How Medicines Work and Their Main Side Effects

Which of the following statements about the systemic action and local action of a medicine is correct?

1. The systemic action of an orally taken medicine does not go through the process of absorption, metabolism, and distribution, so a response appears immediately after taking it.
2. All topical medicines are intended solely for a local effect at the site of application, and none, such as a suppository or a transdermal absorption preparation, is intended for a systemic action.
3. For a medicine intended for local action, the active ingredient stays at the site of application and never moves into the circulating blood, so a systemic side effect never occurs.
4. Even among oral medicines, some, such as bulk-forming laxatives or live bacterial preparations, have an active ingredient that acts within the digestive tract, and the action that appears in such cases is a local action.

Which of the following statements about the absorption of an oral medicine's active ingredient from the digestive tract is correct?

1. The active ingredient is mainly absorbed in the small intestine.
2. Absorption from the digestive tract is a phenomenon of active uptake from a lower concentration toward a higher one.
3. For solid preparations such as tablets, including enteric-coated preparations, most dissolve their active ingredient in the intestine.
4. The amount and rate of absorption of an active ingredient are never affected by the contents of the digestive tract or the action of another medicine.

Which of the following statements about suppositories is correct?

1. A suppository's systemic action appears more slowly than in the case of an oral medicine, because the active ingredient is absorbed slowly.
2. Veins are abundantly distributed beneath the rectal mucosa, so the active ingredient readily enters the circulating blood, and a systemic action appears more quickly than in the case of an oral medicine.
3. Even when the mucosa at the site of application is damaged, a suppository can be used without any problem, since it causes neither a local side effect nor a systemic side effect from rapid absorption.
4. An active ingredient absorbed from the rectum is first metabolized in the liver via a blood vessel called the portal vein, and only after being reduced by that metabolism is it distributed throughout the body.

Which of the following statements about the hepatic first-pass effect is correct?

1. The hepatic first-pass effect refers to the phenomenon in which an orally administered medicine's active ingredient, after being absorbed in the digestive tract, is carried directly to the kidneys without passing through the blood vessel called the portal vein, where it is filtered and excreted in the urine.
2. The active ingredient absorbed in the digestive tract passes through the liver via the portal vein before entering the systemic circulation, so it is first metabolized in the liver, and the amount reaching the systemic circulation is reduced by however much is metabolized in the liver.
3. The active ingredient absorbed in the digestive tract enters the systemic circulation directly, without passing through the blood vessel called the portal vein or through the liver.
4. For an orally administered medicine, the active ingredient absorbed in the digestive tract moves directly into the systemic circulation without passing through the portal vein, so the amount reaching the systemic circulation actually exceeds the amount absorbed in the digestive tract.

Which of the following statements about how a medicine works in a person with reduced liver function is correct?

1. In a person with reduced liver function, the active ingredient's blood concentration no longer rises, so the medicinal effect fails to appear at all.
2. In a person with reduced liver function, the capacity to metabolize a medicine is instead heightened, so the amount of active ingredient reaching the systemic circulation decreases and the effect becomes less likely to appear.
3. Compared with a normal person, the amount of active ingredient reaching the systemic circulation becomes greater, and the effect may appear excessively or side effects may occur more readily.
4. In a person with reduced liver function, excretion of the active ingredient into the urine is delayed, so the blood concentration is known to remain elevated and the effect to persist excessively.

Which of the following statements about the binding of an active ingredient to plasma protein is correct?

1. An active ingredient forming a complex is actively transported into tissue by a transporter.
2. Binding to plasma protein is rapid but irreversible, and once a molecule has bound it never dissociates to again become subject to metabolism or distribution.
3. A molecule that has bound to plasma protein to form a complex is quickly filtered at the kidney and excreted in the urine, so the time it remains in the circulating blood is very short.
4. Many active ingredients bind with plasma protein in the blood to form complexes, and the molecules forming such a complex are not metabolized by the action of drug-metabolizing enzymes.

Which of the following statements about the excretion of a medicine's active ingredient is correct?

1. An active ingredient is always excreted after becoming a metabolite in the liver, and is never excreted unchanged.
2. In a person with reduced kidney function, excretion of the active ingredient into the urine is delayed and the blood concentration remains elevated, so the effect may appear excessively or side effects may occur more readily.
3. An active ingredient may be excreted unchanged into the urine via the kidneys or into bile via the liver, but is never excreted into exhaled breath via the lungs.
4. Excretion into sweat or breast milk is positioned as having a more important significance as a route of elimination from the body than excretion into the urine via the kidneys or into bile via the liver.

Which of the following statements about the blood concentration of a medicine's active ingredient is correct?

1. The medicinal effect, as a response of the body, appears once the blood concentration exceeds a certain minimum effective concentration (threshold).
2. Even after the blood concentration falls below the minimum effective concentration, the medicinal effect continues for a while.
3. Taking additional doses without a sufficient interval to raise the blood concentration will yield a correspondingly stronger medicinal effect.
4. The reason the blood concentration declines after reaching its peak is that the rate of absorption and distribution exceeds the rate of metabolism and excretion.

Which of the following statements about orally disintegrating tablets is correct?

1. They cannot be used by a person whose water intake is restricted.
2. The tablet surface is coated for the purpose of dissolution in the intestine.
3. Because they are designed to dissolve quickly in the saliva in the mouth, they can be taken without water.
4. The site where the medicinal effect is expected is the mouth or throat, and the tablet is used by sucking on it in the mouth without swallowing.

Which of the following statements about chewable tablets is correct?

1. They dissolve the active ingredient sublingually, absorbing it through the oral mucosa.
2. Chewing them before taking must be strictly avoided.
3. They are a dosage form taken by sucking or chewing in the mouth, and can be taken without water.
4. They must always be swallowed together with an appropriate amount of water (or lukewarm water).

Which of the following statements about tablets (oral) is incorrect?

1. An enteric-coated tablet is best chewed in the mouth before taking, to speed up absorption of the active ingredient.
2. For a tablet (oral), disintegration in the stomach or intestine and dissolution of the active ingredient is a precondition for the medicinal effect to appear.
3. If taken with too little water or without water, a tablet may stick to the throat or esophagus, not only failing to produce its effect but also risking damage to the mucosa of the throat or esophagus.
4. Because they are a solid preparation molded into a fixed shape, they can be taken without scattering, and without feeling the bitterness or irritation of the active ingredient in the mouth.

Which of the following statements about tablets for the oral cavity is correct?

1. For many troches and drops, the intended site of medicinal effect is the mouth or throat, and they are used by sucking in the mouth without swallowing, gradually dissolving.
2. Because a drop's intended site of medicinal effect is the stomach or intestine, it must be chewed rather than sucked in the mouth, and taken with an appropriate amount of water.
3. A sublingual tablet is intended to dissolve the active ingredient quickly sublingually, and then have it absorbed not through the oral mucosa but through the digestive tract, such as the stomach or intestine.
4. A troche is swallowed promptly without sucking in the mouth, to be dissolved in the stomach.

Which of the following statements about powders and granules is correct?

1. When taking a powder and the like, to prevent scattering it is good practice to hold a small amount of water (or lukewarm water) in the mouth beforehand before taking it, or to take it in several small portions.
2. Because some granules have coated grain surfaces, to prevent scattering it is good practice to chew them well in the mouth before swallowing them down little by little with water or lukewarm water.
3. If some powder remains in the mouth, it is best not to force it down and just leave it as is.
4. If a powder is taken after first holding a small amount of water (or lukewarm water) in the mouth, it will not spread through the mouth, so it is less likely to be felt as bitter or astringent than a tablet and carries no risk of scattering.

Which of the following statements about oral liquid preparations and syrups is correct?

1. Because the active ingredient in an oral liquid preparation is already dissolved or dispersed in the liquid, its absorption from the digestive tract is slower than that of a solid preparation, which needs to dissolve in the stomach after being taken.
2. Because the blood concentration of an oral liquid preparation's active ingredient readily rises, improper use for a purpose other than its original one can occur with products containing an ingredient that has habit-forming or dependence-forming properties.
3. A syrup is prepared with sugars such as sucrose mixed in, for medicines intended for children, not to make them easier for children to take but rather to make the bitterness or odor more strongly felt.
4. An oral liquid preparation refers to a liquid topical preparation applied directly to the affected area.

Which of the following statements about capsules is correct?

1. Because a capsule's raw material, gelatin, never sticks to the throat or esophagus even when taken without water, it may simply be swallowed as is, without using an appropriate amount of water or lukewarm water.
2. A capsule is a preparation encasing a liquid content, and its characteristics are nearly the same as those of an oral liquid preparation.
3. Gelatin, a capsule's raw material, is mainly composed of protein from pigs and the like, so a person allergic to gelatin needs to take precautions such as avoiding its use.
4. Gelatin, widely used as a raw material for capsules, is mainly composed of plant-derived starch, so a person allergic to gelatin need not be particularly cautious.

Which of the following statements about ointments and creams is correct?

1. A cream has an oil-based base with weak skin irritation, is used when the site of application should be shielded from water, and can be used whether the affected area is dry or moist and oozing.
2. An ointment has an oil-based base with water added, is used when the affected area should be washed off with water, but has strong skin irritation.
3. A cream has an oil-based base with water added, has weak skin irritation, and can be used whether the affected area is dry or moist and oozing, making it also suitable for use on wounds.
4. An ointment has an oil-based base with weak skin irritation, is used when the site of application should be shielded from water, and can be used whether the affected area is dry or moist and oozing.

Which of the following statements about shock (anaphylaxis) is correct?

1. It is characterized by only a single symptom appearing, such as skin itching.
2. In a person who has previously had an allergy such as hives from a given medicine, the likelihood of it occurring is low.
3. It is a type of delayed allergic reaction to a foreign substance in the body.
4. It is characterized by extremely rapid progression after onset, ordinarily changing suddenly for the worse within 2 hours.

Which of the following statements about mucocutaneous ocular syndrome (Stevens-Johnson syndrome) is correct?

1. Its incidence is reported as 0.4 to 1.2 people per million population per year, making it an extremely rare condition even among medicine side effects.
2. Because the details of its onset mechanism have already been elucidated, it is easy to predict with which medicine, in what kind of person, and when it will develop.
3. It presents with a fever of 38°C or higher, and intense symptoms such as a rash, redness, and burn-like blisters appear over a relatively short time on the skin over the whole body and on mucous membranes such as the mouth and eyes.
4. It is also called Lyell's syndrome, after the name of the doctor who first reported it.

Which of the following statements about toxic epidermal necrolysis (TEN) is correct?

1. Its incidence is reported as 1 to 6 people per million population per year, and this incidence is higher than that of mucocutaneous ocular syndrome, making TEN the more commonly occurring of the two conditions.
2. It is also called Stevens-Johnson syndrome, after the names of the two doctors who first reported it, and is never called Lyell's syndrome.
3. It presents with a fever of 38°C or higher, redness over an extensive area of the skin, burn-like blisters, skin peeling, and erosion affecting 10% or more of the body surface, accompanied by symptoms such as redness and erosion of the lips and congestion of the eyes.
4. It is thought to be an entirely separate, unrelated condition from mucocutaneous ocular syndrome, differing in both onset mechanism and symptoms, and cases are never considered to have progressed from mucocutaneous ocular syndrome.

Which of the following statements about mucocutaneous ocular syndrome and toxic epidermal necrolysis is correct?

1. Acute conjunctivitis appearing in both eyes is known to occur not around the same time as the skin and mucosal changes, but always afterward.
2. Once the skin symptoms have improved, no impairment remains in the eyes, respiratory system, or the like.
3. Both develop within 2 weeks of starting use of the causative medicine, and never occur after 1 month or more has passed.
4. Both often develop within 2 weeks of starting use of the causative medicine, but can also occur after 1 month or more has passed.

Which of the following statements about liver dysfunction caused by a medicine is correct?

1. In a mild case of liver dysfunction, there are often no subjective symptoms, and it is often only discovered through a blood test at a health checkup or the like (a worsening of liver function test values).
2. Continuing indefinitely to use a medicine thought to be the cause never results in an irreversible lesion such as liver failure.
3. Liver dysfunction caused by a medicine is always allergic in nature.
4. Jaundice is a condition in which the skin and the whites of the eyes turn yellow, caused by bilirubin no longer being excreted into the urine.

Which of the following statements about pseudoaldosteronism is correct?

1. It occurs when, despite secretion of aldosterone from the adrenal cortex not having increased, salt (sodium) and water accumulate in the body and potassium is lost from the body.
2. Its main symptoms include weakness in the limbs, a drop in blood pressure, leg cramps, malaise, and swelling (edema), and as the condition progresses it can produce muscle weakness, inability to stand, difficulty walking, and convulsions.
3. It is known to occur less readily in people with a small body surface area, such as those who are short or of low body weight, and in the elderly.
4. It occurs when, despite decreased secretion of aldosterone from the adrenal cortex, potassium accumulates in the body and sodium and water are lost from the body.

Which of the following statements about the symptoms and the like of pseudoaldosteronism is correct?

1. It occurs readily in people with a small body surface area, such as those who are short or of low body weight, but is known to occur less readily in the elderly.
2. Its main symptoms include weakness in the limbs, a rise in blood pressure, muscle pain, leg cramps, malaise, and swelling (edema), and as the condition progresses it can produce muscle weakness, inability to stand, difficulty walking, and convulsions.
3. It never develops only after long-term use of the causative medicine, and appears only immediately after starting to take it.
4. It can occur when multiple medicines are used together, but never occurs through an interaction between a medicine and food.

Which of the following statements about reduced resistance to illness and the like as a side effect of a medicine is correct?

1. The initial symptoms are sudden high fever, chills, and sore throat, and can be clearly distinguished from symptoms such as those of a cold.
2. Use of a medicine can cause a decrease in red blood cells in the blood, weakening resistance to bacterial or viral infection, and can present with symptoms such as sudden high fever, chills, sore throat, and mouth ulcers.
3. Use of a medicine can cause a decrease in white blood cells (neutrophils) in the blood, weakening resistance to bacterial or viral infection, and can present with symptoms such as sudden high fever, chills, sore throat, mouth ulcers, and malaise.
4. It is not known that a medicine, including steroidal anti-inflammatory drugs and anticancer drugs, can bring about increased susceptibility to infection.

Which of the following statements about psychoneurological symptoms appearing as a side effect of a medicine is correct?

1. Psychoneurological symptoms never occur from off-label use in infants and young children.
2. Insomnia or anxiety never occurs as a side effect of a medicine.
3. Because drowsiness is a minor side effect, it is fine to operate a vehicle even after using a medicine that causes drowsiness.
4. Psychoneurological symptoms can occur not only with improper use such as taking a large dose or long-term continued use of a medicine, but also at the ordinary dosage and administration.

Which of the following statements about aseptic meningitis is correct?

1. Onset is often acute in many cases, with symptoms such as an intense headache accompanied by neck stiffness, fever, nausea/vomiting, and clouded consciousness appearing.
2. Among cases of meningitis, one in which bacteria are detected in the spinal fluid is called aseptic meningitis.
3. Most cases of aseptic meningitis are thought to be caused by bacteria detected in the spinal fluid, and a virus or a medicine is never the cause.
4. When the cause is a medicine side effect, the risk of developing it is higher in a person with no underlying disease such as systemic lupus erythematosus or rheumatoid arthritis.

Which of the following statements about the course of medicine-induced aseptic meningitis is correct?

1. Even if use of the causative medicine is stopped early, recovery never occurs, and the prognosis is poor in almost all cases.
2. No case leaving a serious central nervous system aftereffect has ever been reported.
3. In a person with an underlying disease such as systemic lupus erythematosus, rheumatoid arthritis, or mixed connective tissue disease, the risk of developing it is instead lower.
4. A person who has previously experienced a mild case may have a recurrence upon using the same medicine again, with symptoms progressing rapidly.

Which of the following statements about a peptic ulcer caused by a medicine side effect is correct?

1. A peptic ulcer refers to a state in which the mucosal tissue of the stomach or duodenum is damaged, with a portion mildly lost without extending beyond the muscularis mucosae.
2. It is known as a characteristic symptom that the stool turns white in association with gastrointestinal bleeding.
3. Because a peptic ulcer always produces a strong subjective symptom, its onset can be ruled out if there is no subjective symptom, and it is never discovered by chance during a test for anemia symptoms.
4. Symptoms such as stomach heaviness, loss of appetite, heartburn, nausea, stomach pain, pain in the pit of the stomach when hungry, and, with gastrointestinal bleeding, black stools, appear.

Which of the following statements about ileus-like symptoms (intestinal obstruction-like symptoms) is correct?

1. Even without the intestine itself being obstructed, if a medicine's action paralyzes intestinal motility and impedes the passage of intestinal contents, intense abdominal pain, cessation of gas passage (flatulence), vomiting, and marked constipation accompanied by abdominal bloating can appear.
2. Even with symptoms such as abdominal pain and cessation of gas passage, if there is no vomiting, intake of fluids and food is not suppressed, so dehydration never occurs.
3. In children and elderly people, intestinal motility is active, so there is no risk of developing ileus-like symptoms.
4. A person who is ordinarily prone to constipation has slower intestinal motility, making the passage of intestinal contents less likely to be impeded, so the risk of developing this is low.

Which of the following statements about interstitial pneumonia is correct?

1. It refers to inflammation of the tissue in the lungs surrounding and supporting the alveoli and capillaries (the interstitium), presenting with symptoms such as breathlessness, difficulty breathing, dry cough (a cough without phlegm), and fever.
2. Because its symptoms are centered on a dry cough (a cough without phlegm) and fever, it can easily be distinguished from the symptoms of a cold or bronchitis.
3. It refers to inflammation from bacterial infection of the bronchi or alveoli, presenting with symptoms such as breathlessness, difficulty breathing, dry cough, and fever, but one in which the interstitium surrounding the alveoli is not affected by inflammation.
4. It generally often occurs about half a year after starting use of the medicine.

Which of the following statements about the course of interstitial pneumonia is incorrect?

1. It is always accompanied by fever.
2. Symptoms can appear transiently and resolve naturally in some cases.
3. Breathlessness is felt during exertion such as climbing a slope in the early stage, but as the condition progresses it comes to be noticed even during light activity such as walking on level ground or housework.
4. If it worsens, it can progress to pulmonary fibrosis (a state in which the lungs become fibrotic and hardened).

Which of the following statements about asthma appearing as a side effect of a medicine is correct?

1. Even in severe cases, recovery occurs within about half a day, and it never persists for 24 hours or more.
2. Within a short time (within 1 hour) after using the causative medicine, runny or stuffy nose appears, followed by coughing, wheezing, and difficulty breathing.
3. About a week after using the causative medicine, runny or stuffy nose appears, followed by coughing, wheezing, and difficulty breathing, and recovery occurs within about half a day even in severe cases.
4. It is induced only by an oral medicine containing a nonsteroidal anti-inflammatory ingredient such as aspirin, and is never induced by a suppository or a topical medicine.

Which of the following statements about congestive heart failure is correct?

1. It is a disease in which the heart becomes unable to pump out the amount of blood the whole body needs, blood accumulates in the liver, and various symptoms such as breathlessness, swelling of the legs, and easy fatigue appear.
2. Sudden weight loss, along with coughing and pink-colored sputum, is one of the characteristic symptoms.
3. A person with a history of heart failure is known to be less prone to medicine-induced heart failure.
4. If breathlessness, easy fatigue, swelling of the legs, sudden weight gain, coughing, and pink-colored sputum are observed, the possibility of congestive heart failure should be suspected, and medical care from a doctor should be sought promptly.

Which of the following statements about arrhythmia appearing as a side effect of a medicine is correct?

1. Dizziness, lightheadedness, palpitations, breathlessness, and discomfort in the chest are not included among the symptoms of arrhythmia.
2. Even if arrhythmia symptoms such as dizziness, lightheadedness, or palpitations appear, there is no need to stop using the medicine immediately, and use may simply be continued.
3. If syncope (loss of consciousness) occurs, a life-threatening arrhythmia may be occurring, so use of an automated external defibrillator (AED) should be considered, and a medical institution capable of emergency lifesaving treatment should be visited immediately.
4. Because a decline in metabolic function, such as reduced kidney or liver function, never raises the risk of developing arrhythmia, there is no need to pay attention to interaction with a medicine used concurrently either.

Which of the following statements about difficulty urinating and urinary retention appearing as a side effect of a medicine is correct?

1. It is a side effect known to appear when a medicine containing an ingredient with an action that suppresses the function of the sympathetic nervous system is used.
2. It is a side effect appearing only in men, with no case ever reported in women.
3. It appears only in a person with an underlying disease such as prostatic hypertrophy, and never appears in a person without such an underlying disease.
4. As it progresses, a person can feel the urge to urinate yet be entirely unable to pass urine (urinary retention), or feel intense pain from distension in the lower abdomen.

Which of the following statements about increased intraocular pressure (acute glaucoma attack) as a side effect of a medicine is correct?

1. A person diagnosed with angle-closure glaucoma, in which the angle serving as the outlet for the aqueous humor has widened, needs to take particular strict caution.
2. Intraocular pressure rises, potentially causing eye pain, congestion of the eye, and a rapid decline in visual acuity, and symptoms such as headache and nausea/vomiting can also appear.
3. Even if high intraocular pressure is left untreated for a long time, the optic nerve is never damaged, so it never leads to a visual impairment such as visual field loss or blindness.
4. A medicine containing an ingredient with anticholinergic action is known to lower intraocular pressure.

Which of the following statements about contact dermatitis is correct?

1. Symptoms ordinarily subside in about a week, and it does not recur even if the same medicine touches the skin again afterward.
2. Contact dermatitis occurs only on the part of the skin that the medicine touched, and is characterized by a clear boundary with normal skin.
3. When the same medicine touches the skin, everyone develops it in the same way, regardless of their constitution.
4. In the case of allergic dermatitis as well, the site of onset is confined to the part of the skin that touched the medicine, with a clear boundary with normal skin.

Which of the following statements about photosensitivity is correct?

1. In the case of a patch, it can develop even after the patch has been removed.
2. The symptoms are confined to the part the medicine touched, and never spread throughout the body.
3. For shielding from light, a white fabric or thin clothing is suitable.
4. Photosensitivity refers to a skin-irritation symptom that occurs even without exposure to sunlight (ultraviolet rays).

Which of the following statements about drug eruption is correct?

1. Only a very limited range of medicines can cause a drug eruption.
2. For the same medicine, the type of rash that appears is the same for everyone.
3. A drug eruption is always accompanied by strong itching, not only in the case of hives.
4. A drug eruption often occurs 1 to 2 weeks after use of a medicine, but can also appear after long-term use.

Which of the following statements about the response to a drug eruption and the like is correct?

1. For symptoms such as itching, it is recommended that an ordinary member of the public treat the symptoms on their own judgment, to make it easier to identify the cause, and there is no need to consult a professional.
2. A person who has previously experienced a drug eruption faces no risk of a serious allergic reaction, such as shock (anaphylaxis) or mucocutaneous ocular syndrome, even upon using a similar type of medicine again.
3. If an abnormality appears in the eyes or oral mucosa accompanied by fever, it can rapidly progress to a serious condition such as mucocutaneous ocular syndrome or toxic epidermal necrolysis, so strict caution is needed.
4. A drug eruption appears only from the use of a medicine itself, and is never triggered by excessive eating and drinking or physical fatigue.