy?
Ribavirin
Isotretinoin (teratogenic)
Methimazole (teratogenic)
Valproate (teratogenic and hepatotoxic risk)
Which antiviral for hepatitis C is a NS5A inhibitor?
Sofosbuvir (NS5B polymerase inhibitor)
Daclatasvir (NS5A inhibitor)
Interferon-alpha (immunomodulator)
Ribavirin (nucleoside analog)
Which trial design feature minimizes selection bias by ensuring blinding of allocation until participants are enrolled?
Open-label randomization
Allocation concealment (e.g., centralized randomization or sealed opaque envelopes)
Per-protocol analysis
Post-hoc subgroup analysis
Which drug is a direct oral anticoagulant that inhibits factor Xa?
Dabigatran
Rivaroxaban
Heparin
Warfarin
A patient with autoimmune disease needs immunosuppression but wishes to father a child soon. Which agent is least preferred due to gonadal toxicity?
Azathioprine
Methotrexate
Hydroxychloroquine
Low-dose prednisone
Which receptor mechanism best explains tachyphylaxis to repeated doses of nasal decongestants (e.g., oxymetazoline)?
Receptor down-regulation
Receptor up-regulation
Receptor desensitization/internalization
Increased second-messenger generation
Which pharmacological property is most important for CNS penetration?
High molecular weight
Lipophilicity and low P-gp efflux
High plasma protein binding only
High ionization at physiological pH
Which pharmacological strategy minimizes opioid-induced constipation without reversing analgesia?
Systemic naloxone infusion
Peripheral α-opioid receptor antagonists (e.g., methylnaltrexone, naloxegol)
Increase opioid dose
Add benzodiazepine
Which drug is recommended as the first-line agent for acute gout flare?
Allopurinol
Colchicine or NSAIDs (e.g., indomethacin) or corticosteroids depending on patient profile
Febuxostat only
Probenecid
Which antibiotic is associated with QT prolongation and torsades de pointes?
Levofloxacin (fluoroquinolones)
Ceftriaxone
Doxycycline
Amoxicillin
Which agent is associated with severe cutaneous adverse reactions (SJS/TEN) particularly in HLA-B*1502 carriers?
Carbamazepine
Levetiracetam
Valproate
Gabapentin
Which anti-TB drug causes optic neuritis requiring visual acuity monitoring?
Isoniazid
Ethambutol
Pyrazinamide
Rifampicin
Which of the following is the hallmark lab abnormality in tumor lysis syndrome?
Hypouricemia
Hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia
Isolated hyponatremia only
Hypokalemia
What is the principal mechanism of action of sulfonylureas?
Activate GLP-1 receptor
Block ATP-sensitive K+ channels on pancreatic β-cells → insulin release
Increase insulin sensitivity in peripheral tissues exclusively
Inhibit α-glucosidase in intestine
Which analgesic is most likely to precipitate asthma exacerbation in aspirin-sensitive individuals?
Paracetamol
Aspirin and other nonselective NSAIDs (COX-1 inhibitors)
Acetazolamide
Ibuprofen (less in many but still possible)
Which inhaled anesthetic is associated with the highest risk of postoperative nausea and vomiting (PONV)?
Sevoflurane
Propofol (IV)
Nitrous oxide
Thiopental
Which vaccine type is contraindicated in severe immunosuppression?
Live-attenuated vaccines (e.g., MMR)
Inactivated vaccines
Conjugate vaccines
Recombinant subunit vaccines
Which antiarrhythmic is safest in patients with structural heart disease (reduced proarrhythmia risk)?
Flecainide (contraindicated in structural disease)
Amiodarone
Quinidine
Dofetilide (careful monitoring required)
Which drug interaction causes decreased efficacy of hormonal contraceptives leading to failure?
St. John’s Wort (CYP3A4 inducer)
Cimetidine (CYP inhibitor)
Ketoconazole (inhibitor)
Erythromycin (inhibitor)
Which anticonvulsant is most associated with aplastic anemia and therefore used cautiously?
Carbamazepine
Ethosuximide
Valproate
Lamotrigine
Which of the following is the best antidote for acetaminophen (paracetamol) overdose?
Activated charcoal only
N-acetylcysteine (NAC) to replenish glutathione
Atropine
Flumazenil
Which protein mutation is classically associated with multi-drug resistance (MDR) via efflux of chemotherapeutics?
BCR-ABL
P-glycoprotein (ABCB1) overexpression
EGFR mutation
BRAF V600E
Which drug class increases the risk of tendon rupture especially in elderly and corticosteroid users?
Macrolides
Fluoroquinolones
Aminoglycosides
Tetracyclines
Which drug requires therapeutic drug monitoring due to narrow therapeutic index and non-linear kinetics?
Phenytoin
Gabapentin
Levetiracetam
Pregabalin
Which drug is most appropriate for Parkinson’s disease tremor predominant in an elderly patient with urinary retention?
Trihexyphenidyl (anticholinergic — avoid in elderly with urinary retention)
Levodopa/carbidopa (preferred in elderly for symptomatic control)
Amantadine only
Deep brain stimulation (not first-line drug choice)
Which antiplatelet agent irreversibly inhibits the P2Y12 receptor?
(a)
Which enzyme inhibition would most reduce formation of the active metabolite of clopidogrel?
CYP3A4 inhibition
CYP2C19 inhibition
CYP1A2 induction
Glucuronidation inhibition
Which drug used for chronic heart failure provides mortality benefit by neprilysin inhibition when combined with an ARB?
ACE inhibitor alone
Sacubitril + valsartan (ARNI)
Hydralazine only
Dobutamine infusion
Which mechanism explains ACE inhibitor–induced angioedema?
Bradykinin accumulation increasing vascular permeability
IgE-mediated allergic reaction exclusively
Direct mast cell degranulation only
Complement activation only
Which antibiotic is contraindicated in children under 8 years because of permanent tooth discoloration?
Tetracyclines (e.g., doxycycline in prolonged use)
Amoxicillin
Erythromycin
Trimethoprim
Which drug reduces mortality in systolic heart failure with reduced ejection fraction when added to standard therapy?
Hydralazine alone
Spironolactone (aldosterone antagonist) in selected patients
Terazosin
Nifedipine
Which CNS stimulant is approved for narcolepsy and has abuse potential?
Modafinil (lower abuse potential)
Methylphenidate / amphetamines (higher abuse potential)
Baclofen
Pregabalin
Which analgesic is safest for a breastfeeding mother with pain?
Codeine (avoid in ultra-rapid metabolizers)
Ibuprofen (short half-life NSAID)
Tramadol (avoid)
High-dose aspirin (avoid)
Which antiviral requires dose adjustment in renal impairment due to renal excretion?
A. Acyclovir
B. Zidovudine (hepatic metabolism)
C. Nevirapine
D. Efavirenz
Which antiarrhythmic exhibits reverse-use dependence (greater APD prolongation at slower heart rates) increasing torsades risk?
Amiodarone
Sotalol
Lidocaine
Verapamil
Which glucose-lowering agent reduces cardiovascular mortality in patients with established atherosclerotic CVD?
Glimepiride
Pioglitazone
Empagliflozin
Acarbose
Which drug is used to reverse the effects of dabigatran in major bleeding?
Vitamin K
Idarucizumab (a monoclonal antibody fragment)
Protamine sulfate
Andexanet alfa (for factor Xa inhibitors)
Which antifungal interacts seriously with statins causing rhabdomyolysis?
Fluconazole (less)
Itraconazole/ketoconazole (strong CYP3A4 inhibitors)
Nystatin (no systemic absorption)
Terbinafine (less interaction)
Which antimicrobial combination is antagonistic in vitro when bactericidal activity is required?
Penicillin + gentamicin (synergy in enterococcal endocarditis)
Chloramphenicol + penicillin
TMP-SMX (synergy)
Piperacillin + tazobactam
Which laboratory parameter best monitors heparin therapy in most hospitals (unfractionated heparin)?
PT/INR
aPTT (activated partial thromboplastin time)
Serum creatinine
Platelet count only
Which antihyperlipidaemic decreases triglycerides primarily via PPAR-α activation?
Statins
Fibrates (e.g., fenofibrate, gemfibrozil)
Bile acid sequestrants
Ezetimibe
Which cytokine blockade is targeted by tocilizumab?
TNF-α
IL-6 receptor
IL-1 receptor
CD20
Which antiplatelet is reversible and useful when rapid offset is needed (e.g., pre-surgery)?
Clopidogrel (irreversible)
Ticagrelor (reversible P2Y12 inhibitor — faster offset than clopidogrel)
Aspirin (irreversible)
Which method is most appropriate to detect latent TB infection before starting anti-TNF therapy?
Chest X-ray only
IGRA or Mantoux (TST) testing plus history and chest imaging
No screening necessary
Start therapy and monitor
A patient on chronic statin therapy is started on diltiazem. Which adverse reaction should be anticipated?
Increased risk of statin-induced myopathy
Increased LDL cholesterol
Statin withdrawal syndrome
Hypoglycaemia
Which antibiotic’s toxicity is potentiated by concurrent loop diuretics leading to ototoxicity?
Amoxicillin
Gentamicin
Vancomycin (less ototoxic)
Azithromycin
Which antiemetic is associated with extrapyramidal side effects and should be used cautiously?
Ondansetron (less EPS)
Metoclopramide (dopamine D2 antagonist — risk of acute dystonia, tardive dyskinesia)
Domperidone (less central EPS)
Aprepitant
Which antiarrhythmic is contraindicated in patients with long QT syndrome?
Lidocaine (class IB — generally safe)
Sotalol and other class III agents that prolong QT
Adenosine (paroxysmal SVT use)
Digoxin
For an elderly patient with CKD (eGFR 25 mL/min/1.73m²), which analgesic is least preferable long-term?
Paracetamol
Naproxen (NSAID)
Low-dose buprenorphine patch
Topical diclofenac
