Pharmacology Therapeutic Applications and Clinical Use 3 — Questions and Answers
Question 1: Tamoxifen is used in estrogen receptor-positive breast cancer. It acts as a:
- Full estrogen agonist
- Selective estrogen receptor modulator (SERM) (Correct answer)
- Aromatase inhibitor
- GnRH agonist
Correct answer: Selective estrogen receptor modulator (SERM)
Tamoxifen is a SERM that antagonizes estrogen receptors in breast tissue while acting as a partial agonist in other tissues.
Question 2: Which antiepileptic drug is preferred for absence seizures and works by blocking T-type calcium channels?
- Phenytoin
- Carbamazepine
- Ethosuximide (Correct answer)
- Valproate
Correct answer: Ethosuximide
Ethosuximide selectively blocks T-type calcium channels in thalamic neurons, reducing the spike-wave discharges of absence seizures.
Question 3: A patient on long-term corticosteroid therapy is at risk for osteoporosis. Which drug should be co-prescribed as prophylaxis?
- Calcium carbonate alone
- Bisphosphonate plus vitamin D and calcium (Correct answer)
- Calcitonin alone
- Fluoride supplements
Correct answer: Bisphosphonate plus vitamin D and calcium
Bisphosphonates (e.g., alendronate) with calcium and vitamin D are recommended to prevent glucocorticoid-induced osteoporosis.
Question 4: Clozapine is reserved for treatment-resistant schizophrenia despite its efficacy because it carries a risk of:
- Tardive dyskinesia
- Agranulocytosis (Correct answer)
- Neuroleptic malignant syndrome
- QT prolongation
Correct answer: Agranulocytosis
Clozapine can cause life-threatening agranulocytosis, requiring mandatory ANC monitoring with a REMS program.
Question 5: Naloxone is administered to an unconscious patient suspected of opioid overdose. The expected immediate clinical effect is:
- Sedation and analgesia
- Reversal of respiratory depression (Correct answer)
- Reduction of blood pressure
- Induction of vomiting
Correct answer: Reversal of respiratory depression
Naloxone competitively displaces opioids from mu-receptors, rapidly reversing respiratory depression.
Question 6: Isotretinoin (13-cis-retinoic acid) is highly effective for severe acne but requires a REMS program primarily because it is:
- Nephrotoxic
- Teratogenic (Correct answer)
- Cardiotoxic
- Hepatotoxic
Correct answer: Teratogenic
Isotretinoin is a potent teratogen that causes severe fetal malformations, requiring pregnancy prevention measures under iPLEDGE.
Question 7: A patient with Type 2 diabetes is started on an SGLT2 inhibitor. Which additional clinical benefit beyond glucose lowering makes this drug class preferred in patients with established cardiovascular disease?
- Weight gain
- Reduced risk of heart failure hospitalization (Correct answer)
- Increased blood pressure
- Improved LDL cholesterol
Correct answer: Reduced risk of heart failure hospitalization
SGLT2 inhibitors (e.g., empagliflozin) have demonstrated cardiovascular outcome benefits, including reduced heart failure hospitalization.
Pharmacology Therapeutic Applications and Clinical Use 3
Tamoxifen is used in estrogen receptor-positive breast cancer.
It acts as a: