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Worksheets

Pharmacology Multiple Choice Questions

Total questions: 60

Worksheet time: 30mins

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.

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

11.

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

a)

Glimepiride

b)

Pioglitazone

c)

Empagliflozin

d)

Acarbose

12.

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

13.

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

a)

Fluoxetine

b)

Ketoconazole

c)

Clopidogrel

d)

Omeprazole

14.

Which drug pair poses the highest risk of serotonin syndrome?

a)

Sertraline + tramadol

b)

Amitriptyline + warfarin

c)

Fluoxetine + metoprolol

d)

Citalopram + calcium channel blocker

15.

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

16.

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

a)

Sevoflurane

b)

Propofol

c)

Nitrous oxide

d)

Thiopental

17.

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

a)

Isoniazid

b)

Hydralazine

c)

Doxycycline

d)

Omeprazole

18.

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

19.

Which antiplatelet agent irreversibly inhibits the P2Y12 receptor?

a)

Clopidogrel

b)

Aspirin

c)

Dipyridamole

d)

Tirofiban

20.

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

a)

Haloperidol

b)

Clozapine

c)

Olanzapine

d)

Fluphenazine

21.

What is the principal mechanism of action of sulfonylureas?

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

22.

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

a)

Phenytoin

b)

Gabapentin

c)

Levetiracetam

d)

Pregabalin

23.

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

a)

Levofloxacin

b)

Ceftriaxone

c)

Doxycycline

d)

Amoxicillin

24.

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

a)

Ticagrelor

b)

Clopidogrel

c)

Cangrelor

d)

Dipyridamole

25.

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

a)

Acyclovir

b)

Zidovudine

c)

Nevirapine

d)

Efavirenz

26.

Which analgesic is safest for a breastfeeding mother with pain?

a)

Codeine

b)

Ibuprofen

c)

Tramadol

d)

High-dose aspirin

27.

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

a)

Dabigatran

b)

Rivaroxaban

c)

Heparin

d)

Warfarin

28.

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

a)

Ethambutol

b)

Isoniazid

c)

Rifampicin

d)

Pyrazinamide

29.

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

a)

Isoniazid

b)

Ethambutol

c)

Pyrazinamide

d)

Rifampicin

30.

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

a)

St. John’s Wort

b)

Cimetidine

c)

Ketoconazole

d)

Erythromycin

31.

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

a)

Morphine

b)

Buprenorphine

c)

Fentanyl

d)

Methadone

32.

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

a)

Flecainide

b)

Amiodarone

c)

Quinidine

d)

Dofetilide

33.

Which cytokine blockade is targeted by tocilizumab?

a)

TNF-α

b)

IL-6 receptor

c)

IL-1 receptor

d)

CD20

34.

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

35.

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

36.

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

a)

Hydralazine alone

b)

Spironolactone

c)

Terazosin

d)

Spironolactone

37.

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

38.

Which antihyperlipidaemic decreases triglycerides primarily via PPAR-α activation?

a)

Statins

b)

Fibrates

c)

Bile acid sequestrants

d)

Ezetimibe

39.

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

a)

Ribavirin

b)

Isotretinoin

c)

Methimazole

d)

Valproate

40.

Which antiviral for hepatitis C is a NS5A inhibitor?

a)

Sofosbuvir

b)

Daclatasvir

c)

Interferon-alpha

d)

Ribavirin

41.

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)

42.

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

a)

Paracetamol

b)

Aspirin

c)

Acetazolamide

d)

Ibuprofen

43.

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

a)

Macrolides

b)

Fluoroquinolones

c)

Aminoglycosides

d)

Tetracyclines

44.

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

a)

Simvastatin

b)

Atorvastatin

c)

Rosuvastatin

d)

Lovastatin

45.

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

46.

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

47.

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

a)

Tetracyclines

b)

Amoxicillin

c)

Erythromycin

d)

Trimethoprim

48.

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

a)

Ondansetron

b)

Metoclopramide

c)

Domperidone

d)

Aprepitant

49.

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

50.

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

51.

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

52.

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

53.

Which antiarrhythmic is contraindicated in patients with long QT syndrome?

a)

Hypouricemia

b)

Hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia

c)

Isolated hyponatremia only

d)

Hypokalemia

54.

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

a)

Lidocaine

b)

Sotalol

c)

Adenosine

d)

Digoxin

55.

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

a)

Clopidogrel

b)

Ticagrelor

c)

Aspirin

d)

Prasugrel

56.

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

a)

Vancomycin

b)

Azithromycin

c)

Tetracycline

d)

Cephalexin

57.

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

a)

VEGF

b)

PD-1 immune checkpoint receptor

c)

HER2 receptor

d)

EGFR

58.

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

59.

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

60.

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

a)

Modafinil

b)

Methylphenidate / Amphetamines

c)

Baclofen

d)

Pregabalin