REPUBLIC OF KENYA

MINISTRY OF HEALTH

PHARMACY AND POISONS BOARD

MODEL EXAMINATION QUESTION PAPER

STAGE ONE: PAPER 2

TIME: 2.00 P.M. – 5.00 P.M. DATE: SEPTEMBER 2017

EXAM NUMBER: ………………………………………………………………………..

INSTRUCTIONS TO CANDIDATES
This examination consists of THREE PARTS as follows:

Part I:

This consists of 100 Multiple Choice Questions. Use the answer sheet provided to indicate
to indicate your answer choices. For each question, select only one most appropriate answer
choice. Write your Exam Number clearly on the separate answer sheet provided using blue or
black ink pen.

Part II:

This part consists of 15 Short Answer Questions. Answer all the questions in the spaces
provided.

Part III:

This consists of 3 Essay Questions. Attempt all. Write all your answers on the sheets of
paper provided. Start each question on a separate sheet of paper and write your Exam
Number on all the answer sheets.

At the end of the examination, put all your answers sheets in the envelope provided. Write
your Exam Number on the envelope. DO NOT write your name on the Answers Sheet, any
page of this Examination Paper nor the envelope.
PART I:

This part consists of Multiple Choice Questions. Use the answer sheet provided to
indicate your answer choices

1. Which of the following statements is false regarding respiratory acidosis?

A. More hydrogen ions are excreted by the kidneys
B. Bicarbonate is excreted by the kidneys
C. Bicarbonate is generated by the kidneys
D. There is increased concentration of bicarbonate in the body

2. Metabolic alkalosis can be due to

A. vomiting
B. diarrhoea
C. renal failure
D. respiratory failure

3. Assessment of renal function involves measurement of all the following except

A. creatinine
B. blood urea nitrogen
C. potassium
D. zinc

4. Elevated level of aldosterone is associated with

A. Conn’s Syndrome
B. diabetes insipidus
C. phaechromocytoma
D. thyrotoxicosis

5. Insulin does not promote

A. glucose uptake by cells
B. glycolysis
C. lipolysis
D. hypoglycemia

6. The following are causes of hypophosphatemia except

A. decreases absorption
B. intracellular shift
C. increased renal losses
D. increased vitamin D secretion

7. Which of the following is used as an indicator of cholestatic liver disease?

A. Alkaline phosphatase
B. Alanine transaminase
C. Aspartate transaminase
D. Lactate dehydrogenase
8. An increase in the number of cells in the human body is referred to as
A. hypertrophy
B. hyperplasia
C. atrophy
D. angiogenesis

9. Which of the following is not associated with acute inflammation?

A. Redness
B. Heat
C. Swelling
D. Atrophy

10. The following conditions can cause hypercoagulability of blood except

A. myocardial infarction
B. breast cancer
C. bone fractures
D. thrombocytopenia

11. An appropriate counselling point for a female purchasing intravaginal

miconazole is
A. avoid usage during menstruation
B. all male partners should be treated concomitantly
C. avoid concomitant use of external creams
D. side effects may include burning or sensation

12. Which of the following agents used in prinzmetal’s angina has spasmolytic
actions which increase coronary blood supply?
A. Captopril
B. Diltiazem
C. Timolol
D. Propranolol

13. Which of the following antihypertensive drugs may cause a dry cough?
A. Carvedilol
B. Captopril
C. Irbesartan
D. Propranolol

14. Long standing hypertension leads to tissue damage in the following organs
except
A. heart
B. lungs
C. kidneys
D. brain
15. Which of the following is used as first line therapy in heart failure due to its
cardiac remodelling effects?
A. Hydrochorthiazide
B. Carvedilol
C. Furosemide
D. Ramipril

16. The following drugs are appropriate therapies for a lower urinary tract infection
due to Pseudomonas aeruginosa except
A. Norfloxacin
B. Tobramycin
C. Cotrimoxazole
D. Ciprofloxacin

17. Phenytoin is effective in the treatment of the following types of seizures except
A. absence seizures
B. generalized tonic clonic seizures
C. simple partial seizures
D. complex partial seizures

18. The drug that can cause hyponatremia is

A. phenytoin
B. spironolactone
C. carbamazepine
D. ibuprofen

19. The following is not a protease inhibitor

A. lopinavir
B. abacavir
C. saquinavir
D. indinavir

20. An antiepileptic drug that has the greatest effect on the efficacy of oral
contraceptives is
A. diazepam
B. phenytoin
C. ethosuximide
D. lamotrigine

21. A tricyclic antidepressant that causes the most anticholinergic side effects is
A. nortriptyline
B. desimipramine
C. amitriptyline
D. protriptyline
22. The primary goals of asthma therapy in an adult patient excludes
A. maintaining normal activity levels
B. preventing destruction of lung tissue
C. control of symptoms
D. avoiding adverse drug effects

23. The least likely trigger of asthmatic attacks is

A. bacterial or viral pneumonia
B. hypersensitivity reaction of penicillin
C. discontinuation of asthma medication
D. hot dry weather

24. The triple therapy for peptic ulcer disease does not include
A. cotrimoxazole
B. lansoprazole
C. erythromycin
D. amoxicillin

25. The following conditions may cause hypothyroidism except

A. endemic goitre
B. Grave’s disease
C. Hashimoto’s thyroiditis
D. thyroidectomy

26. The following are causes of chronic kidney disease except

A. diabetes mellitus
B. systematic lupus erythematosus
C. glomerular nephritis
D. long term exposure to lisinopril or captopril

27. The most common cause of liver cirrhosis?

A. hepatitis A
B. hepatitis E
C. alcohol
D. renal dysfunction

28. The key organ involved in drug metabolism is the

A. brain
B. lung
C. kidney
D. liver

29. Which of the following statements regarding first pass effect is not true?
A. it can occur in the GIT wall
B. it affects drugs that are administered orally
C. it increases the mean residence time
D. it reduces bioavailability
30. The volume of distribution of a drug is
A. used to calculate is loading dose
B. not affected by plasma protein binding
C. is affected by multiple doses
D. not affected by adipose tissues

31. Which of the following drugs is absorbed from the the gut?
A. Mannitol
B. Cholestyramine resin
C. Acarbose
D. Selegiline

32. The no side/adverse effect dose (NOAEL) of a drug is

A. greater than LD 50
B. the threshold dose that produces the first adverse effect
C. the lowest dose that is therapeutically active
D. the highest dose that not produce an adverse effect

33. Drugs that are highly basic tend to bind to

A. albumin
B. alpha-1 glycoproteins
C. lipoproteins
D. haemoglobin

34. Which of the following is an example of α1 (alpha-one) receptor blocker?

A. Prazosin
B. Propranolol
C. Clonidine
D. Methyldopa

35. Which of the following is not a likely clinical manifestation of an

organophosphate poisoning?
A. Lacrimation
B. Vomiting
C. Meiosis
D. Increased heart rate

36. Opioid analgesics are not used for management of

A. diarrhoea
B. cough
C. hypertension
D. severe pain
37. The the most effective antidote for morphine toxicity is
A. pralidoxime
B. naloxone
C. clonidine
D. atropine

38. Overdose of paracetamol causes

A. an antiplatelet effect
B. gastric ulceration
C. Reye’s syndrome
D. hepatotoxicity

39. Which of the following agents is used in management of an acute attack of

gout?
A. Allopurinol
B. Probenecid
C. Colchicine
D. Sumatriptan

40. The type of insulin with shortest duration of action is

A. regular insulin
B. insulin aspart
C. insulin glargine
D. protamine-zinc insulin

41. Which of the following parameters should be monitored in a patient on

warfarin?
A. International Normalized Ratio (INR)
B. Platelet count
C. Prothrombin time
D. Bleeding time

42. A drug that is not effective in the management of acute asthma attack include
A. cromolyn sodium
B. theophyline
C. β2 receptor agonists
D. ipratropium

43. An example of a diuretic that is potassium sparing is

A. acetazolamide
B. thiazide diuretics
C. spironolactone
D. furosemide
44. The following side effects are associated with angiotensin II receptor antagonists
except
A. teratogenicity
B. cough
C. hyperkalemia
D. hypotension

45. Statins do not

A. increase levels of low density lipoproteins
B. cause myopathy
C. reduce risk of atherosclerosis
D. have a synergistic effect in combination with bile – resins

46. The drug used for radial cure of Plasmodium vivax infection is
A. primaquine
B. quinine
C. artemisinin – lumefantrine
D. chloroquine

47. Extra-intestinal ameobiasis can be treated with

A. diloxanide furoate
B. clioquinol
C. amoxicillin
D. chloroquine

48. The drug of choice for eradicating schistosomiasis is

A. praziquantel
B. albendazole
C. diethylcarbamazine
D. ivermectin

49. Sulfonamides act by

A. blinding to 50S ribosomal subunit
B. interfering with utilization of folic acid
C. blocking bacterial porins
D. interruption of cell wall synthesis

50. Which of the following compound inhibits bacterial cell wall synthesis?
A. Streptomycin
B. Vancomycin
C. Trimethoprim
D. Polymyxin B
51. The immediate natural precursor to cholesterol in animals is
A. mevalonic acid
B. ergosterol
C. acetyl CoA
D. mevaldic acid

52. What term is used for small molecules that bind to different regions of a
binding site?
A. Epimers
B. Isomers
C. Isotopes
D. Epitopes

53. The adrenergic agent whose structure is shown below is

CH3

O N CH3
H
OH

A. xylometazoline
B. epinephrine
C. salbutamol
D. propranolol

54. The following amino acids have a side chain containing a basic group except
A. arginine
B. histidine
C. cysteine
D. lysine

55. The vitamin that contains a cyanide group co-ordinately bonded to a cobalt
atom is
A. B12
B. B6
C. E
D. K

56. The following compounds have an indole nucleus except

A. serotonin
B. lysergic acid diethylamide
C. sumatriptan
D. theophylline
57. Which analytical test is carried out by ignition with concentrated sulphuric
acid?
A. Loss on drying
B. Gravimetry
C. Sulphated ash
D. Moisture content

58. An example of protic solvent is

A. chloroform
B. acetic acid
C. hexane
D. benzene

59. The following drugs are nitroimidazoles except

A. metronidazole
B. secnidazole
C. mebendazole
D. tinidazole

60. Which of the following antibiotics is not derived from amino acids?
A. Cephalexin
B. Chloramphenicol
C. Oxacillin
D. Streptomycin

61. The correct instrument operation module in ultraviolet visible spectrometry is of

the following sequence
A. light source→ recorder→ detector → sample → wavelength selector
B. light source → sample → recorder → detector → wavelength selector
C. light source →wavelength selector → sample → detector → recorder
D. wavelength selector → detector → sample → light source →recorder

62. An atomizer is unique to

A. a chromatograph
B. an IR spectrometer
C. flame spectrometer
D. a spectrofluorimeter

63. The classical infrared spectrophotometers which operate in the spectral

frequency range of 400 cm-1 to 400cm-1, monitor frequencies in the
A. near IR region
B. mid-IR region
C. far IR region
D. remote IR region
64. Which of the following is NOT commonly used as a solvent in UV-visible light
spectrophotometry?
A. Water
B. Chloroform
C. Ethanol
D. Methanol

65. Ascending, descending and horizontal solvent flow chromatography are

techniques deployed in
A. thin layer chromatography
B. gas chromatography
C. paper chromatography
D. column chromatography

66. In a quantitative analytical assay, the minimum number of determinations that

must be performed in order to conclude on the value of the determinant is
A. two
B. three
C. four
D. five

67. Which one the following spectroscopic methods uses radio frequency detectors
in its recording system?
A. Nuclear magnetic resonance
B. Mass spectroscopy
C. X-ray diffraction
D. Differential scanning calorimetry

68. An ideal method for the extraction of thermolabile compound is

A. hydrodistillation
B. ultrasound assisted extraction
C. pressurized solvent extraction
D. soxhlet extraction

69. Which pathway is used to biosynthesize digitoxigenin?

A. Shikimic acid
B. Phenyl propanoate
C. Cinnamic acid
D. Mevalonic acid

70. The Goldbeater’s skin test is an assay method for

A. tannins
B. saponins
C. phenolic compounds
D. alkaloids
71. Which of the following alkaloids is not heterocyclic?
A. Nicotine
B. Cocaine
C. Quinine
D. Ephedrine

72. The following oils used in aromatherapy are classified as reviving oils except
A. chamomile
B. eucalyptus
C. lemon
D. rosemary

73. Which of the following is a toxic agent found in cassava?

A. Mescaline
B. Amygdaline
C. Linamarin
D. Colchicine

74. The most active ingredient of Catha edulis is

A. Merucathine
B. Cathinone
C. Cathine
D. Catheduline

75. Ethnopharmacological fieldwork involves all the following except

A. interviewing traditional healers
B. interpreting traditional terminologies
C. administering herbal remedies
D. examining patients consuming herbal remedies

76. A which of the following is not an element of bioprospecting policy?

A. Benefit sharing among concerned parties
B. Traditional applications of the natural product
C. Capacity building for value addition
D. Source of funding

77. In the quality control herbal products, all the following are important
parameters except
A. total ash value
B. acid soluble ash
C. water soluble ash
D. foreign matter
78. In the microscopic examination of fennel one would expect to see
A. glandular trichomes
B. microsphenoidal crystals
C. elliptical vittae
D. cicatrix

79. In the botanical name Acer palmatum, the epithet palmatum refers to;
A. originating from the palmtree
B. shaped like the hand
C. originating from the coast region
D. the latin name for maple

80. Suberin is found in the

A. stem
B. cork
C. roots
D. fibers

81. Honey consists mainly of

A. sucrose
B. liquid glucose
C. invert sugar
D. cane sugar

82. A pineapple can be classified as

A. aggregate fruit
B. multiple fruit
C. simple fruit
D. dehiscent fruit

83. Which of the following statements relates to wet granulation?

A. It is suitable for processing heat-sensitive active pharmaceutical
ingredients
B. It may be carried out using volatile solvent as granulating fluid instead of
water
C. It is performed using roller compactors
D. It is suitable for reducing flowability of primary powders

84. Which of these mills is best suited for comminution of fine powders?
A. Cutter mills
B. Ball mill
C. Roller mills
D. Hammer mills
85. What component in the Noyes-Whitney equation has the greatest impact on
drug dissolution?
A. effective surface area of drug particles
B. thickness of the diffusion layer
C. diffusion coefficient of drug in solution
D. saturation solubility of the drug in solution

86. Arrhenius theory is employed in

A. Long term stability testing
B. Accelerated stability testing
C. Intermediate stability testing
D. Stress testing

87. The concentration of a steroid in a formulation is 20 mg at time 0; 16 mg at day

7; 12 mg at day 14 and 8 mg at day 21. What order of reaction does the
decomposition follow?
A. Zero
B. First
C. Pseudo first
D. Second

88. In what proportion must 10% alcohol and 90% alcohol be mixed to make 500ml
of 50% alcohol
A. 125ml 10% alcohol/375ml 90% alcohol
B. 250ml% 10% alcohol/250ml 90% alcohol
C. 375ml 10%alcohol/125ml90% alcohol
D. 400ml 10% alcohol/100ml 90%alcohol

89. Which of these is not a colligative property of a solution?

A. Osmotic pressure elevation
B. Boiling point elevation
C. Dissolution rate elevation
D. Freezing point depression

90. A characteristic of a deflocculated suspension include

A. rapid sedimentation
B. large sedimentation volume
C. sedimentation of practices in loosely associated clusters
D. likelihood of caking

91. Which of these excipients is correctly matched with its function in tablet
formulation?
A. Lactose - lubricant
B. Magnesium stearate – filler
C. Colloidal silicon dioxide - glidant
D. Mannitol – disintegrant
92. Eutectic system is described as a
A. mixture of cis and trans isomers in equal proportions
B. solid that is characterized by long range positional order
C. chemical entity that crystallizes in different crystalline form
D. mixture of compounds which melts at a lower temperature than the
melting point of either of the compounds

93. In lyophobic colloids

A. viscosities are much higher than the viscosities of vehicle
B. pseudoplastic flow is the predominant behaviour
C. the viscosities are comparable or slightly than those for vehicle
D. there is greater shear-thinning tendency than in lyophilic colloids

94. Which of the following characteristics is associated with lyophobic but not
lyophilic colloids?
A. Large surface free energy that is rapidly lowered by solvation
B. Spontaneous dispersal process
C. Easy reconstitution
D. Intrinsic instability

95. Which of the following approaches of raising filtration rate my result in a

decrease in bed porosity?
A. Including filtration aids
B. Use of large filter
C. Raising pressure differential across a filter cake
D. Periodic removal of the filter cake

96. The expression of the concentration of a solution as percentage weight in

volume means
A. the grams of solute in a litre of solution
B. the milligrams of solute in millilitres of solvent
C. grams of solute in 100ml of solution
D. milligrams of solute in 100ml of solvent

97. In assessing the quality of mixing , he number of particles assessed will

increase with a decrease in
A. density
B. sample weight
C. the bulk from which sample is drawn
D. time of mixing
98. Segregation of particles by percolation occurs when
A. small particles are blown up by air current
B. fine particles sediment and settle on top of coarse particles
C. small particles pass between large particles to settle at the bottom of a
container
D. small particles are separated from large particles due to the distance
moved by the larger particles

99. One advantage of using ionizing radiations as sterilizing agents is that they
A. do not affect the potency of formulations
B. do not raise the temperature of articles being sterilized
C. have no effect on containers previously sterilized by other methods
D. have minimal effects on personnel

100. Eye drop preparations can be preserved with the following compounds
except
A. benzalkonium chloride
B. chlorhexidine acetate
C. phenylmercuric nitrate
D. hydrogen peroxide
This part consists of Short Answer Questions. Answer ALL the questions in the spaces
provided.
1. Give any five reasons why drying is necessary in pharmaceutical processing.
(5 Marks)

2. State any five approaches that may be used to increase the dissolution rate of solids
during formulation processes. (5 Marks)

3. Describe any five quality control tests that should be carried out on compressed tablets.
(5 Marks)

4. Name any five natural polysaccharides that are commonly used in hydrophilic colloidal
systems. (5 Marks)

5. List any five colloidal drug delivery systems used in pharmaceutical formulations.
(5 Marks)

6. Goats in West Pokot died after ingesting a certain leaf. The farmer has brought the leaf
to you. Describe five leaf features that you would note for identification and for each
feature give one example: (5 Marks)

7. Write short notes on senna, stating the botanical source, leaf type, major constituents
and therapeutic uses (5 Marks)

8. Match each of the following clinical compounds with their botanical sources (5 Marks)
(Botanical Sources: Pilocarpus jaborandi, Datura strammonium, Cinchona succirubra,
Papaver somniferum, Erythroxylum coca, Digitalis purpurea, Catharanthus roseus)

Clinical Compounds
a) Morphine

b) Quinine

c) Vincristine

d) Pilocarpine

e) Hyoscine
9. A 68 year old man with chronic kidney disease presents with weakness and progressive
worsening of shortness of breath. Laboratory findings show a potassium concentration
of 7.2 mmol/L; an electro-cardiogram reveals tall T peaked waves and widening QRS
complex.

i) Explain why this patient should be treated in an acute care setting? (1 mark)

ii) Give four pharmacological agents (with reason for treatment of elevated
potassium). (4 marks)

10. A 55 year old man presents to his doctor complaining of tightness in his chest when he
climbs stairs to his bedroom. It eases when he has a rest. On investigation, he has
raised serum glucose concentration and is being considered to be a newly diagnosed
type II diabetic. Outline cardiovascular investigations and treatment this man should
receive. (5 Marks)
Investigation

Treatment

11. Regarding cephalosporins,

i) outline their mechanism of action (1 Mark)

ii) show how they are classified, giving an example in each class (4 Marks)

12. Outline the pharmacological actions and site of action of the following agents.
(5 Marks)
i) Filgrastim (Neupogen®)

ii) Epoetin alfa

iii) Baclofen

iv) Thiopental sodium

v) Atosiban

13. Mrs. FM, a 70 year old with chronic asthma and mild heart failure, has been prescribed
naproxen 250mg three times daily. On inspection of her medication record you discover
that she is also receiving:
 Furosemide 40mg po mane
 Ramipril 5mg po mane
 Prednisolone 5mg OD
 Salbultamol inhaler 2 puffs 4 times daily when required
 Salmeterol 50mcg inhaler one puff twice daily
  Beclomethasone 250mcg inhaler two puffs twice daily
 Calcium carbonate tablets (2) when required.
When you ask her about symptoms control, she tells you that she is still breathless at
night, in addition to her painful knee.

i) Explain why you would advise against naproxen prescription. What would you
recommend? (2 Marks)

ii) What other aspects of patient medication regimes could be improved? (2 Marks)

iii) What is the likely effect of the prescribed therapy on plasma potassium? (1 Mark)

14. A 60 year old lady is intolerant to her anti-hypertensive treatment (Bendroflumethiazide,

nifedipine, doxazosin and atenolol) she presents with intolerable postural hypotension,
headache, breathlessness, wheezing and acute gout attack.

i) Outline the antihypertensive agent(s) responsible for these complaints. (2 Marks)

ii) Outline other options available for controlling her blood pressure. (3 Marks)

15. Outline any five beneficial effects of acute inflammation (5 Marks)

PART III:

This part consists of 3 Essay Questions. Attempt ALL.

1. a) Give the class of compounds to which each of the following disinfectants belong and
the use to which they may be put. (10 Marks)
i) Cresol:

ii) Hydrogen peroxide:

iii) Chlorhexidine:

iv) Ethanol:

v) Glutaraldehyde:

b) Give the functions of the following additives in the formulation of suspensions.

(5 Marks)
i) Surface active agents:

ii) Tragacanth:

iii) Inorganic electrolytes:

iv) Preservatives:

v) Flavouring agents:
c) With the aid of diagrams describe the extraction of phytochemicals using:
(10 marks)

i) Percolation

ii) Soxhlet extraction

2. a) AJ, a 40-year old diabetic patient presents with cough, chest pain, lower limb swelling,
facial puffiness and dyspnoea.
Physical examination reveals the following:

 Temperature 39.5oC
 Crackles on the right side of the chest
 BP=180/110 mm Hg
 Bilateral pedal pitting oedema
Laboratory results Reference range
 Creatinine - 600mg/L (90-115)
  Potassium - 6.5meq/L (3.5-5.5)
 Blood sugar - 13 mmol/L (2.2 -8)
 Sodium - 150mmol/L (135-145)
 Blood pH - 7.15 (7.3-7.35)
 HCO3- -
18mmol/L (22-26)
CXƦ – consolidation in the right side pleural effusion

i) Interpret the laboratory results (3 Marks)

ii) The following drugs were prescribed to manage A.J

 Bendrofluazide 10mg od
 Gentamicin 80mg tid
 Benzylpenicillin 2 mu qid
 Enalapril 10mg od
Critically evaluate this prescription and give recommendations. (7 Marks)

iii) Briefly discuss the main complications of persistent high blood pressure (8 Marks)
a) Retina of the eye

b) Heart

c) Kidneys

d) Brain

b) AM is a 40 year old hyperthyroid female, presenting with profuse sweating, fever and
hypertension. Examination reveals neutropenia and severe sore throat. A diagnosis of
thyroid storm is made. Formulate an appropriate management plan. (7 Marks)

3. a) Briefly discuss five patient factors considered when selecting antimicrobial

agents for use. (10 Marks)

b) Describe the mode of action of each of the following agents (5 Marks)

i) Fexofenadine

ii) Formoterol

iii) Enalapril

iv) Ceftazidime

v) Esomeprazole
c) Briefly explain the rationale and consequences of the concurrent administration of:
(5 Marks)
i) Phenobarbitone and glibenclamide in a patient.

ii) Amikacin and ceftriaxone in a patient with pneumonia

iii) Probenecid and Amoxicillin in a patient with pyelonephritis

iv) Propranolol and salbutamol in a hypertensive and asthmatic patient

v) Spirolonolactone and enalapril in a patient with renal failure

d) Indicate the pharmacological class of each of the following drugs (5 Marks)

i) Phenelzine
ii) Haloperidol
iii) Clomipramine
iv) Aprepitan
v) Azithromycin
vi) Losartan
vii) Moxifloxacin
viii) Efavirenz
ix) Cyclosphophamide
x) Warfarin