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π Pharmacology 2 Flashcards (150 Questions)
π« Antiarrhythmics
Q1. Which class of antiarrhythmic drugs prolongs the QT interval by blocking potassium channels?
A: Class III β (e.g., amiodarone, sotalol) block KβΊ channels β prolonged repolarization β extended QT.
Q2. Which antiarrhythmic drug is contraindicated in asthma due to risk of bronchospasm?
A: Propranolol β non-selective Ξ²-blocker; blocks Ξ²β receptors in bronchi β bronchoconstriction.
Q3. A patient with ventricular tachycardia is treated with lidocaine. What is its mechanism?
A: Sodium channel blockade β Class IB; stabilizes cardiac membranes by blocking fast NaβΊ channels.
Q4. A 72-year-old develops thyroid dysfunction after long-term antiarrhythmic use. Which drug?
A: Amiodarone β contains iodine; causes both hypo- and hyperthyroidism with long-term use.
π©Ί Antihypertensives
Q5. A 60-year-old man with hypertension and diabetes starts an ACE inhibitor. What is the key benefit?
A: Protects kidneys β ACE inhibitors reduce intraglomerular pressure and slow diabetic nephropathy.
Q6. Which antihypertensive is contraindicated in pregnancy?
A: Enalapril (ACE inhibitor) β causes fetal renal damage and oligohydramnios (Category D/X).
Q7. A patient develops a persistent dry cough after starting antihypertensive therapy. Which drug?
A: Enalapril β ACE inhibitor; inhibits bradykinin degradation β bradykinin accumulation β cough.
Q8. Which drug class is preferred in African-American patients with hypertension?
A: Calcium channel blockers β African-American patients respond less to ACE inhibitors/ARBs as monotherapy.
Q9. Which antihypertensive benefits a patient with hypertension AND benign prostatic hyperplasia (BPH)?
A: Terazosin / Doxazosin β Ξ±β-blockers; relax smooth muscle in both vessel walls and prostate/bladder neck.
Q10. Which antihypertensive works by reducing sympathetic outflow from the CNS?
A: Clonidine β centrally-acting Ξ±β agonist; stimulates central Ξ±β receptors β reduced sympathetic tone.
Q11. Which drug is a direct vasodilator used in hypertensive emergencies?
A: Hydralazine β directly relaxes arteriolar smooth muscle; often causes reflex tachycardia.
Q12. A patient with heart failure and hypertension takes spironolactone. What is its primary mechanism?
A: Aldosterone antagonism β competes with aldosterone at mineralocorticoid receptors β NaβΊ excretion, KβΊ retention.
Q13. Which antihypertensive commonly causes ankle edema?
A: Amlodipine β dihydropyridine calcium channel blocker; vasodilation β fluid shift into interstitium.
Q14. Which antihypertensive class most likely causes hypokalemia?
A: Thiazide diuretics β increase KβΊ excretion via enhanced distal tubule NaβΊ/KβΊ exchange.
Q15. Which drug is associated with reflex tachycardia?
A: Hydralazine β rapid vasodilation activates baroreceptors β compensatory sympathetic stimulation.
Q16. A hypertensive patient with proteinuria benefits most from:
A: Lisinopril (ACE inhibitor) β reduces efferent arteriolar tone β lowers intraglomerular pressure β reduces proteinuria.
Q17. Which drug class reduces mortality in heart failure with reduced ejection fraction (HFrEF)?
A: Beta-blockers β (e.g., carvedilol, metoprolol succinate) reduce cardiac remodeling and sudden death.
Q18. Which antihypertensive may cause hyperkalemia?
A: Lisinopril (ACE inhibitor) β reduces aldosterone β reduced KβΊ excretion β hyperkalemia.
Q19. Which drug is preferred in hypertensive emergencies?
A: Labetalol β combined Ξ±/Ξ²-blocker; rapid IV onset, controllable titration.
Q20. Which antihypertensive is associated with drug-induced lupus-like syndrome?
A: Hydralazine β also procainamide; mechanism involves altered DNA and immune activation.
π Proton Pump Inhibitors (PPIs) & Gastroprotectives
Q21. A patient on long-term PPI therapy develops hypomagnesemia. What is the cause?
A: Drug-induced malabsorption β PPIs impair intestinal MgΒ²βΊ absorption, especially with prolonged use.
Q22. Which PPI has the longest half-life?
A: Omeprazole β note: pantoprazole/rabeprazole have longer plasma tΒ½ practically; for this exam answer = Omeprazole.
Q23. Which adverse effect is most commonly associated with long-term PPI use?
A: Osteoporosis β impaired CaΒ²βΊ absorption due to reduced gastric acid needed for CaΒ²βΊ solubility.
Q24. A patient with NSAID-induced gastric ulcer is prescribed misoprostol. What is its primary action?
A: Mucosal protection β PGEβ analogue; stimulates mucus/bicarbonate secretion and reduces acid secretion.
Q25. What is the best time to administer sucralfate?
A: Before meals β requires acidic environment to polymerize and coat ulcer base.
Q26. Which gastroprotective drug increases prostaglandin synthesis, reduces pepsin activity, and binds bile salts?
A: Sucralfate β polymerizes in acid β forms protective paste over ulcer; also weak antacid effect.
Q27. Which gastroprotective agent forms a physical barrier over ulcers?
A: Sucralfate β binds to ulcer crater proteins creating a cytoprotective barrier.
Q28. What is the mechanism of action of PPIs?
A: Inhibit gastric HβΊ/KβΊ-ATPase (proton pump) β irreversibly block the final step of acid secretion.
Q29. PPIs are best taken:
A: Before meals β taken 30β60 min before meals so active proton pumps are available for binding.
Q30. A patient with Zollinger-Ellison syndrome is prescribed high-dose PPI. Why?
A: To inhibit acid hypersecretion β gastrinoma causes massive gastric acid output; high-dose PPIs suppress it.
Q31. A patient on clopidogrel needs a PPI. Which is least likely to interfere with clopidogrel metabolism?
A: Lansoprazole β minimal CYP2C19 inhibition compared to omeprazole/esomeprazole.
Q32. A patient with NSAID use needs mucosal protection. Which agent?
A: Misoprostol β PGEβ analogue specifically counters NSAID-induced inhibition of prostaglandins.
Q33. Which drug should be avoided in patients with salicylate allergy?
A: Bismuth subsalicylate β contains salicylate; cross-reactivity risk in salicylate-allergic patients.
Q34. Which agent is contraindicated in pregnancy due to risk of uterine contractions?
A: Misoprostol β PGEβ analogue; stimulates uterine contractions β risk of abortion/preterm labor.
Q35. Which agent is most effective in healing NSAID-induced duodenal ulcers?
A: Omeprazole β PPIs are first-line for NSAID-induced ulcer healing.
Q36. What is the best initial treatment for GERD?
A: Omeprazole (PPI) β superior acid suppression compared to Hβ blockers.
π Antiemetics
Q37. A patient with vertigo experiences nausea. Which antiemetic is most appropriate?
A: Meclizine β antihistamine/anticholinergic; specifically effective for motion sickness and vestibular vertigo.
Q38. Which antiemetic is a dopamine antagonist with prokinetic properties?
A: Metoclopramide β blocks Dβ receptors in CTZ and gut; accelerates gastric emptying.
Q39. Which antiemetic is a neurokinin-1 (NK1) receptor antagonist?
A: Aprepitant β used for chemotherapy-induced nausea; blocks substance P in the CNS.
Q40. Which antiemetic is most likely to cause sedation?
A: Promethazine β phenothiazine with strong Hβ and muscarinic blockade β sedation.
π« Cholelitic Therapy
Q41. Which is a limitation of cholelitic therapy?
A: Long duration of treatment β ursodeoxycholic acid (UDCA) requires months to years to dissolve stones.
Q42. Which imaging modality monitors gallstone dissolution?
A: Ultrasound β non-invasive, real-time visualization of gallstones.
Q43. Which patient is least likely to benefit from ursodeoxycholic acid?
A: Patient with calcified stones β UDCA only dissolves radiolucent (cholesterol) stones; calcified stones are resistant.
Q44. What is a benefit of cholelitic therapy?
A: Avoids surgery β conservative dissolution approach for patients who are poor surgical candidates.
π© Laxatives & Purgatives
Q45. Which laxative is used for bowel preparation before colonoscopy?
A: Polyethylene glycol (PEG) β osmotic laxative; causes large-volume intestinal lavage without electrolyte absorption.
Q46. Which purgative may cause electrolyte imbalance with prolonged use?
A: Senna β stimulant laxative; chronic use β hypokalemia, melanosis coli.
Q47. Which laxative is contraindicated in intestinal obstruction?
A: Psyllium (bulk-forming) β increases stool bulk; in obstruction this would worsen blockage.
Q48. Which agent is both a laxative and an ammonia-lowering drug?
A: Lactulose β metabolized by colonic bacteria; traps NHβ as NHββΊ β used in hepatic encephalopathy.
π¬ Enzymes
Q49. Which enzyme is used to reduce flatulence?
A: Simethicone β anti-foaming agent; breaks up gas bubbles in the GI tract.
Q50. Which enzyme/marker is used in celiac disease diagnosis?
A: Tissue transglutaminase (tTG) β anti-tTG antibodies are the primary serological test for celiac disease.
Q51. Which enzyme is used in pancreatic enzyme replacement therapy?
A: Pancrelipase β contains lipase, amylase, protease; used in pancreatic exocrine insufficiency.
π¬οΈ Bronchodilators & Antiasthmatics
Q52. Which drug is a non-selective Ξ²-adrenergic agonist?
A: Isoprenaline β stimulates both Ξ²β and Ξ²β receptors.
Q53. Which bronchodilator is derived from ephedra alkaloids?
A: Ephedrine β naturally derived from Ephedra plant; indirect sympathomimetic.
Q54. Which drug inhibits phosphodiesterase to increase cAMP levels?
A: Theophylline β methylxanthine; inhibits PDE β elevated cAMP β bronchodilation + CNS stimulation.
Q55. Which of the following is NOT a methylxanthine?
A: Cromolyn sodium β mast cell stabilizer; aminophylline, theophylline, and caffeine are methylxanthines.
Q56. Which is a leukotriene receptor antagonist?
A: Zafirlukast β blocks CysLT1 receptors; also montelukast.
Q57. Which drug is administered via inhalation to reduce airway inflammation?
A: Beclomethasone β inhaled corticosteroid (ICS); reduces eosinophilic airway inflammation.
Q58. Which drug blocks muscarinic receptors in the airways?
A: Ipratropium bromide β anticholinergic; blocks Mβ receptors β reduced bronchoconstriction and mucus secretion.
Q59. Which drug is a synthetic derivative of atropine used as a bronchodilator?
A: Atropine methyl-nitrate β quaternary ammonium derivative of atropine; does not cross BBB.
Q60. Which corticosteroid is used orally for asthma?
A: Prednisolone β systemic corticosteroid for acute asthma exacerbations.
Q61. Which drug is used to prevent exercise-induced bronchospasm?
A: Cromolyn sodium β mast cell stabilizer; used prophylactically before exercise.
Q62. Which of the following is NOT a Ξ²β-agonist?
A: Zafirlukast β it is a leukotriene receptor antagonist.
Q63. Which drug inhibits leukotriene synthesis?
A: Zileuton β 5-lipoxygenase (5-LOX) inhibitor; blocks leukotriene production.
Q64. Which is a long-acting inhaled corticosteroid?
A: Budesonide β used as maintenance ICS therapy (also beclomethasone for this exam context).
Q65. Which is a selective Ξ²β-agonist?
A: Salbutamol (albuterol) β selectively stimulates Ξ²β receptors β bronchodilation without significant cardiac effects.
Q66. Which drug reduces airway hyperresponsiveness?
A: Cromolyn sodium β prevents mast cell degranulation; reduces early and late-phase allergic responses.
Q67. Which is NOT a common side effect of theophylline?
A: Hypoglycemia β theophylline side effects include nausea, tachycardia, seizures, insomnia, arrhythmias.
Q68. Which drug is a mast cell stabilizer?
A: Cromolyn sodium β inhibits mast cell degranulation; used prophylactically.
Q69. Which drug is used to prevent nocturnal asthma symptoms?
A: Salmeterol β long-acting Ξ²β-agonist (LABA); 12-hour duration; used for nocturnal and exercise-induced asthma.
Q70. Which of the following is NOT a glucocorticoid?
A: Zafirlukast β it is a leukotriene receptor antagonist.
Q71. Which drug treats asthma by blocking leukotriene receptors?
A: Zafirlukast β CysLT1 receptor antagonist.
Q72. Which is NOT used in asthma management?
A: Atropine methyl-nitrate β not standard asthma therapy; ipratropium bromide is used instead.
Q73. Which drug reduces inflammation in the airways?
A: Dexamethasone β systemic corticosteroid with potent anti-inflammatory effects.
Q74. Which drug prevents allergen-induced asthma?
A: Cromolyn sodium β prophylactic mast cell stabilizer; taken before allergen exposure.
Q75. Which short-acting Ξ²β-agonist (SABA) is used as a bronchodilator?
A: Salbutamol β first-line SABA for acute bronchospasm (rescue inhaler).
Q76. Which drug is classified as a methylxanthine bronchodilator?
A: Theophylline β PDE inhibitor; increases cAMP β bronchial smooth muscle relaxation.
Q77. Zafirlukast acts by antagonizing which receptor type?
A: Cysteinyl leukotriene (CysLT1) receptors β blocks LTCβ, LTDβ, LTEβ binding.
Q78. Which is a 5-lipoxygenase inhibitor?
A: Zileuton β prevents conversion of arachidonic acid to leukotrienes.
Q79. Which glucocorticoid is commonly used in inhaled form for asthma?
A: Beclomethasone β ICS with local anti-inflammatory action, minimal systemic absorption.
Q80. Which is a long-acting Ξ²β-agonist (LABA)?
A: Salmeterol β 12-hour duration; used as add-on therapy, never as monotherapy in asthma.
Q81. Which drug is a combination of theophylline and ethylenediamine?
A: Aminophylline β ethylenediamine improves theophylline solubility for IV administration.
Q82. Which is NOT a sympathomimetic bronchodilator?
A: Cromolyn sodium β it is a mast cell stabilizer, not a sympathomimetic.
Q83. Salbutamol's mechanism of action:
A: Beta-2 adrenergic receptor agonist β activates Ξ²β receptors β adenylyl cyclase β βcAMP β smooth muscle relaxation.
β οΈ Miscellaneous / High-Yield Pharmacology
Q84. A 65-year-old woman on warfarin β which drug is contraindicated due to bleeding risk?
A: Aspirin β inhibits platelets (COX-1) AND potentiates anticoagulation β significantly increased bleeding risk.
Q85. Which antibiotic is contraindicated during pregnancy?
A: Tetracycline β chelates CaΒ²βΊ β deposits in fetal bones/teeth β discoloration and impaired bone growth.
Q86. What drug is used for paracetamol (acetaminophen) poisoning?
A: Acetylcysteine (N-acetylcysteine) β replenishes glutathione β neutralizes toxic NAPQI metabolite.
Q87. What drug is used to treat malaria?
A: Chloroquine β accumulates in parasite food vacuole β prevents heme detoxification β toxic to parasite.
Q88. What drug causes gingival hyperplasia?
A: Phenytoin β also cyclosporine and calcium channel blockers can cause gingival overgrowth.
Q89. What drug is used for angioedema / anaphylaxis?
A: Adrenaline (Epinephrine) β Ξ±β vasoconstriction reverses vasodilation; Ξ²β bronchodilation reverses bronchospasm.
Q90. Which drug is used for hyperkalemia (to stabilize the myocardium)?
A: Calcium gluconate β stabilizes cardiac membrane potential; does not lower serum KβΊ but protects the heart.
Q91. Which drug causes "red man" syndrome?
A: Vancomycin β rapid infusion β histamine release β flushing, erythema, hypotension (not a true allergy).
Q92. Which drug is used for benzodiazepine overdose?
A: Flumazenil β competitive benzodiazepine receptor antagonist; rapidly reverses CNS depression.
Q93. Which drug causes photosensitivity?
A: Tetracycline β absorbs UV light β free radical generation in skin β phototoxic reaction.
Q94. Which drug causes dry mouth as a side effect?
A: Atropine β muscarinic antagonist; blocks Mβ receptors on salivary glands β xerostomia.
Q95. Which drug is used for gastric ulcers?
A: Omeprazole β PPI; most effective for ulcer healing by maximally suppressing acid.
Q96. Which drug is used for iron poisoning?
A: Deferoxamine β chelating agent; binds free iron β forms ferrioxamine β excreted in urine.
Q97. Which drug is used to treat severe hypoglycemia in an unconscious patient?
A: Glucagon β stimulates hepatic glycogenolysis β raises blood glucose without IV access needed.
Q98. Which medication is contraindicated in Prinzmetal's angina due to risk of vasospasm?
A: Propranolol β non-selective Ξ²-blocker; unopposed Ξ±-adrenergic activity β worsened coronary vasospasm.
Q99. What is the antidote for opioid overdose?
A: Naloxone β competitive opioid receptor antagonist; rapidly reverses respiratory depression.
Q100. Which drug is contraindicated in pregnancy due to teratogenicity (among anticoagulants)?
A: Warfarin β crosses placenta β fetal warfarin syndrome (nasal hypoplasia, stippled epiphyses); heparin is safe.
Q101. What is the antidote for benzodiazepine overdose? (Note: one question in the document incorrectly lists Naloxone as the answer β the correct answer is:)
A: Flumazenil β GABA-A receptor antagonist; reverses benzodiazepine sedation.
π‘ Study Tips:
- Antidote mnemonics: Paracetamol β NAC | Opioid β Naloxone | Benzo β Flumazenil | Iron β Deferoxamine | Atropine/organophosphates β Atropine/Pralidoxime | Warfarin β Vit K / FFP
- Dry cough = ACE inhibitor (bradykinin)
- Ankle edema = Amlodipine (CCB)
- Hyperkalemia = ACE inhibitor / KβΊ-sparing diuretic
- Hypokalemia = Thiazides / Loop diuretics
- Contraindicated in pregnancy: Tetracycline, Warfarin, Enalapril, Misoprostol
- Asthma + antihypertensive β avoid: Propranolol (non-selective Ξ²-blocker)
Give basic tricks to link question term with answers
Memory Tricks to Link Question Terms β Answers
These are keyword-trigger patterns. Spot the term in the question β instantly know the answer.
π THE MASTER TRICK: "What word jumps out?"
Train your brain to spot one keyword in the question that locks in the answer.
β οΈ Side Effects / Adverse Effects
| Spot this word in the question | β Answer |
|---|---|
| Dry cough | ACE inhibitor β Enalapril/Lisinopril |
| Ankle edema | Calcium channel blocker β Amlodipine |
| Gingival hyperplasia | Phenytoin |
| Red man syndrome | Vancomycin |
| Photosensitivity | Tetracycline |
| Dry mouth | Anticholinergic β Atropine |
| Thyroid dysfunction (long-term) | Amiodarone |
| Lupus-like syndrome | Hydralazine |
| Reflex tachycardia | Hydralazine |
| Hypomagnesemia (long-term drug) | PPI β Drug-induced malabsorption |
| Osteoporosis (long-term PPI) | Osteoporosis |
| Hyperkalemia (antihypertensive) | Lisinopril (ACE inhibitor) |
| Hypokalemia (antihypertensive) | Thiazide diuretics |
| Bronchospasm (antiarrhythmic) | Propranolol |
π§ Trick: Side effect questions = think "what does this drug do TOO MUCH of?" Atropine blocks all secretions β dry everything (mouth, eyes, bladder) ACE inhibitor keeps bradykinin β bradykinin irritates throat β cough
π Antidotes β "Poison β Antidote" Pairs
Use the first letter trick:
| Poison | Antidote | Memory Hook |
|---|---|---|
| Paracetamol / Acetaminophen | Acetylcysteine | Acetaminophen β Acetylcysteine (same first letter) |
| Opioid | Naloxone | No opioid = Naloxone |
| Benzodiazepine | Flumazenil | Flip off the benzo = Flumazenil |
| Iron | Deferoxamine | DeFer iron away = Deferoxamine |
| Warfarin overdose | Vitamin K / FFP | Warfarin Withered by Vitamin K |
| Organophosphate | Atropine | same drug that causes dry mouth β reverses the wet (SLUDGE) |
π§ Trick: The exam always gives you the poison β your job is to recall the antidote. Practice saying them as pairs out loud 5 times each.
π€° Contraindicated in Pregnancy
Spot the word "pregnancy" β scan your list:
MEWT = drugs to avoid in pregnancy:
- Misoprostol β uterine contractions
- Enalapril (ACE inhibitors) β fetal renal damage
- Warfarin β fetal warfarin syndrome
- Tetracycline β teeth/bone damage
π§ Trick: "MEWT like a cat complaining in pregnancy β avoid these!"
π« Asthma Drugs β "Action Word" Trick
Spot the action word in the question:
| Action word in question | β Drug |
|---|---|
| "blocks KβΊ channels / prolongs QT" | Class III (Amiodarone) |
| "blocks NaβΊ channels" | Lidocaine (Class IB) |
| "blocks muscarinic / anticholinergic" | Ipratropium bromide |
| "inhibits phosphodiesterase" | Theophylline |
| "5-lipoxygenase inhibitor" | Zileuton |
| "leukotriene receptor antagonist" | Zafirlukast |
| "mast cell stabilizer" | Cromolyn sodium |
| "long-acting Ξ²β" | Salmeterol |
| "short-acting Ξ²β / rescue" | Salbutamol |
| "inhaled corticosteroid" | Beclomethasone |
| "non-selective Ξ²-agonist" | Isoprenaline |
| "derived from ephedra" | Ephedrine |
| "theophylline + ethylenediamine" | Aminophylline |
π§ Trick: Zileuton ZAPs leukotriene synthesis (makes zero leukotrienes). Zafirlukast ZAPs leukotriene receptors (blocks them from acting). Z-synthesis = Zileuton. Z-receptor = Zafirlukast.
π©Ί Antihypertensives β "Patient Profile" Trick
Match the special patient to the drug:
| Patient description | β Drug |
|---|---|
| Diabetes + hypertension | ACE inhibitor (kidney protection) |
| Hypertension + BPH | Terazosin / Doxazosin (Ξ±β-blocker) |
| Hypertension + proteinuria | Lisinopril |
| Hypertension + HFrEF | Beta-blocker |
| African-American + hypertension | Calcium channel blocker |
| Hypertensive emergency | Labetalol (IV) |
| Hypertension + "needs CNS effect" | Clonidine |
| Heart failure + hypertension + edema | Spironolactone |
π§ Trick: BPH = Big Prostate β needs Ξ±-blocker to relax it β Block alpha = Doxazosin/Terazosin.
π‘ PPI / GI Drugs β "Timing & Barrier" Trick
| Clue in question | β Answer |
|---|---|
| "before meals" | Sucralfate OR PPI |
| "physical barrier" | Sucralfate |
| "PGEβ analogue / mucosal protection" | Misoprostol |
| "Zollinger-Ellison" | High-dose PPI |
| "clopidogrel + PPI / least interference" | Lansoprazole |
| "salicylate allergy / avoid" | Bismuth subsalicylate |
| "calcified gallstones / won't work" | Not UDCA (ursodeoxycholic acid fails) |
| "bowel prep / colonoscopy" | Polyethylene glycol |
| "laxative + hepatic encephalopathy" | Lactulose |
π§ Trick for sucralfate vs misoprostol:
- Sucralfate = Stick (forms a sticky barrier)
- Misoprostol = Mucus (makes mucus + used in Miscarriage risk β avoid in pregnancy)
π― Universal Exam Strategy
Step 1: Read question β find the ONE KEY WORD
Step 2: Match key word to your trigger table above
Step 3: Confirm by eliminating obviously wrong options
Step 4: Never second-guess if your trigger fires correctly
Top 5 "always tested" triggers:
- Dry cough β Enalapril β
- Pregnancy contraindication β Tetracycline / Warfarin / Enalapril β
- Antidote for paracetamol β Acetylcysteine β
- BPH + hypertension β Ξ±β-blocker (Doxazosin/Terazosin) β
- Mast cell stabilizer β Cromolyn sodium β
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