Question: Beta blocker used safely in hepatic disease is

Ans) a (Esmolol) Ref: Gondmun & Gilman 11thedition KDT 6th ed p.139, Katzung edEsmolol has a half-life of about 8 minutes and it contains an ester linkage, and it is hydrolyzed rapidly by esterases in erythrocytes. The half-life of the carboxylic acid metabolite of esmolol is far longer and is about 4 hours which accumulates during prolonged infusion of esmolol which is excreted in the urine. Soit can be safely given in liver diseasesBisoprolol is well absorbed following oral administration with bioavailability of -90%. It is eliminated by renal excretion (50%) and liver metabolism to pharmacologically inactive metabolites (50%).CarvedilolCarvedilol is a third-generation b receptor antagonist that has a unique pharmacological profile. It blocks bl, b2, and al receptors similarly to labetalol, but also has antioxidant and antiproliferative effects. It has membrane-stabilizing activity but it lacks intrinsic sympathomimetic activity. Carvedilol produces vasodilation.It is thought that the additional properties (e.g., antioxidant and antiproliferative effects) contribute to the beneficial effects seen in treating congestive heart failure. Carvedilol does not increase b receptor density and is not associated with high levels of inverse agonist activity. Carvedilol is rapidly absorbed following oral administration, with peak plasma concentrations occurring in 1 to 2 hours. It is highly lipophilic and thus is extensively distributed into extravascular tissues. It is >95% protein bound and is extensively metabolized in the liver, predominantly by CYP2D6 and CYP2C9. No significant changes in the pharmacokinetics of carvedilol were seen in elderly patients with hypertension, and no change in dosage is needed in patients with moderate-to- severe rend insufficiencyBETA BLOCKERSCardioselective (betal) beta blockersMetoprolol, Acebutalol, Atenolol. Bisoprolol ,Esmolol, Betaxolol, Celiprolol, and NebivololNon selective beta blockersPropranolol ,SotalolTimolol, Pindolol, Labetalol, Carvedilol, Medroxolol, Bucindolol and Levubunonol.Beta blocker with intrinsic sympathomimetic activityDilevalolPindololAcebutalolLabetalolCarteololOxyprenololAlprenololPenbutalol Non selective blocker betal + beta2 + alphaK - Crazy Buss Die in Medicine Lab)CarvedilolBucindololLabetolol,DilevalolMedroxalol, IMPORTANT POINTS REGARDING BETA BLOCKERSPropranalol has highest degree of membrane stabilizing action. Nadolol is longest acting beta blocker (t 1/2 -14-24 hrs) and Esmolol is the shortest acting.(t 1/2 2-10 minutes)Propranolol has poor oral bioavailability. Pindolol and Penbutolol have approx 100% bioavailabilityHepatic elimination - propranolol, metoprolol and labetalol. Renal elimination - atenololbeta blockers not crossing CNS -Atenolol, Nadolol and Sotalol (mnemonic: ANS will not cross CNS)Pindolol has intrinsic sympathomimetic activity. Butoxamine is a beta 2 selective blocker.Carvedilol is a non-selective beta blocker showing anti-oxidant property and alpha 1 receptor antagonism.Labetolol, Medroxalol, and Bucindolol also shows alpha 1 receptor blocking activity.Propranalol has highest degree of membrane stabilizing actionNadolol is longest acting beta blocker (t Y=2-14-24 hrs) and Esmolol is the shortest acting.(t Y=2 -10 minutes)Propranolol has poor oral bioavailability. Pindolol and Penbutolol have approx 100% bioavailability Propranolol and Metoprolol are extensively metabolized in the liver, with little unchanged drug appearing in the urine.USES1) Hypertension -They are one of the first choice drugs used in treat ment of hypertension.2) Angina pectoris- Beta-blockers reduces the frequency of anginal episodes and improves exercise tolerance in many patients with angina3) Cardiac arrhythmias- Beta antagonists are often effective in the treatment of both supraventricular and ventricular arrhythmias.4) Myocardial infarction- beta antagonists are strongly indicated in the acute phase of a myocardial infarction. In this setting, relative contraindications include bradycardia, hypotension, moderate or severe left ventricular failure, shock, heart block, and active airways disease5) Congestive heart failure - drugs used are bisoprolol, metoprolol & carvedilol (BMC)6) Dissecting aortic aneurysm7) Pheochromocytoma8) Thyrotoxicosis - controls the sympathetic symptoms without affecting thyroid status.9) Migraine - Propranolol is the most effective drag for prophylaxis of migraine10) Anxiety,11) Essential tremor12) Glaucoma13) HOCM- drags used are beta blockers and calcium channel blockers14) Portal hypertensionAdverse effectsCentral nervous system effects include sedation, sleep disturbances, and depressionWorsens pre existing asthma and COPD Worsening of peripheral vascular diseaseBeta-receptor blockade depresses myocardial contractility and excitability, caution must be exercised in starting a beta receptor antagonist in patients with compensated heart failureBeta blockers may interact with the calcium antagonist verapamil causing severe hypotension, bradycardia, heart failure, and cardiac conduction abnormalities.Exacerbates variant (prinzmetal's) angina.The incidence of hypoglycemic episodes in diabetics that are exacerbated. They also can cause impaired carbohydrate tolerance Plasma lipid profile is altered. Total triglycerides and LDL cholesterol tend to increase while HDL cholesterol decreases.


Question: The following drugs are avoided with warfarin


Question: Arrange the following opioids according to their potency (most potent first) a. Fentanyl b. Sufentanil c. Morphine d. Pethidine

a. Fentanyl group of opioids are most potent opioids. Among these most potent is Sufentanil (approx 1000 times more potent than morphine) . The sequence of potency from high to low in this group is Sufentanil > Fentanyl > Alfentanil. b. Pethidine is 10 times less potent than morphine


Question: Increase in cAMP is caused by


Question: Pseudocholinesterase is synthesized by

Pseudocholinesterase which metabolizes succinylcholine is synthesized by liver and is present in plasma. True cholinesterase which metabolizes acetylcholine is synthesized by muscle end plate. Ref: KD Tripathi 8th ed.


Question: Anticancer drug also used in RA, produces acrolein in urine that leads to hemorrhagic cystitis

Cyclophosphamide IMPOANT POINTS ON HEMORRHAGIC CYSTITIS: Drugs causing: Cyclophosphamide Ifosfamide Metabolite responsible: Acrolein - In Cyclophosphamide Chloracetaldehyde - In Ifosfamide Treatment: Mesna. Nitrogen mustards: 1. Cyclophosphamide: Powerful vesicant Prodrug - Activated by hepatic biotransformation to aldophosphamide. Acrolein - One of its degradation products. Responsible for hemorrhagic cystitis - Characteristic adverse effect. Use: DOC for Wegener's granulomatosis. Adverse effects: Hemorrhagic cystitis (Characteristic) - Treated by mercapto ethane sulfonic acid (mesna). May cause cardiac dysfunction, pulmonary toxicity & syndrome of inappropriate ADH secretion. 2. Ifosfamide: Produces chloracetaldehyde & acrolein as metabolites. Adverse effects: HIGHER risk of neurotoxicity & hemorrhagic cystitis. Chloracetaldehyde - Responsible for nephrotoxic.


Question: Omalizumab is used for


Question: The following drug is

The picture shows the drug inhibiting the release of acetylcholine into synapse.so it is either botulinum or beta bungaro toxin Ref: KD Tripathi 6th ed pg 94


Question: Wof is a limiting adverse effect of ACE inhibitors

Adverse effects:- By reducing aldosterone levels, ACE inhibitors decrease K + excretion in the distal nephron leading to hyperkalemia. Hyperkalaemia: more likely in patients with impaired renal function and in those taking K+ sparing diuretics, NSAIDs. Ref:- kd tripathi; pg num:-495,502


Question: Ipilimumab is a

Ipilimumab and Tremelimumab are CTLA4 inhibitors used in BRAF -ve malignant melanoma.


Question: Melanosis coli is caused by

Senna and cascara are anthraquinone derivatives, which are used as stimulant purgatives. On chronic use they can lead to melanosis coli.


Question: Longest actin statin is


Question: Therapeutic index of a drug is indicative of

Ans: A (Measure of safety)Ref: Thripathi 5 ed. Pg. 46Therapeutic index is a measure of drug safety.Therapeutic index (TD)It is the ratio of the dose that produces toxicity to the dose that produces a clinically desired or effective response. A large value indicates that there is a wide margin between doses that are effective and doses that are toxic.TD = TD50/ED50 TD50 is the dose that produces a toxic effect in half the population.ED 50 is the dose that produces a desired effect in half the population.

Dose range across which the drug can be safely administered


Question: In Ampicilline & Amoxycilline, Amoxycilline is better due to

(Better bioavailability in taken with foods) (700-701-KDT 6th)AMOXYCILLINE - is close congener of ampicillin (but not a pro drug) similar to it in all respects EXCEPT* Oral absorption is better, food does not interfere with absorption; higher and more sustained blood levels are produced* Incidence of diarrhoea is lower* It is less active against Shigella and H. influenza.

Better bioavailobility in taken with foods

Lesser bioavailability in taken with foods

More active against Shigella and H. influenza


Question: Alpha blocker used as anti hypertensive agent


Question: Km is

Km is that concentration of substrate at which velocity of reaction is Vmax /2 (half of the maximum)
It corresponds to X-axis and denotes potency.

Substrate concentration at which the velocity of reaction is maximum

Substrate concentration at which velocity of reaction is half of the maximum


Question: Drug of choice for central diabetes insipidus is

Desmopressin (dDAVP):- This synthetic peptide is a selective V2 agonist; but has negligible vasoconstrictor activity. It is also longer acting because enzymatic degradation is slow; t 1/2 1-2 hours; duration of action 8-12 hours. Desmopressin is the preparation of choice for all V2 receptor related indications. The intranasal route is preferred, though bioavailability is only 10-20%. Uses :- Based on V2 actions (Desmopressin is the drug of choice). 1. Diabetes insipidus DI of pituitary origin (neurogenic) is the most impoant indication for vasopressin. It is ineffective in renal (nephrogenic) DI, since kidney is unresponsive to ADH. Life- long therapy is required, except in some cases of head injury or neurosurgery, where DI occurs transiently. The dose of desmopressin is individualized by measuring 24 hour urine volume. It can be used in transient DI and to differentiate neurogenic from nephrogenic DI--urine volume is reduced and its osmolarity increased if DI is due to deficiency of ADH, but not when it is due to unresponsiveness of kidney to ADH. Ref:- kd tripathi; pg num:-596,597


Question: Drug of choice in drug induced parkinsonism is

(Benzhexol) (421-KDT 6th)* Trihexyphenidyl (Benzhexol) is most commonly used drug in drug induced Parkinsonism* "Anticholinergics are the only drugs effective in drug (phenothiazine) induced parkinsonism "Drug used in Alzheimer's disease Acetylcholinesterase inhibitors - donepezil, galentamine, rivastigmine, tacrine NMDA receptor antagonists - Memantine


Question: Drug of choice in a patient with severe complicated falciparum malaria is


Question: The most impoant drug in the psychosis is

Thioridazine is a typical antipsychotic drug.used in schizophrenia,acute psychosis Ref: Katzung 13th ed. Pg 493.


Question: The beneficial effect of drug neostigmine in the treatment of Myasthenia gravis is due to the action

It inhibits the action of cholinesterase

It produces more acetylcholine receptors

It increases the action of cholinesterase


Question: Wof sulfonylureas is used in treatment of neurogenic diabetes Insipidus

Chlorpropamide:- is one of the first SUs which has been discontinued because of long duration of action (> 2 days) and frequent hypoglycaemia. Side effects:- It was also prone to cause dilutional hyponatraemia (by sensitizing kidney to ADH action- used in treating central DI), cholestatic jaundice and alcohol flush(disulfiram like reaction). Ref:- kd tripathi; pg num:-273


Question: Reflex bronchoconstriction is most likely to occur with the following form of inhaled antiasthma medication

Dry powder inhalers are poable devices in which the capsule (rotacap) containing the drug is punctured/cut across and the powder is aerosolized by the inspiratory air flow of the patient. It requires high velocity inspiration which children, elderly and the very sick may not be capable of. Complications The dry powder is also more likely to irritate the air passage producing cough and bronchoconstriction. Ref:- kd tripathi;pg num :-232


Question: Most common cause of Death in high income nations includes

(B) Ischemic Heart Disease # ISCHEMIC HEART DISEASE is the cause of 25 to 30% of deaths in most industrilised countries.> WHO has drawn attention to the fact that Coronary Heart Disease (CHD) is our modern epidemic, i.e., a disease that effects populations, not an unavoidable attribute of aging.> CHD may manifest itself in many presentations -1. Angina pectoris of effort, 2. Myocardial infarction, 3. Irregularities of the Heart, 4. Cardiac failure and 5. Sudden Death.> CHD is assuming serious dimension in developing countries.> CHD is expected to be the single most important cause of death in India by the year 2015.


Question: Long acting dopamine agonist is

Bromocriptine has greater action on D2 receptors. Cabergoline is more potent and longer acting than bromocriptine. ERGOT-DERIVED DOPAMINE AGONISTS Examples of this type of dopamine agonist are bromocriptine, pergolide, lisuride, and the long acting ergoline, cabergoline. (REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 237)


Question: Hea rate is decreased by

ref; KD Tripathi Pharmacology 6th edition (page no;136) Propranolol is a beta blocker which decreases hea rate, force of contraction (at relatively higher doses) and cardiac output (c.o.). beta blocker inhibits adrenergic responses mediated through the beta receptors. Isoprenaline,Dobutamine,Dopamine are adrenergic drugs , which are cardiac stimulators so increases hea rate


Question: Drug of choice for ventricular arrhythmia due to myocardial infarction is

Refer kDT 6/e p 519 Drug of choice for ventricular arrhythmias with myocardial infarction is lignocaine Drug of choice for supraventricular arrhythmia after myocardial infection is beta blockers cardiac function is adequate


Question: Extrapyramidal side effects are common in

Antipsychotic medications commonly produce extrapyramidal symptoms as side effects. The extrapyramidal symptomsinclude acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome. Ref: KD tripathi 8th ed.


Question: Aliskiren is

(Renin/ Angiotensin antagonist): (508.562- KDT 7th edition)ALISKIREN is a nonpeptide which binds selectively to the catalytic site of renin and competitively blocks the access of angiotensinogen to this site - Ang I is not produced and the chain of renin angiotension system is interrupted while the concentration of renin in plasma is increased by feed back, the plasma renin activity is decreased. Ang I and Ang II level fall.* Bradvkinin Antagonist * HOE 140 (Icatibant) selective b2 antagonist* FR173657* Aldosterone antagonist* Spironolactone, Eplerenone* Canrenone, Potassium canrenoate***


Question: Gynaecomastia is caused by

Ans. is c i.e., Spironolactone Causes of Gynecomastia* Digitalis* Spironolactone* Ethionamide* Ketoconazole* Estrogens* Calcium antagonists* INH* Griseofulvin* Reserpine* Methyldopa* Cimetidine* Phenytoin* Cyproterone acetate* Flutamide* Clomiphene* GoserelinGynecomastia occurs as a result of imbalance between estrogens which stimulate breast tissue and androgens which counteract these effects.The gynecomastia causing drugs can be categorized into :The first type are drugs that act exactly like estrogens, such as diethylstilbestrol, birth control pills, digitalis, and estrogen containing cosmetics.The second type is drugs that enhance endogenous estrogen formation such as gonadotropins and clomiphene.The third type is drugs that inhibit testosterone synthesis and action such as spironolactone, ketoconazole, metronidazole and cimetidine.The final type is drugs that act by unknown mechanisms such as isoniazid, methyldopa, captopril, tricyclic antidepressants, diazepam and heroin.Also know,Testosterone also causes Gynecomastia


Question: Oral complication of Cyclosporin is

Adverse effects Cyclosporin is nephrotoxic--the major limitation, and impairs liver function. Other adverse effects are sustained rise in BP, precipitation of diabetes, anorexia, lethargy, hyperkalaemia, hyperuricaemia, oppounistic infections, hirsutism, gum hyperplasia, tremor and seizures. Ref:- kd tripathi; pg num:-880,881


Question: Roxithromycin is


Question: Mechanism of action of exenatide in diabetes mellitus is

Exenatide is a Glucagon like peptide analogue which is approved as an injectable, adjunctive therapy in persons with type 2 DM Saxagliptin -> DPP4 inhibitor which inhibit the metabolism of GLP-1, therefore increase insulin. Canagliflozin, Dapagliflozin, Empagliflozin, Eugliflozin etc. Drugs-inhibit SGLT-2 -Inhibit glucose reabsorption, -result in glucosuria Pramlintide - amylin analogue - Given subcutaneously

It is analogue of GLP released from gut and increase glucose dependant insulin secretion

It is DPP-4 inhibitor and result in decreased breakdown of GLP

It is amylin analogue and decrease glucagon


Question: Dopamine agonist used in diabetes

Bromocriptine and cabergoline are dopamine agonists but bromocriptine usage in type 2 diabetes is approved.It has an interesting mechanism of action by inhibiting the dopamine dip that causes in early morning leading to hyperglycemia. Ref: Goodman and Gillman 13th ed


Question: Dystrophic calcification is seen in (NOT RELATED)


Question: Drug of choice for Bupivacaine induced cardiac arrythmia

Bretylium is a class III Antiarrythmic used to treat Bupivacaine induced ventricular tachycardia.


Question: Anticholinesterases with effect on CNS is

Refer kDT 6/e p 101 Because it enhances the transmission of acetylcholine signals in the brain and cancross the blood-brain barrier,physostigmine salicylate is used to treat anticholinergic poisoning (that is, poisoning by substances that interfere with the transmission of acetylcholine signaling, such as atropine, scopolamine,


Question: Drug used in the treatment of steroid resistant ulcerative colitiis


Question: Drug efficacy refers to

Range of diseases in which the drug is beneficial

Maximal intensity of response that can be produced by the drug


Question: The drug of choice for treatment of meningococcal meningitis is

Ans. b. CeftriaxoneRef: Goodman Gilman 13th E/PI 035Ceftriaxone is the drug of choice for treatment of meningitis caused by H. influenza, N. meningitidis (meningococcal meningitis) and S. pneumoniae.Ampicillin is the drug of choice for treatment of meningitis caused by L. monocytogenes.Meningitis seen in post neurosurgery or penetrating head trauma patients caused by staphylococcus, Propionibacterium, pseudomonas or acinetobacter is treated by meropenem+vancomycin.Note: For prophylaxis of meningococcal meningitis (contacts or mass chemoprophylaxis) ciprofloxacin is the drug of choice. Ceftriaxone though us the best drug for prophylaxis is not the drug of choice as it is a parenteral drug.


Question: Fellypressin is a


Question: The selective β1 receptor agonist is


Question: Ebstein anamoly is caused by usage of wof

Lithium In take by mother during pregnancy leads to Ebstein anomaly in fetus. Teratogenicity It refers to the capacity of a drug to cause foetal abnormalities when administered to the pregnant mother. The placenta does not constitute a strict barrier, and any drug can cross it to a greater or lesser extent. The embryo is one of the most dynamic biological systems and in contrast to adults, drug effects are often irreversible. The thalidomide disaster (1958-61) resulting in thousands of babies born with phocomelia (seal like limbs). Drugs can affect the foetus at 3 stages-- (i) Feilization and implantation-- conception to 17 days--failure of pregnancy which often goes unnoticed. (ii) Organogenesis-- 18 to 55 days of gestation--most vulnerable period, deformities are produced. (iii) Growth and development-- 56 days onwards-- developmental and functional abnormalities can occur, e.g. ACE inhibitors can cause hypoplasia of organs, especially of lungs and kidneys; NSAIDs may induce premature closure of ductus aeriosus; androgens and progestins cause masculanization of female foetus, antithyroid drugs and lithium cause foetal goiter. Ref:- kd tripathi; pg num:-89


Question: Majority of drugs are transported across the membrane by


Question: The neuromuscular blocker that does not need reversal of action by neostigmine at the end of the operation is

Mivacurium:- It is the shoest acting competitive blocker; does not need reversal. Dose and speed of injection related transient cutaneous flushing can occur due to histamine release. Fall in BP is possible, but change in HR is minimal. It is metabolized rapidly by plasma cholinesterases. Prolonged paralysis can occur in pseudocholinesterase deficiency, but this can be reversed by neostigmine. Ref:- kd tripathi; pg num:-354


Question: A partial agonist at acetylcholine nicotinic receptors that can be used in smoking cessation programs is


Question: The schematic diagram is depicting some features of autonomic and somatic nervous systems. The neurotransmitter at site 'F' is

Acetylcholine (ACh) is the primary transmitter at ANS ganglia and at the somatic neuromuscular junction .Katzung Pharmacology 12th edition Pg: 80


Question: Pembrolizumab is

Pembrolizumab and Nevolumab are monoclonal antibodies against PDL1 receptor used in BRAF -ve malignant melanoma.

Monoclonal antibody against PDL1 receptor


Question: Broad spectrum antifungal agent is

(Ketoconazole) (762-KDT 6th)* Ketoconazole - It is the first orally effective broad spectrum antifungal drug useful in both dermatophytosis and deep mycosis a major advance* Terbinafine - is the drug of choice for treating dermatophytoses and especially, oncychomycoses (fungal infections of nails)* It is better tolerated, requires shorter duration of therapy, and is more effective than either itraconazole or griseofulvin (4.10 - Pharmacology - Lippincott's 3rd) Rifampicin decreases blood levels & cimetidine increases blood levels of terbinafine


Question: Cardiotoxicity is the side effect of

Ans. is 'c' i.e., Rubidomycin Anthracycline induced cardiotoxicity* Rubidomycin and doxorubicin are the anthracycline anti - tumor antibiotics* They have cardiotoxicity as a adverse effect.* This can manifest either acutely with ECG changes, arrhythmias and hypotension, which are reversible, or be delayed like CHF.* CHF is due to cardiomyopathy and may be fatal.* To prevent the chances of anthracycline induced cardiomyopathy, antioxidants like dexrazone can be used.


Question: Potassium Iodide given for cough acts as

Potassium Iodide is an expectorant that increases bronchial secretion either directly by irritating bronchial glands or indirectly by causing gastric irritation.


Question: Thrombolytics can provide relative morality reduction in the treatment of acute myocardial infarction if patient comes within

Thrombolytic drugs should be given within 12 hours after onset of acute MI and within 3 hours of acute stroke Refer Harrison 18/e p2027


Question: Pulmonary fibrosis is a side effect of

Ans. is 'c' i.e., Bleomycin Pulmonary infiltrates are seen with 3 of the given options - Methotrexate Bleomycin CyclophosphamidePulmonary fibrosis is seen with two of the given optionsBleomycin (Page 1395 G & G 10th/e)Cyclophosphamide (page 1430 G & G 10th/e)I have gone for Bleomycin because pulmonary involvement is most common with Bleomycin."The most serious adverse reaction to Bleomycin is pulmonary toxicity, which begins with dry, cough, fine rales, and diffuse basilar infiltrates on x-ray and may progress to life threatening pulmonary fibrosis"


Question: Thiazides can cause

Anti hypeensive agents like thiazides and -blockers can cause impotence. It is maximum with thiazides among anti-hypeensive drugs and is thought to be due to volume depletion.


Question: Drug of choice for Hairy cell leukemia

Cladribine is a purine analogue, which is  DOC for Hairy cell leukemia.


Question: Anti arrhythmic drug is

Refer kDT 7/e p 529 Phentolamine is a synthetic imidazoline with alpha-adrenergic antagonist activity. As a competitive alpha-adrenergic antagonist, phentolamine binds to alpha-1 and alpha-2 receptors, resulting in a decrease in peripheral vascular resistance and vasodilatation. Phenobarbital belongs to a class of drugs known as barbiturate anticonvulsants/hypnotics. Pentamidine is an antimicrobial medication used to treat African trypanosomiasis, leishmaniasis, babesiosis, and to prevent and treat pneumocystis pneumonia in people with poor immune function


Question: Low molecular weight heparin inhibits

Prophylaxis of neural tube defects require treatment with folic acid.
Methotrexate toxicity can be prevented by 5′-formyltetrahydrofolate (folinic acid).
Pernicious anemia requires the therapy with vitamin B12
Anemia associated with chronic renal failure is treated with erythropoietin.


Question: Status epilepticus Drug of choice is

LORAZEPAM iv is considered as the firset drug to be given followed by phenytoin. Ref: KD Tripathi 8th ed.


Question: The mechanism of action of Apixaban is

(B) Factor Xa inhibitor[?]APIXABAN is an oral anticoagulant and a highly selective direct inhibitor of factor Xa with rapid onset of action.oUsed to decrease the risk of venous thromboses, systemic embolization and stroke in patients with atrial fibrillation, and lower the risk of deep vein thrombosis and pulmonary embolus after knee or hip replacement surgery.oApixaban has been linked to a low rate of serum aminotransferase elevations during therapy and to rare instances of clinically apparent liver injury.oIt does not require routine laboratory monitoring in the majority of patients except in special situations such as serious bleeding into critical organs, potential overdose, emergency surgery.oOther new oral anticoagulants include edoxaban, betrixaban oDirect X2 inhibitoroAnticoagulant for treatment & prophylaxis of venous thromboembolic events


Question: Progesterone is added to estrogens in H to achieve wof effects

Hormone replacement therapy (H) In nonhysterectomised postmenopausal women estrogen therapy is supplemented with a progestin for 10-12 days each month to counteract the risk of inducing endometrial carcinoma. Ref:- kd tripathi; pg num:-318

Decrease the estrogen action on the breast

Decrease the occurrence of endometrial cancers

Increase the effectiveness of the estrogens


Question: Mechanism of action of Levetiracetam is

Levetiracetam blocks SV2A which is a synaptic vesicular protein & inhibits release of excitatory neurotransmitters.


Question: First drug of choice for acute pulmonary edema is

Ans. is 'a' i.e., Furosemide o Loop diuretics (Furosemide) is the DOC for acute pulmonary edema.o In acute left ventricular failure and pulmonary edema, furosemide has benefical effect because of venodilatory action (not because of diuretic action).o Intravenous furosemide causes promt increase in systemic venous capacitance and decreases left ventricular filling pressure even before the diuretic action becomes apparent.


Question: Longest acting insulin

Degludec is the longest acting insulin.it acts for 42hrs so it can be given even once every alternate day. Other long-acting which acts for 24 hrs is glargine, detemir. They are insulin analogues. Ref: KD Tripathi 8th ed.


Question: Longest acting oral sulphonamide is

Sulphadoxine is the longest acting orally absorbable drug. Mafenide is a topical drug.sulphadiazine and sulfacetamide are sho-acting oral drugsRef: KD Tripathi 6th ed .pg: 684


Question: One of the following activities is not meditated through beta 2 adrenergic receptor

Beta-agonist produce smooth muscle relaxation, bronchodilation, vasodilatation and uterine stimulation through beta 2 receptors. Also, Beta 3 receptors are located on adipocytes, not beta 2 beta 1- hea From medical pharmacology Padmaja 4th edition page no 101,105


Question: Fexofenadine is metabolic product of

Terfenadine acts as a peripherally-selectiveantihistamine, or antagonist of the histamine H1 receptor. It is a prodrug, generally completely metabolized to the active form fexofenadine in the liver by the enzyme cytochrome P450 3A4. Due to its near complete metabolism by the liver immediately after leaving the gut, terfenadine normally is not measurable in the plasma. Terfenadine itself, however, is cardiotoxic at higher doses, while its major active metabolite is not. Refer kDT 6/e p158


Question: Drug of choice for the following condition is (endoscopic view)

The picture shows esophageal candidiasis for which azoles are used.fluconozole is preferred due to better safety profile than ketoconazole .clotrimazole, nystatin is topical antifungal drugsRef: KD Tripathi 6th ed pg 761


Question: Drug of choice for Late East African Trypanosomiasis

Early east African trypanosomiasis : Suramine
Late east African trypanosomiasis : Melarsoprol
American trypanosomiasis : Benznidazole


Question: The primary mechanism of action of local anesthetics is

The primary mechanism of action of local anaesthetics is the blockade of voltage-gated sodium channels <img class="fr-fic fr-dib" style="width: 300px;" src=" /> Ref: Katzung 13e pg:443

Blockade of voltage-gated sodium channels

Stimulation of voltage-gated N-type calcium channels

Activation of ligand-gated potassium channels

Blockade the GABA-gated chloride channels


Question: Many signaling pathways involve the generation of inositol trisphosphate (IP3) and diacylglycerol (DAG). These molecules

IP3 DAG are secondary messengers derived from PIP2 they are present in the cell membrane where IP2 crosses the cell membrane and DAG doesnot. Ref: KD Tripathi 8th ed.

Can't activate calcium calmodulin-dependent protein kinases directly or indirectly


Question: Bronchodilator in COPD

Ans. is 'a' i.e., Anticholinergics Anticholinergic bronchodilators Anticholinergic acts on receptors located mainly in the larger central airways (Contrast sympathomimetics whose primary site of action is peripheral bronchioles). Parasympathetic tone is the major reversible factor in COPD. Anticholinergics are more effective than sympathomimetics. Ipratropium and tiotropium are anticholinergic bronchodilators. Tiotropium is longer acting than ipratropium. Inhaled ipratropium / tiotropium are bronchodilators of choice in COPD.


Question: Ethosuximide can be used for the treatment of

The only indication for ethosuximide is absence ccizures; in that also it has been superseded by valproate. ::ON: 20-30 mg/kg/day; ZARONTIN 250 mg/5 ml yr. Ref: KD TRIPATHI 8th ed.


Question: Best treatment of severe digitalis toxicity is

The primary treatment of digoxin toxicity is digoxin immune fab, which is an antibody made up of anti-digoxin immunoglobulinfragments. This antidote has been shown to be highly effective in treating life-threatening signs of digoxin toxicity such as hyperkalemia, hemodynamic instability, and arrhythmias. Fab dose can be determined by two different methods. First method is based on the amount of digoxin ingested whereas the second method is based on the serum digoxin concentration and the weight of the person. Other treatment that may be used to treat life-threatening arrhythmias until Fab is acquired are magnesium, phenytoin, and lidocaine. Magnesium suppresses digoxin-induced ventricular arrhythmias while phenytoin and lidocaine suppresses digoxin-induced ventricular automaticity and delay afterdepolarizations without depressing AV conduction. In the case of an abnormally slow hea rate (bradyarrhythmias), Atropine, catecholamines (isoprenaline or salbutamol), and/or temporary cardiac pacing can be used Refer kDT 6/e p499


Question: Flumazenilis

(Benzodiazepine antagonist) (399-KDT6th)* Flumazenil - Benzodiazepine antagonistUses - (i) To reverse BZD anaesthesia (ii) BZD overdose* Melatonin receptor agonist - Ramelteon


Question: Inverse agonist of BZD

beta carboline is an inverse agonist of BDZ .


Question: Drug treatment for tardive dyskinesia is

Tardive dyskinesia is late symptom which appears on treatment with typical antipsychotic like haloperidol. It occurs due to D2 receptor supersensitivity. Treatment of choice is valbenazine - Ropinirole is used for Restless leg syndrome - Tetrabenazine is drug used in Huntington's chorea - Biperidin is used in drug induced Parkinsonism.


Question: The microsomal enzyme involved in the metabolism of omeprazole is

Omeprazole and clopidogrel are mainly metabolized by CYP2C19.Other drugs metabolized by this enzyme are anti anxiety drugs like diazeoam. Induced by drugs rifampicin and barbituates. Ref: KATZUNG; 13th ed / Page: 80


Question: Local anesthetic action is a result of blockade of the movement of wof channels

LOCAL ANAESTHETICS MECHANISM OF ACTION The LAs block nerve conduction by decreasing the entry of Na+ ions during upstroke of action potential (AP). As the concentration of the LA is increased, the rate of rise of AP and maximum depolarization decreases causing slowing of conduction. Finally, local depolarization fails to reach the threshold potential and conduction block ensues. The LAs interact with a receptor situated within the voltage sensitive Na+ channel and raise the threshold of channel opening: Na+ permeability fails to increase in response to an impulse or stimulus. Impulse conduction is interrupted when the Na+ channels over a critical length of the fibre (2-3 nodes of Ranvier in case of myelinated fibres) are blocked. Ref:- kd tripathi; pg num:-361


Question: Concurrent administration of tetracyclines is most likely to impair the action of


Question: Sialogouges are


Question: Heparin induced thrombocytopenia is due to antibodies against

Antibodies against platelet factor-4 (PF-4) causes aggregation of platelets and thrombosis, thus leads to thrombocytopenia.


Question: Vorapaxar acts by inhibiting

Vorapaxar inhibits Protease Activated Receptor 1 (PAR1) which is a thrombin receptor and thus can be used as a antiplatelet drug in M.I


Question: Reflex tachycardia is most likely to occur after the systemic administration of

Although used primarily via inhalation for asthma, systemic effects of albuterol include vasodilation due to its b2 receptor activation. This can result in a decrease in PVR and mean BP, which elicits a reflex tachycardia. Methoxamine and phenylephrine are a- receptor activators causing vasoconstriction, which would result in reflex bradycardia. Ganglion blockers (trimethaphan) prevent autonomic reflexes, and a reflex increase in heart rate could not occur in the presence of a beta blocker (propranolol).


Question: Drug useful in breast cancer is

Medications Estrogen modulator, Chemotherapy, Hormone based chemotherapy, and Bone health


Question: Mogamulizumab was approved by FDA recently for

Recently approved for non hodgkins lymphoma.


Question: Depression is not a side effect of

Answer is option4, flupenthisol. The antidepressive and anxiolytic efficacy of flupenthixol has been investigated in numerous controlled and open trials involving patients with endogenous, reactive as well as senile depressions. When administered at a mean daily single or multiple dose of 1-2 mg, flupenthixol proved to be a very effective and well-tolerated antidepressant. As opposed to some of the currently available antidepressants, flupenthixol has a rapid onset of action which is often displayed within the first 2-3 days following its application. Ref:


Question: Sildenafil should not be used in

Sildenafil inhibits PDE-5 and prevents Nitric oxide (NO) degradation. Increased NO results in vasodilation. It should not be used in patients taking vosodilators as it can lead to sudden hypotension.


Question: Constipation is a possible side effect of drugs taken by the oral route, but it is highly unlikely to occur with the use of

Docusate is a stool-softening laxative that facilitates mixing of oil and water via its surfactant properties. Drugs that have muscarinic blocking effects, like scopolamine and the antihistamines diphenhydramine and promethazine, tend to cause constipation by decreasing GI motility. Loperamide is an opioid derivative, with no analgesic activity, used in the treatment of diarrheal states.


Question: Probencide interacts with

Interaction of probeecid Competitively blocks active transpo of organic acids at all sites especially renal tubules. it inhibits excretion of penicillin or ampicellin and increases its blood level It also inhibits urinary excretion of cephalosporins, sulfonamides, methotrexates and indomethacin. It enables tubular secretion of nitrofurantoin Salicylates, pyrazinamide and ethambutol inhibit uricosuric action of probeecid It inhibits biliary excretion of rifampicin Refer kDT 6/e p209


Question: Urination in the human subject is decreased by

ANTICHOLINERGIC DRUGS (Muscarinic receptor antagonists, Atropinic, Parasympatholytic) Smooth muscles:- All visceral smooth muscles that receive parasympathetic motor innervation are relaxed by atropine (M3 blockade). Tone and amplitude of contractions of stomach and intestine are reduced; the passage of chyme is slowed--constipation may occur, spasm may be relieved. Atropine has relaxant action on ureter and Urinary bladder; urinary retention can occur in older males with prostatic hyperophy. However,this relaxant action can be beneficial for increasing bladder capacity and controlling detrusor hyperreflexia in neurogenic bladder/enuresis. Ref:- kd tripathi; pg num:-114,115


Question: Tadalafil inhibits

Tadalafil & Sildenafil inhibits Phosphodiesterase - 5 (PDE -5) and increase cGMP, They are used in pulmonary hypertension & erectile dysfunction.


Question: Imatinib is used in the treatment of

Imatinib is used in the treatment of certain types of leukemia and gastrointestinal stromal tumors (GIST).
This medication is also used to treat dermatofibrosarcoma protuberans, a type of skin tumor. Imatinib is a biologic drug, also known as targeted therapy.


Question: Quinidine exes action on hea by

Refer katzung 11e p 237 * Mechanism of action Like all other class I antiarrhythmic agents, quinidine primarily works by blocking the fast inward sodium current (INa). ... The effect of blocking the fast inward sodium current causes the phase 0 depolarization of the cardiac action potential to decrease (decreased Vmax).


Question: Bulls eye retinopathy is seen in

Refer Kanski clinical ophthalmology 6/e p842-843 Chloroquine can cause Bulls eye retinopathy. The risk of retinotoxicity increases significantly with cumulative dose of more than 300 g.it is rare if duration is less than than one year


Question: Opioid agonist are ALE aEUR'


Question: The activation of muscarinic receptors in bronchiolar smooth muscle is associated with

M3 receptors:- Visceral smooth muscle contraction and glandular secretions are elicited through M3 receptors, which also mediate vasodilatation through EDRF release. The muscarinic receptors are G-protein coupled receptors having the characteristic 7 membrane traversing amino acid sequences. The M1 and M3 (also M5) subtypes function through Gq protein and activate membrane bound phospholipase C (PLc)--generating inositol trisphosphate (IP3) and diacyl-glycerol (DAG) which in turn release Ca2+ intracellularly-- cause depolarization, glandular secretion, raise smooth muscle tone and release NO (from endothelium). They also activate phospholipase A2 resulting in enhanced synthesis and release of prostaglandins and leucotrienes in ceain tissues. Ref:- kd tripathi; pg num:-101,102


Question: Effect of atropine on eye is

Parasympatholytics like atropine produce passive mydriasis due to blockade of m3 receptors. sympathomimetics produce active mydriasis due to contraction of dilator papillae Ref: Katzung 11th ed pg 117


Question: The positive inotropic effect of digitalyzers is due to invitation of Na+/K+ ATPase pump in cardiac muscle cell membrane leading to

Ref-Goodman and Gillman 12/e p802,803 The positive inotropic effect of digitalis is due to inhibition of Na+/K+ ATPase pump in cardiac muscle cell membrane leading to decreased activity of Na+/Ca++ exchanger causing decrease the influx of sodium and decreased efflux of CA++ in the sarcolemma

Decrease the activity of Na+/Ca+ exchanger causing decrease the influx of sodium and decreased efflux of Ca++ in the sarcolemma

Decreased efflux of Na+ leading to less negative resting membrane potential and opening of voltage gated Ca+ + channels on the T tubules

Increased intracellular Na+ causing increased efflux of any place and increase the influx of Ca + + through Na+/ Ca + + exchanges in sarcolemma

Increased intracellular Na+ decreasing the activity of Ca + + pump in the sarcoplasmic reticulum


Question: Pirenzepine is used for

Pirenzepine & Telenzepine are M1 antagonists used for peptic ulcer disease.


Question: The following can be used to antagonise the action of heparin in case of overdose

HEPARIN ANTAGONIST Protamine sulfate Given i.v. it neutralises heparin weight for weight, i.e. 1 mg is needed for every 100 U of heparin. For the treatment of heparin induced bleeding, due consideration must be given to the amount of heparin that may have been degraded by the patient's body in the mean time. However, it is needed infrequently because the action of heparin disappears by itself in a few hours, and whole blood transfusion is needed to replenish the loss when bleeding occurs. Protamine is more commonly used when heparin action needs to be terminated rapidly, e.g. after cardiac or vascular surgery. Ref:- kd tripathi; pg num:-620


Question: DOC for acute attack of Hereditary angioneurotic edema

Medication C1 inhibitor concentrate (Plasma-derived) (Berine, Berine P, Cinryze. Recombinant C1 inhibitor Conestat alfa (Ruconest, Rhucin). Bradykinin Bzreceptor antagonist Icatibant (Firazyr). Kallikrein inhibitor Ecallantide (Kalbitor) REF : katzung pharmacology : 14th ed


Question: Red man syndrome is seen with


Question: Secukinumab is

Ustekinumab (anti-IL-12/23) and secukinumab (anti-IL-17) monoclonal antibodies have shown promising efficacy in clinical trials, but have not yet been approved for use in Ankylosing Spondylitis. Reference: Harrison&;s Principles of Internal Medicine; kd tripathi 9th ed


Question:
The antiviral drug recommended for treatment of Herpes Zoster infection of Trigeminal nerve
distribution in an immunocompromised host is


Question: Most potent cycloplegic among the following


Question: Low Vd means

The volume of distribution (V) relates the amount of drug in the body to the concentration of drug (C) in blood or plasmaVd = amount of drug in body/concentration of drug (C)Drugs with low volumes of distribution have much lower concentrations in extravascular tissue than in the vascular compament.Katzung Pharmacology 12th edition Pg: 38

The drug has weak plasma protein binding


Question: Carbapenem with maximum seizure risk is

* Imipenem is a Carbapenem group of Beta-Lactam antibiotic with highest propensity to induce seizures compared to the other Carbapenem congeners. * Seizure is noted in 1.5% patients receiving Imipenen. Seizure risk is increased in patients receiving high doses in the presence of renal insufficiency and CNS lesions. Ref:- Goodman & Gilman Pharmacological Basis of Therapeutics 13th Ed; Pg num:- 1035


Question: Multiple drug resistance is transferred through

Refer KDT 6/e p 671 Multiple drug resistance is transferred through Pladmids Mostly by conjugation


Question: Topical Antifungal agent in candidiasis is


Question: One of the following is a prodrug

Ans. is 'a' i.e. Enalapril Remember, * The end result of drug metabolism is usually the abolition of activity of the drugs and conversion of drug from lipid soluble to water soluble compounds but sometimes the drug may be converted from its inactive form to active form.ProdrugsFew drugs are inactive as such and need conversion in the body to one or more active metabolites. Such a drug is called a prodrug.The prodrug may offer advantage over the active form in being more stable, having better bioavailability or other desirable pharmaco-kinetic properties or less side effects and toxicity.ProdrugActive form* LevodopaDopamine* EnalaprilEnalaprilat* S-methyldopaa methyl norepinephrine* DipivefrinEpinephrine* SulindacSulfide metabolites* Hydrazide MAO inhibitorsHydrazine derivatives* ProguanilProguanil Triazine* PrednisonePrednisolone* BacampicillinAmpicillin* Sulfasalazine5 Aminosalicylic acid* CyclophosphamideAldophosphamide, Phosphoramide mustard* FluorouracilFluoruridine monophosphate* MercaptopurineMethyl mercaptopurine ribonucleotide


Question: The major clinical use of Nimodipine is in

Refer kDT 6/e p532 subarachnoid hemorrhage USES: Nimodipine is used to decrease problems due to a ceain type of bleeding in the brain (subarachnoid hemorrhage-SAH).Nimodipine is called a calcium channel blocker. The body naturally responds to bleeding by narrowing the blood vessel to slow blood flow.


Question: Mechanism of action of sildenafil is

Ans. is 'c' i.e., Inhibits PDE 5 * Sildenafil (Viagra) acts to increase cGMP by inhibiting its breakdown by phosphodiesterase isoform 5 (PDE-5).


Question: Therapeutic index indicates


Question: Baricitinib was approved by FDA recently for

barcitinib is a janus kinase inhibitoe JAK . Ihibits the activity of JAK 1 and JAK 2 enzymes interfering with JAK STAT pathway.


Question: Anaesthetic that has a smooth induction is

Refer Katzung 10/e 404 KDT 6/e p372 Halothane and Sevoflurane have smooth induction So these are preferred agents for anaesthesia in children


Question: Drug is absorbed rapidly in the following form


Question: Green frothy vaginal discharge is produced by

Ans. is 'c' i.e., Trichomonas vaginalis Trichomoniasis - It is a sexually transmitted disease It is almost entirely a disease of child-bearing age The vaginal discharge is frothy, slightly green in colour and profuse.There are multiple punctate strawberry spots on the vaginal vault and portio vaginalis of cervix.Diagnosis : Culture is 98% reliableT/T : Metronidazole 200 mg T.D.S. for 7 days


Question: Loading drug of dose primaraly depends on

Loading dose; This is a single or few quickly repeated doses given in the beginning to attain target concentration rapidly. Loading dose =Target Cp * V /F Cp-concentration, V - the volume of distribution, F-oral bioavailabilityThus, the loading dose is governed only by V and not by Clearance or t1/2 Ref ; KD Tripathi Pharmacology 7th edition (page no;33)


Question: The plane of surgical anesthesia during ether anesthesia is defined as

Refer KDT 7th/373 The plane of surgical anesthesia during ether anesthesia is defined as from onset of regular respiration to cesssation of spontaneous breathing

Loss of consciousness to the onset of spontaneous respiration

From onset of regular respiration to cessation of spontaneous breathing


Question: Eltrombopag is a

Eltrombopag is a thrombopoietin analogue used in ITP, but carries the risk of hepatotoxicity.
Lustrombopag & Avatrombopag are other thrombopoietin analogues used to prevent bleeding in patients of liver disease.


Question: Omeprazole is a


Question: Cilastatin is given in combination with Imipenem because

* Cilastatin is a renal dipeptidase (or dehydropeptidase) enzyme inhibitor, used in conjunction with Imipenem antibiotic to prevent degradation of Imipenem by the renal tubular dipeptidase. * Imipenem is a carbapenem class of Beta-Lactam antibiotic. It has poor absorption following oral administration. Given IV, the drug is rapidly catabolized by the dipeptidase enzyme expressed by the brush border cells of proximal tubules in kidney. * Both Imipenem and Cilastatin have identical pharmacokinetic profile - so ideal for combination. * Following concurrent administration, Imipenem degradation is blocked significantly, biovailability and duration of action is enhanced, around 70% active drug is recovered from urine (When Imipenem is used alone, only about 5.5-42.5% of unchanged drug is recovered from urine). Ref:- Goodman & Gilman Pharmacological Basis of Therapeutics 13th Ed; Pg num:- 1035

Cilastatin prevents degradation of Imipenem in kidney

Cilastatin increases absorption of Imipenem

Inhibits the enzymes that digest Imipenem in stomach


Question: Most common Digoxin induced arrythmia is

Ventricular bigeminy is the most common arrythmia induced by Digoxin.


Question: Ibuprofen acts on

(Cyclo-oxygenase pathway) (157, 176-KDT) (184-KDT 6th)Biosynthesis of prostaglandins (PG) and LeukotrienesIBUPROFEN - Propionic acid derivative. All inhibits PG synthesis, naproxen being most potent. They inhibit platelet aggregation and prolong bleeding time.A. Non selective COX inhibitors (Conventional NSAIDS)1. Salicylates - Aspirin, Diflunisol2. Pyrazolone derivative - Phenylbutazone, Oxyphenbutazone3. Indole derivative - Indomethacin, Sulindac4. Propionic acid derivatives - Ibuprofen, Naproxen, Ketoprofen, Flurbiprofen5. Anthranilic acid derivative - Mephenamic acid6. Aryl-acetic acid derivatives - Diclofenac7. Oxicam-derivatives - Piroxicam, Tenoxicam8. Pyrrolo-pyrrole derivative - KetorolacB. Preferential COX-2 inhibitors - Nimesulide, Meloxicam, NabumetoneC. Selective COX inhibitors - Celecoxib, Rofecoxib, Veldecoxib, Etoricoxib


Question: Dilator pupillae is supplied by

ref : A K Khurana ophthalmology 6th edition (page no:7) Ganong 23/e p261,265 dilator pupillae muscle is supplied by the sympathetic fibers from the carotid plexus which enter the Gasserian ganglion of 5th cranial nerves. ultimately reach the muscle along with long ciliary branches of nasociliary nerves (ophthalmic division 5th CN)

postganglionic parasympathetic from Edingerwest phal nucleas

Postganglioninc sympathetic from cervical sympathetic chain

Sympathatic fibres of fronto-orbital branch of trigeminal nerve


Question: New vaginal ring used to prevent pregnancy for an entire year

It is a ring shaped non biodegradable , flexible, white opaque system contain a estrogrn n progesterone ative compounds.


Question: ATT most commonly implicated in causing peripheral neuropathy is

INH Peripheral neuritis and a variety of neurological manifestations Paraesthesia Numbness Mental disturbances Rarely convulsions Refer KDT 6/e p741


Question: Lactic acidosis is a side effect of

(B) Metformin # LACTIC ACIDOSIS: occurs when the rate of production of lactic acid from pyruvate in muscle, skin, brain & erythrocytes exceeds the rate of removal by liver & kidney.# Causes of Lactic Acidosis:# Group A (Due to poor tissue perfusion)> Shock from any cause, Respiratory failure, Severe anaemia, Mitochondrial enzyme inhibitor (Cyanide or CO)# Group B (Due to aerobic disorder)> Diabetes mellitus; Hepatic failure; Renal failure; Severe infection (cholera, malaria)> Malignancies; Seizures> Drugs (biguanides such as metformin, salicylates, isoniazid, sorbitol, AZT analogues, fructose)> Toxins (ethanol, methanol), Congenital enzyme defect


Question: Sustained neutropenia is seen with

Refer Goodman Gilman 11/e p1330 KDT 6/e p822. Myrelosuppression leading to neutropenia ,thrombocytopenia and anemia is seen is seen with most of the anticancer drugs The characterstic features of Myelosuprresion produced by carmustine


Question: Maximum dose of lignocaine given with adrenaline for infiltration anesthesia is

Refer Goodman Gilman 12/e p576 For normal healthy adults, the individual maximum recommended dose of lignocaine HCI with epinephrine should not exceed 7mg/kg of body weight and in general it is recommended that the maximum total dose not exceed 500mg When used without epinephrine the maximum individual dose should not exceed 4.5 mg/kg of body weight and in general it is recommended that the maximum total dose not exceed 300mg


Question: Drug not used for Pseudomembranous colitis

All except streptogramins are used. Drug of choice for pseudomembranous colitis is metronidazole,in resistant cases vancomycin given orally. Fidaxomycin is newer class of macrolide type of antibiotic used specially for PMC Ref:KDT 6/e p799


Question: Drug A, has Bioavailabity of 80% volume of distribution is 10 L, Calculate the loading dose to be given to achieve plasma concentration of 0.6 mg/L


Question: Fastest acting proton pump inhibitor is

Rabeprazole is the fastest acting proton pump inhibitor.


Question: The mechanism of action of local anesthetics is that they act on Na+ channels in their

The mechanism of action of local anesthetic is by blockade of sodium channels in their activated state. Local anesthetic drugs interfere with excitation and conduction by action potentials in the nervous system and in the hea by blockade of the voltage-gated Na channel. Drug affinity varies with gating state of the channel. The drugs show low affinity at slow excitation rates, but high affinity when the channels are opened and inactivated during action potentials at high frequency, as they are during pain or during a cardiac arrhythmia. The drugs are thought to access their binding site in the inner pore by passage through the membrane and entry through the inner pore vestibule. There have been three major developments in the last decade that greatly increase our understanding of their mechanism of action. Firstly, amino acid residues critical to drug binding have been located by mutagenesis, and it is possible to develop a molecular model of the drug binding site. Secondly, a path for drug access directly from the outside has been characterized in the cardiac isoform of the channel. Thirdly, the hypothesis that high affinity binding stabilizes the fast inactivated conformation of the channel has been challenged. Rather, the drug may stabilize a slow inactivated state and immobilize the voltage sensor in domain III in its activated outward position. The combination of mutational study of the cloned Na channels and patch clamp offers the oppounity to understand the detailed molecular mechanism of drug action and to resolve drug structure-function. From Tripati 7th edition. Page no 362, figure 26.2


Question: Most serious side effect of valproate is

Ans. is 'a' i.e., Fulminant hepatits Valproate Valproate acts by multiple mechanism : Prolongation of inactivated Na* channel. Inhibition of T type Ca' current. Inhibition of degradation of GABA by GABA transminase - facilitation of GABA mediated Cl- channel opening. Its most serious adverse effect is fulminant hepatitis especially in children below 3 years. Used during pregnancy, it has produced spina bifida and other neural tube defects. Uses (other than epilepsy) --> mania & bipolar illness, prophylaxis of migraine, trigeminal neuralgia, tardive dyskinesia. Adverse effect of Valproate Neurological - Ataxia, sedation,tremor Systemic- Hepatotoxicity, thromobocytopenia,GI irritation, weight gain, transient alopecia, hyperammonemia, pancreatitis,coagulation disorder.


Question: Provisional sho antiretroviral regime given in the peripaum period reduces the risk of veical transmission by

Most transmission of HN occurs during pregnancy and bih, breastfeeding may account for 5-15% of infants becoming infected after delivery Studies have demonstrated that truncated regimens of zidovudine alone or with Lamivudine given to mother during last few weeks of pregnancy or even during labour & delivery & to the infant for a week or less reduced transmission to infant by 50% compared to placebo. rEF : katzung 12 th ed.


Question: The following antiarrhythmic drug has the most prominent anticholinergic action

Disopyramide It is a quinidine like Class IA drug that has prominent cardiac depressant and anticholinergic actions, but no a adrenergic blocking propey. Disopyramide usually has no effect on sinus rate because of opposing direct depressant and antivagal actions. Ref:- kd tripathi; pg num:-530


Question: Renal lesion in chronic use of lithium is

(C) Chronic interstitial nephritis # "Nephrogenic Diabetes Insipidus and Other Renal Adverse Effects> Polydipsia and polyuria are common but reversible concomitants of lithium treatment, occurring at therapeutic serum concentrations. The principal physiologic lesion involved is loss of responsiveness to antidiuretic hormone (nephrogenic diabetes insipidus). Lithium-induced diabetes insipidus is resistant to vasopressin but responds to amiloride.> Extensive literature has accumulated concerning other forms of renal dysfunction during long-term lithium therapy, including chronic interstitial nephritis and minimal-change glomerulopathy with nephrotic syndrome. Some instances of decreased glomerular filtration rate have been encountered but no instances of marked azotemia or renal failure.> Patients receiving lithium should avoid dehydration and the associated increased concentration of lithium in urine. Periodic tests of renal concentrating ability should be performed to detect changes."


Question: Bacteria implicated in dental caries

Ans. is 'a' i.e., streptococcus mutans Viridans streptococci is implicated in causing Dental caries.Various species of viridans streptococci are -S. Salivarius S. Mitis S. Sanguis S. MutansThese bacterias are a part of normal flora of the mouth.They can cause bacteremias through minor trauma such as eating, brushing md flossing, these bacteremias can then cause endocarditis.


Question: Quinidine belongs to class antiarrhythmic drug is

i.e. (class I): (510-17-KDT 6th) (367-68-MDT-l1)ANTIARRHYTHMIC DRUGSClass Ia Sodium channel blockers* Depress phase O depolarization* Slow conduction, prolong repolarization Drugs* Quinidine, Procainamide, Disopyramide, MoricizineClass Ib * Shorten repolarization Drugs* Lidocaine, MexiletineClass IC * Depress phase O repolarization, slow conduction* Propafenone is a week calcium channel blocker and b-blockers and prolongs action potential and refractionariness Drugs* Flecainide, PropafenoneClass II b-blockers* Slow AV conduction Drugs* Esmolol, Propanolol, MetoprololClass III * Prolong action potential* Prolong repolarization and ERP Drug* Amiodarone, Bretylium (also class II) Dofetilide, Ibutilide, Dronedarone, SotalolClass IV Calcium Channel blockers Drugs* Verapamil, diltiazem


Question: Less sedating antiemetic used in motion sickness and veigo

Meclizine and cyclizine are often used in preventing motion sickness and for sho-term treatment of veigo because they are less sedating than diphenhydramine and promethazine. Promethazine also causes antiemetic activity and is available as a suppository or for injection. Chlorpheniramine and brompheniramine, which are less sedating than diphenhydramine and promethazine, are often used alone or in combination with decongestants for allergies and colds. Cyproheptadine has antiserotonin activiry and may be useful in treating patients with carcinoid tUmor, where it blocks the effects of serotonin and histamine on smooth muscle. Aztemizole, loratadine, and terfenadine are nonsedating antihistamines that do not cross the blood-brain barrier. Ref: katzung 12th ed.


Question: 'Lock and Key model' of enzyme action was proposed by

Lock and key hypothesis By emil Fischer Active site is rigid Substrate has complimentary shape Demerits: 1. Rigid active site in reversible reaction. 2. Stabilization of transition state Ref: G n G 13th ed.


Question: Nootropic drug

Ans. d (Piracetam). (Ref. KD Tripathi, Pharmacology, 4th ed., 481)CEREBROACTIVE DRUGS (COGNITION ENHANCERS)1NootropicPiracetam2Metabolic enhancerDihydrergotaxine,Nicergoline,Piribedil3Cholinergic activatorTacrine4Vasoactive cerebral protectorsPyritinol, Ginko biloba.Educational Points:DRUGUsed in Rx of:Newer cholinesterase inhibitors (Donepezil, Revastigmine, Galantamine) & Mementine (NMDA antagonist)Alzheimer's diseaseRiluzoleAmyotropic lateral sclerosisD2 receptor blockers (Chlorpromazine, haloperidol)Huntington's choreab-IFN, Glatiramer & NatalizumabMultiple sclerosisTemozolomide, an orally administered alkylating agent, has replaced nitrosureas, including carmustine (BCNU) and lomustine (CCNU), as the most widely used chemotherapeutic agent for :High-grade gliomas.


Question: Drug S is most like

The effects of Drug S are changed by treatment with the beta blocker, but not by the alpha blocker (choices A, C, and D are ruled out). Terbutaline is beta2 selective and would not increase heart rate directly. Drug S is isoproterenol.


Question: Drugs causing afterload reduction is

Along with oxygen, medicationsassisting with symptom relief include: (1) diuretics, which reduceedema by reduction of blood volume and venous pressures; (2) vasodilators, for preload andafterload reduction; (3) digoxin, which can cause a small increase in cardiac output; (4) inotropic agents, which help to restore Refer katzung 11e p 219


Question: Pain in early labor is transmitted through


Question: Menadione (Vitamin K3)

Menadione is fat-soluble synthetic vitamin K3. It can cause hemolysis in G-6-PD deficient individuals. In severe hepatic disease, large doses of menadione can further depress liver function. Menadione is not used to prevent haemorrhagic disease of the newborn as it can cause kernicterus, instead phytonadione is used. Phytonadione is also the drug of choice to overcome the toxic effects of warfarin as it acts rapidly.

Can cause hemolysis in a patient with G-6-PD deficiency

Is the preparation of choice to antagonize the effect of warfarin overdose

Is useful to prevent hemorrhagic disease of the newborn

Is given in large doses in patients with severe liver disease


Question: Tricyclic antidepressants

In addition to blocking reuptake of NE and 5HT, pharmacodynamic actions of the tricyclic antidepressants include block of peripheral adrenergic and muscarinic receptors--the former resulting in postural hypotension and the latter, via mydriasis, exacerbating glaucoma. TCAs block the uptake of guanethidine into sympathetic nerve endings, decreasing its antihypertensive effects, and they may cause arrhythmias in overdose. They have no effect on the absorption of levodopa.

increase the antihypertensive effect of guanethidine

should not be used in patients with glaucoma

may increase oral absorption of levodopa


Question: For Arsenic poisoning Antidote is


Question: Name the drug used for this procedure

Tolazoline is an alpha blocker used in peripheral aeriography as it produces vasodilatation and has more selective action on peripheral vessels. Refr: KD Tripathi 8th ed.


Question: A patient came to the casualty with acute bronchial asthma after treatment for glaucoma .the probable drug maybe

Timolol is a non selective Beta blocker and can precipitate acute attacks of asthama in a suitable individual blockade of Beta 2 receptors. Betaxolol is a cardioselective Beta blocker and this less likely to cause this adverse effect Ref-KDT 6/e p139


Question: Pilocarpine reduce the intraocular pressure in person with closed angle glaucoma by

Refer kDT 7/e p 156 It has also been used in the treatment of chronic open-angle glaucoma and acute angle-closure glaucoma It acts on a subtype of muscarinic receptor (M3) found on the iris sphincter muscle, causing the muscle to contract -resulting in pupil constriction (miosis). Pilocarpine also acts on the ciliary muscleand causes it to contract. When the ciliary muscle contracts, it opens the trabecular meshwork through increased tension on the scleral spur. This action facilitates the rate that aqueous humor leaves the eye to decrease intraocular pressure


Question: Beta blockers used in CHF is

[D) (Carvedilol): (523-KDT7th edition)CARVEDILQL is a Betaj + Beta2 + Alpha! adrenoceptor blocker produces vasodilatation due to Alpha 1 blockade as well as calcium channel blockade and has antioxidant property. It has been used in hypertension and is the Beta blocker especially employed as cardioprotective in CHF (151-KDT7th)* b1 blockers mainly (metoprolol, bisoprolol, nebivolol) in mild to moderate CHF treated with ACE inhibitor + diuretic digitalis* There is no place for b blockers in decompensated patients. b blockers should be stopped during an episode of acute heart failure and recommended at lower doses followed by uptitration after compensation is restored


Question: Oral incretin analogue

GLP analogues are usually given by SC route but now recently oral analogue was prepared-semaglutide. Ref: Ktzung 12 th ed.


Question: Indications of somatostatin include

GH Inhibitors Somatostatin Mech of action:- This- 14 amino acid peptide inhibits the secretion of GH, prolactin and TSH by pituitary; insulin and glucagon by pancreas, and of almost all gastrointestinal secretions including that of gastrin and HCl. Side effects:- The g.i.t action produces steatorrhoea, diarrhoea, hypochlorhydria, dyspepsia and nausea as side effect. Uses:- 1) Somatostatin constrict splanchnic, hepatic and renal blood vessels. The decreased g.i. mucosal blood flow can be utilized for controlling bleeding esophageal varices and bleeding peptic ulcer, but octreotide is preffered now due to longer duration of action. 2) it's antisecretory action is beneficial in pancreatic, biliary or intestinal fistulae; can also be used to reduce complications after pancreatic surgery. 3) it also has adjuvant value in diabetic ketoacidosis (by inhibiting glucagon and GH secretion). 4) somatostatin in acromegaly. 5) insulinoma, glucaganoma. Ref:- kd tripathi; pg num:-237


Question: The following antitussive is present in opium but has no analgesic or addicting propeies

Noscapine (Narcotine):- An opium alkaloid of the benzoisoquinoline series. Mech of action:- It depresses cough but has no narcotic, analgesic or dependence inducing propeies. It is nearly equipotent antitussive as codeine, especially useful in spasmodic cough. side effects:- Headache and nausea avoided r contraindication:- It release histamine and produce bronchoconstriction in asthmatics. Ref:- kd tripathi; pg num:- 220


Question: Aldosterone exes action on

Aldosterone acts on the late DT and CD cells by combining with an intracellular mineralocoicoid receptor - induces the formation of' aldosterone-induced proteins' (AlPs) which promote Na+ reabsorption by a number of mechanisms and K+ secretion. Aldosterone (AL) penetrates the cell from the interstitial side and combines with the mineralocoicoid receptor (MR). The complex translocates to the nucleus-promotes gene mediated mRNA synthesis. The mRNA then directs the synthesis of aldosterone-induced proteins (Alps). The AlPs activates Na+ channel, translocate Na+ channels from cytosolic site to the luminal membrane and Na+K+ATPase of the basolateral membrane, increase ATP production by mitochondria. All these changes promote Na+ reabsorption-more K+vand H+ is secreted indirectly ( Essentials of Medical Pharmacology, K.D Tripathi,6tth edition, page 570 )


Question: Treatment of choice in a patient big acute pulmonary embolism with right ventricular hypokinesia and a compromised cardiac output but normal blood pressure is

Ref KDT 6 /e p606 Anticoagulants are the most mainstay for the treatment of pulmonary embolism Thrombolytic therapy is indicated bin massive pulmonary embolism with hemodymica instability and in hemodymically stable patients but with compromised right ventricular function


Question: A patient of schizophrenia was staed on haloperidol 5 mg. Next day, he presented with uprolling of eyes. Complete neurological examination revealed no spasticity or any other abnormality. Visual acuity and opthalmoscopic findings are normal. Most likely diagnosis is

Acute muscular dystonias Bizarre muscle spasms, mostly involving lingua-facial muscles -grimacing, tongue thrusting, toicollis, locked jaw; occurs within a few hours of a single dose or at the most in the first week of therapy. It is more common in children below 10 years and in girls, paicularly after parenteral administration; overall incidence is 2%. It lasts for one to few hours and then resolves spontaneously. One of the central anticholinergics, promethazine or hydroxyzine injected i.m. clears the reaction within 10-15 min. REF KD TRIPATHHI 8TH ED.


Question: Quinidine exes its action on the hea by

It is d-isomer quinidine is used as an antiarrhythmic drug. Quinidine blocks myocardial Na channels. Class 1a group of drugs- quinidine, procainamide, disopyramide Ib: Lidocaine, phenytoin Ic-encainide, flecainide Ref: KD tripathi 8th ed.


Question: Clopidogrel is an


Question: D Tubocurarine acts by

Refer Katzung 10/e p 429 D-Tubocurarine is a skeletal muscle relaxant that acts by competitive inhibition of NM receptors at neuron muscular junction

Inhibiting nicotinic receptors at myoneural junction

Inhibiting nicotinic receptors at autonomic ganglion

By inhibiting re-uptake of acetyl choline


Question: Ivabradine is used in the treatment of

Ivabradine-direct acting bradycardiac agent is used in angina and in rare cases- CCF As it decreases myocardial oxygen demand. Ref. HH Sharma 3rd ed.


Question: Dialysis is not indicated in toxicity of

Refer kDT 6/e p 499 Indications for Dialysis: A Mnemonic And Explanation Severe fluid overload. Refractory hypeension. Uncontrollable hyperkalemia. Nausea, vomiting, poor appetite, gastritis with hemorrhage. Lethargy, malaise, somnolence, stupor, coma, delirium, asterixis, tremor, seizures, Pericarditis (risk of hemorrhage or tamponade)


Question: Sucralfate

Ans. is 'c' i.e., Is ulcer protective Sucralfateo Sucralfate is an ulcer protective agent. It preferentially and strongly adheres to the ulcer base, specially duodenal, and acts as a physical barrier preventing acid, pepsin and bile from coming in contact with the ulcer base. However, this protective action is attributed to sucralfate because of certain properties which are achieved only in acidic medium:Acidic medium gives it a viscous consistency, alsoIt polymerises at pH < 4 by cross linkages of molecule assuming sticky gel like consistency,o It is this viscous and gel like properties that are responsible for its action.o When antacids are given concurrently they raise the pH of gastric secretion and this interferes with the very basic mechanism of action of sucralfate (requires pH < 4) and thus makes them ineffective.


Question: Ezetimibe acts by

Refer kDT 6/e p 618 Ezetimibe is an intestinal cholesterol absorption inhibits and is combined with statins


Question: Norepinephrine action at the synaptic cleft is terminated by


Question: "Monday disease" is seen with

Isosorbide Mononitrate is a venodilator, which is associated with Monday disease, where nitrate industry workers gets dizziness & hypotension on Monday, but symptoms disappear by the weekend because of down regulation of enzymes.


Question: One of the longer acting analogue among uterine stimulants

Carbetocin is a newer longer acting analogue of oxytocin . Now a days oxytocin use is reduced and this newer acting analogue is being used. Ref: katzung 12th ed, endocrinology.


Question: Drugs that are highly bound to albumin

Plasma protein binding 1) Highly plasma protein bound drugs are largely restricted to the vascular compament because protein bound drug does not cross membranes,thus they tend to have smaller volumes of distribution. 2)High degree of protein binding generally makes the drug long acting, because bound fraction is not available for metabolism or excretion, unless it is actively extracted by liver or by kidney tubules. 3) One drug can bind to many sites on the albumin molecule. Conversely, more than one drug can bind to the same site. This can give rise to displacement interactions among drugs bound to the same site(s). The drug bound with higher affinity will displace that bound with lower affinity. Some clinically impoant displacement interactions are: * Aspirin displaces sulfonylureas. * Indomethacin, phenytoin displace warfarin. Ref:- kd tripathi; pg num:-19,20

Can undergo competition with other drugs for albumin binding sites


Question: Phase II in a clinical drug trial is

Ans. is 'b' i.e., Therapeutic exploration and dose ranging Summary of clinical tarilsPhaseNameConducted onBlinding and controlPurposeIHuman pharmacology and safetyHealthy volunteers (20-100)OPEN LABEL (No bliniding)* To know maximum tolerable dose (MTD).* Safety and tolerability.IITherapeutic exploratory100-150Patients (homogenous population)Single blindControlled* To establish therapeutic efficacy.* Dose ranging and ceiling effect.IIITherapeutic confirmatoryUpto 5000 patients from several centres (heterogenous population)Double blindRandomizedControlled* To confirm therapeutic efficacy.* To establish the value of drug in relation to existing therapy.IVPost marketing surveillanceLarge number of patients being treated by practicing physicians * To konwn rare and long-term adverse effects* Special groups like children, pregnancy etc can be tested.


Question: A new diuretic is being studied in human volunteers. Compared with placebo, the new drug increases urine volume, decreases urinary Ca2+, increases body pH, and decreases serum K+. If this new drug has a similar mechanism of action to an established diuretic, it probably

The effects described are typical of thiazide diuretics, which inhibit the Na/Cl cotransporter in the distal convoluted tubule. This action facilitates reabsorption of Ca2+, which is the basis for the use of thiazides in nephrolithiasis, and which can result in hypercalcemia. The increased load of Na+ in the collecting tubules leads to increased excretion of both K+ and Hi, so hypokalemia and alkalosis may occur.

blocks the NaCl cotransporter in the DCT

inhibits the Na/K/2Cl cotransporter in the TAL


Question: High dose methotrexate is used for the treatment of(REPEAT)

Ref: Harrison's 17th/612 Drugs used for osteosarcoma are: Doxorubicin Ifosfamide Cisplatin High dose methotrexate with leucovorin


Question: Escitalopram is a

(A) Selective serotonin reuptake inhibitor # Mechanism of action of Escitalopram: Highly potent blockade of serotonin reuptake transport mechanism S CT without its inactive R-enantiomer.> Selective serotonin reuptake inhibitors: include Citalopram, Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine, Sertraline, Venlafaxine. Norepinephrine uptake inhibitors: Amitriptyline, Clomipramine, Doxepin, Imipramine, Desipramine.Trimipramine, Amoxapine, Maprotiline, Nortryptalline, protyptalline. Atypical Antideppressants: Amoxapine. Atomoxetin, Maprotiline, Trazodone and Bupropion, Venlafaxine, Mirtazapine, Nefazodone, and Duloxetine. MAO Inhibitors: Tranylcypromineto phenelzine, Selegiline

Nonspecific norepinephrine uptake inhibitor


Question: Dry skin seen due to excess dosage of datura is due to

One of the anticholinergic effects is dry skin due to absence of sweating due to blockade of m3 receptors on sweat glands Datura is nothing but atropine-anticholinergic drug Ref: KDT 6th ed pg 114-116


Question: Wof agents is often combined with local anesthetics to prevent its systemic distribution from the site of injection

Addition of a vasoconstrictor, e.g. adrenaline (1:50,000 to 1:200,000): * Prolongs duration of action of LAs by decreasing their rate of removal from the local site into the circulation: contact time of the LA with the nerve fibre is prolonged. * Enhances the intensity of nerve block. * Reduces systemic toxicity of LAs: rate of absorption is reduced and metabolism keeps the plasma concentration lower. * Provides a more bloodless field for surgery. * Increases the chances of subsequent local tissue edema and necrosis as well as delays wound healing by reducing oxygen supply and enhancing oxygen consumption in the affected area. Ref:- kd tripathi; pg num:-363


Question: Epalrestat is used in

It is a aldose reductase inhibitor. Thereby it prevent conversion of glucose in to sorbitol. Sorbitol act like a tissue toxin & is responsible for many of the complica on of diabetes. So Epalrestat is use as a drug to prevent the complica on of diabetes. But it does not reduce the blood sugar level.


Question: Thiopentone is fast acting inducing agent because of

Thiopentone is fast acting because of its high lipid solubility.
And action of this drug terminates very quickly because of rapid redistribution.


Question: The compound obtained from the following plant is used in

The picture shows datura from which atropine is obtained. It is used in iritis, iridocyclitis and digoxin induced bradycardia as it increases hea rate. Contraindicated in glaucoma as it produces mydriasis and decreased sweating-hyperpyrexiaRef: Goodman Gillman 12th ed pg 234


Question: Trisodium phosphonoformate (foscarnet) is a potent antiviral agent for treating herpes simplex infections. It works by affecting

Trisodium phosphonoformate (foscarnet) inhibits herpes simplex virus (HSV) replication. Foscarnet is a potent inhibitor of HSV-induced DNA polymerase, and has little effect on known cellular DNA polymerases. Herpesvirus mutants resistant to the drug arise easily. To a lesser extent, foscarnet also appears to inhibit the polymerase of hepatitis B virus and retroviruses. Combinations of antivirals, including foscarnet, are currently prescribed to increase the clinical usefulness of the drugs..


Question: Maximum glucocoicoid activity is seen with

Fludrocoisone has max mineralocoicoid activity.Triamcinolone, dexa, and betamethasone are having pure glucocoicoid activity. Methylprednisolone is having 5 times more glucocoicoid activity than prednisolone. Ref: KDT 7th ed P:289


Question: An 80 kg patient brought to casualty in shock. Dopamine needs to be started at 10 μg/ kg / min. A 5 ml vial contains 200mg of dopamine. Two vials are diluted to solution of 250ml with the help of normal saline. Calculate drops per minute required to be administered if 1 ml = 16 drops

5 ml vial : 200 mg 2 vials : 400 mg
2 vials in a solution of 250 ml
→ Each ml contains : 400mg /250ml = 1.6mg
16 drops: 16 mg 1drop: 0.1 mg.
Dose of dopamine need to be started: 10 μg / kg / min
Dose of dopamine for 80 kg: 800 μg / min
Dose of dopamine for 80 kg: 0.8 mg / min
(1drop : 0.1 mg)
Drops required per minute : 8 drops.


Question: Volume of distribution of drug is given by

Apparent volume of distribution (Vd); Presuming that the body behaves as a single homogeneous compament with volume V into which drug gets immediately and uniformly distributedvd =dose administered i.v./ plasma concentration volume of distribution is the theoretical volume that would be necessary to contain the total amount of an administered drug at the same concentration that it is observed in the blood plasma. Ref -KD Tripathi Pharmacology 7th edition (page no;17)

Vd=Dose administrated i.v./Plasma concentration

Vd=Maximum tolerated dose/Dose administered i.v.

Vd=Dose administered i.v./Total lipid solubility


Question: Most characteristic arrhythmia seen with Digoxin toxicity is

Atrial tachycardia (because of increase intracellular calcium levels) and AV nodal blockade (because of parasympathomimetic activity) is the most characteristic arrhythmia seen with Digoxin toxicity.
But Ventricular bigeminy is the most common arrythmia seen with Digoxin toxicity.


Question: A drug having narrow therapeutic range is

Therapeutic range is bounded by the dose which produces a minimal therapeutic effect and the dose which produces a maximal acceptable adverse effect.
Example of the narrow therapeutic range are lithium, Phenytoin.


Question: AIDS is a disease of the immune system primarily affecting


Question: For a 23 old pregnant female having severe sensitivity to amoxicillin, drug used to treat gonorrhoea in a single dose should be

(Ref: Katzung 10/e p719,762) Ceftriaxone is contraindicated in patients having severe allergy to penicillins. Tetracyclines are noty effectyive against gonorrhoea. Although ciprofloxacin is effective as a single dose treatment of gonorrhoea but it is contraindicated in pregnancy. Spectinomycin can be given as single dose treatment of PPNG.


Question: Heparin inhibits Xa by

Heparin contains pentasaccharide unit that activates Antithrombin III & inhibits factor Xa (Thus it is a indirect thrombin inhibitor).
Unfractionised heparin also contains a heteropolysaccharide unit that inhibits factor II a.
LMWH lacks this heteropolysacchoride unit and therefore inhibitors factor Xa only.

Blocking vitamin K mediated activation of Xa


Question: The best stimulator of Vasopressin includes

(D) Hypertonicity > Main stimulus for secretion of vasopressin is increased osmolality of plasma.> Reduced volume of extracellular fluid also has this effect, but is a less sensitive mechanism.> Serum osmolarity/osmolality is affected by vasopressin due to its role in keeping proper electrolytic balance in the blood stream.> mproper balance can lead to dehydration, alkalosis, acidosis or other life-threatening changes. The hormone ADH is partly responsible for this process by controlling the amount of water the body retains from the kidney when filtering the blood stream.# Vasopressin has three main effects:> Increasing the water permeability of distal convoluted tubule & collecting duct cells in the kidney, thus allowing water reabsorption & excretion of more concentrated urine, i.e., antidiuresis. This occurs through increased transcription and insertion of water channels (Aquaporin-2) into the apical membrane of distal convoluted tubule and collecting duct epithelial cells. Aquaporins allow water to move down their osmotic gradient and out of the nephron, increasing the amount of water re-absorbed from the filtrate (forming urine) back into the bloodstream. This effect is mediated by V2 receptors. Vasopressin also increases the concentration of calcium in the collecting duct cells, by episodic release from intracellular stores. Vasopressin, acting through cAMP, also increases transcription of the aquaporin-2 gene, thus increasing the total number of aquaporin-2 molecules in collecting duct cells.> Increasing permeability of the inner medullary portion of the collecting duct to urea by regulating the cell surface expression of urea transporters, which facilitates its reabsorption into the medullary interstitium as it travels down the concentration gradient created by removing water from the connecting tubule, cortical collecting duct, and outer medullary collecting duct.> Acute increase of sodium absorption across the ascending loop of Henle. This adds to the countercurrent multiplication which aids in proper water reabsorption later in the distal tubule and collecting duct.# Drug Stimulators of Vasopressin secretion: Vincristine, cyclophosphamide, tricyclic antidepressants, nicotine, epinephrine, and high doses of morphine. Lithium, which inhibits the renal effects of vasopressin, also enhances vasopressin secretion. Inhibitors of vasopressin secretion: Ethanol, phenytoin, low doses of morphine, glucocorticoids, fluphenazine, haloperidol, promethazine, oxilorphan, and butorphanol. Carbamazepine has a renal action to produce antidiuresis in patients with central diabetes insipidus but actually inhibits vasopressin secretion by a central action.


Question: Hydrochlorothiazide works by inhibiting

Thiazide diuretics: Inhibits Na-Cl- sympoer in early DCT acts on distal tubule Includes- chlorothiazide, indapamide Decreases Na+, K+, Mg2+, H+ Increases glucose, uric acid, lipid Increase in calcium - used in osteoporosis Name Site of action Example Mechanism Loop diuretics Thick ascending limb of Loop of Henle Furosemide, Torsemide Na-K-2Cl sympoer inhibition Carbonic anhydrase inhibitors PCT Acetazolamide, Dorzolamide, Brinzolamide Carbonic anhydrase inhibition Thiazides DCT Hydrochlorothiazide, Chlohalidone Na-Cl sympoer inhibition Osmotic diuretics Non-specific Mannitol By osmotic effect Epithelial sodium channel blockers Collecting duct Amiloride, Triamterene eNa channel blockade Aldosterone antagonists Collecting duct Spironolactone, Eplerenone Antagonism of aldosterone receptors

Na+ K+ 2CT pump in descending limb of loop of Henle

Na+K+2CT pump in ascending limb of loop of Henle


Question: The drug of choice for treatment of typhoid is


Question: Hand, foot mouth syndrome is caused by ~

Ans. is 'c' i.e., 5FU Hand foot syndromeo Hand foot syndrome is a form erythromyelalgia manifested as tingling, numbness, pain, erythma, swelling and increased pigmentation of hands and feet,o Two most common drugs causing 'Hand foot' syndrome are:Capecitabine (most common)5-FU (2nd most common)Drugs causing 'Hand foot' syndromeCommonly associated drugso Capecitabineo Surafenibo Cytarabino 5-FUo Doxorubicin (liposomo!)Rarely associated drugso Cisplatino Cyclophosphamideo Docetaxelo Daunorubicino Etoposideo Hydroxyureao Methotrexateo Mitotaneo 6-MPo Suramino Paclitaxel


Question: Zileuton is a

Zileuton is an orally active inhibitor of 5-lipoxygenase, and thus inhibits leukotrienes (LTB4, LTC4, LTD4, and LTE4) formation, used for the maintenance treatment of asthma. Ref: KD Tripathi 8th ed


Question: The most impoant factor governing absorption of a drug from intact skin is

Lipid solubility is an impoant factor governing the absorption through skinRef: KDT 6/e , pg 15

Nature of the base used in the formulation


Question: Svere myopathy commonly is a side effect of

ESSENTIALS of medical PHARMOCOLOGY SEVENTH EDITION KD TRIPATHI Page :636,637 Impoant statins are :lovastatin Simvastain, pravastatin, rosuvastatin etc Rosuvastatin This is the latest and the most potent statin (10 mg rosuvastatin :::::. 20 mg atorvastatin), with a plasma tlh. of 18-24 hours. Greater LDL-CH reduction can be obtained in severe hypercholesterolaemia; paly due to its longer persistence in the plasma. In patients with raised TG levels, rosuvastatin raises HDL-CH by 15--20% (greater rise than other statins). Dose: Sta with 5 mg OD, increase if needed upto 20 mg/ day, (max 40 mg/ day) ROSUV AS, ROSYN 5, 10, 20 mg tabs. Adverse effects All statins are remarkably well tolerated; overall incidence of side effects not differing from placebo. Notable side effects are: * Headache, nausea, bowel upset, rashes. * Sleep disturbances (probably more with lipophilic drugs). * Rise in serum transaminase can occur, but liver damage is rare. * Muscle tenderness and rise in CPK levels occurs infrequently. Myopathy is the only serious reaction, but is rare ( < 1 per 1000). Few fatalities due to rhabdomyolysis are on record. Myopathy is more common when nicotinic acid/ gemfibrozil or CYP3A4 inhibitor- ketoconazole I erythromycin/ cyclosporine I HIV protease inhibitor is given concurrently. Gemfibrozil inhibits the hepatic uptake of statins by the organic anion traspoer OATP2.it must not be given to pregnant ladies. Uesd in primary hyperlipipidemias.


Question: Spironolactone should not be given with

Sprinolanctone is a potassium sparing diurectic It doesn't excrete potassium - increasing potassium levels in the blood ACE IN. also increases potassium levels in the blood Hence the combination is contraindicated Ref: KD Tripathi 8th ed


Question: Sacubitril is a/an

(B) Neuro-endopeptidase inhibitor[?]Sacubitril is a pro-drug used in combination with valsartan to reduce the risk of cardiovascular events in patients with chronic heart failure (NYHA Class II-IV) and reduced ejection fraction.oIt acts by inhibiting neprilysin (neutral endopeptidase) which is responsible for the degradation of atrial and brain natriuretic peptide.oANP & BNP are released under atrial and ventricle stress, which activate downstream receptors leading to vasodilation, natriuresis and diuresis.oInhibition of neprilysin leads to reduced breakdown and increased concentration of endogenous natriuretic peptides in addition to increased levels of vasoconstricting hormones such as angiotensin II.oIt is given in combination with valsartan which is an aangitensin receptor blocker, resulting in a decrease in vascular resistance and blood pressure.oMost common adverse reactions (>=5%) are hypotension, hyperkalemia, cough, dizziness, & renal failure.oCardiovascular & renal effects of sacubitril is a result of the increased levels of peptides that are normally degraded by neprilysin. PHARMACOKINETICS OF SACUBITRIL* ClassAntiotensin-receptor nepilysin inhibitor* ForumulationSacubitril/valsatran-24/26mg,49/51mg,97/103mg tablets* RouteOral* Tmax0.5 hrs (Sacubitril); 2 hours (LBQ657)*; 1.5 hrs (Valsartan)* EliminationSacubitril (52-68% urine 37-48% feces; Valsartan (-13% urine; 86% feces)* Half-life1.4 hrs (sacubitril); 11.5 hrs (LBQ657)*; 9.9 hrs (valsartan)* Active metabolite of sacubitril.[?]VALSARTANois mainly used for treatment of high blood pressure, congestive heart failure, & to increase the chances of living longer after a heart attack. It is an angiotensin II receptor antagonistoSACUBITRILoSacubitril blocks the activity of an enzyme called neprilysin. When neprilysin is active, it breaks down helpful peptides Sacubitril inhibits nepnlysin so peptide levels can go up. These peptides help relax blood vessels & decrease sodium and fluid in the body.[?]ACE inhibitoroAn angiotensin-converting-enzyme inhibitor (ACE inhibitor) is used primarily for the treatment of hypertension (elevated blood pressure) and congestive heart failure.[?]Renin inhibitorsoRenin inhibitors are used primarily in treatment of essential hypertension (high blood pressure).oThese drugs inhibit the first and rate-limiting step of the renin-angiotensin-aldosterone system (RAAS), namely the conversion of angiotensinogen to angiotensin[?]Angiotensin receptor antagonist: Angiotensin II receptor blockers (ARBs) are medications that block the action of angiotensin II by preventing angiotensin II from binding to angiotensin II receptors on muscles surrounding blood vessels


Question: Crofelemer is a

Crofelemer blocks CFTR and chloride channels and is approved for relieving symptoms of diarrhoea is AIDS patients on antiretroviral therapy.


Question: Therapeutic drug monitoring is done for;

Therapeutic drug monitoring is adjustment of dose of the drug according to its plasma concentration. It is required for A Aminoglycosides (e.g. gentamicin) Drug Digitalis Possessing Phenytoin (anti-epileptics) Low Lithium Therapeutic Tricyclic antidepressants Index Immunomodulators (e.g. cyclosporine) Criteria for doing TDM Low therapeutic index When therapeutic response cannot be easily measured Inconsistent pharmacokinetics of the drug.


Question: An anesthetic agent with boiling temperature more than 75 C is

Refer Anesthesiology by Longnecker 2008/777 Boiling point of methoxyflurane is 104,7 degree Celsius whereas other flurrinated anesthetics have boiling point between 50 C and 60 C


Question: Voriconazole is not effective against

Mucormycosis Voriconazole Voriconazole is recent systemic antifungal agent belonging to the azole chemical .family. It is a broad spectrum azole that has been approved for t/t by F.D.A. in 2002. As with other triazoles voriconazole impairs the biosynthesis of ergosterols by inhibiting the p450 enzyme 14a sterol demethylase. Voriconazole is administered by i.v. and oral routes. It is formulated as lyophilized powder ,for solution for i.v. infusion as well as tablets and powder for suspension for oral administration. Uses of Voriconazole Varoconazole is a broad spectrum azole. It can be used in all diseases where azoles are effective. It is especially used for ? Invasive aspergillosisQ In patients with invasive aspergillosis, initial therapy with voriconazole led to better responses and improved survival and resulted in.fewer side effects than the standard approach of initial therapy with amphotericin B. Emerging fungal pathogensQ Voriconazole is used in the primary treatment of amphotericin B and fluconazole resistant fungal infections e.g., Fusarium, Scendosporium. Patients with neutropenia and feverQ Pts with neutropenia and fever are often treated empirically with AMB or liposomal AMB to prevent invasive fungal infections. Voriconazole is a suitable alternative to AMB preparation for empirical antifungal therapy in patients with neutropenia and persistent fever. Those with Fluconazole resistant candida infection Voriconazole is a broad spectrum antifungal showing in vitro activity against candida species uncluding fluconazole resistant candida albicans2 and candida krusei2. Some impoant adverse effect of Voriconazole : ? Teratogenecity - Voriconazole is teratogenic in animals and contraindicated in pregnancy (class 0) QTc prolongation and arrhythmias - Voriconazole like some other azoles causes a prolongation of the QTc intervals which can become significant in patient with other risk factors for Torsades-de-points.


Question: Potassium iodide is useful in the treatment of

Cutaneous and lymphocutaneous sporotrichosis have historically been treated with saturated solution of potassium iodide (SSKI). Although relatively inexpensive, SSKI is poorly tolerated by many patients because of frequent adverse effects. The orally available azole antifungals are the drugs of choice for cutaneous or lymphocutaneous sporotrichosis in developed nations. Ketoconazole has been used but is less effective than itraconazole or fluconazole; thus, ketoconazole is no longer indicated. Fluconazole is less effective than itraconazole. Itraconazole is the drug of choice for all types of sporotrichosis but CNS and disseminated sporotrichosis.Terbinafine has been demonstrated to be effective in the treatment of lymphocutaneous sporotrichosis, but no comparative data with itraconazole therapy exist. REFERANCE:emedicine.medscape.com


Question: Muscle relaxant of choice in liver disease is

Refer Katzung 11/e p456 Atracurium and cis-Atracurium are degraded spontaneously by Hoffman's elimination These don't require liver or kidney for elimination and thus are muscle relaxant of choice in a patient with renal and hepatic dysfunction


Question: Use of tiotropium is contraindicated in

Refer katzung 10e 117,kdt 6/e 113 Ipratropium and tiotropium are anti muscarinic drugs used for the treatment of bronchial asthma and COPD by inhalational route Anti muscarinic drugs are contraindicated in patients with Glaucoma especially angle closure glaucoma History of BPH


Question: Calicitonin causes hypocalcemia by

Refer KDT 6/e p 330 Calcitonin inhibits bone resorption by direct action on osteoclasts Calcitonin recetpors are present on osteoclasts It also inhibits proximal tubular calcium and and phosphate reabsorption by direct action on kidney However hypocalcemia which occurs overrides the direct action by decreasing the total Ca2+ filtered at the Glomerulus

Decreasing renal tubular reabsorption of calcium


Question: Systemic vascular resistance is twice that of normal, treatment should be

Increase in systemic vascular resistance means vasoconstriction, this is a vasodilator drugs like nitroprusside is given. Adrenaline and noradrenaline act as vasopressors whereas isoprenaline increases systolic blood pressure by acting on hea Refer kDT 7/e p567


Question: Racemic mixture of two enantiomers with different pharmacokinetic pharmacodynamic propeies is seen in

Refer Goodman and Gilman 11e p836 Verapamil is present as a racemic mixture of R and S verapamil. S verapamil has more stronger negative dromotropic action and higher first pass metabolism than R verapamil


Question: Muscle relaxant of choice in renal and hepatic failure Is

Cis-Atracurium is an isomer of Atracurium. It undergoes inactivation in plasma by spontaneous non enzymatic degradation(Hoffman elimination) in addition to that by cholinesterases. Consequently it's duration of action is not altered in patients with hepatic or renal insufficiency.. All the other given drugs don't undergo Hoffman elimination. From KD Tripati 7th edition Page no 253


Question: A 2 years old child without fever develops bone pain, vomiting, and features of increased intracranial pressure following excessive meditation. The drug most likely to be responsible for this is;

Vitamin A is stored in the liver, deficiency symptoms appear only after long-term deprivation, but vit A deficiency is quite prevalent, especially among infants and children in developing countries. Manifestations are • Xerosis (dryness) of the eye, 'Bitot's spots', keratomalacia (softening of the cornea), corneal opacities, night blindness (nyctalopia) progressing to total blindness. • Dry and rough skin with papules (Phrynoderma), hyperkeratinization, atrophy of sweat glands. • Keratinization of bronchopulmonary epithelium increased susceptibility to infection. • Unhealthy gastrointestinal mucosa, diarrhoea. • Increased tendency to urinary stone formation due to the shedding of ureteric epithelial lining which acts as a nidus. • Sterility due to faulty spermatogenesis, etc


Question: Anaesthetic agent causing pain on intravenous administration

Refer Katzung 12th/431 Propofol is highly lipid soluble It's solution is made in oil(oliy liquid employed as 1 percnt emulsion) Thus it is painful on injection


Question: Wof agent is used to prevent hemorrhagic cystitis caused by cyclophosphamide and ifosfamide

To prevent hemorrhagic cystitis mesna is routinely given with the drugs. Mesna is a -SH compound that is excreted in urine--binds and inactivates the vasicotoxic metabolites(Acrolein) of ifosfamide and cyclophosphamide. Ref:- kd tripathi; pg num:-860