MCQ Quiz-Toxicology

MCQ Quiz: Toxicology

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Toxicology, the science of poisons and adverse effects, is a critical area of expertise for every pharmacist. From managing an acute overdose in the emergency department to counseling patients on the risks of their chronic medications, understanding toxicology is essential for ensuring patient safety. This quiz, designed for PharmD students, will test your knowledge of key toxicological principles, specific drug toxicities, antidotes, and the pharmacist’s role in preventing and managing adverse effects.

1. Toxicology is best defined as the study of:

  • The therapeutic effects of drugs.
  • The adverse effects of chemical agents on living organisms.
  • The absorption and distribution of medications.
  • The economic impact of pharmaceuticals.

Answer: The adverse effects of chemical agents on living organisms.

2. The concept that “the dose makes the poison” is a fundamental principle in toxicology that describes the importance of the:

  • Dose-response relationship.
  • Drug formulation.
  • Patient’s age.
  • Route of administration.

Answer: Dose-response relationship.

3. In an acute acetaminophen overdose, toxicity is caused by the accumulation of a toxic metabolite, N-acetyl-p-benzoquinone imine (NAPQI), which depletes:

  • Cytochrome P450.
  • Glutathione.
  • Serum albumin.
  • Vitamin K.

Answer: Glutathione.

4. What is the primary antidote administered for an acetaminophen overdose?

  • Naloxone
  • Flumazenil
  • N-acetylcysteine (NAC)
  • Vitamin K

Answer: N-acetylcysteine (NAC)

5. A patient presents to the emergency department with respiratory depression, pinpoint pupils (miosis), and sedation. This clinical triad is classic for an overdose of which substance?

  • Acetaminophen
  • Benzodiazepines
  • Opioids
  • Cocaine

Answer: Opioids

6. The specific antagonist used to rapidly reverse opioid-induced respiratory depression is:

  • N-acetylcysteine
  • Naloxone
  • Flumazenil
  • Atropine

Answer: Naloxone

7. A major, dose-limiting toxicity associated with the chemotherapy agent cisplatin is:

  • Cardiotoxicity
  • Hepatotoxicity
  • Neurotoxicity
  • Nephrotoxicity

Answer: Nephrotoxicity

8. The anthracycline class of chemotherapy agents, such as doxorubicin, is well known for causing which dose-dependent, cumulative toxicity?

  • Pulmonary fibrosis
  • Ototoxicity
  • Cardiotoxicity
  • Peripheral neuropathy

Answer: Cardiotoxicity

9. Bleeding is the primary toxicity associated with which class of medications?

  • Antibiotics
  • Anticoagulants.
  • Antihypertensives
  • Antidepressants

Answer: Anticoagulants.

10. A patient taking multiple serotonergic agents, like an SSRI and tramadol, is at risk for developing which toxic syndrome?

  • Neuroleptic Malignant Syndrome
  • Anticholinergic crisis
  • Serotonin Syndrome
  • Malignant hyperthermia

Answer: Serotonin Syndrome

11. The Therapeutic Index (TI) of a drug is a measure of its:

  • Efficacy
  • Potency
  • Safety.
  • Half-life

Answer: Safety.

12. A drug with a narrow therapeutic index:

  • Has a wide margin between its effective dose and its toxic dose.
  • Has a small margin between its effective dose and its toxic dose, requiring careful monitoring.
  • Rarely causes side effects.
  • Does not require therapeutic drug monitoring.

Answer: Has a small margin between its effective dose and its toxic dose, requiring careful monitoring.

13. The Poison Prevention Packaging Act (PPPA) is a regulation designed to:

  • Ensure all medications are packaged in amber vials.
  • Require child-resistant packaging for certain hazardous household substances and most oral prescription drugs.
  • Regulate the advertising of medications.
  • Control the price of over-the-counter drugs.

Answer: Require child-resistant packaging for certain hazardous household substances and most oral prescription drugs.

14. A patient with a deficiency in the DPYD enzyme is at a significantly higher risk for severe toxicity from which chemotherapy agent?

  • Cisplatin
  • Paclitaxel
  • 5-fluorouracil (5-FU).
  • Doxorubicin

Answer: 5-fluorouracil (5-FU).

15. Digoxin toxicity is exacerbated by which electrolyte abnormality?

  • Hypernatremia
  • Hypercalcemia
  • Hypokalemia
  • Hypomagnesemia

Answer: Hypokalemia

16. Which of the following is the specific antidote for benzodiazepine overdose?

  • Naloxone
  • N-acetylcysteine
  • Flumazenil
  • Physostigmine

Answer: Flumazenil

17. The FDA’s MedWatch program is a system for:

  • Reporting suspected adverse drug reactions and medication toxicities.
  • Prescribing controlled substances.
  • Tracking pharmacy inventory.
  • Approving new drug applications.

Answer: Reporting suspected adverse drug reactions and medication toxicities.

18. Ototoxicity (hearing damage) and nephrotoxicity are well-known toxicities associated with which class of antibiotics?

  • Penicillins
  • Macrolides
  • Aminoglycosides
  • Tetracyclines

Answer: Aminoglycosides

19. A patient taking an MAO inhibitor who consumes tyramine-rich foods like aged cheese is at risk for:

  • A severe skin rash.
  • A hypertensive crisis.
  • Agranulocytosis.
  • Lactic acidosis.

Answer: A hypertensive crisis.

20. The “first pass effect” can be a mechanism that reduces the systemic toxicity of an orally administered drug by:

  • Increasing its absorption.
  • Allowing the drug to bypass the kidneys.
  • Significantly metabolizing the drug in the liver before it reaches systemic circulation.
  • Binding the drug to proteins in the blood.

Answer: Significantly metabolizing the drug in the liver before it reaches systemic circulation.

21. A Risk Evaluation and Mitigation Strategy (REMS) is required by the FDA for certain drugs to:

  • Ensure the benefits of a drug with known serious toxicities outweigh its risks.
  • Promote the drug for off-label uses.
  • Lower the price of the medication.
  • Speed up the dispensing process.

Answer: Ensure the benefits of a drug with known serious toxicities outweigh its risks.

22. A patient experiencing anticholinergic toxicity might present with which symptoms?

  • Salivation, lacrimation, urination, defecation (SLUD)
  • Bradycardia and sedation
  • Dry mouth, blurred vision, urinary retention, and confusion.
  • Pinpoint pupils and respiratory depression.

Answer: Dry mouth, blurred vision, urinary retention, and confusion.

23. The role of a Poison Control Center is to:

  • Provide expert information and advice on managing poisonings and toxic exposures.
  • Discipline pharmacists for dispensing errors.
  • Regulate the sale of poisonous substances.
  • Prescribe antidotes to patients directly.

Answer: Provide expert information and advice on managing poisonings and toxic exposures.

24. In toxicology, “LD50” refers to the:

  • Dose of a substance that is lethal to 50% of a test population.
  • Dose that is effective in 50% of a test population.
  • Lowest dose that causes a toxic effect.
  • Maximum recommended dose for a human.

Answer: Dose of a substance that is lethal to 50% of a test population.

25. A key role of the pharmacist in preventing toxicity is:

  • Patient counseling on correct medication use and potential side effects.
  • Screening for drug interactions and contraindications.
  • Recommending dose adjustments based on organ function.
  • All of the above.

Answer: All of the above.

26. Methanol poisoning is treated with an antidote like fomepizole or ethanol to:

  • Directly neutralize the methanol.
  • Prevent the metabolism of methanol to its toxic metabolites, formic acid and formaldehyde.
  • Speed up the elimination of methanol.
  • Chelate the methanol from the bloodstream.

Answer: Prevent the metabolism of methanol to its toxic metabolites, formic acid and formaldehyde.

27. Long-term use of NSAIDs can lead to toxicity in which organ system?

  • Lungs
  • Heart
  • Kidneys and Gastrointestinal tract.
  • Brain

Answer: Kidneys and Gastrointestinal tract.

28. A black box warning is the most serious type of warning in a drug’s labeling and is intended to alert prescribers to:

  • The high cost of the drug.
  • A potentially severe or life-threatening toxicity.
  • The drug’s lack of efficacy.
  • The availability of a generic version.

Answer: A potentially severe or life-threatening toxicity.

29. What is the primary toxicity associated with the anti-arrhythmic drug amiodarone?

  • It has a very favorable side effect profile with no major toxicities.
  • Hepatotoxicity.
  • Nephrotoxicity.
  • It has multiple potential toxicities, including pulmonary, thyroid, and liver toxicity.

Answer: It has multiple potential toxicities, including pulmonary, thyroid, and liver toxicity.

30. Pharmacogenomic testing for TPMT is used to prevent toxicity from which drug?

  • Warfarin
  • Clopidogrel
  • Azathioprine.
  • Simvastatin

Answer: Azathioprine.

31. The process by which the body transforms a drug into different compounds (metabolites), some of which can be more toxic than the parent drug, is known as:

  • Absorption
  • Distribution
  • Biotransformation.
  • Excretion

Answer: Biotransformation.

32. What is the reversal agent for heparin-induced bleeding?

  • Vitamin K
  • Protamine sulfate
  • Idarucizumab
  • Andexanet alfa

Answer: Protamine sulfate

33. The principle of “bioactivation” in toxicology refers to:

  • The process of a drug being detoxified by the body.
  • A drug being metabolized to a more reactive and toxic chemical species.
  • The binding of a drug to its therapeutic target.
  • The elimination of a toxin from the body.

Answer: A drug being metabolized to a more reactive and toxic chemical species.

34. A patient with renal impairment is at higher risk of toxicity from a drug that is:

  • Primarily metabolized by the liver.
  • Highly protein-bound.
  • Primarily eliminated unchanged by the kidneys.
  • Administered topically.

Answer: Primarily eliminated unchanged by the kidneys.

35. Extrapyramidal symptoms (EPS), such as dystonia and akathisia, are a classic toxicity associated with which drug class?

  • Antidepressants
  • Antihypertensives
  • Antipsychotics
  • Antibiotics

Answer: Antipsychotics

36. A drug-drug interaction leading to a toxic effect is an example of what type of adverse drug reaction?

  • Idiosyncratic
  • Type A (Augmented/Predictable)
  • Allergic
  • Delayed

Answer: Type A (Augmented/Predictable)

37. Chelation therapy with agents like deferoxamine or succimer is a treatment for toxicity caused by:

  • Benzodiazepines
  • Heavy metals.
  • Beta-blockers
  • Acetaminophen

Answer: Heavy metals.

38. The pharmacist’s patient care process is critical for identifying risk factors for toxicity during which step?

  • Plan
  • Implement
  • Collect and Assess
  • Follow-up

Answer: Collect and Assess

39. Rhabdomyolysis is a rare but severe toxicity characterized by muscle breakdown, which can be caused by:

  • High-dose statin therapy.
  • Penicillin.
  • Metformin.
  • Aspirin.

Answer: High-dose statin therapy.

40. A patient’s understanding of their medication’s potential toxicity can be improved through:

  • Effective pharmacist counseling.
  • Providing the package insert with no explanation.
  • Using complex medical terminology.
  • Withholding all safety information.

Answer: Effective pharmacist counseling.

41. Which of the following is a key symptom of salicylate (aspirin) toxicity?

  • Bradycardia
  • Hypothermia
  • Tinnitus and metabolic acidosis.
  • Constipation

Answer: Tinnitus and metabolic acidosis.

42. The term “toxicokinetics” describes:

  • What the body does to a poison (absorption, distribution, metabolism, excretion of a toxicant).
  • What a poison does to the body (the mechanism of toxicity).
  • The study of poisons from natural sources.
  • The legal regulations surrounding poisons.

Answer: What the body does to a poison (absorption, distribution, metabolism, excretion of a toxicant).

43. A drug that is a strong inhibitor of a CYP450 enzyme can cause toxicity by:

  • Increasing the metabolism of other drugs that are substrates for that enzyme.
  • Decreasing the metabolism of other drugs that are substrates for that enzyme, leading to their accumulation.
  • Inducing its own metabolism.
  • Having no effect on other drugs.

Answer: Decreasing the metabolism of other drugs that are substrates for that enzyme, leading to their accumulation.

44. What is the purpose of administering activated charcoal in certain acute oral poisonings?

  • To neutralize the poison.
  • To induce vomiting.
  • To bind the poison in the GI tract and prevent its absorption.
  • To serve as a specific antidote.

Answer: To bind the poison in theGI tract and prevent its absorption.

45. “Red Man Syndrome” is a pseudoallergic infusion reaction associated with which antibiotic?

  • Ciprofloxacin
  • Azithromycin
  • Vancomycin
  • Doxycycline

Answer: Vancomycin

46. The goal of individualizing drug therapy is to optimize efficacy while minimizing:

  • Cost
  • Toxicity.
  • Dosing frequency
  • Patient adherence

Answer: Toxicity.

47. A “drug holiday” may be a strategy used to manage:

  • An acute overdose.
  • A chronic, cumulative drug toxicity.
  • A medication error.
  • A drug-food interaction.

Answer: A chronic, cumulative drug toxicity.

48. Why is it crucial for a pharmacist to ask about OTC and herbal product use when assessing for potential toxicities?

  • These products can cause significant drug interactions and have their own toxicities.
  • These products are never associated with toxicity.
  • It is only necessary to ask about prescription drugs.
  • To recommend more expensive alternatives.

Answer: These products can cause significant drug interactions and have their own toxicities.

49. Anaphylaxis is a severe, life-threatening allergic reaction (toxicity) that requires immediate treatment with:

  • An oral antihistamine.
  • A topical corticosteroid.
  • Intramuscular epinephrine.
  • An inhaled beta-agonist.

Answer: Intramuscular epinephrine.

50. The ultimate goal of a pharmacist’s involvement in clinical toxicology is to:

  • Prevent and mitigate harm from adverse effects of drugs and poisons.
  • Document all poisonings for research purposes.
  • Ensure all toxic drugs are removed from the market.
  • Increase the number of prescriptions for antidotes.

Answer: Prevent and mitigate harm from adverse effects of drugs and poisons.

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