1.2.3.4.5.6. Angiotensin II :

1. is a powerful vasodilating agent2 .induces vasodilation of the afferent arterioles3. inhibit ADH ( antidiuretic hormone ) production4. inhibit renin release 5. all the above are correct

7. The clearance of creatinine is proportional to the 1. glomerular filtration rate ( GFR)2. tubular secretion rate (TSR)3. GFR+TSR4. cyclosporine clearance rate 5. cholic acid clearance rate

8. Serum creatinine levels are:1. low in pregnancy2. low in elderly patients 3. low in stage 3 chronic kidney disease 4. directly proportional to the liver function 5. inversely proportional to the white blood cell production

9. What fraction of the bile acid is normally reabsorbed in the intestine?1. 1%2. 5%3. 15%4. 40%5. 90%

10. Thoracic duct is a part of the following system:1. Nervous 2. Urogenital3. Gastrointestinal4. Lymphatic5. Musculo-skeletal

11. Majority of the proteins that are secreted by cells are synthesized in the1. Nucleus2. Endoplasmic reticulum 3.

12. Which of the following amino acids is aromatic?1. Lysine2. Tyrosine3. Cysteine4. Arginine5. Alanine

13. Hematuria can occur in all of the following except:1. Acute glomerulonephritis

2. Cancer of urinary tracts3. Stone in urinary tract4. Mismatched blood transfusion5. Benign prostatic hyperplasia

14. Low density lipoproteins (LDL) are rich in:1. Chylomicrons2. Cholesterol3. Mono-glycerides4. Proteins5. hormones

15. The P wave of the electrocardiogram (ECG) results from:1. Hyperpolarization of the atria2. depolarization of the atria3. hyperpolarization of the ventricles4. depolarization of the ventricles contraction of the aorta

16. Which of the following can cause diabetes?1. Shortage of receptors for extracellular proteins2. Shortage of G-proteins 3. Excess of glucose receptors4. Production of antibodies against the glucose receptors5. None of the above

17. Cellular immune response is mediated by:1. B-lymphocytes2. T-lymphocytes3. .4. .5. .

18. Sympathetic nervous system contain:1. Short postganglionic fibers 2. Long preganglionic fibers3. Ganglions located close to the spinal cord4. The vagus nerve5. All of the above

19. Adrenaline and noradrenaline :1. Are amino acids 2. Activate alpha-adreno receptors , but not beta-adrenergic receptors3. Are synthesized from dopamine4. Are characterized by a half-life of approximately 2-3 hours 5. None of the above answers are correct

20. Increased secretion of human growth hormone in adults causes :1. Gigantisim2. Acromegaly3. Increased skeletal muscle glucose utilization4. Decreased thyroid function5. Increased adrenal function

21. Hormones produced by the parathyroid gland (PTH):1. Regulates the phosphate levels in the blood

2. Leads to release of calcium from the bones3. Increases the excretion of calcium in urine4. Reduce the absorption of calcium in the gastrointestinal tract 5. All of the above

22. Substance that is secreted into the blood by a neuron is a :1. Neurohormone2. Neuromodulator3. Neuromediator4. neurotransmitter5. neurogene

23. The neurotransmitter that is normally released in the sinoatrial node in response to increased blood pressure is :

1. Acetylcholine2. Dopamine 3. Epinephrine 4. Glutamate5. norepinephrine

24. Which pyrimidine base is found only in RNA?1. Cytosine2. Thymine3. Uracil4. Adenine5. None of the above

25. Pharmacy A pharmacist prepare a solution by adding 1 g of sodium chloride to 100ml. water what is the percentage of sodium chloride in the prepared solution?

1. 10%2. 1%3. 0.1%4. 0.01%5. 100%

26. 100 µg are equal to:1. 100,000 ng2. 0.1 mg3. 0.001 g4. 1+35. 1+2+3

27. A tablet of multi-vitamin contains 250 µg of (something).(same something) of 6mg - is1. 10-fold higher 2. 24-fold higher3. 250-fold higher4. The same5. lower

28. Which of the following processes is bypassed by the sublingual rout of administration?1. Absorption2. Dissolution 3. First-pass metabolism

4. Plasma protein binding 5. Entero-hepatic cycle

29. A patient weighs 80 kg. A vial with concentrated solution of the drug is labeled “20mg/mL”. How many milliliters of the solution should be added to 50mL water if Patient should receive 0.5 mg/kg drug?

1. 0.22. 0.53. 14. 25. 4

30. Vial containing 1,000 units if a drug powder is labeled “add 9ml saline water forInjection to obtain 100 units /ml. How many milliliters of diluent should be added if the Required concentration is 120 units /ml?

1. 7.32. 8.33. 9.04. 105. 11

31. A pharmacist adds 200 mL of alcohol USP to the mouthwash solution-Make 1 L of final product. What is the percentage of the ethanol percentage of ethanol present in the original mouthwash contained 12% v/v ethanol?

1. 102. 193. 234. 295. 36

32. The infusion rate of theophylline for an infant is 0.08 mg/kg/h. how many –Drug should be added to the 12-hour infusion bottle if the body weight-7.3kg?

1. 0.582. 143. 304. 1505. 7

33. You were given the following prescription:Cocaine HCL 4%Tetracaine HCL 2% 0.5 mLEpinephrine HCL 1/2,000

Sodium chloride injection q.s. 4mL

How many milligrams of cocaine HCL will be present in the final solution?1. 42. 83. 164. 405. 160

34. P-gp (p-glycoprotein) pumps are found in all the following cells except:1. Brain vascular endothelial cells2. Nerve cells3. Gut epithelial cells4. Liver cells5. Kidney cells

35. Drugs with narrow therapeutic window:1. Are usually very safe2. Require administration at high doses3. Have extremely high clearance rate4. Require administration at low doses with high frequency5. Are administered only as iv infusion

36. Therapeutic drugs monitoring is usually performed for all the following drugs except:1. Phenytoin2. Insulin3. Lithium4. Digoxin5. Theophylline

37. Therapeutic antibodies are characterized by:1. Predominantly hepatic and renal excretion2. Effective penetration into cells in the peripheral tissues and the blood-brain barrier3. Once-a-day or twice –a-day dosing frequency4. Effective absorption after –5. Doses are in the

38. Patient is taking one pill of ibuprofen by mouth three times a day ( every 8 hours).if she would start to take the pill four times a day ( every 6 hours) it would change the following pharmacokinetic parameters of ibuprofen , except of :

1. The peak plasma drug concentration2. The average blood drug concentrations3. The free drug concentration in the blood4. The amount of drug excreted in the urine 5. The volume of distribution of the drug

39. The value of the oral bioavailability for a specific drug reflects the :1. Fraction of the drug that is absorbed by the intestinal epithelial cells2. Fraction of the drug that reaches the systemic circulation3. Fraction of the drug that reaches the site of action4. Rate of the drug absorbed from the gastrointestinal tract5. The rate of drug eliminated by the liver and kidneys

40. ) A patient received an oral dose of 650 mg aspirin. the plasma drug concentration and its Inhibiting effect on thromboxane B2 product were measured ( see the graphs below)

From the data, it can be determined that aspirin :1. Is slowly absorbed from in the gastrointestinal tract 2. Has a long half-life ( approximately 24 hours)3. Has a short duration of action4. Has indirect concentration-effect relationship5. Undergoes very rapid renal elimination

41. What represented by the area under the drug concentration vs. time :1. Rate of drug renal and hepatic elimination2. Rate of drug intestinal absorption3. Efficacy of drug permeation of peripheral tissues 4. Amount of drug that reaches the blood circulation 5. Solubilization and ionization state of the drug molecules

42.43.44.45.46. What is the appropriate dosing regimen of allopurinol in this patient?

1. 100 mg once a day2. 300 mg once a day3. 900 mg once a day4. 1200 mg once a day 5. Cannot be calculate – insufficient data

47. The half-life of cyclosporine is 20 hours. Blood sample that has been obtained from a Patient contained 0.8 mg/mL cyclosporine. How soon the cyclosporine concentration in the Patient’s blood is expected to reach the concentration of 0.2 mg /ml?

1. In 4 hours2. In 20 hours3. In 40 hours4. In 44 hours5. None of the above answers is correct

48. Phase II clinical trials :1. Are conducted in healthy volunteers

2. Investigate the relationship between the drug dose and the clinical -3. Investigate the clinical response of the drug on more than 100 patients 4. Are not double-blinded5. Usually examine several types if drugs formulation (e.g. immediate Release )

49. What parameters are needed to calculate body surface :1. Height and waist circumference 2. Height , gender and the age of the patient 3. Height and weight 4. Height, weight and the age of the patient5. Weight and the waist circumference

50. The renal clearance of ampicillin is 25 L/hr. it is known that ampicillin protein binding ( f= 80%). What processes are responsible for the =

1. Only filtration 2. Filtration and 3. .4. .5. .

51. Potassium supplements are administered in all of the following routes except:1. IV infusion 2. Iv bolus3. Oral elixirs4. Effervescent tablets5. Slow-release tablets

52. A pharmacist has reviewed several clinical papers concerning irritable bowel syndrome and is preparing a publication with a summary of his findings. What issued to describe this type of review?

1. Dimensional analysis 2. Double blind study3. Review article4. Peer review5. Crossover design

53. What are the common building blocks for generation of liposomes?1. Anionic surfactant and mineral oil2. Nonionic surfactant and mineral oil3. Phospholipids4. Polyethylene glycols (PEGs)5. Linear hydrocarbons combined with phosphoric acid

54. Which of the following parameters must be identical between a solution and the blood, for a solution to be considered isotonic with blood?

1. Total salt count2. PH3. Fluid pressure4. Osmotic pressure5. Concentration of sodium chloride

55. When mixing a hypertonic solution with red blood cells (RBCs) the RBCs might undergo:1. Bursting2. Chelation

3. Shriveling4. Hemolysis5. Hydrolysis

56. What is the capacity of the human eye for instillation of ophthalmic drops?1. 0.01-0.05 ml2. 0.1 ml3. 0.5 ml4. 1.0 ml5. 2.0 ml

57. Ibuprofen has pKa of 5.5. If the ph. of a patient is 7.5, what would be the ratio of Ionized to un-ionized drug?

1. 1:22. 1:1003. 1:204. 2:15. 100:1

58. Pharmaceutical policy and regulationsA customer came to the pharmacy with a prescription for a drug that is not registered in the Israeli state drug list. The pharmacist should explain (“to” not written on the paper )the customer that :

1. It is absolutely prohibited to use a drug which is not listed in the Israeli state drug list

2. The drug can be imported from abroad according to regulation number 29(a)3 of the drug regulations ( medical preparations 1986 ) if a physician will sign an appropriate form

3. Since the import of drug from abroad will be handled by the pharmacy, it is possible to import it following an oral request by the physician

4. Only a medical institution is allowed to import a drug that is not registered in the Israeli state drug list from abroad

5. Only if a drug is registered and approved for marketing in Israel , it is allowed to register if for a different indication than that stated in the Israeli state drug list

59. An application for inclusion of a drug in Israeli state drug list in applied by the :1. Pharmacist 2. Registration owner 3. Registration applicant 4. Physician5. Pharmaceutical factory

60. The use of narcotic drug in a higher daily dose than stated in column B of the second amendment to the schedule drug regulations is allowed when:

1. A specialist physician prescribed a daily dose which is higher than the allowed by the law

2. A patient suffers from cancer and physician specified in the prescription 3. if the prescription that was brought to the pharmacy was issued by a hospital

physician4. There is no limitation for a drug doe that can be prescribed in a narcotic

prescription

5. A prescribing physician is an oncologist from a certified hospital61. Which of the following statements regarding psychotropic drugs from the fourth

amendment to the Israeli pharmacist’s regulations is correct?1. The drugs should be in a safe2. The drugs should be stored inside a closed drawer3. There is no requirement to store the drugs inside a closed drawer/closet4. The law requires submitting a daily report regarding such drugs5. The drugs should be stored inside a refrigerator

62. Which of the following statements is correct?1. The general manager of the ministry of health is allowed to require an additional

examination to be taken by a candidate for pharmacist’s license before issuing him the license

2. The governmental examination in pharmacy is intended only for those who accomplished degree in a non-recognized university

3. Those possessing a doctor of clinical pharmacy (pharm D) degree from abroad automatically receive an Israeli pharmacist license

4. Those possessing master’s degree in pharmacy from abroad, automatically receive and Israeli pharmacist license

5. None of the above63. If a medical board was appointed to examine an applicant’s fitness to practice pharmacy

then:1. The general manager of the ministry of health can’t issue the applicant a license

pharmacy as long as he didn’t appear before the board2. The board can issue the license to practice pharmacy 3. This means that the applicant didn’t receive a certificate of good conduct from –4. Such board is appointed only after the applicant received a temporary license to

practice pharmacy5. Such board is appointed for each pharmacist before he gets the permanent license

to practice pharmacy64. A pharmacist or an assistant pharmacist who turned out to have a disease which may

clearly endanger the public :1. The general manager of the ministry of health may suspend ( temporarily deny) his

license to practice pharmacy 2. The medical board can revoke his license to practice pharmacy3. Only the minister of health may order the suspension of his license4. He must not practice pharmacy in drug rooms of health medical organizations (

חולים קופות5. He is allowed to continue practicing pharmacy if he filed the board proof that he is

properly treated 65. The minimal area of a drug room belonging to a medical institution is

1. 30 square meters2. 45 square meters3. 60 square meters4. 120 square meters5. There is no maximal area of a drug room defined by the law

66. The validity of a medical prescription is :1. Two months

2. Six months3. One year4. For life5. One month from the date issued

67. When the district pharmacist is allowed to cancel the license 1. When the pharmacist has obtained the license after presenting false documents2. When the pharmacist committed gross negligence of duty3. When the pharmacist continued to violate the provisions of the pharmacist’s

regulations4. The district pharmacist has no authority to cancel a license of a licensed

pharmacist 5. When the pharmacist acted in a manner unbecoming his profession

68. The area of the laboratory of an institutional pharmacy which area is below 120 square meters1. Should not exceed half of the area of the pharmacy2. Should not be below half of the area of the pharmacy3. Should not be below 12 square meters4. Should not exceed 12 square meters5. Should be at least 18 square meters

69. The pharmacy’s lab :1.can be locate at a different level if no pharmaceutical preparations 2.must be large enough to be used as storage when no3.must be adjacent to the storage and at the same level4.must be adjacent to the reception room and at the same5. The toilets in the pharmacy must be inside the lab.

70. Providing a schedule drug to a hospitalized person – the daily dose specified in column B of the second amendment – regulates:1is subjected to approval of a district pharmacist of the hospit-2.is subjected to a signed approval of the hospital director 3.is subjected to a signed approval of the department head nurse4.there is no dosage limit for a hospitalized patient and no ho-5. Exceeding the daily dosage specified in column B of the second– drugs regulations is prohibited.

71. Pharmacies on duty are scheduled by:1. The municipal authority (municipality or the local -) or the ministry of health2. The ministry of health3. The pharmacy department of the ministry of health4. The pharmacists association5. The minister of health

72. Supply of a generic substitute is possible:1. Only if the prescribed product is out of the market2. If the physician didn’t explicitly specified to supply the exact – substituting it3. You can always issue a generic substance if it contain the- dose as the prescribed

drug, even if the physician explicitly -4. Generic substitute cannot be issued without a telephone ap-5. Issuing of a generic substitute is completely prohibited - substance

73. Which of the following statement is correct?1. Any drug product containing codeine requires a prescription 2. Any psychotropic drug product requires a prescription3. All the “separanda” drug products contain psychotropic active ingredients4. All the pharmaceutical preparations prepared at the pharmacy don’t require a

prescription 5. A drug product containing a schedule drug מסוכן listed in the fourth סם

amendment of the pharmacist’s regulations is necessary defined as “ toxica”74. According to the law, the appointment of a responsible pharmacist requires

1. Written examination 2. Oral examination3. The pharmacy owner is the one who determines whether the pharmacist fits for

the pharmacy management4. The district pharmacist’s approval5. At least one year of experience of working at the ministry of health

75. An approval of residency in pharmacy to the graduates of forging universities is issued by 1. The director of the medical professions division 2. The pharmacy where the residency was conducted 3. The district pharmacist of the pharmacy district 4. The administrative physician of an health medical organization ( חולים in קופות

the pharmacy district 5. One who studied pharmacy in Israel has full exemption from the

76.77.78.79.80.81. The next two question ( 81 – 82) refer to the following case :

A 73-year-old patient suffering from HTN (hypertension), CHF (chronic heart failure) and s/p MI (status post myocardial infraction). The patient is being treated with the following drugs:Digoxin 0.25 mg X 2/d – new treatment Hydrochlorothiazide 50 mg X 1/dEnalapril 2.5 mg x 1/dAtenolol 100 mg 1/dMark the incorrect statement:

1. The initial dose of digoxin for this elderly patient is too high 2. The recommended daily dose of hydrochlorothiazide is 25 mg since at higher

doses there are more adverse effects but no increase in efficiency 3. Combination of enalapril with digoxin may cause hypokalemia that may lead to

dangerous arrhythmias 4. Combination of hydrochlorothiazide with digoxin may cause hypokalemia that

might lead to dangerous arrhythmias 5. Combination of digoxin and atenolol slows the conduction through the AV node

82. The patient complains of erectile dysfunction (impotence). What would be the right treatment:

1. Lower the dose of digoxin as erectile dysfunction is common at doses above 0.25 mg

2. Immediately discontinue atenolol as erectile dysfunction is its common side effect3. Immediately discontinue enalapril as erectile dysfunction is its common side effect4. Replace enalapril with losartan5. None of the above

83. Patient underwent heart valve replacement with bio-prosthetic heart valve. On his first night of hospitalization began to receive treatment with warfarin 5 mg/d. on the second day of warfarin treatment the patient developed blood clots at his hands and feet.Select the correct statement:

1. The doctors should have started at higher warfarin dose – the dose was too low2. The dose of warfarin should be increased until hypercoagulation phenomenon

passes 3. To prevent this phenomenon heparin should be given the first few days of warfarin

treatment 4. To prevent this phenomenon heparin should be administered during the entire

period of warfarin treatment 5. This is a rare allergic reaction to warfarin

84. Simultaneous administration of ferrous sulfate 325 mg with sinemet ® containing a combination of levodopa 100 mg with carbidopa 25 mg , will:

1. Increase the bioavailability of levodopa and carbidopa as result of decreased first pass metabolism

2. Decrease the bioavailability of levodopa and carbidopa as a result of decreased first pass metabolism

3. Decrease plasma concentration of levodopa and carbidopa as a result of interaction in intestinal lumen

4. Increase concentration of levodopa and carbidopa as a result of interaction in the intestinal wall

5. Mot affect the plasma concentration profile of sinemet85. A patient received phenazopyridine to relive the pain associated – infection.

During the treatment the patient reported that his urine – red brown.Select the correct statement:1. The patient has glucose-6-phosphate dehydrogenase ( G6PD) deficiency 2. This is due to the acute kidney failure3. This is due to hemolysis of red blood cells in the urinary tract4. The treatment with this drug must be immediately discontinued 5. None of the above

86. Co-administration of codeine and fluoxetine:1. is expected to cause reduction in the analgesic activity of codeine2. Leads to enhanced respiratory depression side-effect3. Is expected to cause an increase in the analgesic activity of codeine 4. There is no clinically significant interaction between these two drugs5. At least two-hour interval is required between codeine and fluoxetine

87. Woman suffering from epilepsy became pregnant, what treatment – teratogenic risk?1. Phenytoin 600 mg per day 2. Valporic acid 1400 mg per day

3. Valporic acid 800 mg per day4. Lamotrigine 150 mg per day5. Tegretol 100 mg and phenobarbital 5 mg per day

88. A 70 year old patient is being treated with the following medication:T. verapamil 240 mg x 1/dT. digoxin 0.25 mg x 1/dT. furosemide 80 mg x 1/dThe patient has been diagnosed with: edema and arrhythmia. The patient was admitted in hospital due to digoxin poisoning.Mark the incorrect answer:

1. It’s possible that the toxicity was caused due to a pharmacokinetic interaction following P-gp inhibition by verapamil causing a decrease in the renal clearance of digoxin

2. The toxicity could be a result of hyponatremia caused by furosemide3. The toxicity could be avoided by consuming potassium-rich foods4. The use of digoxin antibodies is effective in the treatment of digoxin toxicity5. It is possible that the toxicity was caused due to a pharmacokinetic interaction

following P-gp inhibition by verapamil causing an increase in the digoxin absorption

89. The following statements refer to treatment with furosemide and hydrochlorothiazide, mark the correct statement.

1. Furosemide has a very strong diuretic effect and therefore it is an appropriate treatment of edema

2. In treatment of patients suffering from kidney failure furosemide should be replaced with hydrochlorothiazide which is more efficient in this disease

3. Hydrochlorothiazide containing sulfur atom, therefore patients who are sensitive to sulfonamides might develop sensitivity to this drug

4. Common side effects of furosemide is Hypercalcemia, as opposed to hydrochlorothiazide which causes hypoglycemia

5. None if the above90. The following statements refer to metoclopramide and Domperidone.

All of the following statements are correct except:1. Metoclopramide does not cross the blood-brain barrier (BBB) and therefore has

no extra-pyramidal side effect2. Domperidone does not cross the blood-brain barrier (BBB) and therefore has no

extra-pyramidal side effect3. Domperidone increases the motility of the gastrointestinal tract 4. Metoclopramide is safe drug (risk factor B) to treat nausea vomiting during

pregnancy 5. Domperidone is not intended for chronic administration due to the risk of QT

interval prolongation 91. Tremor and tachycardia are typical side effects of :

1. Salbutamol2. Propranolol3. Metformin4. Cefuroxime5. Budesonide

92. Which of the following pharmaceutical combinations does not require dose adjustment – treatment discontinuation in patients with severe kidney failure ( CLcr <10):

1. Alendronate, pravastatin 2. Digoxin, metoclopramide3. Enalapril, spironolactone4. Ciprofloxacin, metformin5. Lactulose, paracetamol

93. Prolonged treatment with which two drugs (at least for over a month) does not have to be discontinued gradually?

1. Prednisone, verapamil2. Metoprolol, propranolol3. Amiodarone, fluoxetine 4. Brotizolam, amitryptyline5. Venlafaxine, paroxetine

94. Which of the following substances is a pro-drug?1. Prednisone2. Cilazapril3. Enalapril 4. Vitamin D5. All of the above

95. A 45 year old patient suffers from heart failure and newly diagnosed type 2 after receiving a drug to control her blood sugar level, her edema and syn – heart failure got worse. Which of the following medication did she receive?

1. Rosiglitazone2. Metformin3. Glibenclamide4. Acrabose5. Insulin

96. Which of the following drugs may elevate the liver damage tests (‘the liver enzymes’) therefore requires monitoring liver metabolic function before and during the drug treatment

1. Risperdone 2. Fluconazole3. Metformin4. Glibenclamide 5. 2+4

97. Mark the correct statement referring to methylphenidate:1. Common side effects of the drug are: increased appetite and agitation2. The drug is an adrenergic agonist3. When having difficulty to swallow the capsule with the drug (concerta), it can be

opened and the content can be dispersed on soft food 4. Ritalin LA is an extended-release formulation of methylphenidate, however is has

fast onset of drug action5. All of the above

98. A pharmacy student reads a patients chart and notes that the patient has blepharitis.The patient suffers from inflammation of what organ

1. Colon

2. Eyelid3. Throat4. Tongue5. Ear

99. What is true regarding who block the beta-adrenergic receptors?1. At low doses they are selective to B1 receptor, however at high doses the lose

their selectivity2. Their use during pregnancy is common and is not associated with health risks the –3. There is no correlation between their half-life and their duration of action4. They have pharmacokinetic interaction with amiodarone, digoxin and verapamil5. None of the above

100. Co-administration with fluconazole may increase the blood concentration of which of the following drugs:

1. HMG CoA reductase inhibitors, atenolol2. HMG CoA reductase inhibitors, cyclosporine3. Cyclosporine, codeine 4. Brotizolam, cefuroxime5. Amitriptyline, methylphenidate

101. Which fetal organ/s are still considerably susceptible to teratogenic effects at the fifth month of pregnancy?

1. Heart2. Brain3. Upper limbs4. Lower limbs5. 1+2

102. Which of the following patients will enjoy the maximal analgesic effect of codeine?1. Poor CYP2D6 metabolizer2. Poor CYP2C9 metabolizer3. Extensive CYP2C9 metabolizer4. Extensive CYP2D6 metabolizer5. The analgesic effect of codeine is dependent only on the glucuronidation efficiency

103. A patient was hospitalized with severe arrhythmia as a result of hyperkalemia. Doctors that checked his drug chart identified three medications that could, each by itself, cause hyperkalemia. Which drugs could have caused this effect?

1. Digoxin; enalapril; spironolactone2. Prednisone; potassium chloride; cilazapril3. Losartan; spironolactone; potassium chloride4. Enalapril; hydrochlorothiazide; furosemide

104. Which medication is not indicated for migraine prophylaxis?1. Propranolol2. Amitriptyline3. Citalopram4. Topiramate5. Valporic acid

105. Which of the following beta-blockers has the highest incidence of the central nervous system side effects

1. Propranolol 2. Atenolol3. Metoprolol4. Timolol5. The incidence of central nervous system side effects is the same for all beta-

blockers106. Combination of lithium with which of the following drugs may cause lithium toxicity?

1. Simvastatin2. Hydrochlorothiazide3. Atenolol4. Famotidine5. 1+2

107. Which one if the following drugs increase the level of dopamine in the brain?1. Methylphenidate 2. Paroxetine3. Risperdone4. Amitriptyline5. Fluoxetine

108. A woman is referred to a teratology consulting center at the ninth week of pregnancy because up to that day she was receiving warfarin treatment.What would be your diagnosis/advice?

1. Warfarin does not cross the placenta so there is no additional risk to the fetus 2. There is a risk of fetal abnormalities: stippled epiphyses and hypoplasia of nasal

bridge3. To monitor the pregnancy by ultrasound. It can be concluded that the fetus was

not affected if the abnormalities will be detected4. Warfarin can cause risk of fetal abnormalities only if taken in the 12th week of

pregnancy 5. Replacing warfarin with heparin at this time point will prevent fetal abnormalities

109. The following two questions (109-110) refer to the following case:A patient comes to the pharmacy with the following prescription:T. Amitriptyline 25 mg X 2/dOvules clindamycin 100 mg X 1/d , for 3 daysT. Levodopa 250 mg + carbidopa 25 mg X 4/dT. simvastatin 20 mg X 1/dWhat illnesses does he suffer from?

1. Depression, Parkinson’s, hypercholesterolemia and vaginal candidiasis2. Herpes zoster, Parkinson’s, hypercholesterolemia and vaginal bacterial infection3. Migraine, Parkinson’s, hypercholesterolemia and vaginal candidiasis4. Depression, Parkinson’s, hypercholesterolemia and vaginal bacterial infection5. Neuroleptic pain, Parkinson’s, hypercholesterolemia and vaginal candidiasis

110. Which of the following drugs can be co-administered without the risk of drug interactions :1. Lithium2. Risperdone3. Fluconazole4. Entacapone5. Metformin

111. The better treatment for nausea and vomiting in patients having Parkinson’s disease is:1. Domperidone2. Metoclopramide3. Either Metoclopramide or Domperidone4. Both metoclopramide and Domperidone are contraindicated for treatment of

Parkinson’s disease patients5. None of the above

112. Which if the following is not typical side effect of amiodarone?1. QT interval prolongation at ECG2. Blue skin discoloration3. Liver damage4. Pulmonary fibrosis5. Kidney damage

113. Which of the following is defined as primary data source?1. Cohort studies 2. Review articles3. Brief description of the information displayed in an article-abstract4. Textbooks 5. 1+2+3

114. Which statement regarding spironolactone is incorrect?1. Co-administration of spironolactone and ACE inhibitor is dangerous due to the risk

of hypokalemia2. During the treatment, potassium blood levels should be monitored due to the risk

of hyperkalemia3. Gynecomastia ( breast enlargement ) in men is considered to be one of the drug’s

side effects4. The regular dose for treatment of heart failure treatment is lower than of edema

treatment5. This drug is used for the treatment of hepatic cirrhosis with edema and ascites

115. All the statements regarding digoxin toxicity are correct except:1. Hypokalemia may exacerbate digoxin-induced toxicity 2. Dioxin toxicity cannot occur at the steady-state plasma digoxin concentration of

0.8 mcg\L ( the accepted therapeutic window is 1-2 mcg\L)3. Gastrointestinal disorder such as loss of appetite are early symptoms of digoxin

toxicity4. Strict monitoring of drug blood levels can reduce the risk of digoxin toxicity5. Drugs that inhibit P-gp may increase the risk of digoxin toxicity

116. Choose the correct statement:1. As compared to verapamil, nifedipine has greater effect on the AV node

conduction2. Grapefruit juice increases metabolism of nifedipine 3. Verapamil reduces blood pressure mainly by dilating of peripheral vessels 4. Verapamil inhibits P-gp pumps and CYP3A4 enzyme is the intestinal epithelial cells

(enterocytes)5. None of the above

117. A patient was discharged from the hospital 2 days ago with a prescription for the following drugs:Tab. Aspirin 100 mg * 1/dayTab. Clopidogrel 75 mg *1/dayChoose the incorrect statement:

1. patient with active bleeding can be treated with Clopidogrel but not aspirin2. the combination of aspirin and Clopidogrel in patients after acute myocardial

infraction is not recommended3. a loading dose of Clopidogrel should be given to a patient after and acute

myocardial infraction4. in patients with cardiovascular disease the combination of the drugs is more

effective that when administered alone5. the combination of aspirin and Clopidogrel in patients after stroke is not

recommended 118. Choose the incorrect statement:

1. The most side effect associated with nitrates is headache2. Nitrates mainly dilates systemic veins and reduce preload3. When nitrates are co-administered with PDE5 inhibitors (e.g. sildenafil) the dose of

both drugs should be reduced to prevent a sharp decline of blood pressure 4. When daily nitrate-free of 8 – 12 hours is not provided, tolerance to nitrate

treatment can develop5. Sildenafil is used to treat pulmonary hypertension

119. The interaction between aspirin and naproxen is :1. Pharmacokinetic – ibuprofen competes with aspirin for its binding site at cox2 and

reduce the effect of aspirin on platelet aggregation 2. Pharmacodynamics – ibuprofen increases the risk of gastrointestinal bleeding

associated with aspirin use 3. Pharmacokinetic – aspirin inhibits the activity of CYP3A4 enzyme responsible for

the metabolism of ibuprofen, therefore ibuprofen levels are increased4. Pharmacodynamics – ibuprofen competes with aspirin for its site at cox1 and

reduce the effect of aspirin on platelet aggregation5. There is no interaction between the two drugs

120. A patient has been treated with enalapril for a month. Two days ago started to complain about suspicious cough and swelling of the face. The doctor decided to change his treatment to cilazapril. What was the reason for his decision?

1. Cilazapril belongs to the family of angiotensin receptor blockers, which don’t have cough as side effect

2. Swelling of the face may be a manifestation of angioedema, which is not typical side of cilazapril, thus the treatment was exchanged

3. Apparently a mistake was made, both drugs belong to the family of angiotensin converting enzyme inhibitors and their side effect profile is similar

4. There is no need to change the treatment; cough and swelling are common side effects of enalapril that pass on their own

5. None of the above121. Combinations of the following drugs pair increase the risk of reduced blood pressure in

which drug combination will not cause this side effect?1. Naproxen – sildenafil

2. Doxazosin – nifedipine3. Furosemide – isosorbide mononitrate 4. Doxazosin – furosemide5. Enalapril – cilazapril

122. Select the correct statement regarding pharmacokinetic parameters1. All the pharmacokinetic parameters of drugs, except for the volume of

distribution, are affected by child’s growth and development 2. In younger children the oxidation processes in the liver by the cytochrome p450

are slow and therefore the daily dose of phenobarbital ( per weight ) should be lower

3. Maturation of renal function is a dynamic process that begins during fetal organogenesis and ends only in adolescence (12years)

4. Extent of protein binding of drugs, that are weak acids, is lower in neonates than in children

5. None of the above 123. Patient with diabetes checked his blood sugar levels and discovered that he suffers from

hypoglycemia. The last time he took any medication was 10 hours ago. Which of the following drugs did he take?

1. Glibenclamide 2. Metformin 3. Rosiglitazone 4. Prednisone 5. lactulose

124. The following statement refers to acyclovir. Select the incorrect statement:1. It is an anti-viral drug which inhibits viral DNA synthesis and viral replication2. It should be taken immediately with the onset of symptoms3. The drug does not cure herpes, but shortens the duration of the infection outbreak4. When acyclovir is administered by IV infusion, hydration fluid should be given to

prevent precipitation of the drug in the kidneys5. The drug is safe in patients with renal insufficiency as it is mainly eliminated by the

liver 125. The following graph shows the steady-state concentrations of

phenytoin in patients chronically treated with the drug. X-axis describes the daily dose administered per kg of body weight and the y-axis represents the steady-state concentration in the individual patients.

What can be deduced from the data shown in the graph?

1. The high degree of variability presented in the graph demonstrates inter-patient pharmacodynamics variability

2. Normalizing patient dose according to patient body weight reduces the variability in drug plasma concentration

3. It is important to maintain a dose of 5 mg/Kg in order to achieve steady-state concentration within the therapeutic window (10-20 mg\L)

4. Plasma blood levels should be monitored in each patient personally5. The finding are misleading as drug’s plasma concentration depend on the time the

drug was administered 126. Why treatment with B blockers should be discontinued gradually

1. Chronic treatment stimulates the up-regulation of B receptors therefore sudden treatment discontinuation may lead to a sharp decline in blood pressure and loss of consciousness

2. Only selective B1 receptor blocker should be discontinued gradually 3. Gradual cessation is important only if the patient took the drug for at least six

months4. Similarly to other drugs used to lower blood pressure, treatment with B blockers

should be discontinued gradually 5. Abrupt B blocker withdrawal may cause rhythm disturbance and hypertension

127. A 35 year old patient entered a pharmacy with a prescription for rizatriptan prescribed by her neurologist. Additionally, she is being regularly treated for high blood pressure by her family doctor.Which of the following is incorrect?

1. If the effect of the first dose wears off she can take another does every two hours as long as maximum daily dose in not exceeded

2. If the first dose of rizatriptan was not effective at all, she can take another dose of rizatriptan after two hours

3. The pharmacist must ensure that her blood pressure is balanced, since the use of trip – contraindicated in patient with uncontrolled blood pressure

4. She should be informed that there are effervescent tablets available allowing the ea– of swallowing in case she experience nausea and vomit

5. If she is being treated with propranolol for her high blood pressure her doctor – as propranolol may increase rizatriptan’s plasma concentration by 70%

128. Which of the following statements regarding atorvastatin is correct 1. The most dangerous side effect is myopathy2. Must be taken at bed time3. Not intended to be used in the elderly patients due to the risk of adverse drug –4. Co-administration with metformin increases the risk of hypoglycemia

129. Mark the incorrect statement regarding haloperidol :1. Is used to treat hiccups and nausea2. May cause prolongation of the QT interval on ECG3. Should not be used in patients with Parkinson’s disease 4. Decanoate formulation is administered once a week 5. Co-administration with tramadol lowers the seizure threshold

130. Mark the incorrect statement regarding venlafaxine:1. Blocks reuptake of both serotonin and norepinephrine 2. Is not effective from the first dose taken3. May increase blood pressure and cause tachycardia4. May cause sexual dysfunction5. Has long half-life thus can be discontinued at once

131. A diabetic patient comes into the pharmacy with a prescription for atenolol during the interview the pharmacist realizes that atenolol was prescribed to the patient for the first

time.Mark the most correct statement:

1. Atenolol can mask signs of hypoglycemia, therefore the patients should be instructed to monitor blood glucose levels especially at the beginning of the treatment

2. Atenolol can mask signs of hypoglycemia, therefore is contraindicated in patients with diabetes

3. Atenolol, at low doses, selectively blocks B2 receptors, therefore does not mask the signs of hypoglycemia

4. Atenolol is contraindicated in patients treated with insulin5. Due to the risk of renal damage diabetic patients should not be treated with

atenolol132. Enoxaparin is less likely to cause dangerous bleeding than standard heparin, because

enoxaparin:1. Does not bind to anti-thrombin – III2. Does not inhibit coagulation factor II3. Affects only the platelet function4. Is not efficiently absorbed after SC administration5. Not correct, both drugs have similar risk of bleeding

133. The following statements refer to drugs of the fibrates and statins group.Mark the correct answer.

1. Statins therapy has been shown to reduce morbidity and mortality2. Fibrates are more effective in lowering LDL levels3. Statins are more effective in lowering triglycerides levels4. Statins are more effective in lowering HDL levels5. Statins have no advantage over fibrates

134. Selegiline and rasagiline are approved for use in Parkinson’s disease.Their mechanism of action is:

1. Dopamine agonists2. Monoamine oxidase B enzyme inhibitors3. Anticholinergic agents4. Dopa decarboxylase inhibitors5. COMT enzyme inhibitors

135. Which statement regarding tardive dyskinesia is incorrect1. It is caused by antipsychotic medications2. It is more common in older women3. it is a disorder that involves involuntary movement , especially of the mouth ,jaw

and tongue 4. this phenomenon can be relieved by lowering the dose of antipsychotic drug 5. it appears at the beginning of the treatment and passes by itself during chronic

treatment 136. Clinical symptoms of hypoparathyroidisim include

1. Hypocalcemia and hyperphospatemia 2. Hypocalcemia and Hypophospatemia3. Hypercalcemia and hypochlorhydia 4. Hypercalcemia and hypophosphatemia

5. Hypercalcemia and hyperphosphatemia 137. What is the typical for aminoglycoside antibiotics

1. Can be orally administered for treatment of acute systemic infection with pseudo2. Dosage adjustment is necessary in patients with hepatica dysfunction 3. Active against a wide range of gram- positive and gram-negative bacteria4. Suitable for long-term treatment of several urinary tract infections5. Drug of choice for prevention of infections in neonates and premature infants

138. What is the advantage of dopamine use in cardiogenic shock?1. Dopamine dies not cross the blood brain barrier and therefore, does cause

system side effects2. Dopamine does not increase blood pressure3. Dopamine can be orally administered 4. Dopamine causes a dose-dependent increase in cardiac output and renal perfusion 5. Dopamine does not affect alpha and beta adrenergic receptors

139. Which of the following substances provide the greatest value of calories/gram?1. Ethanol2. Protein3. Carbohydrate4. Long chain triglycerides5. dextrose

140. Which of the following drugs can cause an increase in – concentration?1. Nifedipine2. Losartan3. Enalapril4. Clonidine 5. Metoprolol

141. What is the choice for 7-years old boy with otitis media?1. Amoxicillin 2. Gentamycin3. Tetracycline HCL4. Ciprofloxacin5. Metronidazole

142. Which antidote is useful for systemic atropine toxicity?1. Acetylcysteine 2. lactulose3. Polyethylene glycol4. Flumazenil5. Physostigmine

143. Which of the following symptoms is not typical in type 1 diabetes?1. Weight loss2. Thirst3. Appearance of glucose in urine4. Urinary retention5. weakness

144.

Which of the following curves represent best the time course of plasma levels of insulin detemir ( levemir )

1. A2. B3. C4. D5. E

145. Which of the following curves represent best the time course of plasma levels of insulin aspart ( novorapid)

1. A2. B3. C4. D5. E

146. Which of the following curves represent best the time course of plasma levels of insulin NPH (humulin NPH)

1. A2. B3. C4. D5. E

147. Which of the curves represents best the time course of plasma levels of human insulin (humulin R)?

1. A2. B3. C4. D5. E

148. In addition to treating epilepsy, carbamazepine is approved by the FDA for:A. Management of diabetic neuropathy

B. Migraine prophylaxis C. Management of neuropathic pain and trigeminal neuralgia D. Treatment of bipolar disorder

1. A only2. C only3. A and C4. C and D5. A, B, C, and D

149. Which of the following medication when given to infant cause “gray baby syndrome”?1. Gentamycin2. Ciprofloxacin3. Doxycycline4. Amphotericin B5. chloramphenicol

150. Patients receiving clozapine should be monitored since they can develop:1. Agranulocytosis2. Hepatocellular necrosis3. Lupus-like side effects4. Thrombocytopenia5. Stevens Johnson syndrome

151.