41.

Organ and tissue effect of corticosteroids:

A. Intracranial hypotension
B. Muscle protein anabolism
C. Inhibition of gluconeogenesis
D. Growth inhibition in children
Correct Answer: D
These are all true: Blood glucose rises, muscle protein catabolism increases, inhibition of cell-mediated
immunologic functions & ACTIVELY LYMPHOTOXIC, anti-inflammatory, and may cause behavioral disturbances

42. Which if the following glucocorticoids has the highest salt retaining activity?
A. Aldosterone
B. Prednisone
C. Dexamethasone
D. Cortisol
Correct Answer: D
PREDNISONE is a synthetic glucocorticoid with the highest salt-retaining activity (0.3). But CORTISOL still has the
highest NATURAL glucocorticoid with the salt-retaining activity (1.0). ALDOSTERONE is a mineralocorticoid not a
glucocorticoid.

43. Which of the following synthetic glucocorticoids has a better penetration of lipid barriers in topical use?
A. Aldosterone
B. Cortisol
C. Prednisone
D. Dexamenthasone
Correct Answer: D As discussed, DEXAMETHASONE is a synthetic glucocorticoid with the longest duration of action,
highest anti-inflammatory activity, and great topical activity with a half-life of 4-5 hours. CORTISOL is also known as
hydrocortisone or Compound F. It is a major natural glucocorticoid. See explanation for no. 42.

44. Fetus is protected from genital abnormalities caused by congenital adrenal hyperplasia by administration of
_________ to the mother.
A. Betamethasone
B. Dexamethasone
C. Triamcinolone acetonide
D. Methylprednisolone
Correct Answer: B DEXAMETHASONE is given in pregnancies at high risk for CAH, to protect the
fetus from genital abnormalities. BETAMETHASONE is for lung maturation. METHYLPREDNISOLONE is for nonadrenal
disorders such as asthma, organ transplant rejection, collagen diseases. TRIAMCINOLONE ACETONIDE is a synthetic
glucocorticoid given topically to reduce systemic effects.

45. Indication/s for high dose IV hydrocortisone:

A. Bilateral adrenalectomy
B. Irradiation of pituitary tumor
C. Both A & B
D. Neither A & B
Correct Answer: C In cushings syndrome, part of the treatment is the Surgical removal of tumor; part of the regime
is to administer large doses of cortisol during and after the surgery for the irradiation of pituitary tumor, or the
Resection of one or both adrenals. 300mg of soluble IV hydrocortisone is given on the day of surgery.
- Dose must be reduced slowly to normal replacement levels
Can also be used for Congenital Adrenal Hyperplasia:
- In infants with CAH, give appropriate electrolyte solutions and administer IV hydrocorticosterone in stress doses.
- Once the infant is stabilized; oral hydrocortisone is given in 12-18mg/m2/d in two unequally divided doses is
begun (2/3 in the morning and 1/3 in the late afternoon)
46. Which of the following statements BEST describes Cushings syndrome?
A. Caused by nodular hyperplasia of adrenal glands
B. Rounded plethoric face with truncal obesity
C. Dexamethasone suppression test is used to differentiate it from psychiatric conditions
D. All of the above
Correct Answer: D From the CSC trans & Dr. Fermins Lecture, secretion of adrenocorticoid steroids most
commonly due to increased amounts of ACTH. It is usually the result of bilateral adrenal hyperplasia.
Manifestations include: rounded, plethoric face ( moon facie), trunk obesity, muscle wasting, easy bruisability, poor
wound healing, osteoporosis, mental disorders, hypertension, diabetes, cataract.
Also, If you suspect Cushings syndrome or you want to rule out any psychiatric problems, you use Dexamethasone
Suppression Test. Normal hydrocortisone level should be below 3mcg/dL.

47. A potent steroid with glucocorticoid and mineralocorticoid activity:

A. Aldosterone
B. Fludrocortisone
C. Deoxycorticosterone
D. Ketoconazole
Correct Answer: B FLUDROCORTISONE is Potent steroid with mineralocorticoid and significant
glucocorticoid activity, a long duration of action; and is favored for replacement therapy after adrenalectomy and in
other conditions in which MC therapy is needed. DEOXYCORTICOSTERONE is Naturally occurring precursor of
aldosterone, Normally secreted in about 200mcg/d, and its Secretion is regulated by ACTH. ALDOSTERONE is the
major natural mineralocorticoid in humans, which is discussed in connection with hypertension and with control of
its secretion by angiotensin II.

Also take note that aldosterone is regulated by ACTH and RAAS, while Deoxycortisone is regulated by ACTH alone.

48. Ketoconazole acts as a glucocorticoid antagonist by:

A. Inhibition of cytochrome P450 enzymes necessary for synthesis of all steroids
B. Blockage of the conversion of cholesterol to pregnenolone
C. Inhibition of progesterone receptors
D. Blockage of 17a-hydroxylase ( P450c17) and 17, 20 lyase

Correct Answer: A is the action of ketoconazole as stated in her lecture. B. the blockage of conversion of cholesterol
is the mechanism of action of AMINOGLUTETHIMIDE. Meanwhile, choice C is the action of MIFEPRISTONE which is
a competitive inhibitor of glucocorticoid receptors as well as progesterone receptors. Meanwhile, MITOTANE Blocks
17-hydroxylase and 17,20-lyase.

49. Aminoglutethimide is used in conjunction with ______ to reduce/ eliminate estrogen production in patients with
carcinoma of the breast.
A. Metyrapone
B. Ketoconazole
C. Hydrocortisone
D. A & B only
Correct Answer: C
As Dr. Fermin discussed in her lecture, it is used in conjunction with:
o Dexamethasone or hydrocortisone- To reduce or eliminate estrogen
production in patients with breast carcinoma
o Metyrapone or ketoconazole- To reduce steroid secretion in patients with Cushings syndrome,

Metyrapone targets cushing syndrome, while ketoconazole is used in a number of conditions in which reduced
steroid levels are desirable (adrenal carcinoma, hirsutismm breast and prostate cancer). She did not mention any
combo drugs for ketoconazole.

50. A 30-yr old primigravid was diagnosed with Cushings Syndrome. Which of the following medications can be given
to the patient?
A. Mifepristone
B. Trilostane
C. Mitotane
D. Metyrapone
Correct Answer: D These drugs are corticosteroid antagonists, except for mifepristone which is a receptor inhibitor.
METYRAPONE is a selective inhibitor of steroid 11-hydroxylation, interfering with cortisol and corticosterone
synthesis. It is the ONLY ADRENAL-INHIBITING MEDICATION THAT CAN BE ADMINISTERED TO PREGNANT WOMEN
WITH CUSHINGS SUNDROME. TRILOSTANE is a 3-17 hydroxysteroid dehydrogenase inhibitor that interferes with
the synthesis of adrenal and gonadal hormones that is Comparable to aminoglutethimide, which is used to reduce
or eliminate estrogen production in patients with BREAST CA. MIFEPRISTONE is a RECEPTOR INHIBITOR that is an
antagonist at the steroid receptor antagonist & Has a strong antiprogestin activity and initially was proposed as
contraceptive agent used to treat Cushings syndrome due to ectopic ACTH production or adrenal carcinoma, given
orally. MITOTANE is a drug related to DDT class of insecticides with a Nonselective cytotoxic action on the adrenal
cortex on dogs. Who let the dogs out indeed?

51. Which of the following drugs has the highest selectivity to COX2 isozyme?
A. Etoricoxib
B. Celexocib
C. Rofecoxib
D. Valdecoxib
Correct Answer: B CELECOXIB is highly* selective( according to Katzung. In her lecture, it is variably selective). as it
increases risk of arterial thrombosis due to the COX-2 inhibitors having a greater inhibitory effect on endothelial
prostacyclin (PGI2) formation than on platelet TXA2 formation. Dont get this confused with MELOXICAM, another
COX 2 Inhibitor which is preferentially selective, according to Katzung. ETORICOXIB (Arcoxia) is also a COX-2
inhibitor, but not as selective as Celecoxib. ROFECOXIB & VALDECOXIB, which are removed from the market, have
no remarkable notes about selectivity, but they may cause an inc risk of MI or Stroke.

52. The only NSAID available in parenteral formulation:

A. Ibuprofen
B. Aspirin
C. Acetaminophen
D. Ketorolac
Correct Answer: D As mentioned during lecture, KETOROLAC is the only* (according to Dr. Fermins lecture) NSAID
available in a parenteral Formulation. It is given intramuscularly, or IV, but oral dose is also available. It is generally
restricted to 72 hours because of the risk of GI and renal damage with longer administration. IBUPROFEN, which can
be used for patent ductus arteriosus, can be given orally, topically, or IV* (according to Katzung). Acetaminophen (
or Tylenol/ paracetamol) is given orally/rectally/trandermally. ASPIRIN is given orally/rectally too. ( yeah, ASSpirin
can be shoved in the ASS).

53. Advantage of COX2 Selective inhibitors over other NSAIDs:

A. Greater antiplatelet effect
B. Reduced risk of gastrointestinal effects
C. Better analgesic property
D. Less cardiothrombotic effect
Correct Answer: B NSAIDs inhibit COX 2 only. COX 1 affects gastric acid production. As Katzung emphasized, COX 1
has housekeeping functions for the GI tract, kidneys, or platelets. As for analgesic properties, COX-2 have the same
analgesic, antipyretic, and anti-inflammatory effects like non-selective NSAIDs, but with lesser GI SE; but NO impact
on platelet aggregation ( mediated by thromboxane produced by COX-1). Also, they have MORE cardio effects as
COX-2 inhibits the prostacyclin synthesis in the vascular endothelium-> causing a higher incidence of cardiovascular
thrombotic events.

Also, COX-2 inhibitors have the same renal toxicity as NSAIDS.

54. Therapeutic dose of Aspirin that has better effect on platelet aggregation reduction:
A. <300 mg/day
B. 300-2400 mg/day
C. 2400-4000 mg/day
D. >4000 mg/day
Correct Answer: A. For aspirin: Low Range (<300mg/d)-> Effective in reducing platelet aggregation. Intermediate
Dose (300-2400mg/d)-> Anti-pyretic and analgesic effect. High Dose (2400-4000 mg/d) -> Anti-inflammatory effect.
Take note though that ASPIRIN is now rarely* used as an anti-inflammatory med.

55. This drug is useful as an aspiring substitute in children with viral infections:
A. Mefenamic acid
B. Acetaminophen
C. Ibuprofen
D. Celecoxib
Correct Answer: B All these drugs are under the NSAID family except for acetaminophen/paracetamol. NSAIDS may
cause Reyes Syndrome (liver encephalopathy) if given to children. Also take note that aspirin is sometimes called
baby aspirin but its not! So be careful!

56. 40-yr old patient with COPD was diagnosed with rheumatoid arthritis. Which of the following DMARDs will make
the patients condition worse?
A. Methotrexate
B. Hydroxychloroquine
C. Abatacept
D. Rituximab
Correct Answer: C Dr. Fermin emphasized how ABATACEPT may cause Infection, exacerbation of COPD,
hypersensitivity reactions + URTI! So be careful when giving it with TNF-a antagonists. METHOTREXATE can cause
nausea, mucosal ulcer; and the inhibition of cellular proliferation can cause leukopenia, anemia, stomatitis, GI
ulcerations, and alopecia (this is an anticancer drug, remember!). HYDROXYCHLOROQUINE (anti-malarial) - also safe
for pregnancy, may cause ocular toxicity and some mild GI symptoms & nightmares. RITUXIMAB- just rashes and
immunoglobulins may decrease but it is not directly associated with Rituximab.

Also guys, for COPD/Asthma. Take note that they should not be given drugs that may inhibit coughing* coz they
gotta spit out their sludge. Failure to do so may result in respiratory distress.

57. Which of the following drugs prevents conversion of purine to uric acid by xanthine oxidase?
A. Tolmetin
B. Colchicine
C. Probenecid
D. Febuxostat
Correct Answer: D FEBUXOSTAT( nonpurine inhibitor of xanthine oxidase), ALLOPURINOL (between acute attacks), &
ALLOXANTHINE (irreversible suicide inhibitor of enzyme) are XANTHINE OXIDASE INHIBITORS. TOLMETIN was
specifically mentioned as the nsaid that CANNOT be used for gout acute symptoms. COLCHICINE is cute for acute
gouty attacks, but will not have an effect on uric acid production. PROBENECID is a uricosuric agent which helps to
pee uric acid.

58. This drug is used as an adjunct to cancer chemotherapy to slow the formation of uric acid form purines released
by the death of large number of neoplastic cells:
A. Allopurinol
B. Indomethacin
C. Sulfinpyrazone
D. Febuxostat
Correct Answer: A ALLOPURINOL as mentioned, is a xanthine oxidase inhibitor. FEBUXOSTAT, though it inhibits
xanthine oxidase it has not effect on purines. INDOMETHACIN is for acute gouty attacks. SULFINPYRAZONE is a
uricosuric agent.

59. Pharmocologic treatment/s for acute gouty arthritis:

A. NSAIDs
B. Corticosteroids
C. Colchicine
D. All of the Above
Correct Answer: D Probably the easiest question ever. She has emphasized that all of those may be used for acute
gouty arthritis. Just take note of the TREATMENT STRATEGIES for gout:
1. Reducing inflammation during acute attacks (Colchicine, NSAIDs or GC)
2. Accelerating renal excretion of uric acid with uricosuric drugs (Probenecid or Sulfinpyrazone)
3. Reducing (with Allopurinol or Febuxostat) the conversion of purines to uric acid by Xanthine Axodase (Allopurinol
or Febuxostat)

60. Probenecid inhibit/s the secretion of:

A. Penicilllin
B. Methotrexate
C. Aspirin
D. All of the Above
Correct Answer: D Probenecid is a uricosuric agent that is a weak acids that compete with UA for reabsorption by
the weak acids transport mechanism in the proximal tubules, thereby increasing the UA excretion. So basically, it
affects the excretion of weak acid drugs. PROBENECID was originally used to prolong PENICILLIN blood levels. Also
ASPRIN in large doses, can prevent uric acid reabsorption. But if too low ( below less than 2.6 g daily), uric acid is
retained.

Also, take note that if the uric acid is too much, like UBER too much, uricosuric agents should not be used as uric
acid will not be eliminated.