1. A drug shows first-pass metabolism. Which route bypasses it?
A. Oral
B. Sublingual
C. Intramuscular
D. Rectal (lower)
Answer: B
Explanation: Sublingual absorption drains into SVC → bypasses liver → avoids first-pass.
2. Drug X has high Vd. What does it indicate?
A. Strong plasma protein binding
B. Lipophilic drug
C. Hydrophilic drug
D. Renal elimination
Answer: B
Explanation: High Vd → drug leaves plasma → lipophilic distribution into tissues.
3. A drug with zero-order elimination:
A. Elimination proportional to concentration
B. Constant amount eliminated per time
C. Constant fraction eliminated per time
D. Saturation never occurs
Answer: B
Explanation: Zero-order = constant amount/time (phenytoin, ethanol, aspirin).
4. Efficacy of a drug is shown by:
A. EC50
B. Emax
C. Potency
D. LD50
Answer: B
Explanation: Emax = maximal effect → efficacy measure.
5. Competitive antagonist effect on agonist curve:
A. Shift left
B. Shift right
C. Decrease Emax
D. No change
Answer: B
Explanation: Competitive antagonists shift curve right (reduce potency) but same Emax.
6. A drug metabolized by CYP450 increases metabolism of other drugs. It is:
A. Inhibitor
B. Activator
C. Inducer
D. Substrate
Answer: C
Explanation: Inducers ↑ CYP → ↓ effect of other drugs.
7. Phase II reaction example:
A. Oxidation
B. Reduction
C. Hydrolysis
D. Glucuronidation
Answer: D
Explanation: Conjugation = Phase II.
8. Weak acid overdose treated by:
A. Acidifying urine
B. Alkalinizing urine
C. Giving charcoal only
D. IV lipids
Answer: B
Explanation: For weak acids (aspirin) → alkalinize urine → ion trapping.
9. Loading dose depends on:
A. Clearance
B. Bioavailability & Vd
C. Half-life
D. Steady state
Answer: B
Explanation: LD = Cp × Vd / F.
10. Steady state achieved after:
A. 1 half-life
B. 2
C. 3
D. 4–5
Answer: D
11. Drug A increases effect of drug B without binding same receptor.
A. Chemical antagonism
B. Physiological antagonism
C. Pharmacodynamic synergy
D. Pharmacokinetic antagonism
Answer: C
12. Drug potency depends on:
A. EC50
B. Emax
C. Vd
D. Clearance
Answer: A
13. A partial agonist:
A. Reduces efficacy of full agonist
B. Increases Emax
C. Always increases potency
D. No antagonist effect
Answer: A
14. Clearance formula:
A. CL = Vd × Ke
B. CL = Ke / Vd
C. CL = Dose × F
D. CL = LD / F
Answer: A
15. Drug with high first-pass metabolism requires:
A. Higher oral dose
B. Lower oral dose
C. IV dose decreased
D. Slower titration
Answer: A
16. Activation of α1 receptor causes:
A. Vasodilation
B. Mydriasis
C. Bradycardia
D. Bronchodilation
Answer: B (via pupillary dilator muscle)
17. Phenylephrine is used to treat:
A. Asthma
B. Nasal congestion
C. Glaucoma
D. Bradycardia
Answer: B
18. Clonidine acts on:
A. α1
B. α2
C. β1
D. β2
Answer: B
Explanation: α2 agonist → ↓ sympathetic outflow.
19. Dobutamine is mainly a:
A. α1 agonist
B. β1 agonist
C. β2 agonist
D. α2 antagonist
Answer: B
20. Isoproterenol acts on:
A. β1 only
B. β2 only
C. Non-selective β1/β2
D. α only
Answer: C
21. β2 agonist used in asthma:
A. Metoprolol
B. Propranolol
C. Salbutamol
D. Atropine
Answer: C
22. Drug causing reflex tachycardia:
A. Phenylephrine
B. Clonidine
C. Atenolol
D. Esmolol
Answer: A
23. Norepinephrine primarily increases:
A. HR
B. MAP
C. Bronchodilation
D. Decreased TPR
Answer: B
24. Contraindicated in cocaine use:
A. Benzodiazepines
B. β-blockers
C. Calcium blockers
D. α-blockers
Answer: B
Explanation: β-blockers → unopposed α → severe vasoconstriction.
25. Drug for hypertensive emergency (α+β blocker):
A. Metoprolol
B. Labetalol
C. Propranolol
D. Atropine
Answer: B
26. Prazosin adverse effect:
A. Bradycardia
B. First-dose hypotension
C. Hyperkalemia
D. Constipation
Answer: B
27. Tamsulosin used for:
A. Hypertension
B. BPH
C. Asthma
D. Tachycardia
Answer: B
28. Phentolamine used in:
A. Asthma
B. Pheochromocytoma
C. Heart block
D. COPD
Answer: B
29. A patient on propranolol should avoid:
A. Insulin
B. Alcohol
C. NSAIDs
D. Aspirin
Answer: A
Explanation: β-blockers mask hypoglycemia signs.
30. Esmolol useful because:
A. Long-acting
B. Very lipid soluble
C. Ultra-short acting
D. α-blocker
Answer: C
31. β-blockers decrease BP by:
A. Vasoconstriction
B. Blocking α1
C. ↓ renin
D. ↑ cardiac output
Answer: C
32. β2 agonist side effect:
A. Hypokalemia
B. Hyperkalemia
C. Bradycardia
D. Miosis
Answer: A
33. Epinephrine effect at low dose:
A. α1 dominance
B. β2 > β1
C. α2 inhibition
D. Only β1
Answer: B
34. Epinephrine reversal occurs with:
A. β-blockers
B. α-blockers
C. MAO inhibitors
D. COMT inhibitors
Answer: B
Explanation: α-blocker turns Epi from vasoconstrictor to vasodilator.
35. MAO inhibitors increase concentration of:
A. Acetylcholine
B. GABA
C. Norepinephrine
D. Serotonin only
Answer: C (and serotonin, dopamine)
36. Reserpine MOA:
A. Blocks NET
B. Inhibits VMAT
C. MAO inhibitor
D. α agonist
Answer: B
37. Cocaine toxicity best treated with:
A. Propranolol
B. Benzodiazepines
C. Clonidine
D. Aspirin
Answer: B
38. Amphetamine mechanism:
A. Blocks reuptake
B. Displaces catecholamines from vesicles
C. Direct agonist
D. MAO inhibition only
Answer: B
39. Metyrosine inhibits:
A. COMT
B. Tyrosine hydroxylase
C. MAO
D. VMAT
Answer: B
40. Epinephrine preferred in anaphylaxis due to:
A. α1
B. β1
C. β2 bronchodilation
D. All of the above
Answer: D
41. Bethanechol used for:
A. Asthma
B. Urinary retention
C. Bradycardia
D. Hypertension
Answer: B
42. Pilocarpine used in:
A. Mydriasis
B. Glaucoma
C. Asthma
D. Bradycardia
Answer: B
43. Methacholine challenge test used to diagnose:
A. Asthma
B. COPD
C. Pneumonia
D. Pulmonary hypertension
Answer: A
44. Muscarinic agonist toxicity symptoms:
A. Dry skin, mydriasis
B. Sweating, miosis
C. Hyperthermia
D. Tachycardia
Answer: B
45. Atropine poisoning sign:
A. Diarrhea
B. Sweating
C. Dry mouth
D. Miosis
Answer: C
46. Atropine causes:
A. Bradycardia
B. Cycloplegia
C. Diarrhea
D. Urination
Answer: B
47. Scopolamine used for:
A. Motion sickness
B. Asthma
C. Hypertension
D. Glaucoma
Answer: A
48. Ipratropium used in:
A. Asthma/COPD
B. Glaucoma
C. BPH
D. Tachycardia
Answer: A
49. Tropicamide used for:
A. Miosis
B. Mydriasis
C. HR reduction
D. Bronchoconstriction
Answer: B
50. Physostigmine crosses CNS; used in:
A. Organophosphate poisoning
B. Atropine overdose
C. Glaucoma only
D. MG
Answer: B
51. Neostigmine used for:
A. Myasthenia gravis
B. Bradycardia
C. Motion sickness
D. Glaucoma
Answer: A
52. Pyridostigmine:
A. Short-acting
B. Long-acting for MG
C. Crosses BBB
D. CNS antidote
Answer: B
53. Edrophonium used for:
A. Diagnosis of MG
B. COPD
C. Asthma
D. Bradycardia
Answer: A
54. Organophosphate poisoning presentation:
A. Hypertension
B. Dry skin
C. Diarrhea, salivation
D. Tachycardia
Answer: C
55. Antidote for organophosphate poisoning:
A. Atropine only
B. Atropine + Pralidoxime
C. Neostigmine
D. Epinephrine
Answer: B
56. Pralidoxime regenerates:
A. MAO
B. Ach receptors
C. AChE
D. VMAT
Answer: C
57. Atropine overdose causes:
A. Miosis
B. Flushing
C. Diarrhea
D. Wet skin
Answer: B (“red as a beet”)
58. Avoid antimuscarinics in:
A. Asthma
B. Glaucoma (angle-closure)
C. Bradycardia
D. Ileus
Answer: B
59. Oxybutynin used for:
A. COPD
B. Overactive bladder
C. Asthma
D. Hypertension
Answer: B
60. Carbachol acts on:
A. Muscarinic only
B. Nicotinic only
C. Both M and N receptors
D. β receptors
Answer: C
61. Nicotine effect:
A. Only parasympathetic
B. Only sympathetic
C. Both SYM + PARASYM stimulation
D. Only CNS
Answer: C
62. Ganglion blocker:
A. Hexamethonium
B. Succinylcholine
C. Atropine
D. Propranolol
Answer: A
63. Succinylcholine causes:
A. Bradycardia always
B. Malignant hyperthermia
C. Hypokalemia
D. Miosis
Answer: B
64. Succinylcholine MOA:
A. Non-depolarizing blocker
B. Depolarizing NMJ blocker
C. Acetylcholinesterase inhibitor
D. α antagonist
Answer: B
65. Non-depolarizing NMJ blockers:
A. Succinylcholine
B. Rocuronium
C. Nicotine
D. Bethanechol
Answer: B
66. Neostigmine reverses:
A. Succinylcholine phase I
B. Succinylcholine phase II
C. Rocuronium block
D. Nicotine toxicity
Answer: C
67. Muscarinic antagonist in COPD:
A. Atropine
B. Scopolamine
C. Ipratropium
D. Bethanechol
Answer: C
68. Drug that increases secretions and salivation:
A. Atropine
B. Pilocarpine
C. Ipratropium
D. Tropicamide
Answer: B
69. Organophosphate aging prevented by early use of:
A. Atropine
B. Pralidoxime
C. Naloxone
D. Vitamin K
Answer: B
70. Cholinergic crisis vs MG crisis identified by:
A. Neostigmine
B. Edrophonium
C. Atropine
D. Salbutamol
Answer: B
71. Ach increases HR at:
A. Low dose
B. High dose
C. Moderate dose
D. Never increases
Answer: B (M3 vasodilation → reflex tachycardia)
72. Muscarinic agonists contraindicated in:
A. Asthma
B. Urinary retention
C. Postoperative ileus
D. Glaucoma
Answer: A
73. Atropine does NOT block:
A. M3
B. M2
C. Nn
D. M1
Answer: C (nicotinic receptors are not blocked)
74. Drug causing cycloplegia:
A. Pilocarpine
B. Atropine
C. Bethanechol
D. Neostigmine
Answer: B
75. Antimuscarinic toxicity in elderly causes:
A. Bronchoconstriction
B. Urinary retention
C. Diarrhea
D. Sweating
Answer: B
76. Mixed agonist causing tachycardia + vasodilation:
A. NE
B. Epi
C. Phenylephrine
D. Dobutamine
Answer: B
77. Drug causing orthostatic hypotension:
A. Prazosin
B. Propranolol
C. Salbutamol
D. Epinephrine
Answer: A
78. β-blockers reduce mortality in:
A. COPD
B. Asthma
C. MI
D. Vasospasm
Answer: C
79. Contraindicated in asthma:
A. β-blockers
B. Muscarinic antagonists
C. β2 agonists
D. Theophylline
Answer: A
80. Drug causing hyperglycemia in diabetics:
A. Salbutamol
B. Clonidine
C. Pilocarpine
D. Atropine
Answer: A
81. Uses of atropine include:
A. Myasthenia gravis
B. Organophosphate poisoning
C. Glaucoma
D. Hypertension
Answer: B
82. Drug improving AV conduction:
A. Atropine
B. Neostigmine
C. Physostigmine
D. Pilocarpine
Answer: A
83. Timolol used in glaucoma by:
A. Increasing aqueous production
B. Decreasing aqueous production
C. Increasing outflow
D. Reducing pressure by diuresis
Answer: B
84. Drug that causes bronchodilation:
A. Ach
B. Atropine
C. Physostigmine
D. Bethanechol
Answer: B
85. Drug causing excessive sweating:
A. Ipratropium
B. Atropine
C. Pilocarpine
D. Propranolol
Answer: C
86. NMJ blocker causing histamine release/bronchospasm:
A. Succinylcholine
B. Atracurium
C. Rocuronium
D. Vecuronium
Answer: B
87. Indirect-acting sympathomimetic:
A. Dopamine
B. Phenylephrine
C. Amphetamine
D. Dobutamine
Answer: C
88. Non-selective α blocker:
A. Doxazosin
B. Prazosin
C. Phenoxybenzamine
D. Tamsulosin
Answer: C
89. Drug useful in Raynaud disease:
A. Propranolol
B. Captopril
C. Prazosin
D. Atropine
Answer: C
90. Muscarinic receptor causing bronchoconstriction:
A. M1
B. M2
C. M3
D. Nn
Answer: C
91. Beta-blocker with ISA:
A. Acebutolol
B. Propranolol
C. Metoprolol
D. Timolol
Answer: A
92. Milrinone MOA:
A. PDE3 inhibitor → ↑ cAMP
B. PDE5 inhibitor
C. β1 agonist
D. α1 antagonist
Answer: A
93. Drug causing urinary retention in BPH:
A. Prazosin
B. Atropine
C. Pilocarpine
D. Neostigmine
Answer: B
94. Drug that stimulates all adrenergic receptors:
A. NE
B. Epi
C. Isoproterenol
D. Phenylephrine
Answer: B
95. Dopamine low dose effect:
A. Renal vasodilation
B. Vasoconstriction
C. Bronchodilation
D. Bradycardia
Answer: A
96. Dobutamine used in:
A. Asthma
B. Acute heart failure
C. Hypoglycemia
D. Malaria
Answer: B
97. Propranolol contraindicated in:
A. Tremor
B. Hyperthyroidism
C. COPD
D. Hypertension
Answer: C
98. Drug causing miosis:
A. Atropine
B. Tropicamide
C. Pilocarpine
D. Ipratropium
Answer: C
99. MAO inhibitor food interaction:
A. Histamine
B. Tyramine
C. Glucose
D. Lactose
Answer: B
100. Drug with “first dose syncope”:
A. Clonidine
B. Atenolol
C. Prazosin
D. Phenylephrine
Answer: C