Question: Ivabradine is indicated in the management of

Ivabradine This 'pure' hea rate lowering antianginal drug has been introduced recently. mech of action:- The only significant action of ivabradine is blockade of cardiac pacemaker (sino-atrial) cell 'f' channels, which are 'funny' cation channels that open during early pa of slow diastolic (phase 4) depolarization. The resulting inward current (If) determines the slope of phase 4 depolarization. Selective blockade of If current by ivabradine results in hea rate reduction without any other electrophysiological or negative inotropic or negative lucitropic (slowing of myocardial relaxation) effect. Hea rate reduction decreases cardiac O2 demand and prolongation of diastole tends to improve myocardial perfusion (O2 supply). Accordingly, in clinical trials, ivabradine has been found to improve exercise tolerance in stable angina and reduce angina frequency. Indications:- Used in chronic stable angina in patients with sinus rhythm. Ref:- kd tripathi;pg num:-554


Question: The most impoant channel of elimination of digoxin is

PHARMACOKINETICS Presence of food in stomach delays absorption of digoxin. The volume of distribution of digoxin is large. It is concentrated in the hea, skeletal muscle, liver and kidney. Digoxin is primarily excreted unchanged by the kidney: mainly by glomerular filtration; rate of excretion is altered parallel to creatinine clearance. Its t 1/2 is prolonged in elderly patients and in those with renal insufficiency: dose has to be reduced. Ref:- kd tripathi; pg num:-515,516


Question: Apixaban is a new drug that acts by

Rivaroxaban and Apixaban are newer oral anticoagulants that act by inhibiting factor Xa. Newer oral anticoagulants that are currently being asked in the exams are: Direct thrombin inhibitor- Dabigatran Direct factor Xa inhibitors Apixaban Rivaroxaban Edoxaban Betrixaban


Question: Recently used topical NSAID for ophthalmic use

Nepafenac is the newly launched Topical NSAID for ophthalmic use. Nepafenac is an NSAID, usually sold as an eye drop(0.1% solution). It is used to treat pain and inflammation associated with cataract surgery. It is used in the management of cystoids macular edema because of its good penetration into the posterior segment.


Question: Drug of choice for drug induced Parkinsonism is

Condition Drug DOC for Parkinsonism Pramipexole/Ropinirole DOC for Drug induced Parkinsonism Benzhexol (Trihexiphenidyl) Most effective drug for Parkinsonism Levo-dopa + Carbidopa Gold standard drug for Parkinsonism Levo-dopa + Carbidopa Disease modifying drug in Parkinsonism Selegiline


Question: The site of action of vasopressin antagonist in kidney

V2 receptors are located on medullary collecting ducts. drugs acting on V2 receptor antagonists are vaptans like convivaptan and tolvaptan Ref: Goodman Gillman 12th ed pg 707


Question: The mechanism of action of haloperidol is the blockage of

(C) Dopamine receptor # Haloperidol, Trifluperidol, Droperidol, Penfluridol are Butyrophenones and act as antipsychotic drugs.> All antipsychotic (except clozapine like) have potent dopamine D2 receptor blocking action.> So, it is clear that Haloperidol act by blocking dopamine receptor.> Uses of haloperidol are in acute schizophrenia, Huntington's disease.> Clozapine has significant 5-HT2 and at blocking action.> Dopaminergic blockade in basal ganglia cause extrapyramidal sign while that in CTZ is responsible for antiemel action.


Question: Drug of choice for Huntington's chorea is

Huntigton's chorea is characterized by dopaminergic overactivity and Tetrabenazine is a dopamine depleter which is the drug of choice for this condition.


Question: Fluoroquinolone with highest oral bioavailability

Fluoroquinolones:- * Gemifloxacin is a third generation fluoroquinolone having absolute oral bioavailability. * All third generation fluoroquinolones: Sparfloxacin, Gatifloxacin and Gemifloxacin have 100% oral biovailability. * Among the Fluoroquinolones, Norfloxacin has the least oral bioavailability. Ref:- HL & KK Sharma's Principles of Pharmacology 3rd Ed; Pg Num:- 724


Question: Most common Cytochrome P450 involved in drug metabolism is

Cytochrome P-450 (CYP) isoenzymes are grouped into families designated by numerals (1, 2, 3....; each having several sub-families designated by capita: letters (A, B, C. .... ), while individual isoenzymes are again allocated numerals (1, 2, 3 .... ). In human beings, only a few, members of three isoenzyme families (CYP 1, 2 and 3 carry out the metabolism of most of the drugs, The CYP isoenzyme: CYP3A4/5 Carryout biotransformation of largest number: (nearly 50%) of drugs. 20-30% of metabolism is done by the next common cyp2d6 In addition to liver, these isoforms are expressed in the intestine (responsible for the first-pass metabolism at this site) and kidney as well. Ref: KD Tripathi pharmacology 7th edition (page.no: 24)


Question: The mydriatic drug with sho duration of action is

Tropicamide, is a medication used to dilate the pupil and help with examination of the eye. Specifically it is used to help examine the back of the eye. It is applied as eye drops. Effects occur within 40 minutes and last for up to a day.


Question: Vigabatrine is drug of choice for

Ans. is'c'i.e., Infantile spasmRef: Harrison 18n/e p. 3262, 3266Vigabatrin is DOC for infantile spasm.


Question: Route of choice for analgesics in cancer patients


Question: Antagonist of Benzodiazepine is

Ans. is 'd' i.e., Flumazenil Flumazenil is a benzodiazepine analogue which competes with BZD agonists as well as acts as inverse agonists for the BZD receptor and reverses their depressant or stimulant effects respectively.


Question: Drug responsible for the below condition

Thalidomide given to pregnant lady can lead to hypoplasia of limbs called as "Phocomelia".


Question: The major limitation in the use of clozapine for treatment of schizophrenia is

Clozapine:- It is the first atypical anti- psychotic. It has only weak D2 blocking action, produces few/no extrapyramidal symptoms; tardive dyskinesia is rare and prolactin level does not rise. Both positive and negative symptoms of schizophrenia are improved and clozapine is the most effective drug in refractory schizophrenia, i.e. patients not responding to typical neuroleptics may respond to it. Pharmacokinetics:- Clozapine is metabolized by CYP1A2, CYP2C19 & CYP3A4 into active and inactive metabolites with an average t 1/2 of 12 hours. Adverse effects:- It's major limitation is higher incidence of agranulocytosis (0.8%) and other blood dyscrasias: weekly monitoring of leucocyte count is required. Metabolic complication like weight gain, hyperlipidemia and precipitation of diabetes is another major limilation. Ref:- kd tripathi; pg num:-441

High incidence of extrapyramidal side effects

Its inability to benefit negative symptoms of schizophrenia


Question: Metastatic calcification is most commonly seen in (NOTRELATED)


Question: In Aspirin mechanism of action

(B) Cyclooxygenase decreased # Aspirin acts by inhibiting cyclooxygenase enzyme, thereby inhibiting prostaglandin synthesis.> Leukotriens acts by inhibiting Lipooxygenase> Steroids acts by inhibiting phospholipase


Question: Drug contraindicated in hyperiglyceridemia

Bile acid binding resins like cholestyramine causes increase in triglycerides and are thus contraindicated in patients with hyperiglyceridemia due to risk of development of pancreatitis. Statins - decrease LDL and increase HDL Niacin - decrease LDL and triglyceride, maximum increase in HDL Fibrates - decrease triglyceride, decrease LDL.


Question: The drug of choice for hypehyroidism in third trimester of pregnancy is;

HYPEHYROIDISM IN PREGNANCY DOC for hypehyroidism in pregnancy is Propylthiouracil. DOC for hypehyroidism in first trimester of pregnancy is Propylthiouracil. DOC for hypehyroidism in 2nd and 3rd trimester of pregnancy is Carbimazole.


Question: An Anti epileptic drug, but NOT a mood stabalizer includes

(D) Leviracetam# VALPROIC ACID: Available in extended release form. This drug can be very irritating to the stomach, especially when taken as valproic acid. Liver function and CBC should be monitored.> Lamotrigine: Particularly effective for bipolar depression. Usual dose is 100-200 mg daily, which can be built up by 25 mg every 2 weeks. The patient should be monitored for signs and symptoms of Stevens-Johnson syndrome, a very rare but potentially fatal skin condition.> Carbamazepine: CBC should be monitored, as carbamazepine can lower white blood cell count. Therapeutic drug monitoring is required. Carbamazepine was approved by the US Food and Drug Administration as a bipolar disorder treatment in 2005, but had been widely used previously.> Oxcarbazepine: Oxcarbazepine is not FDA approved for bipolar disorder. Still, it appears to be effective in about one-half of patients with bipolar disorder and be well tolerated.> Other anticonvulsants, such as gabapentin and topiramate, also are mood stabilizers.


Question: Digitalis acts in atrial fibrillation by

Ans. is 'a' i.e., Increase in A.V. node refractoriness Digitalis in arrhythma Digitalis is the drug of choice for controlling ventricular rate in atrial fibrillation (AF) with hea failure. Digitalis reduces the ventricular rate in AF by decreasing the number of impulses that are able to pass down the A-V node and bundle of His. It increases effective refractory period-ERP refractoriness) of A-V node by direct, vagomimetic and antiadrenergic action - the minimum interval between consecutive impulses that can successfully traverse the conducting tissue is increased. A degree of A-V block is naturally established in AF. Because of the relatively long ERP of A-V node, many atrial impulses impinge on it while it is still refractory; others falling early in the relative refractory period get extinguished by decremental conduction - These concealed impulses leave upper margin of A-V node refractory for a fuher period. Thus, any influence which increases atrial rate in AF (e.g. digitalis), by itself reduces ventricular rate.


Question: Drug of choice for NSAID induced peptic ulcer disease is

Misoprostol is the most specific drug for NSAIDS induced peptic ulcer but it is not the drug of choice for any ulcer. DOC for all types of peptic ulcer including NSAIDs induced peptic ulcer are proton pump inhibitors.


Question: Beta blocker with intrinsic sympathomimetic activity is

Beta blockers with intrinsic sympathomimetic activity are acebutolol, celiprolol, pindolol etc Ref: KD tripathi 8th ed.


Question: Mechanism of action of benzodiazepine is

Ans. is 'a' i.e., GABAA - BZD - Cl- channel stimulator Mechanism of action of benzodiazepines (BZDs)* Muscle relaxation is produced by action on medulla.* Ataxia is due to action on cerebellum.* BZDs acts on GABAA receptors.* GABAa receptor has 5 subunits a / b, b, a / g.* GABA binding site is on b. subunit, while BZDs binding site is on a / g subunit.* BZDs receptor increase the conductance of Cl channel.* BZDs do not themselves increase Cl conductance, i.e. they have only GABA facilitatory but no GABA mimetic action. (Barbiturates have both GABA facilitatory and GABA mimetic actions).Effect on CNS* In contrast to barbiturates, BZDs are not general depressant, but exert relatively selective anxiolytic, hypnotic, muscle relaxant and anticonvulsant effects.* The antianxiety action of BZDs is not dependent on their sedative property - with chronic administration relief of anxiety is maintained, but drowsiness wanes off due to development of tolerance.* Stage 2 sleep is increased, while REM, Stage 3 & 4 sleep are decreased.* Nitrazepam is the only benzodiazepine, which increases REM sleep.* Clonazepan and diazepam have more marked muscle relaxant property.* Clonazepam, diazepam, nitrazepam and flurazepam have more prominent anticonvulsant activity than other BZDs.* Diazepam (but not other BZDs) has analgesic action.* Diazepam produces short lasting coronary dilatation on i.v. injection.* Diazepam decreases nocturnal gastric secretion and prevents stress ulcers.


Question: Drug used in mild hemoplilia is

DDAVP is an analogue of ADH. It acts on V2 receptors to cause increased release of factor VIII and vWF from the endothelium. Due to this propey, it can be used for the treatment of mild hemophilia.


Question: Carbachol acts as

M2 agonist: MethacholineM3 agonists: Carbachol, bethanecholRef: Katzung 12th Ed.Pg 100


Question: Toxicity of Oral Xa inhibitors are treated by

Andexanite alfa is a Xa factor analogue used to treat poisoning of Oral Xa inhibitors like Epixaban, Rivaroxaban.


Question: Drug of choice for Polycystic ovarian disease is

Refer CMDT 2014/744 Oral contraceptives are used for the treatment of mennstrul irregularity These are the drug of choice for PCOD PCOD is also known as Stein-Levanthal syndrome. Weight loss by regular exercise low glycemic index diet combined with insulin lowering drugs like metformin can restore feility in 85 percnt of females For females who don't respond to weight loss, metformin therapy may be helpful

Estrogen and progesterone combination pill


Question: Anticancer macrolide is

Tacrolimus, sirolimus, everolimus are macrocyclic lactones or macrolides.Ref: KK Sharma 2nd ed. Pg: 885


Question: Drugs within the following groups react unourably with lithium

Causes worsening of lithium toxicity and renal damage


Question: Mechanism of action of the sulfonylureas is

Ans. is 'a' i.e., K ATP channel blocker * Sulfonylurease provoke a brisk release of insulin from pancreas. They act on the so called "Sulfonylurea receptors" (SUR1) on pancreatic b-cell membrane - cause depolarization by reducing conductance of ATP sensitive K+ channels. This enhances influx of Ca+2 - degranulation. They do not cause hypoglycemia in pancreatectomized animals and type 1 diabetes (Presence of at least 30% of functional b-cells in essential for their action). A minor action reducing glucagon secretion by increasing insulin and somatostatin release has been demonstrated.


Question: Combination of ampicillin and gentamicin is an example of


Question: Least narcotic

Papaverine The term narcotic was derived from the Greek word "stupor". At one time, the term referred to any drug that induced sleep, but then it became associated with "opioids". Now it is often used in legal context to refer to a variety of substances with abuse or addictive potential. Least potent narcotic does not mean opioid with least analgesic activity. - It means substance which has least addictive or abuse potential. "Papaverine is an alkaloid originally extracted from opium but devoid of narcotic propeies". - It is present in opium but is structurally unrelated to morphine. - It is a nonspecific phosphodiesterase inhibitor and its principal action is to relax smooth muscles throughout the body. It is occasionally injected into an area where local vasodilation is desired especially into and around aeries and veins to relieve spasm during vascular surgery and when setting up intravenous infusions. It is also used to treat male erectile dysfunction - It is self injected in corpora cavernosa sholy before intercourse.


Question: A young man is with known heroin addiction is brought in the emergency in unconscious state. On examination, the patient has decreased bowel sounds, depressed respiration and pin point pupil. The treatment of choice for this patient is

IV Naloxone 0.1-0.4 mg . Dose repeated every 1-2 hour as naloxone is sho acting. As patient is unconscious drug cannot be given orally. Ref: KD Tripathi 8th ed.


Question: Respiratory depression is seen with


Question: Receptors for thyroid hormones are


Question: Indomethacin reduce the diuretic action of furosemide by

NSAIDS inhibit specifically PGE2, PGI2 synthesis in renal tubules effecting the hemodynamic changes done by Prostaglandins for water, sodium reabsorption Ref: katzung 12th ed, Autocoids.

Preventing prostaglandin mediated heamodynamic actions

Blockade of furosemide action in loop of henle

Enhancing water reabsorption in distal tubule


Question: Peripheral neuritis is a complication of


Question: Terlipressin is preferred over vasopressine for esophageal varices because of

Ans. is'c'i.e., Iess side effects Terlipresin is preferred over vasopressin because : -Fewer adverse effectsGreater convenience in use


Question: Drug not useful in hypeensive emergency is

Refer kDT 6/e p554 Indapamide is thiazide like diuretics, having mild diuretic effect, not used in emergency situation Indapamide is a thiazide-like diuretic drug generally used in the treatment of hypeension, as well as decompensated hea failure. Combination preparations with perindopril


Question: Perampanel is

Perampanel is recently approved selective non-competitive antagonist of AMPA receptorwhich is used as add on therapy for paial seizure. Adverse effect of this drug is somnolence, weight gain Felbamate is NMDA inhibitor Barbiturates are GABA mimetic Ethosuximide , valproate inhibit the calcium channels.


Question: Digoxin is contraindicated in(REPEAT)

non selective beta blockers(propanolol)are the Agents of choice for hyperophic obstructive cardiomyopathy in hyperophic obstructive cardiomyopathy, the left ventricular outflow tract is narrowed during systole due to hyperophic septum.. obstraction is worsened by Factors increasing myocardial contractility-digitalis,sympathetic stimulation factors decreasing left ventricular filling-valsalva maneuver,peripheral vasodilators Refer kDT 6/e p143


Question:
An aminoglycoside that is often combined with
polymyxin and bacitracin for the treatment of
topical infection is


Question: Idiosyncracy is known as to have


Question: Drug of choice for syphilis during pregnancy is

Ans. c (Benzathine penicillin). (Ref. KD Tripathi - 4th/ 741, 751; William's Obstetrics - 780)# Penicillin is DOC during pregnancy as it also protects the newborn from developing syphilis.# If patient is allergic to penicillin, desensitize the patient & give penicillin (not erythromycin).DOC for syphilisPenicillinAlternative to penicillinErythromycinDuring pregnancyDOC (even if patient is allergic to penicillin) is Penicillin. (Because erythromycin never protect baby from developing syphilis)


Question: Neuro adaptation to drug is same as


Question: Wof is the most likely explanation for multiple drug resistance to antibiotics that spreads from one type of bacteria to another

Gene transfer (infectious resistance) The resistance causing gene is passed from one organism to the other; is called horizontal transfer of resistance. Rapid spread of resistance can occur by this mechanism and high level resistance to several antibiotics (multidrug resistance) can be acquired concurrently. Ref :- kd tripathi; pg num:-692


Question: Mechanism of action of sodium nitrite in cyanide poisoning

Cyanide poisoning:- Nitrates generate methaemoglobin which has high affinity for cyanide radical and forms cyanomethaemoglobin. However, this may again dissociate to release cyanide. Therefore, sodium thiosulfate is given to form Sod. thiocyanate which is poorly dissociable and is excreted in urine. Cytochrome and other oxidative enzymes are thus protected from cyanide. Ref:- kd tripathi; pg num:-545


Question: Use of anticoagulant is

Ans. is'a'i.e., Venous thrombosisRef : Katzung /e p. 599; l$hle p. 554Prophylaxis for venous thrombus:Heparin (unfractionated, LMW, or fondaparinux) and oral anticoagulants (warfarin).


Question: Doc for Gille de la tourette's syndrome

Haloperidol:- It is a potent antipsychotic with strong D2 receptor blocking activity. it produces few autonomic effects, is less epileptogenic, does not cause weight gain, jaundice is rare. Uses-- It is the preferred drug for acute schizophrenia, Huntington's disease and Gilles de la Tourette's syndrome. Pharmacokinetics It is metabolised by CYP3A4 and 2D6 both. Elimination t 1/2 averages 24 hours. Ref:- kd tripathi; pg num:-441


Question: MOA of oral hypoglycemic agent

Ans. (b) Enhance glucose uptake by skeletal muscleRef.: KDT 6th ed. / 267OHA DrugsMechanism of actionMetformin and thiazolidinedi- ones* Inhibition of hepatic gluconeogenesis* Enhance glucose uptake in skeletal muscleSulfonylureas and ripaglindeStimulate insulin release from pancreasAcarboseDecrease absorption of glucose from intestine

Inhibit glucose uptake by skeletal muscle


Question: Alemtuzumab is antibody against


Question: Emesis receptor is

ANSWER: (C) 5HT3REF: Goodman Gillman manual of pharmacology and therapeutics 2008 edition, page 646Iheprocessofnauseaandvomiting appears to be coordinated by a central emesis center in the lateral reticular formation of the mid-brainstem adjacent to both the chemoreceptor trigger zone (CTZ) in the area postrema (AP) at the bottom of the fourth ventricle and the solitary tract nucleus (STN) of the vagus nerve.The lack of a blood-brain barrier allows the CTZ to monitor blood and cerebrospinal fluid constantly for toxic substances and to relay information to the emesis center to trigger nausea and vomitingThe CTZ has high concentrations of receptors for serotonin (5-HT3), dopamine (D2), and opioids, while the STN is rich in receptors for enkephalin, histamine, and ACh, and also contains 5-HT3 receptors.The most effective agents for chemotherapy-induced nausea and vomiting are the 5-HT3 antagonists and metoclopramidePharmacological view of emetic stimuli


Question: Large bilateral painless effusions of the knees occurring in late congenital syphilis in patients between ages 8 to 18 are designated as


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

Refer Katzung 10/e p 546 Unlike unfranctioned heparin, LMW heparins have more consistent SC bioavalilabilty and thus do not require monitoring Adverse effects of both type of heparins are similar Both are contraindicated in heparin induced thrombocytopenia

Are absorbed more uniformly when given subcutaneously

Require more frequent laboratory monitoring

Can be given to patients with heparin induced thrombocytopenia


Question: Mechanism of action of paxclitaxel is

Refer Katzung 10th/893 Refer KDT 6/e p825 Taxanes act by increasing the polymerization of beta tubulin whereas vinca alkaloid cause inhibition of tubulin polymerization. Both of these drugs act by causing the disruption of mitosis and are active in M phase of cell cycle


Question: Antibiotic that achieves high concentration in Hard tissue, because of its molecular size is


Question: Drug used for drug induced parkinsonism

Sodium valproate, used to treat epilepsy, and lithium, used in depression, both commonly cause tremor which may be mistaken for Parkinson's. Some repos have linked SSRI antidepressant drugs such as fluoxetine (Prozac) to drug-induced parkinsonism but hard evidence of causeand effect is unsubstantiated. Ref: KD T ripathi 8th ed.


Question: Coronary vasodilatation is caused by

Refer kDT 7/e p536 It serves as a metabolic coupler between oxygen consumption andcoronary blood flow. ... Parasympathetic stimulation of the hea (i.e., vagal nerve activation) elicits modest coronary vasodilation(due to the direct effects of released acetylcholine on the coronaries). In some types of blood vessels, there is evidence that adenosine producesvasodilation through increases in cGMP, which leads to inhibition of calcium entry into the cells as well as opening of potassium channels. Incardiac tissue, adenosine binds to type 1 (A1) receptors, which are coupled to Gi-proteins.


Question: Drug of choice for prevention of NSAID induced peptic ulcer disease is

Ans. is 'b' i.e., Proton pump inhibitors * PPI are the DOC for peptic ulcer (gastric or duodenal), GERD, ZE syndrome, prevention of aspiratory pneumonia and NSAID induced gastric / duodenal ulcers. Note - PGE1 analogue (Misoprostol) is specific drug for prevention and treatment of NSAID induced ulcer, but DOC is PPL


Question: Latanoprost (PGF0 alf

ANSWER: (D) GlaucomaREF: Goodman and Gillmans 11TH edition page 1103, http://en.udkipedia.org/wiki/Latanoprost "Latanoprost ophthalmic solution is a topical medication used for controlling the progression of glaucoma or ocular hypertension by reducing intraocular pressure. It is a prostaglandin analogue (more specifically an analogue of Prostaglandin F2a)""The PGF2a analogs consist of Latanoprost, travoprost, bimatoprost, and unoprostone. PGF2a analogs appear to lower IOP by facilitating aqueous outflow" through the accessory uveoscleral outflow pathway. The mechanism by which this occurs is unclear"


Question: Histamine release is one of the common features with administration of

histamine is released by atracurium , all skeletal musle relaxants release histamine other drugs releasing histamine are morphine,vancomycin etc. Ref: kd tRipathi 8th ed.


Question: Wof is an immunosuppressant that acts by inhibiting mTOR and is non nephrotoxic

mTOR INHIBITORS Sirolimus This new and potent immunosup-pressant is a macrolide antibiotic (like tacrolimus), which was earlier named Rapamycin. Mech of action:- It binds to immunophillin FKBP and the sirolimus-FKBP complex inhibits kinase called 'mammalian target of rapamycin' (mTOR). uses:- 1)For prophylaxis and therapy of graft rejection reaction, sirolimus can be used alone, but is generally combined with lower dose of cyclosporine/tacrolimus and/or coicosteroids and mycophenolate mofetil. It is paicularly suitable for patients developing renal toxicity with cyclosporine.( Sirolimus is non nephrotoxic). 2)sirolimus coated stents are being used to reduce the incidence of coronary aery restenosis, by inhibiting endothelial proliferation at the site. Adverse effects:- Significantly, sirolimus is not nephrotoxic, but it can suppress bone marrow, mainly causing thrombocytopenia. Rise in serum lipids is common. Other adverse effects are diarrhoea, liver damage and pneumonitis. Ref:- kd tripathi; pg num:-882


Question: Physiological antagonism is found in

ref ; KD Tripathi pharmacology 7th edition (page no; 58) Physiological/functional antagonism; The two drugs act on different receptors or by different mechanisms but have opposite ove effects on the same physiological function, i. e . have pharmacological effects in the opposite direction, e.g.Histamine and adrenaline on bronchial muscles and BP Hydrochlorothiazide and triamterene on urinary k+ excretion Glucagon and insulin on blood sugar level. Ref: KD Tripathi 8th ed


Question: Drug of choice for treatment of chloroquine resistant falciparum Malaria is

Among the given options quinine is the best answer. DOC for uncomplicated chloroquine resistant P. Falciparum Malaria Is ACT


Question: Drug of choice for hypeension with hyperlipidemia is

Thiazide diuretics and beta blockers produce unourable lipid profile.Hence prazosin which is an alpha blocker is prefered as it has no effect on lipid profile. Ref: KD Tripathi 8th ed.


Question: Post dural (spinal) puncture headache is due to

(Seepage of CSF) (517 - Lee's 13th) (360-KDT 6th)* Post spinal headache is due to seepage of CSF: can be minimised by using smaller bore needle (KDT)* Typical location is bifrontal and / or occipital* It is more common in Young pregnant patients and with accidental dural puncture rate during epidural anaesthesia using Touhyneedle (60 - 80%) Reduced by introduction of size 25 G and 27 - G whitacre pencil point needles. Which replaced cutting needles* Paralysis of cranial nerve. All cranial nerves except 1st, 9, 10th can be involved after spinal Anaesthesia. Most commonly (90%) 6th nerve is involved (Because of the longest course of 6th nerve)


Question: Linaclotide is a

Linaclotide is a Guanylate cyclase - C agonist that increases levels of cGMP and stimulates secretion of chloride & bicarbonate ions into the intestinal lumen. It is used in treatment of IBS with constipation.


Question: An antibiotic not acting on tubulin is

ANSWER: (A) BleomycinREF: Goodman Gillman manual of pharmacology and therapeutics 2008 edition various pages, h ttp://e n. wikipe dia. org/wiki/ Spindle_poisonMitotic spindle poisons:These poisons disrupt cellular reproduction by affecting the protein threads which connect the centromere regions of chromosomes, known as spindles (tubulin).MebendazoleColchicineGriesofulvinVinca Alkaloids (vincristine, vinblastine)Paclitaxel (Taxans)


Question: Antiarrhythmic drugs not causing torsade De points are

Refer kDT 6/e 510 Torsedes de points is seen with potassium channel blocker (class 1 and class 3 antiarrhythmic drugs) Eg: beryllium, ibutilide,disopyramide, quinidine, procainamide


Question: Drug of choice for essential tremors

Ref: HL Sharma 3rd ed pg no:189 Nonselective beta blockers are used for essential tremors they occur due to contraction of skeletal muscles (beta 2 receptors) cardioselective beta blockers are not useful


Question: Inhalational form of Insulin is

Afrezza is the inhalational form of insulin used to treat post prandial hyperglycemia.


Question: Alkaline diuresis is done for treatment of poisoning due to

Alkaline diuresis is useful for poisoning of acidic drugs as acidic drugs ionize in alkaline medium ionized drugs will get eliminated easily eg for acidic drugs- Barbiturates, benzodiazepines, tetracyclines, penicillins, sulphonamides, etc Ref: KD Tripathi pharmacology 7th edition (page.no: 81)


Question: Dobutamine is preferred over Dopamine in cardiogenic shock because of its effects related to

Dobutamine is a catecholamine with b-1 and b-2 adrenergic agonist propeies which help improve myocardial contractility. In patients with cardiogenic shock due to decompensated hea failure,dobutamine decreases left ventricular end-diastolic pressure and raises blood pressure by increasing cardiac output. Refer kDT 7/e p 134


Question: Bevacizumab is used in

Bevacizumab is an anti-VEGF monoclonal antibody used in renal cell carcinoma.Ref: Goodman Gillman 12th ed; Pg 1739


Question: The drugs increasing trabecular outflow in glaucoma is

Miotics like pilocarpine increase trabecular outflow in glaucoma Beta blockers and CA inhibitors decrease aqueous production PG analogues increase UV outflow Ref: KDT 6th ed pg 145


Question: Drug commonly used in the treatment of iridocyclitis is

Atropine is used in iridocyclitis to break adhesions in the uveal tract Ref: KDT 6th ed pg 116


Question: Drug H is most like

The effects of Drug H are changed by treatment with either an alpha or beta blocker, so Drug H must have activity at both receptors (choices B, D, and E are ruled out). "Reversal" of a pressor effect can only occur if the drug has beta2 activity (choice C is ruled out). Drug H is epinephrine.


Question: Safest treatment for hyperthyroidism in pregnant women is

Ans. d (Propylthiouracil). (Ref. Harrison, Internal Medicine, 18th ed.,/Chapter 40., KD Tripath 5th/232)Propylthiouracil:# During pregnancy thyroidectomy and I131 are contraindicated. With anti-thyroid drugs risk of foetal hypothyroidism and goiter are there.# However, low doses of propylthiouracil are preferred as it has greater protein binding, allowing less transfer to foetus. For the same reason it is preferred in nursing mothers also.HYPERTHYROIDISM IN PREGNANCYHyperthyroidism in pregnancy should be aggressively evaluated and treated. It is most commonly caused by Graves disease, but autonomously functioning nodules, gestational trophoblastic disease, thyroiditis, and hyperemesis gravidarum should also be considered. Methimazole crosses the placenta to a greater degree than propylthiouracil and has been associated with fetal aplasia cutis. However, propylthiouracil can be associated with liver failure. Some experts recommend propylthiouracil in the first trimester and methimazole thereafter. Radioiodine should not be used during pregnancy, either for scanning or treatment, because of effects on the fetal thyroid. In emergent circumstances, additional treatment with beta blockers and a saturated solution of potassium iodide may be necessary. Hyperthyroidism is most difficult to control in the first trimester of pregnancy and easiest to control in the third trimester.


Question: Floppy baby syndrome occurs due to fetal exposure to

Adverse effects of lithium Nephrogenic Diabetes Insipidus Hypothyroidism ECG Changes Reversible elevation of T waves Fine Tremor(MC) Nausea , Loose Stools Leucocytosis Teratogenecity: Fetal Li+ exposure is associated with Neonatal goiter, CNS depression, Hypotonia ("floppy baby" syndrome) Ebstein's anamoly


Question: Radiation protector drug in clinical use among the following is

Amifostine is used therapeutically to reduce the incidence of neutropenia-related fever and infection induced by DNA-binding chemotherapeutic agents including alkylating agents and platinum-containing agents . It is also used to decrease the cumulative nephrotoxicity associated with platinum-containing agents. Amifostine is also indicated to reduce the incidence of xerostomia in patients undergoing radiotherapy for head and neck cancerReference: Perez and Brady&;s textbook of radiation oncology; 6th edition


Question: Antiparkinson's drug known to cause cardiac valvular fibrosis is

Pergolide, ergot derivative, directly stimulates both D1 and D2 receptors. It has been widely used for parkinsonism but is no longer available because its use has been associated with the development of valvular hea disease.Reference: Katzung Pharmacology; 13th edition; Chapter 28; Pharmacologic Management of Parkinsonism & Other Movement Disorders


Question: Cloudy swelling is due to (not related)


Question: Mechanism of action of transexaminic acid is


Question: Omeprazol is used in the treatment of


Question: Thiazides do not produce

Loop and thiazide diuretics cause loss of H+ ions in urine.body will be in metabolic alkalosis state .potassium sparing diuretics cause metabolic acidosis.Ref:Katzung 10th ed Pg 246


Question: Trimetazidine acts by

It  inhibits pFox enzyme and inhibits β - oxidation of fatty acids and increases glucose oxidation. Thus reduces the oxygen consumption & demand in an ischaemic cell.

Inhibits Molecular light chain kinase (MLCK) and increase cGMP

Inhibits pFox enzyme and inhibits β - oxidation of Fatty acids

Inhibits sodium channels and decreases funny current


Question: The antiulcer agent detaches and kills H. Pylori organism and prevent relapses is


Question: Fenoldapam is

Fenoldopam is a agonist  at D1 & α2 receptor and used in hypertensive emergencies.


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

Dexamethasone is very potent and highly selective glucocoicoid to be staed before 10 weeks of gestation to suppress fetal androgen production effectively It has a long duration of action and cause marked pituitary-adrenal suppression. DOC for CAH is hydrocoisone but DOC for pregnant women having baby with CAH - dexamethasone REF.Essential of medical pharmacology K D TRIPATHI 6 Edition, Page No - 283


Question: Alprostadil is used for

Ref: HL Sharma 3rd ed pg no: 370 alprostadil - PGE1 analog used for erectile dysfunction -produces vasodilatation if it is used for PDA, It could lead to ductus fragility and rupture


Question: A patient with hypeension also suffers from essential tremor. Optimal treatment of the patient should include management with

Essential Tremor is the commonest movement disorder. It can present in childhood but dramatically increases in prevalence over the age of 70 years. ET is characterized by a high-frequency tremor (6-10 Hz) that predominantly affects the upper extremities. The tremor most often manifest as a postural or action (kinetic) tremor and, in severe cases, can interfere with functions such as eating and drinking. It is typically bilateral and symmetric but may begin on one side and remain asymmetric. TREATMENTMany cases are mild and require no treatment other than reassurance. Beta blockers and primidone are the standard drug therapies for ET and help in about 50% of cases. Propranolol (20-120 mg daily, given in divided doses) is usually effective at relatively low doses, but higher doses may be effective in some patients. The drug is contraindicated in patients with bradycardia or asthma.Reference: Harrison&;s Principles of Internal Medicine; 19th edition; Chapter 449 Parkinson's Disease and Other Movement Disorders


Question: Renal stones are seen as a complication by using the following drug

Side effects of zonisamide are metabolic acidosis, renal stones, somnolence, dizziness, headache, irritability and anorexia. REF; KD TRIPATHI 8TH ED.


Question: 'Diffusion hypoxia' is likely to occur only after use of nitrous oxide because it

Nitrous oxide (N2O) N2O having low blood solubility rapidly diffuses into alveoli and dilutes the alveolar air, and PP of oxygen in alveoli is reduced. The resulting hypoxia, called diffusion hypoxia, is not of much consequence if cardiopulmonary reserve is normal, but may be dangerous if it is low. Diffusion hypoxia can be prevented by continuing 100% O2 inhalation for a few minutes after discontinuing N2O, instead of straight away switching over to air. Diffusion hypoxia is not significant with other , anaesthetics because they are administered at low concentrations (0.2-4%) and cannot dilute alveolar air by more than 1-2%. Ref:- kd tripathi; pg num:-376

Has low blood solubility and is used in high concentration

Interferes with diffusion of oxygen into the tissues


Question: A young man is with known heroin addiction is brought in the emergency in an unconscious state. On examination, the patient has decreased bowel sounds, depressed respiration and pinpoint pupil. The treatment of choice for this patient is


Question: The  drug recently approved to be used along with phenteramine in the management of obesity is


Question: Contraindications of beta blockers are

Ref:KD Tripathi pharmacology 7th edition (page.no: 146) the beta blocker is contraindicated in asthma because of beta 2 blocking effect (beta 2 agonist cause bronchodilation). Uses of beta blockers are Hypeension, Myocardial infarction, Pheochromocytoma, Cardiac arrhythmias, Thyrotoxicosis, MIGRAINE, essential tremors etc


Question: Afrezza is used to treat post prandial hyperglycemia available in color coded formulations yellow colour indicates

Afrezza is inhalational form of insulin available in color coded forms
Blue : 4IU
Green : 8IU
Yellow : 12IU


Question: Nephrotoxicity is seen with

(B) Aminoglycoside DRUGS ASSOCIATED WITH ACUTE RENAL FAILUREPre-renalIntrinsicPost-renal* Diuretics* ACE inhibitors* ARBs* NSAIDs* Cyclosporine* Interferon* lnterleukin-2* Tacrolimus* Radiocontrast dye* Aminoglycosides* Foscarnet* Amphotericin B* Penicillins* Rifampin* Immunoglobulin* Methotrexate,* Lithium,* Tetraclines,* Phenytoin,* Cimetidine,* Cocaine,* Mannitol,* Statins,* Cidofovir,* Pentamidine,* Fluoroquinolones,* Allopurinol,* Cisplatin,* Cephalosporins,* Thiazide diuretics,* Ifosfamide,* Indinavir,* Gold,* Mesalamine* Indinavir* Acyclovir* Sulfonamides


Question: Most commonly used insulin for emergencies of diabetes like diabetes ketoacidosis

Regular-actrapid insulin is most commonly used for DKA, Hyperosmolar coma. But the ultra long acting and ultra shio accting insulin are not preferred in emergency situations. other treatment for DKA is 0.9% normal saline , regular insulin I.V,management o f metabolic acidosis due to ketone bodies . Ref: Katzung 12 th ed.


Question: Disulfiram like reaction is seen with

Chlorpropamide is a sulphonyl urea that causes Disulfiram like reaction and also dilutional hyponatremia.


Question: The following Potassium channel opener is used in angina

Nicorandil, minoxidil, pinacidil are potassium channel openers used in angina which produce hyperpolarization. and causing the vasodilation and reducing the oxygen demand and increase the oxygen supply yo the infracted area. Ref: KD Tripathi 8th ed.


Question: Selective Alpha 2a agonist is

Clonidine, Tizanidine are selective alpha 2 agonists. But dexmedetomidine is more selective acting on Alpha 2a receptors-cause sedation. Used as pre-anesthetic medication. Ref: H.L. Sharma 3rd ed Pg:179


Question: Drug of choice for myoclonic seizures is


Question: Sibutramine is indicated for

Ref: HL Sharma 3rd ed pg no: 334 sibutramine is used for obesity as it decreases appetite rimonabant also could be used, but it is banned


Question: Drug the choice for hyperthyroidism in first trimester of pregnancy is

Propylthiouracil is the only thioamide which is least teratogenic and hence it is the drug of choice to hyperthyroidism in pregnancy and lactation.


Question: The most potent drug to reduce the plasma low density lipoprotein cholesterol level is

Refer kDT 6/e p 614 The Most Common Cholesterol Meds: Statins These are usually the first type ofdrug that doctors prescribe to lower LDL. They also lower triglycerides, which are another type of blood fat, and mildly raise your "good" (HDL)cholesterol. Statins include: Atorvastatin (Lipitor


Question: Dobutamine differs from dopamine in that

Dopamine (DA):- It is a dopaminergic (D1 and D2) as well as adrenergic a and b1 (but not b2) agonist. Dobutamine:- A derivative of DA, but not a D1 or D2 receptor agonist. Though it acts on both a and b adrenergic receptors. Ref:- kd tripathi; pg num:-134

It has good blood-brain barrier penetrability

It does not activate adrenergic b receptors

It does not activate peripheral dopaminergic receptors


Question: First to recover after muscle relaxants

The sequence of recovery is in the same way as it goes i.e., first to recover are central muscles like larynx and diaphragm and then limb muscles. Ref: KATZUNG 12 th ed.


Question: Most impoant mechanism of development of resistance to drugs in tuberculosis is

Most impoant mechanism of development of resistance to anti-tubercular drugs is mutation. DRUG RESISTANCE MUTATION IN GENE Rifampicin rpoB Isoniazid katG and inhA Ethambutol embB Pyrazinamide pncA


Question: Most specific drug used for NSAID induced peptic ulcer

Gastric mucosal damage:- Gastric pain, mucosal erosion/ulceration and blood loss are produced by all NSAIDs to varying extents. Mech of peptic ulcer formation:- Inhibition of COX-1 mediated synthesis of gastroprotective PGs (PGE2, PGI2) is clearly involved. Deficiency of PGs reduces mucus and HCO3- secrection, tends to enhance acid secretion and may promote mucosal ischaemia. Thus, NSAIDs enhance aggressive factors and contain defensive factors in gastric mucosa--are ulcerogenic. Paracetamol, a very weak inhibitor of COX is practically free of gastric toxicity and selective COX-2 inhibitors are relatively safer. Treatment:- PGE2 analogue (misoprostol) administered concurrently with NSAIDs counteract their gastric toxicity. DOC for NSAID induced peptic ulcer is PPI. Ref:- kd tripathi;pg num:-194


Question: A patient suffering from syphilis is given penicillin. He may develop


Question: Brinzolamide is a

Ans is 'd' i.e. Highly specific reversible and noncompetitive carbonic anhydrase inhibitor o Carbonic anhydrase inhibitors act by a non-competitive, reversible inhibition of the enzyme carbonic anhydrase. o Brinzolamide is a highly .specific inhibitor of carbonic anhydrase II (CA II), which is the main carbonic anhydrase isoenzyme involved in the secretion of aqueous humour. o Inhibition caused by brinzolamide is reversible and non-competitive.

Highly specific irreversible and noncompetitive carbonic anhydrase inhibitor

Highly specific irreversible and competitive carbonic anhydrase inhibitor.

Highly specific reversible and competitive carbonic anhydrose inhibitor

Highly specific reversible and non-competitive carbonic anhydrase inhibitor.


Question: Plasma half life of Carbimazole is

Refer KDT 6/e p 250 Half life of Carbimazole is around 8 hours Where'as propylthiouracil has t1/2 of 2hrs


Question: Misoprostol is a

Natural prostaglandin in body is PG E2 whereas Misoprostol and alprostadil are synthetic prostaglandins which are PG E1 analogues. Refer kDT 6/e p181


Question: Common dose dependant side effects of Ethambutol is

(Loss of visual acuity) (701-KDT) (742-43-KDT 6th)ETHAMBUTOL - It is distributed widely but penetrates meninges incompletely and is temporarily stored in RBC's* * Loss of visual acuity/ colour vision, field defects due to optic neuritis is the most important dose and duration of therapy dependent toxicity.* It should not be used below 6 years of age.* * Hyperuricemia is due to interference with urate excretion.


Question: Drug of choice for central diabetes insipidus

Ans. is'b'i.e., DesmopressinDesmopressin (intranasal) is the DbC for central DI.


Question: Black widow spider toxin is known to cause

Excess release of Acetylcholine Black widow spider toxin Induces massive release and depletion of acetylcholine Decrease release of Acetylcholine Botulinum toxin Inhibits synthesis of Acetylcholine Hemicholinium (HC3) blocks choline uptake (the rate limiting step in Achsynthesis) and depletes Ach Active transpo of ACh into synaptic vesicle Inhibited by vesamicol

Blocking Active transpo of ACh into synaptic vesicle


Question: Agent causing hemorrhagic cystitis

Ans: a (Cyclophosphamide)Ref: KD Tripathi, 6th ed. Pg. 822Haemorrhagic cystitis is caused by a metabolite of cyclophosphamide - acrolein If severe, the cystitis may be effectively treated by mesna.Drugs causing Haemorrhagic cystitisIfosfamide Cyclophosphamide Aniline or toluidine derivatives Penicillins - rare Danazol - rare Ifosfamide is the most common cause of haemorrhagic cystitis.


Question: Loading dose of a drug depends upon

(a)Volume of distributionRef: Lippincott, 6th ed., pg. 21 and Katzung, 13th ed., pg. 50-51Sometimes rapid achievement of desired plasma concentrations of drugs is needed to produce the prompt response (e.g. in serious infections or arrhythmias). When the time to reach steady state is long, as it is for drugs with long half-lives and having high volume of distribution (Vd) due to their tissue affinities, it may be desirable to administer a large dose (loading dose) to achieve the desired plasma levels rapidly. The volume ot distribution is the proportionality factor that relates the total amount of drug in the body to the concentration in the plasma (Cp).LOADING DOSE= Vd X Desired steady state plasma concentrationLoading dose can be given as single dose or multiple doses over a short time. E.g. in case of treatment of AF by digoxin (longer acting drug with high Vd), loading dose is must to saturate the tissues and to achieve desired plasma concentration rapidly (otherwise it would take about a week for digoxin to achieve the steady state plasma concentration). Loading dose of Chloroquine is also required to treat the malaria.On the other hand, maintenance dose is dependent of the clearance (Cl) as we have to maintain the steady state concentration in view of the volume of the plasma cleared of drug per unit time. Hence, equation for maintenance dose isMAINTENANCE DOSE= Cl X Desired steady state plasma concentration


Question: Toxic dose of lidocaine causes

Lignocaine reaching bloodstream causes severe CNS stimulation followed by coma.Ref:KDT 6/e p356.


Question: Drug of choice for treatment of Pneumocystitis jiroveci pneumonia is

DOC for both prophylaxis and treatment of Pneumocystis jiroveci pneumonia is Cotrimoxazole Other drugs that can be used are Dapsone Clindamycin Pentamidine Atovaquone


Question: Acylovir triphosphate inhibits the synthesis of DNA by competing with


Question: Induction agent of choice in day care surgery is

(Propofol) 585 - Lee's 13th) (375-KDT6th)* Geneal anaesthesia for day surgery should use agents that are rapidly eliminated and titratable* Most of those in common use are appropriate intravenous propofol or inhalation sevoflurane are both highly suitable for induction of anaesthesia in adults and childrenAdvantages of propofol over Thiopentone1. Rapid and smooth recovery2. Completely eliminated from body in 4 hours so patient is ambulatory early3. Antiemetic4. Antipruritic5. BronchodilatorDisadvantages of Day Surgery* Where day surgery is not well established, it may promote an over cautions attitude* May encourage poor management of operating list order* Surplus overnight capacity can attract emergency out liers and block beds* Antisocial hours may deter - day care nursing staff


Question: Most effective agent to prevent motion sickness is

Moon sickness is more easily prevented than cured.
 Transdermal hyoscine (scopolamine) is the best agent for the prevention of motion sickness.
 Antihistamines can also be used for prevention.


Question: Drug used for trabeculectomy

The main reason of failure of trabeculectomy surgery is scarring and closure of drainage site
 Antimetabolites prevent scarring and can be used to increase the success rate of trabeculectomy
 The most commony used antimetabolites are mitomycin-C and 5-fluorouracil.


Question: Pitolisant is approved for treatment of

Pitolisant is a new drug approved for treatment of excessive day time sleepiness in patients with narcolepsy. It acts as inverse agonist of H3 receptors of histamine. New drugs recently approved for conditions mentioned in options are:* Tenosynol giant cell tumor: Pexidainib* Polyneuropathy in transthyretin amyloidosis: Tafamidis meglumine* Primary and secondary myelofibrosis: Fedratinib

Excessive day time sleepiness in patients with narcolepsy

Polyneuropathy due to transthyretin amyloidosis


Question: In spinal anesthesia is the drug is deposited between

Refer Katzung 10/e p 419. In spinal anesthesia ,drug is deposited in the sub Arachnoid space.,,whereas in epidural anesthesia, it is given outside the duramater


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

Adrenaline causes vasoconstriction of coronary vessels and hence not used in hea failure. Digoxin cause an increase in accumulation of intracellular Calcium accumulation and is useful in hea failure. Thiazide decreases preload. enalapril or ACE inhibitors are useful to prevent remodeling of hea in hea failure (REF. Essentials of medical pharmacology KD TRIPATHI 6 Edition)


Question: Most common cause of acute cervicitis is

Causes of acute cervicitis are : 1. Gonorrhoea 2. Septic aboion 3. Puerperal Sepsis. Ref Ktzung 12th ed.


Question: Drugs like barbiturates precipitate symptoms of porphyria because


Question: Botulinum toxin acts by

Ref: HL Sharma 3rd ed pg no:133 botulinum toxin and beta-bungaro toxin inhibits the release of Ach into the synapse


Question: Treatment of choice for extended spectrum betalactamase producing enterococci


Question: Schizophrenia is treated by


Question: Common side effects of Dapsone is

Hemolysis develops in almost every individual treated with 200-300 my Dapsone pe day. Doses of Les than 100 my in healthy persons and less than 50mg per day in persons with G6PD deficiency do not causes Hemolysis b Refer Goodman Gilman 12/e p 1564


Question: Mechanism of action of disgitalis is

Digoxin's primary mechanism of action involves inhibition of the sodium potassium adenosine triphosphatase (Na+/K+ ATPase), mainly in the myocardium. This inhibition causes an increase in intracellular sodium levels, resulting in decreased activity of the sodium-calcium exchanger, which normally impos three extracellular sodium ions into the cell and transpos one intracellular calcium ion out of the cell. The reversal of this exchanger causes an increase in the intracellular calcium concentration that is available to the contractile proteins. Increased intracellular calcium lengthens phase 4 and phase 0 of the cardiac action potential, which leads to a decrease in hea rate. Increased amounts of Ca2+ also leads to increased storage of calcium in the sarcoplasmic reticulum, causing a corresponding increase in the release of calcium during each action potential. This leads to increased contractility (the force of contraction) of the hea without increasing hea energy expenditure Refer kDT 7/e p 212


Question: Zero order kinetics is seen with


Question: A paial agonist can antagonize the effects of a full agonist because it has

High affinity but low intrinsic activity. The activity is mainly governed by affinity , intrinsic activity of a drug. iagonist has high affinity and intrinsic activity,antagonist has affinity but no intrinsic activity zero. Paial agonist has high affinity and low intrinsic activity. KDT 6/e pg 37

Low affinity but high intrinsic activity


Question: Oral vancomycin is indicated in the following condition

GLYCOPEPTIDE ANTIBIOTICS Vancomycin Mech of action:- Vancomycin acts by inhibiting bacterial cell wall synthesis. It binds to the terminal dipeptide 'D-ala-D-ala' sequence of peptidoglycan units-- prevents its release from the bactoprenol lipid carrier so that assembly of the units at the cell membrane and their cross linking to form the cell wall cannot take place. pharmacokinetics:- Vancomycin is not absorbed orally. After i.v. administration, it is widely distributed, penetrates serous cavities, inflamed meninges and is excreted mainly unchanged by glomerular filtration with a t 1/2 of 6 hours. Dose reduction is needed in renal insufficiency. Toxicity:- Systemic toxicity of vancomycin is high. It can cause plasma concentration dependent nerve deafness which may be permanent. Kidney damage is also dose-related. Other oto- and nephrotoxic drugs like aminoglycosides must be very carefully administered when vancomycin is being used. Skin allergy and fall in BP during i.v. injection can occur. Vancomycin has the potential to release histamine by direct action on mast cells. Rapid i.v. injection has caused chills, fever, uicaria and intense flushing-- called 'Red man syndrome'. Uses:- Given orally (125-500 mg 6 hourly), it is the second choice drug to metronidazole for antibiotic associated pseudomembranous enterocolitis caused by C. difficile. Staphylococcal enterocolitis is another indication of oral vancomycin. Ref:- kd tripathi; pg num:-757

Antibiotic associated pseudomembranous enterocolitis


Question: Prodrug of cetrizine is

Ans. is 'c' i.e., Hydroxyzine Cetrizine is a metabolite of Hydroxyzine with marked affinity for peripheral HI receptors; penetrates brain poorly. It inhibits release of histamine and of cytotoxic mediators from platelets as well as eosinophil chemotaxis during secondary phase of allergic response. It is indicated in upper respiratory allergies, pollinosis, uicaria and atopic dermatitis; also used as adjuvant in seasonal asthama.


Question: Bull's eye retinopathy is seen with


Question: Drug used for atrial fibrillation and atrial flutter is

For AF, digoxin can be used- it decreases ventricular rate in AF Verapamil decreases conduction velocity and increases the refractory period of the AV node and so used in PSVT. REF.Essentials of Pharmacology KD Tripathi 8th ed.


Question: Finasteride acts by blocking

Finasteride is a competitive inhibitor of the enzyme 5alpha-reductase which conves testosterone into more active DHT responsible for androgen action in many tissues. finasteride, dutasteride- used for prostate cancer and BPH (Ref.Essentials of medical pharmacology TD Tripathi 7th edition page no.302)


Question: Maximum incidence of impotance is seen in the patients with following anti hypeensive drug

Common side effects of beta blockers include: Dizziness. Weakness. Drowsiness or fatigue. Cold hands and feet. Dry mouth, skin, or eyes. Headache. Upset stomach. Diarrhea or constipation. Refer kDT 6/e p139


Question: Single lesion leprosy treatment

ROM Regimen is used in single lesion leprosy.Now a days singlw lesion leprosy is also treated as paucibacillary leprosy and standared MDT of leprosy is given for 6 months- 1 yr. Ref: Harrison 17thed/1127


Question: Mechanism of action of Acyclov ir is

(D) Inhibitor of HSV polymerase # Mechanism of action:> Acyclovir differs from previous nucleoside analogues in containing only a partial nucleoside structure: the sugar ring is replaced with an open-chain structure. It is selectively converted into acyclo-guanosine monophosphate (acyclo-GMP) by viral thymidine kinase, which is far more effective (3000 times) in phosphorylation than cellular thymidine kinase.ANTIVIRAL AGENTS ACTIVE AGAINST HERPESVIRUSESAgentDescription* AcyclovirInhibits HSV polymerase* FamciclovirProdrug of penciclovir (a guanosine analogue)* ValacyclovirProdrug of acyclovir; better absorption* GanciclovirMore potent polymerase inhibitor; more toxic than acyclovir* ValganciclovirProdrug of ganciclovir; better absorption* CidofovirNucleotide analogue of cytosine* FoscarnetPhosphonoformic acid; inhibits viral DNA polymerase

Inhibitor of viral reverse transcriptase


Question: Apalutamide was approved by FDA recently for


Question: Mehemmoglobinemia is caused by

Refer Katzung 11/e p449. The admistration of large doses of prilocarpine during regional anesthesia may lead to accumulation of the metabolite o-toludine an oxidizing agent capable of conveing hemoglobin to methemoglobin


Question: The term balanced anesthesia has been given by

Refer Goodman Gilman 12/e p 528 Term balanced anaesthesia was introduced by Lundy in 1926


Question: Leukotriene receptor antagonist used for bronchial asthma

Refer KDT 6 /e p 222 Montelukast, zafirlukast and idalukast are Cys-LT, receptor antagonist Zileuton inhibits the production if Leukotriene by inhibiting the enzyme 5-lipoxygenase


Question: Most common side effect seen with bisphosphonates

-Bisphosphonates like alendronate and risedronate are used for prophylaxis and treatment of osteoporosis. -Esophagitis is their distinctive side effect. -Precaution is to be taken while taking the drug is to take it with full glass of water and in a sitting/ standing position.


Question: Bisphosphonates are prescribed to a patient with the following advice

Ans. (A) Take empty stomach with plenty of water(Ref: KDT 8th/370)Bisphosphonates are to be taken empty stomach in the morning with full glass of water and patient is instructed not to lie down or take food for at least 30 min. These measures are required to prevent contact of the drug with esophageal mucosa which result in esophagitis.


Question: A 60 year old hypeensive patient is on angiotensin II receptor antagonists (losaan) is post for hernia repair surgery. The hypeensive drug should be

Before surgery antihypeensive drug should be used till the day of surgery Refer CMDT 2014_47

Administered in increased dosage on the day of operation


Question: Muscarinic cholinergic agonists

In addition to activating inhibitory G-proteins (Gi), muscarinic cholinergic agonists stimulate the activity of phospholipase C, increase production of IP 3, and increase release of intracellular calcium. Ref:- KD Tripathi

Decrease release of intracellular calcium


Question: Vitamin K dependent clotting factors are

Vitamin K-dependent clotting factors II, VII, IX, X, proteins C, and S,


Question: Anticholinesterase inhibitor that binds to the anionic site is

Neostigmine and pyridostigmine antagonize nondepolarizing neuromuscular blockade by increasing the availability of acetylcholine at the motor endplate, mainly by inhibition of acetylcholinesterase. They bind to esteric site. Edrophonium binds to anionic site. It has a more rapid onset of action but may be less effective than neostigmine in reversing the effects of nondepolarizing blockers in the presence of a profound degree of neuromuscular blockade Reference: Katzung Pharmacology; 13th edition; Chapter 8; Cholinoceptor-Blocking Drugs


Question: Dicyclomine is a

Dicyclomine is an antispasmodic anticholinergic drug used in various spasms also in dysmenorrheal .meftal spas contains dicyclomine along with mefenamic acid Ref: KDT 6th ed pg 104


Question: Drug of choice for gonococcal as well as non gonococcal urethritis is

Gonococcal Infections For gonococcal urethritis: DOC is ceftriaxone For non gonococcal urethritis: DOC is AZITHROMYCIN It is used in combination with ceftriaxone in both gonococcal & non gonococcal urethritis AZITHROMYCIN (Single dose is enough)


Question: Bull's eye maculopathy is an adverse effect caused by

Bull's eye maculopathy It is a rare dystrophy, also known asbenign concentric annular macular dystrophy (BCAMD). It causes a daboard, or ring-shaped, pattern of damage around the macula. It can be caused bychloroquineorhydroxychloroquine Side effects of antimalarial drugs Chloroquine (4-aminoquinoline) - Bull's eye maculopathy,confusion,psychosis,agranulocytosis. Primaquine (8-aminoquinoline ) - hemolytic anaemia in G6PD deficiency,leukopenia,agranulocytosis,leukocytosis,cardiac arrhythmias. Quinine - Cinchonism (constellation of symptoms:tinnitus,headache,nausea,dizziness,flushing,visual disturbances. Tafenoquine (8-aminoquinoline) - Hemolysis in G-6PD Def Pt


Question: Ipratropium bromide used in Bronchial asthma, is

(Anticholinergic) (217-KDT 6th)CLASSIFICATIONS OF DRUGS USED IN Br, ASTHMAI- Bronchodilators A. b2 sympathomimetics -Salbutamol, Terbutaline, Bambuterol, Salmeterol, formoterol, EphedrineB. Methvlxanthines -Theophylline, Aminophylline, Choline, theophylline, DoxophyllineC. Anticholinergics -Ipratropium bromide**, Tiotropium bromideII. Leukotriene antagonists -Montelukast, ZafirlukastIII. Mast cell stabilizers -Sodium cromoglycate, KetotifenIV. Corticosteroids - A-SystemicHydrocortisone, Prednisolone and othersB. Inhalational -Beclomethasone, dipropionate, Budonide, Fluticasone propionate, Flunisolide, CiclesonideV. Anti-IgE antibody -Omalizumb


Question: Acetazolamide acts at

Acetazolamide is a reversible inhibitor of the carbonic anhydrase enzyme that results in the reduction of hydrogen ion secretion at the renal tubule and increased renal excretion of sodium, potassium, bicarbonate, and water by inhibiting the enzyme CA


Question: Methotrexate resistance is due to

Mechanism for Methotrexate resistance Impaired transpo of Methotrexate into cells Production big altered forms of DHFR that have decreased affinity for the inhibitor Increased concentrations of intracellular DHFR through gene amplification Decreased ability to synthesize Methotrexate polyglutamtes Increased expression of a drug reflux transpoer, of MRP class Refer Goodman Gilman 11/e p1336


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

Quaternary ammonium compounds are water soluble and thus cannot cross blood brain barrier neostigmine is a quaternary derivatives where as physostigmine is a teritiary amine Ref-KDT 6/e p101


Question: Pharmacokinetics is

(Includes absorption, distribution, binding/storage/biotransformation and excretion of the drug) (1-4-KDT 6th)Pharmacokinetics - to discover how the drug is distributed in and disposed of by, the bodyPharmacodynamics - to explore actions relevant to the proposed therapeutic use, and other effects at a range of doses.

Includes absorption, distribution, binding / storage/ biotransformation and excretion of the drug

Includes physiological and biochemical effects of drugs

Application of pharmacological information together with knowledge of the disease


Question: Donepezil has the following mechanism of action

Donepezil: cerebro selective and reversible anti-AchE produces improvement in several cognitive as well as non cognitive (activities of daily living) scores in Alzheimer's Dementia. The benefit is ascribed to elevation of Ach level in the coex, especially in the surviving neurons that project from basal forebrain to cerebral coex and hippocampus. Therapeutic doses produce only weak peripheral AchE inhibition: cholinergic side effects are mild. Because of long t 1/2 (~70 hr), donepezil is administered once daily at bedtime It is generally well tolerated and is not hepatotoxic.


Question: Impoant adverse effect of nesiritide is

The recommended dose of Natrecor is an IV bolus of 2 mcg/kg followed by a continuous infusion of 0.01 mcg/kg/min....Common side effects may include: headache, mild dizziness; nausea, vomiting; back pain; numbness or tingly feeling; tremors; or. vision changes Refer Goodman and Gilman 11e p696


Question: Fulvestrant is used in the treatment of

Fulvestrant is a selective estrogen receptor downregulator (SERD) used in cases of hormone receptor positive metastatic breast carcinoma in post menopausal women.

HR positive metastatic breast cancer in post menopausal women

Acute myeloid leukemia associated with Down's syndrome


Question: Wof is the fastest acting inhaled bronchodilator

Salbutamol (Albuterol):- A highly selective b2 agonist when inhaled from pressurized metered dose inhaler (pMDI) produces bronchodilatation within 5 min and the action lasts for 2-4 hours(sho acting,fast acting),therefore used to abo and terminate attacks of asthma, but is not suitable for round-the-clock prophylaxis. side effects:- Muscle tremors are the dose related side effect. Palpitation, restlessness, nervousness, throat irritation and ankle edema can also occur. Hypokalaemia is a possible complication. Formoterol, Salmeterol are long acting B2 agonists, formoterol is fast acting compared to Salmeterol. Ref:- kd tripathi; pg num:- 223


Question: First choice DMARD in rheumatoid ahritis is

Rheumatoid Ahritis - Pain and inflammation of joints - For acute treatment we use: - NSAIDS - Steroids But it is only symptomatic treatment. It cannot slow down the joint destruction DMARDs- (Disease modifying anti-rheumatoid drugs) - As they are very slow acting so they are also called SAARDs (slow acting anti rheumatic drugs). Classification Conventional DMARDs Biologicals Chloroquine Penicillamine Azathioprine Gold salts Leflunomide Immunosuppressants Methotrexate (DOC) sulfasalazine Anakinra Sarilumab Adalimumab Cerolizumab Etanercept Infliximab Golimumab Abatacept Methotrexate - Drug of choice - Acts by increasing adenosine which possesses anti-inflammatory activity. DMARD of choice in pregnancy - CHLOROQUINE Sulfasalazine: It is a prodrug& can be used in ankylosing spondylitis.


Question: Muscle relaxant of choice in renal and hepatic failure

Refer Katzung 9/e p432 Atracurium and cis-Atracurium are muscle relaxants of choice for renal and hepatic failure patients


Question: Peginesatide is


Question: Enhancement of the effects of bradykinin is most likely to occur with drugs like

ACE inhibitors prevent the conversion of angiotensin I to angiotensin II and lower blood pressure by decreasing both the formation of aldosterone formation and the vasoconstrictive action of AII at AT-1 receptors. ACEIs also inhibit the metabolism of bradykinin, and this leads to additional hypotensive effects, because bradykinin is an endogenous vasodilator. Unfortunately, increases in bradykinin are associated with side effects, including cough and angioedema. Losartan, which blocks AT-1 receptors, does not increase bradykinin levels.


Question: Nimodipine is used in(REPEAT)

Nimodipine- A sho-acting calcium channel blocker Crosses blood brain barrier because of its high lipid solubility Selectively relaxes cerebral vasculature Can prevent and reduce the neurological deficit caused by cerebral vasospasm following subarachnoid hemorrhage


Question: Drug capable of causing ocular hypotension with apnoea in infants is

Brimonidine * Brimonidine, an alpha 2 selective adrenergic agonist used in treatment of Glaucoma has propensity to cause respiratory depression when used in children. * Brimonidine is notorious in causing CNS depression and apnoea in neonates. Hence, its use in children <2 years of age is contraindicated. * Brimonidine and Apraclonidine are Clonidine derivates - alpha 2 selective adrenergic agonist - reduce intraocular pressure by decreasing aqueous production. * Unlike Apraclonidine, Brimonidine being lipophilic can traverse the blood brain barrier and induce CNS depression. * Brimonidine is administered as topical eye preparation to reduce IOP in ocular hypeension and open angle glaucoma. * Topical Brimonidine gel (0.33%) is also used as a once daily treatment for persistent erythema of rosacea. Ref:- Goodman & Gilman Pharmacological Basis of Therapeutics 13th Ed; Pg num:- 1260


Question: The drug used in petit mal seizures and has a narrow spectrum of antiepileptic activity is

Ethosuximide and valproate are the drugs of choice for absence seizures and are more effective than lamotrigineReference: Katzung Pharmacology; 12th edition; Page no: 418


Question: Bictegravir was approved by FDA recently for

Bictegravir (an Integrase Inhibitor) is a component of the fixed-dose combination product bictegravir/emtricitabine/tenofovir alafenamide (brand name: Biktarvy), which received marketing approval for the treatment of HIV infection by U.S. Food and Drug Administration in February 2018.


Question: Aeriolar dilators used in the treatment of CHF

Nifedipine is a calcium channel blocker. Enalapril is an ACE inhibitor. Prazosin is alpha 1 blocker. Hydralazine is an aerial dilator and potassium channel opener (REF.Essentials of medical pharmacology KD TRIPATHI 8 Edition)


Question: High concentration of bupivacaine during labour is contraindicated due to its


Question: Tricyclic antidepressants can alter the oral absorption of many drugs by

Alter gut motility Ref: KDT 6/6 pg 14,411

Complexing with other drugs in the intestinal lumen


Question: The absolute CONTRAINDICATION to lithium is March 2004


Question: Pentostatin inhibits

Pentostatin is a purine analogue that inhibits Adenosine deaminase. It is used in cases of Hairy cell leukemia (Doc: Uadiribine).


Question: An antiemetic drug that also decreases acid secretion due to its action on H1 receptors is

promethazine is a first generation H1 antihidtaminic drug.it is inficated fir treatment of allergic reactions.because of its anticholinergic action and abikity to cross blood brain barrier it can be used as an antiemetic and an anti parkinsonian drug . acid secretion is reduced mainly by H2 blocking drugs like ranitidine but even H1 anti histamainics can also reduce secretion at high doses .


Question: Drug of choice for Type 1 Brittle asthma is

Brittle asthma is very severe asthma resistant to inhalational Beta 2 agonists.
DOC for Type1 Brittle Asthma: Subcutaneous Terbutaline.
DOC for Type2 Brittle Asthma: Subcutaneous Adrenaline.


Question: If a thiazide diuretic is administered for hypeension, the response that is seen within 24 hrs on excretion is

Thiazides- medium efficacy diuretics with primary site of action in the early DT (Site III). Here they inhibit Na+-Ct sympo at the luminal membrane. Under their action, an increased amount of Na is presented to the distal nephron, more of it is exchanges with K+, urinary K+ excretion increased in parallel to the natriuretic response. They decrease renal Ca excretion and increase Mg excretion by a direct distal tubular action. They also decrease urate excretion by the same mechanism as furosemide. They are used in idiopathic hypercalciuria REF Essentials of Medical Pharmacology, K.D Tripathi,6 th edition, page 564

sodium excretion increases, potassium decreases

Sodium increases, Potassium decreases, Calcium increases

Sodium increases, Potassium increases, Calcium excretion decreases

Sodium, Potassium, Calcium excretion increases


Question: Following monoclonal antibody is directed against alpha 4 integrin (REPEAT)

Natalizumab is anti-integrin monoclonal antibody used in ulcerative colitis, Crohn&;s disease and multiple sclerosis.Ref: Katzung 13th ed.pg 962.


Question: Inhalational agent of choice for induction in children is

Desflurane has the lowest blood partition co-efficient and hence it is the fastest inducing agent. But it can lead to coughing & bronchospasm on inhalation.
Therefore Sevoflurane is the inhalational agent of choice for induction in children.


Question: Mechanism of action of Clonidine in opioid withdrawal syndrome is

Ans. is 'c' i.e., Action on a2 presynaptic nerve ending Many of the symptoms of opioid withdrawl such as nausea, vomiting, cramps, sweating, tachycardia, and hypertension are a result of loss of opioid suppression of locus ceruleus system during abstinence syndrome. Clonidine is an a2 agonist that reduces adrenergic transmission from locus ceruleus.Clonidine acts on these a2 receptors and supress adrenergic activity in locus ceruleus. (Thus mimicking the action of opioids).In this way it alleviates mainly the autonomic symptoms of opioid withdrawl.Non autonomic symptoms of opioid withdrawl are not affected.


Question: Dopamine is preferred in treatment of shock because of

ref; KD Tripathi 6th edition pharmacology (page no;134) Dopamine (DA) is a dopaminergic (D1 and D2) as well as adrenergic alps 1 &b 1 (but not b2 ) agonist. The D1 receptors in renal and mesenteric blood vessels are the most sensitive: i.v. infusion of a low dose of DA dilates these vessels (by raising intracellular cAMP). This increases GFR and Na+ excretion.


Question: Mechanism of action of levosimendon include

Mechanism of action Levosimendan exes its positive inotropic effect by increasing calcium sensitivity of myocytes by binding to cardiac troponin C in a calcium-dependent manner. ... The combined inotropic and vasodilatoryactions result in an increased force of contraction, decreased preload and decreased afterload. Refer katzung 11e p221


Question: Pregnant patient can be safely given


Question: The action of botulinum toxin is through wof mechanisms

Botulinum toxin Botulinum toxin A and B are highly potent exotoxins produced by Clostridium botulinum that are responsible for 'botulism' (a type of food poisoning). mech of action:- These neurotoxic proteins cause long-lasting loss of cholinergic transmission by interacting with axonal proteins involved in exocytotic release of ACh. uses:- In the treatment of a number of spastic and other neurological conditions due to overactivity of cholinergic nerves, like blepharospasm, spastic cerebral palsy, strabismus, spasmodic toicollis, nystagmus, hemifacial spasm, post stroke spasticity, spasmodic dysphonia, axillary hyperhydrosis, etc. It is increasing being employed as beauty treatment by removal of age-related facial wrinkles. Ref:- kd tripathi; pg num:-99,100


Question: The treatment of single lesion paucibacillary leprosy is

ROM Regimen is used in single lesion leprosy.For patients with single-lesion paucibacillary leprosy, the WHO recommends a single dose of rifampin (600 mg), ofloxacin (400 mg), and minocycline (100 mg). Multibacillary adults should be treated with 100 mg of dapsone plus 50 mg of clofazimine daily (unsupervised) and with 600 mg of rifampin plus 300 mg of clofazimine monthly(supervised).Ref: Harrison 19th ed/1127


Question: Diphenhydramine used as antitussive is a

Diphenhydramine is an anti histamine used for mild cough.


Question: Praziquantel is used for the treatment of

Platyhelminthes (flukes & tapeworms) DOC for all the platyhelminths is praziquantel DOC for Fasciola hepatica (liver fluke) is triclabendazole DOC for dog tapeworm is albendazole DOC for trichomoniasis is metronidazole Surgery is done for rhinosporidiosis Nematodes DOC for nematodes is albendazole DOC for filaria is diethyl carbamazine DOC for strongyloidiasis & onchocerca volvulus is Ivermectin


Question: Nausea and vomiting that are associated with administration of opioid analgesic is the result of stimulation of the


Question: Opiod induced respiratory depression can be reversed with

Ans: A (Naloxone) Ref: Goodman &Gillman's The Pharmacological Basis of Therapeutics, 2011, 12'h Edition, McGrow Hill, Burton LL P519- 520Explanation:Naloxone is the treatment of choice in the reversal of respiratory depression due to opioids.Naloxone has to be diluted and slowly administered intravenously to avoid withdrawal in opioid dependent patientsMonitoring of arousal and respiratory function are essential during this treatmentRestoration of respiration without naloxone therapy may still results in death of the patient due to complication that develop during comaNoncardiogenic pulmonary edema that develops during opioid poisoning can be reversed by positive pressure ventilation


Question: Prolonged testosterone treatment to a man results in

Prolonged use of testosterone may produce testicular atrophy thus causing azoospermia. (Ref.Essentials of medical pharmacology TD Tripathi 7th edition page no.299)


Question: Treatment for methotrexate poisoning

Methotrexate poisoning: The toxicity of Mtx cannot be overcome by folic acid, because it will not be conveed to the active coenzyme form(due to inhibition of DHFA reductase by Mtx) Treatment:- Folinic acid (N5 formyl THFA, cirovorum factor) rapidly reverses the effects. Thymidine also counteracts Mtx toxicity. Ref:- kd tripathi; pg num:- 862


Question: The drug that acts by inhibiting bacterial RNA polymerase is

Answer: b) RifampicinANTI TUBERCULAR DRUGSFirst line DrugsEssential: Isoniazid (H), Rifampin (R), Pyrazinamide (Z), Ethambutol (E),Supplementary: Streptomycin (S), Rifabutin, RifapentineSecond Line DrugsOld Drugs: Thiacetazone, Paraaminosalicylic acid, Ethionamide , Cycloserine, Kanamycin,Amikacin, Capreomycin, Ciprofloxacin, Ofloxacin, Levofloxacin, Moxifloxacin, LinezolidAll first line Anti tubercular drugs are bactericidal except Ethambutol which is static.* Isoniazid: bacteriostatic against resting & bactericidal against rapidly multiplying organisms,o Effective against intracellular & extracellular organisms.o Resistance occurs d/t mutation in Kat G (gene for catalase peroxidase) or INH-A* Rifampicin: excreted in feces- safe in renal failure. Bactericidal against dormant organisms.o Effective against intracellular & extracellular organisms.* Ethambutol: inhibits the synthesis of arabinogalactan (cell wall component), d/t inhibition of arabinosyl transferase.* Pyrazinamide: active against intracellular bacteria only & in acidic media.* Streptomycin: active against extracellular bacteria only, given IM, contraindicated in pregnancyDrugMechanisms of Action and ResistanceAdverse effectsIsoniazidInhibit mycolic acid synthesisHigh level resistance - mutation in gene coding for Catalase peroxidaseHepatitis, Peripheral neuritis (always given in combination with pyridoxine), Hemolysis in G6PD deficiency, SLE in, slow acetylators, cheese reactionRifampicinInhibits DNA dependent RNA polymeraseResistance due to mutation in repo B geneProteinuria, Hepatitis, Flu-like syndrome,Red orange urine, Thrombocytopenia.Potent microsomal enzyme inducer;Contraindicated in patients on ARTEthambutolInhibits synthesis of arabinogalactan (cell wall component)Dose dependent retro bulbar neuritis, |.visual acuity and Red-green blindnessPyrazinamideAction similar to that of INHResistance due to mutation in the gene which encodes for enzyme generation in the active metabolite.Polyarthralgia, myalgia, Hepatitis & RashHyperuricemia, phototoxicity,| porphyrin synthesis, non gouty arthritis (40%)StreptomycinProtein synthesis inhibitorDeafness, Vestibular dysfunction &Nephrotoxicity.ISONIAZID* Isoniazid: prodrug that is activated by KatG, the mycobacterial catalase-peroxidase.* The target of the isoniazid derivative is enoyl-ACP reductase of fatty acid synthase II.* Fast acetylators: (30-40% of Indians) tl/2 of INH: 1 hr.* Slow acetylators: (60-70% of Indians tl/2 of INH: 3 hrs.* Isoniazid forms a covalent complex with an acyl carrier protein (AcpM) and KasA, a beta-ketoacyl carrier protein synthetase, which blocks mycolic acid synthesis.* Fast multiplying organisms are rapidly killed, but quiescent ones are only inhibited.* It acts on extracellular as well as on intracellular TB (bacilli present within macrophages); is equally active in acidic and alkalinemedium.* Isoniazid penetrates well into caseous material and persists in therapeutic concentrations.* Main excretory products in humans result from acetylation (acetylisoniazid) and hydrolysis (isonicotinic acid).* Hepatitis is d/t the metabolite acetylhydrazine.* Isoniazid induced peripheral neuritis - more common in slow acetylators.* Mental abnormalities may appear, including euphoria, transient memory impairment, loss of self- control, and psychosis.* Approximately 1 in 106tubercle bacilli will be genetically resistant to isoniazid.* INH neurotoxicity is treated by pyridoxine-100 mg/day.* The other congener of hydrazine- iproniazid is found to be a mood elevator.RIFAMPICIN* Acts best on slowly or intermittently (spurters) dividing ones, as well as on many atypical mycobacteria.* Both extra- and intracellular organisms are affected.* It has good sterilizing and resistance preventing actions.Rifampicin toxicity* Major adverse effecto Hepatitis, a, is dose-related and is reversible on discontinuation,o 'Respiratory syndrome': breathlessness associated with shock and collapse,o Purpura, haemolysis, shock and renal failure.* Minor reactions: not requiring drug withdrawal and more common with intermittent regimenso 'Cutaneous syndrome': flushing, pruritus + rash (especially on face and scalp), redness and watering of eyes.o 'Flu syndrome': with chills, fever, headache, malaise and bone pain,o 'Abdominal syndrome': nausea, vomiting, abdominal cramps with or without diarrhoea,o Orange discolouration of soft contact lenses.Other uses of rifampin* Leprosy* Prophylaxis of Meningococcal and H. influenzae meningitis and carrier state.* Second/third choice drug for MRSA, diphtheroids and Legionella infections.* Combination of doxycycline and rifampin is the first line therapy of brucellosis.DERIVATIVES OF RIFAMPICINRIFABUTIN: (Ansamycin)* Similar in action to rifampicin and shows cross resistance to rifampicin.* Mild inducer of cytochrome P-450 unlike rifampicin & rifapentin. Causes pseudojaundice.* Indicated in the treatment of tuberculosis in HIV patients on anti retroviral therapy due to less toxicity.* Rarely, it can cause anterior uveitis, hepatitis, Clostridium difficile-associated diarrhea, diffuse polymyalgia syndrome, yellow skin discoloration (Pseudo-jaundice) and pancytopenia. Unlike rifampicinRifabutin (as compared to rifampicin) is* Less effective against TB* More effective against MAC* Longer acting, ti/2 (45 hours)* Less potential to induce microsomal enzymes* Donot require dose adjustment in liver diseaseRIFAPENTIN:* Similar in action to rifampicin and shows cross resistance to rifampicin.* Potent Inducer of cytochrome P-450. Can cause light chain proteinuria.* Metabolized to 25-desacetyl rifapentin.* Should not be used in HIV individuals as it leads to drug resistance & more prone for toxicity.RIFAXIMIN: indicated for traveler's diarrhea (E.coli) & hepatic encephalopathy.OTHER DRUGS* Thiacetazone: tuberculostatic drug. Major adverse effects include hepatitis, bone marrow suppression and Steven Johnson syndrome (not used in HIV positive patients).* Para amino salicylic acid (PAS): bacteriostatic. It can cause kidney, liver and thyroid dysfunction.* Cycloserine is a cell wall synthesis inhibiting drug and can cause neuropsychiatric adverse effects.* Kanamycin, capreomycin and amikacin are injectable aminoglycosides, used in MDR tuberculosis.* Ethionamide: tuberculostatic can cause hepatitis, optic neuritis and impotence. Also used in leprosy.o Ethionamide also inhibit mycolic acid biosynthesis with consequent impairment of cell-wall synthesis.o Resistance can develop rapidly in vivo when ethionamide is used as a single-agent treatment, including low-level cross-resistance to isoniazid.* Fluoroquinolones: ciprofloxacin, ofloxacin, moxifloxacin& sparfloxacin. Effective against MAC in AIDS patients.* Newer macrolides like azithromycin and clarithromycin are effective against non-tubercular atypical mycobacteria.* Bedaquiline is an inhibitor of mycobacterial ATP synthase. It is indicated as a part of MDT in adults with pulmonary MDR-TB. It can cause QT prolongation.MULTI DRUG RESISTANT TUBERCULOSIS (MDR-TB)* Resistance to both Isoniazid & Rifampicin and may be any number of other anti-TB drugs.* Treatment is mainly based on culture sensitivity.* Usually fluoroquinolones are added.* For H resistance: RZE is given for 12 months.* For H+R resistance: ZE + S/ Kanamycin/Amikacin/ Capreomycin + cipro/Ofloxacin + Ethionamide.EXTENSIVELY DRUG RESISTANT TUBERCULOSIS (XDR-TB)* Resistance to four most effective drugs: H, R, a fluoroquinolone, one of Kanamycin/Amikacin/ Capreomycin and may be any number of other anti-TB drugs* Virtually untreatable: high mortality, particularly among HIV positive patients.


Question: A patient after valve replacement will require follow up treatment with

Warfarin-Warfarin being oral anticoagulant is used as prophylaxis after valve replacement because of propensity of these pts. developing thromboembolism is higher. Rx- warfarin + Inj heparin -life time use Heparin is discontinued after five days where as warfarin is taken lifelong. As warfarin takes at least 5 days to show its effect. Note-with warfarin therapy INR monitoring should be done.


Question: Bisphoshonates are prescribed to a patient with the following advice

Refer KDT 7th/345 Bisphoshonates are to be taken empty stomach in the morning with full glass water and patient is instructed not to lie down or take food for at least 30 min. These measures are required to prevent contact of the drug with esophageal mucosa which result in esophagitis


Question: Theophylline is a

Theophylline- Phosphodiesterase inhibitor (inhibit the degradation of CAMP) Sodium cromoglycate is a mast cell stabilizer used for prophylaxis of asthma Montelukast and zafirlukast are leukotriene antagonist Zileuton is a LOX inhibitor


Question: Mercaptopurine is

Ref: Katzung, 14th ed. pg. 960; KDT, 6th ed. pg. 820* Mercaptopurine is synthetic purine used in cancer chemotherapy.* Use: Childhood acute leukemia.


Question: One of the following diuretic does not require its presence in the tubular lumen for its pharmacological effects

Most of the diuretics act from the luminal side of membrane in the nephron. Thazides,loop diuretics,carbonic anhydrase inhibitors and epithelial Na+ channel blockers are secreted in the proximal tubules through organic anion/cation transpo process. Osmotic diuretics reach the lumen of proximal tubules glomerular filtration. Aldosterone antagonists like spironolactone do not act through luminal side rather they act from basolateral side of the membrane.Therefore,these agents do not require access to the tubular lumen.


Question: Inhalational anesthetic with highest respiratory irritation is

* Desflurane, a fluorinated inhalational anesthetic agent - is highly irritant on the tracheobronchial tree - making it unsuitable for use as the primary anesthetic for induction of anesthesia. * Among the fluorinated inhalational anaesthetics, Desflurane and Isoflurane are respiratory irritants; Sevoflurane is devoid of tracheobronchial irritation.Ref:- Goodman & Gilman Pharmacological Basis of Therapeutics 13th Ed; Pg num:- 395


Question: LMV heparin is preferred over unfranctioned heparin because

Refer KDT 7/e p 619 Major advantage of LMV heparins over unfranctioned heparin is that it does not require monitoring bad it has consistent subcutaneous bioavalilabilty Both of these work by activating antithrombin Risk of bleeding is present with both LMV as well as unfranctioned heparin None of these us effective orally

LMV heparin directly inhibits thrombin whereas unfranctioned heparin acts activation of antithrombin

LMV heparins have been lesser risk of causing bleeding

LMV heparin have lesser risk of causing bleeding

LMV heparin has consistent bioavalilabilty


Question: Carbonic anhydrase inhibitors should not be given in

Carbonic anhydrase inhibitors(CAIs)are more likely to produce acidosis in patients of COPD,CRF and DM.They are contraindicated in COPD as they may precipitate respiratory acidosis. They are sulfonamides in structure,so should not be given in hypeensitive persons.


Question: Prolonged treatment with INH leads to deficiency of

Refer Katzung 11/e p825 Isoniazid can cause peripheral neuropathy It is due to deficiency of Pyridoxine


Question: Warfarin induced skin necrosis is more common in patients with

It is due to decreased levels of protein C. It is more likely to occur in patients with genetic deficiency of protein C. Most common side effect of warfarin:Bleeding Dermal vascular necrosis is early appearing adverse effect. Due to decreased osteocalcin synthesis Warfarin causes nasal hypoplasia and therefore contraindicated in pregnancy


Question: Metabolite of progesterone in urine

Metabolites of progesterone may be classified into 3 groups based on degree of reduction. Pregnanediones: the C4-5 double bond is reduced producing 2 pregnanediones and allopregnanediones Pregnanolones: the keto group at C3 is reduced producing a hydroxyl groups in alpha and beta orientation. Urinary pregnanolones exit in alpha orientation Pregnanediols: keto group at c20 is reduced and compounds with c20 hydroxyl groups in alpha orientation are quantitatively more impoant. Hence urinary measurement of pregnanediols can be used as an index of endogenous production of progesterone and also its concentration correlates well with many clinical conditions Ref: Katzung 12 th ed.


Question: Long term adverse effect of tamoxifen is

TAMOXIFEN - It is SERM - Actions Bone - | formation of bone; decrease risk of osteoporosis Blood - | HDL Breast -Decrease risk of breast cancer Liver - | clotting factor leading to thromboembolism Endometrium - | risk of endometrial cancer


Question: Drug of choice for invasive aspergillosis is

Voriconazoleis the drug of choice for invasive aspergillosis, Posaconazole is the only azole active against mucormycosis. Liposomal AMB is the drug of choice or co drug of choice for most systemic fungal infections. It can be used intrathecally in fungal meningitis and locally for corneal ulcers and keratitis. Caspofungin is approved for invasive aspergillosis not responding to AMB or voriconazole. It is quite nontoxic and causes only infusion related reaction.


Question: Most common drug transpo mechanism is

Passive diffusion- entry of drugs from high to low conc. with no requirement of ATP or energy Pg.no 30 KD TRIPATHI Seventh edition


Question: The following sympathomimetic amine has agonistic action on a1 + a2 + b1 + b3 adrenoceptors, but not on b2 receptors


Question: Wof antimetabolite anti neoplastic agent is used in treatment of mesothelioma

Pemetrexed Mech of action:- The newer congener of Mtx primarily targets the enzyme thymidylate synthase. Though, it is also a DHFRase inhibitor, the pool of THFA is not markedly reduced. Adverse effects:- mucositis, diarrhoea, myelosuppression, itching, erythematous rash mostly involving the hands and feet, 'hand- foot syndrome' is quite common. Dexamethasone can relieve it. Uses:- In combination with cisplatin,pemetrexed is approved for treatment of mesoepithelioma and non-small cell lung carcinoma. Ref:- kd tripathi; pg num:-863


Question: The following drug is available in the form of transdermal patch

Scopolamine is used as transdermal patch for motion sickness .sticked in post-auricular region 30min before travel Ref: KDT 6th ed pg 114


Question: Cough syrup acts by inhibiting

Ans. (a) Cough center* Forceful expulsion of air from lungs due to pulmonary irritation is called coughing. It can be productive or non- productive.* Anti-tussive is a class of drug which relieves coughing by suppressing cough center. These drugs are mainly used for dry cough. Example of anti-tussives are:# Opioids: Codeine, Phalcodeine, Ethylmorphine# Non-Opioids: NOSCAPINE, Dextromethorphan* Expectorants are class of drugs that increase bronchial secretion or reduce its viscosity (mucolytics). They are mainly used in productive cough. Example of expectorants are:# Mucolytics: Bromhexeine, Ambroxol# Bronchial secretion enhancers: Guaiphenisine, sodium or potassium citrate


Question: The aim of post marketing pharmacokinetics is

(Safety and comparisons with other medicines) (43-Bennett & Brown) (61-62-GG)Pharmacokinetics - what the body does to the drag. This refers to movements of the drug in and alteration of the drug by the body; includes absorption, distribution, binding/localization/storage, biotransformation and excretion of the drug (1-KDT)* Post licensing (marketing) studies of safety and comparisons with other medicines (43-BB)Pharmacodynamics - What the drug does to the body. This includes physiological and biochemical effects of drugs and their mechanism of action at macromolecular/subcellular/ organ system levels.Post marketing detection of adverse reaction - several strategies exist to detect adverse reactions after marketing of a drug, but debate continues about the most efficient and effective method. Formal approaches for estimation of the magnitude of an adverse drug effect are the follow-up or "cohort" study of patients who are receiving a particular drug, the "case control" study where the potential for a drug to cause a particular disease is assessed, and meta-analysis of pre and post marketing (61-62-Goodman & Gillman's 10th)

Deals with alteration of the drug includes absorption, distribution, binding / storage

Safety and comparisions with other medicines


Question: Not a feature of Stein Leventhal syndrome is

Stein-Leventhal syndrome is another term for polycystic ovarian disease (PCOD). In this condition, androgens are raised due to hypehecosis leading to hirsutism. Oestrogen level is normal but LH level and LH / FSH ratio is raised. It is an impoant cause of secondary amenorrhoea and infeility in young women. Clomiphene is the drug of choice for infeility in PCOD and cyproterone acetate is the drug of choice for hirsutism. ref Katzung 12th ed.


Question: Chloroquine is used in the treatment of


Question: Idazoxan is a (REPEAT)

Yohimbine, idazoxan -selective alpha 2 blockers.


Question:
Drug of choice to treat severe fungal infection in
AIDS is


Question: Approved drug for prostate cancer is

Apalutamide was approved by FDA in 2018 for the treatment of HIV. It is androgen antagonist. Nilutamide, flutamide, bicalutamide are old drugs used in prostate cancerRef: <a href="


Question: Lofexidine has been approved recently for the withdrawal of

Lofexidine is a first nonopioid approved for the mitigation of withdrawal symptoms to facilitate abrupt discontinuation of opioids in adults. While Lofexidine may lessen the severity of withdrawal symptoms, it may not completely prevent them and is only approved for treatment for up to 14 days.


Question: Treatment of choice in hypeension with diabetes mellitus is

The angiotensin-conveing-enzyme (ACE)inhibitors are able to slow the progression of diabetic nephropathy by reducing the glomerular hypeension that causes it. ... Severe or resistant hypeension usually requires treatment with combinations ofdrugs, including a diuretic. Refer kDT 6/e p551


Question: Insulin acts on

Insulin, Prolactin, Growth hormone acts on Tyrosine kinase receptors.


Question: Following serum levels are suggestive of lithium toxicity


Question: The bacterial drug resistance in tuberculosis results from

Refer Katzung 11/e p824 Resistance to INH occurs due to point mutation in inhA gene Resistance to Rifampicin occurs due to point mutation in rpoB gene Resistance to Ethambutol is due to mutation resulting in over expression of embB gene


Question: The therapeutic index of a drug is a measure of its

Safety is indicated by TI.drug having a TI of more than 1 is considered to be safe when compared to drug having a TI of less trhan one which requies constant plasma monitoring. Ref: KDT 6/e pg 48.


Question: Infection in HIV patients resistant to Fluconazole is treated with


Question: DOC for primary open angle glaucoma is

Latanoprost-pgf2 alpha is the DOC for primary open angle glaucoma while acetazolamide is the DOC for acute congestive glaucoma Ref: KDT 6th ed pg 139-140


Question: Oral contraceptive failure occurs with

(Rifampicin) (1628 - Man & Gillmann) (741-KDT 6th)CONTRACEPTION FAILURE - May occure if the following drugs are used concurrently(a) Enzyme inducers - Phenytoin, Phenobarbitone, Primidone, Carbamazepine, Rifampicin, Rifabutin(b) Suppression of intestinal micro flora - Tetracyclines Ampicilline Doxycycilline


Question: Relatively higher dose of theophylline is required to attain therapeutic plasma concentration in

Drug interactions:- 1) Agents which enhance theophylline metabo lism primarily by inducing CYP1A2 lower its plasma level so, dose has to be increased in case of Smoking, phenytoin, rifampicin, phenobarbitone, Charcoal broiled meat meal. 2 ) Drugs which inhibit theophylline metabolism and increase its plasma level are--erythromycin, ciprofloxacin, cimetidine, oral contraceptives, allopurinol; dose should be reduced. 3. Theophylline enhances the effects of--furosemide, sympathomimetics, digitalis, oral anticoagulants, hypoglycaemics. 4. Theophylline decreases the effects of--phenytoin, lithium. Ref:- kd tripathi; pg num :-226,227


Question: Ketamine is a


Question: Apixaban is classified as

Apixaban is an oral, direct, selective factor Xa inhibitor with a rapid onset of action. Parenteral direct thrombin Inhibitors Oral direct thrombin inhibitor Oral factor Xa inhibitor Lepirudin Desirudin Argatroban Bivalirudin Dabigatran Rivaroxaban Apixaban Edoxaban (Undergoing regulatory review) Ref: Goodman and Gilman 13th edition Pgno: 262


Question: Ototoxicity and nephrotoxicity are characteristic adverse effects of wof

Aminoglycoside Antibiotics SHARED TOXICITIES The aminoglycosides produce toxic effects which are common to all members( include ototoxicity, nephrotoxicity), but the relative propensity differs Ref:- kd tripathi; pg num:-744


Question: More potent and non toxic drug against herpes virus is


Question: Wof drug is used for cervical priming to facilitate labour

Cervical priming (ripening) :- Low doses of PGE2 applied intravaginally or in the cervical canal, do not affect uterine motility, make the cervix soft and compliant. PGE2 (Dinoprostone) PROSTIN-E2 for induction/augmentation of labour. Ref:- kd tripathi;pg num:-189


Question: Warfarin anticoagulants inhibits following coagulation factors

Warfarin inhibits factor II, VII, IX and X.


Question: Therapeutic level of phenytoin is

Phenytoin therapeutic plasma concentration is 10-20 mg/ml. Ref: K D Tripati 7th edition Page no 422. Table 30.2


Question: In new drug designing. problern arises in

Ans. b. Increasing drug interaction with non-target proteins

Decreasing interaction of drug with target proteins


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

Timolol is a non selective Beta blocker and can precipitate acute attacks of asthma in a susceptible individual blockade of Beta 2 receptors. Betaxolol is a cardioselective Beta blocker and is less likely to cause this adverse side effect Refer kDT 6/e p 139


Question: Arrange the duration of treatment of the following conditions in the increasing order 1. Treatment of P. vivax malaria 2. Treatment of multibacillary leprosy 3. Treatment of catergory 1 tuberculosis 4. Treatment of Hypeension

Treatment of malaria is for 3 days. Multibacillary leprosy is treated for 12 months. Category 1 tuberculosis is treated for 6 months Hypeension treatment is life long

Mycobacterial Diseases (TB, Leprosy and MAC)


Question: Drug used in the treatment of Scorpion sting

Prazosin is α blocker used in the treatment of Scorpion sting.