Question: Lovastatin acts by inhibiting

Ans. a (HMGCoA reductase). (Ref. Harrison Medicine I6th/I43I, 2168, 2296, table 335-6)HMG-CoA REDUCTASE INHIBITORS# HMG-CoA reductase is the rate-limiting step in cholesterol biosynthesis.# By inhibiting cholesterol biosynthesis, HMG-CoA reductase inhibitors (statins) lead to -- increased hepatic LDL receptor activity and accelerated clearance of circulating LDL, resulting in a dose-dependent reduction in plasma LDL-C.# HMG-CoA reductase inhibitors are the drug class of choice for LDL-C reduction.# They also reduce plasma triglycerides in a dose-dependent fashion, which is proportional to their LDL-C lowering effects .# They have a modest HDL-raising effect (5 to 10%), and this effect is not dose-dependent.# HMG-CoA reductase inhibitors are well tolerated and can be taken in tablet form once a day.# Potential Side Effects include:Dyspepsia,- Headaches,- Fatigue,- Muscle or joint pains- Severe myopathy- Rhabdomyolysis (rarely).- Hepatitis# The risk of myopathy is increased by the presence of renal insufficiency and by coadministration of drugs that interfere with the metabolism of HMG-CoA reductase inhibitors, such as erythromycin and related antibiotics, antifungal agents, immunosuppressive drugs, and fibric acid derivatives.# Serum CPK levels do not need to be monitored on a routine basis as an elevated CPK in the absence of symptoms does not predict the development of myopathy and does not necessarily suggest the need for discontinuing the drug.DRUGS USED FOR THE TREATMENT OF HYPERLIPIDEMIADrugMajor indicationsMechanismCommon side effectsHMG-CoA reductase inhibitors (statins)Elevated (LDL)|Cholesterol synthesis;|LDL receptors,| hepatic VLDLProductionMyalgias, arthralgias, DyspepsiaBile acid sequestrantsElevated triglycerides| Bile acid excretion and| LDL receptorsBloating, constipation.Nicotinic acidElevated LDL, |HDL,Elevated TG|VLDL hepatic synthesis and | HDL.Cutaneous flushing;GI upset;Elevated glucose, uric acid, levels and liver function tests.Fibric acid derivatesElevated remnants| LPL, |VLDLDyspepsia myalgia; gall stones.


Question: The drug of choice in scleroderma induced hypeensive crisis is

Refer kDT 7/e p 505 Blood pressure control is the mainstay of therapy in sclerodermarenal crisis. ... An ACE inhibitor is the agent of choice, leading to an improvement in blood pressure in up to 90% of patients by reversing the angiotensin II-inducedvasoconstriction.


Question: Drug of choice for post menopausal osteoporosis is

Drug used in osteoporosis Inhibit resorption:Bisphosphonates (drug of choice), Denosumab, calcitonin, estrogen, SERMS, gallium nitrate. Stimulate formation: Teriparatide (PTH analogue), calcium, calcitriol, fluorides. Both actions: Strontium ranelate.


Question: Brinzolamide is

Carbonic anhydrase (CAse) is an enzyme which catalyses the reversible reaction H2O + CO2 - H2C03 Hence, Carbonic anhydrase functions in CO2 and HC03 transpo and in H+ ion secretion. Carbonic anhydrase inhibitors act by non-competitive but reversible inhibition of the enzyme -Decreases the production of aqueous humor from ciliary body epithelium. Ex: Acetazolamide, dorzolamide and Brinzolamide.

Competitive and reversible carbonic anhydrase inhibitor

Non-competitive and reversible carbonic anhydrase inhibitor

Competitive and irreversible carbonic anhydrase inhibitor

Non-competitive and irreversible carbonic anhydrase inhibitor


Question: Drug of choice for late cisplatin induced vomiting is

Anti - Emetic Drugs:- - Neurokinin antagonist (NK1antagonist / Substance-P antagonist) Aprepitant Fosaprepitant Rolapitant Netupitant - These are drug of choice for delayed vomiting due to chemotherapy


Question: The drug not used in acute asthma is

Refer KDT 6/e p 222 Only bronchodilator drugs are useful for the treatment of acute attack of asthma Beta 2 agonists eg salbutomol, terbutaline. Antichokinergics eg Iprqtropoum, tiotropium Methylxanthine eg Theophylline


Question: Muscle relaxant of choice in a patient with serum bilirubin 6mg/dl and serum creatinine of 4.5mg/dl

Refer KDT 7th, /353 Atracurium is eliminated by Hoffman's elimination. It means it neither require liver for metabolism nor kidney for excretion. It's molecules spontaneously reaarnge to make it reactivity. Thus it safest muscle relaxed in a patient on a patient with liver and kidney disease


Question: Tyramine acts by

C i.e. Release norepinephrine Tyramine, ephedrine & amphetamine (TEA) augment autonomic activity by releasing norepinephrineQ from endings of post-ganglionic neurons. Stnne drugs and toxins affecting Autonomic activity /IP Site of Action Compounds That Augment Autonomic Activity Compounds That Depress Autonomic Activity Sympathetic and parasympathetic ganglia * Stimulate postganglionic neurons - Nicotine - Low concentrations of acetylcholine * Inhibit acetylcholinesterase - DFP (diisopropyl fluorophosphate) - Physostigmine (Eserine) - Neostigmine (Prostigmin) - Parathion * Block conduction - Hexamethonium (C-6) - Mecamylamine (inversine) - Pentolinium - Trimethaphan (Arfonad) - High concentration of acetylcholine Endings of postganglionic noradrenergic neurons * Release norepinephrine - Tyramine - Ephedrine - Amphetamine * Block norepinephrine synthesis - Metyrosine (Demser) * Interfere with norepinephrine storage - Reserpine - Guanethidine (Ismelin) * Prevent norepinephrine release - Bretylim (Bretylol) - Guanethidine (Ismelin) * Form false transmitters - Methyldopa (Aldomet) Muscarinic receptors Atropine, scopolamine a adrenergic receptors * Stimulate alreceptors - Methoxamine (Vasoxyl) - Phenylephrine (Neo-Synephrine) * Block a receptors - Phenoxybenzamine (Dibenzyline) - Phentolamine (Regitine) - Prazosin (Minipress) (block al) - Yohimbine (blocks a2) b adrenergic receptors * Stimulate 13 receptors - Isoproterenol (Isuprel) * Block $ receptors - Propranolol (Inderal) and others (blocks 01 - Atenolol (Tnormin) and others (blocks 01) Butoxamine (blocks 02) C i.e. Release norepinephrine


Question: Aspirin is contraindicated in

B. i.e. (Peptic Ulcer) (190- KDT 6th)* Aspirin is contra indicated in1. Peptic ulcer, bleeding tendencies2. Viral infection in children (Develop Reys syndrome)3. Warfarin*** Aspirin is avoided in1. Chronic liver disease2. Diabetes3. Breast feeding mothers4. Avoid high dose in G-6PD deficient individuals**Aspirin should be stopped 1 week before elective surgery ***.* Salicylism (tinnitus, and hearing difficulty, dizziness, headache and confusion) develops on high doses of aspirin intake* Aspirin is one of the worst for causing gastric irritation* Low doses of aspirin also decreases the incidence of transient ischaemic attacks* Analgesic effect of Aspirin is due to Inhibit prostaglandin synthesis (cyclo- oxygenase decreases)**


Question: Amylin analog among the following is

Pramlintide, a synthetic analog of amylin, is an injectable antihyperglycemic agent that modulates postprandial glucose levels and is approved for preprandial use in persons with type 1 and type 2 diabetes. It is administered in addition to insulin in those who are unable to achieve their target postprandial blood sugar levels.Pramlintide suppresses glucagon release undetermined mechanisms, delays gastric emptying, and has central nervous system mediated anorectic effects.Ref: Katzung; 13th edition; Page no: 760


Question: Variation in sensitivity of response to increasing doses of the drug in different individuals can be obtained from

Quantal DRC When the response is an 'all or none' phenomenon (e.g. antiemetic drug stopping the vomiting or not), the y-axis (response axis) shows the number of person responding and X-axis shows the plasma concentration. It thus shows that how many person respond to a paicular dose of the drug. It is used to calculate ED50 and LD50. Median Effective Dose (ED50): It is the dose that will produce the desired response in half of the (50%)recipients. More is ED50, lower is the potency and vice a versa. Median Lethal Dose (LD50): It is the dose that will result in death of 50% of the animals receiving the drug. More is LD50, safer is the drug. Therapeutic Index (T.I.): It is a measure of the safety of a drug. It is calculated as a ratio of LD50 to ED50. Drugs having high T.I. are safer whereas those having low T.I. are more likely to be toxic.


Question: A patient presents with malignant hyperthermia and metabolic acidosis. Immediate treatment should be started with


Question: Drug causing impaired taste is

antibiotics, such as ACE inhibitors like <a class="content-link" style="-webkit-font-smoothing: antialiased; box-sizing: inherit; background-color: transparent; cursor: pointer; text-decoration-line: none; border-color: currentcolor; color: ;" href=" anhydrase inhibitors, such as methazolamide etc
 ESSENTIALS of medical PHARMACOLOGY SIXTH EDITION-KD TRIPATHI Page:688,689


Question: Antidote for opioid poisoning;

Naloxone is an opioid antagonist given intravenously. It blocks mu, kappa and delta receptors. It is the DOC for opioid toxicity. is given parenterally (ineffective orally) and is a very sho acting drug. Pethidine (Meperidine)- fully agonist at opiod receptors Flumazenil-Flumazenil is specific antidote for benzodiazepines. Physostigmine - it is a lipid soluble anticholinesterase. It is the specific antidote for poisoning with belladonna.


Question: Colourblindess is caused by

Ans. b (Ethambutol). (Ref. Katzung 12th/Chapter 47)Hypersensitivity to ethambutol is rare. The most common serious adverse event is retrobulbar neuritis, resulting in loss of visual acuity and red-green color blindness. This dose-related adverse effect is more likely to occur at dosages of 25 mg/kg/d continued for several months. At 15 mg/kg/d or less, visual disturbances are very rare. Periodic visual acuity testing is desirable if the 25 mg/kg/d dosage is used. Ethambutol is relatively contraindicated in children too young to permit assessment of visual acuity and red-green color discrimination.Drugs causing color vision alterationDrugs causing cataractDrugs causing retinopathyBarbituratesBusulfanChloroquineDigoxin (yellow vision)SteroidPhenothiazidesEthambutol (red-green blindness)PhenothiazidesDEC (anti-filarial)Sildenafil citrate (blue-green blindness)Miotics Thioridazone, thiazidesGold SulfonamidesChloroquine SYSTEMIC DRUGS:ADVERSE OCULAR EFFECTSOxygen> Retinopathy of prematurity.0Digitalis> Disturbances of color vision (yellow vision), scotomas, photopsia.Quinidine> Optic neuritis (rare).Thiazides> Xanthopsia (yellow vision), myopia.Carbonic anhydrase inhibitors> Ocular hypotony, transient myopia.Amiodarone> Corneal deposits.Anticholinergic agents> Risk of angle closure glaucoma due to mydriasis. Blurring of vision due to cycloplegia.Barbiturates> Extraocular muscle palsies with diplopia, ptosis, cortical blindness.Chloral hydrate> Diplopia, ptosis, miosis.Phenothiazines> Deposits of pigment in conjunctiva, cornea, lens and retina. Oculogyric crises.Amphetamines> Widening of palpebral fissure. Dilation of pupil, paralysis of ciliary muscle with loss of accommodation.Monoamine oxidase (MAO) inhibitors> Nystagmus, extraocular muscle palsies, optic atrophy.Tricyclic agents> Dilation of pupil (risk of angle closure glaucoma)0, cycloplegia.Phenytoin> Nystagmus, diplopia,0 ptosis, slight blurring of vision (rare).Neostigmine> Nystagmus, miosis.Morphine> Miosis.Haloperidol> Capsular cataract.Lithium carbonate> Exophthalmos, oculogyric crisis.Diazepam> Nystagmus.Corticosteroids> Cataract (posterior subcapsular), local immunologic suppression, causing susceptibility to viral (herpes simplex), bacterial, and fungal infections; steroid induced glaucomaFemale sex hormones> Retinal artery occlusion, retinal vein occlusion, papilledema, ocular palsies with diplopia, nystagmus, optic neuropathy, retinal vasculitis, scotomas, migraine, mydriasis and cycloplegia, and macular edema.Chloramphenicol> Optic neuritis and atrophy.Rifabutin> Uveitis.Streptomycin> Optic neuritis.Tetracycline> Pseudotumor cerebri, transient myopiaChloroquine> Macular changes, central scotomas, pigmentary degeneration of the retina, chloroquine keratopathy, ocular palsies, ptosis, ERG depression.lodochlorhydroxyquin> Optic atrophy.Sulfonamides> Stevens Johnson syndrome.Ethambutol> Optic neuritis and atrophy.Isoniazid> Optic neuritis and atrophy/ color blindness.Gold salts> Deposits in the cornea and conjunctiva.Lead> Optic atrophy, papilledema, ocular palsies.Penicillamine> Ocular pemphigoid, optic neuritis, ocular myasthenia.Chlorpropamide> Transient change in refractive error, diplopia, Stevens Johnson syndrome.Vitamin A> Papilledema, retinal hemorrhages, loss of eyebrows and eyelashes, nystagmus, diplopia, blurring of vision.Vitamin D> Band shaped keratopathy.Salicylates> Nystagmus, retinal hemorrhages, cortical blindness (rare).Indomethacin> Corneal deposits.Phenylbutazone> Retinal hemorrhages


Question: Steady state plasma concentration obtained after a dosage regimen depends on

Factors on which steady state depends:* Half life of drug, it is obtained after 4-5 half lives.* Frequency of administration i.e. more frequently we give, lesser is the variation between peak and trough at steady state.* Dosing rate i.e. more the dosing rate , more will be the concentration of drug in plasma. Note: Read the question carefully. If the question is asked, time to reach steady state plasma concentration depends upon?, then answer would he half life. But if they ask how much plasma concentration is obtained at steady state, it depends upon dosing rate.


Question: Drug of choice in treatment of partial complex seizures

Ans. a (Carbamazepine). (Ref. Harrison, Internal Medicine, 16th ed., 1848)Type of seizurePrimary generalized tonic clonic seizurePartial complex seizuresAbsence seizureAtypical absence;Myoclonic; Atonic* First line treatmentValproic acidCarbamazepineEthosuximideValproic acidPhenytoin Valproic acid Valproic acid Lamotrigine * Valproate is broad spectrum anti-epileptic.


Question: Drug of choice for primary syphilis is

Ans. b (Benzathine penicillin). (Ref. Pharmacology KD Tripathi 5th/657, 673, 688; Harrison's Medicine 16th/980)Rx of SyphilisEarly & latent syphilisLate syphilis1.2 MU Procaine penicillin x 10 daysOR2.4 MU benzathine penicillin 1-3 weeklyBenzathine penicillin2.4 MU weekly for 4 weeksDrug used for treatment of syphilis# Penicillin# Erythromycin# Tetracycline# Cephalosporins.


Question: Digoxin increases cardiac contractility by directly engaging in wof

Mechanism of action:- Digoxin increases force of cardiac contraction by a direct action independent of innervation. It selectively binds to extracellular face of the membrane associated Na+K+ ATPase of myocardial fibres and inhibitis this enzyme. Inhibition of this cation pump results in progressive accumulation of Na+ intracellularly. This indirectly results in intracellular Ca2+ accumulation. During depolarization Ca2+ ions enter the cell driven by the steep Ca2+ gradient through voltage sensitive L type Ca2+ channels. This triggers release of larger amount of Ca2+ stored in sarcoplasmic reticulum (SR) through Ryanodine calcium channel 2 (RYR2) - cytosolic Ca2+ increases transiently (calcium transients) - triggers contraction by activating troponin C on myofibrils. Ref:- kd tripathi; pg num:-514

Inhibiting myocardial Na + /Ca 2+ -ATPase


Question: Local anesthetics act by blocking

Local anesthetics are weak bases that peneterate cell membrane in unionized form and within the cell membrane in ionized form they block voltage gated Na+ Channels.


Question: QY prolongation can be caused by


Question: The following anticancer drug has high emetogenic potential

PLATINUM COORDINATION COMPLEXES Cisplatin Mech of action:- It is hydrolysed intracellularly to produce a highly reactive moiety which causes cross linking of DNA. The oured site is N7 of guanine residue. Adverse effects:- It is a highly emetic drug. Antiemetics are routinely administered before infusing it. The most impoant toxicity is renal impairment which is dependent on total dose administered. Renal toxicity can be reduced by maintaining good hydration. Tinnitus,deafness, sensory neuropathy and hyperuricaemia are other problems. Ref:- kd tripathi; pg num:-861


Question: The drug of choice for paroxysmal supraventricular tachycardia

Refer kDT 6/e p 519 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: The tissues most sensitive to atropine are

Atropine is highly selective for muscarinic receptors. Its potency at nicotinic receptors is much lower, and actions at nonmuscarinic receptors are generally undetectable clinically.The effectiveness of antimuscarinic drugs varies with the tissue and with the source of agonist. In most tissues, antimuscarinic agents block exogenously administered cholinoceptor agonists more effectively than endogenously released acetylcholine.Tissues most sensitive to atropine are the salivary, bronchial, and sweat glands.Secretion of acid by the gastric parietal cells is the least sensitive. Katzung 13e pg: 122

The salivary, bronchial and sweat glands


Question: Drug of choice for pregnancy induced hypeension is

Alpha methyldopa is a drug of choice for pregnancy induced hypeension. However these days labetalol is preferred for this case of indication. Refer Goodman and Gilman 12e p773 Katzung 12e p176


Question: Displacement is the defensive mechanism for (NOT REALTED)

In Phobia patient has fear of something which then is replaced by generalized fear of so many things.


Question: AZT, DD1, HAART are combination of three drugs are used in AIDS acts by

(Nucleoside reverse transcriptase inhibitors) (770-KDT 6th)* Nucleoside reverse transcriptase inhibitors (NRTIs) -Zidovudine (AZT), Didanosine (ddl) Stavudine (d4T) Lamivudine (3TC) abacavir(ABC)Single- stranded viral RNA||Virus directed reverse transcriptase(Inhibited by zidovudine triphosphate)Double - stranded viral DNA* Non nucleoside reverse transcriptase inhibitors (NNRTIs)Nevirapine (NVP) Efavirenz (EFV) Delavirdine* Protease inhibitors - Ritonavir, Indinavir, Nelfinavir, Saquinavir* Fusion inhibitor - Enfuvirtide (binding to HIV envelope glycoprotein (grp 41) and preventing fusion of viral and cellular membranes


Question: In Bact. fragilis infection drug of choice is

C. i.e. (Clindamycin) (731 - KDT 6th)* CLINDAMYCIN. Potent lincosamide antibioticIt inhibits most gram positive cocci, C. diphtheriae, Nocardia Actinomyces, Toxoplasma* High activity against a variety of anaerobes especially Bact.fragilis*** AZITHROMYCIN - more active than other macrolides against H. influenzae* High activity is exerted on respiratory pathogens- Mycoplasma, Chla. pneumonia, Legionella, Moraxella and on others like Campylobacter, Ch. trachomatis, H. ducreyi, Calymm. granulomatis, N. gonorrhoeae.CLARITHROMYCIN - More active against sensitive strains of gram - positive cocci, Moraxella, Legionella. Mycopneumoniae and Helicobacter- pylori.


Question: Lactation is suppressed by

Ans. is'c'i.e., ApomorphineRef : Clinical Pharmacology 3'd/e p. 799Impoant drugs inhibiting lactation are : -DopamineBromocriptineCabergolineApomorphine


Question: One of the following is not a 5HT receptors on antagonist

Lanreotide is a medication used in the management of acromegaly and symptoms caused by neuroendocrine tumors, most notably carcinoid syndrome. It is a long-acting analogue of somatostatin, like octreotide Refer kDT 6/e p166


Question: Most teratogenic in pregnancy

Valproate is the most teratogenic, phenytoin also isn't safe. Phenobarbitone, lamotrigine, topiramate are relatively safe drugs but 4mg folic acid is required per day. Ref: KD Tripathi 8th ed.


Question: Omalizumab is

ANTI-IgE ANTIBODY Omalizumab It is a humanized monoclonal antibody against IgE. Administered s.c., Mech of action:- It neutralizes free IgE in circulation without activating mast cells and other inflammatory cells. On antigen challenge, little IgE is available bound to the mast cell surface receptors (FceR1) to trigger mediator release and cause bronchoconstriction. In severe extrinsic asthma, omalizumab has been found to reduce exacerbations and steroid requirement. No benefit has been noted in nonallergic asthma. Ref:- kd tripathi; pg num:-231


Question: A child presents with bladder exstrophy and chronic renal failure. The muscle relaxant of choice to be used during surgery if exstrophy in this child is

Refer Ref Katzung 11/e p453 Atracurium is eliminated by Hoffman's elimination I. e, it does not require liver of kidney, it is the muscle relaxant of choice in hepatic and renal failure


Question: DOC for belladona poisoning

Physostigmine is an anticholinesterase & chemically it is a tertiary amine which can cross BBB.
It is DOC for Belladona, Datura & Atropine poisoning.


Question: Coarse tremors, polyuria and hypothyroidism are adverse effects of

Bipolar Disorder - Drug of Choice (in general)- Lithium - Drug of Choice (In pregnancy)-Atypical Antipsychotic drugs Lithium L - Leucocyte I - Increase T - Tremors (most common) H - Hypothyroidism I - Increase U - Urine M- Mother (Avoided in pregnancy as it causes Ebstein anomaly in baby i.e. Congenital tricuspid atresia)


Question: OCP should not be used with


Question: High anticholinergic propey is present in the following antihistaminic agent


Question: The following cytotoxic drug acts by inhibiting depoly merization of tubulin and thus producing abnormal arrays of microtubules

Taxanes mechanism of action:- It binds to b-tubulin and enhances its polymerization. The microtubules are stabilized and their depolymerization is prevented. This stability results in inhibition of normal dynamic reorganization of the microtubule network that is essential for interphase and mitotic functions. Adverse effects:- Reversible myelosuppression (mainly granulocytopenia) and 'stocking and glove' neuropathy. Nausea, chest pain, ahralgia, myalgia, mucositis and edema. Ref :- kd tripathi; pg num:-865,866


Question: DOC for Neisseria gonorrhea infection is

Ans. is 'a' i.e., Ceftriaxone Recommended Rx of Gonococcal infection (Penicillinase producing NG):* Gonococcal infection of cervix, urethra, pharynx, rectum# First line - Ceftriaxone, ciprofloxacin, ofloxacin.# Alternatives - Spectinomycin, ceftizoxime, cefotetan.* Gonococcal conjuctivitis and ophthalmia neonatorum - Ceftriaxone.* Disseminated gonoccal infection (Gonococcal arthritis)# Patient tolerant to b-lactam drugs - ceftriaxone, cefotaxime, ceftizoxim.# Patient allergic to b-lactam drugs - ciprofloxacin, ofloxacin, spectinomycin.# Continuation therapy - Ciprofloxacin, ofloxacin, levofloxacin.* Gonococcal epididymitis - ceftriaxone followed by doxycycline.DOC for gonorrhea is ceftriaxone


Question: Detoxication of drugs is controlled by

Cytochrome p450 enzymes are microsomal enzymes that are involved in phase I metabolism of many drugs,
Most of the drugs are metabolized by CYP 3 A4 isoform. Drug metabolizing enzymes The drug-metabolizing enzymes are divided into two types :
1. Microsomal These are located on smooth endoplasmic reticulum primarily in the liver, also in kidney, intestinal mucosa and lungs.
Examples are monooxygenase, cytochrome P450, glucuronyl transferase.
They catalyze most of the oxidation, reduction, hydrolysis and glucuronide conjugation.
They are inducible by drugs, diet and other agencies.
2. Nonmicrosomal These are present in the cytoplasm and mitochondria of hepatic cells as well as in other tissues including plasma.
Examples are flavoprotein oxidase, esterases, amidases and conjugases.
They catalyze some oxidation and reduction, many hydrolysis and all conjugation except glucuronidation.
They are not inducible but many show genetic polymorphism (acetyltransferase, pseudocholinesterase)


Question: The drug approved for obesity treatment along with Phentermine is

Topiramate causes weight loss. Recently it was approved for obesity treatment along with Phentermine.This drug is an extended release or controlled release preparation.Phenteramine is an non adrenergic sympathomimetic and topiramate anti seizure and antimigrate drug available in FDC known as Qsymia.Ref: H.L.Sharma; 3rd ed.; pg 925


Question: A bactericidal drug would be preferred over a bacteriostatic drug in a patient with

Bactericidal drugs kill the bacteria whereas bacteriostatic drugs only inhibits bacterial growth. Bacteriostatic activity is adequate for the treatment of most infections ,bactericidal activity nay be necessary for cure in patients with altered immune system like neutropenia ,HIV and other immunosuppressive conditions Refer KDT 6/e p686


Question: Apremilast is

Ustekinumab, a monoclonal antibody to the shared IL-23/IL-12p40 subunit, is an efficacious treatment for psoriasis and has shown promise in Psoriatic ahritis in clinical trials. Other newer drugs that have shown efficacy for both psoriasis and PsA include the anti-IL-17 pathway agents, such as secukinumab and brodalumab, and an oral phosphodiesterase-4 inhibitor, apremilast. Data on the oral Jak inhibitor, tofacitinib, has been very limited but promising. Ref: Harrison&;s Principles of Internal Medicine; 20th ed KD TRIPATHI 9th ed


Question: Select the diuretic that is most effective in acute congestive glaucoma

Angle closure (narrow angle, acute congestive) glaucoma It occurs in individuals with a narrow iridocorneal angle and shallow anterior chamber. The i.o.t.remains normal until an attack is precipitated, usually by mydriasis. The i.o.t. rises rapidly to very high values (40-60 mmHg). It is an emergent condition with marked congestion of eyes and severe headache. Treatment:- 1. Hypeonic mannitol (20%) 1.5-2 g/kg or glycerol (10%): infused i.v. decongest the eye by osmotic action. 2. Acetazolamide:- 0.5 g i.v. followed by oral twice daily is staed concurrently. 3. Miotic:- Once the i.o.t. stas falling due to the above i.v. therapy, pilocarpine 1-4% is instilled every 10 min initially and then at longer intervals. Contraction of sphincter pupillae changes the direction of forces in the iris tolessen its contact with the lens and spreads the iris mass centrally - pupillary block is removed and iridocorneal angle is freed. 4. Topical b blocker:- Timolol 0.5% is instilled 12 hourly in addition. 5. Apraclonidine (1%)/latanoprost 0.005% instillation may be added. Drugs are used only to terminate the attack of angle closure glaucoma. Definitive treatment is surgical or laser iridotomy. Ref:- kd tripathi; pg num:-155,156,157


Question: Clomiphene acts to induce ovulation by wof mechanisms

Antiestrogens Clomiphene citrate:- It binds to both ERa and ERb and acts as a pure estrogen antagonist.it induces Gn secretion in women by blocking estrogenic feedback inhibition of pituitary. The amount of LH/FSH released at each secretory pulse is increased. In response, the ovaries enlarge and ovulation occurs if the ovaries are responsive to Gn. Adverse effects:- Polycystic ovaries, multiple pregnancy, hot flushes, gastric upset, veigo, allergic dermatitis. Risk of ovarian tumour may be increased. Ref:- kd tripathi; pg num:-312

Diminishing ER-mediated negative feedback at the pituitary

Increasing the action of ER a in the ovary

Increasing the action of ER a in the hypothalamus


Question: Site of action of levetiracetam is


Question: Therapeutic plasma level of the digoxin is

Ref-KDT 6/e p497 Digitoxin digoxin Therapeutic plasma concentration 15-30ng/ml 0.5-1.4 ng/ml Toxic plasma concentraton >35 ng/ml >2.5 ng/ml


Question: Children are more susceptible than adults to the following action of atropine

PHARMACOLOGICAL ACTIONS (Atropine as prototype) Body temperature:- Rise in body temperature occurs at higher doses. It is due to both inhibition of sweating as well as stimulation of temperature regulating centre in the hypothalamus. Children are highly susceptible to atropine fever. Ref:- kd tripathi; pg num:-115


Question: Vigabatrin is used for the treatment of

Sabril (vigabatrin) is an anti-epileptic medication, also called an anticonvulsant,used in combination with other medications to treat complex paial seizures in adults and adolescents who are at least 16 years old. Ref: KD Tripathi 8th ed.


Question: Cinacalcet acts by

Cinacalect is a calcimimetic drug. It resembles calcium and activates calcium sensing receptor(CaSR) present on parathyriod gland and decreases parathormone secretion.


Question: Calcium channel blocker agent used in treatment of hypeension are

Nifedipine and amilodipine like calcium channel blockers can be used for hypeension. Calcium channel blockers are prescription medications that relax blood vessels and increase the supply of blood and oxygen to the heawhile also reducing the hea's workload. Examples of calcium channel blockers include: Amlodipine (Norvasc) Bepridil (Vascor) Diltiazem (Cardizem, Cardizem CD, Cardizem SR, Dilacor XR, Diltia XT, Tiazac) Felodipine (Plendil) Nicardipine (Cardene, Cardene SR) Nifedipine (Adalat, Adalat CC, Procardia, Procardia XL) Nisoldipine, (Sular) Verapamil (Calan, Calan SR, Covera-HS, Isoptin, Isoptin SR, Verelan, Verelan PM) Refer kDT 6/e p543


Question: Anticholinergic drug useful in treatment of peptic ulcer disease is

Peptic Ulcer Disease 1) Drug inhibiting the M1 receptor - Pirenzepine 2) Drug blocking the H2 receptor - Cimetidine - Ranitidine 3) Prostaglandin - Misoprostol - It is chemically PGE1 but work like PGE2 4) Proton pump inhibitors: - Omeprazole - Esomeprazole - Pantoprazole - Lansoprazole - Rabeprazole


Question: Less gastrointestinal bleed is seen in the following NSAID.


Question: Agent used for eliciting diagnostic differentiation of Myasthenia Gravis from Cholinergic crisis is

Edrophonium test * Edrophonium test is used to distinguish between Myasthenic crisis of autoimmune Myasthenia Gravis and Cholinergic crisis. * Edrophonium is a sho acting reversible non-carbamate Acetylcholinesterase inhibitor (indirectly acting cholinomimetic). * It is based on the scientific rationale that muscular weakness of myasthenic crisis (caused by inadequate cholinergic stimulation) dramatically improves on administration of Edrophonium. * In Cholinergic crisis - caused by overeatment with anticholinesterases --> resulting in muscle weakness by induction of persistent depolarization, fuher administration of Edrophonium causes drastic worsening of muscle weakness. Ref:- Goodman & Gilman Pharmacological Basis of Therapeutics 13th Ed; Pg num:- 172


Question: Drug used for cobra bite is

In cobra bite, there is Neuromuscular paralysis. Neostigmine increase acetylcholine metabolism at synapse so that more ach is available to act on NM receptors producing muscle contraction physostigmine may have unnecessary central side effects Ref: KDT 6th ed pg 102


Question: Treatment of choice for prinzmetal's angina

Ans. is 'a' i.e., Nitroglycerine Treatment of variant angina Prinzmetal's variant angina is due to spasm of coronary vessels. The drugs which dilate the coronary vessels, are the main treatment of Prinzmental's angina. Drugs are : Nitrates Calcium channel blockers (verapamil, diltiazem) Nitroglycerin is considered the drug of choice for the patient with variant angina. Prazosin a selective a-blocker may also be used because it prevents a mediated vasospasm. ii-blocker's are contraindicated because they cause constriction of coronary aery due to unopposed a mediated vasoconstriction. Prevention of variant angina In contrast Nitrates are not used for the prevention of variant angina because of delevelopment of tolerance. CCBs are the DOC for prevention.


Question: The drug affecting the trabecular outflow in Glaucoma

Miotics like pilocarpine reduce intraocular tension by increasing the trabecular outflowBeta-blockers reduce production of aqueous humor by acting on the ciliary bodyBrimonidine and prostaglandin analogs increase uveoscleral outflow Ref: Katzung 12th ed. pg: 161


Question: Drug of choice for Paroxysmal Supraventricular Tachycardia

Ref: Katzung 14lh ed. pg. 246; KD Tripathi, 6th ed. pg. 509 & 518* Paroxysmal supraventricular tachycardia (PSVT) is sudden onset episodes of atrial tachycardia (rate 150-200/min) with 1:1 atrioventricular conduction* An attack of PSVT can be terminated by i.v. injection of verapamil, diltiazem, esmolol or digoxin; but most cardiologists now prefer adenosine.* Adenosine has a very short t1/2 in blood ( 10sec)* Almost complete elimination occurs in a single passage through coronary circulation.


Question: Most common side effect of levodopa

Ans) b (Nausea vomiting) Ref: Katzung 11th editionWhen levodopa is given without a peripheral decarboxylase inhibitor, anorexia and nausea and vomiting occur in about 80% of patients.These adverse effects can be minimized by taking the drug in divided doses, with or immediately after meals, and by increasing the total daily dose very slowly; antacids taken 30-60 minutes before levodopa may also be beneficial. The vomiting has been attributed to stimulation of the chemoreceptor trigger zone located in the brain stem but outside the blood-brain barrier. Fortunately, tolerance to this emetic effect develops in many patients. Antiemetics such as phenothiazines should be avoided because they reduce the antiparkinsonism effects of levodopa and may exacerbate the disease.


Question: A patient with ruptured spleen is taken for laparotomy. His blood pressure is 80/50 and hea rate is 125/min.Induction agent of choice for this patient is

Refer Goodman Gilman 12/e p 538-539 Ketamine increases all pressures Blood pressure.. Intracranial tension Introcular pressure In the body ****it is therefore intravenous anesthetic of choice for shock


Question: The pathological state that alerts the volume of distribution of many drugs is


Question: Ethambutol causes

Refer Katzung 10/e p774 KDT 6/e p 742 Ethambutol causes retobulbar neuritis It can result in red green colour blindness


Question: a peptide that causes increased capillary permeability and edema is

Although both histamine as well as bradykinin can cause edema and increase in permeability, histamine is an amine, whereas bradykinin is a peptide. Refer KDT 6/e p490


Question: Drug causing gynecomastia is

Impoant drugs causing gynaecomastia are: D-Digitalis I-Isoniazid S-Spironolactone C-Cimetidine O-Oestrogens


Question: Juvenile myoclonic epilepsy is worsened by

Phenytoin & Carbomazepine can worsen absence & myoclonic seizures.


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

Postoperative shivering (halothane shakes) and hypothermia is maximum with halothane among inhalational anesthetics. It can be used to sta or maintain anaesthesia. One of its benefits is that it does not increase the production of saliva, which can be paicularly useful in those who are difficult to intubate


Question: The most significant adverse effect of ACE inhibition is

On initiation of therapy ACE inhibitors may cause significant hypotension -first dose phenomenon. Hence treatment should be staed with small doses and if patients are on diuretic it is temporarily stopped. Hyperkalemia is another side effect. Ref: KD tripathi 8th ed Page no 129


Question: Aldosterone antagonists are not useful in the treatment of

Aldosterone antagonists cause gynaecomastia as an adverse effect.


Question: Time taken for digitalization is

Digitization is the process of changing from analog to digital form" Refer kDT 6/e p497


Question: Variation in drug responsiveness to a paicular dose of the drug in different individuals can be obtained from

* Drug response to the same drug used in same doses in a population varies based on many factors governing pharmacodynamic variability (like age, genetics, co- morbid condition, concomitant medication, etc) operant in that subset of population under study. * This pharmacodynamic variability in a population is analyzed using a Quantal Dose Response Curve * Quantal Dose Response relationship is an "all or none" plot traced based on response elicited to varying dose of drug administered to a population. * Therapeutic Index of a drug is determined based on data plots from Quantal Dose Response Curves. * Median Effective Dose (ED50) is the dose of a drug required to produce a specified effect in 50% of the population. * In preclinical studies, the Median Lethal Dose (LD50) is determined in experimental animals - the dose that produced moality of 50% of animal group used in testing. * Therapeutic Index is determined as a ratio of LD50/ED50 - provides the safety margin of a drug. The wider the Lethal DRC is spaced away from the Therapeutic effect DRC --> Drug has a wide safety margin. Ref:- Goodman & Gilman's Pharmacological basis of Therapeutics 13th Ed; Pg Num:- 36


Question: The drug that is NOT useful in congestive hea failure

Adrenaline, also known as epinephrine, is a hormone, neurotransmitter, and medication. Adrenaline is normally produced by both the adrenal glands and ceain neurons. It plays an impoant role in the fight-or-flight response by increasing blood flow to muscles, output of the hea, pupil dilation response, and blood sugar level. It does this by binding to alpha and beta receptors. It is found in many animals and some single cell organisms Refer kDT 6/e p493


Question: Tildrakizumab was approved in March 2018 for

Tildrakizumab was designed to block interleukin-23, a cytokine that plays an impoant role in managing the immune system and autoimmune disease. It is approved for the treatment of moderate-to-severe plaque psoriasis.Ref:


Question: A 29yr old women comes to clinic because of heat intolerance, excess sweating, thinning of hair. She had family H/O of autoimmune disease, she is 8 wks pregnant and has had no other issues during pregnancy. Medical H/O includes hypehyroidism. Lab studies are positive for thyroid stimulating immunoglobulin. Wof drug is most appropriate for treatment

This is a case of Grave's disease, which results in thyrotoxicosis. Inhibit hormone synthesis (Antithyroid drugs) Includes Propylthiouracil, Methimazole, Carbimazole. Mech of action:- Antithyroid drugs bind to the thyroid peroxidase and prevent oxidation of iodide/ iodotyrosyl residues, thereby; (i) Inhibit iodination of tyrosine residues in thyroglobulin (ii) Inhibit coupling of iodotyrosine residues to form T3 and T4. Ref:- kd tripathi; pg num:- 252,253


Question: Zidovudine and didanosine used in HAART act by

These drugs act by Nucleoside reverse transcriptase inhibition


Question: Drug of choice for MRSA is

(B) Vancomycin > Drugs used in the treatment of MRSA: Vancomycin, Linezolid, Teicoplanin, Cotrimoxazole, Oxacillin, Rifampicin


Question: Best antihypeensive drug in pulmonary hypeension is

Among the given drugs only to drugs that is bosentan and amilodipine are indicated in pulmonary hypeension. Calcium channel blockers like amlodipine are indicated only in those patient who are positive for intravenous vasodilator challenge (less than 5% patient ). The patient is negative then endothelin drugs are indicated like ok Bosenton. Refer Harrison 19e p1659


Question: Calcium carbonate is used for

Ref: Katzung's, 14th ed. pg. 1089* This medication is used to treat symptoms caused by too much stomach acid such as heartburn, upset stomach, or indigestion.* It is an antacid that works by lowering the amount of acid in the stomach.* It can also be used in renal osteodystrophy with hyperphosphatemia, hypocalcemia and osteoporosis like conditions.* It can cause metabolic alkalosis (Milk-alkali syndrome)


Question: Drug of choice for central precocious puberty in girls


Question: Lipid lowering drug that significantly decreases lipoprotein A

Refer katzung 11e p 613 While one group of drugs, statins, lowerscholesterol, the other group, fibrates, is known to take care of fatty acids and triglycerides. In addition, other drugs, such as ezetimibe, colesevelam, torcetrapib, avasimibe, implitapide, and niacin are also being considered to manage hyperlipidemia.


Question: Drug of choice for acute severe migraine is

Acute migraine is a general term for migraines that aren't diagnosed as chronic. Another name for this type is episodic migraine.People who have episodic migraines have headachesup to 14 days a month. Thus, people with episodic migraines have fewerheadaches a month than people with chronic ones. Triptans are drugs of choice for severe migranes along with NSAIDs . Ref: KD Tripathi 8th ed.


Question: Anesthetic not painful on Intravenous administration is

Ketamine:- * Ketamine on intravenous administration is absolutely devoid of pain at injection site. * Ketamine is a NMDA antagonist intravenous general anesthetic agent - that induces a characteristic cataleptic state called "Dissociative Anesthesia" - a state of induced dissociation from onself and surrounding. * Dissociative anesthesia is due to selective interruption of association pathways in the neocoex and thalamus --> characteristic somato-sensory blockade, a combination of Catalepsy +Catatonia+ Analgesia+ Amnesia (without complete loss of consciousness like other general anesthetics) Ref:- Goodman & Gilman Pharmacological Basis of Therapeutics 13th Ed; Pg num:- 391


Question: The postmarketing trial comes under

There are 4 phases of a clinical trial. Once the drug is released into market pharmacovigilance is done - comes under phase 4 of drug trial to asses the safety, cost effectiveness of the drug once marketed Ref: K.D.Tripati.7th ed. Pg 82-83


Question: The most preferred acute emetic for emesis induced by anticancer drugs is


Question: Two drugs with opposite action on different receptors is

physiological antagonism- functional antagonism - 2 drugs binding to two diff receptors, produces opp effects in same physiological system physical antagonism - by viue of physical propeies - opp to each other- charcoal helps in adsorption in alkaloid poisoning pharmacological anatagonism- competitive and non-competitive types Refer kDT 6/e ,katzung 12e


Question: Lid retraction is caused by

Apraclonidine is sympathomimetic agent used in open angle glaucoma. It decreases aqueous secretion. It can result in upper lid retraction as an adverse effect It can also result in ocular allergy( less likely with brimonidine) Both apraclonidine and brimonidine can cause CNS depression and Apnea in neonates under contraindicated in the children less than 2 years of age Refer drug facts and comparisons 2006/2257


Question: The most potent diuretic amongst the following is


Question: NSAID Drug induced edema is due to

(A) Increased hydrostatic pressure# EDEMA> Causes due to increase hydrostatic pressure (due to enchanced renal salt & water): Congestive heart failure; Acute enphritis; Nephrotic syndrome; Chronic renal disease; Cirrhosis liver; Hypothyroidism. Drug induced fluid retention (E.g NSAID use)\ Idiopathic or cyclical edema.> Edema due to decreased oncotic pressure (due to low serum albumin): Neprhotic syndrome; Cirrhosis liver; Malnutrition.> Edema due to inherent defects in edema preventing mechanisms (seen in face and neck/upper half of body): Prolonged Trendelenberg's position; Edema seen with 'weightlessness (space travel)'.> Lymphedema: Edema due to increased capillary permeability; Angioderma; Vasodilators, e.g. amlodepine; xPostural edema; Inflammatory edema.


Question: Denileukin diftitox is used in

It is a immunotoxin that binds to IL - 2.


Question: A patient with NHL is staed on CHOP regimen. Wof agents is most likely to be protective against the toxicity of doxorubicin

DOXORUBICIN It is an anthracycline antibiotic having anti- tumour activity. Mech of action :- It intercalates between DNA strands and block DNA as well as RNA synthesis. They are also capable of causing breaks in DNA strands by activating topoisomerase-2 and generating quinone type free radicals. As such, they have mutagenic and carcinogenic potential. Maximum action is exeed at S phase, but toxicity is usually exhibited in G2 phase. Adverse effects:- It produces cardiotoxicity as a unique adverse effect. This can manifest either acutely within 2-3 days, causing ECG changes, arrhythmias and hypotension, all of which are reversible; or be delayed--congestive hea failure (related to the total dose administered). CHF is due to cardiomyopathy and may be fatal. Marrow depression, alopecia, stomatitis, vomiting and local tissue damage (on extravasation) are other adverse effects. Urine may be coloured red The anthracycline antibiotics (doxorubicin, etc.) produce cumulative total dose related cardiotoxicity (usually at doses >300 mg/m2). Dexrazoxane is an iron chelating agent when infused i.v. before doxorubicin has been found to reduce risk of such toxicity. However, it may also compromise the anticancer efficacy of doxorubicin. Ref :- kd tripathi;pg num:-867,876


Question: Mechanism of Mianserin

Mianserin is an atypical antidepressant that acts by inhibiting α - adrenergic, H1 & certain serotonin receptors.

Inhibitis α - adrenergic, H1 & some type of 5 - HT receptors

Inhibits α - adrenergic, H2 & some type of 5-HT receptors

Inhibitis β - adrenergic, H1 & some type of 5 - HT receptors


Question: In low dose aspirin acts on

Refer KDT 6 /e p 609 Aspirin acts by inhibiting the enzyme cyclooxygenase


Question: Secretory immunoglobulin is


Question: Anti inflamatory action of coicosteroids is due to blocking of

Breakdown of phospholipids cause the release of phospholipase A2 from the cell membrane Coicosteroid helps in induction of lipocoins in macrophages. Lipocoins inhibits phospholipase A2. This lead to decreased production of prostaglandins, Leukotriens.Thus pro inflammatory mediators are reduced. (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 279)


Question: Drug of choice for the following worm infection is

The picture shows whipworm (Whip is shown clearly) for which the drug of choice is albendazoleRef: KD Tripati 6th ed Pg 810


Question: Least teratogenic antiepileptic drug in pregnancy is;

Anti-epileptic with highest risk of teratogenicity - Valproate - causes neural tube defects Anti-epileptic with lowest risk of teratogenicity- Lamotrigine >Levetiracetam


Question: Sweating as a result of excretion is mediated through

Refer kDT 7/e p 93 Most aeries and veins in the body are innervated by sympathetic adrenergic nerves, which release norepinephrine (NE) as a neurotransmitter. Some blood vessels are innervated by parasympathetic cholinergic orsympathetic cholinergic nerves, both of which release acetylcholine (ACh) as their primary neurotransmitter.


Question: Patient complaints of muscle weakness. It was rivers on administration of neostigmine because

(Ref: Katzung 11/e p105) Neostigmine acts by inhibiting the enzyme acetylcholinesterase. This enzyme is involved in degradation of ACh,consequently neostigmine inereases the synaptic level of ACh. Muscle weakness can be improved by stimulation of NM receptors at muscle end plate due to increased ACh.

It interferes with the action of monoamine oxidase

It interferes with the action of carbonic anhydrase

Interferes with the action of Acetyl chlolinesterase


Question: The following drug is given in pulsatile manner

GNRH agonists are given both in Pulsatile and continuous manner. GNRH antagonists are usually given in continuous manner. Goserelin is GNRH agonist. Abarelix is GNRH antagonist.Ref: Goodman Gillman 12th ed.Pg:1121


Question: As compared to unfractionated heparin, low molecular weight heparins

Low molecular weight heparin has higher subcutaneous bioavailability. Lab monitoring is not required unlike heparin. LMWH has lower risk of osteoporosis and lower incidence of thrombocytopenia. From medical pharmacology padmaja 4th edition Page no 337, 339

Are absorbed more uniformly when given subcutaneously

Require more frequent laboratory monitoring

Cannot be given to patients with heparin induced thrombocytopenia

Predispose to a higher risk of osteopenia


Question: Aspirin acts by

(A) Cyclo oxygenase pathway # ASPIRIN prduces its antithrombotic effect by irreversibly acetylating and inhibiting platelet cyclo-oxygenase (COX)-1, a critical enzyme in the biosynthesis of thromboxane A2. At high doses, aspirin also inhibits COX-2, an inducible COX isoform found in endothelial cells and inflammatory cells.> Analgesic action of aspirin is mainly due to obstructing of peripheral pain receptors and prevention of prostaglandin mediated sensitization of nerve endings.> Aspirin & some NSAIDs blocked PG generation by inhibiting cyclooxygenase (COX) enzyme.> Aspirin, even in small doses, irreversibly inhibit TXA2 synthesis> Aspirin resets the hypothalamic thermostat & rapidly reduces fever by promoting heat loss but does not decrease heat production


Question: Severe myopathy commonly is a side effect of


Question: b2 agonist with a long duration of action is

A new generation of long-acting b2- selective agonists includes salmeterol (a paial agonist) and formoterol (a full agonist). Both drugs are potent selective b2 agonists that achieve their long duration of action (12 hours or more) as a result of high lipid solubility. These drugs appear to interact with inhaled coicosteroids to improve asthma control. Because they have no anti-inflammatory action, they are not recommended as monotherapy for asthma. An ultra-long-acting b agonist, indacaterol, is currently approved in Europe. It needs to be taken only once a day but is used only for the treatment of chronic obstructive pulmonary disease (COPD). Data on its efficacy and safety in the management of asthma are lacking. Reference: Katzung Pharmacology; 13th edition; Chapter 20; Drugs Used in Asthma


Question: Bone resorption is enhanced by

Bone resorption is increased by prostaglandin E2. Increased PGE2 stimulates binding of RANK ligand to RANK- stimulating osteoclast-causing resorption (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 325)


Question: Blockade of vasomotor reversal(Re reversal) is seen with

Vasomotor re-reversal means only rise in BP is seen with adrenaline because of administration of beta blocker. Fall in BP is neutralized by beta blocker Ref: Katzung 12th ed.


Question: Thiopentone is absolutely contraindicated in

(Porphyria): (381 -- KDT 7th edition; 536- Goodman 12th7or variegate)Thiopentone can precipitate acut intermittent or variegate porphyria in susceptible individuals therefore contraindicated. The abnormal synthesis of protoporphyrin (important in hemoglobin production) results in excess porphobilinogen. Barbiturates induce amino levulinic acid synthase, an enzyme responsible for phosphobilinogen synthesis, This leads to excessive porphobilinogen levels and can precipitate acute porphyric crises, that are manifested by severe abdominal pain, nausea, vomiting, psychiatric disorders and neurologic abnormalities


Question: Thalidomide used for multiple myeloma is

Refer Katzung 10th/919 Thalidomide used for morning sickness but later withdrawn due to teratogenic effects It is not extensively metabolized by microsomal enzymes It is now used for multiple myeloma It can also result in constipation ,peripheral neuropathy

Characterised by enantiomeric interconvesions

Metabolized extensively by hepatic CYP system


Question: An anxiolytic, not interacting with GABAergic system and used in generalized anxiety is


Question: The most potent Narcotic Analgesic is


Question: Oral therapy of choice in MRSA skin infection is


Question: Shoest acting benzodiazepine is


Question: Drug of choice for Clostridium difficile infection is

Drugs used for Clostridium difficile infection are DOC is oral Vancomycin Alternatives are metronidazole and fidoxamicin Monoclonal antibody against Clostridium toxin is bezlotoxumab.


Question: Montelukast is

Montelukast and zafirlukast is selective antagonists of the CysLT1 receptor for leukotrienes. Competetively inhibit the bronchoconstictor effects of leukotrienes. Basic and clinical pharmacology Katzung 13th edition pg 324

Selective antagonists of leukotrienes receptor


Question: Pain is caused by injection of

Ans. is 'd' i.e., Thiopentone Thiopentone is an ultrashort acting Barbiturate.It is usually given intravenously to achieve rapid induction of anaesthesia.Inadvertent intra-arterial injection or extravasation of Thiopentone leads to thrombosis and necrosis. This produces intense pain.


Question: INH induced neuropathy is treated with


Question: Wet pillow syndrome is caused by

Clozapine carries the side effect of sialorrhoea, termed as "Wet pillow syndrome".


Question: Catalase negative member of the family Enterobacteriaceae is (NOT RELATED)

The general finding that members of the family enterobacteriaceae produce catalase has impoant exceptions in Shigella dysenteriae serotype 1 and a few strains of Shigella flexneri (mostly in serotype 4a) which are catalase negative.


Question: Mechanism of action of oximes is

Oximes are acetylcholinesterase reactivators which are used in OP poisoning, not in carbamate poisoning Ref: KDT 6th ed pg 105


Question: Buprenorphine acts by following mechanism


Question: Ocular effects that include mydriasis and fixed far vision are characteristic of

Mydriasis and fixed far vision can be due to either muscarinic receptor antagonists or ganglionic blockade. Because no M blockers are listed, the correct answer is mecamylamine. Alpha agonists (phenylephrine) have no effects on the focus of the eye. The cholinesterase inhibitor (neostigmine) and alpha blocker (phentolamine) cause miosis. Ocular effects of the beta blocker (timolol) are restricted to decreased formation of aqueous humor by the ciliary epithelium.


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

Ref Wikipedia A spider angioma as a nevus araneus, spider nevus, vascular spider ,spider telangiectasia is type of telangiectasia found slightly beneath the skin surface The central red dot is the dilated aeriole and the red spider legs are small veins carrying away the freely flowing blood. The dilation is caused by increased estrogen levels in the blood


Question: Ibalizumab was approved by FDA in 2018 April for ( REPEAT)

Ibalizumab was approved for HIV in 2018 Ibalizumab belongs to a new class of HIV drugs called post-attachment inhibitors. Post-attachment inhibitors work by attaching to CD4 receptor on the surface of the immune cells. When ibalizumab attaches to the CD4 receptor, HIV cannot attach to, enter, or infect the cell.


Question: The electrical potential difference necessary for a single ion to be at equilibrium across a membrane is best described by the (NOT RELATED)


Question: Following analgesic combination should be avoided


Question: A patient complains of muscle weakness it was reversed on administration of neostigmine, because

Refer katzung 11e p 105 neostigmine acts by inhibiting the enzyme acetylcholinesteresis This enzyme is involved in the degradation of acetylcholine, consequential neostigmine increases the synaptic level of acetylcholine. Muscle weakness can be improved with the stimulation of Nm receptors at muscle endplate due to increase the acetylcholine

It interfere with the action of monoamine oxidase

It interfere with the action of carbonic anhydrase

It interfere with action of acetylcholine esterases


Question: Iodine content in amiodarone is

Amiodarone contains around 37% of iodine This iodine content is repsonsible for thyroid disorders, corneal microdeposts and pulmnary fibrosis of amiodarone amiodarone is a class 3 agent Ref: KD Tripathi 8th ed


Question: Cyclosporine acts by inhibiting the proliferation of

Ans. is 'b' i.e., IL2 Cyclosporine enters target cells and bind to cyclophilin (an immunophilin). This cyclosporine-cyclophilin complex inactivates calcineurin IL-2 trascripitan and proliferation of T cells.


Question: Amitryptyline is a


Question: ATT contraindicated in pregnant women

Ref: KDT, 6th ed. pg. 743-44* Streptomycin has been assigned to pregnancy category D by the FDA.* Streptomycin crosses the placenta; reported cord concentrations have been equal to or less than the mothers serum concentration.* There are reports of fetal eighth cranial nerve damage with subsequent bilateral deafness. Most authorities, including the Centers for Disease Control and the American Thoracic Society, discourage the use of streptomycin during pregnancy due to the risk of fetal ototoxicity.* Note: Streptomycin is no longer an ATT drug


Question: Metoclopramide

metoclopramide incerase peristalsis ,no significant action on colonic motility ESSENTIALS OF MEDICAL PHARMACOLOGY SEVENTH EDITION KD TRIPARHI PG NO.664

Inhibit cholinergic smooth muscle stimulation in the gastrointestinal tract

Decrease lower esophageal sphincter pressure

No significant action on colonic motility


Question: Longest acting erythro poietin analogue is

Darbo poietin is the longest acting erythropoietin analogue.
Epoietin α & Epoietin β are other erythropoietin analogues.
Romiplostim is a thromboplastin analogue.


Question: Buspirone is an

(B) Anti anxiolitic> Buspirone is an anxiolytic psychoactive drug of the azapirone chemical class, and is primarily used to treat generalized anxiety disorder (GAD).


Question: 1st dose hypotension is commonly seen with

Alpha blockers produce 1st dose hypotension. also seen with ACE inhibitors. hence there are to be given when the patient is in supine position and asked to be taken care not to stand immediately so preffered to be given at night. Ref: KD Tripathi 8th ed.


Question: BNP is regarded by

Inhibition of the neutral endopeptidase (NEPinh) had been investigated as a potential novel therapeutic approach because of its ability to increase the plasma concentrations of the natriuretic peptides (NPs). Indeed, the NPs have potent natriuretic and vasodilator propeies, inhibit the activity of the renin-angiotensin-aldosterone system, lower sympathetic drive, and have antiproliferative and antihyperophic effects Refer katzung 11e p303


Question: Sumatriptan is contraindicated in

Ans: D (Peripheral vascular disease) Ref: Goodman & Gilman s The Pharmacological Basis of Tin . aeutics, 12th ed. 2011, Pg 346. 348Explanation:Sumatriptan is a 5HTIBID. agonist used in treatment of migraine. All triptans are effective in the treatment of acute migraine.The available triptans include sumatriptan, naratriptan. rizatriptan, frovatriptan, zolmitriptan and eletriptan.All triptans are contraindicated in:Ischemic or vasospastic coronary artery diseaseHistory of stroke or transient ischemic attacksCerebrovascular diseasePeripheral vascular diseaseHemiplegic ! basilar migrainesIschemic bowel diseasesUncontrolled hypertensionWithin 2 weeks of MOA inhibitor administrationHence the answer to the above question is peripheral vascular disease.In addition, naratriptan is contraindicated in severe hepatic and renal impairment while eletriptan is contraindicated in hepatic disease.Ergot alkaloids which are also used in migraine as that of triptans are contraindicated in:PregnancyPeripheral vascular diseaseCoronary artery diseaseHypertensionImpaired hepatic or renal functionSepsisWithin 24 hrs of triptan administration


Question: X in the graph represents

Therapeutic index : LD50/ED50 Therapeutic window Range of steady-state concentrations of drug that provides therapeutic efficacy with minimal toxicity Therapeutic efficacy: Ability of a drug to activate a receptor and generate a clinical response is Therapeutic efficacy Therapeutic dose: Dose of a drug required to have a clinical response


Question: Drug used in ameliorative test for myasthenia gravis is


Question: MDR gene acts by aEUR'

Causes efflux of drug A major problem in cancer chemotherapy is development of cellular drug resistance. These are of two types:- (i) Primary resistance When there is absence of response to drug on first exposure e.g. Malignant melanoma, Renal cell cancer and brain cancer. The presence of inherent drug resistance is thought to be associated with genomic instability that gave rise io the cancer. (ii) Acquired resistance In these cases the cancers were initially drug sensitive and became drug resistant, later on in the course of therapy. It can be :- Single drug resistance Cancer is resistant to a single drug and is based on change in genetic apparatus of a given tumour cell. Multi drug resistance Resistance develops to a variety of anticancer drugs. It is associated with increased expression of a normal gene --)MDR1 gene. MDRI gene encodes for P-glycoprotein Pcgp). P glycoprotein is a protective mechanism possessed by normal cells. Pgp is an ATP dependent membrane efflux pump. Its function is to expel a variety of foreign molecules including antitumour drugs from the cell. Long lived cells such as the haemopoietic stern cells, cells on excretory surfaces such as biliarr hepatocytes, proximal renal tubules and intestinal cells and the cells of the blood- brain barrier, all have high expression of Pgp. The MDR phenomenon illustrates how tumour cells adapt and enhance normal cell mechanism to deal with the effects of chemotherapy and how repeated cycles of chemotherapy select out a population of cells which have developed adaptive survival mechanism e.g. in myeloma where MDR proteins are rare at diagnosis but common at progression.


Question: Anaesthesia contraindicated In volvulus of gut is

Nitrous oxide displaces nitrogen in air filled cavities and while doing so it enters the cavities faster that is even before nitrogen escapes. This results in expansion of such cavities leading to pnemothorax and air embolus.Hence nitrous oxide should be avoided in such patients. From padmaja 4th edition Page no 191


Question: Rifampin kills tubercle bacilli by

Rifampin (Rifampicin, R) Mech of action:- Rifampin interrupts RNA synthesis by binding to b subunit of mycobacterial DNA-dependent RNA polymerase (encoded by rpoB gene) and blocking its polymerizing function. Pharmacokinetics:- It is well absorbed orally, (bioavailability is ~ 70%), but food decreases absorption; rifampin is to be taken in empty stomach. It is widely distributed in the body: penetrates intracellularly, enters tubercular cavities, caseous masses and placenta. Though it crosses meninges, it is largely pumped out from CNS by P-glycoprotein. It is metabolized in liver to an active deacetylated metabolite which is excreted mainly in bile, some in urine also, t 1/2 of rifampin is variable (2-5 hours). Rifampin resistance:- It is nearly always due to mutation in the rpoB gene reducing its affinity for the drug. No cross resistance with any other antitubercular drug, except rifampin congeners, has been noted. uses of rifampin :- 1. Leprosy, Tuberculosis 2. Prophylaxis of Meningococcal and H. influenzae meningitis and carrier state. 3. Second/third choice drug for MRSA, diphtheroids and Legionella infections. 4. Combination of doxycycline and rifampin is the first line therapy of brucellosis. Ref:- kd tripathi; pg num:-768

Inhibiting synthesis of mycolic acids in mycobacteria

Binding to mycobacterial DNA dependent RNA polymerase


Question: Ullipristal acetate is

Refer Harrinson 19/e p 2391 Ullipristal is a selective progesterone receptor modulator like mifepristone It is used as an emergency contraceptive that can be used within 120 hours of unprotected intercourse

Selective progesterone receptor modulator


Question: Arrange the drug in decreasing order of antiplatelet potency a. Clopidogrel b. Prasugrel c. Aspirin d. Abciximab

Order of potency -Abciximab > Prasugrel >Clopidogrel > Aspirin


Question: Cyclosporine is active against

Ans. is 'a' i.e., CD4+ Lymphocyte Cyclosporine acts on cell mediated immunity It profoundly and selectively inhibitsT Lymphocyte proliferation (CD4+ Cells)IL-2 and other cytokine proliferationResponse of inducer T cells to IL-1It does not has any effect on suppressor cells.


Question: Neostigmine differs from Pilocarpine in having effects on

Pilocarpine is a muscarinic receptor agonist so it doesn't have effects on skeletal muscle (NM). Neostigmine, on the other hand, has indirect actions on both muscarinic and nicotinic receptors.Ref: Katzung Pharmacology; 13th edition


Question: Oral sacubitril is approved for the treatment of

Sacubitril is given in combination with valsaan for hea failure. Sacubitril is a prodrug that is activated to sacubitrilat (LBQ657) by de-ethylation esterases. Sacubitrilat inhibits the enzyme neprilysin, which is responsible for the degradation of atrial and brain natriuretic peptide, two blood pressure-lowering peptides that work mainly by reducing blood volume. In addition, neprilysin degrades a variety of peptides including bradykinin, an inflammatory mediator exeing a potent vasodilatory action. Ref: KK Sharma 3rd ed.


Question: Glucagon acts via

Ans. (a) cAMP* G-protein receptor for glucagon is Gs which acts via| Adenylyl cyclase causing |cAMP.G Proteins and Their Receptors and EffectorsG ProteinReceptors for:Effector/ Signaling PathwayGt1, Gt2Photons (rhodopsin and color opsins in retinal rod and cone cells)|cGMP phosphodiesterase- |cGMP (phototransduction)G5b-Adrenergic amines, glucagon, histamine, serotonin, and many other hormones|Adenylyl cyclase- |campGi1' Gi2' Gi3a2-Adrenergic amines, acetylcholine (muscarinic), opioids, serotonin, and many othersSeveral, including:| Adenylyl cyclase - |cAMPOpen cardiac K+ channels- | heart rateG5b-Adrenergic amines, glucagon, histamine, serotonin, and many other hormones|Adenylyl cyclase-- |cAMPGolfOdorants (olfactory epithelium)|Adenylyl cyclase- |cAMPGqAcetylcholine (muscarinic), bombesin, serotonin (5-HT1C), and many others|Phospholipase C- |IP3, diacylglycerol, cytoplasmic Ca2+


Question: Tetrabenazine acts by inhibiting

Tetrabenazine: Inhibit VMAT 2(vesicular monoamine transpoer), which transpo dopamine and norepinephrine into adrenergic vesicle in nerve ending. Use for treatment of chorea in Huntington and tardive dyskinesia. In above figure: Pharmacologic strategies for dopaminergic therapy of Parkinson's disease. Drugs and their effects are indicated (see text). MAO, monoamine oxidase; COMT, catechol-O-methyltransferase; DOPAC, dihydroxyphenylacetic acid; L-DOPA, levodopa; 3-OMD, 3-O-methydopa; 3-MT, 3-methoxytramine.


Question: The mechanism of action of Sodium nitroprusside is

Sodium nitroprusside acts by releasing nitric oxide(NO). This stimulate guanylate cyclase and results in the elevation of cGMP, which are vasodilators. Refer kDT 6/e p549


Question: Vigabatrin acts by

Mechanism of Action: Vigabatrin is an irreversible inhibitor of GABA aminotransferase (GABA-T), the enzyme responsible for the degradation of GABA. It may also inhibit the vesicular GABA transpoer. Vigabatrin produces a sustained increase in the extracellular concentration of GABA in the brain. This leads to some desensitization of synaptic GABA A receptors but prolonged activation of nonsynaptic GABA A receptors that provide tonic inhibition. A decrease in brain glutamine synthetase activity is probably secondary to the increased GABA concentrations. Vigabatrin is useful in the treatment of paial seizures and infantile spasms Reference: Katzung Pharmacology; 13th edition; Chapter 24; Antiseizure drugs


Question: Glyceryl trinitrate route of administration

GTN is usually given by SL route .kept under the tongue and can be spit it out when sufficient pain relief is obtained.SL-1st pass metabolism can be bypassed. Ref: KD Tripathi 8th ed.


Question: Drug NOT used in pulmonary hypeension aEUR'

alpha blockers Pulmonary hypeension General management Diuretic therapy may be useful as it relieves pulmonary edema. Anticoagulant therapy is advocated for all patients. Specific management Calcium channel blockers Patients who have substantial reductions in pulmonary aerial pressure in response to sho acting vasodilators at the time of cardiac catheterization should he initially treated with calcium channel blockers. Endothelin receptor antagonist Bostenan is a non-selective endothelium receptor antagonist, is an approved t/t ,for patients who are NYHA .functional classes III and IV. Phosphodiesterase-5 inhibitors Slidenafil is used for patients who are NYHA functional classes II and Prostacyclins Iloprost is a prostacyclin analogue used in PAH patients who are NYHA functional classes III and IV. Pulmonary circulation is unique in that it accommodates a blood flow that is almost equal to that of all the other organs of body but still maintains low pressure. The factors responsible for low pressure in pulmonary circulation (even with large volume of blood) are:- - Larger diameter of pulmonary vessels due to thin wall of pulmonary aery and aerioles. - Greater compliance (distensibility) of pulmonary vessels. numoral factors responsible for maintaining pulmonary circulation:? Normally NO causes vosodilation and proliferation of smooth muscles by r in the conc. of cGMP --) this increases the diameter of pulmonary vessels. causes vosodilation and decreased proliferation of smooth muscles by increasing the conc. of cAMPincrease in the diameter of pulmonary vessels. Prostaglandin also decreases coagulation. Endothelin causes vasoconstriction and increase smooth muscle proliferation si lumen of pulmonary vessels. - Normally the vasodilators and antiprolifeave effects of NO and PGI7 dominate In Pulmonary hypeension There is l production of NO (and cGMP) and PGI2 (and cAMP), t vasoconstriction and proliferation of smooth muscles, st lumen of pulmonary vessel. Decreased production of PGI2 also causes increased coagulation. There is T production of endothelin, /vasoconstriction and smooth muscle proliferation, .1 lumen. Drug therapy in puhnonan, hypeension is targetted at these growth factor pathways which are involved in the pathogenesis of pulmonary hypeension: Endothelium receptor antagonist Bostenan is an endothelin receptor antagonist. It prevents endothelin mediated contraction of vessels. Phosphodiesterase-5 inhibitors Nitric oxide mediates its action through increasing cGMP concentration. Increased cGMP relaxes the vessels. cGMP is degraded by an enzyme phosphodiesterase-5 (PDE-5). - Slidenafanil is a phosphodiesterase 5 inhibitor. It reduces the degradation of cGMP, thus causing vascular relaxation and reducing pulmonary hypeension. Prostacyclins In pulmonary hypeension, the level of prostacycline is reduced. This causes pulmonary constriction as prostacyclin causes dilatation of pulmonary vessels.


Question: Most unpleasant side effect of salbutamol is

Ans. a (Tremors.) (Ref: KD Tripathi, Pharmacology, 4th ed., 125, 237)Salbutamol is highly selective beta, agonist used to treat attacks of asthma.Its side effects are:# Tremors (unpleasant, dose-related).- Palpitations# Restlessness- Ankle edema# Nervousness- Throat irritation


Question: Higher auditory centre determines

Sound localization is markedly disrupted by lesions of the auditory coex.


Question: Digoxin is not indicated in

Digitalis is an agent that is indicated when hea is not able to pump the blood adequately. Higher output Failure is seen in conditions like anaemia and thyrotoxicosis in which hea is already contracting vigorously. Cardiac glycoside,thus are not indicated in high output failure Refer kDT 6/e p502


Question: A pregnant woman with the recent onset of urinary frequency, urgency and dysuria, and evidence of bacteriuria should be treated with

Tetracyclines may cause staining of fetal teeth when given during pregnancy. Trimethoprim-sulfamethoxazole may cause neonatal jaundice when administered late in pregnancy because sulfonamides may displace bilirubin from plasma proteins. Fluoroquinolones, such as ciprofloxacin and norfloxacin, are best avoided in pregnancy because of their potential to cause ahropathy in the fetus caused by damage to cailage. The 13-lactam antibiotics, including penicillin's such as ampicillin and various oral cephalosporin's, may be safely administered to pregnant women. First- or second-generation cephalosporins are usually preferred because of their antimicrobial spectrum..


Question: Mechanism of action of Aspirin

Ans. (b) Inhibit TXA2 formationRef KDT 6th ed. / 609; Katzung 9th ed. / 446Thromboxane helps in platelet aggregation.* TXA2 formation is suppressed at very low doses of aspirin.* Aspirin blocks thromboxane formation by inhibiting COX activity by enzyme COX1 and TX- synthase irreversibly.


Question: Out of two anticholinesterases, drug 'X' is a teiary amine while drug 'Y' is a quaernary ammonium compound. Then

Drug X is physostigmine and Drug Y is neostigmine. Physostigmine:- It is rapidly absorbed from g.i.t. and parenteral sites. Applied to the eye, it penetrates cornea freely. It crosses blood-brain barrier and is disposed after hydrolysis by ChE. Neostigmine and congeners:- These are poorly absorbed orally; oral dose is 20-30 times higher than parenteral dose. They do not effectively penetrate cornea or cross blood-brain barrier. They are paially hydrolysed and paially excreted unchanged in urine. Ref:- kd tripathi; pg num:-107,108

Drug 'X' is likely to be more potent than 'Y'

Drug 'Y' will be completely metabolized in the body

Drug 'X' will be more suitable to be used as a miotic


Question: Monoclonal antibody used in cancer is

Rituximab is a monoclonal antibody against CD20. It is used for treatment of: - Non-Hodgkin lymphoma Chronic lymphoid leukemia Rheumatoid ahritis SLE Auto-immune hemolytic anemia Idiopathic thrombocytopenic purpura OTHER OPTION: Cisplatin is most emetogenic anticancer drug - DOC- esophageal or gastric cancer 5-fluorouracil is a pyrimidine analog and inhibit DNA synthesis by competing with DNA polymerase. Methotrexate is a dihydro folic acid reductase inhibitor. It decreases the formation of DNA.


Question: Bleomycin toxcity is characterized by destructionof aEUR'

Type I Pneumocytes {Ref: Fishman's pulmonary disease and disorders 4/e p 1069; Devito Oncology 8/e p 2673] Neomycin is well known to cause pulmonary toxicity. -The incidence of Neomycin induced pulmonary toxicity is 5% for a total cumulative dose of 450 units and 15%.for higher dosages. - Bleomycin is concentrated preferentially in the lung and is inactivated by hydrolase enzyme. This enzyme is relatively deficient in lung tissue. - This may explain relative sensitivity of Neomycin to lung tissue Pathological features of Neomycin toxicity i) Early endothelial cell damage ii) Destruction of type I pneumocytesdeg iii) Migration of type 11 pneumocytes into alveolar spaces inducing interstitial changes Type 1 epithelial _cells are more vulnerable to Neomycin toxicity and are destroyed by bleonlycin2 -Following destruction of tope 1 pneumocytes repair is characterized by hyperplasia and dysplasia of type 11 pneumocytes - Fibroblast proliferation with subsequent pulmonary fibrosis is probably the basis for irreversible changes induced by Neomycin. Also know Histopathology of lung in Neomycin toxicity Endothelial cell edema and Webbing Necrosis of type 1 pneumocytes Hyperplasia and metaplasia of type Il pneumocytes Inflammatory infiltrate with PMN Proliferation of fibroblast and fibrosis


Question: Drug not causing enzyme inhibition is

Ans. is 'a' i.e., Phenobarbitone Drugs that induce microsomal enzymes* Phenobarbitone* Carbamezepine* Phenytoin* Omeprazole* Rifampin* Clofibrate* Glucocorticoids* Meprobamate* Isoniazid* Ritonavir* Chloral hydrate* Glutethimide* Phenylbutazone* Chronic alcohol intake* Griseofulvin* Cigarette smoking* DDT* Cyclophosphamide Drugs that inhibit drug metabolizing enzymes* Allopurinol* Diltiazem* Omeprazole* Amiodarone* Erythromycin* Propoxyphene* Clarithromycin* Isoniazid* Chloramphenicol* Cimetidine* Phenylbutazone* Quinidine* Ketoconazole* Metronidazole* Itraconazole* Disulfiram* Ciprofloxacin* Verapamil* Sulfonamides* MAO inhibitors


Question: Find therapeutic index of drug from the information given below in the graph


Question: Total dose of Levonorgestrel for emergency contraception

Refer KDT 7tg/e Pg 322 Levonorgestrel 0.75mg two doses 12 hours apa or 1.5mg single dose should be taken within 72 hrs of unprotected intercourse for emergency contraception


Question: A drug that blocks the hea rate effect of a slow intravenous infusion of Phenylephrine is


Question: Drug of choice for ventricular premature beats(VPB) with digitalis toxicity is

Digoxin remains a very useful agent for chronic atrial fibrillation or for the ectopic beats associated with hea failure. But when rapid control of the ventricular rate is required to arrhythmias such as atrial fibrillation, atrial flutter, or paroxysmal atrial tachycardia, a slow infusion of verapamil is the agent of choice. In general, verapamil may be added to digoxin or given intravenously while a digoxin effect is awaited, unless there is digitalis toxicity. In digitalis toxicity, lignocaine remains the agent of choice for ventricular arrhythmias, and is given in the same doses as for acute myocardial infarction; phenytoin is used for digitalis-arrhythmias with A-V block. Verapamil may be infused very cautiously for digitalis-induced supraventricular tachyarrhythmias. The use of oral agents such as quinidine, disopyramide and mexilitene for chronic prophylaxis of ventricular ectopic beats is of doubtful effectiveness, unless the ectopic activity is symptomatic. Serious ventricular arrhythmias may be induced by quinidine and disopyramide. Beta-blockade is especially useful for ectopic beats associated with anxiety, or when arrhythmias are associated with angina of effo or hypeension. As always, major contraindications to the use of beta-blockade include cardiomegaly, hea failure or asthma


Question: Best treatment for kawasaki's disease is

Kawasaki disease: IVIG is given within the first 10 days of illness. Concomitant aspirin should be staed until the patient is afebrile If fever persist beyond 36 hours after the initial IVIG infusion, a new dose of IVIG should be given if no other source of fever is found. Methylprednisolone should follow if the disease persists after the second IVIG administration. Fuher options for refractory cases include TNF blockers (infliximab), cyclophosphamide, methotrexate, and plasmapheresis.

Targeted Anticancer Drugs and Immunosuppressants


Question: GnRH analogue used In hormonal treatment of carcinoma of prostate Is

Goserelin is a long acting GnRH agonist. It is used in the treatment of prostate cancer. nilutamide is also used in prostate cancer but it is anti androgen not a GNRH analogue finatseride is 5 alpha reductase inhibitor cyproterone- anti androgen with progestational propeies (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 239)


Question: Most common side efiect of mifepristone

Mifepristone (RU 485) It is a 19 norsteroid with potent antiprogestational and significant antiglucocoicoid and antiandrogenic actitity.It is used in termination of pregnancy, cervical ripening postcoital contraceptive, once a month contraceptive, in induction of labour and to treat cushing's syndrome.Commonly repoed side afects include vaginal bleeding, cramping, nausea, vomiting, diarrhea, dizziness, back pain & tenderness.


Question: The drug of choice for prevention of seizures in a patient with severe preeclampsia is

given by i.v. infusion, it has been used for long to control convulsions and to reduce BP in toxaemia of pregnancy. As per WHO, it is the drug of choice for prevention and treatment of seizures in preeclampsia and eclampsia Ref: KD Tripathih 8th ed. page 333


Question: Recombinant form of a hormone used in osteoporosis is

Recombinant form of PTH used in osteoporosis for both mineralization and preventing demineralization of bone.Ref: CMDT 2018/1173


Question: Sequence of clinical trials is


Question: Nitrates are not used in

Renal colic The main pharmacological action of Nitrates Nitroglycerine relaxes all types of smooth muscle irrespective of the state of the preexisting muscle tone. The most prominent action is exeed on the vascular smooth muscle. - Apa .from vascular smooth muscle nitrates also cause relaxation of the smooth muscles of the bronchi, gastrointestinal tract (including biliary system) and genitourinary tract. Nitrates are rapidly denitrated in the smooth muscle to release nitric oxide which activates cytosolic guanyl cyclase which in turn increases CGMP that leads to vasodilation Effect of nitrate on cardiovascular system Enzymes activates Nitrates --4 NO --> Gyanylcyclase 1' CGMP Vasodilation Nitrates cause relaxation of all the components of vascular system from large aeries to veins, aerioles and capillaries. Veins respond at the lowest concentrations and aeries at slightly higher one (Veins express greater amount of the enzyme that generates NO )from organic nitrates). The primary direct result of an effective dose of nitroglycerine is marked relaxation of veins with increased venous capacitance and decreased ventricular preload. This leads to reduction in pulmonary vascular pressure and hea size. Effect of nitrates on coronary circulation '* In normal subjects without coronary disease - Nitroglycerine can induce a significant if transient increase in total coronary blood flow. In patients with angina due to atherosclerosis - There is no evidence that total coronary .flow is increased in patients with angina due to atherosclerotic obstructive coronary aery disease. However, in these patients - Nitrates cause redistribution of coronary blood flow from normal to ischemic regions which may play role in therapeutic effect. There are two types of vessels in coronary circulation :Larger conducting aeries They run epicardially and send perforating branches to deeper tissue. Smaller resistance vessels These are the perforating branches of larger conducting aeries. These aerioles supply blood to endocardium. If there is ischemia in any region of endocardium the perforating vessels of those region are dilated due to autoregulation (hypoxia causes vasodilation). Nitrates preferentially dilates larger conducting vessels. This pattern of action ours more blood flow towards the ischaemic zone as the smaller endocardial vessels are already dilated as a result of hypoxia / ischaemia. Nitrates in hea failure Nitrates afford relief by causing venous pooling of blood. - Nitrates reduce venous return (preload) decreases end diastolic volume -4 improvement in left ventricular function by Laplace law regression of pulmonary congestion. Nitrates are used in cyanide poisoning Cyanide poisoning results from complexing of cytochrome iron by the CV ion. - Methemoglobin has a very affinity for CN ion. - Methemoglobin combines with CN to form cyamnethemoglobin which is rapidly excreted by the body. It is a well known fact that Nitrates generate generate Methemoglobin when they combine with Hb. - Thus administration of nitrates will generate large amount of methemoglobin. - Due to its high offinity.for cyanide, methemoglobin combines with cyanide .forming cyanmethemoglobin. - This will regenerate active cytochrome. - However this may again dissociate to release cyanide. - The cynamethemoglobin can be fuher detoxified by the intravenous administration of sodium thiosulfate. This results in formation of thiocyanate ion a less toxic ion that is readily excreted. Biliary colic Esophageal spasm Sublingual GIN promptly relieves pain. Nitrates taken before a meal facilitate feeding in esophageal achalasia by reducing esophageal tone. Also remember these impoant propeies of Nitrates. Oral availability of Nitrates is low The liver contains a high capacity organic nitrate reductase that removes nitrate groups in a stepwise _fashion from the parent molecule and ultimately inactivates the drug. Therefore oral bioavailability of the traditional organic nitrates e.g. nitroglycerine and isosorbidedinitrate is very low. For this reason sublingual route is preferred for nitrates. Nitroglycerine and isosorbide dintrate are both absorbed effectively by this route and reach therapeutic blood levels within a few minutes. Nitrates develop tolerance With continued exposure smooth muscles develop tolerance to nitrates. The mechanism by which tolerance develops are not completely understood. As noted above diminished release of nitric oxide resulting from depletion of tissue thiol compounds may be paly responsible ,for tolerance to nitrates. Some student argue that cyanide poisoning should be the answer because nitrites not nitrates are used in cyanide poisoning but we are not convinced. All the standard books group them together and do not differentiate between nitrates or nitrites. More so Nitrates have'nt found wide clinical use in Renal colic - None of the standard text books mention use of nitrates in renal colic. - Both Goodman Gilman and KDT says that unlike its consistent effect on muscles of biliary tract, the action of nitrates on ureteric muscles is variable therefore it has not found application in renal colic. - None of the studies and research papers convincingly state that nitrates should be used in renal colic. Nitrates have been anecdotally used only in uruguay to treat renal colic. A trial was conducted based on this but it did'nt come out with conclusive results. - It states that large trials and studies should be undeaken before nitrates before nitrates use is begun clinically.


Question: Antihypertensive not contraindicated in pregnancy

Ans. is 'b' i.e. Labetalol Drugs used for the t/t of Hypertensive pregnancy B etter M other C are D uring H ypertensive P regnancy Beta blockers (labetalol, atenolol) Methyl dopa (.D.O.C. in pregnancy) Clonidine Dihydropyridine CCB's (discontinue before labour as they weaken uterine contractions) Hydralazine (D.O.C in hypertensive emergency) Prazosin Antihypertensives to be avoided during pregnancy Diuretics Tends to reduce blood volume - accentuate uteroplacental perfusion deficit (of toxemia) - increased risk of foetal wastage, placental infarcts, miscarriage, still birth. ACE inhibitors, AT1 antagonists Risk of foetal damage, growth retardation. Reserpine Suicidal depression in mother, nasal obstruction, deranged respiratory and temperature control in the new bom. Nonselective b blockers Propranolol has been implicated to cause low birth weight decreased placental size, neonatal bradycardia and hypoglycemia. Sodium Nitroprusside Contraindicated in eclampsia Pregnancy hypertension There is a lack of good clinical trial evidence, on which to base recommendations of one agent over another. Instead, drug usage reflects longevity of use without obvious harm to the fetus. Hence methyldopa is still the drug of choice for many obstetricians. Calcium channel blockers (especially nifedipine) are common second line drugs. Parenteral hydralazine is reserved for emergency reduction of blood pressure in late pregnancy, preferably in combination a b blocker to avoid unpleasant tachycardia (labetalol and atenolol) are often effective and probably the drug of choice in the third trimester. There is anecdotal evidence to suggest growth retardation with b blockade used in first and second trimester. Diuretics reduce the chance of developing preeclampsia but are avoided in pre-eclampsia itself because these patients, already have a contracted circulatory volume. Spironolactone is a diuretic which is avoided in pregnancy because of its antiandrogenic effect on fetus. ACE inhibitors (and by implication angiotensin AT1receptor antagonist) are absolutely contraindicated during pregnancy where they cause fetal death, typically midtrimester (they can be prescribed during first trimester) Note : There is no evidence that ACE inhibitors - or any of the commonly used antihypertensive drugs are teratogenic and women who become pregnant while receiving these should be reassured but should, of course, then discontinue the ACE inhibitor or AT1receptor antagonist.


Question: Moxidectin was approved by FDA recently for

moxidectin is a macro cyclic lactone which is similar to ivermectin.it binds to the glutamate gated chloride channels leading to increased permeability and hyperpolarization and muscle paralysis. Ref: www.fda.gov.in


Question: The following laxative lowers blood ammonia level in hepatic encephalopathy

Lactulose:- It is a semisynthetic disaccharide of fructose and lactose which is neither digested nor absorbed in the small intestine--retains water. Fuher, it is broken down in the colon by bacteria to osmotically more active products. In a dose of 10 g BD taken with plenty of water, it produces soft formed stools in 1-3 days. Flatulence and flatus is common, cramps occur in few. In patients with hepatic encephalopathy, lactulose causes reduction of blood NH3 concentration by 25-50%. The breakdown products of lactulose are acidic--lower the pH of stools. Ammonia produced by bacteria in colon is conveed to ionized NH4 + salts that are not absorbed. Ref:- kd tripathi; pg num:-676


Question: Anti Leprotic drug useful for lepra reactions

Lepra reactions occur due to hypersensitivity reaction to dapsone.Two types are known type 1 lepra reaction is treated usingcoicosteroids and clofazamine and type 2 with Clofazamine - an anti-inflammatory drug apa from thalidomide and coicosteroids, chloroquine,aspirin,cholchicine. Ref: KD Tripathi 8th ed.


Question: Azaserine inhibits

In de novo synthesis of purine nucleotides, there are 10 steps.The 4th step (addition of N3) is catalysed by the enzyme Formyl glycinamide ribonucleotide amidotransferase.This enzyme is inhibited by azaserine, an anticancer drug.


Question: Beta blockers are antiarrhythmic agents of class

Refer kDT 6/e p 511 The five main classes in the Vaughan Williams classification of antiarrhythmic agents are: Class I agents interfere with the sodium (Na+) channel. Class II agents are anti-sympathetic nervous system agents. ... Class III agents affect potassium (K+) efflux. Class IV agents affect calcium channels and the AV node.


Question: Most cardiotoxic local anaesthetic agent

Bupivacaine is more prone to prolong QTc interval and induce ventricular tachycardia or cardiac depression should not bbe used for intravenous regional analgesia (Bier's). Levobupivacaine is equally potent but less cardiotoxic and less prone to cause seizures then bupivacaine. Ref Katziung 12th ed


Question: Narcotic overdose can be antagonized by


Question: Digoxin action is not affected in

Ref-KDT 5/e p463 Digoxin is eliminated mainly excretion through kidney. Dose of big ox and therefore does not require adjustment in hepatic failure where as it has to be reduced in renal failure


Question: Methicilline resistance staph aureus NOT responds to

(Oxacillin): (721-KDT 7th edition 396, 1070, 2069, 2135 - Harrison 18th)Oxacilline (Not marketed in India)CLOXACILLIN / DICLOXAC1LLIN - is highly penicellinase as well as acid resistant.More active than methicilline against penicillinase producing Staph but not against MRS AMethicilline resistant staph, aureus (MRSA) - These are insensitive to all penicillin- resistant penicillins (Methiciline, Cloxacilline, Dicloxacilline) and to Beta lactams as well as as to erythromycin, aminoglycosides, tetracyclines etc.* Drug of choice for these organism is vancomycin / linezolid but ciprofloxacin can also be used, Rifampin, Imipenem (362 - Lippintott's 4th)* Quinopristin / dalfopristin, Daptomycin and Linezolid are currently for the treatment of vancomycin resistant organism (370- Lippencott 4th)* Lincosamide antibiotics - Clindamycin, Lincomycin* Current recommendation for the treatment of community acquired MRSA. Atopic dermatitis is - Trimethoprim / sulfamethoxazole, minocycline-doxycycline or clindamycin (396- Harrison's 18th)Antibiotics for the treatment of osteomyelitis (1075 H 18th)* Methicilline susceptible Staph.aureus* Oxacilline or nafcilline* Cephalosporins* Clindamycin* Methiciline resistant S.aureus* Vancomycin* Daptomycin* Linezolid


Question: Filgrastim is used for the treatment of

Refer Katzung 11/e p 580-581 Filgrstim (G-CSF) and sargramostim(GM-CSF) are used to prevent or treat chemotherapy induced neutropenia Erythropoietin is used to treat anemia assosciated with chronic renal failure and cancer chemotherapy


Question: Anaemia produced by phenytoin

Megaloblastic as it causes mild folic acid deficiency. Ref: KD Tripathi 8th ed.,


Question: Most emetogenic drug is aEUR'

Cisplatin; 'c' i.e., High dose cyclophosphamide The most common side effect of chemotherapy administration is nausea and vomiting. Antineoplastic agents may vary in their capacity to cause nausea and vomiting.


Question: The percentage of drug remaining in the plasma after 3 half life is

HALF-LIFE of drug : * The time taken for its plasma concentration to be reduced to half of its original value 1st t1/2 50% 2nd t1/2 (50+25) 75% 3rd t1/2 (50+25+12.5) 87.5% 4th t1/2 (50+25+12.5+6.25) 93.75% So Remaining is 100 - 87.5% = 12. 5% Note : Nearly complete drug elimination occurs in 4-5 half lives. Drugs eliminated by First order kinetics Zero order kinetics t 1/2 remains constant because V and CL do not change with dose. t 1/2 increases with dose CL progressively decreases as dose is increased t1/2= 0.693 x Vd/ CL


Question: A patient came to the casualty with acute bronchial asthma after treatment of glaucoma. The probable drug may be

Timolol is a non selective β blocker (act on β1& β2 ). β2 blocking effect of Timolol cause blockage of dilator β2 receptor so it can precipitate asthma. Whereas Betaxolol is cardioselective beta blocker that acts only on β2  receptor.


Question: Cough is an adverse reaction seen with intake of

Refer kDT 6/e p984 ACE inhibitor cause adverse reaction like cough. The CAPTOPRIL mnemonic can be used to remember the side effects of ACE inhibitors: cough, angioedema, potassium changes, taste change, hyp-O-tension, pregnancy changes, rash, increased renin, and lower angiotensin II. Another side effect is hyperkalemia.


Question: ACE inhibitors are contraindicated in

Refer kDT 6/e p 484 Angiotensin-conveing enzyme inhibitors (ACEIs) are contraindicated in patients with bilateral 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: Tolerance is seen in

Tolerance and withdrawal symptoms are seen in physical dependence


Question: Potassium channel opener with anti anginal activity is

Refer katzung 11e p 158 Nicorandil is a vasodilatory drug used to treat angina. Angina is chest pain that results from episodes of transient myocardial ischemia. This can be caused by diseases such as atherosclerosis, coronary aery disease and aoic stenosis. Angina commonly arises from vasospasm of the coronary aeries.


Question: Glyceryl trinitrate is given by sublingual route, because it has

Glyceryl trinitrate (GTN) has high first pass metabolism. So preferred route is sublingual to bypass the metabolism liver Advantage of sublingual route Fast acting No first pass metabolism Self administration is possible After action drug can be spitted out

CHF, Angina Pectoris and Myocardial Infarction


Question: Colesevelam is a

It is a bile acid sequestrantIt bind bile acids but mechanism of glucose lowering not known.


Question: Tim dependent killing and prolonged post antibiotic effect is seen with

Ref Katzung 13th/879 Long post antibiotic effect is shown by most of the drugs against gram positive bacteria but few drugs have long PAE against gram negative bacteria Clindamycin and erythromycin are static6 drugs that exhibit time dependent inhibitory activity Fluroquinolone follow concentratn dependent killing


Question: Voricanazole is not effective against

Refer Harrison 17th/1243 Voricanazole is drug of choice for treatment of Aspergillosis. It can also be used for Candida species Mucormycosis is treated by Amphotercin B.Posaconazole can also be used


Question: Xylometazoline nasal drops given before nasotracheal intubation to


Question: Drug used in irritable bowel syndrome with constipation is

-Lubiprostone acts by stimulating Cl- channel opening in the intestine, increasing liquid secretion in gut and decreasing transit time, therefore used for chronic constipation. -It has also been approved for constipation dominant irritable bowel syndrome in women. -Irritable bowel syndrome is a condition characterized by abdominal pain, bloating and altered bowel habits (diarrhea or constipation) For diarrhea dominant IBS, drugs that can be used are Loperamide or diphenoxylate New kappa opioid receptor antagonist- Fedotozine Reserpine analog - Mebeverine 5 HT3 antagonist - Alosetron (also reduces pain) Clonidine (also reduces distension induced pain ) For constipation dominant IBS, drugs effective are 5 HT4 agonists (tegaserod, prucalopride) Loxiglumide Lubiprostone Plecanatide


Question: Wof is long acting NSAID

ENOLIC ACID DERIVATIVES (Oxicams) Piroxicam:- It is a long-acting potent NSAID with anti-inflammatory potency similar to indomethacin and good analgesic-antipyretic action. It is a nonselective, reversible inhibitor of COX; lowers PG concentration in synol fluid and inhibits platelet aggregation--prolonging bleeding time. In addition, it decreases the production of IgM rheumatoid factor and leucocyte chemotaxis. Pharmacokinetics:- It is rapidly and completely absorbed: 99% plasma protein bound; largely metabolized in liver by hydroxylation and glucuronide conjugation; excreted in urine and bile; enterohepatic cycling occurs. Plasma t 1/2 is long nearly 2 days. (Due to enterohepatic circulation). Ref:- kd tripathi;pg num:-201