Revision SEM 2

Nehal M. Ramadan
NSAIDs
Q
A 35-year-old man presents to his doctor with complaints of epigastric
pain. The patient has a history of a lower back injury in which his pain is
managed with ibuprofen. He is diagnosed with gastritis. Which of the
following best explains the reason for the patient's symptoms?
A. Inhibition of phospholipase A2

B. Inhibition of COX-1 production of PGE2

C. Inhibition of COX-2 production of PGI2

D. Inhibition of COX-2 production of TXA2

E. Inhibition of 5-Lipoxygenaae production of LTA4

Q
A 45-year-old surgeon has developed symmetric early morning stiffness
in her hands. She wishes to take an NSAID to relieve these symptoms and
wants to avoid gastrointestinal side effects. Which one of the following
drugs is most appropriate?
A. Aspirin

B. Celecoxib
C. Ibuprofen

D. Indomethacin

E. Piroxicam
Q
A 79-year-old woman is admitted to the hospital with acute renal
failure. She bas a history of rheumatoid arthritis and the pain in
her hands was much worse over the last week; therefore, she
took a pain medication. Which of the following drugs is most likely
responsible for the adverse renal effect?
A. Acetaminophen
B. Colchicine
C. Ibuprofen
D. Prednisone
Q
Which one of the following statements concerning
selective Cox-2 inhibitors is correct:
A. They show greater analgesic activity than traditional NSAIDs

B. They show anti-inflammatory activity greater than traditional NSAIDs

C. They increase platelet aggregation

D. They harm the kidney more than non-selective cox inhibitors

E. They are cardio protective

Q
A 7-year-old girl is diagnosed with chickenpox. Her symptoms included a fever
for which she took a medication. Two days later, she is taken to the emergency
room due to persistent vomiting and mental status changes. Her blood work
reveals elevated liver enzymes. Which of the following medications, when given
at an appropriate dose, may cause this patient presentation?
A. Acetaminophen
B. Aspirin
C. Celecoxib
D. Ibuprofen
E. Naproxen
1
2
 Q
A 33-year-old man spends the morning outside gardening in the sun on
a warm spring day. He develops a tension headache, and the only
medication he has at home is aspirin. After taking two regular-sized
aspirin tablets, there was an increase in his respiration rate. What is
the reason for the increased respirations?
(A) Salicylates are agonists at the CO2 receptors in the carotid bodies

(B) Salicylates at this dose directly stimulate the respiratory center of the
brain

(C) Salicylates shift the oxygen dissociation curve to the right

(D) Salicylate uncoupling of oxidative phosphorylation

Q
Which of the following NSAID is used to treat patent ductus
arteriosus in neonates:
A. Ketoprofen
B. Mefenamic acid
C. Celecoxib
D. Phenylbutazone
E. Indomethacin
Q
A 22-year-old woman ingests an entire bottle of acetaminophen in an
attempted suicide. She unexpectedly feels well for the next 24 h, at which
time her husband discovers what she has done and takes her to the ER.
The toxic metabolite of acetaminophen exerts its deleterious effect by
what mechanism?

(A) Depletion of endogenous antioxidant

(B) Hapten formation leading to autoantibody production

(C) Inhibition of cytochrome C oxidase

(D) Ischemia from decreased hepatic blood flow

(E) Paralysis of gall bladder causing bile stasis

Glucocorticoid
pharmacology
Q
A 74-year-old woman with a long history of rheumatoid arthritis has
been receiving prednisone for the past 3 months. Which of the
following laboratory results would be most likely to occur in this
patient?

A. Hyponatremia

B. Hypercalcemia

C. Hyperkalemia

D. Hyperglycemia

E. Hypocholesterolemia
Q
A 57-year-old man suffering from severe dermatomyositis had been
receiving high-dose prednisone for 6 months. Which of the following
laboratory results would be most likely to occur in this patient?

A. Hyponatremia

B. Hypocalcemia

C. Hyperkalemia

D. Hypoglycemia

E. Hyperchloremia
Q
A 49-year-old woman underwent a blood test during a routine clinic visit. The
woman, recently diagnosed with lupus erythematosus, had been receiving high-
dose prednisone for 3 weeks. Which of the following changes in the patient’s
blood cell concentration most likely occurred because of her therapy?

A. Decreased neutrophils

B. Decreased erythrocytes

C. Increased basophils

D. Decreased lymphocytes

E. Increased eosinophils
Q
A 33-year-old woman, 29 weeks’ pregnant, was admitted to the obstetrical unit
with ruptured membranes. The patient was treated with nifedipine to delay
premature labor and with another drug to accelerate maturation of the fetal
lungs, thus decreasing the incidence of neonatal respiratory distress syndrome.
Which of the following drugs was most likely administered?

A. Indomethacin

B. Acetaminophen

C. Dexamethasone

D. Ergonovine

E. Dinoprostone
Q
A 65-year-old man complained to his physician of epigastric distress, muscle weakness,
hypertension, and white plaques in his mouth. The patient, diagnosed with polyarteritis nodosa
8 months ago, had been receiving an appropriate therapy since then. Laboratory values showed
fasting blood glucose of 135 mg/dL (normal 70−110 mg/dL). Which of the following drugs most
likely caused the patient’s signs and symptoms?

A. Indomethacin

B. Ketoconazole

C. Fludrocortisone

D. Spironolactone

E. Prednisone
DMARDs
 I. Methotrexate
Use in RA:
• 1st line DMARD → it is used in more

than 60% of RA cases.

• It is given once weekly orally or IM.

• The toxic effects of methotrexate can be

reversed by the subsequent administration of

folinic acid (leucovorin)

Q
A 43-year-old man suffering from rheumatoid arthritis complained to his physician that his
joint pain had increased recently despite naproxen therapy. The patient was otherwise
healthy, and his past medical history was unremarkable. Which of the following drugs
would be appropriate to add to the patient’s therapy at this time?

A. Diclofenac

B. Acetaminophen

C. Methotrexate

D. Fentanyl

E. Amitriptyline
Q
A 42-year-old woman with a 1-year history of rheumatoid arthritis comes to
see her primary care physician complaining of worsening symptoms. IL-1 and
TNF-a are two key cytokines involved in the negative sequelae of rheumatoid
arthritis. Which of the following drugs is a recombinant form of an
endogenous IL-1 antagonist?

(A) Abatacept

(B) Anakinra

(C) Methotrexate

(D) Hydroxychloroquine

(E) Rituximab
Q
A 48-year-old woman with 2-year history of rheumatoid arthritis has not had
sufficient relief with methotrexate alone. Her physician prescribes a biologic
TNF-a inhibitor that consists of a fusion protein to TNF-a. Which of the following
drugs is this?

(A) Adalimumab

(B) Certolizumab

(C) Etanercept

(D) Golimumab

(E) Infliximab
Q
A 55-year-old man complained to his physician of blurred vision, night blindness, light
ashes, and photophobia. The man was diagnosed with mild rheumatoid arthritis 6 months
ago and was taking a combination therapy that included a disease-modifying
antirheumatic drug (DMARD). Ophthalmoscopy disclosed a macular area of
hyperpigmentation surrounded by a zone of hypopigmentation on the left retina. Which of
the following drugs most likely caused the patient’s signs and symptoms?

A. Hydroxychloroquine

B. Etanercept

C. Methotrexate

D. Infliximab

E. Ibuprofen
III. Hydroxychloroquine (anti-malarial drug)
MOA: unknown, but might be:
• Inhibition of phagocytic functions.

• Stabilization of lysosomal membranes

Side effects:
1. GIT: diarrhea

2. Corneal deposits & Retinopathy: the

most disturbing toxic effect, rare, is a result of
gradual accumulation of the drug in the retina →
irreversible retinal damage with permanent
blindness
3. Skin discoloration & rash

4. Hemolysis in G6PD deficiency.

Anti-coagulant drugs
Q
A 55-year-old woman undergoes an open cholecystectomy. She is
admitted for postoperative observation and started on subcutaneous
heparin treatment to prevent formation of deep venous thrombosis.
How does heparin prevent these potential complications?
(A) Increases activity of antithrombin III

(B) Increases activity factors II and X

(C) Increases conversion of fibrinogen to fibrin

(D) Inhibits clot-bound IX and XII

(E) Inhibits clot-bound lipoproteins

Q Remember UFH & LMWH cannot cross BBB
or placenta (safe in pregnancy).

A 26-year-old woman at 33 weeks gestation presents to the

emergency department with pain and swelling in her right calf. A
duplex of the right calf confirms the presence of a deep vein
thrombosis (DVT). What is the most appropriate anticoagulant
treatment for the rest of her pregnancy?
(A) Abciximab
(B) Aspirin
(C) LMWH
(D) Streptokinase
(E) Warfarin
 Q
The anticoagulant action of heparin can be effectively antagonized
by:
A. Vitamin C Bleeding is the most common and
B. Vitamin K dangerous SE of UFH
C. EDTA ➔ can be reversed by antidote
D. Thromboplastin protamine sulfate ➔ a basic +ve
charged protein that combines with
E. Protamine
heparin
 Q
All the following anticoagulant drugs are correctly matched with their
mechanism of action EXCEPT:
A. Warfarin – inhibits synthesis of vitamin K-dependent clotting factors in the
liver

B. Heparin – increases the activity of antithrombin III in plasma

C. Dabigatran – selectively inhibits thrombin action

D. Rivaroxaban – selectively inhibit factor IX.

E. Fondaparinux – selectively inhibits factor X.

1972
Q
A 45-year-old woman is admitted to the hospital with complaints of fatigue and dark
tarry stools. One hour after admission, she begins vomiting what look like coffee
grounds. Laboratory results reveal an INR of 8.1. She has a history of deep vein
thrombosis, for which she is taking warfarin. Which of the following would be the
most appropriate treatment for this patient?

(A) Andexanet alfa

Remember ➔
(B) Desmopressin Monitoring of warfarin effect is by
prothrombin time (PT) or International
(C) Idarucizumab
Normalized Ratio (INR) ➔ It must be kept
(D) Vitamin K1 2-3 times as the normal value.
(E) Protamine
Anti-platelet & fibrinolytic
drugs
Q
The following statements about platelet activity are correct EXCEPT:
A. Intact vascular endothelium does not attract platelets because it synthesizes
PGI2.

B. TXA2 is synthesized mainly by platelets.

C. Dipyridamole reduces platelet activity by increasing cAMP concentration.

D. Clopidogrel blocks platelet ADP receptors.

E. Aspirin is a reversible inhibitor of TXA2.

Q
A 56-year-old woman presents to her physician with 1h complaints of a
temporary loss of peripheral vision, loss of coordination. and dizziness 2
days ago. Her family history reveals that her mother bad a stroke at the age
of 61. At this point in time, which of the following medications would be the
best prophylactic regimen for this patient?
(A) Abciximab

(B) Aminocaproic acid

(C) Clopidogrel

(D) Enoxaparin

(E) Alteplase
Fibrin-specific
Q
Which of the following pharmacological agents is a fibrin-specific
plasminogen activator?
A. Streptokinase

B. Urokinase

C. Alteplase (tPA)

D. Antiplasmin

E. Aminocaproic acid
Immune suppressants
Q
A 45-year-old woman has just received a kidney transplant. She is placed
on several immunosuppressants to prophylactically prevent her body
rejecting the donor organ. Which of the following immunosuppressants
interferes with T-cell activation by modifying the activity of calcineurin?
(A) Cyclosporine

(B) Methotrexate

(C) Prednisolone

(D) Sirolimus

(E) Temsirolimus
Q
A patient is treated with an immunosuppressant drug following a liver
transplant. The drug is known to bind to cyclophilin and inhibit the actions
of calcineurin. For what drug toxicity should this patient be monitored?
A. Pulmonary fibrosis
B. Hypotension
C. Hypoglycemia
D. Nephrotoxicity

E. CHF
Anti-histamines
 Diphenhydramine
Dimenhydrinate
Chlorpheniramine

Loratadine
Cetirizine
Fexofenadine
Q
A 32-year-old man presents to his primary care physician with complaint of
burning and watery eyes and constant sneezing. He experiences these
symptoms each spring for about 1 month. The patient is a truck driver and
is concerned about potential aide effects of any new medications. Which
of the following drugs would be most appropriate to treat this patient?

(A) Cimetidine

(B) Dimenhydrinate

(C) Fexofenadine

(D) Scopolamine
Q
Which of the following antihistamines has the LEAST sedation at
therapeutic dose?
A. Diphenhydramine
B. Loratadine
C. Promethazine
D. Antazoline
E. Cyproheptadine