Endocrine, GI, respiratory and immunopharmacology

30 Gulf Prometric Pharmacist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Endocrine, GI, respiratory and immunopharmacology, part of Pharmacology and Medicinal Chemistry. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   Tacrolimus prevents transplant rejection by:

   1. AInhibiting xanthine oxidase
   2. BInhibiting calcineurin, reducing IL-2 production
   3. CInhibiting inosine monophosphate dehydrogenase in lymphocytes
   4. DBlocking the CD20 antigen

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   Answer: B · Inhibiting calcineurin, reducing IL-2 production

   Tacrolimus binds FKBP-12, and the complex inhibits calcineurin, which prevents NFAT dephosphorylation and IL-2 transcription, so T cell activation is reduced. Ciclosporin acts through the same pathway via cyclophilin. Trough levels are monitored because of its narrow therapeutic index.

   • A: Xanthine oxidase inhibition is the action of allopurinol.
   • C: IMPDH inhibition is the action of mycophenolate.
   • D: CD20 is the target of rituximab.

   Remember this

   Calcineurin inhibitors (tacrolimus, ciclosporin) block IL-2 synthesis; monitor trough levels.

2. Question 2 · Hard

   An 84 kg patient on a high-dependency unit has an insulin infusion ordered at 0.05 units/kg/h. The syringe holds 100 units of soluble insulin in 100 mL of saline. At what rate should the pump run?

   1. A8.4 mL/h
   2. B42 mL/h
   3. C4.2 mL/h
   4. D0.42 mL/h

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   Answer: C · 4.2 mL/h

   The dose is 0.05 units/kg/h x 84 kg = 4.2 units/h. The syringe holds 100 units in 100 mL, which is 1 unit/mL, so the rate is 4.2 mL/h. A decimal slip would give a tenfold error either way.

   • A: 8.4 mL/h doubles the intended dose.
   • B: 42 mL/h is a tenfold overdose.
   • D: 0.42 mL/h is a tenfold underdose.

   Remember this

   Rate (mL/h) = dose (units/h) / concentration (units/mL); check the syringe strength.

3. Question 3 · Medium

   Loperamide should not be used in which situation?

   1. AIleostomy output
   2. BChronic diarrhoea in irritable bowel syndrome
   3. CAcute watery travellers' diarrhoea without fever
   4. DBloody diarrhoea with fever

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   Answer: D · Bloody diarrhoea with fever

   Loperamide is a peripheral mu agonist that slows gut motility. In invasive infections such as dysentery or Clostridioides difficile colitis, slowing transit may retain the toxin or organisms and risk toxic megacolon. It remains suitable for watery diarrhoea without fever or blood.

   • A: It is used to reduce ileostomy output.
   • B: It is used for IBS with diarrhoea.
   • C: Loperamide is acceptable in non-febrile watery diarrhoea.

   Remember this

   Avoid loperamide in bloody diarrhoea, fever or suspected C. difficile.

4. Question 4 · Medium

   A man with benign prostatic hyperplasia and urinary hesitancy is prescribed tiotropium for COPD. Which warning is the most relevant?

   1. AIt raises the heart rate through beta-1 stimulation
   2. BIt suppresses adrenal function
   3. CIt causes marked hypoglycaemia
   4. DAntimuscarinic effects may cause urinary retention

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   Answer: D · Antimuscarinic effects may cause urinary retention

   Tiotropium is a long-acting muscarinic antagonist that blocks M3 receptors in airway smooth muscle. Some systemic absorption occurs, and it can cause dry mouth, urinary retention (relevant in BPH) and may worsen narrow-angle glaucoma. Patients should be told about eye pain and visual halos.

   • A: Tiotropium has no beta-1 agonist action.
   • B: Adrenal suppression relates to systemic corticosteroids.
   • C: Hypoglycaemia is not an effect of tiotropium.

   Remember this

   LAMAs need caution in BPH and narrow-angle glaucoma.

5. Question 5 · Medium

   A patient with NYHA class III heart failure and type 2 diabetes is being considered for pioglitazone. What is the appropriate advice?

   1. AAvoid it, as fluid retention may worsen heart failure
   2. BUse it, because it improves ejection fraction
   3. CUse it, because it lowers cardiac preload
   4. DUse it, because it has no effect on sodium handling

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   Answer: A · Avoid it, as fluid retention may worsen heart failure

   Pioglitazone activates PPAR-gamma and increases renal sodium and water retention, plasma volume and peripheral oedema. This can precipitate or worsen heart failure, so it is contraindicated in heart failure of any NYHA grade. Bladder cancer and fractures are other concerns.

   • B: No benefit on ejection fraction has been shown.
   • C: Pioglitazone raises, not lowers, preload.
   • D: Pioglitazone does increase sodium retention.

   Remember this

   Thiazolidinediones are contraindicated in heart failure because of fluid retention.

6. Question 6 · Medium

   A mother notes that her 9-year-old son on montelukast has become irritable, anxious and has nightmares. Which statement is correct?

   1. AMontelukast acts as a beta-2 receptor agonist in the lung
   2. BThese effects show the drug is working well in the lungs
   3. CThese effects occur only with doses above 100 mg
   4. DMontelukast has a neuropsychiatric warning and should be reviewed

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   Before prescribing semaglutide, which history is a contraindication?

   1. AHypertension controlled with an ACE inhibitor
   2. BA previous gastric sleeve operation two years ago
   3. CFamily history of medullary thyroid carcinoma or MEN2
   4. DMild intermittent asthma using salbutamol only

   Answer and explanation in LearnFree account

8. Question 8 · Medium

   A woman taking levothyroxine 100 micrograms also takes calcium carbonate and ferrous sulfate each morning, and her TSH rises. What is the best advice?

   1. ADouble the dose because calcium has no effect on absorption
   2. BTake it with a large breakfast to avoid nausea
   3. CTake levothyroxine together with the calcium and iron to improve absorption
   4. DTake it fasting and separate it from calcium and iron by 4 hours

   Answer and explanation in LearnFree account

9. Question 9 · Easy

   Omeprazole controls acid production through which target?

   1. AThe histamine H2 receptor of the parietal cell
   2. BThe gastrin receptor of the enterochromaffin-like cell
   3. CThe parietal cell H+/K+-ATPase, which is blocked irreversibly
   4. DThe muscarinic M3 receptor of the parietal cell

   Answer and explanation in LearnFree account

10. Question 10 · Easy

    Salbutamol relieves acute asthma because it is a:

    1. ALeukotriene receptor antagonist
    2. BSelective beta-2 agonist relaxing bronchial muscle
    3. CMuscarinic antagonist that blocks vagal bronchoconstriction
    4. DPhosphodiesterase inhibitor

    Answer and explanation in LearnFree account

11. Question 11 · Medium

    A kidney transplant recipient on tacrolimus has a new tremor and a rise in creatinine. What is the most appropriate step?

    1. AStart ciclosporin in addition
    2. BGive an NSAID for the tremor
    3. CMeasure a trough tacrolimus level
    4. DStop all immunosuppression at once

    Answer and explanation in LearnFree account

12. Question 12 · Hard

    A patient with severe asthma has had repeated nebulised salbutamol and now has tremor, palpitations and K+ 2.8 mmol/L. What is the mechanism of the hypokalaemia?

    1. ASalbutamol inhibits the renal Na+/K+/2Cl- cotransporter
    2. BSalbutamol causes renal potassium loss by blocking aldosterone
    3. CSalbutamol blocks intestinal potassium absorption
    4. DBeta-2 stimulation shifts potassium into cells

    Answer and explanation in LearnFree account

13. Question 13 · Medium

    How do DPP-4 inhibitors such as sitagliptin lower blood glucose?

    1. AThey prolong the action of endogenous incretin hormones
    2. BThey stimulate insulin release by closing K-ATP channels
    3. CThey block intestinal glucose absorption
    4. DThey bind PPAR-gamma

    Answer and explanation in LearnFree account

14. Question 14 · Hard

    A patient is on dexamethasone 6 mg daily and needs to be converted to an equivalent dose of prednisolone. Given that 0.75 mg of dexamethasone is equivalent to 5 mg of prednisolone, what dose is needed?

    1. A40 mg
    2. B30 mg
    3. C60 mg
    4. D20 mg

    Answer and explanation in LearnFree account

15. Question 15 · Medium

    Delayed nausea after cisplatin is added to an ondansetron-dexamethasone regimen with aprepitant. Which receptor does aprepitant block?

    1. ADopamine D2 receptor in the brainstem
    2. BHistamine H1 receptor
    3. CNeurokinin-1 (substance P) receptor
    4. DSerotonin 5-HT3 receptor at the gut

    Answer and explanation in LearnFree account

16. Question 16 · Medium

    A woman has taken prednisolone 10 mg daily for 6 months for polymyalgia rheumatica and wants to stop. What is the main concern if she stops abruptly?

    1. AAdrenal insufficiency from HPA axis suppression
    2. BHyperkalaemia from mineralocorticoid excess
    3. CCushing syndrome from steroid excess
    4. DImmediate osteoporosis and fractures

    Answer and explanation in LearnFree account

17. Question 17 · Medium

    Which antiemetic should be avoided in a patient with Parkinson disease because it blocks central dopamine receptors?

    1. ACyclizine
    2. BDomperidone
    3. CMetoclopramide
    4. DOndansetron

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18. Question 18 · Medium

    How does sucralfate promote ulcer healing?

    1. AIt is a synthetic prostaglandin E1 analogue
    2. BIt coats the ulcer base as a paste in an acid environment
    3. CIt blocks H2 receptors on parietal cells
    4. DIt irreversibly inhibits the parietal proton pump

    Answer and explanation in LearnFree account

19. Question 19 · Hard

    A patient with rheumatoid arthritis took methotrexate 10 mg every day for 5 days instead of once weekly. He has mouth ulcers and a white cell count of 1.8 x 10^9/L. Which treatment is the most appropriate?

    1. AVitamin B6 (pyridoxine) 50 mg
    2. BFerrous sulfate and vitamin C
    3. CFolinic acid (leucovorin) rescue
    4. DFolic acid 5 mg once weekly as usual

    Answer and explanation in LearnFree account

20. Question 20 · Hard

    A patient taking metformin 2,000 mg daily has an eGFR of 38 mL/min/1.73 m2 on repeat testing and no acute illness. What is the best action?

    1. AIncrease the dose to improve glycaemic control
    2. BContinue the dose unchanged and recheck in a year
    3. CStop metformin permanently and start a sulfonylurea
    4. DHalve the dose to 1,000 mg daily and monitor eGFR

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21. Question 21 · Medium

    A pharmacist counsels a patient prescribed alendronate 70 mg weekly. Which advice is correct?

    1. ATake it with a glass of milk to improve absorption
    2. BChew the tablet first to reduce stomach irritation
    3. CTake with plain water; stay upright for 30 minutes
    4. DTake it at bedtime so it is absorbed during sleep

    Answer and explanation in LearnFree account

22. Question 22 · Medium

    A 32-year-old woman who has migraine with aura asks for a combined oral contraceptive. What is the best advice?

    1. ACombined pills are safe, because migraine is not a risk factor
    2. BUse the pill, but only on days without aura
    3. CUse a higher oestrogen dose to prevent the migraine
    4. DAvoid oestrogen-containing methods because of ischaemic stroke risk

    Answer and explanation in LearnFree account

23. Question 23 · Medium

    A 28-year-old woman with lupus nephritis is started on mycophenolate mofetil. Which counselling point is essential?

    1. AUse effective contraception, as the drug is teratogenic in pregnancy
    2. BIt can be continued unchanged if she becomes pregnant
    3. CIt acts by inhibiting calcineurin, so check trough levels
    4. DTake it with grapefruit juice to raise absorption

    Answer and explanation in LearnFree account

24. Question 24 · Hard

    In thyroid storm, why is potassium iodide given at least an hour after the thionamide?

    1. AThionamides need an acid pH from iodide to be absorbed
    2. BIodide given first can supply substrate for new hormone synthesis
    3. CIodide inactivates the thionamide in the gut
    4. DIodide stimulates TSH release

    Answer and explanation in LearnFree account

25. Question 25 · Easy

    Sulfonylureas such as gliclazide increase insulin release by:

    1. AClosing ATP-sensitive K+ channels in beta cells
    2. BOpening calcium-activated chloride channels
    3. CInhibiting alpha-glucosidase in the small intestine
    4. DStimulating GLP-1 receptors

    Answer and explanation in LearnFree account