Pharmacology Final Exam
D (clomiphene is a partial estrogen agonist used to induce ovulation in anovulatory patients -
common side effects are enlarged ovaries [due to overstimulation of multiple follicles], hot flashes,
vasomotor flushing, multiple gestations, and visual disturbances) -
A 26-year-old female comes to your clinic concerned about why she only has one period
every four to five months on average. After stating she has been trying to conceive, you do a
complete infertility work up and rule out all etiologies that might cause oligomenorrhea and/or
amenorrhea. You conclude that she has an anovulatory dysfunction secondary to polycystic ovarian
syndrome and decide to treat her with clomiphene. Of the following, the most likely side effect of
taking clomiphene is
A. Deep vein thrombosis
B. Endometrial cancer
C. Gynecomastia
D. Enlarged ovaries
E. Uterine contractions
C (remember that bioavailability for an IV drug is always 100% - injecting 50 mg of compound X gives
an AUC of 60 mghr/L, so injecting 100 mg of compound X should give an AUC of 120 - the oral form,
administered at 100 mg, gave an AUC of 80, which means that, for the same administered amount,
the oral form's bioavailability relative to the injected form's is 80/120, or 2/3, which equates to
66.6%) (the formula is absolute bioavailability = [oral AUC x IV dose]/[IV AUC x oral dose]) -
A pharmaceutical company is attempting to determine the bioavailability of a new glucose-
lowering agent, Compound X, they have developed. They have previously studied the
pharmacokinetics of both IV and oral forms of this drug. The company has obtained the following
information regarding the IV formulation of Compound X: Administration of 50 mg of Compound X
by IV yields an area under the curve (AUC) on a plasma drug concentration versus time plot of 60 mg
hr/L. Additionally, the company has also obtained the following information regarding the oral
formulation of Compound X: Administration of 100 mg of Compound X by a PO route yields an AUC
on a plasma drug concentration versus time plot of 80 mg hr/L. Which of the following is the
absolute bioavailability of Compound X?
A. 58%
B. 64%
C. 67%
D. 70%
1|Page
,E. 74%
D (this is a rule of thumb - it takes about 4 half lives to reach a steady-state concentration of over
90%, and 1.5 x 4 = 6) -
An experimental infusable drug, X729, is currently being studied to determine its
pharmacokinetics. The drug was found to have a half life of 1.5 hours and is eliminated by first order
kinetics. What is the minimum number of hours required to reach a steady state concentration of
>90%?
A. 1.5
B. 3
C. 4.5
D. 6
E. 7.5
C (potency is defined as the ability of drug to exude effect at a particular concentration, in this case
the EC50- the lower the concentration, the higher the potency - efficacy is defined as the maximum
effect a drug can produce) (all four drugs have an equal efficacy, but A is the most potent because it
can achieve this efficacy at the lowest concentration) -
A laboratory is conducting a study to assess the safety, efficacy, and potency of a group of
drugs before allowing the agents to proceed to clinical trials. Shown are the dose-response curves for
four different drugs from the same class of medications (Drugs A, B, C, & D). Which of the following is
true regarding these medications?
A. Drug A has greater efficacy than Drug D
B. Drug D has greater efficacy than Drug A
C. Drug A has greater potency than Drug D
D. Drug D has greater potency than Drug A
E. All four drugs have equal potencies
A (you can remember the mechanism of the alpha1, alpha 2, beta1, and beta2 receptors with the
mnemonic QISS, which tells you which G protein subtype is activated by those 4 receptors
respectively - since Gs is stimulatory, it must increase cAMP) -
A 23-year-old woman presents to the emergency department with acute onset of shortness
of breath, wheezing, and chest tightness. This is her 4th visit for these symptoms in the last 5 years.
She tells you she recently ran out of her normal "controller" medication. Concerned for an asthma
2|Page
,exacerbation, you begin therapy with a short-acting beta2-agonist. What is the expected cellular
response to your therapy?
A. Gs protein coupled receptor activates adenylyl cyclase and increases intracellular cAMP
B. Gs protein coupled receptor activates phospholipase C and increases intracellular calcium
C. Gq protein coupled receptor activates phospholipase C and increases intracellular calcium
D. Gq protein coupled receptor activates adenylyl cyclase and increases intracellular cAMP
E. Gi protein coupled receptor inhibits adenylyl cyclase and decreases cAMP
D (I dunno about you, but when I see a sweaty anxious farmer in the emergency room, I think
organophosphate poisoning, which causes inhibition of AChE, overstimulating the nicotinic and
muscarinic receptors with too much acetylcholine - the antidote is atropine to compete with the
acetylcholine, and pralidoxime to reverse the AChE inhibition) -
A 32-year-old farmer is brought to the emergency department by his wife. The patient was
reportedly anxious, sweaty, and complaining of a headache and chest tightness before losing
consciousness on route to the hospital. Which of the following is mechanistically responsible for this
patient's symptoms?
A. Competitive inhibition of acetylcholine at post-junctional effector sites
B. Binding of acetylcholine agonists to post-junctional receptors
C. Inhibition of presynaptic exocytosis of acethylcholine vesicles
D. Irreversible inhibition of acetylcholinesterase
E. Reversible inhibition of acetylcholinesterase
A (neostigmine is an indirect cholinomimetic agent that doesn't penetrate the CNS [so no miosis]
used to reverse non-depolarizing muscle relaxants at the end of surgery - it causes bradycardia if not
also given with a muscarinic antagonist such as glycopyrrolate) -
As the surgeon is dressing the incisions upon completion of an elective cholecystectomy, the
anesthesiologist administers neostigmine immediately followed by glycopyrrolate. If neostigmine
were given without glycopyrrolate, what changes would you expect to see in the patient?
A. Reversal of neuromuscular blockade, bradycardia
B. Reversal of neuromuscular blockade, tachycardia
C. Miosis, bradycarida
D. Miosis, tachcardia
3|Page
, E. Reversal of neuromuscular blockade, miosis
A ("methacholine challenge" should be synonymous with "asthma diagnosis" - methacholine is a
direct cholinergic agonist that can induce an asthma attack in an asymptomatic agent, and is rapidly
metabolized so is very short-acting) (B, D; these are direct cholinergic agonists used for glaucoma) (C;
this is a direct cholinergic agonist used for urinary retention) (E; this is used for glaucoma and
atropine poisoning) -
A 16 year-old female is being evaluated for shortness of breath. For the last year she has had
shortness of breath and subjective wheezing with exercise and intermittent coughing at night. She
reports waking up from sleep coughing 1-2 times per month. She now skips gym class because of her
symptoms. She denies any coughing, chest tightness, or shortness of breath on the day of her visit.
On exam, her lungs are clear to auscultation bilaterally, with normal inspiratory to expiratory
duration ratio. Her pulmonary function tests (PFTs) show normal FEV1 and FVC based on her age,
gender, and height. She is told to inhale a medication, and her PFTs are repeated, now showing a
FEV1 79% of her previous reading. The patient is diagnosed with asthma. Which of the following
medications was used to diagnose the patient?
A. Methacholine
B. Pilocarpine
C. Bethanechol
D. Carbachol
E. Physostigmine
C (the kid is wearing scopolamine patches to treat his seasickness, but symptoms suggest that he
overdosed - scopolamine is an anti-muscarinic agent, causing visual symptoms, dry skin, fever, and
tachycardia - other antimuscarinic overdose symptoms are constipation and urinary retention, as
well as dry mouth) (treatment is supportive with pheostigmine to inhibit AChE) -
A 5-year-old boy is brought to the ED with fever and altered mental status. The boy was in
his normal state of health until a few hours ago when he began to "not feel good" while on a deep-
sea fishing trip as part of his family vacation. By the time that the family made it back to shore, the
boy was experiencing blurred vision and confusion. In the ED his vitals were 101.6F, HR160, RR18,
and O2 99% on room air. On exam, his skin is dry and flushed, and his abdomen is covered in small,
round, stickers similar to that in the image. What gastrointestinal and urinary symptoms would you
expect in this patient?
A. Incontinence of stool; urine retention
B. Incontinence of stool and urine
C. Constipation; urine retention
4|Page
D (clomiphene is a partial estrogen agonist used to induce ovulation in anovulatory patients -
common side effects are enlarged ovaries [due to overstimulation of multiple follicles], hot flashes,
vasomotor flushing, multiple gestations, and visual disturbances) -
A 26-year-old female comes to your clinic concerned about why she only has one period
every four to five months on average. After stating she has been trying to conceive, you do a
complete infertility work up and rule out all etiologies that might cause oligomenorrhea and/or
amenorrhea. You conclude that she has an anovulatory dysfunction secondary to polycystic ovarian
syndrome and decide to treat her with clomiphene. Of the following, the most likely side effect of
taking clomiphene is
A. Deep vein thrombosis
B. Endometrial cancer
C. Gynecomastia
D. Enlarged ovaries
E. Uterine contractions
C (remember that bioavailability for an IV drug is always 100% - injecting 50 mg of compound X gives
an AUC of 60 mghr/L, so injecting 100 mg of compound X should give an AUC of 120 - the oral form,
administered at 100 mg, gave an AUC of 80, which means that, for the same administered amount,
the oral form's bioavailability relative to the injected form's is 80/120, or 2/3, which equates to
66.6%) (the formula is absolute bioavailability = [oral AUC x IV dose]/[IV AUC x oral dose]) -
A pharmaceutical company is attempting to determine the bioavailability of a new glucose-
lowering agent, Compound X, they have developed. They have previously studied the
pharmacokinetics of both IV and oral forms of this drug. The company has obtained the following
information regarding the IV formulation of Compound X: Administration of 50 mg of Compound X
by IV yields an area under the curve (AUC) on a plasma drug concentration versus time plot of 60 mg
hr/L. Additionally, the company has also obtained the following information regarding the oral
formulation of Compound X: Administration of 100 mg of Compound X by a PO route yields an AUC
on a plasma drug concentration versus time plot of 80 mg hr/L. Which of the following is the
absolute bioavailability of Compound X?
A. 58%
B. 64%
C. 67%
D. 70%
1|Page
,E. 74%
D (this is a rule of thumb - it takes about 4 half lives to reach a steady-state concentration of over
90%, and 1.5 x 4 = 6) -
An experimental infusable drug, X729, is currently being studied to determine its
pharmacokinetics. The drug was found to have a half life of 1.5 hours and is eliminated by first order
kinetics. What is the minimum number of hours required to reach a steady state concentration of
>90%?
A. 1.5
B. 3
C. 4.5
D. 6
E. 7.5
C (potency is defined as the ability of drug to exude effect at a particular concentration, in this case
the EC50- the lower the concentration, the higher the potency - efficacy is defined as the maximum
effect a drug can produce) (all four drugs have an equal efficacy, but A is the most potent because it
can achieve this efficacy at the lowest concentration) -
A laboratory is conducting a study to assess the safety, efficacy, and potency of a group of
drugs before allowing the agents to proceed to clinical trials. Shown are the dose-response curves for
four different drugs from the same class of medications (Drugs A, B, C, & D). Which of the following is
true regarding these medications?
A. Drug A has greater efficacy than Drug D
B. Drug D has greater efficacy than Drug A
C. Drug A has greater potency than Drug D
D. Drug D has greater potency than Drug A
E. All four drugs have equal potencies
A (you can remember the mechanism of the alpha1, alpha 2, beta1, and beta2 receptors with the
mnemonic QISS, which tells you which G protein subtype is activated by those 4 receptors
respectively - since Gs is stimulatory, it must increase cAMP) -
A 23-year-old woman presents to the emergency department with acute onset of shortness
of breath, wheezing, and chest tightness. This is her 4th visit for these symptoms in the last 5 years.
She tells you she recently ran out of her normal "controller" medication. Concerned for an asthma
2|Page
,exacerbation, you begin therapy with a short-acting beta2-agonist. What is the expected cellular
response to your therapy?
A. Gs protein coupled receptor activates adenylyl cyclase and increases intracellular cAMP
B. Gs protein coupled receptor activates phospholipase C and increases intracellular calcium
C. Gq protein coupled receptor activates phospholipase C and increases intracellular calcium
D. Gq protein coupled receptor activates adenylyl cyclase and increases intracellular cAMP
E. Gi protein coupled receptor inhibits adenylyl cyclase and decreases cAMP
D (I dunno about you, but when I see a sweaty anxious farmer in the emergency room, I think
organophosphate poisoning, which causes inhibition of AChE, overstimulating the nicotinic and
muscarinic receptors with too much acetylcholine - the antidote is atropine to compete with the
acetylcholine, and pralidoxime to reverse the AChE inhibition) -
A 32-year-old farmer is brought to the emergency department by his wife. The patient was
reportedly anxious, sweaty, and complaining of a headache and chest tightness before losing
consciousness on route to the hospital. Which of the following is mechanistically responsible for this
patient's symptoms?
A. Competitive inhibition of acetylcholine at post-junctional effector sites
B. Binding of acetylcholine agonists to post-junctional receptors
C. Inhibition of presynaptic exocytosis of acethylcholine vesicles
D. Irreversible inhibition of acetylcholinesterase
E. Reversible inhibition of acetylcholinesterase
A (neostigmine is an indirect cholinomimetic agent that doesn't penetrate the CNS [so no miosis]
used to reverse non-depolarizing muscle relaxants at the end of surgery - it causes bradycardia if not
also given with a muscarinic antagonist such as glycopyrrolate) -
As the surgeon is dressing the incisions upon completion of an elective cholecystectomy, the
anesthesiologist administers neostigmine immediately followed by glycopyrrolate. If neostigmine
were given without glycopyrrolate, what changes would you expect to see in the patient?
A. Reversal of neuromuscular blockade, bradycardia
B. Reversal of neuromuscular blockade, tachycardia
C. Miosis, bradycarida
D. Miosis, tachcardia
3|Page
, E. Reversal of neuromuscular blockade, miosis
A ("methacholine challenge" should be synonymous with "asthma diagnosis" - methacholine is a
direct cholinergic agonist that can induce an asthma attack in an asymptomatic agent, and is rapidly
metabolized so is very short-acting) (B, D; these are direct cholinergic agonists used for glaucoma) (C;
this is a direct cholinergic agonist used for urinary retention) (E; this is used for glaucoma and
atropine poisoning) -
A 16 year-old female is being evaluated for shortness of breath. For the last year she has had
shortness of breath and subjective wheezing with exercise and intermittent coughing at night. She
reports waking up from sleep coughing 1-2 times per month. She now skips gym class because of her
symptoms. She denies any coughing, chest tightness, or shortness of breath on the day of her visit.
On exam, her lungs are clear to auscultation bilaterally, with normal inspiratory to expiratory
duration ratio. Her pulmonary function tests (PFTs) show normal FEV1 and FVC based on her age,
gender, and height. She is told to inhale a medication, and her PFTs are repeated, now showing a
FEV1 79% of her previous reading. The patient is diagnosed with asthma. Which of the following
medications was used to diagnose the patient?
A. Methacholine
B. Pilocarpine
C. Bethanechol
D. Carbachol
E. Physostigmine
C (the kid is wearing scopolamine patches to treat his seasickness, but symptoms suggest that he
overdosed - scopolamine is an anti-muscarinic agent, causing visual symptoms, dry skin, fever, and
tachycardia - other antimuscarinic overdose symptoms are constipation and urinary retention, as
well as dry mouth) (treatment is supportive with pheostigmine to inhibit AChE) -
A 5-year-old boy is brought to the ED with fever and altered mental status. The boy was in
his normal state of health until a few hours ago when he began to "not feel good" while on a deep-
sea fishing trip as part of his family vacation. By the time that the family made it back to shore, the
boy was experiencing blurred vision and confusion. In the ED his vitals were 101.6F, HR160, RR18,
and O2 99% on room air. On exam, his skin is dry and flushed, and his abdomen is covered in small,
round, stickers similar to that in the image. What gastrointestinal and urinary symptoms would you
expect in this patient?
A. Incontinence of stool; urine retention
B. Incontinence of stool and urine
C. Constipation; urine retention
4|Page
