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Pharmaceutical Worker Certification Assessment (Kazakhstan) study materials
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Pharmaceutical Worker Certification Assessment (Kazakhstan) practice questions

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Question 1Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

According to the Law of the Republic of Kazakhstan "On Medicines and Pharmaceutical Activity", which body is authorized to issue a marketing authorization for a medicinal product in Kazakhstan?

  1. The Ministry of Health through its authorized expert organization Correct answer.
  2. The National Bank of the Republic of Kazakhstan
  3. The Chamber of Commerce of the Republic of Kazakhstan
  4. The local akimat of the region where the manufacturer is located

Explanation

Marketing authorization (registration) of medicines in Kazakhstan falls within the competence of the authorized state body for healthcare, which acts through a designated expert organization that conducts the pharmaceutical evaluation. Regional akimats and other bodies have no registration authority.

Question 2Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

In Kazakhstan, pharmaceutical activity is licensed. Which body issues and revokes the license for pharmaceutical activity?

  1. The territorial department of the sanitary-epidemiological service
  2. The licensing authority designated by the Government of the Republic of Kazakhstan Correct answer.
  3. The manufacturer's own quality assurance department
  4. The professional association of pharmacists

Explanation

Licensing of pharmaceutical activity is carried out by a state licensing authority determined by the Government under the permit system legislation. The sanitary service and professional associations do not issue pharmaceutical licenses.

Question 3Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

A pharmacy in Kazakhstan wishes to dispense prescription medicines. What is the minimum requirement regarding its staff according to the licensing rules for pharmaceutical activity?

  1. A head with a pharmaceutical education and the required qualification category or certification Correct answer.
  2. At least two sellers with secondary education only
  3. At least one employee with any higher education
  4. No specialist requirement if the pharmacy is small

Explanation

Pharmaceutical activity licensing requires that the responsible head and specialists have a pharmaceutical education and appropriate qualification, confirmed by certification. Sellers without pharmaceutical education cannot independently run a pharmacy.

Question 4Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Which document in Kazakhstan establishes the list of medicines dispensed only by prescription?

  1. The order of the authorized healthcare body approving the prescription and dispensing rules Correct answer.
  2. The price list of the distributor
  3. The contract between the pharmacy and the wholesaler
  4. The internal order of the pharmacy manager

Explanation

Prescription and dispensing rules, including the categories of prescription-only medicines, are approved by orders of the authorized state healthcare body. Distributor price lists and internal documents cannot change the prescription status of a medicine.

Question 5Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

A prescription for a narcotic medicinal product presented at a Kazakh pharmacy must be retained by the pharmacy. What is the standard handling rule for such a prescription?

  1. It is retained in the pharmacy and stored for the period established by the healthcare authority Correct answer.
  2. It is forwarded to the wholesaler that supplied the medicine
  3. It is returned to the patient after dispensing
  4. It is destroyed immediately after dispensing without records

Explanation

Prescriptions for narcotic and psychotropic medicines subject to strict accounting are retained by the pharmacy for the period set by the authorized healthcare body so that dispensing can be controlled. They are not returned to the patient or destroyed without record.

Question 6Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Which of the following is the correct definition of a "medicinal product" under Kazakh pharmaceutical legislation?

  1. Only substances of plant origin
  2. Only finished dosage forms produced industrially
  3. Any substance or combination of substances used for the treatment, prevention or diagnosis of disease, or for restoring or correcting physiological function Correct answer.
  4. Any product sold in a pharmacy, including cosmetics and food supplements

Explanation

The legal definition covers substances and combinations used for treating, preventing or diagnosing disease, or for restoring, correcting or modifying physiological functions. It is not limited to industrial or plant-origin products, and cosmetics are regulated separately.

Question 7Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

What is the purpose of the state register of medicines in the Republic of Kazakhstan?

  1. To record medicinal products authorized for circulation in the country Correct answer.
  2. To register pharmaceutical workers' employment contracts
  3. To list prices negotiated by distributors
  4. To identify pharmacies that are licensed

Explanation

The state register consolidates information on medicines that have passed evaluation and received marketing authorization, thereby defining what may circulate in the country. It is not a price list, a pharmacy register, or an employment database.

Question 8Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

A manufacturer wants to place a medicine on the Kazakh market. Which principle governs the relationship between registration and circulation?

  1. Only medicines registered in the Republic of Kazakhstan may be circulated, with exceptions established by law Correct answer.
  2. Registration is required only for medicines included in the essential medicines list
  3. Registration is required only for imported medicines, not for locally produced ones
  4. A medicine may circulate freely once manufactured, and registration follows later

Explanation

Circulation of medicines in Kazakhstan is allowed only after state registration, subject to specific exceptions defined by legislation. The requirement applies equally to imported and locally produced products and does not depend on inclusion in the essential medicines list.

Question 9Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Which of the following activities is included in the legal concept of "pharmaceutical activity" in Kazakhstan?

  1. Construction of hospital buildings
  2. Retail and wholesale trade in medicines and medical devices Correct answer.
  3. Operation of a medical laboratory for clinical diagnostics
  4. Production of food products for retail sale

Explanation

Pharmaceutical activity encompasses the manufacture, wholesale and retail trade, storage and other handling of medicines and medical devices carried out by licensed entities. Construction, food production and clinical diagnostics fall outside this concept.

Question 10Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

A wholesaler in Kazakhstan stores medicines requiring a cold chain. Which regulatory requirement applies to this storage?

  1. Storage conditions may be chosen freely by the wholesaler if the product is sold quickly
  2. Storage must comply with the conditions approved during registration and with good distribution practice requirements Correct answer.
  3. Cold chain is required only for vaccines, not for other medicines
  4. Only the manufacturer's advertising materials specify storage conditions

Explanation

Medicines must be stored and transported under the conditions approved in their registration dossier and in line with good distribution practice. The wholesaler cannot substitute its own conditions, and cold chain requirements are not limited to vaccines.

Question 11Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

In Kazakhstan, who may be the holder of a marketing authorization for a medicine?

  1. Only a pharmacy with a retail license
  2. Only the state-owned manufacturer
  3. Only a natural person resident in Kazakhstan
  4. A legal entity that has submitted the registration dossier and received the authorization Correct answer.

Explanation

A marketing authorization is issued to the applicant legal entity that submitted the dossier and completed registration; it is not restricted to state manufacturers or natural persons. A retail pharmacy license does not confer registration rights.

Question 12Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

A pharmacy receives a batch of a medicine with a label in a foreign language only. Under Kazakh requirements for labelling of medicines, what is the correct action?

  1. Dispense it, because the manufacturer's language is acceptable
  2. Sell it only to healthcare professionals
  3. Refuse circulation until labelling in the state and Russian languages as required is confirmed Correct answer.
  4. Relabel it locally without any documentation

Explanation

Medicines circulating in Kazakhstan must carry labelling and instructions in the state language and Russian as established by regulation. A foreign-language-only label does not meet this requirement, and undocumented relabelling is not permitted.

Question 13Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Which type of control is performed on medicines before they are released to the market in Kazakhstan to confirm that each batch meets the registered specification?

  1. Only verification of the price
  2. Only visual inspection by the pharmacist
  3. Batch (series) quality control with a certificate of conformity or quality certificate Correct answer.
  4. Only verification of the transport route

Explanation

Each batch of a medicine must be accompanied by a quality document confirming conformity with the registered specification, and batch control is part of the release system. Visual inspection alone, price checks and route checks do not constitute batch quality control.

Question 14Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

A patient brings an adverse drug reaction report to a Kazakh pharmacy. What is the pharmacy's obligation under pharmacovigilance rules?

  1. Record and forward the report to the authorized pharmacovigilance authority within the established procedure Correct answer.
  2. Publish the report on social media to warn the public
  3. Discard the report because pharmacies are not part of pharmacovigilance
  4. Send the report directly to the manufacturer only and take no further action

Explanation

Pharmacies participate in the pharmacovigilance system by detecting, recording and reporting adverse drug reactions to the authorized body according to the established procedure. Ignoring or bypassing the system would undermine drug safety monitoring.

Question 15Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Which of the following best describes the status of good manufacturing practice (GMP) requirements for medicine manufacturers in Kazakhstan?

  1. They are mandatory requirements confirmed during inspection and licensing Correct answer.
  2. They are replaced by the manufacturer's internal standards
  3. They are voluntary recommendations with no legal force
  4. They apply only to manufacturers exporting products

Explanation

GMP requirements are binding for manufacturers of medicines and are verified through state inspection within the licensing and supervision system. They are not optional, export-only, or replaceable by internal standards.

Question 16Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

A pharmacy manager wants to set prices for medicines included in the list of socially significant medicines. What rule applies under Kazakh price regulation?

  1. Prices are frozen permanently at the level of import
  2. Prices for regulated medicines are subject to state regulation, including mark-up limits established by the authorized body Correct answer.
  3. Prices are set only by the manufacturer and cannot be changed at retail
  4. The pharmacy may set any price without restriction

Explanation

For medicines on the regulated lists, the state applies price regulation, including limits on wholesale and retail mark-ups set by the authorized body. Pharmacies cannot ignore these limits, and prices are not permanently frozen at import level.

Question 17Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Which body maintains state control over the quality, safety and efficacy of medicines circulating in Kazakhstan?

  1. The customs service alone
  2. The tax committee
  3. The antimonopoly service alone
  4. The authorized state healthcare body and its subordinate control structures Correct answer.

Explanation

State control over the quality, safety and efficacy of medicines is exercised by the authorized healthcare body and its subordinate control organizations. Tax, antimonopoly and customs bodies have different mandates and do not replace pharmaceutical quality control.

Question 18Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

A pharmacy discovers that a medicine in stock has been withdrawn from circulation by the authorized body due to a safety issue. What is the correct action?

  1. Immediately stop dispensing, quarantine the remaining stock and follow the recall instructions Correct answer.
  2. Continue selling it until the stock is exhausted
  3. Return it to the shelf after checking the expiry date
  4. Sell it at a discount with a warning to customers

Explanation

When a medicine is withdrawn or recalled for safety reasons, the pharmacy must stop dispensing it, segregate the stock and act on the recall instructions, including return or destruction as directed. Continued sale or discounting would expose patients to risk.

Question 19Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Which document must a pharmaceutical worker follow when dispensing a medicine extemporaneously prepared in a pharmacy?

  1. The wholesaler's delivery note
  2. The marketing leaflet of a similar industrial product
  3. Only the patient's verbal request
  4. The prescription and the approved pharmacy procedures for compounding and quality control Correct answer.

Explanation

Extemporaneous compounding is performed according to the prescription and approved in-house procedures covering preparation and quality control. Verbal requests, delivery notes and advertising leaflets are not valid bases for compounding and dispensing.

Question 20Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Under Kazakh legislation, what is the significance of the essential medicines list (list of vital and essential medicines)?

  1. It defines medicines guaranteed for state procurement and used for price and availability regulation Correct answer.
  2. It lists medicines that pharmacies may not sell
  3. It defines medicines whose registration is waived
  4. It lists only imported medicines

Explanation

The vital and essential medicines list underpins state guarantees for medicine provision, public procurement and price regulation. It does not waive registration, prohibit retail sale, or apply only to imports.

Question 21Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Which requirement applies to a pharmaceutical worker's handling of confidential patient information obtained while dispensing medicines?

  1. The worker may disclose it to any third party on request
  2. The worker must keep medical confidentiality as required by healthcare legislation Correct answer.
  3. The worker may publish it if the patient's name is removed
  4. The worker may share it freely with the wholesaler

Explanation

Pharmaceutical workers are bound by medical confidentiality regarding information learned in the course of providing pharmaceutical care. Disclosure is permitted only in cases defined by law, not at the worker's discretion or on any third-party request.

Question 22Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

A pharmacist suspects that a prescription presented contains a falsified or incorrectly issued entry. What is the appropriate professional response?

  1. Clarify the prescription with the prescriber and follow the established procedure for irregular prescriptions Correct answer.
  2. Dispense the medicine to avoid conflict with the patient
  3. Refuse all future service to the patient without explanation
  4. Alter the prescription personally to correct it

Explanation

Irregular or doubtful prescriptions must be clarified with the prescriber and handled under the established procedure; the pharmacist may not unilaterally alter a prescription or dispense on a doubtful basis. Blanket refusal without explanation is not the prescribed handling.

Question 23Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Which of the following is required for a legal entity to carry out wholesale trade in medicines in Kazakhstan?

  1. Ownership of a manufacturing plant
  2. Only registration as a business entity
  3. A license for pharmaceutical activity and compliance with licensing requirements for wholesale trade Correct answer.
  4. Membership in a foreign trade association

Explanation

Wholesale trade in medicines is a licensed type of pharmaceutical activity and requires compliance with the corresponding licensing requirements, including qualified staff and suitable premises. Simple business registration, association membership or manufacturing ownership is insufficient.

Question 24Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

What is the role of the instruction for medical use (patient information leaflet) approved during registration of a medicine in Kazakhstan?

  1. It is a commercial price list
  2. It is the approved document governing indications, dosing, contraindications and warnings for use of the medicine Correct answer.
  3. It is an optional document provided at the manufacturer's discretion
  4. It is an advertising text that may be changed by the pharmacy

Explanation

The instruction for medical use is part of the registration dossier and defines the approved indications, dosing, contraindications and warnings. It is binding information that cannot be rewritten by a pharmacy or treated as optional advertising.

Question 25Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

How does Kazakh legislation treat advertising of prescription-only medicines to the general public?

  1. It is allowed if the medicine is registered
  2. It is allowed if the advertisement is brief
  3. It is allowed only on television
  4. Advertising of prescription medicines to the general public is restricted, with information intended for healthcare professionals Correct answer.

Explanation

Advertising of prescription-only medicines is directed at healthcare professionals rather than the general public, reflecting the need for medical supervision. Brevity, medium of broadcast, or registration status does not lift this restriction.

Question 26Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Under Kazakh pharmaceutical legislation, which document establishes the mandatory quality requirements that a registered medicine must meet throughout its shelf life?

  1. The pharmacovigilance periodic safety update report
  2. The marketing authorization dossier, including the approved specification and normative technical document Correct answer.
  3. The regulatory submission dossier of the manufacturing site
  4. The wholesale contract between the distributor and the pharmacy

Explanation

A medicine may circulate in Kazakhstan only within the parameters of the dossier approved at state registration, which fixes the specification, analytical methods and shelf-life claims. Subsequent changes to that dossier are permitted only through the established variation procedure. The wholesale contract and safety reports do not define quality requirements.

Question 27Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

A Kazakh pharmacy receives a prescription written on a form that does not correspond to the required prescription form for that medicine group. What is the most appropriate action by the pharmaceutical worker?

  1. Refuse to dispense and refer the matter for clarification to the prescribing organization Correct answer.
  2. Dispense a partial quantity until a correct form is provided
  3. Substitute a similar over-the-counter medicine without contacting the prescriber
  4. Dispense the medicine and note the discrepancy in the internal journal

Explanation

A prescription that does not meet the established form and completion requirements cannot serve as a lawful basis for dispensing, so the pharmacy must not release the medicine. The correct route is to return the matter to the prescribing organization for correction. Internal notes or partial dispensing do not cure an invalid prescription.

Question 28Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Which function belongs to the authorized state body for pharmaceutical activity when a serious safety signal emerges for a medicine already on the Kazakh market?

  1. Issuing binding decisions on suspension or withdrawal of the medicine from circulation based on the assessed risk Correct answer.
  2. Approving the interior design of pharmacy premises
  3. Negotiating the retail price directly with each pharmacy chain
  4. Certifying individual pharmacists' professional qualifications

Explanation

The authorized body exercises state control over quality, safety and efficacy, and may restrict, suspend or withdraw a medicine when the benefit-risk balance is unfavourable. Price negotiation, individual certification and premises design fall outside this decision-making function.

Question 29Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

Which principle governs the circulation of medicines in Kazakhstan with respect to medicines that have not passed state registration?

  1. They may circulate only in regions with limited pharmacy coverage
  2. They may circulate only under the conditions expressly provided by legislation, such as defined import exemptions Correct answer.
  3. They may circulate if the wholesale organisation accepts liability for them
  4. They may circulate freely if accompanied by a foreign manufacturer's certificate

Explanation

As a rule, only registered medicines may be placed on the market, and any circulation of unregistered products is confined to the narrow exceptions set out in legislation, for example specified import or clinical-use cases. A foreign certificate or a distributor's liability statement does not replace registration. Regional availability gaps likewise do not create a legal basis.

Question 30Pharmaceutical legislation and regulation of pharmaceutical activity in the Republic of Kazakhstan

In Kazakhstan, what is the principal obligation of a pharmaceutical organisation regarding the licensing of its pharmaceutical activity?

  1. It must hold a licence for the specific activity type and comply with the licence conditions throughout the period of operation Correct answer.
  2. It must hold a licence only when serving state healthcare organisations
  3. It must renew the licence every quarter regardless of changes
  4. It must obtain a separate licence for each medicine it handles

Explanation

Pharmaceutical activity is licensable, and the organisation must hold the licence for the relevant activity type while continuously meeting the attached conditions. Licences are not issued per medicine, are not tied to a particular category of customer, and are not renewed quarterly.

Question 31Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Каков основной механизм действия бисопролола при артериальной гипертензии?

  1. Селективная блокада β1-адренорецепторов Correct answer.
  2. Ингибирование ангиотензинпревращающего фермента
  3. Блокада медленных кальциевых каналов L-типа
  4. Прямая вазодилатация через активацию калиевых каналов

Explanation

Бисопролол относится к кардиоселективным β1-адреноблокаторам: он снижает частоту сердечных сокращений, сердечный выброс и секрецию ренина, что уменьшает артериальное давление. Селективность к β1-рецепторам снижает риск бронхоспазма по сравнению с неселективными средствами.

Question 32Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Какой механизм действия лежит в основе антиагрегантного эффекта ацетилсалициловой кислоты в низких дозах?

  1. Обратимое антагонистическое связывание с рецепторами P2Y12 на тромбоцитах
  2. Необратимое ацетилирование циклооксигеназы-1 в тромбоцитах Correct answer.
  3. Блокада гликопротеиновых рецепторов IIb/IIIa
  4. Активация антитромбина III

Explanation

Ацетилсалициловая кислота необратимо ацетилирует циклооксигеназу-1 в тромбоцитах, блокируя синтез тромбоксана A2, который стимулирует агрегацию и вазоконстрикцию. Поскольку тромбоциты не синтезируют белок заново, эффект сохраняется на весь срок их жизни.

Question 33Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Какой побочный эффект наиболее характерен для петлевых диуретиков, таких как фуросемид?

  1. Гиперкалиемия
  2. Гипокалиемия Correct answer.
  3. Гиперкальциемия
  4. Метаболический алкалоз с гиперхлоремией

Explanation

Петлевые диуретики блокируют Na-K-2Cl-котранспортёр в восходящем колене петли Генле, увеличивая доставку натрия в дистальные отделы и усиливая калиурез, что приводит к гипокалиемии. Поэтому при их применении контролируют уровень калия и при необходимости назначают калийсберегающие средства.

Question 34Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Какое из перечисленных состояний является абсолютным противопоказанием к назначению метформина?

  1. Тяжёлая почечная недостаточность с клиренсом креатинина ниже 30 мл/мин Correct answer.
  2. Компенсированный сахарный диабет 2 типа с ожирением
  3. Хронический гастрит вне обострения
  4. Артериальная гипертензия 1 степени

Explanation

Метформин выводится почками, и при клиренсе креатинина ниже 30 мл/мин он накапливается, повышая риск лактатацидоза. Поэтому тяжёлая почечная недостаточность служит противопоказанием, а при умеренном снижении функции почек требуется коррекция дозы.

Question 35Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Какой механизм действия у омепразола?

  1. Необратимое ингибирование протонной помпы H+/K+-АТФазы Correct answer.
  2. Блокада H2-гистаминовых рецепторов париетальных клеток
  3. Блокада M3-холинорецепторов париетальных клеток
  4. Нейтрализация соляной кислоты в просвете желудка

Explanation

Омепразол относится к ингибиторам протонной помпы: в кислой среде канальцев париетальной клетки он активируется и необратимо связывает H+/K+-АТФазу, подавляя конечный этап секреции соляной кислоты. Это обеспечивает наиболее выраженное и длительное снижение желудочной секреции.

Question 36Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Какой антибиотик действует путём необратимого ингибирования бактериальной ДНК-гиразы и топоизомеразы IV?

  1. Амоксициллин
  2. Ципрофлоксацин Correct answer.
  3. Доксициклин
  4. Азитромицин

Explanation

Ципрофлоксацин относится к фторхинолонам и подавляет бактериальные ферменты ДНК-гиразу и топоизомеразу IV, нарушая репликацию ДНК. Этот механизм не связан с рибосомами, что отличает фторхинолоны от большинства других антибиотиков.

Question 37Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Какое из перечисленных средств является прямым антикоагулянтом, действующим через ингибирование фактора Xa?

  1. Протамина сульфат
  2. Варфарин
  3. Гепарин натрия
  4. Апиксабан Correct answer.

Explanation

Апиксабан - прямой пероральный антикоагулянт, который избирательно и обратимо ингибирует фактор Xa, снижая образование тромбина. Он не требует рутинного контроля МНО, в отличие от антагонистов витамина K.

Question 38Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Какой механизм действия у сальбутамола при бронхиальной астме?

  1. Агонизм к β2-адренорецепторам бронхиальной мускулатуры Correct answer.
  2. Антагонизм к лейкотриеновым рецепторам
  3. Ингибирование фосфодиэстеразы-4
  4. Блокада мускариновых рецепторов бронхов

Explanation

Сальбутамол - селективный β2-агонист короткого действия, который расслабляет гладкую мускулатуру бронхов и быстро купирует бронхоспазм. Он применяется как средство неотложной помощи и не заменяет базисную противовоспалительную терапию.

Question 39Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациент с сахарным диабетом 2 типа принимает глибенкламид. Через несколько часов после пропущенного приёма пищи у него появились дрожь, холодный пот и спутанность сознания. Какой механизм развития этого состояния наиболее вероятен?

  1. Гипогликемия вследствие стимуляции секреции инсулина сульфонилуреей Correct answer.
  2. Лактатацидоз на фоне накопления метформина
  3. Гипергликемия из-за снижения чувствительности к инсулину
  4. Развитие диабетического кетоацидоза

Explanation

Глибенкламид относится к сульфонилуреям и стимулирует секрецию инсулина β-клетками поджелудочной железы независимо от приёма пищи. При пропуске еды это приводит к гипогликемии с адренергическими и нейрогликопеническими симптомами.

Question 40Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациент получает эналаприл. Через неделю появился сухой кашель без признаков инфекции. Какой механизм объясняет этот побочный эффект?

  1. Повышение уровня ангиотензина II в крови
  2. Блокада медленных кальциевых каналов гладкой мускулатуры
  3. Накопление брадикинина из-за ингибирования АПФ Correct answer.
  4. Прямое раздражение β2-рецепторов бронхов

Explanation

Ингибиторы АПФ блокируют превращение ангиотензина I в ангиотензин II и одновременно снижают распад брадикинина. Накопление брадикинина в дыхательных путях вызывает сухой кашель, который исчезает после отмены препарата или перехода на сартаны.

Question 41Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациент принимает варфарин по поводу фибрилляции предсердий. Какой препарат при одновременном назначении повышает риск кровотечения за счёт усиления антикоагулянтного эффекта?

  1. Фуросемид
  2. Метронидазол Correct answer.
  3. Алюминия гидроксид
  4. Аскорбиновая кислота

Explanation

Метронидазол ингибирует цитохром P450 (в частности, CYP2C9) и замедляет метаболизм варфарина, повышая его концентрацию и МНО. Это требует контроля МНО и коррекции дозы варфарина при совместном назначении.

Question 42Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациент с бронхиальной астмой принимает пропранолол. Какой риск наиболее значим при таком назначении?

  1. Гиперкалиемия из-за активации β2-рецепторов
  2. Усиление бронходилатации
  3. Повышение секреции инсулина
  4. Бронхоспазм из-за блокады β2-адренорецепторов Correct answer.

Explanation

Пропранолол - неселективный β-адреноблокатор, который блокирует не только β1-, но и β2-рецепторы бронхов. У пациентов с астмой это может провоцировать бронхоспазм, поэтому при необходимости предпочитают кардиоселективные средства с осторожностью.

Question 43Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациент принимает амиодарон. Какой лабораторный показатель требует регулярного контроля из-за характерного побочного эффекта препарата?

  1. Клиренс креатинина
  2. Функция щитовидной железы (ТТГ) Correct answer.
  3. Уровень калия в сыворотке
  4. Уровень тромбоцитов

Explanation

Амиодарон содержит йод и может вызывать как гипотиреоз, так и тиреотоксикоз, поэтому до начала лечения и в дальнейшем контролируют функцию щитовидной железы, включая ТТГ. Также препарат требует наблюдения за функцией печени и лёгкими.

Question 44Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациенту с острым приступом подагры назначен колхицин. Какой механизм объясняет его противовоспалительное действие?

  1. Увеличение почечной экскреции уратов
  2. Подавление миграции нейтрофилов и образование микротрубочек Correct answer.
  3. Блокада циклооксигеназы-2
  4. Ингибирование синтеза мочевой кислоты

Explanation

Колхицин связывается с тубулином, нарушает сборку микротрубочек и тем самым подавляет миграцию нейтрофилов и их активацию в очаге воспаления. Это уменьшает воспалительную реакцию на кристаллы уратов при подагрическом артрите.

Question 45Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациент с хронической болезнью почек принимает спиронолактон. Какой электролитный риск наиболее характерен?

  1. Гипонатриемия
  2. Гипокалиемия
  3. Гипокальциемия
  4. Гиперкалиемия Correct answer.

Explanation

Спиронолактон - калийсберегающий диуретик, который блокирует альдостероновые рецепторы и снижает экскрецию калия. При нарушении функции почек риск гиперкалиемии возрастает, поэтому необходим контроль калия и креатинина.

Question 46Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациент получает изониазид по поводу туберкулёза. Какой профилактический препарат обычно назначают для предотвращения его нейротоксического эффекта?

  1. Пиридоксин (витамин B6) Correct answer.
  2. Фолиевая кислота
  3. Тиамин (витамин B1)
  4. Цианокобаламин (витамин B12)

Explanation

Изониазид нарушает метаболизм пиридоксина и может вызывать периферическую нейропатию. Назначение пиридоксина предупреждает этот побочный эффект, особенно у пациентов с факторами риска.

Question 47Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациентке с вагинальным кандидозом назначен флуконазол. Какой механизм действия у этого препарата?

  1. Ингибирование синтеза эргостерола грибковой клеточной мембраны Correct answer.
  2. Ингибирование синтеза клеточной стенки грибов
  3. Блокада синтеза белка на грибковых рибосомах
  4. Нарушение синтеза ДНК грибов

Explanation

Флуконазол относится к азолам и подавляет грибковой фермент 14α-деметилазу, блокируя синтез эргостерола - ключевого компонента клеточной мембраны грибов. Нарушение целостности мембраны приводит к гибели или подавлению роста гриба.

Question 48Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациент принимает карбамазепин. Какое серьёзное дерматологическое нежелательное явление требует немедленной отмены препарата?

  1. Себорейный дерматит
  2. Крапивница, связанная с приёмом пищи
  3. Акне vulgaris
  4. Синдром Стивенса - Джонсона Correct answer.

Explanation

Карбамазепин, особенно у носителей аллеля HLA-B*1502, может вызывать тяжёлые буллёзные реакции, включая синдром Стивенса - Джонсона и токсический эпидермальный некролиз. При появлении сыпи препарат немедленно отменяют и оценивают состояние пациента.

Question 49Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациент получает длительную терапию преднизолоном. Какой профилактический препарат обычно добавляют для снижения риска остеопороза?

  1. Метформин
  2. Кальций с витамином D Correct answer.
  3. Фуросемид
  4. Железа сульфат

Explanation

Глюкокортикоиды снижают всасывание кальция и повышают его выведение, а также угнетают костное ремоделирование, что ведёт к остеопорозу. Кальций с витамином D служит базовой профилактикой, при необходимости добавляют антирезорбтивные средства.

Question 50Pharmacology and pharmacotherapy: mechanisms of action, indications, contraindications, and adverse effects

Пациенту с анафилактической реакцией ввели адреналин. Какой эффект является ключевым для купирования анафилаксии?

  1. Ингибирование циклооксигеназы
  2. Стимуляция α1- и β2-адренорецепторов Correct answer.
  3. Блокада мускариновых рецепторов
  4. Блокада H1-гистаминовых рецепторов

Explanation

Адреналин стимулирует α1-рецепторы, вызывая вазоконстрикцию и повышение давления, а также β2-рецепторы, обеспечивая бронходилатацию. Это делает его препаратом первой линии при анафилаксии, тогда как антигистаминные средства являются вспомогательными.