Part -1:

1. Briefly present the most common clinical problems that patients experience during treatment with Histamine H2 Receptor antagonists, such as cimetidine (Tagamet). Does it interfere with hepatic CYP enzymes? How this can affect the plasma concentration of other drugs? Give some examples.

2. Laxatives, including lubricants, are commonly used by patients at different age. How these affect the absorption of fat-soluble vitamins?

3. Briefly present the most common clinical problems that patients experience during treatment with hypothalamic hormones and analogs, such as GnRH, somatostatin analogs and dopamine agonists.

4. What are the most common indications for clinical use of mineralcorticoids and glucocorticoids?

5. Which of the significant adverse effects of estrogen-only administration is significantly reduced if a progestin is combined with an estrogen?

6. Side effects, such as dry mouth, visual disturbance, constipation, and difficulty in urination are related to medications or drugs affecting the gastrointestinal system. What type of receptors are they antagonizing?

7. Methicillin-resistant Staphylococcus aureus (MRSA) is a common nosocomial pathogen that is increasing in frequency in community settings. Describe the most common mechanism of resistance by S. aureus? What treatment can be used?

8. An antibiotic is administered once daily in the intensive care unit to treat sepsis caused by an abdominal wound. Serum and urine concentrations of the patients are monitored during the course of therapy. Ten days after therapy is discontinued, the drug is still detectable in the urine.

Which one antibiotic was administered knowing that it acts by entering the bacterial cell and inhibiting protein synthesis due to binding to ribosomal sites? To what category of antibiotics this drug belongs?

9. A patient with advanced renal carcinoma has not responded to traditional chemotherapeutic agents. Which of the drugs can be added to his regimen to inhibit tyrosine kinase activity associated with vascular endothelial growth factor and platelet-derived growth factor?

Part 2. Choose the best answer.

1. Major serious effect associated with the long-term use of an aluminum-containing antacid include:
A. Dementia
B. Diarrhea
C. Kidney stones
D. Phosphate depletion
E. Severe alkalosis
2. A patient is prescribed drug for the treatment of his prostate cancer that blocks testosterone from binding to its intracellular receptor. Which of the following drugs has this mechanism of action?
A. Flutamide
B. Tamoxifen
C. Leuprolide
D. Sunitinib

3. Which of the statements best describes why patient who fail to respond to first-line chemotherapy have a decreased likelihood of a response to a second-line regimen?
A. Decreased performance status of patient
B. Tumor cell resistance caused by multidrug resistance gene
C. Tumor cell resistance caused by selection of resistant clones
D. Increased tumor burden
E. All of the above

4. A 29-year-old woman develops an exfoliate rash with painful joints, anemia, and nephritis while being treated for a first episode of a urinary tract infection. Which of the following drugs is responsible for these effects?
A. Ciprofloxacin
B. Polymyxin B
C. Trimethoprim-Sulfamethoxazole
D. Nitrofurantoin

5. Which of the following medications, when taken prior to eating, is especially effective for correcting postprandial hyperglycemia after a high-carbohydrate meal, so that hypoglycemia post dosing is minimized?
A. Acarbose
B. Glyburide
C. Glitazone
D. Tolbutamide

6. Which of the following best describes the outcome resulting from the use of 17alpha-alkylated testosterone to enhance athletic performance?
A. Decreased hepatotoxicity compared with testosterone esters
B. Decreased spermatogenesis
C. Reduced effects on serum lipid levels compared with testosterone esters
D. Cannot be converted to DHT, which reduces effects on prostate size

7. Which one of the following is most likely to interfere with cytochrome P450 metabolism?
A. Cimetidine
B. Ranitidine
C. Sucralfate
D. Metoclorpramide

8. A 28-year-old patient is newly diagnosed with active TB. Which of the following drug combinations should be initiated in this patient?
A. Ethambutol, pyrazinamide, rifampin, streptomycin
B. Ethambutol, isoniazid, rifampin, streptomycin
C. Ethambutol, pyrazinamide, rifampin, streptomycin
D. Isoniazid, rifampin, pyrazinamide, ethambutol

9. A 21-year-old student presents to ED reporting with chest pain and non-productive cough that began 1 week ago. His sympotoms are progressing, and he now has a low-grade fever, productive cough, weakness, hemoptysis and anorexia. Chest X-ray reveals an infiltrate in an upper left lobe of the lungs. Culture of the infiltrate reveals fungal elements of Blastomyces dermatitidis. The patient was started on an intravenous antifungal. Two weeks later patient's serum creatinine is significantly elevated. Which of the following was most likely prescribed for this patient?
A. Clotrimazole
B. Itraconazole
C. Colloidal amphotericine B
D. Voriconazole

10. An HIV-infected patient develops rapidly progressing cryptococcal meningitis.
He was hospitalized and treated with Amphotericin B and flucytosine.
What therapy would you recommend after his release from the hospital for prophylactic therapy?
A. Clotrimazole
B. Fluconazole
C. Metronidazole
D. Itraconazole

1. A 27-year old student started to receive combination therapy for tuberculosis. Which of the following would interfere with her use of contraceptives?
A. Isoniazid
B. Rifampin
C. Ethambutol
D. Pyrazinamide

2. A 21-year old student came to ememrgency room due to blurred vision and loss of ability to distinguish color. He is taking only an antifungal medication. Which of the following could result in these effects? Does it require any additional treatment and why?
A. Griseofulvin
B. Nystatin
C. Voriconazole
D. Flycytosine
3. Does it require any additional treatment and why? __________________________