Pharma: 8088 -

#1 Aminophylline: a) Reduces intracellular cAMP. b) Is a non-selective adenosine agonist. c) Inhibits the effects of dipyridamole. d) Is longer acting than theophylline.

Explanations: a) F. Aminophylline acts as a phosphodiesterase inhibitor and therefore increases intracellular cAMP. It also activates protein kinase A, inhibits TNF-alpha and inhibits leukotriene synthesis. b) F. Aminophylline is a non-selective adenosine antagonist c) T. The statement is true. d) F. Aminophylline is less potent and shorter acting than theophylline.

Pharma: 8135 -

#2 Paracetamol (acetaminophen): a) Has 100% bioavailability. b) Has a half-life of 30 minutes. c) Inhibits COX-3 receptors in the brain and spinal cord. d) Toxicity is primarily due to glutathione production.

Explanations: a) T. Paracetamol has 100% bioavailability b) F. Paracetamol has a half-life of 1-4 hours. c) T. Paracetamol is thought to work by selectively inhibiting COX-3 receptors in the brain and spinal cord. COX-3 is responsible for the production of prostaglandins in these areas, which sensitizes free nerve endings to the chemical mediators of pain. Therefore by selectively inhibiting COX-3 paracetamol effectively reduces pain sensation. d) F. N-hydroxylation via the hepatic cytochrome p450 enzyme system is responsible for the production of NAPQI (N-acetyl-p-benzo-quinone imine). NAPQI is primarily responsible for the toxic effects of paracetamol. NAPQI is an intermediate product and is subsequently irreversibly conjugated with the antioxidant glutathione to produce an inactive, non-toxic, metabolite.

Pharma: 8066 -

#3 Regarding warfarin: a) It should be avoided in pregnancy. b) The risk of bleeding is increased with co-prescription of ibuprofen. c) Warfarin necrosis is more common in patients with protein C deficiency. d) The INR should be between 3 and 4 for the treatment of DVT.

Explanations: a) T. Warfarin passes across the placenta and may cause bleeding in the fetus. b) T. The bleeding risk of warfarin is increased when warfarin is co-prescribed with antiplatelet agents, NSAIDs and aspirin. c) T. Warfarin necrosis is a rare complication of warfain administration that causes massive thrombosis with skin necrosis and limb gangrene. It is associated with protein C and S deficiency. d) F. The target INR is between 2 and 3 for the treatment of DVT.

Pharma: 8109

#4 Digoxin specific antibodies fragments (Digibind): a) Are made from immunoglobulin fragments from cattle. b) Are the antigen-binding fragments of the antibodies. c) Use should be reserved for cases of severe poisoning only. d) Work by binding to the action site on target cells.

Explanations: a) F. Digoxin specific antibodies are made from immunoglobulin fragments from sheep. b) T. The statement is true. c) T. The use of digibind should be reserved for severe cases of digoxin poisoning when measures beyond the withdrawal of the drug and correction of electrolyte abnormalities are felt to be necessary. d) F. Digibind works by binding to digoxin and preventing it from binding to the action site on target cells.

Pharma: 8035 -

#5 Regarding vasopressors and inotropes: a) Noradrenaline reduces afterload and is therefore inappropriate to use in the treatment of cardiogenic shock. b) Noradrenaline is an alpha and beta2 agonist. c) Isoproterenol is a powerful alpha agonist. d) The IM dose of adrenaline in anaphylaxis is 0.5 mL of 1:1000.

Explanations: a) F. Noradrenaline increases afterload and is used in the management of cardiogenic shock. b) F. Noradrenaline is an alpha and beta1 agonist with no clinically significant beta2 effects. c) F. Isoproterenol is a powerful beta agonist with virtually no alpha effects. d) T. The statement is true.

Pharma: 8057 -

#6 Regarding amiodarone: a) It prolongs phase III of the cardiac action potential. b) Its side effects include hyperthyroidism. c) The loading dose in the treatment of ventricular tachycardia is 300 mg IV. d) It has a lower efficacy than dronedarone.

Explanations: a) T. Amiodarone prolongs phase III of the cardiac action potential, the repolarisation phase, where there is increased potassium and reduced calcium permeability. b) T. Amiodarone chemically structurally thyroxine and is can cause both hyperthyroidism and hypothyroidism. c) T. The loading dose in the treatment of ventricular tachycardia is 300 mg IV. d) F. Dronedarone has a lower efficacy than amiodarone but also has a lower incidence of side effects.

Pharma: 8071 -

#7 Heparin: a) Binds to the enzyme inhibitor antithrombin II. b) Has a duration of action of 4 to 6 hours. c) Is more effective than its low molecular weight derivates in preventing mortality from thrombosis. d) Overdose can be treated with vitamin K.

Explanations: a) F. Heparin binds to and activates the enzyme inhibitor antithrombin III. Antithrombin III forms a 1:1 complex with thrombin and inactivates it. The heparin-antithrombin III complex also inhibits factor Xa and some other proteases involved with clotting. b) T. The statement is true. c) F. There is no evidence that heparin is superior to LMWH in preventing mortality from thrombosis. d) F. Vitamin K can be used to reverse the effects of warfarin but not heparin. Protamine sulphate is used to counteract the effects of heparin.

Pharma: 8127 -

#6 Regarding salicylate poisoning: a) Ingestion of greater than 125 mg/kg and less than 250 mg/kg of aspirin is associated with mild toxicity. b) Hyperpyrexia is a risk factor for death in severe poisoning. c) Haematemesis is a common feature. d) The typical acid-base picture is a mixed respiratory and metabolic acidosis.

Explanations: a) T. Ingestion of greater than 125 mg/kg is associated with mild toxicity, greater than 250 mg/kg with moderate toxicity and greater than 500 mg/kg with severe and potentially fatal toxicity. b) T. Risk factors for death in severe poisoning include: Age < 10 or > 70 years CNS features Metabolic acidosis Hyperpyrexia Late presentation Pulmonary oedema Salicylate concentration > 700 mg/L c) F. Haematemesis is an uncommon feature of salicylate poisoning. Common features include: Nausea and vomiting Tinnitus Lethargy Dizziness Restlessness Sweating Bounding pulses Warm extremities Hyperventilation d) F. The typical acid-base picture is a mixed respiratory alkalosis and metabolic acidosis with a normal or high arterial pH.

Pharma: 8026 -

#5 Dobutamine: a) Is a derivative of isoprenaline. b) Reduces cell membrane permeability to calcium ions. c) Acts on catecholamine receptors. d) May precipitate atrial fibrillation.

Explanations: a) T. Dobutamine is a synthetic isoprenaline derivative. b) F. Dobutamine increases cell membrane permeability to calcium ions. c) T. Dobutamine acts on catecholamine receptors to actvate adenyl cyclase. This catalyses the conversion of ATP to cAMP and subsequently increases membrane permeability to calcium ions. d) T. Dobutamine enhances AV nodal conduction and may precipitate AF in predisposed patients.

Pharma: 8020 -

#4 Regarding phaeochromocytoma: a) Beta blockers such as atenolol should be used to manage hypertensive crises. b) Alpha blockers such as phenoxybenzamine should be used prior to surgery. c) 30% of tumours are bilateral. d) 80% of tumours are solitary.

Explanations: a) F. Pure beta blockade can result in unopposed alpha agonism and result in severe refractory hypertension. b) T. The use of irreversible alpha blockers such as phenoxybenzamine is important as a massive release of catecholamines from the tumour may overcome reversible blockade. c) F. 10% of tumours are bilateral. d) T. 80% of tumours are solitary and unilateral, 10% are extra-adrenal and 10% bilateral.

Pharma: 8066 -

#3 Regarding warfarin: a) It should be avoided in pregnancy. b) The risk of bleeding is increased with co-prescription of ibuprofen. c) Warfarin necrosis is more common in patients with protein C deficiency. d) The INR should be between 3 and 4 for the treatment of DVT.

Explanations: a) T. Warfarin passes across the placenta and may cause bleeding in the fetus. b) T. The bleeding risk of warfarin is increased when warfarin is co-prescribed with antiplatelet agents, NSAIDs and aspirin. c) T. Warfarin necrosis is a rare complication of warfain administration that causes massive thrombosis with skin necrosis and limb gangrene. It is associated with protein C and S deficiency. d) F. The target INR is between 2 and 3 for the treatment of DVT.

Pharma: 8081 -

#2 Hydrocortisone: a) Long term usage can cause osteoporosis. b) Has poor oral bioavailability. c) Is 10 times more potent than dexamathasone. d) Is longer acting than prednisolone.

Explanations: a) T. Long term usage of hydocortisone and other corticosteroids can cause diabetes, hypertension, osteoporosis and fragility fractures and avascular necrosis of the femoral head. b) F. Hydrocortisone has 96% oral bioavailability and is 90% bound to plasma proteins. c) F. Dexamethasone is 25 times more potent than hydrocortisone. d) F. Prednisolone is longer acting than hydrocortisone. The half-life of hydrocortisone is approximately 100 minutes. The half-life of prednisolone is approximately 3-4 hours.

Pharma: 8082 -

#1 Prednisolone: a) Binds with alpha and beta glucocorticoid receptors. b) Inhibits gene transcription for COX-2. c) Is 25 times more potent than dexamethasone. d) Has a longer half-life than dexamethasone.

Explanations: a) T. Prednisolone binds with both alpha and beta glucocorticoid receptors. b) T. The statement is true. c) F. Dexamethasone is approximately 6 times more potent than prednisolone. d) F. Prednisolone has a half-life of 3-4 hours. Dexamethasone has a half-life of 36-54 hours.

Pharma: 8069 -

#10 Drugs that should be routinely monitored include: a) Teicoplanin. b) Aminophyllin. c) Lithium. d) Sodium valproate.

Explanations: a) F. Teicoplanin does not require monitoring. b) T. Drugs that require routine monitoring include: gentamicin, digoxin, theophyllines, phenytoin, lithium and cyclosporin. c) T. The statement is true. d) F. The statement is false.

Pharma: 8031 -

#7 Metaraminol: a) Acts mainly as an alpha1 adrenergic receptor agonist. b) Causes a reflex bradycardia. c) Should be used in small bolus doses of 0.5-1mg and titrated to effect. d) Onset of effect following intravenous injection is within 1-2 minutes.

Explanations: a) T. It also has some effect on beta adrenergic receptors. b) T. The statement is true. c) T. The statement is true. d) T. The statement is true.

Pharma: 8090 -

#7 The following drugs are matched with their correct antidotes: a) Beta-blockers glucagon. b) Heroin naloxone. c) Ethylene glycol omeprazole d) Gliclazide atropine.

Explanations: a) T. The statement is true. b) T. The statement is true. c) F. The antidotes for ethylene are alcohol and fomepizole. d) F. The antidotes for sulphonylureas are glucose and octreotide.

Pharma: 8101 -

#6 Regarding the extrapyramidal side effects of antipsychotic drugs: a) Dystonia occurs more commonly in children. b) Akathisia is characterized by an inability to initiate movement. c) Haloperidol is the most common causative antipsychotic drug. d) Tardive dyskinesia is always reversible on withdrawal of the causative drug.

Explanations: a) T. Dystonia (abnormal face and body movements) is more common in children and young adults and tends to appear after only a few doses. b) F. Akathisia is characterized by an unpleasant sensation of restlessness. Akinesia is an inability to initiate movement. c) T. The statement is true. d) F. Tardive dyskinesia (rhythmic, involuntary movements of tongue, face and jaw) usually develops after long-term treatment or with high dosage. It is the most serious manifestation of extrapyramidal symptoms as it may be irreversible on withdrawing the causative drug and treatment is generally ineffective.

Pharma: 8048 -

#2 Pabrinex contains the following vitamins: a) Folic acid. b) Vitamin C. c) Vitamin B1. d) Vitamin B12.

Explanations: a) F. Pabrinex contains thiamine (vitamin B1), riboflavin (vitamin B2), nicotinamide (vitamin B3, niacin and nicotinic acid), pyridoxine (vitamin B6) and ascorbic acid (vitamin C). b) T. The statement is true. c) T. The statement is true. d) F. The statement is false.

Pharma: 8076 -

#1 Salbutamol: a) Is a short acting beta2-adrenergic receptor agonist. b) Can be used as a tocolytic. c) A standard metered dose inhaler carries a dose of 200 micrograms per metered inhalation. d) Can cause potentially serious hyperkalaemia.

Explanations: a) T. The statement is true. b) T. Intravenous salbutamol can be used as a tocolytic agent to relax uterine smooth muscle and delay premature labour. c) F. A standard metered dose inhaler carries a dose of 100 micrograms per metered inhalation. d) F. Salbutamol can cause potentially serious hypokalamia.

Pharma: 8137 -

#10 Regarding paracetamol overdose: a) If a patient has ingested less than 75 mg/kg it is unlikely that serious toxicity will occur. b) The initial loading dose of acetylcysteine is 150 mg/kg over 1 hour. c) An adverse reaction to acetylcysteine is more likely in patients with a family history of allergy. d) Abdominal pain is a common early feature.

Explanations: a) T. The statement is true. b) T. The full course of treatment with acetylcysteine comprises 3 consecutive intravenous infusions: 1st infusion: 150 mg/kg over 1 hour 2nd infusion: 50 mg/kg over the next 4 hours 3rd infusion: 100 mg/kg over the 16 hours c) T. Adverse effects to acetylcysteine are more common in women, asthmatics and in patients with a family history of allergy. d) F. Nausea and vomiting are common early features following paracetamol overdose. Abdominal pain does not typically occur until 12-36 hours following overdose in severe cases.

Pharma: 8030 -

#8 Ephedrine: a) Causes the release of noradrenaline from sympathetic nerve terminals. b) Increase cardiac contractility and heart rate. c) The duration of action when administered intravenously is approximately 10 minutes. d) Causes bronchodilatation.

Explanations: a) T. The statement is true. b) T. The statement is true. c) F. When administered intravenously the drugs effects are very rapid and the duration of action is approximately 1 hour. d) T. The statement is true.

Pharma: 8111 -

#6 The following are recognized side effects of typical neuroleptic drugs: a) Akathisia. b) Parkinsonism. c) Dystonia. d) Neuroleptic malignant syndrome.

Explanations: a) T. The typical, or first generation, neuroleptics include chlorpromazine, pipotiazine, prochlorperazine and haloperidol. They tend to block dopamine pathways in the brain and have prominent extrapyramidal side effects including parkinsonism, dystonia, akinesia, akathisia and tardive dyskinesia. b) T. The statement is true. c) T. The statement is true. d) T. Neuroleptic malignant syndrome is an adverse reaction to neuroleptic drugs. The syndrome consists of muscle rigidity, pyrexia, autonomic instability and cognitive changes. There is usually also an elevated plasma creatine kinase level.

Pharma: 8139 -

#4 Morphine: a) Is an alkaloid. b) Has 50-80% oral bioavailability. c) Causes local histamine release. d) Should be used first line in the management of acute cardiogenic pulmonary oedema (ACPO).

Explanations: a) T. Morphine is an alkaloid opiate analgesic drug. b) F. Morphine has 20-40% oral bioavailability, 35-70% rectal bioavailability and 100% intravenous bioavailability. c) T. Morphine causes local histamine release which can cause itching and flushing of the skin. It can also trigger wheeze in asthmatics and anaphylactoid reactions. d) F. Morphine should no longer be used in the management of acute decompensated heart failure and ACPO due to an increased risk of adverse events. The ADHERE analysis, published in 2008, revealed a greater risk of mechanical ventilation, prolonged hospitalization, ICU admission and mortality when used in these patients.

Pharma: 8122 -

#3 Ondansetron: a) Is a 5-HT3 receptor agonist. b) Has antimuscarinic effects. c) Tends to cause a tachycardia. d) Is excreted renally.

Explanations: a) F. Ondansetron is a 5-HT3 receptor antagonist. b) F. Ondansetron has no effect on muscarinic or dopamine receptors. c) F. Tachycardia is commonly seen with other anti-emetics such as cyclizine but this is not the case with ondansetron. d) T. Ondansetron is excreted renally and has a half-life of approximately 6 hours.

Pharma: 8100 -

#1 Regarding antipsychotic drugs: a) Extrapyramidal side effects occur most commonly with the piperazine phenothiazines and butyrophenones. b) Doses should be reduced in renal impairment. c) Haloperidol is the first-line drug for dementia-related psychosis. d) Haloperidol is a phenothiazine derivative.

Explanations: a) T. Extrapyramidal side effects occur most commonly with the piperazine phenothiazines (fluphenazine, prochlorperazine and trifluoperazine) and butyrophenones (benperidol and haloperidol). b) T. There is increased cerebral sensitivity in renal impairment and reduced doses should be used. c) F. There is an increased risk of mortality in elderly patients with dementia-related psychosis treated with haloperidol. This appears to be due to increased risk of cardiovascular events and infections such as pneumonia. d) F. Haloperidol is a butyrophenone derivative.

Pharma: 8108 -

#5 Regarding digoxin toxicity: a) Xanthopsia is a common feature. b) Female gender is a recognized risk factor. c) Severe toxic effects are generally seen at levels greater than 2.0 g/l. d) Activated charcoal should be given if the patient presents within 1 hour of an overdose involving digoxin.

Explanations: a) F. Xanthopsia is a rare feature of digoxin toxicity. b) F. Risk factors for digoxin toxicity include: Age over 55 Male gender Underlying heart disease Pre-existing renal failure c) F. The therapeutic range of digoxin is 1-2 g/l. Severe toxic effects are generally seen at levels greater than 4.0 g/l. d) T. Repeated doses of activated charcoal can be used and are thought to be of value in increasing elimination.

Pharma: 8097 -

#1 Regarding chlordiazepoxide: a) It has a half-life of 5-30 hours. b) It is commonly used as an adjunct in alcohol withdrawal. c) The dose should be reduced in patients with renal impairment. d) Has predictable intramuscular absorption.

Explanations: a) T. The statement is true. b) T. Chlordiazepoxide is commonly used as an adjunct in alcohol withdrawal. Diazepam is a suitable alternative and also commonly used. c) T. Patients with renal impairment have increased cerebral sensitivity to benzodiazepines. If treatment is required reduced doses should be used. d) F. Lorazepam is the only benzodiazepine with predictable intramuscular absorption.

Pharma: 8086 -

#4 Drug doses in adult asthma: a) Terbutaline 5 mg via oxygen-driven nebuliser. b) Prednisolone 40-50 mg orally. c) Aminophylline 25 mg/kg IV loading dose over 20 minutes. d) Magnesium sulphate 1.2-2 mg IV.

Explanations: a) F. Terbutaline can be used instead of salbutamol and the dose is 10 mg via oxygen-driven nebuliser. b) T. The statement is true. c) F. Aminophylline 5 mg/kg IV loading dose over 20 minutes. d) F. Magnesium sulphate 1.2-2 g IV (over 20 minutes).

Pharma: 8005 -

#5 Regarding proton pump inhibitors. a) They are associated with an increased risk of Clostridium Difficile infection. b) Long term use is associated with an increased risk of pelvic fractures. c) They are associated with an increased risk of bradyarrhythmias. d) Long term use can cause low serum magnesium levels.

Explanations: a) T. It is suspected that acid suppression results in poor elimination of pathogenic organisms leading to increased infection risk. b) F. Long term use has been associated with an increased risk of hip, wrist and spine fractures but not pelvic fractures. c) F. They are associated with an increased risk of focal tachyarryhtmias. See Marcus et al. Innnovations in Cardiac Rhythm Managament 2010. d) T. This was highlighted by the US FDA in March 2011.

Pharma: 8022 -

#6 ACE inhibitors have been shown to: a) Reduce the progression of diabetic nephropathy. b) Reduce cardiac cachexia in heart failure. c) Reduce mortality in heart failure. d) Cause lung fibrosis.

Explanations: a) T. Epidemiological studies have shown this effect to be independent of their anti-hypertensive action. b) T. The statement is true. c) T. Meta-analysis has shown ACE inhibitors to result in a 28% reduction in death, MI and overall admission. d) F. They cause a dry cough but there is no proven causal link to lung fibrosis.

Pharma: 8103 -

#7 Regarding the extrapyramidal side effects of antipsychotic drugs: a) Acute dystonia is a recognized cause of jaw dislocation. b) Akinesia is characterized by restlessness. c) Clozapine is the most common causative antipsychotic drug. d) Acute dytsonia can be treated with cyclizine.

Explanations: a) T. The statement is true. b) F. Akathisia is characterized by an unpleasant sensation of restlessness. Akinesia is an inability to initiate movement. c) F. Haloperidol is the most common causative antipsychotic drug. Clozapine generally has fewer extrapyramidal side effects and is the drug of choice in the treatment of Parkinsons disease patients that require antipsychotic treatment. d) F. Acute dystonia can be treated with procyclidine 5mg IV or benzatropine 2mg IV as a bolus.

Pharma: 8119

#8 Cyclizine: a) Has antihistamine properties. b) Has antimuscarinic properties. c) Commonly causes extrapyramidal side effects. d) Can cause urinary retention in patients with prostatic hypertrophy.

Explanations: a) T. Cyclizine is a piperazine derivative with antihistamine (H1-receptor antagonist) properties. It is thought to act on the chemoreceptor trigger zone (CTZ) and the labyrinthine apparatus to prevent nausea and vomiting. It also has antimuscarinic effects. b) T. The statement is true. c) F. Extrapyramidal side effects can occur with cyclizine, but only rarely. The commonest side effects are drowsiness and dry mouth. d) T. Cyclizine has antimuscarinic effects and can precipitate urinary retention in patients with prostatic hypertrophy.

Pharma: 8070 -

#9 Drugs that should be routinely monitored include: a) Gentamicin. b) Vancomycin. c) Phenytoin. d) Cyclosporin.

Explanations: a) T. Drugs that require routine monitoring include: Gentamicin, digoxin, theophyllines, phenytoin, carbemazepine, lithium and cyclosporin. b) F. Vancomycin monitoring is only recommended in patients with renal impairment, children and morbidly obese patients. c) T. The statement is true. d) T. The statement is true.

Pharma: 8007

#10 Regarding diuretics: a) Furosemide can cause a diuresis of 20% of the filtered load of NaCl and water. b) Bendroflumethiazide can result in hypocalcaemia. c) Mannitol is freely reabsorbed at the glomerulus. d) Acetazolamide is useful in aspirin overdose.

Explanations: a) T. Loop diuretics are high ceiling diuretics and can cause a substantial diuresis. b) F. Thiazide diuretics are calcium sparing and result in a low rate of excretion of calcium. c) F. Mannitol is an osmotic diuretic which is filtered at the glomerulus but cannot be reabsorbed. d) T. Acetazolamide can be used to alkalinize the urine in salicylate poisoning.

Pharma: 8059

#1 The following are cytochrome p450 enzyme inducers: a) Omeprazole. b) Sulphonamides. c) Rifampicin. d) Erythromycin.

Explanations: a) F. Omeprazole is a cytochrome p450 enzyme inhibitor. b) F. Sulphonamides are cytochrome p450 enzyme inhibitors. c) T. The mnemonic PC BRASS can be used to memorise the commonly encountered cytochrome p450 enzyme inducers: P Phenytoin C Carbemazepine B Barbiturates. R Rifampicin A Alcohol (chronic ingestion) S Sulphonylureas S Smoking d) F. Erythromycin is a cytochrome p450 enzyme inhibitor.

Pharma: 8123

#2 Milrinone: a) Is a phosphodiesterase inhibitor. b) Is contraindicated in heart failure. c) Can cause atrial arrhythmias. d) Has a half-life of 2-3 minutes.

Explanations: a) T. Milrinone is a phosphodiesterase-3 inhibitor that increases myocardial contractility. It also acts by causing vasodilatation thus reducing afterload. It is used as a positive inotrope in the treatment of heart failure. b) F. The statement is false. c) T. Milrinone can cause atrial fibrillation and other arrhythmias particularly if used following cardiac surgery. d) F. Milrinone has a half-life of 2-3 hours.

Pharma: 8062

#4 The following are cytochrome p450 enzyme inhibitors: a) Barbiturates. b) Chronic alcohol ingestion. c) Clarithromycin. d) Sulphonamides.

Explanations: a) F. Barbiturates are cytochrome p450 enzyme inducers. b) F. Chronic alcohol ingestion causes induction of cytochrome p450 enzymes whilst acute alcohol ingestion causes inihibition of cytochrome p450 enzymes. c) T. The mnemonic O DEVICES can be used to memorise the commonly encountered cytochrome p450 enzyme inhibitors: O - Omeprazole D - Disulfram E - Erythromycin (and other macrolide antibiotics) V - Valproate (sodium valproate) I - Isoniazid C - Ciprofloxacin E - Ethanol (acute ingestion) S - Sulphonamides d) T. The statement is true.

Pharma: 8136

#5 Regarding paracetamol (acetaminophen): a) It is primarily metabolized by the hepatic cytochrome p450 enzyme system. b) Glucuronidation of paracetamol is responsible for the production of the toxic metabolite NAPQI. c) It is excreted renally. d) It has anti-pyretic effects.

Explanations: a) F. Paracetamol is metabolized by 3 main metabolic pathways in the liver: 1. Glucuronidation (40-60%) 2. Sulfate conjugation (20-40%) 3. N-hydroxyloxation via the hepatic cytochrome p450 enzyme system (10-15%) b) F. N-hydroxylation via the hepatic cytochrome p450 enzyme system is responsible for the production of NAPQI (N-acetyl-p-benzo-quinone imine). NAPQI is primarily responsible for the toxic effects of paracetamol. NAPQI is an intermediate product and is subsequently irreversibly conjugated with the antioxidant glutathione to produce an inactive, non-toxic, metabolite. c) T. All three pathways of paracetamol metabolism produce non-toxic metabolites that are excreted renally. d) T. Paracetamol selectively inhibits COX-3 in the brain and spinal cord. This results in inhibition of prostaglandin production and subsequently analgesic and antipyretic effects.

Pharma: 8023

#7 Therapeutic causes of gynaecomastia include: a) Cimetidine. b) Spironolactone. c) Digoxin. d) Aspirin.

Explanations: a) T. Drugs that cause gynaecomastia include: Cimetidine, omeprazole, spironolactone, digoxin, furosemide, finasteride and some anti-pyschotics. b) T. The statement is true. c) T. The statement is true. d) F. The statement is false.

Pharma: 8099

#9 Regarding antipsychotic drugs: a) Chlorpromazine is a phenothiazine derivative. b) Prochlorperazine has more pronounced extrapyramidal side effects than pipotiazine. c) Amisulpiride has a low affinity for mesolimbic D2 and D3 receptors. d) Contraindications to use include phaechromocytoma.

Explanations: a) T. Chlorpromazine is a group 1, first generation, antipsychotic drug. It is a phenothiazine derivative and acts by non-selectively blocking dopamine receptors in the brain. b) T. Prochlorperazine is a group 3, first generation, antipsychotic drug. Pipotiazine is a group 2, first generation, antipsychotic drug. Group 3 drugs have more pronounced extrapyramidal side effects than group 1 or 2 drugs but generally have more pronounced sedative and anti-muscarinic side effects. c) F. Amisulpiride is a second generation, or atypical, antipsychotic drug. It has a high affinity for mesolimbic D2 and D3 receptors. d) T. The contraindications to the use of antipsychotic drugs include: Reduced conscious level / coma CMS depression Phaeochromocytoma

Pharma: 8145

#1 Codeine phosphate: a) Common adverse effects include seizures and respiratory depression. b) Is metabolized via the cytochrome p450 system in the liver. c) Has a half-life of 6-8 hours. d) Can be safely administered orally and intravenously.

Explanations: a) F. Seizures and respiratory depression are rare adverse effects of codeine at therapeutic doses. The commonest side effects are drowsiness, constipation and nausea. b) T. The statement is true. c) F. Codeine phosphate has a half-life of 2.5-3 hours. d) F. Codeine is not recommended via the intravenous route due to the risks of severe hypotension and death due to histamine release and myocardial depression.

Pharma: 8124

#3 Aspirin: a) Reversibly inhibits cyclo-oxygenase. b) Has an anti-inflammatory effect at low doses. c) Usage can produce gastric irritation and erosion. d) Reduces the risk of stroke and myocardial infarction.

Explanations: a) F. Aspirin irreversibly blocks cyclo-oygenase by covalently acetylating the cyclo-oxygenase active site in both COX-1 and COX-2. b) F. At low doses (75 mg per day) aspirin only inhibits COX-1, the enzyme responsible for making thromboxane A2, and therefore principally exhibits an anti-thrombotic effect. At medium to high doses (500-5000 mg per day) aspirin inhibits both COX-1 and COX-2. COX-2 is responsible for the production of prostaglandins and therefore has an anti-inflammatory effect at these doses. c) T. Chronic aspirin usage can produce gastric irritation and erosion, GI haemorrhage, vomiting and renal tubular necrosis. d) T. This is due to its anti-thrombotic effects.

Pharma: 8132

#4 In overdose with antidepressant drugs: a) Tricylic antidepressants (TCAs) are safer than selective serotonin reuptake inhibitors (SSRIs). b) Tricyclic antidepressant cause a metabolic alkalosis. c) Serotonin syndrome may occur. d) Atropine can be used to reverse anticholinergic effects.

Explanations: a) F. SSRIs are far safer than TCAs in overdose. SSRIs are rarely fatal in overdose when taken alone. b) F. TCAs cause a metabolic acidosis. c) T. Serotonin syndrome is a recognized feature with overdose of antidepressant drugs. d) F. Atropine itself is an anticholinergic drug and would worsen any anticholinergic effects present.

Pharma: 8121

#6 Metoclopramide: a) Is a dopamine receptor agonist. b) Is a gastric prokinetic. c) Should be avoided in pregnancy. d) Can cause neuroleptic malignant syndrome.

Explanations: a) F. Metoclopramide exerts its anti-emetic action via dopamine D2-receptor antagonist. At high doses it is also thought to have 5-HT3 antagonist activity. b) T. Metoclopramide exerts its gastric prokinetic activity via dopamine D2-receptor antagonism, antimuscarinic activity and 5-HT4 antagonist activity. c) F. The statement is false. d) T. Metoclopramide is a recognized cause of neuroleptic malignant syndrome.

Pharma: 8056

#7 Regarding amiodarone: a) It is a class III anti-arrhythmic agent. b) Can be used in the management of ventricular fibrillation. c) Is a cytochrome p450 enzyme inducer. d) Should be made up using 0.9% saline solution.

Explanations: a) T. Amiodarone is a class III anti-arrhythmic agent. b) T. Amiodarone is used in the management of shock refractory VF arrests. c) F. Amiodarone is a cytochrome p450 enzyme inhibitor. d) F. Amiodarone is incompatible with 0.9% saline and should be made up using 5% dextrose solution.

Pharma: 8142

#10 Naloxone: a) Is a competitive partial opioid agonist. b) Has a high affinity for -opiod receptors. c) The initial dose is 400-800 mg IV. d) Has a longer half-life than morphine.

Explanations: a) F. Naloxone is a competitive opioid antagonist. b) T. The statement is true. c) F. The initial dose is 400-800 g IV. This can be repeated every 2-3 minutes up to a cumulative dose of 10 mg. d) F. The half-life of naloxone is shorter than that of morphine.

Pharma: 8051

#1 Drug doses in paediatric cardiac arrest: a) Adrenaline 5 mcg/kg. b) Amiodarone 5 mg/kg. c) Magnesium 25-50 mg/kg. d) Lidocaine 0.1 mg/kg.

Explanations: a) F. Adrenaline 10 mcg/kg. b) T. The statement is true. c) T. The statement is true. d) F. Lidocaine 1 mg/kg.

Pharma: 8002

#2 Aluminium hydroxide: a) Is used as an antacid. b) Tends to have a laxative effect. c) Is relatively water soluble. d) Can be used in the treatment of hypophosphataemia.

Explanations: a) T. The statement is true. b) F. Aluminium containing antacids tend to be constipating. c) F. It is relatively water insoluble. d) F. It is used occasionally in the treatment of hyperphosphataemia. It is a phosphate binder and is therefore contraindicated in the presence of hypophosphataemia.

Pharma: 8010

#5 Adenosine: a) Blocks the atrioventicular node. b) The dose for the treatment of supraventricular tachycardia is 6-12 mg IV. c) The dose should be reduced in patients taking theophyllines. d) The dose should be reduced in patients taking clopidogrel.

Explanations: a) T. The statement is true. b) T. The statement is true. c) F. The dose may be increased in patients taking theophyllines as theophylline prevents binding of adenosine at receptor sites. d) F. The dose should be reduced in patients taking dipyridamole as adenosine potentiates the effect of this drug.

Pharma: 8148

#6 Carbemazepine: a) Can be used as a mood stabilizer. b) Levels should be routinely monitored. c) Is a cytochrome p450 enzyme inhibitor d) Stabilizes the inactivated state of voltage-gated sodium channels.

Explanations: a) T. Carbemazepine is used as an antiepileptic, a mood stabilizer in the treatment of bipolar effective disorder and as an analgesic in the treatment of neuropathic pain. b) F. Carbemazepine levels do not require routine monitoring. NICE advises monitoring of levels under in the following circumstances: Suspected non-adherence to the prescribed medication Suspected toxicity Under periods of dose adjustment Whilst managing pharmacokinetic interactions In specific clinical circumstances e.g. status epilepticus, organ failure and pregnancy c) F. Carbemazepine is a cytochrome p450 enzyme inducer d) T. Carbemazepine acts by stabilizing the inactivated state of voltage-gated sodium channels and also by potentiating GABA receptors.

Pharma: 8032

#7 Metaraminol: a) Acts mainly on beta adrenergic receptors. b) Its main action is peripheral vasoconstriction. c) Is positively chronotropic. d) Is positively inotropic.

Explanations: a) F. Acts mainly as an alpha1 adrenergic receptor agonist with a lesser action on beta adrenergic receptors. b) T. This is mediated via alpha1 adrenergic receptors. c) F. It causes a reflex bradycardia. d) T. The statement is true.

Pharma: 8037

#8 Recognised side effects of Ecstasy include: a) Hepatoctoxicity. b) Fulminant hyperthermia. c) Rhabdomylosis. d) Cerebrovascular accident.

Explanations: a) T. Ecstasy is a phenylethylamine compound with similarities to amphetamines and mescaline. Recognised side effects include: fulminant hyperthermia, convulsions, rhabdomylosis, inappropriate ADH secretion, DIC, liver failure and cerebrovascular accidents. b) T. The statement is true. c) T. The statement is true. d) T. The statement is true.

Pharma: 8039

#9 Regarding mephedrone: a) It is structurally similar to amphetamine. b) Myalgia, chest pain and tachycardia are common side effects. c) It is associated with a high incidence of prolonged hospital admission and death. d) Purchase is currently legal.

Explanations: a) T. Mephedrone, also known as M-CAT is a synthetic compound based on the naturally occurring phenylalkylamine cathionone from the Khat plant. It is structurally similar to amphetamine. b) T. The commonest side effects are: headache, vomiting, nausea, tachycardia, dyspnoea, chest pain and myalgia. c) F. Preliminary case series have shown no association with prolonged hospital admission or death when taken alone. d) F. Its was classified a class B drug in March 2010 and delegalised.

Pharma: 8096

#10 Regarding diazepam: a) It enhances effects of the neurotransmitter gamma-aminobutyric acid (GABA). b) Is short-acting. c) Should be avoided in hepatic impairment. d) Crosses into breast milk.

Explanations: a) T. Diazepam enhances the effects of GABA resulting in sedative, hypnotic, anxiolytic, anticonvulsant and muscle relaxant properties. b) F. Diazepam is a long-acting benzodiazepine with a half-life of 20-100 hours. Examples of short-acting benzodiazepines with a half-life of less than 12 hours include midazolam, oxazepam and alprazolam (Xanax). c) T. Benzodiazepines can precipitate coma if used in hepatic impairment. If treatment is required benzodiazepines with shorter half-lives in reduced doses should be used. d) T. The statement is true.

Pharma: 8009

#1 Mannitol: a) The IV dose of mannitol is 0.25-2 g/kg over 1 hours. b) Is an osmotic diuretic. c) Can be used in the treatment of congestive cardiac failure. d) IV injection can cause thrombophlebitis.

Explanations: a) T. The statement is true. b) T. The statement is true. c) F. Mannitol causes an expansion of the extracellular fluid space which may worsen congestive cardiac failure. d) T. Extravasation causes inflammation and thrombophlebitis.

Pharma: 8077

#2 Ipratropium bromide: a) Is an anti-muscarinic drug. b) The BTS guidelines recommend its use in the immediate management of acute severe asthma. c) Commonly causes tremor as a side effect. d) Should be used with caution in patients with prostatic hyperplasia.

Explanations: a) T. Ipratropium bromide is an anti-muscarinic drug used in the management of acute asthma and COPD. b) F. The BTS guidelines recommend the use of ipratropium bromide in acute severe asthma if there is no response to immediate management after 15-30 minutes. The immediate management of acute severe asthma is high flow oxygen, inhaled salbutamol via large-volume spacer or nebulizer and corticosteroid administration. The BTS guidelines recommend the use of ipratropium bromide in the initial management of life threatening asthma. c) F. The commonest side effect of ipratropium bromide is dry mouth. It can also cause constipation, cough, paroxysmal bronchospasm, headache, nausea, palpitations and urinary retention. d) T. Ipratropium bromide can cause urinary retention in patients with prostatic hyperplasia and bladder outflow obstruction. It can also trigger acute closed angle glaucoma in susceptible patients.

Pharma: 8125

#3 Regarding aspirin: a) It inhibits prostaglandin production at low doses. b) It can be given as an anti-pyretic for childhood viral illness. c) Resistance is more common in men than women. d) Long term use predisposes to colon cancer.

Explanations: a) F. At low doses (75 mg per day) aspirin only inhibits COX-1, the enzyme responsible for making thromboxane A2, and therefore principally exhibits an anti-thrombotic effect. At medium to high doses (500-5000 mg per day) aspirin inhibits both COX-1 and COX-2. COX-2 is responsible for the production of prostaglandins and therefore has an anti-inflammatory effect at these doses. b) F. When used as an anti-pyretic for childhood viral illness, aspirin can cause Reyes syndrome. Reyes syndrome is a potentially fatal disease that causes liver failure and encephalopathy. c) F. Aspirin resistance is the inability of aspirin to reduce platelet production of thromboxane A2 and thereby platelet activation and aggregation. The exact frequency and mechanism of aspirin resistance are not known, however it may occur in approximately 1% of users. This phenomenon occurs more commonly in women than men. d) F. Recent research suggests that regular aspirin usage reduces the risk of colorectal cancer. It may also have a protective effect in breast, bladder, prostate and lung cancer.

Pharma: 8004

#4 Regarding the treatment of peptic ulcers: a) The proton pump is the terminal stage in gastric acid secretion. b) The use of proton pump inhibitors reduces the risk of re-bleeding following endoscopic treatment of bleeding peptic ulcers. c) The use of proton pump inhibitors is associated with an increased risk of community acquired pneumonia. d) The use of intravenous rather than oral proton pump inhibitors is associated with a better outcome in the management of acute peptic ulcer bleeding.

Explanations: a) T. This makes the proton pump an ideal target for inhibiting acid secretion. b) T. The statement is true. c) T. It is suspected that acid suppression results in poor elimination of pathogenic organisms leading to increased infection risk. d) F. The outcome is similar with both oral and intravenous PPI use.

Pharma: 8019

#5 Regarding sodium nitroprusside: a) It is a potent vasodilator. b) It is the drug of choice in the management of hypertensive crises requiring parenteral treatment. c) It has a half life of 1-2 hours. d) It must be stored in a dark area.

Explanations: a) T. The statement is true. b) T. The statement is true. c) F. It's half life is 1-2 minutes. The metabolite thiocyanate has a half life of several days. d) T. Sodium nitroprusside breaks down to release 5 cyanide ions upon exposure to UV light.

Pharma: 8058

#6 Amiodarone: a) Has a short half-life. b) Rarely causes corneal microdeposits. c) Commonly causes optic neuritis. d) Can be used in the management of sinus node disease.

Explanations: a) F. Amiodarone has a very long half-life, which can be as long as several weeks. b) F. Most patients taking amiodarone develop corneal microdeposits, this reverses after treatment has been ceased and rarely interferes with vision. c) F. Optic neuritis is a very rare side effect of amiodarone. If it does occur then the amiodarone should be stopped immediately due to the risk of blindness. d) F. Amiodarone is contra-indicated in the presence of sinus node disease.

Pharma: 8091

#7 Regarding the use of antihistamines: a) Cetirizine is an H2-receptor antagonist. b) The dose of chlorphenamine in anaphylaxis is 10 mg IV. c) Loratadine is non-sedating. d) They can be used in the management of C1-esterase inhibitor deficiency.

Explanations: a) F. Cetirizine is a selective H1-receptor antagonist. b) T. The statement is true. c) T. The statement is true. d) F. Antihistamines are ineffective in the management of C1-esterase inhibitor deficiency.

pharma: 8063

#9 The following drugs inhibit the effects of warfarin: a) Phenytoin. b) Sodium valproate. c) Isoniazid. d) Rifampicin.

Explanations: a) T. Cytochrome p450 enzyme inducers inhibit the effects of warfarin resulting in a reduced INR. The mnemonic PC BRASS can be used to memorise the commonly encountered cytochrome p450 enzyme inducers: P - Phenytoin C - Carbemazepine B - Barbiturates R - Rifampicin A - Alcohol (chronic ingestion) S - Sulphonylureas S - Smoking b) F. Sodium valproate is a cytochrome p450 enzyme inhibitor and potentiates the effects of warfarin (increases the INR). c) F. Isoniazid is a cytochrome p450 enzyme inhibitor and potentiates the effects of warfarin (increases the INR). d) T. The statement is true.

Pharma: 8102

Lithium: a) Therapeutic levels are 1.4-2.0 mmol/l. b) Has an elimination half-life of 20-24 hours. c) Side effects include polyuria and polydipsia. d) Interact with thiazide diuretics.

Explanations: a) F. Therapeutic levels of lithium are < 1.2 mmol/l. Lithium toxicity occurs at levels above 1.5 mmol/l. b) T. The statement is true. c) T. Common side effects of lithium include: Tremor Nausea and vomiting Muscle weakness Nephrogenic diabetes insipidus (causing polyuria and polydipsia) Hypothyroidism Depletion of calcium from bone d) T. Lithium interacts with thiazide diuretics and other sodium depleting drugs increasing the risk of lithium toxicity. ACE inhibitors and NSAIDs also reduce lithium excretion and increase the risk of lithium toxicity.

Pharma: 8144

#8 Regarding opioid analgesics: a) 1 mg of IV morphine is equivalent to 20 mg of oral codeine. b) 1 mg of IV diamorphine is equivalent to 1.5 mg of IV morphine. c) True allergic reactions are common. d) Morphine is a phenylpiperadine derivative.

Explanations: a) T. 1 mg of IV morphine is equivalent to 3 mg of oral morphine and 20 mg of oral codeine. b) T. 1 mg of IV diamorphine is equivalent to 1.5-1.8 mg of IV morphine. c) F. True allergic reactions to opioids are rare. d) F. Morphine is a phenanthrene derivative. Pethidine is an example of a phenylpiperadine derivative.

Pharma: 8147

#1 Tramadol: a) Is a strong -opioid receptor agonist. b) Inhibits the reuptake of noradrenaline. c) Blocks serotonin release. d) Has a half-life of 5-7 hours.

Explanations: a) F. Tramadol is a weak -opioid receptor agonist but is converted to O-desmethyltramadol, which has a much higher -opioid receptor agonist activity. b) T. The statement is true. c) F. Tramadol induces serotonin release and its co-prescription with tricyclic antidepressants and serotonin reuptake inhibitors should be avoided or approached with caution as a consequence of this. d) T. The statement is true.

Pharma: 8054

Features of atropine toxicity include: a) Hypothermia. b) Hallucinations. c) Miosis. d) Urinary retention.

Explanations: a) F. Atropine is a competitive antagonist of muscarinic cholinergic receptors and has the following effects: Nausea, dizziness, blurred vision (secondary to mydriasis and cycloplegia), photophobia, dry mouth, urinary retention, increased temperature (secondary to inhibition of sweating), tachycardia, confusion and hallucinations. b) T. The statement is true. c) F. Atropine causes mydriasis and cycloplegia. d) T. The statement is true.

Pharma: 8085

#4 Drug doses in adult asthma: a) Ipratropium bromide 100 mcg via oxygen-driven nebuliser. b) Salbutamol 5 mg via oxygen-driven nebuliser. c) Hydrocortisone 100 mg IV. d) Magnesium Sulphate 8 mg IV.

Explanations: a) F. Ipratropium bromide 500 mcg via oxygen-driven nebuliser. b) T. The statement is true. c) T. The statement is true. d) F. Magnesium sulphate 1.2-2 g IV (over 20 minutes)

Pharma: 8130

#2 The following are common features of salicylate poisoning: a) Tinnitus. b) Hyperpyrexia. c) Hypokalaemia. d) Thrombocytopenia.

Explanations: a) T. Common features of salicylate poisoning include: Nausea and vomiting Tinnitus Lethargy Dizziness Restlessness Sweating Bounding pulses Warm extremities Hyperventilation b) F. Uncommon features of salicylate poisoning include: Haematemesis Hyperpyrexia Hypoglycaemia Thrombocytopaenia Disseminated intravascular coagulation Renal failure Non-cardiogenic pulmonary oedema c) F. The statement is false. d) F. The statement is false.

Pharma: 8055

#5 Atropine: a) Is a non-competitive muscarinic cholinergic receptor blocker. b) Poisoning can be reversed using physostigmine. c) Crosses the blood brain barrier. d) The dose used in paediatric bradycardia is 1-2 mcg/kg.

Explanations: a) F. Atropine is a competitive antagonist of muscarinic cholinergic receptors. b) T. Physostigmine is a reversible cholinesterase inihibitor that can be used in atropine toxicity. c) T. Atropine crosses the blood brain barrier and as a consequence it has CNS side effects such as confusion and hallucinations associated with its use. d) F. The dose used in paediatric bradycardia is 10-20 mcg/kg.

Pharma: 8074

#6 Regarding the following antiplatelet drugs: a) Aspirin is a phosphodiesterase inhibitor. b) Clopidogrel inhibits glycoprotein IIb/IIIa. c) Ticlodipine is a thienopyridine class agent. d) Prasugrel is licensed for use in diabetic patients with acute coronary syndromes undergoing percutaneous coronary intervention (PCI).

Explanations: a) F. Aspirin prevents thromboxane A2 formation by irreversibly inhibiting cyclo-oxygenase. Dipyridamole acts as a phosphodiesterase inhibitor and acts to inhibit the conversion of cAMP to inactive 5' AMP. b) F. Clopidogrel inhibits ADP-mediated platelet aggregation. c) T. The thienopyridine class agents are prasugrel, ticlodipine and clopidogrel. They all act by inhibiting the ADP receptor. Ticlodipine has an increased risk of thrombotic thrombocytopenic purpura and neutropenia so its use has been largely supplanted by that of clopidogrel. d) T. Prasugrel is licensed for use in patients with acute coronary syndromes undergoing percutaneous coronary intervention. The TRITON-TIMI 38 study showed that prasugrel was associated with a significantly lower incidence of ischaemic events than clopidogrel and was particularly effective in patients with diabetes mellitus.

Pharma: 8067

#7 Regarding warfarin: a) The INR should be between 3 and 4 for patients with prosthetic heart valves. b) It affects the synthesis of factors III, XI and protein S. c) It is contraindicated in breast-feeding. d) Overdose can be treated with oral vitamin K.

Explanations: a) T. The INR should be kept between 3 and 4 for high-risk patients such as those with prosthetic heart valves and recurrent thromboemobolism. b) F. Warfarin is a vitamin K antagonist that affects the synthesis of factors II, VII, IX, X and protein C. c) F. Warfarin is not present in significant amounts in breast milk and appears to be safe in breast-feeding. d) T. Treatment of warfarin overdose depends upon both the INR and the presence of major bleeding. If there are risk factors for bleeding but no active bleeding then oral vitamin K alone can be given. However in the presence of bleeding the INR will need to be more rapidly corrected with IV vitamin K and factor concentrate.

Pharma: 8087

#8 Aminophylline: a) Contains ethylenediamine. b) Acts as a phosphodiesterase inhibitor. c) Potentiates the effects of dipyridamole. d) Is more potent than theophylline.

Explanations: a) T. Aminophylline is a compound of theophylline with ethylenediamine in a 2:1 ratio. The ethylenediamine improves its solubility. b) T. Aminophylline acts as both a phosphodiesterase inhibitor and a non-selective adenosine receptor antagonist. c) F. Aminophylline inhibits the effects of dipyridamole. d) F. Aminophylline is less potent and shorter acting than theophylline.

Pharma: 8126

#9 Regarding aspirin: a) It is a competitive cyclo-oxygenase antagonist. b) At low doses it inhibits the production of thromboxane A2 by platelets. c) Side effects include renal tubular necrosis. d) The effects of a single dose last 7-10 days.

Explanations: a) F. Aspirin is a non-competitive cyclo-oxygenase antagonist. It works by covalently acetylating the cyclo-oxygenase active site in both COX-1 and COX-2. b) T. At low doses (75 mg per day) aspirin only inhibits COX-1, the enzyme responsible for making thromboxane A2, and therefore principally exhibits an anti-thrombotic effect. At medium to high doses (500-5000 mg per day) aspirin inhibits both COX-1 and COX-2. COX-2 is responsible for the production of prostaglandins and therefore has an anti-inflammatory effect at these doses. c) T. Chronic aspirin usage can produce gastric irritation and erosion, GI haemorrhage, vomiting and renal tubular necrosis. d) T. The effects of a single dose of aspirin last 7-10 days, the time required for the bone marrow to generate new platelets.

Pharma: 8146

#10 Codeine phosphate: a) Is a moderate agonist at -opioid receptors. b) Can be used in the management of diarrhoea. c) Has half the potency of dihydrocodeine. d) 1 mg of IV morphine is equivalent to 10 mg of oral codeine.

Explanations: a) T. The statement is true. b) T. Codeine is used as an analgesic, an antitussive and as an antidiarrhoeal. c) F. Codeine phosphate and dihydrocodeine have similar potencies. d) F. 1 mg of IV morphine is equivalent to 3 mg of oral morphine and 20 mg of oral codeine.

Pharma 8029

Ephedrine: a) Causes the release of adrenaline from sympathetic nerve terminals. b) Acts on both alpha and beta adrenergic receptors. c) The parenteral dose is 3-30mg titrated to response. d) Causes a marked increase in systemic vascular resistance.

Explanations: a) F. Ephedrine causes the release of noradrenaline from sympathetic nerve terminals. b) T. The statement is true. c) T. The statement is true. d) F. Peripheral vasoconstriction is balanced by vasodilation with little overall change in systemic vascular resistance.

Pharma: 8084 Relative steroid potency: a) Dexamethasone is 6 times more potent than hydrocortisone. b) Methylprednisolone is 5 times more potent than hydrocortisone. c) Prednisoloone is 4 times more potent than hydrocortisone. d) Hydrocortisone is 5 times more potent than triamcinolone.

Explanations: a) F. Relative to hydrocortisone: Dexamethasone is 25 times more potent Methylprednisolone is 5 times more potent Triamcinolone is 5 times more potent Prednisolone is 4 times more potent b) T. The statement is true. c) T. The statement is true. d) F. The statement is false.

Pharma: 8013

Regarding the clinical use of beta blockers: a) Labetolol is used in the management of hypertension in acute stroke. b) Atenolol crosses the blood brain barrier. c) Bisoprolol has a half life of 10-12 hours. d) Propranolol can be used in the prophylaxis of migraine.

Explanations: a) T. Labetolol is indicated if the systolic BP is > 220 mmHg or the diastolic BP is > 120 mmHg. Treating hypertension in acute stroke has been shown to reduce the risk of intracranial haemorrhage. b) F. Atenolol dose not cross the blood brain barrier. c) T. The statement is true. d) T. The statement is true.