1. What is the bioavailability F of this drug (dose given in both graphs is the same)?

A. (300/90) *100%.
B. (90/300) *100%.
C. 300-90= 210.
D. Cannot be calculated from this graph.
B
2. The apparent Volume of distribution of drug W is around 5 liters, what could explain this?
1. The drug is a very large polar molecule.
2. 99% of the drug is bound to plasma proteins.
3. The drug binds significantly to tissue proteins
4. The drug is very lipophilic.
A. 1 only
B. 2 only
C. 3 only
D. 1+2
E. 1+3
Answer D

3. In the stomach the pH is around 2, absorption of which of the following is enhanced and why?
A. Weak acids as their equilibrium shifts more to the protonated (uncharged) form.
B. Weak bases as their equilibrium shifts more to the protonated (charged) form.
C. Weak acids as their equilibrium shifts more to the unprotonated (charged) form.
D. Weak bases as their equilibrium shifts more to the unprotonated (uncharged) form.
E. No difference in absorption between the drugs.
A
4. Of the following which explains the more efficient absorption of all drugs from the intestines as
opposed to the stomach?
A. The surface area of the intestine due to microvilli is much larger than the stomach.
 B. The blood flow to the small intestines is much larger than the blood flow to the stomach.
C. A+B
D. Neither of these factors contributes to absorption.
C
5. Entry of drugs into the cell can occur by:
A. Endocytosis for small hydrophilic drugs.
B. Simple diffusion for protein drugs.
C. Facilitated diffusion for lipophilic drugs.
D. Facilitated diffusion for hydrophilic drugs.
D
6. All of the following represent sites/mechanisms for drug-drug interactions except:
A. CYP450 enzymes activity.
B. Plasma Albumin.
C. Active transporters in the proximal convoluted tubules.
D. Junctions between capillary endothelium.
D
7. P-glycoprotein is highly expressed in some cancer cells. Scientists are researching the potential
use of administering a P-glycoprotein pump inhibitor with anticancer drugs. What would the
effect of this inhibitor be?
A. Enhance the effect of the anticancer drug because its efflux from the cell will increase.
B. Enhance the effect of the anticancer drug because its efflux from the cell will decrease.
C. Enhance the effect of the anticancer drug because its plasma concentration will increase.
D. Enhance the effect of the anticancer drug because its metabolism will decrease.
B
8. First pass effect refers to:
A. The effect of the drug on the body the first time it is administered.
B. The biotransformation of the drug by the intestinal mucosa and the liver before it reaches
the systemic circulation.
C. The biotransformation of the drug in different sites of the body before it reaches its target
tissue.
D. The amount of drug passed to the blood in the first hour.
E. None of the above.
B
9. A patient overdosed on multiple tablets of aspirin a drug that is a weak acid. To enhance the
renal clearance of the drug and reduce its concentration in the blood what should be done?
A. Administer ammonium chloride to acidify the urine.
B. Administer sodium bicarbonate to acidify the urine.
C. Administer sodium bicarbonate to alkalinize the urine.
D. Administer ammonium chloride to acidify the urine.
E. Altering urine pH will not alter the clearance of this drug.
C
10. Digoxin is a drug used in heart failure. It binds strongly to the NA+/K+ membrane pump and
mediates its actions by inhibiting it (The pump is present extensively in skeletal muscle, the
 heart, the kidneys, etc.). From this information, what do you expect its volume of distribution
and half-life to be?
A. VD 25 L, half-life short.
B. VD 25 L, half-life long.
C. VD 450 L, half-life short.
D. VD 450 L, half-life long.
D

11. Drug X has a half-life of 3h, clearance of 20L/h, and Volume of distribution of 40 L. We are
administering an IV loading dose of the drug and maintenance doses afterward. We want the
plasma Css to be 5 mg/L. What is the amount of loading dose (in mg) I need to administer?
A. 2
B. 120
C. 100
D. 8
E. 200
E
12. The graph shows the elimination phase of a drug (no distribution phase), what is the
approximate half-life of this drug and what can we say about its elimination?

A. 1h, elimination follows first order kinetics.

B. 2h, elimination follows first order kinetics.
C. 1h, elimination follows zero order kinetics.
D. 2h, elimination follows zero order kinetics.
E. 0.25h, elimination follows first order kinetics.
A
13. The following is true about protein binding:
A. The pharmacological action of the drug depends on the free and the plasma protein-bound
drug.
B. Only the free fraction of the drug is available for elimination and available to mediate the
pharmacological action.
C. The risk for local drug toxicity is decreased when the drug binds to tissue protein.
D. None of the above is true.
 E. All of the above is true.
B
14. Drug elimination includes all the following EXCEPT:
A. Biotransformation of the drug in the liver.
B. Excretion in the bile.
C. Excretion in the urine.
D. Metabolism of the drug in the blood.
E. Endocytosis of the drug into the cell.
E
15. What is true about drug metabolism?
A. Drug metabolism is always necessary to activate the drug.
B. Drug metabolism always inactivates the drug.
C. Drug metabolism is needed to increase the polarity of lipophilic drugs enough for efficient
renal excretion.
D. Drug metabolism is rare; the drug usually leaves the body unaltered.
E. The main site for drug metabolism is the kidney.
C
16. What is true about renal clearance?
A. Lipophilic molecules are actively secreted in the proximal tubules.
B. Filtration occurs in the distal tubule.
C. Only lipophilic drugs pass into the glomerular filtrate.
D. The protein-bound drugs pass into the filtrate.
E. Lipophilic drugs are reabsorbed in the distal tubules.
E
17. Renal clearance of drug A is 20 L/h in an average individual. In our patient, the renal clearance of
the drug is predicted to be 10 L/h. What do you anticipate about the half-life of the drug in this
patient and what should the doctor consider doing?
A. The half-life will be unchanged; the doctor should decrease the dose.
B. The half-life will be increased; the doctor should decrease the dose.
C. The half-life will be increased; the doctor should increase the dose.
D. The half-life will be decreased; the doctor should increase the dose.
E. The half-life will be decreased; the doctor should decrease the dose.
B
18. Drug W has a very narrow therapeutic window, out of the following what would be the best way
to administer it?
A. 3 mg every 4 hours.
B. 6 mg every 8 hours.
C. A single daily dose of 18 mg.
D. A weekly dose of 120 mg.
A
19. Drug Y is administered as a continuous IV infusion at a certain rate. It reaches steady-state
concentration in 24h and the concentration reached is 10 mg/L. When the infusion rate is
doubled, what do you expect?
A. The drug reaches steady state in 12h, the steady state concentration is 10 mg/L.
 B. The drug reaches steady state in 12h, the steady state concentration is 20 mg/L.
C. The drug reaches steady state in 24h, the steady state concentration is 10 mg/L.
D. The drug reaches steady state in 24h, the steady state concentration is 20 mg/L.
D
20. In question 20 above, what do you approximate the half-life of the drug to be?
A. 48h.
B. 24h.
C. 12h.
D. 6 h.
E. 2h.
D
21. The clearance for drug is 10 L/h and follows first order kinetics. It is administered in doses until
the desired steady state of 5 mg/L is reached. Thus its elimination rate at steady state is 50 mg/h
(clearance= rate of elimination/concentration). What maintenance dosing rate should be used?
A. 10 mg/h
B. 2 mg/h
C. 5 mg/h
D. 50 mg/h
E. 100 mg/h
D
22. Which of the following regarding hepatic metabolism is correct:
A. Phase 1 metabolism conjugates the drug with a polar substrate.
B. The CYP450 family of enzymes mediates phase 2 metabolism.
C. Hydroxylation is an example of phase 1 metabolism.
D. Glucorinadation is an example of phase 1 metabolism.
E. All drugs must undergo phase 1 and phase 2 metabolism.
C
23. CYP450 enzymes:
A. Each enzyme is specific to one drug only.
B. Are identical in all individuals.
C. Are present only in the liver.
D. Their genetic variability explains some of the variability in drug response among individuals.
E. CYP2E1 is responsible for the majority of CYPP50 catalyzed reactions.
D
24. Codeine is a prodrug metabolized by CYP2D6. Its effect is to cause pain relief. Our patient has an
ultra-rapid CYP2D6 metabolizer allele. What do we expect in this patient?
A. Enhanced pain relief.
B. Reduced pain relief.
C. No change in pain relief.
D. Decreased excretion of codeine.
A
25. You are prescribing a new active drug to a patient (the drugs’ metabolites are inactive), and you
learn the patient is a heavy smoker, what might you consider and why?
A. Increasing the dose prescribed because smoking is an inducer of CYP450 enzymes.
 B. Decreasing the dose prescribed because smoking is an inhibitor of CYP450 enzymes.
C. Increasing the dose prescribed because smoking is an inhibitor of CYP450 enzymes.
D. Decreasing the dose prescribed because smoking is an inducer of CYP450 enzymes.
E. You will not consider anything.
A
26. Drug A and drug B are both metabolized only by CYP3A4 to inactive metabolites which of the
following is FALSE?
A. The effect of both drugs will be reduced when used together.
B. The patient should avoid drinking grapefruit juice.
C. Toxic side effects will be more likely.
D. Oral bioavailability of the drugs will change when taken together.
A

1. Which of these drugs would you expect to produce the fastest effect (assuming their
pharmacokinetics are identical)?
A. Drug A an agonist at the glucocorticoid (cortisol) receptor.
B. Drug B an antagonist at the glucocorticoid (cortisol) receptor.
C. Drug C an agonist at the nicotinic acetylcholine receptor.
D. Drug D an agonist at the beta 2 adrenoreceptor.
E. Drug E an agonist at the alpha 1 adrenoreceptor.
C
2. Which of the following about receptors and their properties is correct?
A. Ligand-gated ion channels must migrate to the nucleus to produce their effect.
B. The ligands of GPCR must not be polar.
C. The insulin receptor is an example of a tyrosine kinase-linked receptor.
D. All receptors are found at the cell surface.
E. All receptors exist in dimers.
C
3. Enzyme-linked receptor activation and downstream effect require the following :
A. G protein presence.
B. Opening of a pore.
C. Auto phosphorylation.
D. Binding to DNA.
C
4. Intracellular receptor activation and downstream effect require the following :
A. G protein presence.
B. Opening of a pore.
C. Auto phosphorylation.
D. Binding to DNA.
D
5. What is correct?

A. Drug A is more potent than B but has less efficacy.

B. Drug A, C, and D have the same potency.
C. Drug D is the most potent.
D. Drug B is the most potent.
D
6. From the graph, what do you approximate the threshold and ceiling concentrations to be?

A. Threshold around 1 ceiling around 800.

B. Threshold around 800 ceiling around 1.
C. Threshold around 0.1 ceiling around 1.
D. Threshold around 0.002 ceiling around 80.
E. Threshold around 0.002 ceiling around 800.

E
7. Calculate the therapeutic index for this drug:

A. 0.01
B. 4
C. 39.6
D. 40
E. 100
E
8. Which of the following explains part of drug tolerance:
A. Downregulation of drug receptors after long exposure to an agonist.
B. Enhanced absorption of the drug.
C. Reduced renal filtration of the drug.
D. Increased affinity of the drug.
A
9. Which of the following is a correct?

A. A is a full agonist C is an inverse agonist.

B. A is partial agonist C is an inverse agonist.
C. B is a full agonist D is an antagonist.
D. B is a partial agonist D is an antagonist.
E. B is a partial agonist D is an inverse agonist.
E
10. Drug X has a higher affinity than drug Y, what does this tell us about X?
A. Drug X produces a bigger effect than drug Y.
B. Drug X is an agonist drug Y is an antagonist.
C. Drug X is a full agonist Drug Y is a partial agonist.
D. Drug X will bind more receptors than drug Y (at the same concentration of both drugs).
D
11. Which of the following is correct regarding antagonism :
A. The use of a drug causing vasodilation and a drug causing vasoconstriction is an example of
chemical antagonism.
B. Physiological antagonism is the use of an antagonist at a physiological temperature.
C. A chemical antagonist needs to bind to the cell receptor to produce its effect.
D. Physiological antagonists work through different receptors.
D