Sample pharmacy exam questions

Question 1 · Cardiovascular pharmacology · 5 marks

Amlodipine and other dihydropyridine calcium channel blockers,

1. A.act primarily by blocking L-type calcium channels in vascular smooth muscleTrue

   Dihydropyridines selectively block L-type calcium channels in vascular smooth muscle, causing vasodilation.

2. B.commonly cause ankle oedemaTrue

   Ankle oedema is a well-recognised adverse effect, from preferential arteriolar dilation raising capillary hydrostatic pressure.

3. C.are useful in the treatment of stable anginaTrue

   By reducing afterload and coronary vasospasm they are useful in both stable and vasospastic angina.

4. D.cause reflex tachycardia less than non-dihydropyridinesFalse

   Dihydropyridines cause more reflex tachycardia than non-dihydropyridines, which have direct SA and AV nodal effects that blunt the reflex.

5. E.are safe to combine with beta-blockers in all patients with heart blockFalse

   A blanket claim. Combining calcium channel blockers, especially non-dihydropyridines, with beta-blockers in heart block risks severe bradycardia or asystole.

Question 2 · Gastrointestinal pharmacology · 5 marks

Proton pump inhibitors,

1. A.irreversibly inhibit the H⁺/K⁺-ATPase pump of gastric parietal cellsTrue

   PPIs bind the H⁺/K⁺-ATPase pump covalently and irreversibly.

2. B.are more effective when taken after mealsFalse

   They should be taken 30–60 minutes before meals, when the greatest number of proton pumps are active.

3. C.increase the risk of Clostridioides difficile infectionTrue

   Raised gastric pH weakens the acid barrier against ingested organisms, increasing C. difficile risk.

4. D.reduce the absorption of magnesium with long-term useTrue

   Long-term use is associated with hypomagnesaemia through reduced intestinal absorption.

5. E.are the treatment of choice for H. pylori eradication when used aloneFalse

   PPI monotherapy does not eradicate H. pylori. Triple therapy — a PPI plus two antibiotics — is required.

Question 3 · Neurological pharmacology · 5 marks

A 45-year-old man on long-term phenytoin therapy presents with gum hypertrophy and unsteady gait.

Regarding phenytoin,

1. A.it follows zero-order kinetics at therapeutic dosesTrue

   Metabolism becomes saturated near therapeutic levels, so elimination follows zero-order kinetics.

2. B.gingival hyperplasia is a recognised adverse effectTrue

   Gingival hyperplasia is a classic chronic adverse effect, and a dose-independent one.

3. C.it induces hepatic cytochrome P450 enzymesTrue

   Phenytoin is a potent hepatic CYP450 inducer, reducing the efficacy of drugs such as warfarin and the combined oral contraceptive pill.

4. D.ataxia and nystagmus suggest toxicityTrue

   Nystagmus and ataxia are hallmark signs of phenytoin toxicity.

5. E.it is safe to use in pregnancy without monitoringFalse

   Phenytoin is teratogenic — fetal hydantoin syndrome — and needs careful monitoring plus folic acid in pregnancy.

Question 4 · Respiratory pharmacology · 5 marks

Which of the following are true regarding bronchodilators used in asthma?

1. A.Salbutamol acts on β2-adrenergic receptorsTrue

   Salbutamol is a short-acting selective β2-agonist (SABA).

2. B.Ipratropium is a muscarinic receptor antagonistTrue

   Ipratropium bromide is a short-acting muscarinic antagonist (SAMA).

3. C.Theophylline has a wide therapeutic indexFalse

   Theophylline has a narrow therapeutic index and needs monitoring, because of arrhythmia and seizure risk.

4. D.Montelukast provides rapid relief in acute bronchospasmFalse

   Montelukast is a preventer taken regularly. It has no role in relieving acute bronchospasm.

5. E.Long-acting β2 agonists should be used as monotherapy in asthmaFalse

   LABAs must never be used without an inhaled corticosteroid — a boxed warning, because of the increased risk of asthma death.

Question 5 · Endocrine pharmacology · 5 marks

Insulin therapy,

1. A.soluble (regular) insulin should be injected 15–30 minutes before mealsTrue

   Soluble insulin has an onset of about 30 minutes, which matches the postprandial glucose rise when it is given before the meal.

2. B.glargine has a peakless, prolonged profileTrue

   Glargine forms a microprecipitate at the injection site, giving a slow, relatively flat release over about 24 hours.

3. C.hypoglycaemia is a recognised complication of overdoseTrue

   Hypoglycaemia is the principal dose-related complication of insulin therapy.

4. D.requirements typically decrease during acute infectionFalse

   Requirements typically increase during acute illness, through stress-hormone-induced insulin resistance. Insulin should never be stopped — the “sick day rules”.

5. E.can be stored at room temperature for up to 3 months once opened, away from direct heatFalse

   The in-use limit at room temperature is about 4 weeks, not 3 months. Always check the product's own insert.

Question 6 · Antimicrobial pharmacology · 5 marks

Beta-lactam antibiotics,

1. A.act by inhibiting bacterial cell wall synthesisTrue

   They inhibit penicillin-binding proteins — transpeptidases — involved in peptidoglycan cross-linking.

2. B.cross-reactivity can occur between penicillins and cephalosporinsTrue

   Both share the beta-lactam ring, and roughly 20% of penicillin-allergic patients also react to cephalosporins.

3. C.are effective against organisms lacking a cell wallFalse

   Because the target is the cell wall, beta-lactams are ineffective against organisms without one, such as Mycoplasma.

4. D.resistance can arise through beta-lactamase productionTrue

   Beta-lactamase production, which hydrolyses the beta-lactam ring, is a major resistance mechanism.

5. E.carbapenems have a narrower spectrum than penicillinsFalse

   Carbapenems have one of the broadest spectrums among the beta-lactams, not a narrower one.

Question 7 · Analgesics and anti-inflammatories · 5 marks

Non-steroidal anti-inflammatory drugs (NSAIDs),

1. A.act by inhibiting cyclo-oxygenase enzymesTrue

   NSAIDs inhibit COX-1, COX-2 or both, reducing prostaglandin synthesis.

2. B.increase the risk of peptic ulcerationTrue

   Losing the protective gastric prostaglandins raises the risk of peptic ulceration and gastrointestinal bleeding.

3. C.are safe in patients with significant renal impairmentFalse

   NSAIDs reduce prostaglandin-mediated renal vasodilation and can precipitate or worsen renal impairment.

4. D.can precipitate bronchospasm in aspirin-sensitive asthmaticsTrue

   In aspirin-sensitive asthmatics NSAIDs can shunt arachidonic acid toward leukotrienes, provoking bronchospasm.

5. E.selective COX-2 inhibitors have a lower risk of GI bleeding than non-selective NSAIDsTrue

   Selective COX-2 inhibitors such as celecoxib do carry a genuinely lower risk of gastrointestinal bleeding — though with an increased cardiovascular risk, a separate trade-off.

Question 8 · Acute care and emergencies · 5 marks

A patient develops facial swelling, wheeze and hypotension shortly after a bee sting.

Regarding the management of anaphylaxis,

1. A.intramuscular adrenaline is the first-line treatmentTrue

   Intramuscular adrenaline is the first-line, life-saving treatment.

2. B.antihistamines are the definitive treatment and should be given before adrenalineFalse

   Antihistamines are only adjunctive, and must never delay adrenaline.

3. C.corticosteroids have a rapid onset of action and prevent the immediate reactionFalse

   Corticosteroids act only over hours, and are given mainly to reduce the risk of a biphasic reaction rather than to treat the acute event.

4. D.the anterolateral thigh is the preferred injection site for adrenalineTrue

   The anterolateral thigh — the vastus lateralis — is preferred for reliable intramuscular absorption.

5. E.the patient should be positioned lying flat with legs raised if hypotensiveTrue

   A hypotensive patient is laid flat with the legs raised to maintain venous return, unless breathing difficulty makes that intolerable.

Question 9 · Cardiovascular pharmacology · 5 marks

Regarding the management of a 58-year-old man with type 2 diabetes mellitus and newly diagnosed hypertension (BP 162/98 mmHg, normal renal function),

1. A.an ACE inhibitor or ARB is the preferred first-line agent due to its renoprotective effectTrue

   ACE inhibitors and ARBs are first-line in diabetic hypertensive patients for their renoprotective effect, independent of blood-pressure lowering.

2. B.the antihypertensive effect is mediated by blocking the conversion of angiotensin I to angiotensin IITrue

   This is the core mechanism of the ACE inhibitors.

3. C.a persistent dry cough is a recognised class-specific adverse effectTrue

   Dry cough, mediated by bradykinin, is a well-known class effect of the ACE inhibitors.

4. D.co-administration with spironolactone increases the risk of hyperkalaemiaTrue

   Combining with a potassium-sparing diuretic significantly raises the risk of hyperkalaemia.

5. E.if blood pressure remains uncontrolled on monotherapy, a beta-blocker should always be added next regardless of other factorsFalse

   Guidelines recommend adding a calcium channel blocker or a thiazide-like diuretic next. Beta-blockers are not routine step-2 therapy in uncomplicated hypertension.

Question 10 · Antimicrobial pharmacology · 5 marks

Regarding the management of a 24-year-old non-pregnant woman with an uncomplicated lower urinary tract infection,

1. A.nitrofurantoin is a suitable first-line antibiotic choiceTrue

   Nitrofurantoin is a standard first-line choice for uncomplicated lower urinary tract infection.

2. B.nitrofurantoin acts by inhibiting bacterial cell wall synthesisFalse

   It does not act on the cell wall. It is reduced to reactive intermediates that damage ribosomal proteins and DNA.

3. C.reduced bacterial nitrofuran reductase activity is a recognised mechanism of resistanceTrue

   Reduced activation by nitrofuran reductase is the main resistance mechanism.

4. D.the patient should be advised that her urine may turn dark yellow or brownTrue

   Harmless dark yellow or brown discolouration of the urine is a recognised, expected effect.

5. E.nitrofurantoin is safe to use at any stage of pregnancy, including near termFalse

   It should be avoided at term, 38–42 weeks, because of the risk of neonatal haemolytic anaemia.