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WorksheetsFINAL Draft 1
Total questions: 70
Worksheet time: 35mins
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 antiarrhythmic exhibits reverse-use dependence (greater APD prolongation at slower heart rates) increasing torsades risk?
Amiodarone
Sotalol
Lidocaine
Verapamil
A neonate develops apnea after maternal administration of an analgesic during labor. Which drug is most likely responsible?
Meperidine
Ibuprofen
Paracetamol
Amoxicillin
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
In pharmacokinetics, clearance (CL) equals:
Vd x elimination rate constant (k)
Half-life x Vd
Bioavailability x dose
Area under curve / dose
Which anticonvulsant is most associated with aplastic anemia and therefore used cautiously?
Carbamazepine
Ethosuximide
Valproate
Lamotrigine
Which enzyme modification would most reduce formation of the active metabolite of clopidogrel?
CYP3A4 inhibition
CYP2C19 inhibition
CYP1A2 induction
Glucuronidation inhibition
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 anti-cancer drug’s cardiotoxicity is mediated by free radical generation and is dose-limited?
Cisplatin
Doxorubicin
Vincristine
Methotrexate
Which antibiotic’s absorption is markedly reduced by concurrent oral iron therapy?
Ciprofloxacin
Azithromycin
Cefixime
Doxycycline
For an elderly patient with CKD (eGFR 25 mL/min/1.73m²), which analgesic is least preferable long-term?
Paracetamol
Naproxen
Low-dose buprenorphine patch
Topical diclofenac
Which glucose-lowering agent reduces cardiovascular mortality in patients with established atherosclerotic CVD?
Glimepiride
Pioglitazone
Empagliflozin
Acarbose
Which antimicrobial combination is antagonistic in vitro when bactericidal activity is required?
Penicillin + gentamicin
Chloramphenicol + penicillin
TMP-SMX (synergy)
Piperacillin + tazobactam
Which drug is a mechanism-based (suicide) inhibitor of CYP450 and can cause long-lasting interactions?
Fluoxetine
Ketoconazole
Clopidogrel
Omeprazole
Which drug pair poses the highest risk of serotonin syndrome?
Sertraline + tramadol
Amitriptyline + warfarin
Fluoxetine + metoprolol
Citalopram + calcium channel blocker
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 inhaled anesthetic is associated with the highest risk of postoperative nausea and vomiting (PONV)?
Sevoflurane
Propofol
Nitrous oxide
Thiopental
Which antibiotic’s toxicity is potentiated by concurrent loop diuretics leading to ototoxicity?
Amoxicillin
Gentamicin
Vancomycin
Azithromycin
Which drug is most likely to cause drug-induced lupus?
Isoniazid
Hydralazine
Doxycycline
Omeprazole
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 neuroleptic has the lowest risk of extrapyramidal side effects but higher metabolic adverse effects?
Ticagrelor
Clopidogrel
Cangrelor
Dipyridamole
What is the principal mechanism of action of sulfonylureas?
Haloperidol
Clozapine
Olanzapine
Fluphenazine
Which drug requires therapeutic drug monitoring due to narrow therapeutic index and non-linear kinetics?
Activate GLP-1 receptor
Block ATP-sensitive K+ channels on pancreatic β-cells
Increase insulin sensitivity in peripheral tissues exclusively
Inhibit α-glucosidase in intestine
Which antibiotic is associated with QT prolongation and torsades de pointes?
Phenytoin
Gabapentin
Levetiracetam
Pregabalin
Which antiviral requires dose adjustment in renal impairment due to renal excretion?
Levofloxacin
Ceftriaxone
Doxycycline
Amoxicillin
Which antiviral requires dose adjustment in renal impairment due to renal excretion?
Levofloxacin
Ceftriaxone
Doxycycline
Amoxicillin
Which targeted cancer therapy is a BCR-ABL tyrosine kinase inhibitor?
Acyclovir
Zidovudine
Nevirapine
Efavirenz
Which analgesic is safest for a breastfeeding mother with pain?
Codeine
Ibuprofen
Tramadol
High-dose aspirin
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 drug is a direct oral anticoagulant that inhibits factor Xa?
Dabigatran
Rivaroxaban
Heparin
Warfarin
Which vaccine type is contraindicated in severe immunosuppression?
Live-attenuated vaccines (e.g., MMR)
Inactivated vaccines
Conjugate vaccines
Recombinant subunit vaccines
Which anti-TB drug causes optic neuritis requiring visual acuity monitoring?
Ethambutol
Isoniazid
Rifampicin
Pyrazinamide
Which drug interaction causes decreased efficacy of hormonal contraceptives leading to failure?
Isoniazid
Ethambutol
Pyrazinamide
Rifampicin
Which drug interaction causes decreased efficacy of hormonal contraceptives leading to failure?
St. John’s Wort
Cimetidine
Ketoconazole
Erythromycin
Which opioid is a partial agonist at μ receptor and has ceiling effect for respiratory depression?
Morphine
Buprenorphine
Fentanyl
Methadone
Which antiarrhythmic is safest in patients with structural heart disease (reduced proarrhythmia risk)?
Flecainide
Amiodarone
Quinidine
Dofetilide
Which antifungal interacts seriously with statins causing rhabdomyolysis?
Fluconazole
Itraconazole/ketoconazole
Nystatin
Terbinafine
Which drug is recommended as the first-line agent for acute gout flare?
Allopurinol
Colchicine
Febuxostat
Probenecid
Which drug is used for the treatment of gout?
Colchicine
Febuxostat
Probenecid
Colchicine
Which cytokine blockade is targeted by tocilizumab?
TNF-α
IL-6 receptor
IL-1 receptor
CD20
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 agent is associated with severe cutaneous adverse reactions (SJS/TEN) particularly in HLA-B*1502 carriers?
Carbamazepine
Levetiracetam
Valproate
Gabapentin
Which drug reduces mortality in systolic heart failure with reduced ejection fraction when added to standard therapy?
Hydralazine alone
Spironolactone
Terazosin
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
Bile acid sequestrants
Ezetimibe
Which drug is associated with severe hepatotoxicity and pancreatitis and is contraindicated in pregnancy?
Ribavirin
Isotretinoin
Methimazole
Valproate
Which antiviral for hepatitis C is a NS5A inhibitor?
Sofosbuvir
Daclatasvir
Interferon-alpha
Ribavirin
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 drug class increases the risk of tendon rupture especially in elderly and corticosteroid users?
Paracetamol
Aspirin
Acetazolamide
Ibuprofen
Which drug class increases the risk of tendon rupture especially in elderly and corticosteroid users?
Macrolides
Fluoroquinolones
Aminoglycosides
Tetracyclines
Which statin has the least CYP3A4-mediated interactions and is preferred with potent CYP3A4 inhibitors?
Simvastatin
Atorvastatin
Rosuvastatin
Lovastatin
Which drug used for chronic heart failure provides mortality benefit by neprilysin inhibition when combined with an ARB?
ACE inhibitor
Sacubitril
Hydralazine
Dobutamine infusion
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 antibiotic is contraindicated in children under 8 years because of permanent tooth discoloration?
Tetracyclines
Amoxicillin
Erythromycin
Trimethoprim
Which antiemetic is associated with extrapyramidal side effects and should be used cautiously?
Ondansetron
Metoclopramide
Domperidone
Aprepitant
Which adverse effect is most characteristic of amphotericin B therapy?
Nephrotoxicity and infusion-related chills/fever
Ototoxicity mainly
Severe hepatotoxicity primarily
Pulmonary fibrosis
Which pharmacological strategy minimizes opioid-induced constipation without reversing analgesia?
Systemic naloxone infusion
Peripheral μ-opioid receptor antagonists
Increase opioid dose
Add benzodiazepine
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
The most appropriate drug for Parkinson’s disease tremor predominant in an elderly patient with urinary retention is:
Trihexyphenidyl
Levodopa
Amantadine
Pramipexole
Which of the following is the hallmark lab abnormality in tumor lysis syndrome?
Trihexyphenidyl
Levodopa/carbidopa
Amantadine only
Deep brain stimulation
Which antiarrhythmic is contraindicated in patients with long QT syndrome?
Hypouricemia
Hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia
Isolated hyponatremia only
Hypokalemia
Which CNS stimulant is approved for narcolepsy and has abuse potential?
Lidocaine
Sotalol
Adenosine
Digoxin
Which antiplatelet is reversible and useful when rapid offset is needed (e.g., pre-surgery)?
Modafinil
Methylphenidate / amphetamines
Baclofen
Pregabalin
Which cancer chemotherapy agent causes peripheral neuropathy predominantly by microtubule stabilization?
Clopidogrel
Ticagrelor
Aspirin
Prasugrel
Which cancer chemotherapy agent causes peripheral neuropathy predominantly by microtubule stabilization?
Clopidogrel
Ticagrelor
Aspirin
Prasugrel
Which drug is associated with neurotoxicity by microtubule stabilization causing neuropathy?
Cisplatin (neurotoxicity by other mechanisms)
Paclitaxel (taxanes: microtubule stabilization causing neuropathy)
Doxorubicin
Methotrexate
Which antibiotic requires therapeutic monitoring of peak and trough levels to avoid nephro- and ototoxicity?
Vancomycin
Azithromycin
Tetracycline
Cephalexin
Which target is inhibited by monoclonal antibody pembrolizumab used in oncology?
VEGF
PD-1 immune checkpoint receptor
HER2 receptor
EGFR
Which pharmacologic strategy is most appropriate to prevent methotrexate toxicity in high-dose chemotherapy?
Give folic acid concurrently at full dose
Leucovorin
No rescue required
Increase methotrexate dose further
Which trial design feature minimizes selection bias by ensuring blinding of allocation until participants are enrolled?
Open-label randomization
Allocation concealment
Per-protocol analysis
Post-hoc subgroup analysis
