Question: For drugs with first order kinetics the time required to achieve steady state levels can be predicted from

Ans. is 'b' i.e., Half-life Steady stateplasma concentration After 5 t1/2, nearly complete drug is eliminated from the body o If a constant dose of drug is repeated before 5 V/2, the concentration in blood will be higher, because some remnant of the previous dose will be present in the body. o So, when a drug is infused at a constant rate the plasma concentration rises until a state is reached at which the rate of administration of drug to the body is exactly equal to the rate of elimination. o This is called the steady state ---> when it is attained the amount of drug in the body remains constant i.e. the plasma concentration is on a plateau ---> plateau principal of drug accumulation. o If a drug is administered by a constant rate the time to reach steady state depends only on the t1/2. o With passage of each V/2 period of time, the plasma concentration rises by half the difference between the current concentration and the ultimate steady state (100%) concentration. o For all practical purposes, after 5 t1/2 the amount of drug in the body will be constant and the plasma concentration will be at a plateau. o For example, if a drug with t1/2 4 hours and plasma concentration 100 mg/ml is given at a constant rate ie every 4 hrs. 1st dose --> at 0 hrs 2nd dose --> at 4 hrs 3rd dose at 8 hrs 4th dose --> at 12 hrs-------------------- so on. o After 4 hrs (1 t1/2) the drug concentration --> 50 mg/ml. o After 8 hrs (2 t1/2) 75 mg/ml (50 of 1 st dose + 25 of 2" dose) o After 12 hrs (3 t'/2) --> 87.5 mg/ml (50 of 3" dose + 25 of 2" dose + 12.5 of 1' dose) o After 16 hrs (4 t1/2) --> 93.75 (50 of 4th dose + 25 of 3rd dose + 12.5 of 2' dose + 6.25 of 1" dose) o After 20 hrs (5 t1/2) --> 96.875 (50 of 5th dose + 25 of 4th dose + 12.5 of 3rd dose + 6.25 of 2' dose + 3.125 of V dose) o After 24 hrs (6 t1/2) --> 96.875 (50 of 6th dose + 25 of 5th dose + 12.5 of 4th dose + 6.25 fo 3rd dose + 3.125 of 2' dose + nil from 1st dose, after 5 t1/2 nearly complete drug elimination occurs & first dose is eliminated after 5 VA). o So, after 5 t1/2 plasma concentration will be constant.


Question: INH can be used safely in the presence of

ReferKDT 6/e p740 INH causes hepatitis Peripheral neuritis Neurological manifestations *****its toxic metabolites accumulates in the presence of renal failure so we are left with last option, coronary aery disease, which is our answer of exclusion


Question: Most common cause of neonatal seizures is not related


Question: Iron is most commonly absorbed from

Refer Katzung 11/e p 571 Maximum iron absorption occurs in duodenum and proximal jejunum Vitamin B12 is absorbed in distal ileum whereas folic acid is absorbed in proximal jejunum


Question: Drug contraindicated in bilateral renal aery stenosis

Refer kDT 6/e p 484 Renal aery stenosis is thenarrowing of one of the renal aeries, most often caused by atherosclerosis or fibromuscular dysplasia. This narrowing of therenal aery can impede blood flow to the target kidney, resulting in renovascular hypeension - a secondary type of high blood pressure. Angiotensin-conveing enzyme inhibitors (ACEIs) arecontraindicated in patients withbilateral renal aery stenosis due to risk of azotemia resulting from preferential efferent aeriolar vasodilation in the renal glomerulus due to inhibition of angiotensin II.


Question: Grey baby syndrome is caused by

Amikacin - nephrotoxicity, ototoxicity and neuromuscular blockade Tetracycline - nephrotoxicity when given along with diuretics, phototoxicity, , affect dentition and bones in young children, Fanconi syndrome and Renal tubular acidosis. Vancomycin - red man syndrome Chloramphenicol- grey baby syndrome,nephrotoxicity,ototoxicity.


Question: Nitrous oxide is carried in the blood stream by


Question: Eclampsia seizures drug of choice

Eclampsia in pregnancy can be treated by magnesium sulphate. It is given by i.m route with the monitoring of reflexes mainly the patellar refex Ref: Katzung 12th ed.


Question: Tolvaptan is used for

Tolvaptan:- * Tolvaptan is a selective Vasopressin V2 receptor antagonist indicated in treatment of euvolaemic or hypervolaemic hyponatremia (Na+ < 125mEq/L or clinically symptomatic hyponatraemia, in spite of fluid restrictive corrective measures), including patients with Syndrome of Inappropriate ADH Secretion and Hea Failure. * Bater and Schwaz criteria defines SIADH as follows: Ref:- Goodman & Gilman's Pharmacological basis of Therapeutics 13th Ed; Pg Num:- 466


Question: A female presents with placenta pre with active bleeding and blood pressure of 80/50 MM Hg and pulse rate of 140 bpm. The choice of anesthesia for emergency cesarean section of this female is

Refer Williams Obstetrics 24th/e p 518 The patient is presenting with shock, so spinal anesthesia can't be used Among the general anesthetics, Ketamine is drug of choice for induction in patients with low blood pressure

General anesthesia with intravenous propofol

General anesthesia with intravenous Ketamine


Question: Digoxin toxicity is aggrevated by

Hypokalemia is usually observed with chronic toxicity or in patients taking diuretics; it reduces the rate of Na+/K+ ATPase pump turnover and exacerbates pump inhibition due to digitalis. Hyperkalemia is the usual electrolyte abnormality precipitated by digoxin toxicity, primarily in the acute setting Refer kDT 6/e p499


Question: Basiliximab is a monoclonal antibody against

(A) IL-2 receptor[?]IL-2 is a type of cytokine signaling molecule in the immune system that regulates the activities of white blood cells (leukocytes, often lymphocytes) that are responsible for immunity.oBasiliximab is a chimeric murine monoclonal antibody acts as IL-2 antagonist used to prevent organ rejection in kidney transplant.oMOA: Basiliximab binds with high-affinity to the alpha-subunit (CD25) of IL-2 receptor. This inhibits IL-2 binding, which inhibits T-cell activation and prevents an immune response in organ transplantation.oUses:-Indicated for prophylaxis of acute organ rejection in renal transplant patients and also as a part of an immunosuppressive regimen along with glucocorticoids and cyclosporine.Adverse effects - Anaphylactic reactions & opportunistic infections.Daclizumab: humanized lgG1 chimeric monoclonal antibody.Has a somewhat lower affinity but a longer t1/2 (20 days) than Basiliximab (7 days) MONOCLONAL ANTIBODIESAntibodyType1 TargetIndicationAbciximabChimeric1 Inhibition of Gp lib/IIIaCardiovascular diseaseAdalimumabHumanffInhibition of TNF-alfa signalingSeveral autoimmune disordersAlamtuzumabHumanized1 CD52CLLBasiliximabummericIL-2 receptor (CD25)Transplant rejectionBevacizumabHumanized1 Vascular endothelial GFColorectal cancer, macular degenerationDaclizumabHumanizedIL-2 receptor (CD25)Transplant rejectionEuclizumabHumanizedComplement system protein C5Paroxysmal nocturnal hemoglobinuria4 fefalizumabHumanizedCD11aPsoriasisGemtuzumabHumanizedCD33Acute myelogenous leukemiaInfliximabChimericInhibition of TNF-alfa signalingSeveral autoimmune disordersMuromonab-CD3MurineT cell CD3 receptorTransplant rejectionNatalizumabHumanized Multiple sclerosis and Crohn's diseaseOmalizumabHumanisedIG EAllergy related asthmaRitixumabChimericCD20 Non hodgekin's lymphomaTrastuzumabHumanizedErbB2Breast cancer


Question: Drug distribution is inversely propoional to

The extent of distribution of a drug depends on its lipid solubility, ionization at physiological pH, the extent of binding to plasma and tissue proteins, differences in regional blood flow. If PPB is high VD is low, PPB is inversly propoional to vd drugs with low vd usually have high ppb ref; KD Tripathi pharmacology 6th edition (page no;18)


Question: Arrange the insulin in order of their duration of action (shoest first and longest last) a. NPH b. Glargine c. Detemir d. Degludec

Duration of action of insulin : a<c<b<d a. NPH- Intermediate Acting(10-20h) b. Glargine- Long Acting(20-24h)- pH-Acidic c. Detemir - Long acting(16-24h) d. Degludec- Longest acting (>40h)


Question: Angiotensin II receptor antagonist is

(Losartan) (453-54-KDT) (469-70-BB) (488-KDT6th)I. ACE-Inhibitors - Captropril, Enalapril, Lisinopril, benazepril, ramipril, perindopril (Available in India)* Quinapril, cilazapril, Zolfenopril, fosinopril (Marketed in other countries)II. Angiotensin Antagonists* Losartan, Candesartan and Irbesartan (Available in India)* Valsartan, telmisartan and eprosartan (Marketed elsewhere)


Question: Theophylline metabolism interaction with ciprofloxacin

(Decreases theophylline metabolism) (221-KDT 6th)* Ciprofloxacin and ofloxacin can Increases the serum levels of theophylline by inhibiting its metabolism Agents which induce theophylline metabolism decreases its plasma level Drug which inhibit theophylline metabolism and Increases its plasma levels* Smoking* Phenytoin* RifampicinPhenobarbitoneCharcoalBroiled meat meal* Erythromycin* Ciprofloxacin* CimetidineOralcontraceptiveAllopurinol Theophylline enhances the effects of - Furosemide, sympathomimetics, digitalis, oral anticoagulants, hypoglycemics Theophylline decreases the effects of - Phenytoin, lithium


Question: Dose dependant least neurotoxicity is found in

i.e. (Bleomycin): (527-H17th)DOXORUBICIN (525-H17th)* Predictable myelosuppression* Alopecia, nausea, mucositis* Cardiotoxicy in the form of atrial and ventricular dysarrhythmias* Powerful vesicant with necrosis of tissue apparent 4-7 days after an extravasation* Dexrazoxane is an antidote to doxorubicin-induced extravasationBLEOMYCIN (Antibiotics) (525-H17th)* Fever and chills, facial flush, and Raynaud's phenomenon* Hypertension, anaphylaxis* Pulmonary fibrosis * ** Little myelosuppressionCISPLATIN - (524-H17th)* Renal impairment is common*** Hypomagnesemia, hypocalcemia and tetany** Neurotoxicity with stocking and glove sensory motor neuropathy**** Hearing loss (50%)** Highly emetic drugs * ** Myelosuppression is less* Chronic vascular toxicity (Raynaud's phenomenon, Coronary artery disease) is a more unusual toxicity* Cisplatin is accumulated by proximal tubular cells where it induces mitochondrial injury and causes apoptosis and necrosis of renal tubular cells - ARF* Cisplatin is mutagenic, teratogenic and carcinogenic - Secondary leukemias are reported with the use of cisplatin and the use of cisplatin or carbolatin based chemotherapy for women with ovarian cancer is associated with a fourfold increased risks of developing secondary leukemia (1433-Goodman Gilman 10th)* Cisplatin has been associated with the development of AML usually 4 years or more after treatment -Lawrence


Question: Thiazide causes

The increased hydrogen ion loss in the urine can lead to metabolic alkalosis in the plasma- seen with thiazides and loop diuretics metabolic acidosis is seen with potassium-sparing diuretics- (due to the increase in chloride content in the plasma)and with CA inhibitors Ref KD Tripathi 8th ed


Question: Hemodialysis is NOT useful in poisoning with

(B) Diazepam # HAEMODIALYSIS:> It is very useful for removing ethanol, methanol, ethylene glycol, chloral hydrate, lithium, trivalent arsenic, acetaminophen, bromides, phenobarbital, bromides, salicylates, fluoride, sodium chlorate, digitalis, methaqualone, boric acid and thiocyanates.


Question: A patient on treatment for leukemia, develops chest pain, pulmonary infiltrates and pleural effusion. The likely cause is

Ans. (D) Tretinoin(Ref: Katzung 10th/899; KDT 8th/e p928)Tretinoin causes chest pain, pleuritis, pulmonary infiltrates and pleural effusion. It is a known human teratogen. Daunorubicin and doxorubicin cause cardiotoxicity manifested as arrhythmias and CHF.


Question: Drug of choice for treatment of infestation due to Onchocerca volvolus is

DOC for all nematode including their larvae: ALBENDAZOL Exception:- FILARIA: DEC - STRONGYLOIDES, ONCHOCERCA: IVERMECTIN


Question: Dose of Carbetocin for post paum hemorrhage

Refer Goodman Gilman 12th/1851 Carbetocin is along acting Oxytocin that us useful to prevent post pay hemorrhage given intramuscularly or intravenously in a dose of 100 microorgam


Question: Forced Alkaline diuresis is useful in the poisoning of

Barbiturates Forced alkaline diuresis increses the excreation of some drugs in urine and is used in treatment of drug overdose or treatment of poisioning by these drugs.Sodium bicarbonate is used.Other drugs where it is used as treatment are salicylates,cocaine,amphetamine. Ref: K.D.Tripati.7th Ed., Pg: 29


Question: In leprosy, the best bactericidal agent is

Refer KDT 6/e p753. Best and the fastest acting drug for leprosy is Rifamipicin Clofazimine and Dapsone are bacteriostatic agents


Question: Wof chemotherapeutic drugs inhibit the polymerization of microtubules but is not associated with causing bone marrow supression

Vinca alkaloids Mech of action:- These are mitotic inhibitors, bind to microtubular protein--'tubulin', prevent its polymerization and assembly of microtubules, cause disruption of mitotic spindle and interfere with cytoskeletal function. The chromosomes fail to move apa during mitosis: metaphase arrest occurs. They are cell cycle specific and act in the mitotic phase. Vincristine (oncovin):- Uses:- It is a rapidly acting drug, very useful for inducing remission in childhood acute lymphoblastic leukaemia, but is not good for maintenance therapy. Other indications are acute myeloid leukaemia, Hodgkin's disease, Wilms' tumour, Ewing's sarcoma, neuroblastoma and carcinoma lung. Adverse effects:- peripheral neuropathy and alopecia. It also causes ataxia, nerve palsies, autonomic dysfunction (postural hypotension, paralytic ileus, urinary retention) and seizures. Bone marrow depression is minimal, but syndrome of inappropriate secretion of ADH (SIADH) can occur. Ref:- kd tripathi; pg num:-865


Question: Most effective treatment for severe malaria is

Refer Harrison 19th/1699-1701 Drug for choice for severe or complicated malaria is aesunate .For more6 details see text


Question: The alpha 2 agonist used in glaucoma is

Ref: KD Tripathi pharmacology 7th edition (page.no: 153) a2 agonist used for glaucoma is Brimonidine, Apraclonidine. Drugs used for glaucoma - b blocker; Timolol,Betaxolol PG analogue ; Latanoprost ,Bimatoprost Carbonic anhydrase inhibitors ; acetazolamide ,Dorzolamide Miotics; Pilocarpine


Question: The following is not an immunomodulator

Cycloserine is an antibiotic. Remaining all are immune-modulators which are calcineurin inhibitors.Ref: Katzung 13th ed Pg 1135


Question: An anxiolytic benzodiazepine that has additional antidepressant propey is

Anti-anxiety benzodiazepines are D: Diazepam O: Oxazepam C: Chlordiazepoxide L: Lorazepam A: Alprazolam -- Chlordiazepoxide is benzodiazepine of choice for alcohol withdrawal. -- Lorazepam has high risk of causing amnesia. It is the only benzodiazepine recommended by intramuscular route. -- Alprazolam has additional mood elevating action. It is paicularly useful in anxiety associated with depression.


Question: Atorvastatin is used as an anti dyslipidemic drug. These drugs inhibit their target enzyme by

Atorvastatin: Anti dyslipidemic drug Inhibits HMG COA reductase competitively. Propeies of Atorvastatin: - Antioxidant propey. High efficacy, most commonly used statin capable of lowering LDH by 55-60 % Longer plasma t 1/2 14 - 18 hrs. Competitive Non competitive 1. Antagonist bind with same site as substrate (active site) 2. Antagonist resembles chemically with the substrate 3. Km increase 1. Binds to another site called allosteric site 2. Does not resemble 3. Vmax decrease


Question: Buprenorphine is partial agonist of

Ans. is 'a' i.e., Mu (m) receptor BuprenorphineReceptor p(mu) - Partial agonistK (kappa) - Antagonist (moderate) d (delta) - Also know -Buprenorphine produces ceiling effect


Question: Drug remaining in body after 3 half lives is

Half-life- time taken by the drug to become half of its earlier concentration it takes 5-6 half-lives for a drug to almost get eliminated from the body Ref: KD Tripathi 8th ed


Question: One of the obvious consequences of alchol (ethanol), ingestion in many individuals is facial flushing and increased heart rate triggered off by alcohol getting metabolized to


Question: Drugs highly bound to albumin


Question: Antiinflammatory action of steroid is due to inhibition of

Ans. is'c' i.e., Phospholipase A2(Ref: KDT Vh/e p. 286)Glucocoicoids interfere at several steps in the inflammatory response but the most impoant overall mechanism appears to be limitation of recruitment of inflammatory cells at the local site and production of proinflammatory mediators like PCs. LTs. PAF through inhibition of phospholipase A2


Question: Muscle rigidity due to opiods is becasue of their effect on aEUR'

When used as an anaesthetic opioids may caue muscle rigidity. - Opioid induced rigidity is characterized by increased muscle tone progressing at times to severe stiffness. - When the rigidity increases and involves thoracic and abdominal muscle, it may impair ventilation. - Rigidity of the abdominal and/or thoracic muscles was thought to underlie opioid induced impairment of spontaneous or controlled ventilation. The precise mechanism by which opioids can cause muscular rigidity is not clearly understood. Muscle rigidity is not due to direct action on muscle fibres because it can be decreased or prevented by pretreatment with muscle relaxants. In addition, opioid induced muscle rigidity is not associated with increase in creatinine kinase a .finding suggesting that little or no muscle damage occurs during this period. - Opioids do not have any significant effect on neuromuscular conduction and result in only minimal depression of monosynaptic reflexes associated with muscle stretch receptors. - Some investigators have suggested that opioids produce rigidity by altering dopamine concentrations within the striatum.s of the brain. Rigidity may occur due to the result of stimulation of GABA ergic interneurons which can be blocked by lesion in the striatum. Continuous research and data seems to indicate that the main mechanism responsible for opioid induced muscle rigidity is stimulation of it receptors. - Opioids appear to produce their physiological effects by.binding to at least three types of opioid receptors the mu (p), delta (8) and Kappa (x) receptors. - Muscle rigidity occurs after administration of supra analgesic doses of potent p preferring opioids. - The present data demonstrates that whereas systemic opiate induced muscle rigidity is primarily due to the activation of central mu receptors, supraspinal delta and kapp receptors may attenuate this effect. Anaesthesia review by Michelle Bowman Howard states (p134) -All opioids given in high doses may cause muscular rigidity. It is most likely related to I.i receptors in the caudate nucleus. It is more commonly seen with Fentanyl.


Question: The following drug is a synthetic choline ester (REPEAT)

Remaining all are naturally obtained from plants-alkaloids-the word ends with ''ine'' Ref: KDT 7th ed pg 101


Question: Antiparkinsonian drug activating D2 receptors directly

Direct D2 activators are bromcriptine , pergolide,pramipexole,ropinirole. ENtcapone and tolcapone are COMT inhibitors and selegiline is a MAO inbibitor used in PD.In PD there is decrease of dopamine in the substansia nigra. Ref:KDT 6/e p419


Question: Most common dose limiting toxicity of chemotherapeutic agent

Myelosuppression "Myelosuppression with depression of both antibody and cell mediated immunity is the single most impoant dose limiting factor with cytotoxic agents and carries life threatening consequences". Repeated blood monitoring is essential and transfusion of red cells and platelets may be necessary. Cell growth factors e.g. the natural (granulocyte colony stimulating factor (filgrastim) are available to protect against or resolve neutropenia.


Question: The site of action of the furosemide is

Furosemide is a loop diuretic and this group of drugs act on thick ascending limb of loop of Henle


Question: The following monoclonal antibody is used in senile dementia

The picture shows monoclonal antibody against beta-amyloid- bapineuzumab -new drug for alzhemier'sdisease.''neu'' in bapineuzumab indicates neuroprotectiveRef:HL and KK Sharma 3rd ed pg 548


Question: Digoxin can accumulate to toxic level in patient with

Refer kDT 7/e 497 Digoxin incompletely distributes across the placental barrier. Most of the digoxin is eliminated unchanged by the kidneys. ... Renal failure also decreases the clearance of digoxin, and may cause accumulation to toxic levels if dosage is not adapted thoroughly.


Question: Drug inhibiting release of Ach at myoneural junction is

Ans) a ( Botulinum toxin) Ref Goodman & Gilman 11th ed, KDT 5th ed page 76Two toxins interfere with cholinergic transmission by affecting release. Boutilinum toxin inhibit release, while black widow spider toxin induces massive release and depletion. The site on the presynaptic nerve terminal for block of ACh release by botulinum toxin; death usually results from respiratory paralysis unless patients with respiratory failure receive artificial ventilation.Injected locally, botulinum toxin type A is used in the treatment of certain ophthalmological conditions associated with spasms of ocular muscles (e.g., strabismus and blepharospasm) and for a wide variety of unlabeled uses ranging from treatment of muscle dystonias and palsy to cosmetic erasure of facial lines and wrinklesHemicholinium, a synthetic compound, blocks the transport system by which choline accumulates in the terminals of cholinergic fibers, thus limiting the synthesis of the ACh store available for release.Vesamicol blocks the transport of ACh into its storage vesicles, preventing its release.


Question: Action of alpha 2 and b1 receptors on adenyl cyclase

Beta receptors are GsPCR -so increase adenyl cyclase activity.alpha 1 -g1 pcr,alpha 2 GiPCR-decrease adenyl cyclase activity Ref: KD Tripathi 8th ed.


Question: Aspirin is avoided in children with influenza infection because of association of


Question: Carmustine is a


Question: Toxic dose of lithium

Lithium toxicity, also known as lithium overdose and lithium poisoning, is the condition of having too much lithium in the blood. This condition also happens in persons that are taking lithium in which the lithium levels are affected by drug interactions in the body. Ref: KD Tripathi 8th ed.


Question: Anti cancer drug causing nephrotoxicity


Question: DOC for prophylaxis against Diphtheria

Chemoprophylaxis against Diphtheria:- * Close contacts are subjected to throat cultures to establish their carrier status. * Irrespective of culture results, all contacts are staed on chemoprophylaxis. Chemoprophylaxis Drug options: * Oral Erythromycin (1g/day for adults; children - 40mg/Kg/day): once a day for 7-10 days in patients over 6 months of age. * IM Benzathine Penicillin G (1.2 MU) one dose for contacts >6 years. Half the dose in paediatric contacts less than 6 years. * Apa from Chemoprophylaxis, Immunization of the Contacts of Diphtheria patients is based on their vaccination status. Diphtheria antitoxin vaccine is given to contacts if their vaccination status is unceain or questionable. Ref:- Harrisons Principles of Internal Medicine 20th Ed; Pg Num:- 1098


Question: General anaesthetic most likely to cause bronchodilation is


Question: Drug effective in Tardive dyskinesia

Ans. is 'd' i.e., Terabenazine o There is currently no satisfactory treatment for tardive dyskinesia other than discontinuation of drugo Terabenazine (TBZ) is currently considered as a first line and most effective medication for treatment of persistent and disabling tardive dyskinesia. Reserpine is an alternative to terabenazine.Read following information (from www.ncbi.nlm.nih.gov)The dopamine-depleting drugs reserpine and TBZ inhibit vesicular monoamine transporter (VMAT) at the presynaptic membrane of the nerve terminal; thus exposing monoamines to monoamine oxidase, which results in depletion of the synaptic pool of monoamines. Reserpine has slow onset and a prolonged duration of action that should be taken into consideration while changing the dose. It blocks both types of VMAT: VMAT1 found peripherally and VMAT2 present in CNS. TBZ has quicker onset and shorter duration of effect. It selectively inhibits VMAT2 and therefore does not have peripheral catecholamine depleting side effects, such as orthostatic hypotension and gastrointestinal side effects. TBZ is currently considered a first-line agent and the most effetive medication to treat persistent and disabling TD.


Question: Antidiabetic used safely in renal failure


Question: Drug of choice for termination paroxysmal Supraventricular tachycardia is

Refer kDT 7/e p536 Adenosine is a sho-actingmedication that is commonly used as a first-line drug to treat PSVT. Other treatment options for other atrial tachycardias include calcium channel blockers, beta blockers, digoxin, and amiodarone.


Question: Cerebellar toxicity is seen with

Refer Katzung 11/e p945 Cytarabine causes cerebellar ataxia


Question: H1N1 influenza prophylaxis

Ans. a. OseltamivirRef: Goodman Gilman 12th E/P1114Drug of Choice for Treatment of InfluenzaInfluenza A and BOseltamivir resistant influenza A and BOral Oseltamivir 75 mg BD for 5 daysInhalational Zanamivir 75 mg OD for 7 daysDrug of Choice for Prophylaxis of InfluenzaInfluenza A and BOseltamivir resistant influenza A and BOral Oseltamivir 10 mg BD 5 daysInhalational Zanamivir 10 mg OD 7 days


Question: Alpha methyldopa primarily used for

Methyldopa was primarily used in the past but is now used widely for pregnancy induced hypeension. Refer katzung 11e p173


Question: Drug causing Addison's disease is

Addison's disease, also known as primary adrenal insufficiency and hypocoisolism, is a long-term endocrine disorder in which the adrenal glands do not produce enough steroid hormones A dose dependent decrease in serum hydrocoisone due to synthesis inhibition is noted with the use of ketoconazole. others-mitotane, metyrapone, aminoglutethimide, etomidate (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 763)


Question: The beta blocker with alpha blocking action

Ans) a (Carvedilol) Ref Goodman&Gilman 11th ed.KDT 7th ed, Katzung 11th edCarvedilol is a third-generation beta receptor antagonist that has a unique pharmacological profile.It blocks beta1, beta2, and alphatreceptors similarly to labetalol, but also has antioxidant and anti- proliferative effects.It has membrane-stabilizing activity but it lacks intrinsic sympathomimetic activity.Carvedilol produces vasodilation.It is thought that the additional properties (e.g., antioxidant and antiproliferative effects) contribute to the beneficial effects seen in treating congestive heart failure.Carvedilol does not increase beta receptor density and is not associated with high levels of inverse agonist activity.BETA BLOCKERSCardioselective (betal) beta blockersMetoprololBetaxololAtenololCeliprololBisoprololNebivolol.Esmolol Non selective beta blockersPropranolol ,Sotalol,Timolol, Pindolol, Labetalol, Carvedilol, Medroxolol, Bucindolol and Levubunonol.- Pindolol has intrinsic sympathomimetic activity.- Butoxamine is a beta 2 selective blocker.- Carvedilol is a non-selective beta blocker showing anti-oxidant property and alpha 1 receptor antagonism.- Labetolol, Medroxalol, and Bucindolol also shows alpha 1 receptor blocking activity.Propranalol has highest degree of membrane stabilizing actionNadolol is longest acting beta blocker (t Vi -14-24 hrs) andEsmolol is the shortest acting.(t Vi -10 minutes)Propranolol has poor oral bioavailability.Pindolol and Penbutolol have approx 100% bioavailabilityPropranolol and Metoprolol are extensively metabolized in the liver, with little unchanged drug appearing in the urine.


Question: A 50 year old male presents with malignant hypeension. the drug of choices

It is a first choice drug for malignant hypeension Refer kDT 11e p185


Question: Fluconazole differs from ketoconazole in the following aspect

Fluconazole is a preferred agent because it has

Very good oral absorption.
Maximum CNS penetration. (therefore effective in cryptococcal meningitis).
No inhibitory action on microsomal enzymes.
No anti-androgenic property.

It is a more potent inhibitor of drug metabolism

It is not effective in cryptococcal meningitis

It is unlikely to produce anti-androgenic side effects


Question: Nitroglycerine is used in Angina pectoris. The mechanism of action is primarily a

(Post capillary venodilator): (540 KDT 7th edition)NITRATES (GTN, Nitroglycerine)* Most prominent action is exerted on vascular smooth muscleNitrates dilate veins more than arteries|Peripheral pooling of blood|Decreased venous return (ie preload on heart is reduced)|End diastolic size and pressure are reduced|Decreased cardiac work* Nitroglycerine are used sublingually because terminates first pass metabolism* *** Nitroglycerine is effective when retained sublingually because it is non-ionic and has very high lipid solubility (22-Goodman)


Question: In Addison's disease drug to be given is

Refer KDT 6/e p 283 In chronic adrenal insufficiency or Addinsons disease, hydrocoisone given orally IA the drug of choice Hydrocoisone is a glucocoicoid with maximum mineralocoicoid action


Question: A 40 year old woman was on chemotherapy for 6 months for Ovarian carcinoma. Now she presented with a progressive bilateral Sensorineural hearing loss. The Drug responsible for this includes

(A) Cisplatin# Platinum-containing chemotherapeutic agents, including cisplatin and carboplatin, are associated with cochleotoxicity characterized by high-frequency hearing loss and tinnitus.> Ototoxicity is less frequently seen with the related compound oxaliplatin.


Question: Roflumilast is a

Roflumilast is a PDE-4 inhibitor that inhibits degradation of cAMP and lead to bronchodilation.


Question: DOC for infantile spasms

ACTH is the drug of choice for infantile spasms and vigabatrin is DOC for infantile spasms with tuberous sclerosis. Ref: KD Tripathi 8th ed.


Question: Vasopressin antagonist acts on

Vaspression receptors(V2) are present on principal cells of inner medullary collecting tubule. The antagonist like Conivaptan and Tolvaptan may be used in conditions like SIADH and CHF.


Question: Drugs to be avoided in Hyperophic obstructive cardiomyopathy is

stepwise antihypeensive therapy effectively controlled both obstructive HCM symptoms and hypeension. ... Avoid digitalis, because glycosides are contraindicated except in patients with uncontrolled atrial fibrillation. Refer kDT 7/e p517


Question: Anti TNF is not used in aEUR'

RA with Hepatitis B??? We are still not sure of the answer. Anti TNF-a drugs can be used in all of the conditions mentioned in the question. Anti TNF a the therapy in Hepatitis B For the treatment of HBV, Anti TNF- atherapy showed cases of fulminant HBV reactivation. But any HBV reactivation was treated success fully with lamivudine therapy, thus it was concluded that physicians should consider antiviral therapy in patients with HBV (with or without active viral replication) and initiated treatment should continue for 3-6 months after stopping anti TNF- therapy. Both published British society of Rheumatology guidelines and British society of Gastroenterology guidelines concludes:- Successful treatment of active RA with anti TNF a in patients chronically infected with HBV is possible and can be safe. Our findings together with those of others, suggest that chronic HBV infection need not preclude therapy with anti TNF a where clinically indicated but an individualized approach is required including careful counseling, collaboration with colleagues in gastroenterology and intensive monitoring. HIV and anti TNF- a therapy As of now there are only eight patients treated with HIV and Rheumatoid disease. Retrospective series of eight patients suggests that treatment with anti TNF- a therapy can be used in HIV patients without advanced disease with associated rheumatic diseases. HCV and anti TNF-- cc therapy Anti TNF- a therapy is safe in patients with HCV and Rheumatoid ahritis. In a study involving 31 patients with RA with concomitant HCV infection, TNF a blocker seemed to be safe provided there is close monitoring of clinical virological data. Pulmonary fibrosis and anti TNF- a therapy Anti TNF-a therapy is considered safe in patients with Rheumatoid ahritis and pulmonary fibrosis. In some cases pulmonary. fibrosis seems to have improved with anti-TNF- atherapy.


Question: Mechanism of action of pralidoxime is

Refer kDT 6/e p105, katzung 12e p116 pralidoxime and diacetyl monoxime Arey cholinesterase Re generator compounds used for organophosphorus poisoning


Question: Drug of choice for ventricular arrhythmias induced by bupivacaine

Bupivacaine has got high cardiotoxic potential. Treatment for ventricular arrhythmia produced by bupivacaine is bretylium.


Question: Quinolone antibiotics inhibit bacterial growth by affecting

Quinolones block bacterial DNA synthesis by inhibiting DNA gyrase. This introduces negative superhelical turns into duplex DNA, thereby maintaining the negative superhelical tension of the bacterial chromosome during DNA replication. Ciprofloxacin and norfloxacin are active against a broad range of organisms that cause infections of the lower respiratory tract, intestinal tract, urinary tract and soft tissues. The original form, nalidixic acid, is useful only for urinary tract infections. Rifampin directly inhibits bacterial RNA polymerase. The reverse transcriptase of human immunodeficiency virus is inhibited by azidothymidine (AZT). Penicillins and cephalosporins are transpeptidase enzymes that function in the final stages of cell wall synthesis. They are inactivated by f3-lactamase enzymes, which break a single bond in the f3-lactam ring of these antibiotics. Nonclinical useful drugs such as mitomycin C and actinomycin D can directly interfere with DNA polymerase activity, but they are useful only as biochemical tools in experiments.


Question: Oral anticoagulants given to pregnant women cause

Contradi's syndrome (Skeletal and facial anomalies optic atrophy, microcephaly, chondrodysplasia punctate. Warfarin given in early pregnancy increases bih defects, specially skeletal abnormality foetal warfarin syndrome - hypoplasia of nose, eye socket hand bones, growth retardation. Given later in pregnancy - it can cause CNS defects, foetal haemorrhage, foetal death and accentuates neonatal hypoprothrombinemia Ref: Katzung 12 th ed.


Question: Drugs of the choice for central diabetes insipidus is

*Desmopressin is treatment of choice for central diabetes insipidus. *It acts selectively at V2 receptors to increase urine concentration and decrease urine flow in a dosedependent Manner. *It is also more resistant to degradation than AVP and has a three- to fourfold longer duration of action. *Desmopressin can be given by IV or SC injection,nasal inhalation,or oral tablet.


Question: Hyperprolactinemia is a side effect of


Question: Methotrexate resistance occurs by

Overproduction of DHFR Mechanism of action of methotrexate Methotrexate enter the cell by reduced folate carrier Once inside the cell methotrexate is polyglutamylated. The polyglutamylated.forms of methotrexate are potent inhibitors of dihydrofolate reductase The polyglutamased.forms of methotrexate are conveed back to monoglutamate .form in lysosomes by the glytamyl hydrolase and is subsequently effluxed from the cell Methotrexate resistance can occur through any of the following five mechanism Decreased entry into the cell due to impaired transpo Decreased retention as a consequence of lack of pohyglutammate formation An increase in DHFR An altered mutated DHFR that binds less avidly than the normal enzyme to the drug. Increased level of lysosomal enzyme 2 glutamyl hydrolase that hydrolyse methotrexate polyglutamates Decreased transpo A common mechanism of methotrexate resistance is reduced.folale transpo carrier The decreased transpo is common mechanism to methotrexate resistance in relapsed ALL. Impaired Polyglutammation The polyglutammated.forms of methotrexate inhibits dihydrofolate reductase. The intracellular content of polyglutammate derivatives of methotrexate is controlled by a balance between folypolyglutamate synthetase and glutamyl hydrolase activity. Folypolyglutamate synthetase produces polyglutammate while A glutamyl hydrolase conves its bact to monoglutamate form A lower content of methotrexate polyglutamate could he due to decreased synthesis or an increased catabolism of methotrexate polyglutamates by A glutamate hydrolase. Increased DHFR The main mechanism of action of methotrexate is inhibition of the enzyme DHFR. - Methotrexate is a tight binding inhibitor of DHFR and the concentration of methotrexate required to achieve enzyme activity increases in direct propoion to the amount of enzyme in target cells. - If is now well established that an impoant mechanism of resistance of cells to methotrexate is an increase in DHFR production due to amphification of the DHFR gene Mutation in DHFR Mutation is DHFR genes may be responsible .for methotrexate resistance. Mutation in DHFR causes production of altered forms of DHFR that have decreased affinity.for the inhibitor.


Question: Dose of levonorgestrol for contraception is

Levonorgestrol should be given as 0.75 mg 2 doses 12 hours apart or 1.5 mg single dose within 72 hours of unprotected sexual intercourse.


Question: First line of drug for angle closure glaucoma is

Ref: HL Sharma 3rd ed pg no:140 For acute angle-closure glaucoma, the best option is acetazolamide oral or IV for chronic glaucoma, DOC is phf2 alpha analogs like latanoprost


Question: Drug of choice for medical treatment of hydatid cyst of liver is

Ans. d (Albendazole). (Ref. Harrison, Medicine, 18th /Table 208-1)Albendazole is a broad spectrum, single dose anti-helminthic drug.Used in treatment of:Ascariasis, hookworm, tapeworm, enterobius, strongylodoisis, trichuris infestations.# Trichinosis# Neurocysticercosis (DOC), however it should not be used in ocular cysticercosis as blindness can occur due to reaction.# Hydatid disease (DOC)--MH 2006.Q# FilariasisALBENDAZOLEUsed in Parasitic Infection(s)Adverse EffectsMajor Drug-InteractionsAscariasis, clonorchiasis, cutaneous larva migrans, cysticercosis, echinococcosis, enterobiasis, eosinophilic enterocolitis, gnathostomiasis, hookworm, lymphatic filariasis, microsporidiosis, strongyloidiasis, trichinellosis, trichostrongyliasis, trichuriasis, visceral larva migrans.Nausea, vomiting, abdominal pain, headache, reversible alopecia, elevated aminotransferases. Rare: leukopenia,rashDexamethasone, praziquantel: plasma level of albendazole sulfoxide increased by ~50%


Question: Penicillins are NOT effective against


Question: FDA approved the use of modafinil as an adjunct in

For obstructive sleep apnea the treatment of choice: Continuous positive airway pressure.Adjunct: Modafinil which is a sympathomimetic agonist for alpha and beta receptors.Ref:


Question: Pyronaridine is

Refer KDT 6/e p796 Pyronaridine is an anti malarial agent related to amodoaquine .It is highly effective against chloroquine resistant and falciparum Malaria. Currently it is being evaluated in combination with aesunate


Question: Mechanism of action of Tubocurarine is

Tubocurarine is a non depolarizing muscle relaxant that competitively blocks action of Acetylcholine on its receptors.

Competitive antagonist of acetylcholine receptor


Question: Arrange the following drugs according to increasing volume of distribution. 1. Haloperidol 2. Gentamicin 3. Heparin 4. Chloroquine

* Chloroquine has highest volume of distribution. It is concentrated in liver and retina. * Heparin is high molecular weight compound and thus not able to cross most membranes. It has low Vd. * Gentamicin again cannot cross many membranes because of polar nature and thus has low Vd. * Haloperidol is a drug working in CNS. So, it must be able to cross other membranes also resulting in high Vd. Thus the sequence is Chloroquine > Haloperidol > Gentamicin > Heparin


Question: Treatment agent for scarlet fever is

Ans. is 'a' i.e., Penicillin Treatment : Immediate hospitalization and isolation of the patient is indicated. Penicillin is the treatment of choice.


Question: The following receptor has an intrinsic ion channel

GABA -BDZ receptor is an ion channel receptor , has an intrinsic Cl ion channel opening when a agonist binds to it and causes increase in frequency of channel opening and causes hyperpolarization. KDT 6/ e pg 42


Question: Buspirone is used as a/an

Busiprinone, is a medication primarily used to treat anxiety disorders, paicularly generalized anxiety disorder. Benefits suppo its sho term use. It is not useful for psychosis. It is taken by mouth, and it may take up to four weeks for an effect Ref KD Tripati 8th ed.


Question: Radical curve for plasmodium vivax used

B. i.e. (Primaquine) (784 - KDT 6th)* Drug of choice for radical cure of vivax an ovale malaria is - Primaquine**Commonly used therapeutic options for the Treatment and Prevention of malaria (421-Lippincott,s 3rd)1. All plasmodium species except chloroquine resistant P. falciparum- Chloroquine2. Chloroquine resistant P. falciparum- Quinine + Pyrimethamine - sulfadoxineORDoxycyclineORClindamycinAlternate Mefloquine3. Prevention of relapse P. Vivax and P. ovale only- Primaquine4. Prevention of malaria(i) Chloroquine sensitive geographic areas - Chloroquine(ii) Chloroquine resistant geographic areas - Mefloquine(iii) Pregnancy - Chloroquine** or Mefloquine


Question: Fluconazole is used for the treatment of


Question: Antidote of heparin is

Ans. is 'b' i.e., Protamine sulfate Protamine sulfate* It is a strongly basic, low molecular weight protein obtained from the sperm of certain fish.* Given i. v. it neutralizes heparin weight for weight, i.e., 1 mg is needed for every 100 U of heparin.* It is needed only when the heparin action needs to be terminated rapidly, e.g., after cardiac or vascular surgery.* In absence of heparin, protamine itself acts as a weak anticoagulant by interacting with platelets and fibrinogen.


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

Ans. (c) FinasterideRef. Pharmacology Gobittd Sparsh /135Most 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 BHP, 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: A drug given at the loading dose of 20mg reaches plasma concentration of  0.5mg/L, If apparent volume of distribution is 40L, Calculate Bio availability of the drug


Question: Cholinomimetic is not used for

Ans. b. Bradycardia Cholinomimetic is used for Open angle glaucoma, Cobra bite and Myasthenia gravis Uses of Cholinomimetic Diseases of eye: Glaucoma and accommodative esotropiadeg Gastrointestinal and urinary tract: Post-operative atonydeg, neurogenic bladderdeg Neuromuscular junction: Myasthenia gravisdeg, Curare induced neuromuscular paralysis Hea: Ceain atrial arrhythmiasdeg Atropine overdosesdeg Alzheimer's diseasedeg Cobra bitedeg: Neostigmine and endrophonium (Harrison 18/e p3570)


Question: Probenecid

Does decrease the renal excretion of pencillin

Does not decrease the renal excretion of pencillin

At high doses increases and at low doses decreases


Question: Benzyl peroxide acts in acne vulgaris by

Benzyl peroxide has bacterio static propeies in addition to its action as a peeling agent. Ref; KD Tripathi 8th ed


Question: Mechanism of action of Memantine includes

(B) Glutaminergic action# MEMANTINE is a noncompetitive NMDA receptor antagonist first used as an anti-influenza agent.> Memantine acts on the glutamatergic system by blocking NMDA receptors and inhibiting their overstimulation by glutamate.> Memantine has been shown to be moderately efficacious in the treatment of moderate to severe Alzheimer's disease. Its effects in the initial stages of AD are unknown. Adverse events with memantine are infrequent and mild, including hallucinations, confusion, dizziness, headache and fatigue.


Question: Alteplase differs from streptokinase as it

Refer KDT 6/e p606 Fibrinolytics are the drugs which activate plasminogen to form plasmin and thus helps in lysis of thrombus These drugs can cause bleeding as the major adverse effect due to lysis of physiological thrombi as well as due to excessive amount of plasma generated in the circulation


Question: Esmolol is a sho acting b blocker because

* Esmolol - Shoest acting b blocker * Nadolol - Longest acting b blocker * Esmolol is metabolized by pseudocholinesterase hence it is sho acting. * Drugs metabolized by pseudocholinesterase SUCCINYLCHOLINE ESMOLOL REMIFENTANIL

Its plasma hydrolysis by esterases is rapid


Question: Most emetogienic anticancer drugs (REAPEAT)

Refer CMDT 2010/1508 Cisplantin. Cisplatin is the most emetogienic anticancer drugs


Question: Prodrug is

(Levodopa) (20-KDT) (23-24-KDT 6th)PRODRUGACTIVE-FORMLevodopaDopamineEnalaprilEnalaprilata-methyldopaa methylnorepinephrineDipivefrineEpinephrineSulindacSulfide metaboliteHydrazide MAO inhibitorsHydrazine derivativesProguanilProguanil triazine PRODRUGACTIVE-FORMPrednisonePrednisoloneBecampicillinAmpicillinSulfasalazine5-Aminosalicyclic acidCyclophosphamideAldophosphamide, phosphoramide mustard, acroleinFluorouracilFluorouridine monophosphateMercaptopurineMethyl mercaptopurine ribonucleotide


Question: Neostigmine does not able to cross blood brain barrier because of its

Refer kDT 6/e p 101 Quaternary ammonium compounds are water soluble and thus cannot cross blood brain barrier. New Stickman is a quaernary derivative whereas physostigmine is a teiary amine


Question: Treatment of choice in ventricular fibrillation is

Refer kDT 7/e 538 A class of medications called beta blockers is commonly used in people at risk of ventricular fibrillation or sudden cardiac arrest. Implantable cardioveer-defibrillator (ICD). After your condition stabilizes, your doctor is likely to recommend implantation of an ICD. ... The ICD constantly monitors your hea rhythm


Question: Daily dose of isoniazid in treatment of tuberculosis is

DAILY DOSES OF ANTITUBERCULAR DRUGS: DRUG DOSE (mg/kg) H 5 R 10 Z 25 E 15 S 15

Mycobacterial Diseases (TB, Leprosy and MAC)


Question: Wof vitamin D preparations would be the most appropriate in a patient with poor renal function

1-Hydroxylase activity must be adequate to produce 1,25(OH) 2 D 3. Calcitriol is the only choice that is already 1-hydroxylated. Ref:- kd tripathi; pg num:-341


Question: Verril's sign is seen in


Question: Warfarin act by

Inhibiting the activation of vitamin K dependent factors

Inhibiting thrombin indirectly through antithrombin III


Question: ED50 is used for determining

Ed 50 measures potency Ld 50 measures safety or fatality ed50- dose required to produce 50% of the maximum effect LD50- The dose that causes death in 50 percent of the subjects tested Pgno-54 K D Tripathi Seventh edition


Question: Antidiabetic drug of choice for obese patients

Ans. (a) MetforminRef KDT 6th ed. 1267# metformin* Metformin is an antidiabetic drug from biguanides category.* They improve lipid profile, hence considered as DOC for DM in obese patients.* MOA:# increase peripheral utilization of glucose# Inhibit hepatic gluconeogenesis* Metformin never causes hypoglycemia.* Another drug from Biguanides is Phenformin, which is withdrawn, because it causes lactic acidosis.* Sulfonylureas causes a brisk release of insulin from pancreas which stimulate the functional receptors for the intake of glucose.# they can cause hypoglycemia.# Preferred in thin patients with DM* Repaglinide has same MOA as sulfonylureas, but it is short acting.# Used to control sudden rise of glucose after meal.* Acarbose act by inhibiting G.I. absorption of sugar.# s/e: can cause osmotic diarrhea.Also Know* Safest sulfonylureas: Tolbutamide (safer in elderly also)* Remembered as: MOST- Metformin for Obese; Sulfonylureas for Thin.


Question: Central muscle relaxants act by

Refer KDT 6/e p 348 Centrally acting muscle relaxants reduce skeletal muscle tone by a selective action in the cerebrospinal axis, without altering consciousness They selectively depress spinal and supraspinal polysynaptic reflexes Polysynaptic pathways in the ascending reticular formation which are involved in the maintenance of wakefullness


Question: Major aim of phase 1 clinical trials is to know the

Phase I trial is designed as a dose-escalation study to determine the maximum tolerable dosage (MTD), that is, the maximum dose associated with an acceptable level of dose-limiting toxicity. Phase 1 Clinical Trials: The drug is tested in healthy human volunteers (extremes of ages ; elderly and children are excluded). As the drug is not tested in the patients, so we cannot determine efficacy in this phase. This is mainly for finding the maximum tolerable dose of the drug. This is first in human study. Because anti-cancer drugs can produce unacceptable toxicity and we cannot expose healthy humans to such a toxicity, the phase-1 trials for anticancer drugs are done in the patients


Question: Post cardiac surgery delirium symptoms are worsened by

Ans. b. AnticholinergicsRef: Goodman Gilman 13th E/P156Delirium is an acute change in cognition and attention characterized by alteration in consciousness and disorganized thinking.Since anticholinergics decrease cognition, delirium can be worsened by anticholinergics.Postoperative delirium is decreased by drugs likeAntipsychotics: HaloperidolDexmedetomidineBenzodiazepines: Midazolam


Question: Increased prolactin is associated with aEUR'

Increased estradial Prolactin is a polypeptide produced by the lactotrophs of the pituitary. It is responsible .for the initiation and maintenance of lactation. As with several pituitary hormones, prolactin is secreted in a circadian, fashion with the highest levels being attained during sleep and a nadir occurring between 10 am and noon. Prolactin is secreted in a pulsatile .fashion, the amplitude and frequency of which not only varies throughout the day but is also impacted upon by a variety of physiology stimuli i.e., suckling, stress and increased level of ovarian steroids primarily estrogens. "The general view is that lactotrophs have spontaneously high secretary activity". Therefore pituitary prolactin secretion is under a tonic and predominantly inhibitory control exeed by the hypothalamus. - Hypothalmus releases prolactin inhibitory factor (PIF) which inhibits prolactin release. - PIE is actually dopamine and it suppresses prolactin synthesis and secretion by means of D2 receptors. - These actions constitute the physiologic basis of therapeutic effect of dopamine agonists in hyperprolactinemia. Prolactin acts on the breast tissue where in the setting of estrogen priming, it stimulates lactation. Effect of physiological hormones on prolactin secretion Glucocoicoids seem to have an inhibitory role on PRL secretion. - These hormones stimulate the differentiation of somatotrophs but suppress that of lactotrophs. - Long-term elevation of the serum glucocoicoid levels by chronic administration of coicotrophin (ACTH) or hydrocoisone or by prolonged stress decreases PRL secretion. Estrogens and thyroid hormones have opposite effects on PRL synthesis and release. - "Estrogen increases prolactin levelQ by acting at both pituitary and hypothalamic level" - At pituitary level it increases prolactin secretion by controlling PRL gene expression and modifying its sensitivity to physiological stimuli. - At hypothalamic level it inhibits the activity of all three types of hypothalamic neuroendocrine dopaminergic neurone. - Low thyroxine (T4) and triiodothyronine (T3) levels increase TRH-induced PRL secretion, whereas high T4 and T3 levels inhibit PRL mRNA accumulation and release. An impoant point Increased estrogen causes hyperprolactinemia But Hyperprolactinemia causes decrease in estrogen Prolactin also acts at the hypothalamus to inhibit the secretion of gonadotropin releasing hormone (GnRH). - Inhibition of GnRH results in a decrease in the release of LH and FSH from the anterior pituitary. In females - This leads to decreased in estrogen and progesterone synthesis and secretion by the ovaries and a failure of ovarian .follicular maturation. In males - This leads to decrease in testicular production and synthesis of testosterone and a halt in spermatogenesis. Causes of hyperp rolactinemia Hypothalamic diseases Heavy metals and other chemical substances * Tumors (craniopharyngioma, meningioma, dysgerminoma, third * Manganese * Organic mercury ventricle tumor, cyst, glioma, harnaoma, and metastasis), * Lead * Cadmium * Infiltrative disease (sarcoidosis, tuberculosis, Langerhans's cell * Uranium * Arsenic histiocytosis, and eosinophilic granuloma). * Bari um * Cranial irradiation * Vascular abnormalities * Pseudotumor cerchri * Genetic syndromes (multiple endocrine neoplusia syndrome Carney complex, McCune-Albright syndrome). Pituitary diseases Neurogeic * Functioning and nonfunctioning * Chest wall lesions adenomas, MEN I * Spinal cord lesions * Empty sella sendrome * Breast stimulation * Lymphocytic hypophysitis * Physical or psycho? Primitive tumors (meningioma, germinoma, metastasis, and lymphoma) and metastasis infiltrative diseases (giant cell granuloma and sarcoidosis) logic stress Drugs Other * Neurolepticsdeg (phenothiazines, butyrophenones, and atypical * Hypothyroidism * Chronic renal failure antipsychotics). * Cirrhosis * Antidepressantsdeg (tricyclic and * Adrenal insufficiency tetracyclic antidepressants, MAO inhibitors, SSEIs and others). * Pseudocyesis * Antihypeensive medications (verapamil methyldopa, and reserpine). Gastrointestinal medications (metoclopramide, domperodone and H2 blockers). * Opiates, Cocaine, Estrogensdeg, Protease inhibitors


Question: Drug of choice for prophylaxis of motion sickness is

Doc for prophylaxis of motion sickness is - Hyoscine (scopolamine) If hyoscine is not given in the option them first generation Antihistaminics (Promethazine) Ondansetron -Doc for chemotherapy / radiotherapy induced vomiting. Metoclopramide- prokinetic drug Domperidone (prokinetic drug) - D2 receptor antagonist Drug of choice for levo dopa induced vomiting Both Metaclopromide and Domperidone are used for postoperative, drug and disease induced nausea & vomiting.


Question: Alpha 1a selective blocker is

Tamsulosin, silodosin are more selective alpha blockers in prostrate uhera.used for BPH. Ref: KD Tripathi 8th ed.


Question: Delamanid is used for the treatment of

Delamanid is given to adults with multi-drug resistant (MDR) TB. It is the first in a new class of TB drugs called nitroimidazoles. other new drug in TB is Bedaquiline. Ref: KD Tripathi 8th ed.


Question: In terms of the ability of drugs like digoxin to increase cardiac contractility, their primary action on cardiac cells is

Cardiac glycosides increase contractility by inhibiting the Na/K-ATPase pump, causing an increase in intracellular Na. This, in turn, increases intracellular Ca by slowing down Na/Ca exchange. The increase in intracellular Ca leads to its binding to the troponin-tropomyosin complex, causing an allosteric change and facilitating the interaction between actin and myosin.


Question: A patient presented in emergency with tachycardia,hypehermia,bronchial dilation and constipation.The person is likely to be suffering from overdose of

Ref:KD Tripathi pharmacology 7th edition (page.no: 114,115) Actions of Muscarinic antagonist (atropine) CNS stimulation CVS: the prominent effect is tachycardia by abbretes refractory period of AV node and facilitate AV conduction Gland; decrease salivary, tracheobronchial and lacrimatory secretion, gastric secretions Smooth muscle: decrease tone and contraction, bronchodilatation, constipation Eye; mydriasis by contraction of longitudinal ciliary muscle Rise in body temperature (hypehermia)


Question: Bromhexine acts by

Bromhexine acts by depolymerisation of mucopolysaccarides and making the mucus less viscid and thus acts as a expectorant.


Question: TNF (alpha inhibitors) used in rheumatoid arthritis is

(Infliximab): (2/2- 683- 84 - KDT 7t)INFLIXIMAB - is a chimeral monoclonal antibody which binds and neutralizes TNF-alpha* TNF-alpha inhibitors mainly suppress macrophage and T-cell function; inflammatory changes in the joint regress and new erosions are slowed* Quicker response than non biologic DMARDs* Generally added to methotrexate* Susceptibility to opportunistic infection, including tuberculosis and pneumocystis pneumonia is increasedDisease modifying antirheumatic drugs (DMARDs)A. Nonbiological drugsB, Biological drugs1. Immunosuppressants - Methotrexate, Azathioprine, cyclosporine1TNF alpha inhibitors - Etanercept, Infliximab, Adalimumab2. Sulfasalazine 3. Chloroquine or Hydroxychloroquine2. IL-1 antagonist:- Anakinra4. Leflunomide Gold and penicillamine are obsolete DMARDs


Question: The drug of choice for schistosomiasis is

Refer KDT6/e p435-436 Praziquental is the drug of choice for all trematode and cestode infestations except Fasciola hepatica bad hydatid disease


Question: Mechanism of action of Ezetimibe

Refer kDT 7/e p 641 Ezetimibe is a medication used to treat high blood cholesterol and ceain other lipid abnormalities. Generally it is used together with dietary changes and a statin. Alone, it is less preferred than a statin. It is taken by mouth. It is also available in the combination ezetimibe/simvastatin

Interfere with the absorption of cholesterol by inhibiting NPCIL1


Question: Wof glucocoicoid has significant (max) mineralocoicoid activity

Hydrocoisone (coisol):- Acts rapidly but has sho duration of action. In addition to primary glucocoicoid, it has significant minera- locoicoid activity as well. Uses:- For Replacement therapy, Shock, status asthmaticus, acute adrenal insufficiency. Topically and as suspension for enema in ulcerative colitis. Ref:- kd tripathi;pg num:-288


Question: The following drug is used for

The picture shows levonorgesterol 2 tablets to be used 12 hrs apa within 72hours for emergency contraceptionRef:Goodman Gillman 12th ed pg 1184


Question: Nonselective reversible a receptor blocker among the following is

Nonselective irreversible a receptor blocker Phenoxybenzamine Nonselective reversible a receptor blocker Phentolamine Selective a receptor blocker Prazosin Terazosin Doxazosin


Question: A competitive antagonist is a substance that

In the presence of a fixed concentration of agonist, increasing concentrations of a competitive antagonist progressively inhibit the agonist responseBasic and clinical pharmacology Katzung 13th edition pg 23

Interacts with receptors and produces submaximal effect

Binds to the same receptor site and progressively inhibits the agonist response

Binds to the nonspecific sites of tissue

Binds to one receptor subtype as an agonist and to another as an antagonist


Question: Drug of choice for akathesia caused by use of haloperidol is

EPS Drug Of Choice Dystonia Benzhexol Akathisia Propranolol Parkinsonism Benzhexol Malignant neuroleptic syndrome Dantrolene Tardive dyskinesia Valbenazine


Question: Hemorrhagic cystitis is caused by aEUR'

Cyclophosphamide Hemorrhagic cystitis is commonly associated with Cyclophosphamide Cyclophocphamide is the most common cause of hemorrhagic cystitis. The drug Cyclophosphamide itself is not toxic. The drug toxicity is due to its hepatic conversion to the metabolite "acrolein" which is excreted in the urine and causes damage to the bladder mucosa - It is believed that urothelial damage occurs due to direct contact of the bladder wall with acrotein which causes edema, ulceration, neovascularisation, hemorrhage and necrosis - Thus patients receiving cyclophosphamide should always receive good hydration and a .foley's catheter is often placed to ensure immediate drainage of the bladder. The hemorrhagic cystitis caused by cyclophosphamide can be reduced in intensity or prevented by intravenous administration of "MESNA" -MESNA is a thiol compound. The .free (Thiol) groups of MESNA combine directly with double bond of acrolein of form a stable nontoxic compound. MESNA is given orallyQ. - Cyclophosphamide induced hemorrhagic cystitis appeare to be dose related and is most prevalent in patients who are dehydrated and those receiving intravenous cyclophosphamide.


Question: Mechanism of action of theophylline in bronchial asthma is

Mechanism of action of methylxanthines like theophylline, caffeine: (a) Release of Calcium from the sarcoplasmic reticulum, especially in skeletal and cardiac muscle. (b) Inhibition of phosphodiesterase3 and PDE4 which degrades cyclic nucleotides intracellularly. (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. Beta 2 agonism is also correct because Theophylline acts synergistic with beta 2 agonistsPharmacology and pharmacotherapeutics Satoskar 24th page no. 579 ESSENTIALS OF MEDICAL PHARMACOLOGY 7TH EDITION KD TRIPATHI Page No:225,226


Question: Glucocoicoids act in inflammation mainly by

Glucocoicoid helps in induction of lipocoins in macrophages. Lipocoins inhibits phospholipase A2 enzyme present in the cell membrane and thus lead to decrease production of prostaglandins, Leukotriens which are responsible for inflammation. (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 279)


Question: Laudanosine is a metabolite of

Refer Miller 7/e p 880 Both Atracurium and cis-Atracurium are eliminated by Hoffman's elimination Atracurium is also metabolized by liver to some extent and result in production of a metabolite laudanosine that can cause CNS toxicity including seizures


Question: Most common drug used for prophylaxis of migraine is

Ref: HL Sharma 3rd ed Pg no: 191 beta blockers are the first line of choice for chronic migraine or migraine prophylaxis


Question: Diagnosis of Myasthenia gravis done by using

Refer kDT 6/e p 104 Myasthenia gravis can be differentiated from cholinergic crisis with the help of sho acting anticholinesterase agent,edrophonium. It improves the symptoms in Myasthenia gravis whereas was on the condition in case of cholinergic crisis. Neostigmine is used in the treatment of Myasthenia


Question: Conversion of norepinephrine to epinephrine occur by

Synthesis of NA occurs in all adrenergic neurons while that of adrenaline occurs only in the adrenal medullary cells. It requires a high concentration of glucocoicoids reaching through the intra- adrenal poal circulation for induction of the methylating enzyme - N methyltransferase. From essential of medical pharmacology K D Tripati 7th edition Page no 124


Question: Enzyme inactivation is the main mode of resistance to

Refer KDT 6/e p 720 Resistance to quinolone is due to altered DNA gyrase, to Rifampicin is due to mutation in gene rpo! Reducing it's ability for the target and for glycopeptides like vancomycin due to reduced affintiy6 for target site


Question: Intravenous anaesthetic metabolized by pseudo cholinesterase

Propanidid is no more used in anaesthesia due to severe allergic reactions. It is metabolized by pseudocholinesterase.


Question: Anti IgE monoclonal antibody used in bronchial asthma is

It is a humanized monoclonal antibody against IgE. Administered i.v. or s.c., it neutralizes free IgE in circulation without activating mast cells and other inflammatory cells.
In severe extrinsic asthma, omalizumab has been found to reduce exacerbations and steroid requirement.
It is very expensive; use is reserved for resistant asthma patients with positive skin tests or raised IgE levels who require frequent hospitalization.


Question: The intrinsic potency as local anesthetic is the lowest in


Question: Drug contraindicated in absence seizures is

Ans. is 'c' i.e., Tiagabine * Carbamazepine, vigabatrin, and tiagabine are contraindicated in the treatment of absence seizures, irrespective of cause and severity. This is based on clinical and experimental evidence. In particular, the GABA agonists vigabatrin and tiagabine are used to induce, not to treat, absence seizures and absence status epilepticus. Similarly, oxcarbazepine, phenytoin, phenobarbital, gabapentin, and pregabalin should not be used in the treatment of absence seizures because these medications may worsen absence seizures.


Question: Drug of choice for anaerobic infection is

Ans. is 'b' i.e., Metronidazole * Metronidazole is a prototype nitroimidazole which has broad spectrum cidal activity against the anaerobic micro-organisms including giardia lamblia.* It doesn't affect the aerobic bacteria.* It is selectively toxic to anaerobic and micro-aerophilic micro-organisms.* In anerobic conditions, it produces highly cytotoxic nitro radical which is attenuated in aerobic environment.* It also induces mutagenesis and cause radiosensitization.* Aminoglycosides are active only against aerobes.* Amphotericin B is an anti-fungal agent.


Question: Ciprofloxacin acts on

Ans. is 'b' i.e., DNA gyrase Major mechanism of action of fluoroquinolone is inhibition of bacterial enzyme DNA gyrase.Recent evidence indicates that in gram positive bacterias, the major target is topoisomerase IV.So greater affinity for topoisomerase IV may confer higher potency against gram positive bacteria.


Question: The following angiotensin conveing enzyme inhibi tor can reduce cardiac contractility

Lisinopril:- It is the lysine derivative of enalaprilat; does not require hydrolysis to become active ACE inhibitor. Pharmacokinetics:- Its oral absorption is slow (making first dose hypotension less likely) and incomplete, but unaffected by food. The duration of action is considerably longer, permitting single daily dose and ensuring uniform hypotensive action round the clock. A reduction in venous return, cardiac contractility and cardiac output has been noted after few weeks of lisinopril use. Ref:- kd tripathi; pg num:-503


Question: A a1 selective adrenergic blocking agents used in benign prostatic hypertrophy is

D. i.e. (Tamsulosin) (135- KDT 6th) (83- Lippincott's 3rd)* Prazosi, Terazosin, Doxazosin are useful in the treatment of hypertension. Tamsulosin is indicated for the treatment of benign prostatic hypertrophy (83- Lippincott's 3rd)* According to KDT all are used in BPH. but Tamsulosin is best answer of choice* TAMSULOSIN - is Uroselective aIA/ a1D blocker** better tolerated less side effects* Selective b1 antagonist is - Atenolol*** Selective b2 antagonist is - Butoxamine**


Question: The most likely complication of prolonged use of nasal decongestant drops is

NASAL DECONGESTANTS These are a agonists which on topical application as dilute solution (0.05-0.1%) produce local vasoconstriction. The imidazoline compounds-- naphazoline, xylometazoline and oxymetazoline are relatively selective a2 agonist (like clonidine). They have a longer duration of action (12 hours) than ephedrine. side effects:- They may cause initial stinging sensation (Especially naphazoline). Regular use of these agents for long periods should be avoided because mucosal ciliary function is impaired: atrophic rhinitis and anosmia can occur due to persistent vasoconstriction. They can be absorbed from the nose and produce systemic effects, mainly CNS depression and rise in BP. cautious use:- These drugs should be used cautiously in hypeensives and in those receiving MAO inhibitors. Ref:- kd tripathi; pg num:-136


Question: DSM265 is having promising trials in the treatment of

DSM265 an inhibitor of dihydroorotate dehydrogenase is effective in single oral dose both in prophylaxis and treatment against P.falciparum. Proposed to give as a single dose. Ref:www.thelancet.comjournals.


Question: The recommended time for prophylactic antibiotic is

Antibiotic should be present in adequate concentration at the operative site before incision and through out the procedure Parenteral agents should be admistered during the interval beginning 60 minutes before incision


Question: A patient on treatment for leukemia develoPS chest pain pulmonary infiltrates and pleural effusion. The likely cause is

Refer Katzung 10th,/899 Tretinoin causes chest pain, pleuritis, pulmonary infiltrates and pleural effusion. It is known human teratogen Daunorubicin and Doxorubicin cause cardiotoxicity manifested as arrhythmias and CHF


Question: Tegaserod is a

Cisapride, Mosapride, Prucalopride and Tegaserod are 5HT4 agonists used as prokinetics in constipation.
Tegaserod is withdrawn from market because of increased risk of myocardial infarction & stroke.


Question: Drug of choice for CML

Ans. (a) Imitanib mesylate (Doc for CML & GIST - Imatinib Mesylate)Ref. KD Tripathi 6th Ed. / 828 & 832IMATINIB* It inhibits the tyrosine protein kinases in chronic myeloid leukaemia (CML) cells and and c-kit receptor found in gastrointestinal stromal tumour (GIST).* Adverse effects are fluid retention, edema, vomiting, abdominal pain, myalgia and liver damageDrugs of choice for some commonly asked malignanciesMalignancyFirst line drugsChronic Lymphatic leukaemiaFludarabineChronic Myeloid leukaemiaImatinibHairy cell leukemiaCLADRIBINEMultiple myelomaMelphalanChoriocarcinomaMethotrexateProstate carcinomaBicalutamide/Flutamide


Question: The insulin preparation of choice in diabetic ketoacidosis is

Diabetic ketoacidosis (Diabetic coma) Ketoacidosis of different grades generally occurs in insulin dependent diabetics. It is infrequent in type 2 DM. The most common precipitating cause is infection; others are trauma, stroke, pancreatitis, stressful conditions and inadequate doses of insulin Treatment of DKA:- 1. Insulin:- Regular insulin is used to rapidly correct the metabolic abnormalities. A bolus dose of 0.1-0.2 U/kg i.v. is followed by 0.1 U/kg/hr infusion; the rate is doubled if no significant fall in blood glucose occurs in 2 hr. Fall in blood glucose level by 10% per hour can be considered adequate response. Usually, within 4-6 hours blood glucose reaches 300 mg/dl. Then the rate of infusion is reduced to 2-3 U/hr. This is maintained till the patient becomes fully conscious and routine therapy with s.c. insulin is instituted. 2) I v. Fluids 3) kcl Ref:- kd tripathi; pg num:-267,268

A 30:70 mixture of plain and isophane insulin


Question: Histamine blocker in stomach act through

Histamine H2 blockersinhibit the action of histamine ongastric H2 receptors thereby decreasing gastric acidity. They were considered a breakthrough in the treatment of peptic ulcer disease when first introduced. Refer kDT 6/e 153


Question: Nonselective beta adrenergic antagonist is


Question: Maximum tachycardia is seen with


Question: Orange urine and tears are adverse effect of

A. i.e. (Rifampicin) (742- KDT6th) (398- Lipincott's 3rd* Urine of patients taking Nitrofurantoin becomes dark brown due to its metabolites* Systemic administration of phenol gives - green colour to urineDrugAdverse- effectsCommentsEthambutolOptic neuritis** with blurred vision, red- green color blindnessEstablish baseline visual acuity and color vision test monthlyIsoniazidHepatic enzyme elevation, hepatitis, peripheral neuropathy*** Take base line LFT measurement* Clinically significant interaction with phenytoin* and anifungal agents (azols)PyrazinamideNausea, hepatitis, hyperuricemia**, rash joint ache, gout (rare)Take base line LFT and uric acid measurementRifampinHepatitis, GI upset, flue- like syndrome,**Take baseline LFT and CBC count, Warn patients that urine and tears may turn red- orange in color**StreptomycinOtotoxicity, nephrotoxicity**Do base line audiography and renal function tests* Red Man's Syndrome is caused by vancomycin (Fever, Urticaria and Intense flushing)


Question: Adult dose of Clozapine is

(C) 300 mg# Clozapine:> Indicated for reducing risk of recurrent suicidal behavior in patients with Schizophrenia or Schizoaffective disorder in patients who are judged to be at chronic risk to re-experience suicidal behavior> Also indicated for treatment-resistant Schizophrenia in patients who fail to respond adequately to standard antipsychotic treatment 12.5 mg PO once daily or 12hr initially; increased daily in increments of 25-50 mg/day, if well tolerated, to achieve target dosage of 300-450 mg/day by end of 2 weeks> On occasion, may have to be increased to 600-900 mg/day to obtain acceptable response> Maintenance: Generally, patients who respond should continue maintenance treatment on their effective dose beyond the acute episode


Question: Glyceryl trinitrate is given by sublingual because of

Refer kDT 6/e p 7 Main advantage of Sublingual route of drug administration is that liver is bypassed and drugs with high first pass metabolism are absorbed directly into systemic circulation


Question: Pulmonary fibrosis is seen with(REPEAT)

Reference Katzung 11/e p953 Bleomycin is a marrow sparing drug But it causes pulmonary fibrosis and skin toxicity Another antineoplastic drug causing pulmonary fibrosis is busulfan


Question: An elderly hypeensive has diabetic mellitus and bilateral renal aery stenosis. the best management is

Thiazides and beta blockers should be avoided in diabetes mellitus whereas ACE inhibitor should not be given to patient with bilateral renal aery stenosis therefore, Calcium channel blockers, like verapamil are the best given for the management of hypeension Refer kDT 6/e p484


Question: Antimicrobial agent effective against ESBL producing microorgansims is

(A) Beta lactam plus beta lactamase inhibitorAntimicrobial Agents that must not be reported as susceptibleOrganismESBL - producing K. pneumoniae, K oxytoca, E. coli & P mirabilis1st & 2nd generation cephalosporins, cephamycins & aminoglycosidesSalmonell spp., Shegella spp.Penicillins, beta lactam / beta lactamase inhibitor combinations, cephems & carbapenemsOxacillin - resistant Staphylococcus spp.Aminoglycosides (except high concentrations), cephalosporins, Clindamycin & trimethoprim sulfamethoxazoleEnterococcus spp.#Important resistance mechanisms to beta lactam antibiotics:Beta lactamase Resistance:Many bacteria produce enzymes that are capable of destroying the beta-lactam ring of penicillin, these enzymes are referred to as penicillinases or beta-lactamases and they make the bacteria that possess them resistant to many penicillins.Clavulanic acid is inhibits beta-lactamase enzymes, thereby increasing the longevity of beta-lactam antibiotics in the presence of penicillinase-producing bacteria.Clavamox is a combination of amoxicillin and clavulanate.Combination of the beta-lactamase inhibitor tazobactam and piperacillin.Summary of beta lactam / beta lactamase inhibitor on treatment of ESBL - producing organisms:Limited clinical information:Class A ESBLs are susceptible to clavulanate & tazobactam in vitro, nevertheless many producers are resistant to beta lactamase inhibitor due to:-Hyperproduction of the ESBLs - overwhelm inhibitor.-Co-production of inhibitor-resistant penicillinases (E.g., OXA-1) or AmpC enzyme.-Relative impermeability of the host strain.Beta-lactam/beta lactamase inhibitor should not be used not be used to treat serious infections with ESBL producing organisms.Beta lactamase inhibitors:Almost all have weak antibacterial activitiy.Important in combination with penicillins sensitive to beta lactamase degradation.Clavulanic acid is the first one of this class.Natural product from streptomyces.Has a powerful & irreversible inhibition of beta lactamase enzymes because it will covalently bind to two positions in the active site.Normally used in combination with amoxicillin & other beta lactamase sensitive penicillins.Extended Spectrum Beta Lactamase (ESBL):Enzymes that are produced by Gram negative bacteria.Confer resistance to Cephalosporins, Penicillins & Monobactam (Aztreonam) by opening the beta lactam ring inactivating the antibiotic.Cannot attack Cephamycins (cefoxitin, cefotetan) or the carbapenems (imipenem, meropenem, ertapenem, doripe- nem).Generally susceptible to beta-lactamase inhibitors (Tazobactam)Plasmid mediated TEM, SHV, CTX-M beta lactamases are the most common.Therapy for ESBL producing gram negative rods:Carbapenems: Imipenem, Macropenem, Doripenem, ErtapenemPiperacillin / Tazobactam - Tazobactam blocks beta lactamase action.Beta lactam / beta lactamase inhibitor on treatment of ESBL - producing organisms:Most ESBLs are susceptible to clavulanate & tazobactam in vitro.Nevertheless some ESBL producers are resistant to beta lactamase inhibitor due to:Hyperproduction of the ESBLs - overwhelm inhibitor.Co-production of inhibitor - resistent penicillinases or AmpC enzyme.Relative impermeability of the host strain.Beta lactam/beta lactamase inhibitor should not be used to treat serious infections with ESBL - producing organisms


Question: Vitamin def encountered with isoniazid is

Pyridoxine deficiency is seen with high doses of isoniazedRef:Katzung 11th ed Pg: 825


Question: Loading drug of dose primarily depends on

Loading dose; This is a single or few quickly repeated doses given in the beginning to attain target concentration rapidly.
Loading dose = Target Cp * V /F
Cp - concentration, V - volume of distribution, F - oral bioavailability
Thus, the loading dose is governed only by V and not by Clearance or t1/2


Question: Verapamil is contraindicated in

Ans. b (Complete heart block). (Ref. KDT, Pharmacology, 4th ed., 530)# VERAPAMIL can accentuate conduction defects, hence contraindicated in II and III degree AV blocks and precipitates congestive heart failure in patients with pre-existing disease.# Cardiac arrest can occur in patients with sick sinus syndrome.CALCIUM CHANNEL ANTAGONISTSDrugIndicationContraindications/CautionsFrequent or peculiar side EffectsDihydropyridines:# Nifedipine XL# Amlodipine# Felodipine XL# Isradipine# NicardipineMild to moderate hypertensionHeart failure, 2nd or 3rd degree heart blockTachycardia, flushing, gastro- intestinal disturbances, hyperkalemia, edema,headache.Benzothiazepines:DeltiazemMild to moderate HypertensionHeart failure, 2nd or 3rd degree heart blockSame as amlodipine, except no tachycardia or edema, but can cause heart block, constipation, and liver dysfunction.Phenylalkylamine: VerapamilMild to moderate HypertensionHeart failure, 2nd or 3rd degree heart block.Nausea, Constipation and Bradycardia


Question: The most prominent toxic effect associated with acetaminophen use is


Question: Specific side effect of thalidomide is

Ans. is 'c' i.e., Phacomelia Thalidomide* Thalidomide is an anxiolytic, antiemetic drug with antiinflammatory, cytokine modulatory property.* Thalidomide was introduced in 1958 for morning sickness and was found to be highly teratogenic resulting in thousand of babies with phocomelia (seal like limbs) and withdrawn in 1961.* Now it has come again in the market for use as an anticancer drug in multiple myeloma and melanoma.* Lenalidomide is its more potent and non-teratogenic derivative. Thalidomide most commonly causes sedation and constipation in cancer patients.* It can also cause peripheral sensory neuropathy.* Two enantiomers of thalidomide (R and S) are present but these are interconvertible in body, therefore racemic mixture is used.* Antiangiogenic action is responsible for antitumor activity.


Question: A 70 kg patient needs to be staed on nitroglycerine (NTG) infusion. A 5 ml ampoule contains 5 mg/ml NTG. One ampoule is added to normal saline and to make a total of 500 ml solution. Calculate the rate of infusion if NTG is required at a rate of 10 mcg/min. (1 micro drip = 60 drops/ml )

Dose to be given = 10 mcg/min As, one ampoule (5 ml) is mixed with normal saline to make 500 ml volume, Means 500 ml of solution contains = 5*5 = 25 mg NTG = 25000 mcg NTG 25mg -----500ml 1mg----500/25 10mcg -10*10 -3-----0.2ml So, we need to infuse 0.2 ml/min of the solution As, 1 ml = 60 drops So, 0.2 ml = 60/1 * 0.2 = 12 drops So, we need to infuse 12 drops/min


Question: Topical mitomycin C is used in the treatment of aEUR'

Tracheal stenosis Management of tracheal stenosis The optimal treatment of tracheal stenosis remains undefined Traditionally tracheal stenosis has been managed by thoracic and otorhinolaryngology surgeons. Endoscopic procedures are usually performed as bridge to definitive surgical intervention. With the development of interventrical pulmonology field in the last 20 years definitive management of tracheal stenosis using minimally invasive endoscopic methods becomes a possibility. Endoscopic surgery has been shown to be useful especially in patients who are deemed high risk and too unwell for reconstructive surgery. One of the main drawbacks of endoscopic tit and surgery is the risk of recurrence of tracheal stenosis due to granulation and fibrotic tissue. Scar formation and restenosis is the main cause. Studies have shown that most of the recurrence of tracheal stenosis occurs within one to three months after the procedure and use of mitomycin C has been repoed in case studies to reduce the rate of recurrence. - Both in vitro and invivo mitomycin C has been proved to be a potent inhibitor of human fibroblasts at concentrations of .04 mg/L Topical mitomycin C is a useful adjunct in the management of sho concentric membranous stenosis which does not involve the cailage.


Question: Wof skeletal muscles is relaxed first by tubocurarine

ACTIONS Skeletal muscles:- Intravenous injection of nondepolarizing blockers rapidly produces muscle weakness followed by flaccid paralysis. Small fast response muscles (fingers, extraocular) are affected first; paralysis spreads to hands, feet--arm, leg, neck, face--trunk--intercostal muscles--finally diaphragm: respiration stops. Recovery occurs in the reverse sequence; diaphragmatic contractions resume first. Ref:- kd tripathi; pg num:-350


Question: Elimination after 4 half lives in first order Kinetics is


Question: Drug acting on V2 receptors and used in DI (REPEAT)

Desmopressin is USED IN central DIREF:KDT7/e p597


Question: Cephalosporin that does not require dose reductionin patient with any degree of renal impairment is aEUR'

Cefoperazone [Ref: Goodman Gilman 17thie 1147, 1148; Katzung 10 p. 7371 Remember: ? Most cephalosporins are excreted mainly by tubular secretion. But ceftriaxone and cefoperazone are excreted mainly in bile and no dose adjustment is required in renal insufficiecy. The other unique feature of cefriaxone is its long half life. Thus it can be injected O.D. or B.D. in serious infections. According to Goodman and Gilman "All cephalosporins are excreted through kidney except celPiramide and cefoperazone which are excreted predominantly in the bile". About ceftriaxone Goodman Gilman mentions. "50% of this drug is excreted through urine while 50% of it is excreted through bile". But Katzung differs from Goodman Gilman "All cephalosporins are excreted through kidney except .for cefoperazone and ceftriaxone which are excreted mainly through the bilian' tract". Antimicrobial Drugs that do not require dosage adjustment in Renal Failure Cephalosporins Antitubercular * Cefoperaczone * Rifampicin * Ceftriaxone Other (miscellaneous) * Cefopiramide * Clindamycin * Chloramphenicol * Metronidazole Macrolides * Amphoterecin B * Erythomycin * Linezolid * Clarithomycin * Quinupristin / Dalfopristin * Azithromycin * Nafcillin / Oxacillin Fluoroquinolones Tetracycline * Trovafloxacin * Doxycycline * Grepafloxacin * Minocycline Use of Antimicrobial Agents in the Presence of Renal Dysfunction (Anesthesiology by Longnecker, Newman, Zapol'(2007J/285 Containdicated in the presence of dosage Require Require dosage adjustment only with severe adj adjustment with renal failures: renal failure: moderate renal failure: * Tetracyclines (except doxycycline), * Carbenicillin, ticarcillin, * Ampicillin, * Isoniazid, * Nitrofurantoin, * Cefazolin, * Mezlacillin. * Ethambutol, * Cephaloridine, * Aminoglycosides, * Piperacillin * Meropenem, * Long-acting sulfonamides, * Vancomycin, * Cefoxitin, * Nalidixic acid, * Methenamine, * Irnipenem, * Cefotaxime, * Ciprofloxacin, * Paraaminosalicylic acid * Flucytosine, * Penicillin G, * 5- fluorocytosine, * Fluconazole * Ceftizoxime, * Ofloxacin, * Ceftazidime, * Levofloxacin, * Cefuroxime, * Norfloxacin, * Cefotetan, * Itraconazole * Trimethoprim? * Sulfamethoxazole,


Question: DOC for Cisplatin induced nausea & vomiting occuring within 24 hours is

DOC for Cisplatin induced nausea & vomiting within 24 hours is Ondansetron.
DOC for Cisplatin induced nausea & vomiting after 2days is Aprepitant.


Question: Calculate the therapeutic index of the drug from given DRC.

Therapeutic index is calculated as: TI = LD50/ED50 TI = 128 mg/6 mg = 21.3


Question: Hypokalemia is seen in therapy with


Question: Ganer's duct is present in NOT RELATED GYN

Separates medial pa of epididymis from testis


Question: Drug used in unstable angina to prevent Myocardial infarction is

Aspirin is an antiplatelet agent used mostly in unstable angina to prevent MI. Ref: KD Tripathi 8th ed.


Question: Theophylline therapeutic blood ranges

(5-20) (221-KDT6th)* Therapeutic ranges 5-20 as shown in above figure* Theophylline has a narrow margin of safety. Dose dependent toxicity starts from upper part of therapeutic concentration


Question: The second messengers cyclic AMP and cyclic GMP (REPEAT)

Activate the same signal transduction pathways

Are generated by the activation of cyclases

Are impoant only in sensory transduction


Question: Drug that does not cause sedation


Question: Danaparoid is

Danaparoid is a parenteral Xa inhibitor which is Drug of choice for "Heparin induced thrombocytopenia" in pregnant women as Argatroban is contraindicated.


Question: Quinine is obtained from CINCHONA


Question: Is 70 year old man was administered penicillin intravenous within five minutes, he developed generalized uicaria, swelling of lips, hypotension and bronchospasm. the first choice is to administer

Epinephrine (adrenaline) is a drug of choice for anaphylactic shock. it is given by subcutaneous or intramuscular route in a concentration of 1:1000. intravenous route is rarely used but at match but that much lower concentration(1:10,000) Refer kDT 6/e p128


Question: Drug of choice for cheese reaction is

Phentolamine is the drug of choice in CHEESE REACTION It is a rapidly acting alpha blocker with sho duration of action (in minutes). It is non selective alpha blocker therefore blocks both alpha 1 and 2 Non Selective a Blockers Selective a1 Blockers Irreversible - Phenoxybenzamine - Used for pheochromocytoma Reversible - Phentolamine, Tolazoline,ergotamine - DOC for cheese reaction and clonidine withdrawal Prazosin Terazosin Doxazosin Alfuzosin - These drugs are used for BHP and HTN. - Also used for scorpion sting


Question: Drug of choice for hyperhidrosis is

Darifenacin is considered as drug of choice for hyperhidrosis-excess sweating as it blocks m3 receptors on sweat glands Ref: KDT 6th ed pg 118


Question: Nevirapine is

NIs are - Zidovudine, Lamivudine, Stavudine, Didanosine, Zalcitabine Emtricitabine, Abacavir, Tenofovir PIs are - Saquinavir, Indinavir, Ritonavir, Nelfinavir, Amprenavir, Lopinavir and Amprenavir Fusion inhibitor - Enfuviide Ref: HL Sharma 3rd edition anti retroviral drugs.

Nonnucleoside reverse transcriptase inhibitor (NNI)

Nucleoside reverse transcriptase inhibitor (NIs)


Question: In comparison to inhaled adrenergic agonists, the inhaled anticholinergics

are better suited for control of an attack of asthma

produce slower response in bronchial asthma

produce little benefit in chronic obstructive lung disease


Question: Cyclosporin is used an


Question: Wich one of the following drugs does not produce central anticholinergic syndrome

Ref: KD Tripathi pharmacology 7th edition (page.no: 111) Glycopyrrolate is a potent and rapidly acting antimuscarinic, lacking central effects. It is having a quaternary structure. so it doesn't cause the central anticholinergic syndrome. Atropine has both central and peripheral action. Tricyclic antidepressants, Antihistaminics have central anticholinergic effects


Question: The dose of methyl prednisolone to be given in an acute spinal injury is

(C) 30 mg/kg/body weight# STEROID THERAPY IN SPINAL CORD INJURY: Steroid have verified significant improvement in motor function and sensation in patients with complete or incomplete spinal cord injuries (SCIs) who were treated with high doses of methylprednisolone within 8 hours of injury. High doses of steroids or Tirilazad are thought to minimize the secondary effects of acute SCI.> 30-mg/kg bolus of methylprednisolone administered within 8 hours of injury, whereas the study evaluated methylprednisolone 5.4 mg/kg/h for 24 or 48 hours versus tirilazad 2.5 mg/kg q6h for 48 hours. (Tirilazad is a potent lipid preoxidation inhibitor.)> Between the 2 studies, it was determined that: (1) in patients treated earlier than 3 hours after injury, the administration of methyl- prednisolone for 24 hours was best; (2) in patients treated 3-8 hours after injury, the use of methylprednisolone for 48 hours was best; (3) Tirilazad was equivalent to methylprednisolone for 24 hours.> Both NASCIS studies evaluated the patients' neurologic status at baseline on enrollment into the study, at 6 weeks, and at 6 months and found absolutely no evidence suggests that giving the medication earlier (eg, in the first hour) provides more be nefit than giving it later (eg, between hours 7 and 8).> The authors concluded that there was only a benefit if methylprednisolone or tirilazad were given within 8 hours of injury.> Use of high-dose methylprednisolone in non-penetrating acute SCI had become the standard of care in North America.An increased incidence of infection and avascular necrosis has been documented.> Revised recommendations pertaining to steroid therapy in SCI:- The American College of Surgeons (ACS) has modified their advanced trauma life support (ACLS) guidelines to state that methylprednisolone is "a recommended treatment" rather than "the recommended treatment." Updated guidelines issued in 2013 by the CNS and the American Association of Neurological Surgeons (AANS) recommend against the use of steroids early after an acute SCI. Guidelines recommend that methylprednisolone not be used for the treatment of acute SCI within the first 24-48 hours following injury. Previous standard was revised because of a lack of medical evidence supporting the benefits of steroids in clinical settings and evidence that high-dose steroids are associated with harmful adverse effects. Overall, the benefit from steroids is considered modest at best, but for patients with complete or incomplete quadriplegia, a small improvement in motor strength in one or more muscles can provide important functional gains. Administration of steroids remains an institutional and physician preference in spinal cord injury. Administration of high-dose steroids within 8 hours of injury for all patients with acute spinal cord injury is practiced by most physicians. Current recommendation is to treat all patients with spinal cord injury according to the local/regional protocol. If steroids are recommended, they should be initiated within 8 hours of injury with the following steroid protocol: Methylpred- nisolone 30 mg/kg bolus over 15 minutes and an infusion of methylprednisolone at 5.4 mg/kg/h for 23 hours beginning 45 minutes after the bolus.


Question: Glycoprotein II b / III a receptor antagonists is

(Abciximab) (573-KDT) (610-11-KDT 6th)Antiplatelet Drugs (Antithrombotic drugs)* Aspirin* Dipyridamole* Ticlopidine* Clopidogrel* * Glycoprotein lib /Ilia receptor antagonists - Abciximab, Eptifibatide and TirofibanAbciximab* Given along with aspirin + heparin during PTC A it has markedly reduced the incidence of restenosis, subsequent MI and death* Used in unstable angina and as adjuvant to coronary thrombolysis* Non antigenic, the main risk is haemorrhage. Thrombocytopenia is another complications.Antifibrinolvtics - EACA, Tranexaemic acid, Aprotinin


Question: Quinolones are not effective in the treatment of


Question: Carvedilol is an effective antihypeensive agent that, like propranolol, is capable of blocking beta receptors. An impoant difference between the two drugs is that carvedilol

a + b ADRENERGIC BLOCKERS Includes Labetalol, Carvedilol. Carvedilol:- It is a b1 + b2 + a1 adrenoceptor blocker; produces vasodilatation due to a1 blockade as well as calcium channel blockade, and has antioxidant propey. It has been used in hypeension and is the b blocker especially employed as cardioprotective in CHF. Oral bioavailability of carvedilol is 30%. It is primarily metabolized and has a t 1/2 of 6-8 hrs. Ref:- kd tripathi; pg num:-151

is a selective blocker of cardiac b1 receptors


Question: Contraindications to use of Beta Blockers

* Bronchial asthma is an absolute contraindication of non selective beta Blockers - as they induce bronchoconstriction by knocking off beta 2 mediated adrenergic bronchodilation. Ref:- Sharma's Principles of Pharmacology 3rd Ed; Pg No:- 191-2


Question: Laxative used in hepatic encephalopathy

Ref: Goodman & Gillman 13th ed. P 928, 940USES OF LACTULOSE* Constipation caused by opioids* Idiopathic chronic constipation* Lactulose also used to treat hepatic encephalopathyLACTULOSE IN HEPATIC ENCEPHALOPATHY* Impaired liver function/severe liver disease are unable to detoxify the ammonia coming from colon which is produced by colonic bacterial metabolism of fecal urea.* The drop in luminal pH that accompanies hydrolysis to short-chain fatty acids in the colon results in "trapping" of the ammonia by its conversion to the polar ammonium ion.* Combined with the increase in colonic transit, this therapy significantly lowers circulating ammonia levels. The therapeutic goal in this condition is to give sufficient amounts of lactulose (usually 20-30g three to four times per day) to produce two to three soft stools a day with a pH of 5-5.5.


Question: Most important side effect of Amphotericin B is

Ans. is 'b' i.e., Nephrotoxicity Important adverse effects of Amphotericin B:a) Acute reactions - occurs with each infusion and consists of chills, fever, aches and pain due to release of cytokines like TNF a, IL1 and IL6.b) Nephrotoxicity - It is the most important side effect which occurs uniformly and dose related and often manifests as azotemia, reduced GFR, acidosis, hypokalemia. It reverses slowly and often incompletely after stoppage of therapy.c) Anemia due to bone marrow depression which is largely reversible.d) CNS toxicity.


Question: Drug used only for treatment of postprandial hyperglycemia is

Alpha glucosidase inhibitors - effect on both prandial and post prandial sugar ,that act as competitive inhibitors of enzymes needed to digest carbohydrates Rapaglinide is used only for treatment of postprandial hyperglycemia Sulfonylureas is for maintenance of type 2 DIABETES MELLITUS Metformin is drug of choice for treatment of type 2 DIABETES MELLITUS


Question: Drug not to be given in ishchemic hea disease

Refer kDT 6/e p547 Isopreterenol is a beta adrenergic agonists and is contraindicated in ishchemic hea disease. As it can increase myocardial oxygen demand by causing tachycardia


Question: Pulmonary fibrosis is the most common complication after treatment with

Ans. is 'c' i.e., bleomycin This question has been repeated numerous times before so its well-known that Bleomycin causes Pulmonary fibrosisThe other important fact about Bleomycin is its mechanism of action.* It causes DNA chain scission and inhibits repair by intercalating between DNA strands*Other drugs causing pulmonary fibrosis areacyclovir*amiodarone*busulphan*cyclophosphamide*melphalan*methotrexate*methysergide*


Question: Drug of choice for absent seizures

Many children appear to have a genetic predisposition to absence seizures. In general, seizures are caused by abnormal electrical impulses from nerve cells (neurons) in the brain. Ref: KD Tripathi 8th ed.


Question: In spider nevi, dilatation of blood vessels is due to

Nevus araneus, also known as spider angioma or spider nevus, is a common benign vascular lesion present in 10-15% of healthy adults and young children. They may appear as solitary or multiple lesions. In paicular, when multiple lesions are present, liver disease, estrogen therapy, and thyrotoxicosis should be considered. The name stems from its physical appearance, which is characterized by a central red aeriole, or punctum, representing the body of the spider, surrounded by a radial pattern of thin-walled capillaries, resembling legs


Question: Drug acting tyrosine kinase receptor is

Drugs acting on tyrosinase kinase receptors - Prolactin Insulin Growth hormone TRH, TSH and MSH acts on GPCR receptors


Question: Pharmacogenetics is associated with

The determinants of drug response, viz. transpoers, metabolizing enzymes, ion channels, receptors with their couplers and effectors are controlled genetically The study of the genetic basis for variability in drug response is called 'Pharmacogenetics'. Ref ;KD Tripathi Pharmacology 7th edition (page no;65)

individual variations in drug response due to gene variability

Individual variability in oral absorption

Different mechanism of actions in different individuals


Question: The Loop diuretic acts at

(C) Ascending loop # Loop diuretics: are diuretics that act on the ascending loop of Henle in the kidney.> They are primarily used in medicine to treat hypertension and edema often due to congestive heart failure or renal insufficiency.# Mechanism of action:> Loop diuretics act on the Na+-K+-2CI' symporter (cotransporter) in the thick ascending limb of the loop of Henle to inhibit sodium & chloride reabsorption. This is achieved by competing for the Cl' binding site.> Because magnesium and calcium reabsorption in the thick ascending limb is dependent on sodium and chloride concentrations, loop diuretics also inhibit their reabsorption> By disrupting the reabsorption of these ions, loop diuretics prevent the urine from becoming concentrated and disrupt the generation of a hypertonic renal medulla


Question: Not a side effect of cimitidine is

Common side effects of Tagamet include: headache, dizziness, drowsiness, depression, agitation, breast swelling or tenderness (in men), joint or muscle pain, skin rash,


Question: Hyperkalemia is associated with

Refer Harrison 17e 281 ACE inhibitor can cause hyperkalemia whereas amphotericin B and Thiazide (chlohalidone) cause hypokalemia