Question: The following adverse drug reaction seen in colonoscopy view is due to

The picture shows Melanosis coli caused by Senna and cascara which are stimulant purgatives.bisacodyl usually cause hypokalemiaRef: KD Tripathi 7th ed pg 673


Question: Moclobemide is

Moclobemide is a reversible, competitive, selective MAO-A inhibitor.


Question: Drug of choice for pregnant female suspected of having a baby with congenital adrenal hyperplasia

Refer Goodman Gilman 12/e p 123 To suppress fetal androgen production effectively band consequent virilization Dexamethasone must be initiated before 10 weeks of gestation To treat congenital adrenal hyperplasia is baby hydrocoisone is used.


Question: Filgrastim is a.

Filgrastim is a recombinant G-CSF. From medical pharmacology padmaja 4th edition Page no 333


Question: Buspirone acts on

Buspirone:- * Buspirone is a 5HT1A paial agonist used as an anxiolytic. * It is also used in relief of pain and related anxiety of functional dyspepsia associated with Irritable Bowel Syndrome. * Buspirone (atypical anxiolytic), in contrast to conventional Benzodiazepine anti-anxiety drugs: [?] Have minimal abuse liability [?] No withdrawal reactions on abrupt discontinuation [?] Lesser impairment of psychomotor skills and function Adverse effects of Buspirone:- Tachycardia, nervousness, GI distress, parasthesias and dose dependent miosis. Ref:- Goodman & Gilman Pharmacological Basis of Therapeutics 13th Ed; Pg num:- 230


Question: Oprelvekin is a

Oprelvekin is a IL - 11 analogue that stimulates thrombopoiesis used in thrombocytopenia due to chemotherapy.


Question: A patient presents with malignant hypehermia and metabolic acidosis. Immediate treatment should be staed with

IV dantrolene (1mg/kg repeated if required) is the life saving drug in malignant hypehermia. Oxygen inhalation, treatment of acidosis and immediate cooling of body may also help. Ref: KD Tripathi 8th ed.


Question: Shivering is observed in the early pa of postoperative period is due to

Halothane Post operative shivering and hypothermia is maximum with Halothane Pethidine is used for treatment of this condition Refer Ajay yadav 2/e p 61


Question: The antibiotic of choice in patients sensitive to penicillin is


Question: Drug of choice for Hypertensive emergency is

IV Nicardipine is the drug of choice for hypertensive emergency followed by IV Clevidipine.
These are calcium channel blockers and β - blockers should be given along with them to prevent tachycardia.


Question: Warfarin acts by

Ans. is 'a' i.e., Inhibition of Vitamin K epoxide reductase

Inhibition of gamma glutamyl carboxylase

Activation of Vitamin K epoxide reductase

Activation of gamma glutamyl carboxylase


Question: Intranasal calcitonin is used for

Calcitonin nasal spray is used together with calcium and vitamin D to treat bone loss in women with postmenopausal osteoporosis who have been postmenopause for at least 5 years. REF KD Tripathi 8th ed


Question: Bremelanotide is a drug approved for treatment of

Bremelanotide functions by activating the melanocoin receptors. It was shown to be effective in treating sexual dysfunction in both men (erectile dysfunction or impotence) and women (sexual arousal disorder). Unlike phosphodiesterase inhibitors like sildenafil, it does not act upon the vascular system, but directly increases sexual desire the nervous system. The primary target for ED will be patients non-responsive to PDE-5 inhibitors, with patients receiving bremelanotide either as a monotherapy or in combination with a PDE-5 inhibitor.


Question: Selective Alpha 2 blocker is

Yohimbine, idazoxan -selective alpha 2 blockers. Only two of them are present with no impoant clinical use. Ref: KD Tripathi.


Question: Urgent reversal of warfarin induced bleeding can be done by the administration of

Fresh frozen plasma contains clotting factors . Hence given immediately in warfarin induced bleeding. From essential of medical pharmacology K D Tripati 7th edition Page no 620


Question: Elagolix sodium was approved by FDA in July 2018 for


Question: Cardiomyopathy is caused by

Ref: Katzung 14th ed. pg. 964-65; KDTy 6th ed. pg. 826-27* Doxorubicin and daunorubicin are anti-tumor antibiotics. Activity of Daunorubicin is limited to acute leukemia while doxorubicin is effective in several solid tumors.# MOA: Cause breaks in DNA strands by activating topoisomerse II and generating quinolone type free radicals.# Doxrorubicin and daunorubicin both these antibiotics produce cardiotoxicity as a unique adverse effect.* Actinomycin D (Dactinomycin) It is a very potent antineoplastic drug, highly efficacious in Wilms' tumour and rhabdomyosarcoma# Prominent adverse effects are vomiting, stomatitis, diarrhoea, erythema and desquamation of skin, alopecia and bone marrow depression* Mitoxantrone: Recently introduced analogue of doxorubicin with lower cardiotoxicity, probably because it does not produce quinine type free radicals. Though cardiomyopathy can occur, major toxicity is marrow depression and mucosal inflammation.* Mitomycin C: This highly toxic drug is used only in resistant cancers of stomach, cervix, colon, rectum, bladder, etc# Bone marrow and GIT are the primary targets of toxicity.


Question: The drug used for leishmaniasis treatment

Sodium stibogluconate, is drug of choice in leishmaniasis. Meglumine antimoniate, Pentamidine, Amphotericin B, Miltefosine, Paromomycin are alternative drugs Basic and clinical pharmacology Katzung 13th edition pg 902


Question: Ondonsetron is a potent

Ondansetron, is a medication used to prevent nausea and vomiting caused by cancer chemotherapy, radiation therapy, or surgery. It is also useful in gastroenteritis. It has little effect on vomiting caused by motion sickness. Refer kDT 6/e p646


Question: The drug that can cause hirsutism is

Ans: a (Minoxidil)Ref: katzung 9 ed., Pg. 247Topical minoxidil is used for treating androgenic alopecia. The mechanism of action of minoxidil on hair follicles is unknownDrugs causing hirsutism- Minoxidil- Phenytoin- Cyclosporine- Diazoxide- Androgens- Oral contraceptives - containing progesterone- Penicillamine- Heavy metals- Acetazolamide


Question: Gingival hypertrophy and hirsutism are the side effects of following Antiepileptic drug use

(D) Diphenylhydantoin # Gum hypertrophy: Commonest (20% incidence), more in younger patients, can be minimized by maintaining oral hygiene.> Hirsutism, coarsening of facial features (troublesome in young girls), acne.# Adverse effects These are numerous; some occur at therapeutic plasma concentration after prolonged use, while others are manifestation or toxicity due to overdose.# At therapeutic levels> Gum hypertrophy: Commonest (20% incidence), more in younger patients, can be minimized by maintaining oral hygiene.> Hirsutism, coarsening of facial features (troublesome in young girls), acne.> Hypersensitivity reactions are--rashes, DLE, lymphadenopathy; neutropenia is rare but requires discontinuation of therapy.> Megaloblastic anaemia: phenytoin decreases folate absorption and increases its excretion.> Osteomalacia: phenytoin desensitizes target tissues to vitamin D and interferes with calcium metabolism.> It can inhibit insulin release and cause hyperglycaemia.> Used during pregnancy--can produce foetal hydantoin syndrome (hypoplastic phalanges, cleft palate, hare lip, microcephaly), which is probably caused by its areneoxide metabolite.


Question: The dosage of Testosterone dosage is

(A) 100 mg/week# First, oral agents really have no place in hormone therapy in men.> There is a first pass effect after absorption into the portal system that allows the liver to metabolize the drug, leading to a very small amount of hormone entering the circulation. Injectable agents are more often used for replacement therapy.> The testosterone esters in these compounds are put in depot injections that leach hormone out over a period of weeks.> The average dosage is 100 mg per week.


Question: Mechanism of action of Abatacept is ( REPAEAT)

Abatacept is a soluble fusion protein that consists of the extracellular domain of human cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) linked to the modified Fc (hinge, CH2, and CH3 domains) poion of human immunoglobulin G1 (IgG1). Abatacept is produced by recombinant DNA technology in a mammalian cell expression system. The drug has activity as a selective costimulation modulator with inhibitory activity on T lymphocytes. It is used in the treatment of Rheumatoid ahritis. Ordinarily, full T cell activation requires 1) binding of the T cell receptor to the antigen-MHC complex on the antigen presenting cell (APC) and 2) a costimulatory signal provided by the binding of the T cell's CD28 protein to the B7 protein on the APC. Abatacept, which contains a high-affinity binding site for B7, works by binding to the B7 protein on APCs and preventing them from delivering the costimulatory signal to T cells, thus preventing the full activation of T cells. Abatacept is the basis for the second-generation belatacept currently being tested in clinical trials. In organ transplantation, it is intended to provide extended graft survival while limiting the toxicity generated by standard immune-suppressing regimens such as calcineurin inhibitors (eg, ciclosporin). Ref: katzung 12th ed.


Question: Broad spectrum antihelminthic


Question: drug directly acting on blood vessels is

Hydralazine is used with or without other medications to treat high blood pressure. Lowering high blood pressure helps prevent strokes, hea attacks, and kidney problems.Hydralazine is called a vasodilator. It works by relaxing blood vessels so blood can flow through the body more easily. Refer kDT 6/e p547


Question: Mechanism of action of colchicine in acute gout is

Colchicine used in acute gout inhibits beta-tubulin protein and prevents granulocyte migration.


Question: The drug used in Alzheimer's disease is

Tacrine was not discontinued due to hepatotoxicity Donepezil, gallatamine, rivastigmine can be used which are lipid soluble and can cross BBB easily Pyridostigmine and neostigmine are quaernary amines which do not cross BBB hence not used in Alzheimers Ref: KDT 6th ed pg 104


Question: Drug of choice in Acute migraine is

(Sumatriptan) (170-17l-KDT6th) (523-LP 3rd)Triptans (Sumatriptan, naratriptan, eletriptan, almotriptan, zolmitriptan)* "Triptans rapidly and effectively abort or markedly reduce the severity of migraine headaches in about 80% of patients"* Sumatriptan is an effective and better tolerated than ergotamine* Somatriptan is the first selective 5HT 1B/1D receptor agonist"Propranol is drug of choice for prophylaxis in migraine"


Question: If a drug is given through skin, maximum percutaneous absorption of given drug is from

Posterior auricularOrder of percutaneous absorption of drug applied topically:Posterior auricular > Scrotum > Scalp > Forearm > Plantar surface Ref: katzung 12th ed.


Question: Radiopharmaceutical used for liver scan is

A radio active subtance called radio pharmaceutical is formed or radio active tracer is formed by addition of a radioactive atom to a moleclue absorbed by a normal liver tissue.


Question: Wof is a monoclonal anti CD20 antibody used in treating NHL

Rituximab It is a chimerized MAb. Mech of action:- It binds to the CD20 B-cell antigen expressed on the surface of B-lymphocytes and B-cell lymphomas. Rituximab binding to the antigen promotes apoptosis through transmembrane signalling as well as by ADCC and CDC mechanisms. Uses:- It is indicated in B-cell lymphoma, non-Hodgkin lymphoma and chronic lymphocytic leukaemia. Adverse effects:- are infusion reactions consisting of chills, fever, uicarial rashes, pruritus, dyspnoea and hypotension. Severity of the reaction varies, and is also related to rate of infusion. Pretreatment with antihistaminics dampens the reaction. Ref:- kd tripathi;pg num:-872


Question: Common side effect of colchicine among the following is

Colchicine inhibits the polymerization of tubulin into microtubules. The disruption of the microtubules probably leads to defective intracellular movement of impoant proteins, nutrients, and waste products Common side effects of colchicine include bloating, abdominal cramps, lactose intolerance, and diarrhoea. They can be minimized by staing at a low dose and gradually advancing as tolerated, splitting the dose, use of simethicone for flatulence, and avoidance of dairy products. ref : Harrisons 20th ed


Question: Acetazolamide is

Carbonic anhydrase inhibitor act by non-competitive but reversible inhibition of the enzyme. Examples include acetazolamide,dorazolamide and brinzolamide.

Competitive and reversible carbonic anhydrase inhibitor

Non-competitive and reversible carbonic anhydrase inhibitor

Competitive and irreversible carbonic anhydrase inhibitor

Non-competitive and irreversible carbonic anhydrase inhibitor


Question: Nesiritide is broken down by

Nesiritide is a brain natriuretic (BNP) analog broken by neutral endopeptidase (NEP).Sacubitril is a drug inhibits NEP. Used now a days in ccf.Ref: Katzung 11th ed .pg 303


Question: GABA Reuptake is inhibited by

Reuptake is inhibited by tiagabine as shown in the picture


Question: Drug of choice for Liddle syndrome

Liddle syndrome is charcterized by increased ENaC channels and Amiloride is a ENaC blocker, which can be used for this condition.


Question: Neuroleptic malignant syndrome is caused by

Ans. c (Haloperidol). (Ref. Harrison, Internal Medicine 18th/Table 16-1)Malignant neuroleptic syndrome (MNS)# is a rare dose-related adverse effect of neuroleptics characterised by marked rigidity, immobility, tremors, fever, fluctuating BP and HR, semiconsciousness and myoglobin in blood.# Drugs causing MNS are Phenothiazines; butyrophenones, including haloperidol and bromperidol; fluoxetine; loxapine; tricyclic dibenzodiazepines; metoclopramide; domperidone; thiothixene; molindone; withdrawal of dopaminergic agents.# Drug of choice for Rx of MNS is Dantrolene. (MH 2006); However, bromocryptine may also be of use.


Question: The following antibiotic accentuates the neuromuscular blockade produced by pancuronium

DRUG INTERACTIONS Antibiotics:- Aminoglycoside antibiotics (streptomycin) reduce Ach release from prejunctional nerve endings by competing with Ca2+. They interfere with mobilization of ACh containing vesicles from a central location to near the terminal membrane, and have a weak stabilizing action on the postjunctional membrane. In clinically used doses, they do not by themselves produce muscle relaxation, but potentiate competitive blockers. Tetracyclines (by chelating Ca2+), polypeptide antibiotics, clindamycin and lincomycin also synergise with competitive blockers. Ref:- kd tripathi; pg num:-354


Question: Anaesthetic having epileptogenic potential is

Sevoflurane Enflurane Isoflurane Have epileptic potentials Refer Katzung 11/e p 432L


Question: Ipratropium bromide is used for


Question: Caudal Anesthesia is produced by introduction of local Anesthetic solution into


Question: Drug of choice for neurogenic diabetes insipidus

Desmopressin is used to treat neurogenic diabetes insipidus, bedwetting, hemophilia A, von Willebrand disease it acts as an agonist to vasopressin receptor or ADH receptor- produce antidiuresis- less urine production-used in DI, bedwetting, vasoconstriction - used in esophageal varices and produces vwf- used in von Willebrand disease ref KD Tripathi 8th ed


Question: Drug used for smoking cessation

Varenicline * Varenicline - paial agonist at alpha 3 beta 4, alpha 4 beta 2 & alpha 6 beta 2 subtypes of nAChRs and agonist at alpha 7 nicotinic Acetyl Choline Receptors. Block rewarding propeies of nicotine, alcohol and drugs of abuse. Ref:- Goodman & Gilman Pharmacological Basis of Therapeutics 13th Ed; Pg num:- 430


Question: In patient of hypeension, metoprolol and verapamil are given together. This combination can result in

Beta blocker (metoprolol) and non-DHP CCBs (verapamil) block SA node and AV node. Both combined can cause severe bradycardia and AV block. Drugs causing Torsades' de pointes include: Quinidine, Procainamide, Cisapride, Astemizole, Terfenadine etc.


Question: Calculate Km


Question: NMDA blocker used as antitussive is

Dextromethorphan is a NMDA blocker which is a less potent antitussive. Side effects include addiction liability & hallucination.


Question: Azidothymidine (Zidovudine), commonest side effect is

Ans. is 'd' i.e., Macrocytic anaemia "The most common adverse effect of zidovudine is myelosuppression, resulting in macrocytic anemia (1-4%) or neutropenia (2-8%)". So most common side effect of zidovudine is neutropenia (2-8%) followed by macrocytic anemia (1-4%). Other side effects are - nausea, anorexia, headache, insomnia, abdominal pain, myalgia, malaise, fatigue, myopathy, lactic acidosis, hepatomegaly with steatosis, convulsions and encephalopathy.


Question: Vecuronium acts on

Vecuronium is a non-depolarizing neuromuscular blocking agent.
It acts on the nicotinic receptor at neuromuscular junctions and blocks the depolarization by inhibiting Na+ channels.


Question: Oaubain acts by inhibiting

Ouabain is a cardiac glycoside and in lower doses, can be used medically to treat hypotension and some arrhythmias. It acts by inhibiting the Na/K-ATPase, also known as the sodium-potassium ion pump Refer kDT 6/e p496


Question: An agent of choice in acute hypercalcemia due to malignancy is

Calcitonin is the fastest acting followed by I.V bisphosphonates. hyperccalcimia in malignancy is mainly seen in tumors secreting Parathyroid hormone related peptide PTHrP. Ref: CMDT pg 801 2010 ed.


Question: Cochlear implant used in NOT RELATED ENT


Question: Anti androgen use in hea failure is

Spironolactone is a potassium-sparing diuretic (water pill) that prevents your body from absorbing too much salt and keeps your potassium levels from getting too low. Spironolactone is used to treat hea failure, high blood pressure (hypeension), or hypokalemia (low potassium levels in the blood). Refer kDT 7/e p 514


Question: Maximum rise in Prolactin levels is seen with(2018)

Risperidone is more potent D2 blocker than clozapine; extrapyramidal side effects are less only at low doses (<6 mg/day). Prolactin levels rise dispropoionately during risperidone therapy, but it is less epileptogenic than clozapine. Ref:- KD tripathi; pg num:- 441


Question: Antiemetic effect of Metoclopromide is mainly due to its action as

Antiemetic effect of Metoclopramide is because of D2 antagonism > 5HT3 antagonism.
Prokinetic effect is due to 5HT4 agonism.


Question: Reslizumab used in bronchial asthma is a monoclonal antibody against

Mepolizumab & Reslizumab are monoclonal antibodies against IL-5 used in bronchial asthma, which act by inhibiting recruitment of eosinophils.


Question: Digibind is used to

DIGIBIND (digoxin immune fab) , Digoxin Fab (Ovine), is indicated for treatment of potentially life-threatening digoxin intoxication.3 Although designed specifically to treat life-threatening digoxin overdose, it has also been used successfully to treat life-threatening digitoxin overdose.3 Since human experience is limited and the consequences of repeated exposures are unknown, DIGIBIND (digoxin immune fab) is not indicated for milder cases of digitalis . Refer kDT 6/e p499


Question: Clostridium difficile diarrhoea is most commonly associated with

Clostridium difficile diarrhea is a super-infection also called Pseudomembranous colitis. Mc cause is 3rd generation Cephalosporins Other causes include Clindamycin, Aminopenicillins (Ampicillin and Amoxycillin), and Fluoroquinolones. DOC for treatment of PMC is oral Vancomycin now. Stool transplant can also be done. MAB against toxin of C.difficile : Bezlotoxumab.


Question: The longest acting antihistaminic is

Terfenadine is a prodrug broken down to fexofenadine.so long duration of action followed by astemizole Ref: Goodman Gillman 12th ed.Pg 924.


Question: Best uterine relaxation is seen with

Refer Katzung 10/e p 405 Halogentaed inhalational anesthestic agents like Halothane are powerful tocolytic agents Halothane is anaesthetic of choice for internal version and manual removal of placenta


Question: Nitrates are contraindicated with

Sildenafil & Tadalafil are the PDE-5 inhibitors which are contrainidicated with Nitrates to prevent severe hypotension.


Question: Ivabridine is indicated in the management of

Refer kDT 6/e p 55,katzung 11e p203 Ivabradine is a bradycardia drug. It selectively blocks if sodium channel blocker and reduce hea rate by inhibiting the hyperpolarization activated sodium channel in the SA node. No other significant hemodynamic effects has been noted. It reduces and then attacked similar to Calcium channel blocker and beta blockers


Question: The HIV fusion inhibitor, enfuvirtide, acts at the site


Question: The byproduct of GABA is

It is clear from this picture that GABA metabolite is succinate.


Question: Sodium nitroprusside acts by activation of

Nitroprusside generates NO that relaxes the vascular smooth muscle by activating Guanylate cyclase Refer kDT 6/e p548


Question: Most common mechanism for transfer of resistance in staphylococcus aureus

Refer Goodman Gilman 11/e p 1098 Transduction is paicularly impoant in transfer of resistance among staphylococci Multidrug resistant is transferred by conjugation


Question: Beta blockers are not indicated in

Ref: HL Sharma 3rd ed pg no: 193 Beta blockers are not used in CCF except metoprolol and carvedilol due to their antioxidant propeies they are used only in chronic CHF not in acute in acute CCF or CHF, diuretics , digoxin are used


Question: A patient present to emergency with pinpoint pupil, salivation, lacrimation, tremors and red tears. Plasma cholinesterase level was 30% of normal . Most probable diagnosis is

Refer katzung 12e p110 These are characteristic feature of anticholinesterase(organophosphorous and carbamates) poisoning features of organophosphate poisoning muscarinic symptoms: pinpoint pupil, salivation, lacrimation ,urination,defecation,gastrointestinal distress, vomiting, bronchospasm, bradycardia nicotinic symptoms: fasciculations and fibrillation of muscle, tachycardia and tachypnea CNS symptoms :Tremors, giddiness, ataxia and coma red tears: due to accumulation ofporphyrin in the lacrimal glands


Question: The drug used to treat dry mouth in cancer chemotherapy is

Cevimeline increase salivary secretions and has a specific use in Sjogren's and xerostomia It is a parasympathomimitic and muscarinic agonist with paicular actions on M1 and M3 receptors. Ref: HL Sharma.3rd ed. Pg 138


Question: Hand and foot syndrome can be caused by

5 FU, capecitabine and liposomal doxorubucin can cause hand and foot syndrome Generally this disease affects infants and children Adults with immunodeficiency can also be affected Refer Katzung 10th/889


Question: Riociguat is used for

Used for Chronic-thromboembolic pulmonary hypeension (CTEPH) and Pulmonary aerial hypeension (PAH) It is a stimulator of soluble guanylate cyclase (sGC). Ref: KD Tripathi 7th ed


Question: Anesthetic agent with vasoconstrictor is contraindicated in

Refer Katzung 11/e p446 Vasoconstrictors are contraindicated if LAs are used for organs with end aeries like tips of fingers, toes, nose, pinnacle, and penis due to risk of ischemia and necrosis


Question: Infant mortality rate is defined as

(A) Number of infant deaths per 1000 live birth # Infant mortality rate is the ratio of deaths under 1 year of age in a given year to the total number of live births in the same year; usually expressed as a rate per 1000 live births.> It is one of the most universally accepted indicators of health status not only of infants, but also of whole population and of the socioeconomic conditions under which they live.> In addition, the infant mortality rate is a sensitive indicator of the availability, utilization and effectiveness of health care, particularly perinatal care.

Number of infant deaths per 1000 of total birth

umber of infant deaths per 1000 of mid year population

Number of infant deaths per 1 lakh of mid year population.


Question: The following ADR is caused by

The picture is showing lid retraction which is an ADR of apraclonidine. It is an analogue of clonidine. Ref: KDT 6th ed pg 146-147


Question: Mechanism of action of Ezetimibe is

Ezetimibe inhibits NPC1L1 (Niemann Pick C1 Like1) protein present in intestinal epithelial cells that aids cholesterol absorption.

Interferes with absorption of bile acids

Interferes with absorption of cholesterol by inhibiting NPC1L1


Question: Calcium channel blocker used in subarachnoid hemorrhage

Nimodipine is a cerbroselective calcium channel blocker used in SAH.Ref: KD Tripathi 6th ed pg 532


Question: Arrange the following drugs according to their half life in increasing order1. Amiodarone2. Adenosine3. Esmolol4. Omeprazole

Ans. AExplanation:* Amiodarone is longest acting anti-arrhythmic drug. Its half life is more than 3 weeks.* Adenosine is shortest acting anti-arrhythmic drug having half life less than 10 seconds.* Esmolol is an ultra short acting beta blocker. It is metabolized by pseudocholinesterase and thus has half life less than 5 minutes.* Omeprazole has half life of 1 -2 hours but works for 24 hours due to irreversible inhibition of proton pump.* Thus, the sequence isAdenosine < Esmolol < Omeprazole < Amiodarone


Question: Exogenous adrenaline is metabolized by

Endogenous adrenaline action is terminated mainly by reuptake whereas exogenous agent is metabolized by COMT and MAO.


Question: The drug preferred to stop the growth of prostate in a 70 year old male with Benign hyperplasia of prostate is

Ref: Katzung 14th ed. pg. 1085* Most of the actions of testosterone are mediated by its conversion to DHT by 5-alpha reductase. Important amongst these are growth of prostate, male pattern baldness and hirsutism in females.* Finasteride and dutasteride are 5-alpha reductase inhibitors useful in the treatment of BPH, male pattern baldness and hirsutism by reducing the production of DHT.Note: Flutamide and Nilutamide act as antagonists of androgen receptors. These are useful for the treatment of prostatic carcinoma. Flutamide can cause gynaecomastia and reversible liver damage.


Question: Antidote for paracetamol poisoning is

Paracetamol - has only antipyretic and analgesic activity. It does not possess anti-inflammatory activity as it is believed to be inactivated by the free oxygen radicals generated at site of inflammation. Metabolite of PCM | Acts on TRPV receptor (Vanilloid Receptor) Analgesic action of it may be mediated by this receptor PCM has antidote i.e. N-Acetylcysteine


Question: LHRH analogue used in breast cancer is

GnRH agonists: Goserelin, buserelin, nafarelin, triptorelin, leuprolide GnRH antagonists: cetrorelix, abarelix, degarelix ref KD Tripathi 8th ed


Question: The therapeutic efficiency of antihypeensive drugs is blunted by NSAIDs because they

PG E2 and PGI2 cause renal vasodilatation, natriuresis and increased water clearance due to inhibition of the action of ADH. Loop diuretics act paly by increasing the stimulation of cox. therefore NSAIDs attenuate the diabetic action of these drugs. Refer kDT 6/e p708

Increase the clearance of anti Hypeensive drugs

Decrease the absorption of antihypeensive drugs

Decrease the synthesis of Vascular prostacyclin


Question: Drug used in aneliorative test for Myasthenia gravis is

Drug used in amellorative test (tensilon test) for myasthena gavis is edrophonium. It is a cholinergic drug and can be used for diagnosis of myasthenia gravis becaise of its sho duration of action (10-30 min) Ref-KDT 6/e p104


Question: Leukotriene receptor antagonist used for bronchial asthama is

Examples for leukotriene receptor antagonist are Montelukast and Zafirlukast ESSENTIALS OF MEDICAL PHARMACOLOGY 8TH EDITON Page No :222


Question: β blocker with intrinsic sympathomimetic activity

β blockers with intrinsic sympathomimetic activity have partial agonistic action on β1 receptors thus causing lesser bradycardia.
Ex: Acebutalol, Celiprolol, Cartelol, Pindolol, Penbutolol, Labetalol.


Question: Vitamin K is involved in the post translational modification of

Refer Katzung 11/e p 595 Vitamin K causes gamma carboxylation of glutamate reduces in many clotting factors that result in their activation


Question: Cardiac arrhythmias are most commonly seen during administration of


Question: Hemorrhagic cystitis is caused by

Refer Katzung 11/e p500 It is a prodrug and is activated BBy hepatic biotransformation to aldophosphamade. One of the degradation products is acrolein that is responsible for hemorrhagic cystitis


Question: Treatment for male pattern alopecia includes

Finasteride and dutasteride are 5 alpha reductase inhibitors; inhibit the formation of Dihydrotestosterone. So they are used in alopecia and also in BPH. Minoxidil also used in treatment. Fulvestrant is a SERD selective estrogen down regulator Ref: KD tripathi , 8th ed


Question: The only reliable symptom of hypoglycemia in a patient on beta blocker therapy is

* All the symptoms of hypoglycemia are blocked by beta blockers except sweating as it has cholinergic innervation * Beta blockers (non selective) are contraindicated in : ABSOLUTE C/I Pheochromocytoma Decompensated hea failure symptomatic bradycardia AV block Asthma RELATIVE C/I Peripheral vascular disease


Question: Drug monitoring is required for the following

(A) Lithium# Lithium is generally taken with food, although its absorption is not markedly affected by the presence of food.> Doses vary widely and are adjusted based on measurements of the levels of lithium in the blood.> Early in therapy, dose adjustments are made as often as every 5 to 7 days to establish the correct dose.> Patients with kidney diseases excrete less lithium from the body and, therefore, require lower doses.


Question: Digoxin toxicity is aggravated by

Ref-KDT 6/e p499 Oxygen toxicity is a agravated by Hypokalemia and hypercalcemia


Question: Edrophonium test is helpful in diagnosing

Ref: HL Sharma 3rd ed pg no: 142 edrophonium is very sho acting which helps in differentiating myasthenia and cholinergic crisis


Question: Drug therapy used in treatment of Wernicke's encephalopathy

(C) Thiamine # Thiamin deficiency can result in three distinct syndromes:> A chronic peripheral neuritis, beriberi, which may or may not be associated with heart failure and edema; acute pernicious (fulminating) beriberi (shoshin beriberi), in which heart failure and metabolic abnormalities predominate, without peripheral neuritis; and Wernicke's encephalopathy with Korsakoff's psychosis, which is associated especially with alcohol and drug abuse.> Therapeutic uses of Thiamine: most neurological symptoms in chronic alcoholics are due to thiamine deficiency -peripheral neuritis Wernick's encephalopathy, Korskoffs psychosis: give 100 mg/day paranterally.


Question: DOC for Listeria monocytogenes

Aminopenicillins Ampicillin It is active against all organisms sensitive to PnG. In addition, many gram-negative bacilli, e.g. H. influenzae, E. coli, Proteus, Salmonella Shigella and Helicobacter pylori are inhibited. Ampicillin is more active than PnG for Strep. viridans, enterococci and Listeria monocytogenes; equally active for pneumococci, gonococci and meningococci (penicillin-resistant strains are resistant to ampicillin as well); but less active against other gram-positive cocci. Ref:- kd tripathi; pg num:-722


Question: The dose of a drug required to produce a specified effect in 50% of the population is


Question: Shoest acting mydriatic and cycloplegic drug is

Tropicamide is the shoest acting mydriatic ANTICHOLINERGIC DRUGS FOR EYE Atropine, homatropine, cyclopentolate and tropicamide are used as mydriatic and cycloplegic agents. Mydriatic action is useful in fundus examination whereas cycloplegic action allows correct assessment of refractive error Pain in iridocyclitis occur due to spasm of ciliary muscle which can be relieved due to cycloplegic action. Atropine has very long duration of action (3-5 days) in the eye Tropicamide is the shoest acting mydriatic. Anticholinergic agents are contra-indicated in glaucoma.


Question: The mechanism of action of valproic acid is


Question: Drugs used for remodeling of hea in congestive hea failure is

Refer kDT 7/e 520 Blockade of RAS by angiotensin-conveing enzyme inhibitors or angiotensin II type 1 receptor antagonists attenuates the ventricular dysfunction, but the effects of individual drugs in reducing the morbidity and moality in CHF patients are variable.


Question: The main source of production of relaxin is

The main source of production of relaxin is the corpus luteum of the ovary but pa of it may also be produced by the placenta and decidua. Ref: KD Tripathi 8th ed.


Question: The following ADR is seen with

The picture shows gingival hyperplasia caused by phenytoin Ref: KDT 7th ed Pg: 417-422


Question: DOTS is a community based treatment and care strategy for


Question: Action of angiotensin 11 includes

Refer kDT 6/e p 481 The renin-angiotensin system (RAS) plays an impoant role in the regulation of blood pressure. Angiotensin II is the principal effector hormone in the RAS, causing vasoconstriction and increased sodium and water retention, leading to increased blood pressure

Reabsorption of sodium ions in proximal renal tubule


Question: A patient comes 6 hours after consuming morphine and presents with pin point pupils and respiratory depression. T 1/2 of morphine is 3 hours and volume of distribution (Vd) is 200 L. Current plasma concentration of morphine is 0.5 mg/L. Calculate the initial morphine dose consumed by the person.

* Volume of distribution means how much amount of plasma is required to accommodate the whole drug, if the plasma concentration remains constant. Current plasma concentration is 0.5 mg/L means* 1 litre contains 0.5 mg of morphine So, Vd of 200 L means* 200 litre contain 0.5 x 200=100 mg So now total amount of morphine present in the body is 100 mg. This is the amount present in body after 2 half lives (half life is 3 hours and patient presented after 6 hours)* T1/2 = 3 hrsAfter 1 t1/2 drug remaining in body is 50 % of initial. After 2 t1/2 drug remaining in body is 25 % of initial If initial amount of morphine in body is x mg so, 100 = 25% of x S0, x = 400 mg So the drug present in body initially is 400 mg


Question: A patient on Aspirin will have increasing in

Antiplatelet drugs like asprin and clopidogrel prolong the bleeding time Anticoagulant drugs prolong the clotting time Drugs interfering with extrinsic pathway like Warfare in prolonged the PT Drugs interfering with intrinsic pathway like heparin prolong the aPTT. Thrombin time is prolonged in cases of afibrinoginemia and dysfibrinogenemia. Refer kDT 6/e p609


Question: Haemodialysis is not useful in

Dialysis is mainly done for poisoning due to: Methanol Lithium Aspirin Dabigatran Dialysis is not useful in: A- Amphetamines V: Verapamil O- Opioids, OPC I: Imipramine D- Digoxin Dialysis: Diazepam


Question: Mode of contraception that should be avoided in epilepsy is

Antiepileptic drugs such as phenytoin,carbamazepine,phenobarbitone are enzyme inducers which when used with oral contraceptives can cause its failure. (Ref.Essentials of medical pharmacology TD Tripathi 7th edition Page no.326)


Question: Antidiabetic drug that does not cause weight gain is

Metformin: Can cause megaloblastic anaemia and lactic acidosis. Risk of lactic acidosis increases in kidney and liver disease thus contraindicated in these patients. It causes maximum decrease in HbA1c Do not cause hypoglycaemia. Do not cause weight gain. DOC for type II diabetes mellitus. Pioglitazone: Metabolized by CYP2C8 and CYP3A4 to active metabolites, the risk of bladder cancer appears to be cumulatively increased with high doses. Tolbutamide and glipizide: sulfonylureas which tend to increase weight


Question: Drug of choice for acute PSVT

Adenosine is used for acute termination of PSVT Verapamil and esmolol are used as an alternate 2nd choice of drugsRef: Katzung 11th ed pg 243


Question: Oligospermia caused by aEUR'

Methotrexate "Transient but reversible oligospermia has been repoed in males receiving high dose methotrexate for cancer chemotherapy". Defective oogenesis or spermatogenesis "Occurs in methotrexate therapy"


Question: PFOR inhibitor used in angina

Trimetazidine, ranolazine is paial fatty acid oxidation inhibitors used in angina as they prevent free radicle formation and decrease myocardial oxygen demand. Ref: HL Sharma 3rd ed.


Question: A psychiatric patient taking medication develops a tremor, thyroid enlargement and leucocytosis. Drug implicated is

Tremor is one of the most common adverse effects of lithium treatment, and it occurs with therapeutic doses.Lithium probably decreases thyroid function in most patients exposed to the drug,Leukocytosis is always present during lithium treatment, probably reflecting a direct effect on leukopoiesis rather than mobilization from the marginal pool.Polydipsia and polyuria, Edema are other adverse effectsReference: Katzung Pharmacology; 12th edition; Page no: 517


Question: Prostaglandin used in the treatment of peptic ulcer is

Ans) b (Misoprosotol) Kef: KDT 6th ed p. 629Misoprostol is the prostaglandin analogue used in the treatment of peptic ulcer.DRUGS USED IN PEPTIC ULCER1) H2 antagonists-ranitidine, cimetidine, famotidine roxatidine and nizatidine.Nizatidine has little first-pass metabolism and a bioavailability of al-most 100%. Famotidine is the most potent among them.2) Proton pump inhibitors (PPIs)- omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole. They are the most effective drugs in GERD.3) Mucosal protective agents-sucralfate, colloidal bismuth compounds4) Prostaglandin analogs-misoprostol5) Antacids6) Anticholinergics-Pirenzipine, propantheline7) Anti-H.pylori drugs -Amoxicillin, clarothromycin, metronidazole, tinidazole, tetracycline.


Question: Most potent proton pump inhibitor is

Lansoprazole is the most potent proton pump inhibitor.


Question: Drug of choice for Hypeension in eclampsia is

Refer kDT 7/e p 573 The drug of choice to treat and preventeclampsia is magnesium sulfate. Familiarity with second-line medications phenytoin and diazepam/lorazepam is required for cases in which magnesium sulfate may be contraindicated (eg, myasthenia gravis) or ineffective.


Question: Sodium 2 mercapto ethane sulfonate is used as a protective agent is

Refer KDT 6/e p833 Sodium 2 mercapto ethane sulfonic acid is used to amelioreae the hemorrhagic cystitis caused by cycloohosphamide and Ifosfamide


Question: Intranasal spray of budesonide is indicated in

Budesonide A nonhalogenated glucocoicoid with high topical: systemic activity ratio (greater first pass metabolism). Small fraction that is absorbed is rapidly metabolized; less systemic effects, uses:- 1) Asthma 2). Allergic rhinitis 3) prophylaxis and treatment of seasonal and perennial allergic or vasomotor rhinitis, nasal polyposis side effects:- Nasal irritation, sneezing, itching of throat and dryness may occur, especially in the beginning. Ref:- kd tripathi;pg num:- 231


Question: Opioid induced constipation is treated by

Alvimopan, Naloxegal & Methyl naltrexone are peripherally acting opioid antagonists used to treat opioid induced constipation & paralytic ileus.


Question: Drug used for bleeding GI varices

Ans. is'c'i.e., TerlipressinTerlipressin (analogue vasopressin) is considered the vasoactive agent of choice for acute variceal bleeding.Other drugs used are somatostatin and its analogue octreotide.


Question: Plazomicin was approved by FDA recently for

it is ia new or nect generation aminoglycoside i.e neo glycoside, bactericidal in nature ,inhibiting the protein syunthesis, acting on both gram negetive and positive bacteria.


Question: Methyl xanthines acts on

(Adenosine receptors) (202-3-KDT) (220-KDT 6th)Mechanism of action of Methylxanthines - Three distinct cellular actions(a) Release of Ca++ from sarcoplasmic reticulum especially in skeletal and cardiac muscle.(b) Inhibition of phosphodiesterase which degrades cyclic nucleotides intracellularly.ATPorGTPAdenylcyclase------------guanylcyclasecAMPorcGMPPhosphodiesterase--------------------Inhibited by Theophylline5 AMPor5 GMP(c) ** Blockade of adenosine receptors: adenosine acts as a local mediator in CNS, CVS and other organs- contracts smooth muscles, especially bronchial, dilates cerebral blood vessels, depresses cardiac pacemaker and inhibits gastric secretion. Methylxanthines produces opposite effects.


Question: Ibuprofen is contraindicated in


Question: Pharmacovigilance is done for monitoring aEUR'

Drug safety Pharmacovigilance is defined as "All methods of assessment and prevention of adverse drug reactions". National pharmacovigilance program (India) 2004 India's drugs control depament within the ministry of health and family welfare initiated the establishment of a nationwide network to build a comprehensive phannacovigilance data system in 2004. The national pharmacovigilance programme for India is sponsored by World Health Organization (WHO) and is funded by the World Bank. The national pharmacovigilance programme is based on the recommendations made in WHO document titled "safety monitoring of medicinal products - Guidelines for setting up and running (I pharmacovigilance centre". The programme paicularly solicits repos of:- All "adverse events" suspected to have been caused by new drugs and drugs of current interest (list to be published by CDSCO from time to time). All suspected drug interactions. Reactions to any other drugs which are suspected of significantly affecting a patient's management including reactions suspected of causing:- - Death - Life threatening - Hospitalisation (initial or prolonged) - Disability (significant persistent or permanent) - Congenital anomaly - Required intervention to prevent permanent impairment or damage


Question: Proteasome inhibition is seen with

It is a proteasome inhibitor - an anticancer drugBoezomib was first approved for use in relapsing or refractory multiple myeloma and is now widely used in the first-line treatment of multiple myeloma. This agent is thought to exe its main cytotoxic effects through inhibition of the 26 S proteasome, which results in down-regulation of the nuclear factor kappa B (NF-kB) signaling pathway. Of note,inhibition of NF-kB has been shown to restore chemosensitivity.Ref: Sharma and Sharma 3rd ed/pg 871; Katzung; 13th edition; Page no: 971


Question: Acetylcholinesterase inhibitors are not used in

Carbamate and OP compounds are acetylcholinesterases. Oximes are used in op poisioning where as in carbamates poisioning oximes are not effective. Ref: KDT 6th ed pg 105


Question: Heparin does not cause

Heparin doesnot cause factor V inhibition whereas it causes all the other three. From medical pharmacology padmaja 4th edition Page no 335


Question: Drug of choice for plasmodium vivax is

Chloroquine Chloroquine remains the treatment of choice for clinical cure and suppressive prophylaxis of all types of malaria, except that caused by resistant P.falciparum. In sho time visitors to chloroquine-sensitive endemic areas, suppressive dose should be staed 1 week before and continued for 4 weeks after returning REF : katzung pharmacology : 14th ed


Question: Duration of treatment for multibacillary and paucibacillary leprosy is

Multibacillary (MB) leprosyFor adults, the standard regimen is Rifampicin: 600 mg once a month Dapsone: 100 mg daily Clofazimine: 300 mg once a month and 50 mg daily Duration= 12 months.Paucibacillary (PB) leprosyFor adults, the standard regimen is Rifampicin: 600 mg once a month Dapsone: 100 mg daily Duration= six monthsSingle Skin Lesion Paucibacillary leprosyFor adults, the standard regimen is a single dose of Rifampicin: 600 mg Ofloxacin: 400 mg Minocycline: 100 mg


Question: Tetracycline with highest anti leprotic propey

Minocyline is a tetracycline group given in cases where clozamine is not tolerated minocycline is given in such cases 100mg per day in such cases. Ref: KDT 6/E P753


Question: Surfactant deficiency occurs in NOT RELATED


Question: FDA approved drug for HIV is

Ibalizumab was approved by FDA in 2018 for the treatment of HIVRef: <a href="


Question: Osteoporosis is a major adverse effect caused by the glucocorticoids. It is due to their ability to(Lippincott's 3rd pharmacology)

B. i.e. (Inhibit absorption of calcium) (314- Lippincott's 3rd)Glucocorticoid- induced osteoporosis is attributed to inhibition of calcium absorption as well as bone formation.Increased intake of calcium plus vitamin D or calcitonin or of other drugs that are effective in this condition is indicated.Glucocorticoids suppress rather than stimulate the hypothalamic -pituitary- adrenal axis. The decreased production of prostaglandins does not play a role in bone formation.

Stimulate the hypothalamic - pituitary adrenal axis


Question: Frusemide acts on

Ans: a (Ascending limb of Ref: Katzung 11th edLoop diuretics selectively inhibit NaCl reabsorption in the Thick Ascending Limb.Frusemide is a loop diuretic. Because of the large NaCl absorptive capacity of this segment and the fact that the diuretic action of these drugs is not limited by development of acidosis, which is usually seen with the carbonic anhydrase inhibitors.Loop diuretics are the most efficacious diuretic agents currently availableSegmentFunctionsDiuretic with Major ActionGlomerulusFormation of glomerular filtrateNoneProximal convoluted tubule (PCT)Reabsorption of 65% of filtered Na+/ K+/ CA2+, and Mg2+; 85% of NaHC03 , and nearly 100% of glucose and amino acids. I sos mo tic reabsorption of water.Carbonic anhydrase inhibitorsProximal tubule, Straight segmentsSecretion and reabsorption of organic acids and bases, including uric acid and most di ureticsNoneThin descending limb of Henl e's loopPassive reabsorption of waterNoneThick ascending limb of Henle's loop (TAL)Active reabsorption of 15-25% of filtered Na7 K7 CP; secondaryreabsorption of Ca2+ and Mg2+Loop diureticsDistal convoluted tubule (DCT)Active reabsorption of 4-8% of filtered Na+ and Cl"; Ca2+ reabsorption under parathyroid hormone controlThiazidesCortical collecting tubule (CCT)Na+ reabsorption (2- 5%) coupled to K+ and H+ secretionK+-s paring diureticsMedullary collecting ductWater reabsorption under vasopressin controlVasopressin antagonist


Question: A patient was started on fluphenazine. After few weeks of treatment, he started developing tremors, rigidity, bradykinesia and excessive salivation. First line of management for this patient is

* Fluphenazine - D2 blocker (Anti-psychotic)* This is a case of typical antipsychotic induced parkinsonism.* The only group of drugs effective against "Pharmacological parkinsonism" (Drug induced parkinsonism) are Anti-cholinergic agents* Trihexyphenidyl:# Has high Central: Peripheral anticholinergic actions than atropine# Acts by reducing unbalanced cholinergic activity in striatum of parkinsonism patients# Order of relief of symptoms: Tremors > Rigidity > Hypokinesia# Peripheral actions - responsible for treatment of sialorrhea# Started at low dose and gradually increased


Question: Drug that does not follow nonlinear dose dependent saturation kinetics

(A) Paracetamol # Nonlinear Pharmacokinetics> Nonlinearity in pharmacokinetics (i.e., changes in such parameters as clearance, volume of distribution, and half-life as a function of dose or concentration of drug) usually is due to saturation of either protein binding, hepatic metabolism, or active renal transport of the drug.


Question: Effects mediated by H1 histamine receptor include

The H1 receptor is a histamine receptorbelonging to the family of rhodopsin-like G-protein-coupled receptors.This receptor is activated by the biogenic amine histamine. It is expressed in smooth muscles, on vascular endothelial cells, in the hea, and in the central nervous system. Refer kDT 7/162

Induction of hepatic cytochrome P450 enzyme


Question: Drug of choice for absence seizures is

Ethosuximide and valproate are equally efficacious, but the latter i:more commonly used because it would als, prevent kindling and emergence of GTCS Valproate is clearly superior in mixed absence and GTCS, which is more common than pure absence seizures. REF KD TRIPATHI 8TH ED.


Question: Paial agonist can antagonise the effects of a full agonist because it has

Agonists:- Have both affinity and maximal intrin-sic activity. Competitive antagonists :- Have affinity but no intrinsic activity. Paial agonists:- Have affinity and submaximal intrinsic activity. Inverse agonists:- Have affinity but intrinsic activity with a minus sign (IA between 0 and -1). Ref:- kd tripathi; pg num:-41,42

High affinity but low intrinsic activity

Low affinity but high intrinsic activity


Question: Ankle edema caused by calcium channel blockers is prevented by

Calcium channel blockers can lead to ankle edema caused by precapillary dilation of vessels.
ACE inhibitors or Angiotensin Receptor Blockers can Prevent the edema by causing postcapillary dilation of vessels.


Question: Fastest and briefest action occurs in

(Tropicamide): (118-KDT 7th edition)TROPICAMIDE - has quickest (20-40 min) and briefest (3-6 hours) action but is a relatively unreliable cycloplgic* It is satisfactory for refraction testing in adults and as a short acting mydriatic for fundoscopy* The mydriatic action can be augmented by combining with phenylephrine


Question: Mechanism of action of aspirin as antiplatelet drug is it's inhibitory action on

Refer KDT 7th /629 By inhibiting cyclooxygenase enzyme, aspirin initially decreses6 the level of both prostacyclins and TXA2 Howevr6 after some time prostacyclins synthesis resumes due to presence big nulcues in endothelium where'ass TXA2 remain depressed because platelets are enucleated


Question: Insulin release due to K+ closure is seen with

Glinides acts by the closure of potassium channels like sulphonylureas REF KD TRIpathi 8th ed


Question: Complications of inhalational steroids use include

Adverse effects Hoarseness of voice, dysphonia, sore throat, asymptomatic or symptomatic oropharyngeal candidiasis are the most common side effects. These can be minimized by the use of a spacer, gargling after every dose (to wash off the drug deposited on oral and pharyngeal mucosa) and prevented as well as treated by topical nystatin/clotrimazole. Patients who are to be switched over from oral steroid should receive inhaled steroid in addition for 1-2 weeks before oral steroid is tapered (Peak effect of inhaled steroid is seen after 4-7 days of instituting inhaled steroids and benefit persists for a few weeks after discontinuation), Otherwise steroid with-drawal may manifest (precipitation of asthma, muscular pain, lassitude, depression, hypotension). This confirms lack of systemic activity of inhaled steroids (at doses < 600 ug/day). Systemic effects of long-term inhaled glucocoicoids are clinically relevant only at doses > 600 ug/day. The significant ones are--mood changes, osteoporosis, growth retardation in children, bruising, petechiae, hyperglycaemia and pituitary-adrenal suppression; several repos of adrenal crisis have appeared, especially in children, during stress. Ref:- kd tripathi; pg num:-230,231


Question: Wof bones is affected more with glucocoicoid induced osteoporosis

Adverse effects:- Osteoporosis Especially involving veebrae and other flat spongy bones. Compression fractures of veebrae and spontaneous fracture of long bones can occur, especially in the elderly. Radiological evidence of osteoporosis is an indication for withdrawal of coicoid therapy. Coicosteroid induced osteoporosis can be prevented/arrested by calcium supplements + vit D, and by estrogen/raloxifene or androgen replacement therapy in females and males respectively. However, bisphosphonates are the most effective drugs. Avascular necrosis of head of femur, humerus, or knee joint is an occasional abrupt onset complication of high dose coicosteroid therapy. Ref:- kd tripathi; pg num:-293


Question: Most potent mineralocoicoid is

Aldosterone is the most potent mineralocoicoid. Not used clinically because of the low oral bioavailability. most potent synthetic or man made is- fludrocoisone- having more mineralocoicoid activity (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 282)


Question: Gemtuzumab ozogamycin is a monoclonal antibody against

It is a monoclonal antibody against CD33, used for CD33+ve AML.


Question: Digitalis has positive ionotropic effect by the viue of its effects on

Effects of digitalis on cell biochemistry: sodium pumpinhibition. It is now generally agreed that Na+-K+ adenosine triphosphatase (ATPase), a transpo enzyme derived from the sarcolemmal sodium pump, is the primary site at which digitalis exes its effects on the myocardial cell. Refer kDT 6/e p497


Question: Longest acting statin is

Among statins, shoest acting is simvastatin and longest acting is rosuvastatinRef: KD Tripathi 7thed.Pg: 637


Question: The drug of choice in digitalis induced ventricular arrhythmia is

Refer CMDT 2010/364 Administration of intravenous lignocaineinfusion is indicated as an adjunctive intervention in patients with severe acute pain eg during and post laparotomy, following major trauma or burns and for acute cancer pain flares or neuropathic (nerve memory) pain [such as deafferentation/postamputation pain or from acute ...


Question: Topical antibiotic of choice for MRSA

Ans: C. MupirocinMethicillin resistance staphylococcus aureus (MRSA):Also be referred to as multi-drug resktant staphylococcus aureus or oxacillin resistant staphylococcus aureus (ORSA).Vancomycin is the systemic DOC for MRSAMupirocin is topical antibiotic of choice.Other topical effective drug are fusidic acid and retapamulin.


Question: Most impoant dose limiting toxicity of cancer chemotherapy is

Depression of bone marrow is usually the most significant dose limiting toxicity with cancer chemotherapy Refer CMDT 2010/1499


Question: Wof are anti diabetic agents that acts by increasing insulin sensitivity, and so should be euglycemics

Thiazolidinedione (PPARg agonist) Pioglitazone:- Only one thiazolidinedione Pioglitazone is currently available. Mech of action:- This class of oral antidiabetic drugs are selective agonists for the nuclear peroxisome proliferator-activated receptor g (PPARg) which is expressed mainly in fat cells, but also in muscle and some other cells. It enhances the transcription of several insulin responsive genes. Glitazones tend to reverse insulin resistance by enhancing GLUT4 expression and translocation. Entry of glucose into muscle and fat is improved. Hepatic gluconeo- genesis is also suppressed. Activation of genes regulating fatty acid metabolism and lipogenesis in adipose tissue contributes to the insulin sensitizing action. Lipolysis and plasma fatty acid levels are reduced. Adipocyte turnover and differentiation is accelerated by glitazones. Thus, fatty tissue is a major site of their action. Improved glycaemic control results inlowering of circulating HbA1C and insulin levels in type 2 DM patients. Pioglitazone, in addition, lowers serum triglyceride level and raises HDL level without much change in LDL level, probably because it acts on PPARa as well to induce expression of reverse cholesterol transpoer and some apoproteins. Monotherapy with glitazones is not associated with hypoglycaemic episodes. Ref:- kd tripathi; pg num:-276,277


Question: 35 year old man was found unconscious. Examination revealed bilateral constricted pupil, bradycardia, excessive sweating and secretion. most likely causes

Refer kDT 7/e p 110,111 Signs and Symptoms Muscarinic signs (SLUDGE) salivation, lacrimation, urination, diaphoresis, gastrointestinal upset, emesis and progressing to bronchospasm, bronchorrhea, blurred vision, bradycardia or tachycardia, hypotension, confusion, and shock. Nicotinic effects Skeletal muscle initially exhibits fasciculation (involuntary irregular, violent muscle contractions) followed by the inability to repolarize cell membranes resulting in weakness and paralysis. Severe reactions can lead to ventilatory failure and death (cholinergic crisis).


Question: Beta blockers are contraindicated in


Question: Niacin must be used in diabetics cautiously because

Niacin can result in Insulin resistance and lead to hyperglycemia. Hence, it must be used cautiously in Diabetics.

Increases metabolism of oral hypoglycemic agents


Question: Combination of sulfamethoxazole and trimethoprim is synergistic due to

Sequential blockade in folate metabolism


Question: Dysfunctional uterine bleeding (DUB) is seen in

The term DUB is used for menorrhagia in the absence of any structural abnormality, pelvic pathology or evidence of extra-genital cause for bleeding or endocrine disorder. Metropathia haemorrhagic is a specialized form of DUB. Continuous uterine bleed is the most constant symptom and may be preceded by amenorrhoea of about 8-10 weeks duration. ref katzung 12th ed. Bleeding is always painless and anovulatory. Thick polypoidal endometrium and a cystic follicle are present in one ovary.


Question: Two regarding use of Bromocriptine for suppression of lactation includes

Refer KDT 6/e p236 For suppression of lactation D2 agonists like Bromocriptine can be used In hyoerprolactinemia these are given for long periods Metoclopromide being a D2 antogonist will stop the action of Bromocriptine Adverse effects of Bromocriptine include nausea, vomiting, postural hypotension, digital vasospasm and CNS effects like hallucinations ,psychosis

Metaclopramide potentiates the action of Bromocriptine


Question: sho acting acting beta 2 agonist

sho-acting beta2 agonists- salbutamol., terbutaline, pirbuterol long-acting- salmeterol, formoterol, clenbuterol ref kd Tripathi 8th ed


Question: Vascular dermal necrosis is seen with

Vascular dermal necrosis occurs due to warfarin Cutaneous necrosis with reduced activity of protein C sometimes occurs during the first weeks of therapy. Rarely, the same process causes frank infarction of the breast, fatty tissues, intestine, and extremitiesKatzung 12e pg: 610


Question: Patisiran was approved by FDA recently for

It is a double stranded small interfering ribose neuclic acid ( si RNA) formulated in the form of a lipid complex. used in the treatment of polyneuropathy


Question: The most potent topical coicosteroid is


Question: In staphylococci, plasmids encoding beta lactamase are transmitted by

Ref Goodman Gilman 11/e p 1133 Beta lactamase are encoded by plasmids that can be transferred with the help of bacteriophage in staphylococci and by transformation in pneumococci


Question: The drug contraindicated in variant angina is

Beta blockers are contraindicated invariant or vasospastic angina as they produce vasoconstriction by blocking beta 2 receptors which produce vasodilatation Also, the unopposed action of alpha receptor activation can l.t vasoconstriction. Ref: Katzung 13th ed Pg: 203-206


Question: Propranolol is contraindicated in diabetes mellitus because it

Ref; KD Tripathi pharmacology 7th edition (page no; 146) Propranolol delays recovery from hypoglycemia due to insulin and oral antidiabetics. It masks the warning signs of hypoglycaemia mediated through sympathetic stimulation (tachycardia, tremor).


Question: Drug inhibiting granulocyte migration is

Colchicine * Colchicine, an anti gout medication exes its pharmacological action by hindering granulocyte migration in gouty inflammation. * Colchicine is indicated in the intercritical periods for prolonged prophylaxis against acute attacks of gout. * Mechanism of Colchicine in Acute Gout is illustrated below: Ref:- Goodman & Gilman Pharmacological Basis of Therapeutics 13th Ed; Pg num:- 702-3


Question: The following drug inhibits histamine release

Ketotifen, nedocromil are mast cell stabilizers inhibiting the release of histamine.remaining all options given are histamine releasersRef: KD Tripathi 7th ed pg 229


Question: Safe diuretic in renal dysfunction is

Loop diuretics are safe in renal dysfunction, liver cirrhosis and CCFRef: KDT 7THed Pg 581


Question: New indication of tolvaptan as approved by FDA recently

Tolvaptan is a vasopressin antagonist used for SIADH Now approved for PCKD Ref : HH Sharma 3rd ed.


Question: Longest acting insulin is

(Protamine zinc insulin) (259-KDT 6th)Types of Insulin Preparations and Insulin analogues1. Rapid acting- Insulin lispro, Insulin aspart, Insulin glulisine2. Short acting- Regular (soluble) insuline3. Intermediate acting- Insulin zinc suspension or Lente, Neutral protamine hagedorm (NPH) or Isophane insulin4. Long acting- Protamine zinc insulin (PZI), Insulin glargine


Question: DOC for Extrapulmonary cryptococcal infection without CNS involvement is

Cryptococcal infection with meningitis: DOC IS Amphotericin B with flucytosine,Extrapulmonary without CNS involvement: DOC is fluconazole Ref: Harrison 18th ed/.Pg 1650.


Question: Amphotericin B has the following unwanted effects

Renal impairment occurs in nearly all patients treated with clinically significantdoses of amphotericin.. varying degree of anaemia due to reduced erythropoietin production by damaged renal tubular cellsBasic and clinical pharmacology Katzung 13th edition pg 828


Question: Abatacept is a

Abatacept is a fusion protein consisting of CTLA4 and the Fc poion of IgG1. It inhibits T cell activation by competitively inhibiting the costimulation of T cells that results from an interaction of T cell-expressed CD28 and CD80/86 expressed by antigen-presenting cells. It can be used with or without methotrexate, although its efficacy is greater as cotherapy with methotrexate. It has a positive effect on signs and symptoms of RA and also retards progressive bone damage.


Question: Drug used for acute severe asthma is

Magnesium produce broncho dilatationRef:Harrison 17th ed Pg 1605


Question: Leucovorin is used to decrease the toxicity of

Ref: Katzung 10th/887; KDT 6/e 823 Toxicity of methotrexate can be reversed by the administration of 5-formyltetrahydrofolate (leucovorin or citrovorum factor). Folic acid in the diet is in dihydrofolate form. It is ineffective in reversing methotrexate toxicity.


Question: Cannabinoids are approved by USFDA in June 2018 for new use of

cannabinoids are obatained naturally, semi aynthetic or synthetic in nature. the anti epileptic activity of cannabinoids is proved and approved for use in US by USFDA. Ref: www.ncbi.nlm.nih.gov/pmc/aicles/5767492.


Question: A reasonable explanation for the therapeutic effects of ibuprofen or naproxen in primary dysmenorrhea is that these drugs

PGE, and PGF2a both increase in primary dysmenorrhea, and the therapeutic effects of NSAIDs appear to be due to inhibition of the synthesis of these prostaglandins. Both ibuprofen and naproxen are nonselective COX inhibitors that can inhibit the synthesis of prostacyclin (PGI2 ). NSAIDs do not inhibit phospholipase A2 , and they do not decrease leukotrienes.


Question: Drug of choice for imminent eclampsia is

Labetalol and alpha-methyldopa are safe in pregnancy.Labetol is rapid acting and used in hypeensive emergencies.MgSO4 prophylaxis is used in imminent eclampsia and eclampsia.Ref: KDT 7th ed P 573


Question: The physical half life of radioactive iodine 131 is

RADIOACTIVE IODINE The stable isotope of iodine is 127I. Its radioactive isotope of medicinal impoance is: 131I physical half-life of iodine 131 is 8 days. Mech of action:- 131I emits X-rays as well as b paicles. latter are utilized for their destructive effect on thyroid cells. 131I is concentrated by thyroid, incorporated in colloid--emits radiation from within the follicles. The b paicles penetrate only 0.5-2 mm of tissue. The thyroid follicular cells are affected from within, undergo pyknosis and necrosis followed by fibrosis when a sufficiently large dose has been administered, without damage to neighbouring tissues. Ref:- kd tripathi; pg num:-255


Question: Gender specific adverse effect of valproate is

Long term use of valproate in young girl is associated with higher incidence of polycystic ovarian disease and menstrual irregularities. REf KD Tripathi 8th ed.


Question: Discolouration of the teeth seen in following intake

[A) (Tetracycline) (672 - KDT 5th) (714-KDT 6th)* Tetracyclines have chelating property. Calcium- tetracycline chelate gets deposited in developing teeth and bone Given from mid pregnancy to 5 months to extra uterine life the decidous teeth are affected brown discolouration of teeth, more susceptible to carries. Tetracyclines gives between 3 months to 6 years of age affect permanent anterior dentition. Repeated course are more damaging* Prevention of discolouration of permanent front teeth requires that tetracyclines be avoided from the last 2months of pregnancy to 4 years and of other teeth to 8 years of age (or 12 years if the third molar are valued)* Prolonged tetracyclines therapy can also stain the finger nails at all ages.


Question: Leukotriene antagonist is used as

Ans. is 'b' i.e., Anti asthmatic Drugs used in asthmaBronchodilatorsDrugs reducing inflammation Leukotriene antagonistsMast cell stabilizers CorticosteroidsAnti-IgE antibodya)B2Sympathomimetics* Montelukast* Zafirlukast* Sodium cromoglycate* Ketotifena)Systemic* Hydrocortisone* Prednisolone* Omalizumab* Salbutamol* Bambuteral* Formoterol* Terbutaline* Salmeterol* Ephedrineb)Inhalation* Beclomethasome* Budesonide* Fluticasone* Flunisolide* Ciclesonideb)Methylxanthines* Theophylline* Doxophylline* Aminophyllinec)Anticholinergics* Ipratropium* Tiopratropium* Selective PGE4 inhibitors are under clinical trial as antiasthma drugs. These are cilomilast, roflumilast and tofimilast.


Question: Anti CD20 is


Question: Haemorrhagic cystitis is caused by

Ans. is 'a' i.e., Cyclophosphamide Hemorrhagic cystic is most commonly associated with cyclophosphamide (seen in 5-10 % of patients).In Harrison drugs causing hemorrhagic cystitis have been listed and this also includes Busulphan.Still, I prefer cyclophosphamide as the answer because none of the pharmacology books (This even includes Goodman & Gilman) mention hemorrhagic cystitis as an adverse effect of Busulfan.More question on this topic: -Hemorrhagic cystitis has been attributed to cyclophosphamide because of the presence of acrolein.Adequate hydration and intravenous injection of MESNA (Sodium 2-mercaptoethane sulfonate) minimize this problem.


Question: NADPH actions in RBC are a/e

ATP is not produced by NADPH. ATP is produced by reducing equivalents like NADH, FADH2. W When NADH and other reducing equivalents transfer their electrons through Electron transpo chain in the Mitochondrial inner membrane and generate proton motive force which brings about the ATP synthesis by the ATP synthase complex. Both nicotinamide adenine dinucleotide (NAD+) or nicotinamide adenine dinucleotide phosphate (NADP+) are co-factors of vitamin niacin used by dehydrogenases. However NAD-linked dehydrogenases catalyse oxido-reduction reactions in the oxidative pathways of metabolism, paicularly in glycolysis, in the citric acid cycle and in the respiratory chain of mitochondria.

GP6D deficiency causes decreased synthesis of NADPH


Question: Abciximab is

Ans. b (Gp IIb/IIIa antibody) (Ref. KDT 6th/ Table 112-1)- Abciximab is antiplatelet drug which is Gp Ilb/IIIa antagonist.GPIIb/ IIIa AntagonistsFeatureAbciximabEptifibatideTirofibanDescriptionFab fragment of humanized mouse monoclonal antibodyCyclical KGD-containing heptapeptideNonpeptidic RGD mimeticSpecific for GPIIb/IIIaNoYesYesPlasma half-lifeShort (min)Long (2.5 h)Long (2.0 h)Platelet-bound half-lifeLong (days)Short (sec)Short (sec)Renal clearanceNoYesYes- Other Antithrombotic Drugs are: ANTITHROMBOTIC DRUGS: | ||||Antiplatelet drugsAnticoagulantsDirect thrombin inhibitorsFibrinolytics*Aspirin/*Heparin*Argatroban*Streptokinase*Thienopyridines*LMWH*Lepirudin* Anistreplase(clopidogrel&ticlopidine),*Fondaparinux,*Bivalirudin* rt-PA (alteplase)*Dipyridimole, and*Warfarin * Tenecteplase*GPIIb/llla antagonists.(warfarin is only available oral anticoag)* Reteplase*Desmoteplase* AlfimepraseLMWH and Fondaparinux, ComparisonFeaturesLMWHFondaparinuxNumber of saccharide units15-175Catalysis of factor Xa inhibitionYesYesCatalysis of thrombin inhibitionYesNoBioavailability after subcutaneous administration (%)90100Plasma half-life (h)417Renal excretionYesYesInduces release of tissue factor pathway inhibitorYesNoNeutralized by protamine sulfatePartiallyNoHirudin, Bivalirudinand Argatroban, Comparison. HirudinBivalirudinArgatrobanMolecular mass70001980527Interaction Site with thrombinActive site and exosite 1Active site and exosite 1Active siteRenal clearanceYesNoNoHepatic metabolismNoNoYesPlasma half-life (min)602545


Question: "Eutectic mixture" is

Eutectic mixture is topical applied to skin and mucous membrane and only superficial area is anesthelized, combination of 2.5% lignocanie & 2.5% prilocaine lowers each others melting point & is used as Eutectic mixture.


Question: Renin antagonist is

Direct renin antagonists are aliskiren, remikiren - could be used for HTN in the future- new drugs aliskiren- oral, remikiren- IV side effects- hypotension, hyperkalemia REF KD Tripathi 8th ed


Question: Mechanism of action of Theophylline in bronchial asthma

Refer Katzung 11/e p 345 Theophylline is used in bronchial asthma. It's mechanise of action is Inhibition of phosphodiestesrase paicularly PDE-4 Antagonism of adenosine receptors Enhancement for histone deacetylation


Question: Hyperuricemia is seen with

Chlorthiazide is a thiazide diuretic which can lead to hyper uricema, as Thiazide diuretics competitively inhibit excretion of uric acid.


Question: Low doses of aspirin prolong bleeding time by selec tively inhibiting synthesis of the following mediator in the platelets

Antiplatelet aggregation:- Mech of action:- Aspirin inhibits COX irreversibly and thus inhibits synthesis of PGs. NSAIDs inhibit synthesis of both proaggregatory (TXA2- synthesized in platelets) and anti- aggregatory (PGI2- synthesized by endothelium) prostanoids, but effect on platelet TXA2 predominates . At therapeutic doses most NSAIDs inhibit platelet aggregation, bleeding time is prolonged. Therefore aspirin exes anti- thrombotic effect for several days. Risk of surgical and anticoagulant associated bleeding is enhanced. These drugs should be stopped a week before any elective major surgeries to reduce the risk of bleeding. Ref:- kd tripathi; pg num:-194


Question: Wof alkylating agent is known to cause disulfiram like reaction

Procarbazine It is a weak MAO inhibitor; It produces sedation and other CNS effects, and can interact with foods and drugs. Alcohol causes hot flushing and a disulfiram-like reaction in patients taking procarbazine. Males may suffer sterility. Vomiting, leucopenia, thrombocytopenia are the prominent toxicities. Ref:- kd tripathi; pg num:-861


Question: A 55 year old drug addict from California presents with euphoria, altered time perception, and conjuctival injection. There is impairment of judgment. Most likely cause is addiction from substance


Question: The most likely drug to be effective in diseases caused by cestodes and trematodes is

Praziquantel is the drug of choice for treatment of all fluke (trematode) infections and most tapeworm (cestode) infections. Its antihelminthic action derives from an increase in membrane permeability to Ca, which results in contraction, followed by paralysis, of worm musculature. Mebendazole also has antihelminthic activity, but it is restricted to the nematodes. The other drugs listed are antiprotozoals.


Question: Intravenous inducing agent with maximum plasma protein binding

Ans. is 'd' i.e., Propofol Intravenous inducing agent Protien binding (%) Thiopental 85% Methhexital 85% Propofol 98% Etomidate 75% Ketamine 12%


Question: Arrhythmias refractory to the treatment of lignocaine can be treated by

Katzung 11e p 241. Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types of irregular heabeats. This includes ventricular tachycardia, ventricular fibrillation, and wide complex tachycardia, as well as atrial fibrillation and paroxysmal supraventricular tachycardia.


Question: DOC for acute attack of asthma in patients on Beta blockers

Respiratory airway has beta adrenergic receptors(beta 2 receptors). Beta 2 agonists cause bronchodilatation, and beta 2 blockers cause bronchoconstriction. ipratropium bromide:- Atropine like drugs cause bronchodilatation by blocking M3 receptor mediated cholinergic constrictor tone; act primarily in the larger airways which receive vagal innervation. Ipratropium bromideis a sho acting (duration 4-6 hours) inhaled anticholinergic bronchodilator, while tiotropium bromide is long acting (duration 24 hours). They are the bronchodilators of choice in COPD. Ref:- kd tripathi;pg num:- 227,228


Question: The presence of a drug on left side in the Log DRC tells about its

Dose Response Curve (DRC) - Hyperbola shape Log Dose Response Curve ( log DRC )- Sigmoid shape Three impoant Parameters a) Potency- Potency tells which drug produces more effect on lower dose. Left side graph is of more potent drug as compared to right side graph b) Efficacy- Efficacy tells maximum effect of a drug. It is seen from height of DRC. c) Slope- Slope tells the safety of the drug as more is the slope less is the safety. Quantal DRC - It tells about effect of drug in population Therapeutic index (TI) of a drug = LD50 / ED50 - TI is index of measure of safety.


Question: "Phantom calyx/ Amputed calyx" on IVU is feature of


Question: Duration of action of flumazenil is

Duration of action of flumazenil is 30-60min. So the best answer seems to be 30min The onset of action is about 1 to 2 minutes; 80% response is seen within the first 3 minutes. Peak effect is 6 to 10 minutes after administration.Duration range is from 19 minutes to 50 minutes as it depends on the dose was given and benzodiazepine plasma concentrations Ref: Goodman and Gilman 13th ed.


Question: Selective alpha 2 agonist is

Ref: HL Sharma 3rd ed pg no:180 Clonidine, methyldopa, tizanidine, relminidine are central alpha 2 agonists


Question: Chelating agent used in chronic thalassemia major for iron overload

Defepreninone is oral chelating agent used for chronic use. Whereas desferioxamine is an iron chelator given IV .EDTA is a chelating agent used in blood banks. Ref: KDT 6/e p868


Question: Mechanism of action of sodium nitrate in cyanide poisoning is

Sodium nitroprusside contain 1 Iron molecule coordinated to five cyanide molecules and one molecule of nitric oxide Prolonged use of Sodium nitroprusside may cause cyanide poisoning Detoxification occurs when cyanide and methamoglobin combines to form cyanomethamoglobin. Amyl nitrate and sodium nitrates enhance the oxidation of hemoglobin to methamoglobin, ensuring reliable mechanism of detoxification Refer kDT 6/e p 527


Question: shortest acting mydriatic


Question: Side effect of halothane countered by atropine is

Halothane usually causes sinus or nodal bradycardia which is reversed by atropine. Ref katzung 12th ed.


Question: Free water clearance is decreased by

Flurosemide is a drug which act on both coex and medulla. It acts on the ascending limb of loop of Henle which has both coical and medullary components.Thus,furosemide can block positive as well as negative free water clearance. Vincristine increases the secretion of the harmone ADH and thus decreases positive free water clearance. Chlorpropamide sensitizes the kidney to ADH action.Thus it may decrease the positive free water clearance and in some patients may results in hyponatremia and water intoxication. Most probably the question should have been framed as "All of the following blocks free water clearance,except" But if you have to choose one answer,go for furosemide as it will always block free water clearance where as other drugs will cause them occasionally as it is their adverse effect.


Question: Drug causing ocular hypotension with apnea in an infant is

Brimonidine lowers IOP and causes CNS depression in new born babies and can result in apnea, so it is contraindicated in such patients. Ocular adverse effects of anti-glaucoma drugs DRUG ADVERSE EFFECT Miotics (Pilocarpine) Cataract Stenosis of nasolacrimal system PGF2 analogs (Latanoprost) Heterochromia iridis, Growth of eyelashes, Cystoid Macular Edema Apraclonidine Lid retraction Brimonidine CNS depression and apnea in newborn Adrenaline Conjunctival pigmentation


Question: Aspirin is contraindicated in children suffering from influenza or similar viral infection because of increased risk of

An association has been noted between salicylate therapy and 'Reye's syndrome', a rare form of hepatic encephalopathy seen in children having viral (varicella, influenza) infection. Ref:- kd tripathi; pg num:-197


Question: Mechanism of action of methadone is

Ans. is 'a' i.e., Opioid receptor agonist Methadone* Methadone is opioid receptor agonist.* Most important feature is high oral: parenteral activity ratio (1:2) and firm binding to tissue protein.* It relieves cancer and neuropathic pain not responding to morphine.* Abuse potential is less than morphine.* It also blocks NMDA receptors and uptake of monoamines.* It is the drug of choice for substitution therapy of opioid dependence.* 1 mg of methadone can be substituted for 4 mg of morphine.* Methadone is less hypnotic than morphine (sedative action is less intense).


Question: The drug of choice for treatment of thyrotoxicosis during pregnancy is

Refer KDT 6 /e p 250 Propylthiouracil does not cross placenta and us therefore The drug of choice in first trimester pregnancy


Question: Ketanserine is

5-HT2A antagonistsEdit Antagonists of the 5-HT2A receptor are sometimes used as atypical antipsychotics(contrast with typical antipsychotics, which are purely dopamine antagonists). They include: Cyproheptadine blocks 5-HT2A, H1 and is a mild anticholinergic. Methysergide is a 5-HT2A antagonist and nonselective 5-HT1 receptor blocker. It causes retroperitoneal fibrosis and mediastinal fibrosis. Quetiapine blocks 5-HT2A, 5-HT1A, dopamine receptors D1 and D2, histamine receptor H1, and A1 adrenoreceptors. 5-HT2A/2C antagonistsEdit Ketanserin Antihypeensive. Blocks 5-HT2A, 5-HT2C and Alpha 1 (A1) adrenoreceptors. Risperidone antipsychotic Trazodone antidepressant Clozapine antipsychotic. Blocks 5-HT2A, 5-HT2C and D4 receptors. Nefazodone acts primarily as a potent 5-HT2A antagonist. Refer kDT 6/e p167


Question: Drug of choice for Insulinoma is

Diazoxide is K+ channel opener, which is drug of choice for Insulinoma. It was used for hypertensive emergency but can lead to severe hypotension.


Question: The most significant effect of ACE inhibition is

Refer kDT 6/e p 484 Sho acting ACE inhibitors like captopril main result in postural hypotension.ACE Inhibitors do not affect serum calcium level


Question: Methemoglobinemia is a complication following the administration of


Question: Drug given in OPC poisoning is

Ans. is 'b' i.e., Atropine * Atropine is considered to be a first line drug for treatment of OPC poisoning.* It is highly effective in counteracting the muscarinic symptoms and higher doses counteract the central effects.* 2 mg i.v. repeated every 10 minutes till dryness of mouth or other signs of atropinization appear.* It does not reverse peripheral muscular paralysis which is the nicotinic effect.


Question: INH induced peripheral neuropathy results from deficiency of vitamin

Pyridoxine (vitamin B6) is admistered for the prevention as well as treatment of Isoniazid induced peripheral neuropathy Ref KDT 6/e p741


Question: Prolactin is inhibited by

(A) Dopamine# PITUITARY PROLACTIN secretion is regulated by endocrine neurons in the hypothalamus, the most important ones being the neurosecretory tuberoinfundibulum neurons of the arcuate nucleus, which secrete dopamine to act on the D2 receptors of lactotrophs, causing inhibition of prolactin secretion. Thyrotropin-releasing factor has a stimulatory effect on prolactin release.


Question: Most common side effect of calcium channel blockers is

Calcium channel blockers: Most common side effect is headache CCB cause flushing, headache, angioedema, reflex tachycardia. Verapamil, diltiazem- both vasodilation and decrease in hea rate Nifedipine, clevidipine - only vasodilation but increase in hea rate. Avoid in angina.


Question: Tranexaemic acid is a specific antidote of

ANTIFIBRINOLYTIC DRUGS Tranexamic acid:- It binds to the lysine binding site on plasminogen and prevents its combination with fibrin leading to fibrinolysis. It is preferred for prevention/control of excessive bleeding due to: * Fibrinolytic drugs. * Cardio-pulmonary bypass surgery. * Tonsillectomy, prostatic surgery, tooth extraction in haemophiliacs. * Menorrhagia, especially due to IUCD. * Recurrent epistaxis, hyphema due to ocular trauma, peptic ulcer. side effects:- Nausea and diarrhoea. Thromboembolic events, disturbed colour vision and allergic reactions are infrequent. Thrombophlebitis of injected vein can occur. Ref:- kd tripathi; pg num:-628,629


Question: A single cell within a culture of freshly isolated cardiac muscle cells is injected with a fluorescent dye that cannot cross cell membranes. Within minutes, several adjacent cells become fluorescent. The most likely explanation for this observation is the presence of

Gap junctions are pores composed of paired connexons that allow the passage of ions, nucleotides, and other small molecules between cells. Ref: katzung 12 th ed.


Question: Drug of choice for Neutropenia due to cancer chemotherapy is

ANSWER: (C) FilgrastimREF: KDT 6TH edition, page 833, internet resourcesSee APPENDIX-37 below "ANTICANCER DRUGS TOXIC AMELIORATION" APPENDIX - 37Classification of Cancer Chemotherapy Agents:GroupSubgroups & AgentsAcute ToxicityDelayed ToxicityUsesAlkylatingAgentsNitrogen Mustard Alkylation of DNA at N7 &06 position of Guanine -DNA crosslinking I; b/n 2 strands - prevents duplication(1) Mechiorethamine(First anticancer drug)CINV-chemo induced nausea vomiting (4hr- 48hrs)MyelosuppressionMyelosuppression (delayed type-onset = 7d, Nadir = 10-14d, reco%rerv = 21-28d)AlopeciaMOPP-HodgkinslymphomaAA are commonly used in chronic leukemia(2) Cyclophosphamide1CP - 4hydroxyCP -aldophosphamide- Acrolein (toxic) & phosphamide mustard (active)]CINVMyelosuppression(CP>Ifo)Myelosuppression (CP>Ifo) Alopecia, SIADHHemorrhagic cystitis (Ifo>CP)Sec cancer-transitional cell cancer of bladderWagner'sgranulomatosis DOC CMF-Breast, small cell lung ca Broad spectrumAA are nonphase specific(3) Ifosfamide 4hydroxy ifosfamide (active)CINVMyelosuppression(CP>Ifo)Myelosuppression(CP>Ifo)AlopeciaHemorrhagic cystitis (Ifo>CP)Broad spectrum Lung, breast, ovary, sarcoma, testis, germ cell tumorAA causes secondary leukemia in 4-5 years(4) Melphanamino acid derivative ofmechloretamineCINVMyelosuppressionMyelosuppression No alopeciaMultiple myeloma DOCCan replace C in CMF (5) ChlorambucilMyelosuppression CINV is rareMyelosuppression No alopeciaCLL, Hodgkin's Nitrosoureas(lipophilic-crosses BBB) Nitrosoureas causes delayedMyelosuppression (onset-15d, Nadir-4wks, recovery-6wks) (1) Carmustine (BCNU- bis chloro nitroso urea)CINV (severe-2hrs)Myelosuppression, male infertility,Pulmonary fibrosisBrain tumors DOC(Glioblastomamultiforme.Astrocytoma,Medulloblastoma) (2) Lomustine (CCNU)CINV (severe-2hrs)Myelosuppression Interstitial lung diseasedo (3) Semustine (methyl CCNU)CINV (severe-2hrs)Myelosuppressiondo (4) Streptozocin (methylation of protein & nucleic acid)CINV (severe-2 hrs)No MyelosuppressionPancreatic islet cell tumorCarcinoid tumor Alkyl Sulfonates(Intra strand cross linking of DNA by 2 N7 Guanine) BUSULFAN {Dealkylating agent)Hyperuricemia(MC)Sterility, gynecomastia, seizures, Skin pigmentation, Adrenal insufficiency Pulmonary fibrosis (specific)CM L-DOC until imatinibConditioning of BM transplant Ethyl Enimines Thiotepa(Organophosphorous)CINVMyelosuppressionSeldom used nowNon ClassicalAlkylatingAgentsTriazenes Acts on RNA &Protein synthesis not/ mild DNADacarbazine (Active- methyl carbonium ion)CINV-severePermanent sterility Myelos uppre ssion (early/classical)MAID-sarcoma, ABVD-Hodgkins Malignant melanoma (most active agent) Procarbazine (autoxidize spontaneously, Active- Azoprocarbazine, crosses BBB)CINV, MAO inhibitor Disulfiram like reactionMyelosuppression,DermatitisLeukenogenic,teratogenicMOPP-Hodgkin'sPCV-Glioblastoma AltretamineCINV-severe HypotensionNeuro toxic NephrotoxicRefractory ovarian cancerAlkylating Like AgentsPlatinum Compounds 1st gen platinum Inactivated by aluminumCisplatinCINV (most emitogenic)Hypo Mg, K, Ca sec to hypo Mg)Myelosuppression N ephrotoxicity, Ototoxicity Secondary leukemiaCMF-Solidmalignancies2nc generation platinum, Cross resistance- cisplatinCarboplatinCINV (cis>carbo)Myelosuppression(carbo>ds)No nephrotoxicityLess potent than cisplatin (1:4) GemCarco-Iung cancer3rd generation platinum No cross resistanceOxaliplatinPSN pathy (reversible hand & foot, temp loss)Neurotoxicity (dose limiting)No nephrotoxicity PSN pathyflrreversible, hand, foot, leg, arm, temp loss, propio loss)FOLFOX- colon cancerCis/carboplatin resistance AntimetabolitesFolate Antagonists S phase specificMethotrexate HepatotoxicityMyelosuppressionMucositisChoriocarcinoma DOC, ALL, Osteosarcoma. RA, ectopic Myasthenia, psoriasis, meningeal leukemia (intrathecal route)Inhibits DMA syn thesisPemetrexed : Mesothelioma, nonsmall cell lungNo acute toxicidesPurine Analogue Commonly used in acute leukemias6 THIO Guanine MyelosuppressionHepatotoxicityAdult acute leukemia 6 Mercapto Purine Myelosupp ression, hepatotoxicityChildhood acute leukemia Fludrabine Myelosuppression, Flu like symptom (fever, myalgia, arthralgia) Cladribine Myelosuppression, Nephrotoxic, ClXVHairy cell leukemia Pentostatin NephrotoxicHairy cell leukemia Pyrimidine Analogue 5 Fluorouracil (5-FU) GI upset-diarrhea (MC) Hand foot syndrome, CINVMyelosuppression, neurotoxicity Cerebellar ataxia Cytrabine Stomatitis, CINV, Cerebellar ataxia MyelosuppressionAML Capecitabine CINV, Diarrhea, Hand foot syndrome Myelosupp ression (<5FU)Metastatic breast cancer, Metastatic colorectal cancer Gamecitabine CINV, Myelosuppression (dose limiting)Pancreatic cancer DOC Bladder & Nonsmall cell lung CaAntibioticsAnthracyclinsTopoisomerase 2 inhibitor (me)Quinone Free radical injury & intercalation b/n DNA strandsMembrane binding (responsible for cardiotoxicity) Doxorubicin (Adriamycin)CINV, AlopeciaMyelosuppression (dose limiting, neutropenia >th rombocytopenia) Cardiotoxicity(cardiomy opathy, CHF)Radiation recall Hand foot syndromeBroad spectrum Solid tumors & sarcomas (rhabdo/ leiomyosarcoma, Kaposi sarcoma) DaunorubcinCl MV, AlopeciaMyelosuppression, cardiotoxicity, radiation recallNarrow spectrum AML Idarubcin (synthetic Daunorubicin analogue)CINV, Alopecia, Red urine (not hematuria)Myelosuppression, cardiotoxicity, radiation recallAML (more efficacious than daunorubicin) MitoxantroneCINV, Bluish discoloration of nailsMyelosuppression (dose limiting)Lower cardiotoxicity? Other Antibiotics Bleomycin(Glyco peptide Antibiotic) Free radical injury - ds- ss DMA breaks, have both DNA & Fe binding domainAllergic reaction HypotensionPulmonary fibrosis (dose limiting)Mucocutaneous toxicity? Marrow sparingHL, NHL, SCC Malignant pleural effusionAscitis (sclerosing agent) Mitomycin- CActs as alkylating agentCINVHemolytic uremic syndrome. Pulmonary- fibrosis, 8th nerve damageRadiosensitizer- DOC, SCC Dactinomycin Inhibits all forms of DMA dependent RMA synthesis, r-RNA most sensitiveCINVMyelosupp ression Alopecia Radiation recallPediatric tumors (Ewing's, witm's, Rhabdomyosarcoma) Radiosensitizer ActinomycinCINVDesquamationMyelosuppressionAlopeciaPediatric tumors (Ewing's, wilm's, Rhab domyosarcoma) Radiosensitizer PlicamycinCINV EnzymeL-ASPARGINASE (inhibits protein synthesis of tumor cell by depletion of L-Aspargine)Anaphylaxis/ hyper sensitivity- fever, chills, rash, urticaria (brochospasm, hypotension if severe)Hypercoagulable state Pancreatitis, Hepatotoxicity Marrow sparing, no alopeciaALLIneffective in solid tumors(normal cells spared)Plant DerivedVinca AlkaloidsM phase specificInhibits tubulin polymerizationMitotic inhibitors VincristineAlopeciaPSNpathySIADH, Marrow sparingLymphosarcoma, wilm's, Ewing's Remission of childhood acute leukemia. VinblastineAlopecia (Vc >Vb)PSNpathy (Vc >Vb) MyelosuppressionHodgkin s, testicular carcinoma EpipodophylotoxinsTopoisomerase 2 inhibitor Etopside (VP-16)CINV, HypotensionMyelosuppression, early onset secondary leukemia (1-3 years) alopecia Teniposide (VP-26) TaxansM phase specificEnhance tubulin polymerizationSpindle poison PaclitaxelHypersensitivityPSNpathy (stocking glove type) Myelosuppression,Cisplatin resistance Relapse &resistant breast/ovary ca Docetaxel (more potent)HypersensitivityMyelosuppression, PSNpathy (is less frequent)Cisplatin resistance, Relapse-resistant br/ovary ca CamptothecinTopoisomerase 1 inhibitorss DNA breaks TopothecanCINVMyelosuppression (dose limiting) Irinothecan (active = SN-38)CINV, Cholinergic syndrome (SLUDGE) including early diarrhea-24hrsMyelosuppression, cholinergic syndrome (SLUDGE) including late diarrhea 3-10d (dose limiting)Advanced colorectal ca- DOCMiscellaneousArsenic Trioxide (degradation of PM LI & RARa protein)Headache, lightheadednessCINVCardiotoxicity (QT prolongation, arrhythmias), Myelosuppression Syndrome-fever, fluid retention, wt gain, rashAPL-induction in tretinoin relapse and refractoryHydroxyurea has 100% oral bioavailabilityHydroxyurea (inhibits ribonucleotide reductase - inhibits DMA synthesis)CINVMyelosuppression (dose limiting)HyperpigmentationCMLAML-blast crisis Imatinib (Bcr-Abl Tyrosine kinase inhibitor)CINVFluid retention, Ankle & perioral edemaCML-chronic phase GIST with Ckit tyrosine kinase Dasatinib & Nilotinib (novel agents- TK inhibitors) CML- imatinibresistance/intoleranceAnticancer Drug Toxicities:MYELOSUPPRESSIONAll except Asparginase, Vincristine, BleomycinCARDIOTONICAnthracyclins, arsenic trioxideNEPHROTOXICPlatinum compounds (cisplatin>carboplatin>oxaliplatin)PULMONARY FIBROSISBleomycin. Busulfan, CarmustinePERIPHERAL NEUROPATHYGxaliplatin, vincristine Taxans (stoking & glove type)HAEMORRHAGIC CYSTITISCyclophosphamide, IfosfamideHAND FOOT SYNDROME5FU, Capecitabine, DoxorubicinCEREBELLAR ATAXIAPyrimidine analogs like Cytrabine & 5FUSIADHCyclophosphamide, VincristineSECONDARY LEUKEMIAAll alkylating agents & alkylating like agents (in 4-5 years) E topside (in 1-3 years)STERLITYAlkylating agentsDISULFIRAM LIKE REACTIONProcarbazineCHOLINERGIC SYNDROMEIrinitecanRADIATION RECALL SYNDROMEAnthracydinsAnticancer Drugs Toxic Amelioration:ToxicityMeasuresMethotrexateFolinic acidAlkalization of urine (Mtz is weak acid & reabsorbed in acidic urine)Hemorrhagic cystitis (cyclophosphamide, ifosfamide)ME SNA (2 mercapto ethyl sulfonyl sodium) systemic ACETYLCYSTEINE irrigation of bladderHigh fluid intakeFrequent voidingCINV (Cytotoxic drug induced nausea Stvomiting )Ondansetron (5HT3 Antagonist)Cytotoxic drug induced MucositisPabfermin (human recombinant keratinocyte growth factor)TUMOR LYSIS SYNDROME (hyperkalemia, hypophosphatemia, hyperuricemia, hypemricosuria, hypocalcaemia, acute renal failure)prophylactic ALLOPURINOL (xanthine oxidase inhibitor)alternatively RASBURICASE (urkase)Aggressive hydrationHigh urine outputAlkalization of urine not recommended/controversialDiuresis is reserved for well hydrated patientsHEMODIALYSIS (if above fails) MYE LOS OPPRESSIONFor AnemiaERYTHROPOIETIN (recombinant)For NeutropeniaFILGRASTIM- Granulocyte colony-stimulating factor (G-CSF) analogSARGRAMOSTTM - Recombinant granulocyte macrophage colony stimulating factor (GM-CSF)For ThrombocytopeniaOPRELVEKIN (IL-11)BONE MARROW TRANSPLANT (for extreme suppression)CANCER CACHEXIATHALIDOMIDECYTOPROTECTION of normal tissueAMIFOSTINE= WTR-2721=prodrug(active = free thiol=WR-1065. activation normal tissue)USES=cispIatin based chemotherapy & radiation therapyAnthracyclins induced CARDIOTOXICITYDEXRAZOXAXE (ICRF-187) Iron chelating agent Cardio protective agent, derivative of EDTA


Question: In Lepra reaction, drug useful is

Refer KDT 6/e p752 Anti inflammatory drugs are used in Lepra reaction Steroids ,Clofazimine and thalidomide can be used


Question: Tildrakizumab was approved by FDA in 2018 for

Tildrakizumab was approved by FDA in 2018 to treat adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy


Question: Oral Factor Xa Inhibitor is

Factor Xa inhibitors * Oral Direct Factor Xa (Stua-Prower factor) Inhibitors are Rivaroxaban, Apixaban, Betrixaban and Edoxaban * Rivaroxaban inhibits free and clot associated Factor Xa AE reducing !rombin generation AE suppressing Platelet aggregation and Fibrin formation. * Other options: * Dabigatran etexilate is an Oral Direct Factor IIa (Thrombin) Inhibitor * Fondaparinux is a parenteral synthetic Heparin derivative anticoagulant * Bivalirudin is a parenteral Hirudin-based Thrombin Inhibitor. * Salient features of Rivaroxaban: Ref:- Goodman & Gilman's the pharmacological basis of therapeutics 13th Edition; Pg num:- 594.


Question: Arrange the following drugs according to their half life in increasing order 1. Amiodarone 2. Adenosine 3. Esmolol 4. Omeprazole

Amiodarone is longest acting anti-arhythmic drug. Its half life is more than 3 weeks. Adenosine is shoest acting anti-arrhythmic drug having half life less than 10 seconds. Esmolol is an ultra sho acting beta blocker. It is metabolized by pseudocholinesterase and thus has half life less than 5 minutes. Omeprazole has half life of 1-2 hours but works for 24 hours due to irreversible inhibition of proton pump. Thus, the sequence is Adenosine < Esmolol < Omeprazole < Amiodarone


Question: The surfactant is produced by

The smaller type II pneumocytes are often more numerous than type I pneumocytes, and they contribute less than 10% of the surface area.Their cytoplasm contains numerous characteristic secretory lamellar bodies. Ultrastructurally, the lamellar bodies are comprised of concentric whorls of the phospholipid-rich membrane, the precursors of alveolar surfactant. “Surfactant is stored in lamellar bodies and secreted in the form of tubular myelinby type II pneumocytes.


Question: Tramadol is

Ans. d (Opioid analgesic). (Ref. KD Tripathi, Pharmacology/6th. 453)# Tramadol is synthetic centrally acting opioid analgesic having modest affinity for ji receptors.# Unlike other opioids, it inhibits reuptake of NA and 5-HT and thus activates monoaminergic spinal inhibition of pain.# Its oral bioavailability is good and it has minimal hemodynamic effects and hence safer in patients with compromised CVS function.# It is indicated for medium intensity short lasting pain due to diagnostic procedures, injury, surgery, etc as well as for chronic cancer pain.


Question: Bisphosphonates act by

Bisphosphonates (BPNs) are analogues of pyrophosphate: carbon atom replacing oxygen in the P-0-P skeleton. They inhibit bone resorption by inhibiting osteoclast function- useful to prevent osteoporosis in addition to metabolic bone diseases and hypercalcaemia. (REF.Essentials of Pharmacology TD TRIPATHI 6th EDITION page no 333)

Increasing the mineralization of osteoid

Decreasing the osteoclast mediated resorption of bone

Decreasing the parathyroid hormone secretion


Question: Causes of reduced bioavailability of a drug includes

When the metabolism of a drug is high during its passage from the site of absorption into the systemic circulation, the rate, and extent of absorption of that drug decreases. absorption- amount of drug reaching the systemic circulation from the site of administration (Ref.Essentials of medical pharmacology TD Tripathi 7th edition page no.16,27)


Question: 60 yr old lady with RA is considered for infliximab therapy tests to be done are

TNF alpha inhibitors can cause reactivation of latent TB. Othr drugs in TNF alpha inhibitors are adalimumab, golimumab. Ref: Katzung 11/e p633


Question: Mannitol is used in the management of

Mannitol * Mannitol, an osmotic diuretic is a drug preferred in reduction of acutely raised intraocular pressure due to Acute Congestive Glaucoma. * Other agents used to relieve raised Intraocular Pressure (IOP) are: Glycerin, Hypeonic saline and Acetazolamide. * Sho term management measures to decrease IOP - needed in acute glaucoma attacks or pre/post ocular surgical procedures are met by Glycerin and Mannitol. * In an acute attack of glaucoma, associated symptoms of nausea and emesis - deter the use of oral agents (like glycerin) - in such instances, IV Mannitol or Acetazolamide are preferred. Therapeutic Indications of Mannitol: - By IV route: - * Treatment of dialysis disequilibrium syndrome * Reduction of IOP in acute glaucoma and during periopeaive periods of ocular surgeries. * To reduce intracranial tension associated with cerebral edema and CNS mass lesions. * For treatment and prevention of acute kidney injury * Enhance urinary excretion of Salicylates, Barbiturates, Bromides and Lithium following their overdose. By oral inhalation:- To diagnose bronchial hyperreactivity. Transurethral irrigation:- To prevent hemolysis during urological procedures. Use of Mannitol is contraindicated in:- CongestiveCardiac Failure, Pulmonary Edema, Renal Failure and in patients with active cranial bleeding. Ref:- Goodman & Gilman Pharmacological Basis of Therapeutics 13th Ed; Pg num:-1267


Question: Major neurotransmitter released at end organ effectors of the sympathetic division of autonomic nervous system

Refer katzung 10e p76,kdt 6/e 116 Neurotransmitter secreted at the end organ effects of sympathetic system is mostly nor adrenaline (except hair follicles and sweat glands, where it is Acetylcholinesterase) where as it is acetylcholine in parasympathetic system


Question: Coasting effect is seen with

Platinum compounds can result in Coasting effect. It is the term used to describe the sensory loss seen even after the cessation of chemotherapy.


Question: Quindine is used to treat


Question: Antidote of datura poisoning is

Datura is atropine .antidote is physostigmine because it is a teiary amine which can cross BBB and neutralize central effects produced by atropine Ref: KDT 6th ed pg 101-102


Question: Dabigatran toxicity is treated by

Idarucizumab is a monoclonal antibody used to treat Dabigatran toxicity.