40 Drugs Affecting Blood and 41.1 41.2 41.3 Blood Formation CHOOSE THE MOST APPROPRIATE RESPONSE Absorption of oral iron preparations can be facilitated by coadministering: A. Antacids B. Tetracyclines C. Phosphates D. Ascorbic acid (p. 546) The gut controls the entry of ingested iron in the body by: A. Regulating the availability of apoferritin which acts as the carrier of iron across the mucosal cell B. Regulating the turnover of apoferritin-ferritin interconversion in the mucosal cell C. Complexing excess iron to form ferritin which remains stored in the mucosal cell and is shed off D. Regulating the number of transferrin recep- tors on the mucosal cell (p. 546) Inthe iron deficient state, transferrin receptors increase in number on the: A. Intestinal mucosal cells B. Erythropoietic cells C. Reticuloendothelial cells D. All of the above (p. 547) 41.1D 41.2C 41.3B274 MCQs in Pharmacology 41.4 41.5 41.6 41.7 41.8 The percentage of elemental iron in hydrated ferrous sulfate is: A. 5% B. 10% C. 20% D. 33% (p. 547) Select the oral iron preparation which does not impart metallic taste and has good oral tolerability despite high iron content but whose efficacy in treating iron deficiency anaemia has been questioned: A. Iron hydroxy polymaltose B. Ferrous succinate C. Ferrous fumarate D. Ferrous gluconate (p. 548) The daily dose of elemental iron for maximal haemo- poietic response in an anaemic adult is: A. 30mg B. 100mg C. 200mg D. 500mg (P. 549) The side effect which primarily limits acceptability of oral iron therapy is: A. Epigastric pain and bowel upset B. Black stools C. Staining of teeth D. Metallic taste (p. 547, 549) Choose the correct statement about severity of side effects to oral iron medication: A. Ferrous salts are better tolerated than ferric salts B. Complex organic salts of iron are better tolerated than inorganic salts C. Liquid preparations of iron are better tolerated than tablets D. Tolerability depends on the quantity of ele- mental iron in the medication (p. 547) 41.4C 41.5A 41.6C 41.7A 41.8D41.9 41.10 41.11 41.12 Drugs Affecting Blood and Blood Formation 275 The following is not a valid indication for parenteral iron therapy: A. Inadequate response to oral iron due to patient noncompliance B. Anaemia during pregnancy C. Severe anaemia associated with chronic bleeding D. Anaemia in a patient of active rheumatoid arthritis (p. 549) Iron sorbitol-citric acid differs from iron dextran in that: A. It cannot be injected i.v. B. It is not excreted in urine C. It is not bound to transferrin in plasma D. It produces fewer side effects (P. 549) Choose the correct statement about iron therapy: A. Haemoglobin response to intramuscular iron is faster than with oral iron therapy B. Iron must be given orally except in pernicious anaemia C. Prophylactic iron therapy must be given during pregnancy D. Infants on breastfeeding do not require medi- cinal iron (p. 550) A patient of iron deficiency anaemia has been put on iron therapy. What should be the rate of rise in haemoglobin level of blood so that response is consi- dered adequate: A. 0.05 - 0.1 g% per week B. 0.1 - 0.2 g% per week C. 0.5 - 1.0 g% per week D. More than 1.0 g% per week (p. 550) 41.9B 41.10A 41.11C 41.12C276 MCQs in Pharmacology 41.13 41.14 41.15 41.16 41.17 The following chelating agent should not be used systemically to treat acute iron poisoning in a child: A. Desferrioxamine B. Calcium edetate C. Dimercaprol D. Calcium disodium diethylene triamine penta acetic acid (p. 551) Megaloblastic anaemia occurs in: A. Vitamin B;» but not folic acid deficiency B. Folic acid but not Vitamin B,, deficiency C. Either Vitamin Bj, or folic acid deficiency D. Only combined Vitamin Bj, + folic acid deficiency (p. 553, 555) The metabolic reaction requiring vitamin B,. but not folate is: A. Conversion of malonic acid to succinic acid B. Conversion of homocysteine to methionine C. Conversion of serine to glycine D. Thymidylate synthesis (p. 552) The daily dietary requirement of vit B,. by an adult is: A. 1-3ug B. 50-100ug C. 0.1-0.5mg D. 1-3mg (p. 552) The following factor(s) is/are required forthe absorption of dietary vitamin By»: A. Gastric acid B. Gastric intrinsic factor C. Transcobalamine D. Both ‘A’ and ‘B’ (p. 552) 41.13C 41.14C 41.15A 41.16A 41.17D41.18 41.19 41.20 41.21 Drugs Affecting Blood and Blood Formation 277 A 60-year-old patient presented with anorexia, weak- ness, paresthesia and mental changes. His tongue was red, tendon reflexes were diminished, haemo- globin was 6 g% with large red cells and neutrophils had hypersegmented nuclei. Endoscopy revealed atrophic gastritis. Deficiency of which factor is likely to be responsible for his condition: A. Folic acid B. Vitamin By. C. Pyridoxine D. Riboflavin (p. 553) Features of methylcobalamin include the following: A. It is an active coenzyme form of vit Bj B. It is required for the synthesis of S-adenosyl methionine C. It is specifically indicated for correcting neurological defects of vit Bj, deficiency D. All of the above (p. 553) Hydroxocobalamin differs from cyanocobalamin in that: A. It is more protein bound and better retained B. It is beneficial in tobacco amblyopia C. Itbenefits haematological but not neurologi- cal manifestations of vit B,. deficiency D. Both ‘A’ and ‘B’ are correct (p. 552, 554) Megaloblastic anaemia developing under the following condition is due entirely to folate deficiency not associated with vitamin B,2 deficiency: A. Malnutrition B. Blind loop syndrome C. Phenytoin therapy D. Pregnancy (p. 555) 41.18B 41.19D 41.20D 41.21C278 MCQs in Pharmacology 41.22 41.23 41.24 A patient of megaloblastic anaemia was treated with oral folic acid 5 mg daily. After 2 weeks he reported back with cognitive deficit, sensory disturbance, depressed knee jerk, while blood picture and haemo- globin level were improved. What could be the most likely explanation: A. Folic acid was not adequately absorbed resul- ting in partial response B. Folate therapy has precipitated vitamin By deficiency in the neural tissue C. Folate therapy has unmasked pyridoxine deficiency D. Patient has folate reductase abnormality in the nervous system (p. 555) Folinic acid is specifically indicated for: A. Prophylaxis of neural tube defect in the offspring of women receiving anticonvulsant medication B. Counteracting toxicity of high dose metho- trexate C. Pernicious anaemia D. Anaemia associated with renal failure (p. 555) Recombinant human erythropoietin is indicated for: A. Megaloblastic anaemia B. Haemolytic anaemia C. Anaemia in patients of thalassemia D. Anaemia in chronic renal failure patients (p. 556) 41.22D 41.23B 41.24D41.25 42.1 42.2 42.3 42.4 Drugs Affecting Blood and Blood Formation 279 A patient of chronic renal failure maintained on intermittent haemodialysis has anaemia not respond- ing to iron therapy. Which of the following additional drug is indicated: A. Epoetin B. Cyanocobalamin C. Folic acid D. Pyridoxine (p. 556) Vitamin K is indicated for the treatment of bleeding occurring in patients: A. Being treated with heparin B. Being treated with streptokinase C. Of obstructive jaundice D. Of peptic ulcer (p. 559) Choose the preparation(s) of vitamin K that should not be injected in the newborn: A. Phytonadione B. Menadione C. Menadione sod.diphosphate D. Both ‘B’ and ‘C’ (p. 559, 560) Menadione (vitamin K,) can produce kernicterus in neonates by: A. Inducing haemolysis B. Inhibiting glucuronidation of bilirubin C. Displacing plasma protein bound bilirubin D. Both ‘A’ and ‘B’ are correct (p. 560) Select the correct statement about ethamsylate: A. It checks capillary bleeding B. It inhibits platelet aggregation C. It is an antifibrinolytic drug D. It is used to fibrose bleeding piles (p. 560) 41.25A 42.1C 42.2D 42.3D 42.4A280 MCQs in Pharmacology 42.5 42.6 42.7 42.8 The primary mechanism by which heparin prevents coagulation of blood is: A. Direct inhibition of prothrombin to thrombin conversion B. Facilitation of antithrombin III mediated inhi- bition of factor Xa and thrombin C. Activation of antithrombin III to inhibit factors IX and XI D. Inhibition of factors Xlla and XIIla_ (p. 561) Low concentrations of heparin selectively interfere with the following coagulation pathway(s): A. Intrinsic pathway B. Extrinsic pathway C. Common pathway D. Both ‘A’ and ‘C’ (p. 561) Low doses of heparin prolong: A. Bleeding time B. Activated partial thromboplastin time C. Prothrombin time D. Both ‘B’ and ‘C’ (p. 561) The following action(s) of heparin is/are essential for inhibition of factor Xa: A. Facilitation of antithrombin III mediated inhibition of factor XIla B. Provision of scaffold for the clotting factor to interact with antithrombin III C. Induction of a configurational change in antithrombin III to expose its interacting sites D. Both ‘A’ and ‘B’ (p. 561) 42.5B 42.6A 42.7B 42.8C42.9 42.10 42.11 42.12 Drugs Affecting Blood and Blood Formation 281 The following is true of heparin except: A. Sudden stoppage of continuous heparin therapy causes rebound increase in blood coagulability B. High doses of heparin inhibit platelet aggre- gation C. Heparin is the physiologically active circula- ting anticoagulant D. Heparin clears lipemic plasma in vivo but not in vitro (p. 561, 562) Low molecular weight heparins differ from unfractionated heparin in that: A. They selectively inhibit factor Xa B. They do not significantly prolong clotting time C. They are metabolized slowly and have longer duration of action D. All of the above are correct (p. 563) Low molecular weight heparins have the following advantages over unfractionated heparin except: . Higher efficacy in arterial thrombosis B. Less frequent dosing C. Higher and more consistent subcutaneous D. > bioavailability Laboratory monitoring of response not required (p. 563) Low dose subcutaneous heparin therapy is indicated for: A. Prevention of leg vein thrombosis in elderly patients undergoing abdominal surgery B. Ischaemic stroke C. Patients undergoing neurosurgery D. Prevention of extention of coronary artery thrombus in acute myocardial infarction (p. 562) 42.9C 42.10D 42.11A 42.12A282 MCQs in Pharmacology 42.13 42.14 42.15 42.16 Heparin is contraindicated in patients suffering from the following diseases except: A. Pulmonary tuberculosis B. Bleeding due to defibrination syndrome C. Subacute bacterial endocarditis D. Large malignant tumours (p. 563, 568) The following can be used to antagonise the action of heparin in case of overdose: A. Heparan sulfate B. Dextran sulfate C. Protamine sulfate D. Ancrod (p. 564) Blood level of which clotting factor declines most rapidly after the initiation of warfarin therapy: A. Factor VII B. Factor IX C. Factor X D. Prothrombin (p. 564) The following statements are true of oral anticoagulants except: A. They interfere with an early step in the synthesis of clotting factors B. Irrespective of the dose administered, their anticoagulant effect has a latency of onset of 1-3 days C. Their dose is adjusted by repeated measure- ment of prothrombin time D. They are contraindicated during pregnancy (p. 564, 566) 42.13B 42.14C 42.15A 42.16A42.17 42.18 42.19 42.20 Drugs Affecting Blood and Blood Formation 283 You are treating a patient of deep vein thrombosis with warfarin. What value of International normalized ratio (INR) will you attempt by adjusting dose of the anticoagulant for an adequate therapeutic effect: A. 1.2-1.5 B. 1.3-1.7 C. 1.5-2.0 D. 2.0-3.0 (p. 566) The following drug reduces the effect of oral anti- coagulants: A. Broad spectrum antibiotic B. Cimetidine C. Aspirin D. Oral contraceptive (p. 567) The most clear cut beneficial results are obtained in the use of anticoagulants for the following purpose: A. Prevention of recurrences of myocardial infarction B. Prevention of venous thrombosis and pulmo- nary embolism C. Cerebrovascular accident D. Retinal artery thrombosis (p. 567) Anticoagulant medication is indicated in: A. Immobilized elederly patients B. Buerger’s disease C. Stroke due to cerebral thrombosis D. All of the above (p. 567, 568) 42.17D 42.18D 42.19B 42.20A284 MCQs in Pharmacology 42.21 42.22 42.23 42.24 42.25 Use of anticoagulants in acute myocardial infarction affords the following benefit(s): A. Reduces short-term mortality B. Prevents thrombus extension and subse- quent attack C. Prevents venous thromboembolism D. All of the above The most effective drug for prevention of stroke in atrial fibrillation patients is: A. Aspirin B. Warfarin C. Low dose subcutaneous heparin D. Digoxin (p. 568) Select the fibrinolytic drug(s) that is/are antigenic: A. Streptokinase B. Urokinase C. Alteplase D. Both ‘A’ and ‘B’ (p. 569, 570) Which fibrinolytic agent(s) selectively activate(s) fibrin bound plasminogen rather than circulating plasminogen: A. Urokinase B. Streptokinase C. Alteplase D. Both ‘A’ and ‘C’ (p. 569, 570) The most important complication of streptokinase therapy is: A. Hypotension B. Bleeding C. Fever D. Anaphylaxis (p. 570) 42.21C 42.22B 42.23A 42.24C 42.25B42.26 42.27 42.28 42.29 42.30 Drugs Affecting Blood and Blood Formation 285 Thrombolytic therapy is indicated in the following conditions except: A. Acute myocardial infarction B. Stroke due to cerebral thrombosis C. Deep vein thrombosis D. Large pulmonaryembolism —(p. 570, 571) A patient of acute myocardial infarction has been brought to the ICU. What is the time lapse since symptom onset beyond which you will not consider instituting thrombolytic therapy: A. 3 hours B. 6 hours C. 16 hours D. 24 hours (p. 570) Thrombolytic therapy instituted within 3-6 hours of onset of acute myocardial infarction affords the following benefit(s): A. Reduces mortality B. Reduces area of myocardial necrosis C. Preserves ventricular function D. All of the above (p. 570) The preferred route of administration of streptokinase in acute myocardial infarction is: A. Intravenous B. Subcutaneous C. Intracoronary D. Intracardiac (p. 570) Streptokinase therapy of myocardial infarction is contraindicated in the presence of the following except: A. Peptic ulcer B. Ventricular extrasystoles C. History of recent trauma D. Severe hypertension (p. 571) 42.26B 42.27C 42.28D 42.29A 42.30B286 MCQs in Pharmacology 42.31 42.32 42.33 42.34 A patient has an episode of hematemesis following streptokinase infused for the treatment of deep vein thrombosis. Which of the following drugs would be most effective in controlling the bleeding episode: A. Vitamin K B. Noradrenaline C. Epsilon aminocaproic acid D. Rutin (p. 571) Tranexaemic acid is a specific antidote of: A. Fibrinolytic drugs B. Organophosphates C. Barbiturates D. Heparin (p. 571) Aspirin prolongs bleeding time by inhibiting the synthesis of: A. Clotting factors in liver B. Prostacyclin in vascular endothelium C. Cyclic AMP in platelets D. Thromboxane A, in platelets (p. 572) Inhibition of thromboxane synthesis by aspirin in platelets lasts for 5-7 days because: A. Aspirin persists in the body for 5-7 days B. Aspirin induced depletion of arachidonic acid lasts 5-7 days C. Regeneration of aspirin inhibited cyclooxy- genase takes 5-7 days D. Platelets cannot generate fresh thromboxane synthetase and their turnover time is 5-7 days (p. 572) 42.31C 42.32A 42.33D 42.34D42.35 42.36 42.37 42.38 Drugs Affecting Blood and Blood Formation 287 The following drug increases cyclic-AMP in platelets and inhibits their aggregation without altering levels of thromboxane Az or prostacyclin: A. Aspirin B. Sulfinpyrazone C. Dipyridamole D. Abciximab (p. 572) Choose the correct statement about ticlopidine: A. It blocks GPII,/III, receptors on platelet membrane B. It prevents ADP mediated platelet adenylyl- cyclase inhibition C. It inhibits thromboxane A, synthesis in platelets D. It does not prolong bleeding time —(p. 572) Choose the drug which alters surface receptors on platelet membrane to inhibit aggregation, release reaction and to improve platelet survival in extra- corporeal circulation: A. Dipyridamole B. Ticlopidine C. Aspirin D. Heparin (p. 572) Ticlopidine is recommended for the following except: A. To reduce neurological sequelae of stroke B. Transient ischaemic attacks C. To prevent occlusion of coronary artery bypass graft D. Intermittent claudication (p. 572-573) 42.35C 42.36B 42.37B 42.38A288 MCQs in Pharmacology 42.39 42.40 42.41 42.42 (Note: Once stroke has occurred, no antiplatelet drug (including ticlopidine) alters the course of neurological or other complications. However, they do reduce the occurrence of stroke and transientischaemic attacks.) The following is true of clopidogrel except: A. Itis a GPII,/III, receptor antagonist B. It inhibits fibrinogen induced platelet aggregation C. It is indicated for prevention of stroke in patients with transient ischaemic attacks D. It is a prodrug (p. 573) The following is true of abciximab except: . Itisa monoclonal antibody against GPI},,/TII, B. It inhibits platelet aggregation induced by a variety of platelet agonists C. It is antigenic D. It is used to reduce the risk of restenosis in patients undergoing PTCA (p. 573) Combined therapy with dipyridamole and warfarin is recommended in subjects with the following: A. Risk factors for coronary artery disease B. Prosthetic heart valves C. Cerebral thrombosis D. Buerger's disease (p. 574) Indications for the use of antiplatelet drugs include the following except: A. Secondary prophylaxis of myocardial infare- tion . Unstable angina pectoris . Disseminated intravascular coagulation . Stroke prevention in patients with transient ischaemic attacks (p. 573, 574) > goon 42.39A 42.40C 42.41B 42.42C43.2 43.4 Drugs Affecting Blood and Blood Formation 289 Choose the most potent and most efficacious LDL- cholesterol lowering HMG-CoA reductase inhibitor: A. Lovastatin B. Simvastatin C. Pravastatin D. Atorvastatin (p. 578) The following is true of simvastatin except: A. It is more potent than lovastatin B. At the highest recommended dose, it causes greater LDL-cholesterol lowering than lovastatin C. It does not undergo first pass metabolism in liver D. It can raise HDL-cholesterol level when the same is low at base line (p. 578) Select the most appropriate hypolipidemic drug fora patient with raised LDL-cholesterol level but normal triglyceride level: A. AHMG-CoA reductase inhibitor B. A fibric acid derivative C. Gugulipid D. Nicotinic acid (P. 578, 582) Select the drug which reduces cholesterol synthesis in liver, increases expression of LDL receptors on hepatocytes and has been found to reduce mortality due to coronary artery disease: A. Simvastatin B. Nicotinic acid C. Gemfibrozil D. Colestipol (p. 577, 578) 43.1D 43.2C 43.3A 43.4A290 MCQs in Pharmacology 43.5 43.6 43.7 The rare but characteristic adverse effect of HMG- CoA reductase inhibitors is: A. Onycolysis B. Myopathy C. Alopecia D. Oculomucocutaneoussyndrome — (p. 578) Features of atorvastatin include the following: A. Dose to dose most potent HMG-CoA reduc- tase inhibitor B. Higher ceiling of LDL-cholesterol lowering action than lovastatin C. Antioxidant property D. All of the above (p. 578) Select the hypocholesterolemic drug which interferes with intestinal absorption of bile salts and cholesterol, and secondarily increases cholesterol turnover in the liver: A. Gemfibrozil B. Cholestyramine C. Lovastatin D. Bezafibrate (p. 577, 579) Gemfibrozil has the following features except: A. Itlowers plasma LDL cholesterol to a greater extent than triglycerides B. It tends to raise plasma HDL-cholesterol level C. Itis a first line drug for type III, type IV and type V hyperlipoproteinemia D. It reduces the incidence of myocardial infarc- tion (p. 580) 43.5B 43.6D 43.7B 43.8A43.10 43.11 43.12 Drugs Affecting Blood and Blood Formation 291 Antiatherosclerotic effect of which class of hypo- lipidemic drugs may involve additional mechanisms like improved endothelial function, reduced LDL oxidation and antiinflammatory property: A. Bile acid sequestrant resins B. Statins C. Fibrates D. Nicotinic acid (p. 579) Select the hypolipidemic drug that enhances lipoprotein synthesis, fatty acid oxidation and LDL- receptor expression in liver through paroxisome proliferator-activated receptor a: A. Lovastatin B. Atorvastatin C. Bezafibrate D. Nicotinic acid (p. 579, 580) A patient with coronary artery disease has raised serum triglyceride level (500 mg/dl) but normal total cholesterol level (150 mg/dl). Which hypolipidemic drug should be prescribed: A. Probucol B. Gemfibrozil C. Cholestyramine D. Lovastatin (p. 580, 583) The following is true of bezafibrate except: A. It activates lipoprotein lipase B. It mainly lowers serum triglyceride level with smaller effect on LDL cholesterol level C. It increases the incidence of myopathy due to statins D. It tends to lower plasma fibrinogen level (p. 579, 580) 43.9B 43.10C 43.11B 43.12C292 MCQs in Pharmacology 43.13 Choose the correct statement about lovastatin: A. It markedly lowers plasma triglyceride with little effect on cholesterol level It is used as an adjuvant to gemfibrozil for B. type III hyperlipoproteinemia C. Itis not effective in diabetes associated hyper- cholesterolemia D. It is a competitive inhibitor of the rate limiting step in cholesterol synthesis (p. 577-578) 43.14 Which of the following hypolipidemic drugs is most effective in raising HDL-cholesterol level and lowers serum triglycerides: A. Nicotinic acid B. Fenofibrate C. Cholestyramine D. Pravastatin (p. 580, 581) 43.15 Whatis true of nicotinic acid as well as nicotinamide: A. Both possess vitamin Bs activity B. Both cause cutaneous vasodilatation C. Both lower plasma triglyceride and VLDL levels D. Both cause hyperglycaemia after prolonged medication (p. 580-581) 43.16 Pretreatment with the following drug can be employed to reduce intolerable flushing, warmth and itching caused by nicotinic acid when used for lowering plasma lipids: A. Chlorpheniramine B. Atropine C. Aspirin D. Prednisolone (p. 581) 43.13D 43.14A 43.15A 43.16C43.17 43.18 43.19 43.20 Drugs Affecting Blood and Blood Formation 293 Which hypolipidemic drug has been used to control and prevent pancreatitis in familial hypertri- glyceridemia: A. Lovastatin B. Nicotinic acid C. Cholestyramine D. Clofibrate (p. 581) Select the first line hypolipidemic drug/drugs for treating hypertriglyceridemia in a subject with normal cholesterol level: A. Fibrates B. HMG-CoA reductase inhibitors C. Nicotinic acid D. Both ‘A’ and 'C' are correct (p. 583) Specific drug therapy to lower serum triglycerides (TG) ina subject with normal LDL-cholesterol level is indicated: A. In all subjects with serum TG> 150 mg/dl B. In subjects with existing coronary artery disease and serum TG > 150 mg/dl C. Insubjects with HDL-cholesterol <40 mg/dl and serum TG > 150 mg/dl D. Both 'B' and 'C' are correct (p. 583) In a 50-year-old male without any other coronary artery disease risk factor, hypocholesterolemic drugs are considered necessary when the serum LDL- cholesterol level is higher than: A. 130mg/dl B. 160 mg/dl C. 190 mg/dl D. 240 mg/dl (p. 582) 43.17B 43.18D 43.19D 43.20C294 MCQs in Pharmacology 43.21 43.22 43.23 43.24 High molecular weight, pharmacodynamically inert, nonantigenic substances which form colloidal solution are used as: A. Osmotic purgatives B. Osmotic diuretics C. Plasma expanders D. All of the above (p. 583) As a plasma expander, dextran has the following advantages except: A. It exerts oncotic pressure similar to plasma proteins B. It keeps plasma volume expanded for about 24 hours C. It is nonpyrogenic D. It does not interfere with grouping and cross matching of blood (p. 583-584) Hydroxyethy! starch is a: A. Plasma expander B. Haemostatic C. Heparin substitute D. Bile acid sequestrant (p. 584) Plasma expanders are used in the following condi- tions except: A. Congestive heart failure B. Extensive burns C. Mutilating injuries D. Endotoxin shock (p. 584) (Note: They will increase circulating blood volume and thus preload on heart, which will worsen heart failure.) 43.21C 43.22D 43.23A 43.24A