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Worksheets

FINAL Draft 1

Total questions: 70

Worksheet time: 35mins

Name
Class
Date
1.

Which receptor mechanism best explains tachyphylaxis to repeated doses of nasal decongestants (e.g., oxymetazoline)?

a)

Receptor down-regulation

b)

Receptor up-regulation

c)

Receptor desensitization/internalization

d)

Increased second-messenger generation

2.

Which antiarrhythmic exhibits reverse-use dependence (greater APD prolongation at slower heart rates) increasing torsades risk?

a)

Amiodarone

b)

Sotalol

c)

Lidocaine

d)

Verapamil

3.

A neonate develops apnea after maternal administration of an analgesic during labor. Which drug is most likely responsible?

a)

Meperidine

b)

Ibuprofen

c)

Paracetamol

d)

Amoxicillin

4.

Which protein mutation is classically associated with multi-drug resistance (MDR) via efflux of chemotherapeutics?

a)

BCR-ABL

b)

P-glycoprotein (ABCB1) overexpression

c)

EGFR mutation

d)

BRAF V600E

5.

In pharmacokinetics, clearance (CL) equals:

a)

Vd x elimination rate constant (k)

b)

Half-life x Vd

c)

Bioavailability x dose

d)

Area under curve / dose

6.

Which anticonvulsant is most associated with aplastic anemia and therefore used cautiously?

a)

Carbamazepine

b)

Ethosuximide

c)

Valproate

d)

Lamotrigine

7.

Which enzyme modification would most reduce formation of the active metabolite of clopidogrel?

a)

CYP3A4 inhibition

b)

CYP2C19 inhibition

c)

CYP1A2 induction

d)

Glucuronidation inhibition

8.

A patient on chronic statin therapy is started on diltiazem. Which adverse reaction should be anticipated?

a)

Increased risk of statin-induced myopathy

b)

Increased LDL cholesterol

c)

Statin withdrawal syndrome

d)

Hypoglycaemia

9.

Which anti-cancer drug’s cardiotoxicity is mediated by free radical generation and is dose-limited?

a)

Cisplatin

b)

Doxorubicin

c)

Vincristine

d)

Methotrexate

10.

Which antibiotic’s absorption is markedly reduced by concurrent oral iron therapy?

a)

Ciprofloxacin

b)

Azithromycin

c)

Cefixime

d)

Doxycycline

11.

For an elderly patient with CKD (eGFR 25 mL/min/1.73m²), which analgesic is least preferable long-term?

a)

Paracetamol

b)

Naproxen

c)

Low-dose buprenorphine patch

d)

Topical diclofenac

12.

Which glucose-lowering agent reduces cardiovascular mortality in patients with established atherosclerotic CVD?

a)

Glimepiride

b)

Pioglitazone

c)

Empagliflozin

d)

Acarbose

13.

Which antimicrobial combination is antagonistic in vitro when bactericidal activity is required?

a)

Penicillin + gentamicin

b)

Chloramphenicol + penicillin

c)

TMP-SMX (synergy)

d)

Piperacillin + tazobactam

14.

Which drug is a mechanism-based (suicide) inhibitor of CYP450 and can cause long-lasting interactions?

a)

Fluoxetine

b)

Ketoconazole

c)

Clopidogrel

d)

Omeprazole

15.

Which drug pair poses the highest risk of serotonin syndrome?

a)

Sertraline + tramadol

b)

Amitriptyline + warfarin

c)

Fluoxetine + metoprolol

d)

Citalopram + calcium channel blocker

16.

A patient with autoimmune disease needs immunosuppression but wishes to father a child soon. Which agent is least preferred due to gonadal toxicity?

a)

Azathioprine

b)

Methotrexate

c)

Hydroxychloroquine

d)

Low-dose prednisone

17.

Which inhaled anesthetic is associated with the highest risk of postoperative nausea and vomiting (PONV)?

a)

Sevoflurane

b)

Propofol

c)

Nitrous oxide

d)

Thiopental

18.

Which antibiotic’s toxicity is potentiated by concurrent loop diuretics leading to ototoxicity?

a)

Amoxicillin

b)

Gentamicin

c)

Vancomycin

d)

Azithromycin

19.

Which drug is most likely to cause drug-induced lupus?

a)

Isoniazid

b)

Hydralazine

c)

Doxycycline

d)

Omeprazole

20.

In elderly patients, which pharmacokinetic change commonly increases drug sensitivity?

a)

Increased renal clearance

b)

Increased Vd for hydrophilic drugs

c)

Decreased hepatic metabolism and reduced clearance

d)

Faster gastric emptying

21.

Which neuroleptic has the lowest risk of extrapyramidal side effects but higher metabolic adverse effects?

a)

Ticagrelor

b)

Clopidogrel

c)

Cangrelor

d)

Dipyridamole

22.

What is the principal mechanism of action of sulfonylureas?

a)

Haloperidol

b)

Clozapine

c)

Olanzapine

d)

Fluphenazine

23.

Which drug requires therapeutic drug monitoring due to narrow therapeutic index and non-linear kinetics?

a)

Activate GLP-1 receptor

b)

Block ATP-sensitive K+ channels on pancreatic β-cells

c)

Increase insulin sensitivity in peripheral tissues exclusively

d)

Inhibit α-glucosidase in intestine

24.

Which antibiotic is associated with QT prolongation and torsades de pointes?

a)

Phenytoin

b)

Gabapentin

c)

Levetiracetam

d)

Pregabalin

25.

Which antiviral requires dose adjustment in renal impairment due to renal excretion?

a)

Levofloxacin

b)

Ceftriaxone

c)

Doxycycline

d)

Amoxicillin

26.

Which antiviral requires dose adjustment in renal impairment due to renal excretion?

a)

Levofloxacin

b)

Ceftriaxone

c)

Doxycycline

d)

Amoxicillin

27.

Which targeted cancer therapy is a BCR-ABL tyrosine kinase inhibitor?

a)

Acyclovir

b)

Zidovudine

c)

Nevirapine

d)

Efavirenz

28.

Which analgesic is safest for a breastfeeding mother with pain?

a)

Codeine

b)

Ibuprofen

c)

Tramadol

d)

High-dose aspirin

29.

Which mechanism explains ACE inhibitor-induced angioedema?

a)

Bradykinin accumulation increasing vascular permeability

b)

IgE-mediated allergic reaction exclusively

c)

Direct mast cell degranulation only

d)

Complement activation only

30.

Which drug is a direct oral anticoagulant that inhibits factor Xa?

a)

Dabigatran

b)

Rivaroxaban

c)

Heparin

d)

Warfarin

31.

Which vaccine type is contraindicated in severe immunosuppression?

a)

Live-attenuated vaccines (e.g., MMR)

b)

Inactivated vaccines

c)

Conjugate vaccines

d)

Recombinant subunit vaccines

32.

Which anti-TB drug causes optic neuritis requiring visual acuity monitoring?

a)

Ethambutol

b)

Isoniazid

c)

Rifampicin

d)

Pyrazinamide

33.

Which drug interaction causes decreased efficacy of hormonal contraceptives leading to failure?

a)

Isoniazid

b)

Ethambutol

c)

Pyrazinamide

d)

Rifampicin

34.

Which drug interaction causes decreased efficacy of hormonal contraceptives leading to failure?

a)

St. John’s Wort

b)

Cimetidine

c)

Ketoconazole

d)

Erythromycin

35.

Which opioid is a partial agonist at μ receptor and has ceiling effect for respiratory depression?

a)

Morphine

b)

Buprenorphine

c)

Fentanyl

d)

Methadone

36.

Which antiarrhythmic is safest in patients with structural heart disease (reduced proarrhythmia risk)?

a)

Flecainide

b)

Amiodarone

c)

Quinidine

d)

Dofetilide

37.

Which antifungal interacts seriously with statins causing rhabdomyolysis?

a)

Fluconazole

b)

Itraconazole/ketoconazole

c)

Nystatin

d)

Terbinafine

38.

Which drug is recommended as the first-line agent for acute gout flare?

a)

Allopurinol

b)

Colchicine

c)

Febuxostat

d)

Probenecid

39.

Which drug is used for the treatment of gout?

a)

Colchicine

b)

Febuxostat

c)

Probenecid

d)

Colchicine

40.

Which cytokine blockade is targeted by tocilizumab?

a)

TNF-α

b)

IL-6 receptor

c)

IL-1 receptor

d)

CD20

41.

Which pharmacological property is most important for CNS penetration?

a)

High molecular weight

b)

Lipophilicity and low P-gp efflux

c)

High plasma protein binding only

d)

High ionization at physiological pH

42.

Which agent is associated with severe cutaneous adverse reactions (SJS/TEN) particularly in HLA-B*1502 carriers?

a)

Carbamazepine

b)

Levetiracetam

c)

Valproate

d)

Gabapentin

43.

Which drug reduces mortality in systolic heart failure with reduced ejection fraction when added to standard therapy?

a)

Hydralazine alone

b)

Spironolactone

c)

Terazosin

44.

Which laboratory parameter best monitors heparin therapy in most hospitals (unfractionated heparin)?

a)

PT/INR

b)

aPTT (activated partial thromboplastin time)

c)

Serum creatinine

d)

Platelet count only

45.

Which antihyperlipidaemic decreases triglycerides primarily via PPAR-α activation?

a)

Statins

b)

Fibrates

c)

Bile acid sequestrants

d)

Ezetimibe

46.

Which drug is associated with severe hepatotoxicity and pancreatitis and is contraindicated in pregnancy?

a)

Ribavirin

b)

Isotretinoin

c)

Methimazole

d)

Valproate

47.

Which antiviral for hepatitis C is a NS5A inhibitor?

a)

Sofosbuvir

b)

Daclatasvir

c)

Interferon-alpha

d)

Ribavirin

48.

Which drug is used to reverse the effects of dabigatran in major bleeding?

a)

Vitamin K

b)

Idarucizumab (a monoclonal antibody fragment)

c)

Protamine sulfate

d)

Andexanet alfa (for factor Xa inhibitors)

49.

Which drug class increases the risk of tendon rupture especially in elderly and corticosteroid users?

a)

Paracetamol

b)

Aspirin

c)

Acetazolamide

d)

Ibuprofen

50.

Which drug class increases the risk of tendon rupture especially in elderly and corticosteroid users?

a)

Macrolides

b)

Fluoroquinolones

c)

Aminoglycosides

d)

Tetracyclines

51.

Which statin has the least CYP3A4-mediated interactions and is preferred with potent CYP3A4 inhibitors?

a)

Simvastatin

b)

Atorvastatin

c)

Rosuvastatin

d)

Lovastatin

52.

Which drug used for chronic heart failure provides mortality benefit by neprilysin inhibition when combined with an ARB?

a)

ACE inhibitor

b)

Sacubitril

c)

Hydralazine

d)

Dobutamine infusion

53.

Which pharmacodynamic property explains why naloxone precipitates opioid withdrawal?

a)

Naloxone is an opioid antagonist that displaces agonists from receptors abruptly

b)

Naloxone is a partial agonist producing withdrawal

c)

Naloxone is a long-acting opioid agonist

d)

Naloxone increases opioid receptor synthesis

54.

Which antibiotic is contraindicated in children under 8 years because of permanent tooth discoloration?

a)

Tetracyclines

b)

Amoxicillin

c)

Erythromycin

d)

Trimethoprim

55.

Which antiemetic is associated with extrapyramidal side effects and should be used cautiously?

a)

Ondansetron

b)

Metoclopramide

c)

Domperidone

d)

Aprepitant

56.

Which adverse effect is most characteristic of amphotericin B therapy?

a)

Nephrotoxicity and infusion-related chills/fever

b)

Ototoxicity mainly

c)

Severe hepatotoxicity primarily

d)

Pulmonary fibrosis

57.

Which pharmacological strategy minimizes opioid-induced constipation without reversing analgesia?

a)

Systemic naloxone infusion

b)

Peripheral μ-opioid receptor antagonists

c)

Increase opioid dose

d)

Add benzodiazepine

58.

Which method is most appropriate to detect latent TB infection before starting anti-TNF therapy?

a)

Chest X-ray only

b)

IGRA or Mantoux (TST) testing plus history and chest imaging

c)

No screening necessary

d)

Start therapy and monitor

59.

The most appropriate drug for Parkinson’s disease tremor predominant in an elderly patient with urinary retention is:

a)

Trihexyphenidyl

b)

Levodopa

c)

Amantadine

d)

Pramipexole

60.

Which of the following is the hallmark lab abnormality in tumor lysis syndrome?

a)

Trihexyphenidyl

b)

Levodopa/carbidopa

c)

Amantadine only

d)

Deep brain stimulation

61.

Which antiarrhythmic is contraindicated in patients with long QT syndrome?

a)

Hypouricemia

b)

Hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia

c)

Isolated hyponatremia only

d)

Hypokalemia

62.

Which CNS stimulant is approved for narcolepsy and has abuse potential?

a)

Lidocaine

b)

Sotalol

c)

Adenosine

d)

Digoxin

63.

Which antiplatelet is reversible and useful when rapid offset is needed (e.g., pre-surgery)?

a)

Modafinil

b)

Methylphenidate / amphetamines

c)

Baclofen

d)

Pregabalin

64.

Which cancer chemotherapy agent causes peripheral neuropathy predominantly by microtubule stabilization?

a)

Clopidogrel

b)

Ticagrelor

c)

Aspirin

d)

Prasugrel

65.

Which cancer chemotherapy agent causes peripheral neuropathy predominantly by microtubule stabilization?

a)

Clopidogrel

b)

Ticagrelor

c)

Aspirin

d)

Prasugrel

66.

Which drug is associated with neurotoxicity by microtubule stabilization causing neuropathy?

a)

Cisplatin (neurotoxicity by other mechanisms)

b)

Paclitaxel (taxanes: microtubule stabilization causing neuropathy)

c)

Doxorubicin

d)

Methotrexate

67.

Which antibiotic requires therapeutic monitoring of peak and trough levels to avoid nephro- and ototoxicity?

a)

Vancomycin

b)

Azithromycin

c)

Tetracycline

d)

Cephalexin

68.

Which target is inhibited by monoclonal antibody pembrolizumab used in oncology?

a)

VEGF

b)

PD-1 immune checkpoint receptor

c)

HER2 receptor

d)

EGFR

69.

Which pharmacologic strategy is most appropriate to prevent methotrexate toxicity in high-dose chemotherapy?

a)

Give folic acid concurrently at full dose

b)

Leucovorin

c)

No rescue required

d)

Increase methotrexate dose further

70.

Which trial design feature minimizes selection bias by ensuring blinding of allocation until participants are enrolled?

a)

Open-label randomization

b)

Allocation concealment

c)

Per-protocol analysis

d)

Post-hoc subgroup analysis