Download PGI PG 2020 May Pharm Solved Question Paper

Download PGIMER (Post Graduate Institute of Medical Education & Research, Chandigarh) 2020 May Pharm Solved Question Paper

1.Allofthefollowingareactionsof
muscarinicantogonists,except:
a)Decreasegastricsecretions
b)Decreaserespiratorysecretions
c)Contractradialmusclesofiris
d)FascilitatesAVconduction
e)None
CorrectAnswer-C
Ansis'c'i.e.Contractradialmusclesofiris
Radialmusclesareinnervatedbysympatheticsystemsnotby
parasympathetic(muscarinic)system
Irismusclesthatcontrolthesizeofpupil
Therearetwotypesofmusclesiniristhatcontrolthesizeof
pupil:
1. Theirissphincterorconstrictorpupillae(circularmuscles):These
musclesareinnervatedbytheparasympatheticsystemandcause
constrictionofpupil(miosis).
2. Theirisdilatorordilatorpupillae(radialmuscles):Thesemuscles
areinnervatedbysympathetic(a,adrenergic)systemandcause
dilatationofpupil(mydriasis)
So,pupilsizemaybealteredbyfollowingmechanismsbydifferent
ANSdrugs:
A.Mydriasis(dilatationofpupil)
Sympathomimeticdrugs(a,agonists):Bycontractionofradial
muscles(dilator).
Antimuscarinicdrugs:Byblockingtheactionofcircularmuscles

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(pupillarysphincter).
B.Miosis(constrictionofpupil)
1. Parasympathomimetic(muscarinic)drgus:Bystimulatingthe
contractionofcircularmuscles(pupillarysphincter).
2. Sympatholyticdrugs(a,antagonists):Byblockingtheactionofradial
muscles(irisdilator)Aboutotheroptions
Muscarinicantagonists(antimuscarinicdrugs)decreasebothgastric
andrespiratory(bronchial)secretionsoAntimuscarinicdrugs
facilitateAVconduction(seepreviousexplanations).

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2.Whichoneofthefollowinganaesthetic
agentsdoesnottriggermalignant
hyperthermia?
a)Halothane
b)Isotlurane
c)Suxamethonium
d)Thiopentone
e)None
CorrectAnswer-D
Ans.is'd'i.e.,Thiopentone
DrugscausingMalignanthyperthermia
Succinylcholine
Enflurane
Methoxyflurane
Phenothiazines
Halothane
Sevoflurane
MAOinhibitors
Lignocaine
Isoflurane
Destlurane
TCA
SuccinylcholineisthemostcommoncauseofMH.
Amongstanaesthetics,halothaneismostcommoncause.
CombinationofSchandHalothanehasamuchhigherincidence.

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3.Whichofthefollowingstatementsisfalse
aboutAcyclovir-
a)ItinhibitsDNAsynthesisandviralreplication
b)Itiseffectiveagainstinfluenza
c)Ithaslowtoxicityforhostcells
d)Renalimpairmentnecessitatesdosereduction
e)None
CorrectAnswer-B
Ans.is'b'i.e.,Itiseffectiveagainstinfluenza
Acyclovir
Itisadeoxygunosineanalogue-inhibitsDNAsynthesisby?
1. InhibitsherpesvirusDNApolymerasecompetitively.
2. GetsincorporatedinviralDNAandstopslengtheningofDNAstrand.
TheterminatedDNAinhibitsDNApolymeraseirreversibly.
Itispreferentiallytakenupbythevirusinfectedcells.Becauseof
selectivegenerationoftheactiveinhibitorinthevirusinfectedcells
anditsgreaterinhibitoryeffectonviralDNAsynthesis,acyclovirhas
lowtoxicityforhostcells.
Itisactiveagainstherpesgroupofvirus(HSV-l>HSV-2>VZV=
EBV.CMVisnotinhibited).
Acyclovirisprimarilyexcretedunchangedinurine,bothby
glomerularfiltrationandtubularsecretion.Renalimpairment
necessitatesdosereduction.

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4.Whichofthefollowingisacommonside-
effectofCisplatin-
a)Diarrhea
b)Vomiting
c)Pulmonaryfibrosis
d)Alopecia
e)None
CorrectAnswer-B
Ans.is'b'i.e.,Vomiting
Mostcommonside-effectofCisplatinis:Vomiting(highlyemetic
drug).
Themostimportantdosedependenttoxicityisrenalimpairment.
Amifostineislabelledforreductionofcisplatininduced
nephrotoxicity.
Tinnitus,deafness,sensoryneuropathy&hlperuricaemiaareother
problems.
Shocklikestatesometimesoccurduringi.vinfusion.

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5.Trueaboutbenzodiazepineis:
a)GABAmimetic
b)GABAfacilitator
c)Notasafedrug
d)Highabsuepotential
e)Powerfulenzymeinducer
CorrectAnswer-B
Ans.is'b'i.e.,GABAfacilitator
[Ref.:KDTVh/ep.401,402&6th/ep.393;KatzungILth/ep.375;
Goodman&Gilman1Lth/ep.405]
Mechanismofactionofbenzodiazepines(BZDs):
ActsonGABA-Areceptors.
BZDsreceptorincreasetheconductanceofCl-channel.
BZDsdonotthemselvesincreaseCl-conductance,i.e.theyhave
onlyGABAfacilitatorybutnoGABAmimeticaction.(Barbiturates
havebothGABAfacilitatoryandGABAmimeticactions).

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6.Firstdosesyncopeisseenin?
a)Alphablocker
b)Betablocker
c)CCB
d)ACEinhibitors
e)Alloftheabove
CorrectAnswer-A:D
Ans.is'a'i.e.,Alphablocker&'d'i.e.,ACEinhibitors
[Ref:KDTVh/ep.565&6h/ep.546]
Firstdosehypotension(Firstdosephenomenon):
Thefirst-dosephenomenonisasuddenandseverefallinblood
pressurethatcanoccurwhenchangingfromalyingtoastanding
positionthefirsttimethatanalphablockerdrugisusedorwhen
resumingthedrugaftermanymonthsoff.
Thisusuallyhappensshortlyafterthefirstdoseisabsorbedintothe
bloodandcanresultinsyncope(fainting).
Thealphablockerprazosinisthemostnotoriousforproducingafirst
dosephenomenon.
Otherdrugsofthesamefamily,doxazosinandterazosincanalso
causethisphenomenon,thoughlessfrequently.
OtherdrugsassociatedwithitareACEinhibitors,Sargramostim&
Muromonab,CD3.

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7.Whichofthefollowingdrugisnotusedin
thetreatmentofmucormycosis?
a)Fluconazole
b)Voriconazole
c)Posaconazole
d)5-flucytosine
e)AmphotericinB
CorrectAnswer-A:B:D
Ans.is'a'i.e.,Fluconazole,'b'i.e.,Voriconazole&'d'i.e.,5-
flucytosine
[Ref:Goodman6Gilman1l,h/ep.1254;KDTVh/ep.795;
www.ncbi.nlm.nih.gov)
Amongstazole,onlyposaconazoleisactiveagainstmucormycosis
Antifungaltreatmentofmucormycosis:
First-LineMonotherapy:
Mucormycosisisaseriousinfectionandneedstobetreated
with.prescriptionantifungalmedication,usuallyamphotericinB
(giventhroughanIV),posaconazole(giventhroughanIVororally)
orisavuconazole(giventhroughanIVororally).
Fluconazole,voriconazole,anditraconazoledonothavereliable
activityagainstmucormycosis.
5-flucytosine:
Flucytosineisnotemployedasthesoletherapyexceptoccasionally
inchromoblastomycosis.
Itisusedinlimitedtothetreatmentofcryptococcalmeningitis,in
conjunctionwithAMP-B.

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8.Antibioticsactingbyinhibitionofprotein
synthesisinclude?
a)Penicillin
b)Vancomycin
c)Aminoglycoside
d)Fluroquinolones
e)Chloramphenicol
CorrectAnswer-C:E
Ans.is'c'i.e.,Aminoglycoside,&'e'i.e.Chloramphenicol
[Ref:KDT7/ep.734;Katzung13'h/ep.789]
Inhibitionofproteinsynthesis(translation):
Drugsactingbyinhibitingproteinsynthesisaretetracyclines,
chloramphenicol.aminoglycosides.Erythromycin,clindamycin,
linezolid.
Allproteinsynthesisinhibitorsarebacteriostaticexcept
aminoglycosidesandstreptograminswhicharebactericidal.
Thesedrugscanbedividedinto:
a)Basedonthestepsoftranslation(proteinsynthesis)on
whichdrugact:
Freezeinitiation:Aminoglycosides.
Inhibitelongation:Tetracyclines,puromycin,chloramphenicol.
Inhibittranslocation:Clindamycin,erythromycin.
Causingprematuretermination:Puromycin.
b)Basedonribosomeonwhichtheyact:
30SribosomezTetracycline,streptomycin.
50Sribosome:Chloramphenicol,erythromycin,clindamycin,

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Linezolid,pleuromutilins(retapamulin).
Both305and505ribosomes:Aminoglycoside(except
streptomycin).

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9.Drugscontraindicatedinmyastheniagravis
include?
a)Neostigmine
b)Neomycin
c)Edrophonium
d)Atropine
e)Paracetamol
CorrectAnswer-B:D
Ans.is'b'i.e.,Neomycin&'d'i.e.Atropine
Ref:KDTVh/ep.110&/ep.104;Katzung1Ltu/ep.107;internet
Aspirin,non-steroidalanti-inflammatorydrugs(NSAIDs)suchas
ibuprofenandnaproxen,andacetaminophen(paracetamol)are
consideredsafeforMG,thatis,theyhavenotbeenshownto
worsenMGorcausemuscleweakness.
Neostigmineisusedinmyastheniagravis.
Edrophoniumcanbeusedfordiagnosisofmyastheniagravisas
tensilontest(fordiagnosisofcholinergiccrisis).

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10.Drugswhichhavebotha&receptor
activityinclude?
a)Epinephrine
b)Nor-epinephrine
c)Phenylephrine
d)Dopamine
e)Isprenaline
CorrectAnswer-A:B:E
Ans.is'a'i.e.,Epinephrine,'b'i.e.Nor-epinephrine&'d'i.e.
Dopamine
Ref:GoodmanandGilman's12th/ep.812
Nor-adrenalinehasmainlyalphaactionwithslighteffectoncardiac
beta1receptors(alpha&beta1action).
Adrenalinehasnonselectiveactiononbothalpha(alpha1+alpha
2)&beta(beta1+beta2)receptors.
Phenylephrineisaselectivealpha1agonistandhasnegligiblebeta
action
Dopamineisadopamine(D1&D2)aswellasadrenergicalphaand
beta1agonist(Notbeta2).
Isoprenalinehasbeta(beta1+beta2action),butnoalphaaction.

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11.Sideeffectsoftricyclicantidepressants
include?
a)Diarrhea
b)Weightloss
c)Hypertension
d)Tremers
e)Urinaryretention
CorrectAnswer-D:E
Ans.is'd'i.e.,Tremors&'e'i.e.,Urinaryretention
[RelKDTVh/ep.459;Goodman&Gilmanllth/ep.448]
AdverseeffectsofTCAs:
Anticholinergic-Drymouth,badtaste,urinaryretention,blurred
vision,palpitations,constipation.
Sedation,mentalconfusion,weakness.
Increasedappetiteandweightgain.
Sweatingandfinetremor.

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12.Antiandrogenicdrugsinclude?
a)Danazole
b)Finesteride
c)Ketoconazole
d)Latrezole
e)Spironolactone
CorrectAnswer-B:C:E
Ans.is'b'i.e.,Finasteride,'c'i.e.Ketoconazole&'e'i.e.
Spironolactone
[Ref:KDTVh/ep.858,302;Harrison18th/ep.802,803]
Antiandrogensdrugs:
5-alpha-reductaseinhibitors:
Thesedrugsinhibittheenzyme5-alpha-reductasewhichconverts
testosteroneintomoreactivedihydrotestosterone.
Thesedrugsarefinasterideanddutasteride.
Theseareusedinbenignprostatichypertrophy,hirsutismandrnale
patternbaldness.
Sideeffectsaredecreasedlibido,impotence,skinrashandswelling
oflips.
Note:-
Finasterideselectivelyinhibitstype-25alpha-reductase,whereas
dutasterideinhibitsbothtype-1andtype-25-alphareductases.
Otherdrugswithantiandrogenicactionare:
SuperactiveGnRHagonists,spironolactone,cimetidine,
progesteroneandketoconazole.

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13.Dopamineatthedoseof8?g/kg/min
produces?
a)Increasedsystemicvascularresistance
b)Decreasedsystemicvascularresistance
c)Renalvasodilatation
d)Increasedstrokevolume
e)Increasedheartrate
CorrectAnswer-A:C:D:E
Ans.is'a'i.e.,Increasedsystemicvascularresistance,'c'i.e.
Renalvasodilation,'d'i.e.Increasedstrokevolume&
'e'i'e..Increasedheartrate
[Ref:Modernpharmacologywithclinicalapplication2d/ep.208;
KDTVh/ep.426;KatzungLlth/ep.139)
Dopamine:
Itisadopamine(D1&D2)aswellasadrenergicalpha&beta1
agonist(notbeta-2).
TheD1receptorsinrenalandmesentericbloodvesselsarethe
mostsensitive.
I.v.infusionoflowdose(1-5microgram/kg/min)ofdopaminedilates
thesevesselsbyraisingintracellularcAMp.
Moderatelyhighdosesproduceapositiveionotropiceffect(direct
beta1&D1action+duetoNArelease),butlittlechronotropic
effectonheart).
Theadvantageofthisgreaterinotropiceffect(increasedforceof
contraction)thanchronotropiceffect(increasedheartrate)of
dopamineisthatitproducessmallerincreaseinoxygendemandby

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theheart.
Largedoses(>10microgram/kg/minproducevasoconstriction
(alpha1action).
Athighdoses,itiscalledinoconstrictorbecauseithasinotropicand
vasoconstrictoreffect.

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14.Antiviraldrug(s),whichis/areapro-drug?
a)Acyclovir
b)Ganciclovir
c)Ziduvudin
d)Tenofovir
e)Foscarnet
CorrectAnswer-A:B:C
Ans.is'a'i.e.,Acyclovir,'b'i.e.Ganciclovir&'c'i.e.Zidovudine
[Ref.KDT7/ep.22&p.24;GoodmanGillmanp.534:Bennet
Brownclinicalpharmap.404;Katzungp.361,385;
ww.ncbi.nlm.nih.gov]
Anti-herpesvirus:Acyclovir,Valacyclovir.penciclovir,Famciclovir,
Garciclovir,valganciclovir.
Anti-Retrovirus:Nucleosidereversetranscriptaseinhibitors
(NRTIs)-Zidovudine,Didanosine.Zalcitabine,Stavudine,amirudin,
Abacavir.
Foscametisunrelatedtoanynucleicacidprecursor,sodoesnot
requirephosphorylationforactivation.
Tenofovirisanucleotideanddoesnotrequirebioactivationby
kinases.
Oralbioavailabilityoftenofovirincreaseswithmeals(decreasedfor
otherNRTIs).

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15.Diureticdrugswhicharecarbonic
anhydraseinhibitorsinclude?
a)Acetazolamide
b)Spironolactone
c)Furesemide
d)Chlorthiazide
e)Topiramate
CorrectAnswer-A:E
Ans.is'a'i.e.,Acetazolamide&'e'i.e.Topiramate
Ref:KDT7/ep.5g7,420,155;Katzung13h/ep.255]
Carbonicanhydraseinhibitors(acetazolamide):
Carbonicanhydrase(CAse)isanenzymewhichcatalyzesthe
reversiblereactionofbicarbonateformation.
Theenzymeispresentinrenaltubularcells(specialtyPT),gastric
mucosa,exocrinepancreas,ciliarybodyoftheeye,brainandRBC,
Acetazolamide,dichlorphenamide,methazolamideandtopiramate
arecarbonicanhydraseinhibitors.
Dorzolamide&Brinzolamideisalsoacarbonicanhydraseinhibitors
specificforCA-II.
Carbonicanhydraseinhibitorsactbyanon-competitive,reversible
inhibitionoftheenzymecarbonicanhydrase.
Asinhibitionisreversible,actionofcarbonicanhydraseinhibitorsis
selflimiting.

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16.Drugswhichareusedinacuteasthma
include?
a)Budesonide
b)Terbutaline
c)Salbutamole
d)Theophylline
e)Sodiumcromoglycate
CorrectAnswer-B:C:D
Ans.is'b'i.e.,Terbutaline,'c'i.e.Salbutamole&'d'i.e.
Theophylline
[Ref:KDTVh/ep.223]
Treatmentofacuteasthma:
Theonlydrugseffectiveforthetreatmentofacuteattackofasthma
arebronchodilators(beta2-receptoragonists,anticholinergics,and
methylxanthines).
Mildattacks:
Forpatientswithmildattackinhalationofashortactingbeta-2
receptoragonist,e.g.salbutamol(albuterol),terbutalineisused.
Aninhaledanticholinergic,e.g.ipratropiummaybeaddedifthereis
nosatisfactoryresponsetobeta2-agonistsalone.
Inpatientswhoarerefractorytoinhaledtherapies,i.v.aminophylline
(theophylline)maybeeffective.
Severeattacks:
Oxygenphtscontinuousadministrationofaerosolizedsalbutamol
(albuterol)plussystemicsteroids,e.g.methylprednisolone,
hydrocortisone.

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Recently,MgSO4hasbeentriedinacutesevereasthmabyIVor
inhalationroute.

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17.Antiplateletdrugswithadenosine
receptorinhibitionpropertyinclude?
a)Ticlopidine
b)Clopidogrel
c)Prasugrel
d)Abciximab
e)Cilastazole
CorrectAnswer-A:B:C
Ans.is'a'i.e.,Ticlopidine,'b'i.e.Clopidogrel&'c'i.e.Prasugrel
Ref:KDTVh/ep.629&6h/ep.609;KatzunglLth/ep.598
ADPmediatedplateletactivationthroughcAMPisinhibitedby
(antagonismofP2Y12)receptorsonADP:-
Irreversible:Ticlopidine.clopidogrel.prasugrel
Reversible;Cangrelor,ticagrelor

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18.Drugswithfirstorderkineticsshow?
a)Increasedclearancewithincreaseinconcentration
b)Decreasedeliminationwithconcentration
c)Norelationrateofeliminationandconcentration
d)Constantfractionofdrugiseliminatedperunittime
e)Halfliferemainsconstant
CorrectAnswer-A:D:E
Ans.is.a,i.e.,Increasedclearancewithincreasein
concentration,'d'i.e.constantfractionofdrugiseliminatedper
unittime&'e'i.e.Halfliferemainsconstant
[Ref:KDTp.31;Katzung13th/ep48]
Orderofkinetics:
Therateatwhicheliminationtakeplaceissubjectedtoimportant
influencesthatarereferredtoasorderofkinetics
Therearetwoordersofsuchelimination:
Firstorderkinetic(LinearKinetics)
Secondorderkinetic(Non-LinearKinetics)
Infirstorderkinetic,
Rateofeliminationdirectlyproportionalplasmaconcentration.
Clearanceremainsconstantbecause,astheplasmaconcentration
Increasestherateofeliminationincreasesproportionately(CL=rate
ofelimination/PlasmaConc).
HaIfliferemainsconstantbecausetimerequiredtoreducethe
plasmaconcentrationtohalfissame(rateofelimination).

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19.Whichofthefollowingis/aretrueabout
pregabalin:
a)Approveddrugfordiabeticneuropathy
b)Approvedfortreatmentofgeneralizedtonicclonicseizure
c)Peripheraledemaissideeffect
d)Somnolenceissideeffect
e)ApprovedforuseinPartialseizure
CorrectAnswer-A:C:D:E
Ans.a.ApproveddrugForDiabeticneuropathy;c.Peripheral
edemaissideeffect;d.Somnolenceissideeffect;e.Approved
foruseinpartialseizures.
[RefKDT7th/419;Katzung13th/4M,419;Harrisontgth/2682;
PharmacologybySatoskar24th139)
Pregabalinside-effectincludes:Cognitivechanges,sedation&
peripheraledema.
GABAanalog.
Antiseizureactivityandforitsanalgesicproperty.
Approvedforuseinneuropathicpain,includingpainfuldiabetic
peripheralneuropathy,postherpeticneuralgia&complexregional
painsyndrome.
Toxicityincluded-Somnolence,dizziness,ataxia

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20.Drug(s)usedforoveractivebladder:
a)Oxybutinin
b)Tolterodine
c)Mirabegron
d)OnabotulinumtoxinA
e)Pirenzepine
CorrectAnswer-A:B:C:D
Ans.a.Oxybutynin;b.Tolterodine;c.Mirabegron;D.
OnabotulinumtoxinA
[R4KDf7th/117-18;Katzung13th/127-28;Rang&Date8th/366;
PharmacologybySatoskar24th/3OS-07]
OveractiveBladder:
AntimuscarinicdrugssuchasOxybutynin,Flavoxate,tolterodine&
trospiumareusedforbothneurogenic&non-neurogenicoveractive
bladder.
Sollfenacin&darifenacinarethenewdrugs(M3antagonist)foruse
inoveractivebladder.
Mirabegronisbeta-3adrenergicagonistusedforoveractivebladder.
OnabotulinumtoxinAisusedassingleintradetrusorinjection,to
treatoveractivebladder.

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21.Allaretrueaboutwarfarinexcept:
a)ActthroughinhibitionofcoagulationfactorIX
b)Protaminesulphatereversesitsaction
c)MonitoringisdonethroughINR
d)TargetofINRwithwarfarinisgenerally2-3
e)Skinnecrosisisusuallyoccurin3-10daysofinitiationof
warfarin
CorrectAnswer-B
Ans:b.Protaminesulphatereversesitsaction.
[RefKDT7th/620-24;Katzung13th/590-92;Rang&DaleSth/30q
PharmacologybySatoskar24th/jN-301]
Warfarininducedskinnecrosisisararecomplicationcharacterized
bytheappearanceofskinlesion3-10daysafterinitiationof
treatment.
DoseofwarfarinadjustedtogiveanINRof2-4,theprecisetarget
dependingontheclinicalsituation.
Thereferencerangeforprothrombintimeisusuallyaround12-13
secondsandtheINninabsenceofanticoagulationtherapyis0.8-1.
2
Warfarin:Doseregulationisdonebyprothrombintime&INR
(Heparin/aPTT/clottingtime.
AntagonistisVitK(c.fHeparin-Protaminesulphate).

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22.TrueaboutM/Aofdoxorubicin:
a)Intercalateb/wDNAstrands
b)InhibitionofDNApolymerase
c)InhibitionofRNApolymerase
d)InhibitionoftopoisomeraseII
e)Inhibitionofproteinsynthesis
CorrectAnswer-A:D
Ans.A.Intercalateb/wDNAstrands;D.InhibitionOf
TopoisomeraseII
[Ref:KDT7th/867;Katzung13th/932'j5;G6G1lth/1358;
PharmacologybySatoskar24th/835)
Doxorubicin:Itactsasanon-specificinhibitoroftopoisomerase-II,
thusinterferingwithDNAreplication.

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23.Anticholinergicdrugside-effectincludes:
a)Constipation
b)Urinaryretention
c)Mydriasis
d)Hypothermia
e)Blurringofvision
CorrectAnswer-A:B:C:E
Ans:A.Constipation.B.UrinaryretentionC.MydriasisE.
Blurringofvision
[Ref:KDT7th/120;GdzG11th/194;Katzung13th/129;Rang&
Dale\th/164-65;PharmacologybySatoskar24th/301).
Bodytemperatureisfrequentlyelevated.
Unfortunately,children,especiallyinfants,areverysensitiveto
hyperthermiceffectsofatropine.
Constipation&urinaryretention(precipitationespeciallyinelderly)
canoccurwithatropine
Difficultyinswallowing,drymouth,ferer,dry-flushed&hotskin,
difficultyinmicturition,Mydriasis,photophobia,blurringofnear
vision,palpitations,dreadfulvisualhallucination,ataxia,delirium,
psychoticbehavior,weak&rapidpulse,hypotension,
cardiovascularcollapsewithrespiratorydepression,convulsion&
coma.

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24.Whichofthefollowingis/aretrueabout
benefitsofSustainedreleaseformulation
ofdrugs:
a)Decreasedincidenceand/orintensityofundesiredeffects
b)Increasespotencyofthedrug
c)ReleaseofdrugislessinfluencedbypH
d)Prolongdrugeffect
e)Decreasedfrequencyofadministration
CorrectAnswer-A:C:D:E
AnsA.DecreasedIncidenceand/orIntensityofundesired
effects;c.ReleaseOfDrugIsLessInfluencedBypH;D.
Prolongdrugeffect;E.DecreasedFrequencyofadministration.
[Ref:KDf7th/35;G6'G11th/5;PharmacologybySatoskar24th/7;
http://www.pharmatutor.org/articles/review-sustained-release-
dosage'forms).
Sustainedreleaseimpliesslowreleaseofthedrugoveratime
period.
Itmayormaynotbecontrolledrelease
Advantagesofsustainedreleasedosageforms:
Controlofdrugtherapyisachieved.
Rateandextentofdrugabsorptioncanbemodified
Frequencyofdrugadministrationisreduced.
Patientcompliancecanbeimproved.
Drugadministrationcanbemadeconvenient
Maximizingtheavailabilityofdrugwithminimumdose.
Thesafetymarginofhighpotencydrugcanbeincreased.

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25.Trueaboutdrug-responsecurve(DRC):
a)SteepestinmiddleportionoftheDRC
b)InvertedUshapedcurvemaybeforsomedrug
c)Rectangularhyperbola-whenplottedinlogarithmicscale
d)Sigmoidshape-whenplottedinlogarithmisused
e)Enablescomparisonofpotencyofdrugs
CorrectAnswer-A:B:C:E
Ans.(A)SteepestinmiddleportionoftheDRC(B)InvertedU
shapedcurvemaybeforsomedrug(C)Rectangularhyperbola-
whenplottedinlogarithmicscale(E)Enablescomparisonof
potencyofdrugs
Dose-ResponseRelationship:
Rectangularhyperbola.
Sigmoidalcurveindose-responserelationship:thesteepestportion
inthemiddle-wiki.
DRCisusedtomeasure-drugpotency,drugefficacy&drugsafety-
slideshare.
Somedrugscauselow-dosestimulationandhigh-doseinhibitionof
response.
TheseU-shapedrelationshipsforsomereceptorsystemsaresaidto
displayhormesis.
Severaldrug-receptorsystemscandisplaythispropertye.g.,
prostaglandins,endothelin,andpurinergicandserotonergic
agonists,amongothers),whichislikelytobeattherootofdrug
toxicity.

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26.Trueaboutorganophosphoruspoisoning:
a)Atropineisbestforearlytreatment&maintenance
b)Pralidoximeisimportantforrestoringneuromuscular
transmission
c)Phenytoinistheprimarydrugusedforseizurecontrol
d)Mydriasispresent
e)Pralidoxime&atropineworkssynergistically
CorrectAnswer-A:B:E
Ans.(A)Atropineisbestforearlytreatment&maintenance
(B)Pralidoximeisimportantforrestoringneuromuscular
transmission(E)Pralidoxime&atropineworkssynergistically
[RefReddy32nd/495-97;G&Gltth/21};KDT7th/111:13th/979-80;
PharmacologybySatoskar24th/297]
OrganophosPhorusPoisoning:
AIIcaseofAnti-ChEpoisoningmustbepromptlygivenatropine2
mgi.Vrepeatedevery10mintilldryness&othersignsof
atropinizationappear.
Continuedtreatmentwithmaintenancedosesmayberequiredfor1-
2weeks
Theuseofoximesinorganophosphatepoisoningissecondaryto
thatofatropine.Moreventheclinicalbenefitofoximesishighly
variable.
Controlofconvulsionswithjudicioususeofdiazepam.
Ocularmanifestationsincludemarkedmiosis'ocularpain'
conjunctivalcongestion,diminishedvision,ciliaryspasm,Andbrow
ache.
Atropineinsufficientdosageeffectivelyantagonizestheactionsat

---

muscarinicreceptorsites,andtoamoderateextentatperipheral
ganglionicandcentralsites

---

27.Whichofthefollowingdrug(s)actby
inhibitingproteinsynthesisbyattaching
to50Sribosome:
a)Tetracycline
b)Ampicillin
c)Isoniazid
d)Imipramine
e)Ethionamide
CorrectAnswer-B:C
Ans.(B)Ampicillin(C)Isoniazid
[KDT7th/734,768;Katzung13th/789]
Tetracyclinesbindto30Sribosome&inhibitaminoacylRNA
attachmenttotheAsite
Erythromycin&clindamycinbindto50Sribosome&hinder
translocationoftheelongatedpeptidechainbackfromAsitetoP
site.PeptidesynthesismaybeprematurelyTerminated.
ChloramPhenicolbindsto50Ssubunit'Itinterferewithpeptidebond
formation&transferofpeptidechainfromPsite
Aminoglycosidesbindtoseveralsitesat30S&50Ssubunits-freeze
initiation,interferewithpolysomeformation&causemisreadingof
mRNAcode

---

28.OCPefficacydecreaseswithconcurrent
administrationofwhichofthefollowing
drug(s):
a)Phenytoin
b)Ampicillin
c)Isoniazid
d)Imipramine
e)Ethionamide
CorrectAnswer-A:B
Ans.(A)Phenytoin(B)Ampicillin
[RefKDT7th/326;Katzung13th/712;Rang&DaIe9th/434:
PharmacologybySatoskar24th/967).
Contraceptivefailuremayoccurwithconcurrentadministration
of:
Enzymeinducer:Phenytoin,phenobarbital,primidone,
carbamazepine,rifampin,ritonavir-Metabolismofestrogenic&
progestationalcomponentisincreased.
Tetracyclines-ampicillin.
Deconjugationofestrogenssecretedinbilefailstooccurtheir
enterohepaticcirculationisinterruptedbloodlevelfal

---

29.Allaretrueabouttamoxifeneexcept:
a)Usedasadjuvanttherapyinestrogenreceptorpositivebreast
cancer
b)Approvedfortheprimaryprophylaxisofbreastcancerinhigh
riskwoman
c)Noeffectonuterus
d)Pro-estrogeneffectonbone
e)CauseendometrialCa
CorrectAnswer-A:C:D:E
Ans.(A)Usedasadjuvanttherapyinestrogenreceptorpositive
breastcancer(C)Noeffectonuterus(D)Pro-estrogeneffecton
bone(E)CauseendometrialCa
[Ref;KDT7th/101'02;Katzung13th/106]
NMislocatedinneuromuscularjunction6causedepolarizationof
muscleendPlate
NNlocatedonautonomicganglia,adrenalmedulla&CNS
Mostsmoothmuscles&glandshaveM26M3subtypes;M3
Predominates.
Achisamajorneurotransmitteratautonomic,somaticaswellas
centralsites.ReleaseofAchfromnerveterminalhelpinsynaptic
transmission

---

30.
Whichoffollowingtrueregarding
acetylcholinereceptors:
a)M2receptor-heart
b)MIreceptor-smoothmuscle
c)NMreceptorispresentonneuromuscularjunction
d)Synapticjunction-Achistransmitter
e)NNlocatedonadrenalmedulla
CorrectAnswer-A:C:D:E
Ans.(A)M2receptor-heart(C)NMreceptorispresenton
neuromuscularjunction(D)Synapticjunction-Achis
transmitter(E)NNlocatedonadrenalmedulla
[Ref;KDT7th/101'02;Katzung13th/106]
NMislocatedinneuromuscularjunction6causedepolarizationof
muscleendPlate
NNlocatedonautonomicganglia,adrenalmedulla&CNS
Mostsmoothmuscles&glandshaveM26M3subtypes;M3
Predominates.
Achisamajorneurotransmitteratautonomic,somaticaswellas
centralsites.ReleaseofAchfromnerveterminalhelpinsynaptic
transmission

---

31.Antibioticofchoicefor
Stenotrophomonasmaltophiliainfection
is:
a)Ampicillin
b)Trimethoprim-sulfamethoxazole(TMP-SMX)
c)Penicillin
d)Ciprofloxacin
e)None
CorrectAnswer-B
Ans:b.Trimethoprim-sulfamethoxazole(TMP-SMX)

---

32.TNF-aInhibitorsareusedfor:
a)Ulcerativecolitis
b)Crohn'sdisease
c)Rheumatoidarthritis
d)Psoariasis
e)Lichenplanus
CorrectAnswer-A:B:C:D
Ans.A,UlcerativecolitisB,Crohn'sdiseaseC,Rheumatoid
arthritisD,Psoariasis
[RefHanison19th/1961;NeenaKhanna5th/58,68;CMDT2016/641;
KDT7th/883-84).
TNF-alphaInhibitors:Use
Etanercept-Rheumatoidarthritis,severe/refractoryankylosing
spondylitis,plaquepsoriasis,polyarticularidiopathicjuvenilearthritis.
Infliximab-refractoryrheumatoidarthritis,ankylosingspondylitis,
psoriasis,fistulatingCrohn'sdisease,ulcerativecolitis
Adalimumab-Useaslikeinfliximab
Certolizumab-Crohn'sdisease
Golimumab-ulcerativecolitisPsoriasis:TreatmentincludesTNF
blockerslikeetanercept,infliximab.

---

33.S/EofBevacizumabincludes:
a)Hypertension
b)Hemoptysis
c)Malena
d)Cerebellarstroke
e)Notcausegastrointestinalperforation
CorrectAnswer-A:B:C:D
Ans.A,HypertensionB,HemoptysisC,MalenaD,Cerebellar
stroke
[Ref:KDT7th/871:Katzung13th/937-38;Rang&Dale8th/;
PharmacologybySatoskar24th/840).
S/EofBevacizumab:
Hypertension
Arterialthromboembolism-heartattack6stroke
Vesselinjury6haemorrhages
Heartfailure
Proteinuria
Gastrointestinalperforation
Healingdefect

---

34.Trueaboutmethanolpoisoning:
a)Gastricdecontaminationishelpful
b)Formate&formaldehydeareactivemetabolite
c)TakingwithEthanolcausemoretoxicity
d)Fomipezoleaspecificantagonist,isgivenfortreatment
e)Causehighaniongapacidosis
CorrectAnswer-A:B:D:E
Ans.A,GastricdecontaminationishelpfuB,Formate&
formaldehydeareactivemetaboliteD,Fomipezoleaspecific
antagonist,isgivenfortreatmentE,Causehighaniongap
acidosis
[Ref:KDT7th/394-96;Katzung13th/393;Pharmacologyby
Satoskar24th/9s-96).
TreatmentofMethylAlcohol
Fomepizole,analcoholdehydrogenaseinhibitor,isapprovedforthe
treatmentofethyleneglycolpoisoningandmethanolpoisoning.
Ethanolusedintravenouslyastreatmentformethanolpoisoning.
Methanolconcentrationshigherthan50mg/dlarethoughttobean
absoluteindicationforhemodialysisandtreatmentwithfomepizole
orethanol,althoughformatebloodlevelsareabetterindicationof
clinicalpathology.
Hospitalisation,nursingcare
Gastriclavage,activatedcharcoal
Treatmentofacidosis/hypoglycemia
Inhibitionofmethanolmetabolism-Givingethylalcoholdtfomepizole
(aspecificinhibitorofalcoholdehydrogenase&drugofchoicefor
methanolpoisoning)

---

Promotemetabolicdegradationofformate:folinicacidtogetherwith
folicacid
Diuretics,urinealkalinisation
Hemodialysisinseverecase
Maintenanceofnutrition

---

35.Whichofthefollowingistrueregarding
ropinirolewrtL-dopa:
a)Cognitivesymptomimproves
b)Lowerincidenceofhallucination
c)Causeexcessivesleepiness
d)Moreeffectiveinthetreatmentofpatientswhohavedeveloped
on/offphenomena
e)Provideneuroprotectiveeffect
CorrectAnswer-C:D:E
Ans.C,CauseexcessivesleepinessD,Moreeffectiveinthe
treatmentofpatientswhohavedevelopedon/offphenomena
E,Provideneuroprotectiveeffect
[Ref:KDT7th/430-31;G&G535-j8;Katzung13th/478;Rang6Date
8th/494-95;PharmacologybySatoskar24th/237
Allthedopamineagonistsinlargerdosescancoutetevere
neuropsychiatricadverseeffects.
Ropinirole&Pramipexole
SelectiveD2/D1receptoragonists
Bettertolerateddtdonotshowthefluctuationsinefficacyassociated
withlevodopa.
Theydo,however,causesomnolence6sometimeshallucinations
(recentevidencesuggeststhattheymaypredisposetocompulsive
behaviours,suchasexcessivegambling,overeating6sexual
excess,relatedtotherewardfunctionsofdopamine
Adisadvantageofcurrentdopamineagonistsistheirshortplasma
halfLife(6-8hr),requiring3timesdailydosagethoughslowrelease

---

oncedailyformulationsarenowavailable
Trialhavefoundthemtoaffordsymptomreliefcomparableto
levodopa.
Sometrialshavenotedlowerincidenceofdyskinesias6motor
fluctuationsamongPatientstreatedwiththesedrugsthandose
treatedwithlevodopa
Itislongeractingthanlevodopa.
Highincidenceofhallucination&sleepiness

---

36.Whichofthefollowingdrug(s)comesin
riskcategoryBofFDAteratogenicrisk
categoriesforpregnancy:
a)Phenytoin
b)Resperidone
c)Olanazapine
d)Clozapine
e)Arpirazole
CorrectAnswer-D
Ans.D.Clozapine
[Ref:KDT7th/90;Katzung13th/1018;Rang6Dale8th/700;
PharmacologybySatoskar24th/1122;http://schizophreniabulletin-
oxfordjournal]
CategoryA:
Norisktofetusinhumanstudies
Levothyroxine
Potassium
Supplementation
MgSO4
CategoryB
Animalstudiesshownorisk
Humanstudiesarelacking
Penicillins
Cephalosporins
Macrolides
Brimonidine

---

CategoryC
AnimalstudiesshowPositiveteratogenicrisk
Humanstudiesarenotavailable
Albuterol
Zidovudine
CCB
Morphine
Atropine
CategoryD
Humanandanimalstudiesshowpositiveteratogenicrisk
Canbeusedinpregnancybecauseofbenefitsgreaterthanrisk
mightbeacceptable.
Corticosteroids
Azathioprine
Carbamazepine
Valproate
Methotrexate
Lithium
CategoryX
Humanandanimalstudiesshowpositiveteratogenicrisk
Absolutelycontraindicatedinpregnancybecauseofriskgreaterthan
benefits.
Thalidomide
isotretinoin
Fluoroquinolones
Tetracyclines
Chloramphenicol
Warfarin
ACEinhibitors

---

37.Whichofthefollwingis/areactionof
estrogenexcept:
a)Developmentofthealveolarsystem
b)Proliferationofstromaofbreast
c)Ductalgrowthofthebreast
d)CBoneresorption
e)Developmentoflobulesofbreast
CorrectAnswer-A:E
Ans.(A)Developmentofthealveolarsystem(E)Development
oflobulesofbreast
Oestrogencausesonlyductdevelopment.
Progesteroneisresponsibleforglandulardevelopment.
Itpromotesthegrowthofthelobulesandalveolartissueinbreast.
Promotesthedevelopmentofthealveolar(acinar)systemofthe
breast
Estrogen-functions:
Importantinmaintainingbonemassprimarilybyretargetingbone
resorption.
Producedatpubertycausegrowthofbreastsproliferationofducts
andstroma,accumulationoffat.
Stimulatestromaldevelopmentandductalgrowthinthebreast
Contributetothegrowthofaxillaryandpubiahair.
Pigmentationintheskin,mostprominentintheregianofthenipplas
andareolae.
Continuousexposuretoestrogensforprolongedperiodsleadsto
hyperplasiaoftheendometrium.

---

Decreasetherateofresorptionofbonebypromotingapoptosisof
osteoclastsandbyantagonizingtheosteoclastogenicandpro-
osteoclasticeffectsofparathyroidhormoneandinterleukin-6.

---

38.Allaretrueaboutbisphosphonatesexcept
:
a)Preventreabsorptionofbonebyosteoclast
b)Structurallysimilartopyrophosphate
c)Absorptionincreaseswithfood
d)Canbesafelygiveninliverdisease
e)None
CorrectAnswer-C
Ans.C.Absorptionincreaseswithfood
Bisphosphonates(BPNs):
BPNsareanalogiesofpyrophosphate;carbonatomreplacing
orygenintheP-O-Pskeleton
AlloralBNPsarepoorlyabsorbedandproducegastricirritationas
majorsideeffect.
Theyinhibitsboneresorptionandhaverecentlyattracted
considerableattentionbecauseoftheirabilitytoprevent
osteoporosisinadditiontotheirusefulnessinmetabolicbone
diseasesandhypercalcemia.
MOA:Localizetoregionsofboneresorption&exerttheirgreatest
effectsonosteoclasts.
Foodreducesabsorptionevenfurther,necessitatingtheir
administrationonanemptystomach.
Nearlyhalfoftheabsorbeddrugaccumulatesinbone;the
remainderisexcretedunchangedintheurine.
Decreasedrenalfunction,esophagealmotilitydisorders&peptic
ulcerdiseasearethemaincontraindications.

---

---

39.Whichofthefollowingis/arenewerdrugs
forTB:
a)Bedaquiline
b)Clofazimine
c)Coftaroline
d)Rifapentine
e)Etanercept
CorrectAnswer-A:B:D
Ans.(A)Bedaquiline(B)Clofazimine(D)Rifapentine
NewerAnti-TBdrugs:
CommunityMedicinewithRecentAdvancesbySuryakantha
4ed/371
Rifabutin
Rifapentine-400mgtwiceweekly.
Macrolides:Roxithrornycin,Clarithromycin,Azithromycin
Amikacin
Fluoroquinolones:Ciprofloxacin,ofloxacinandsparfloxacin
B-lactamantibiotic:trialsaregoingonwithamoxicillin-clavulanic
acid
Clofazimine-200mg/d
Paromomycin
Cytokineimmunotherapy:IL-2,cytokinegammainterferonand
cytokineIL-12
Bedaquiline-Multi-drugresistanttuberculosis(MDR-TB)-400mg/d

---

40.Allaretrueaboutoralirontherapyin
anemiaexcept:
a)Mayworseninflammatoryboweldisease
b)Ittakesminimum2weeksforreticulocytecounttoincrease
c)Generally3-6monththerapyisrequiredtoreplenishironstores
d)Gastrointestinalside-effectslimitsitsdose
e)Hblevelisgenerallyattainedin1-3month
CorrectAnswer-B
Ans.B.Ittakesminimum2weeksforreticulocytecountto
increase
OralironTherapy:
Followingoraliron,normalHblevelisusuallyobtainedwithin1to3
months.
DependingmainlyontheinitialHblevel.
Itisimportant,however,tocontinuewiththetherapyfor12-20
weeksaftertheHblevelhasreturnedtonormal,inordertoreplenish
thedepletedironstores.
Thereticulocytecountintheperipheralbloodbeginstorisewithina
week,reachesapeakat10to14daysandreturnstonormalafter3
weeks
AdverseEffectsofOraliron:
Epigastricpain,heartburn,nausea,vomiting,bloatingstainingof
teeth,metallictaste,col:la,
Alterationofintestinalflora.
Gastricirritationandconstipation.
TreatmentofironDeficiency:

---

Abilityofthepatienttotolerateandabsorbmedicinaliron.

---

41.DrugthatcanpotentiateTorsadesde
pointes:
a)Amiodarone
b)Sotalol
c)Chlorpromazine
d)Cisapride
e)Aspirin
CorrectAnswer-A:B:C:D
Ans,A,AmiodaroneB,SotalolC,Chlorpromazine&D,Cisapride
TorsadesdePointes(VentricularTachycardia)
Antiarrhythmics:
Quinidine,procainamide,disopyramide,propafenone,amiodarone
Antimalarials:
Quinine,mefloquine,artemisinin,halofantrine
Antibacterials:
Sparfloxacin,moxifloxacin
Antihistamines:
Terfenadine,astemizole,ebastine
Antidepressants:
Amitriptylineandothertricyclics.
Antipsychotics:
Thioridazine,pimozide,aripiprazole,ziprasidone
Prokinetic:
Cisapride

---

42.Drugwhichcanbegivenbyinhalation
route:
a)Zileuton
b)Steroid
c)Salbutamol
d)Tobramycin
e)None
CorrectAnswer-B:C
Ans.(B)Steroid(C)Salbutamol
lnhalatlonalsteroids.Beclomethasone,dipropionate,budesonide,
fluticasonepropionate,flunisolideandciclesonide.
Salbutamol:usedinformoforal,i.m/s.candinhalation.
Zileuton:Itisavailableonlyasextendedrelease(oral)formulation.
Tobramycin:Usedinformofi.m/i.v,eyedrop

---

43.Liverfunctiontest(LFT)monitoringis/are
requiredinuseofwhichofthefollowing
DiseaseModifyingAntirheumaticDrugs
(DMARDs):
a)Methotrexate
b)Hydroxychloroquine
c)Sulfasalazine
d)Leflunomide
e)Gold
CorrectAnswer-A:D:E
Ans.(A)Methotrexate(D)Leflunomide(E)Gold
DMARDsUsedforthetreatmentofrheumatoidarthritis:
Hydroxychloroquine-Funduscopicandvisualfieldtestingevery12
months.
Sulfasalazine-CBCevery2-4weeksforthefirst3months,then
every3months
Methotrexate&Leflunomide-CBC,creatinine,LFTsevery2-3
months
Tocilizumab-CBCandLFTsatregularintervals

---

44.Trueabouteffectofsteroidintakein
inflammatoryconditions:
a)Proanaboliceffectonmuscles
b)Tglucoseinplasma
c)-vefeedbackoncorticotropin-releasinghormone(CRH)
production
d)Maycauseosteoporosis
e)None
CorrectAnswer-B:C:D
Ans.B,TglucoseinplasmaC,-vefeedbackoncorticotropin-
releasinghormone(CRH)production&D,Maycause
osteoporosis
Glucocorticoids:
GivenchronicallysuppressthepituitaryreleaseofACTH
Glucocorticoidsincreaseserumglucoselevel.
GlucocorticoidsstimulateRNAandproteinsynthesisintheliver,
theyhavecatabolicandantianaboliceffectsintymphofuland
connectivetissue,muscla,peripheralfat'andsldn.
CortisolhasanegativefeedbackonACTHandCRHproduction.

---

45.Drugswhichcanbeusedingestational
hypertension:
a)Metoprolol
b)Labetalol
c)Methyldopa
d)Sustainedreleasenifedipine
e)Losartan
CorrectAnswer-A:B:C:D
Ans.(A)Metoprolol(B)Labetalol(C)Methyldopa(D)Sustained
releasenifedipine
Antihypertensiveagentsusedinpregnancy:Methyldopa,
lrydralazlne,labetalol,Nifedipine,atenolol.

---

46.Trueaboutosmoticdiuretics:
a)Osmoticdiureticshavetheirmajoreffectinthedistal
convolutedtubule
b)Contraindicatedincongestiveheartfailure
c)CausesHyperkalemia
d)Increasesrenalbloodflow
e)None
CorrectAnswer-B:C:D
And.B,ContraindicatedincongestiveheartfailureC,Causes
Hyperkalemia&D,Increasesrenalbloodflow
OsmoticDiuretics:
Majoreffectintheproximaltubuleandthedescendinglimbof
Henle'sloop.
InhibitsTransportprocessesinthethinkAscLH.
Uses:
Usedtoincreasewaterexcretioninpreferencetosodiumexcretion.
ExtracellularVolumeexpansion-Effectcancomplicateheartfailure
andmayproducefloridpulmonaryedema-ContraindicatedinCHF.
Causesdehydration,Hyperkalemia,andHypernatremia
Headache,nausea&vomitingarecommonlyobservedinpatients
treatedwithosmoticdiuretics.

---

47.Whichofthefollowingdyadsshow
clinicallysignificantdruginteractions:
a)Vancomycin--AmphotericinB
b)Rantidine-Atorvastatin
c)Warfarin--Aspirin
d)Allopurinol--Azathioprine
e)Aminoglycoside+Vancomycin
CorrectAnswer-A:C:D:E
Ans.A,Vancomycin--AmphotericinBC,Warfarin--
AspirinD,Allopurinol--Azathioprine&
E,Aminoglycoside+Vancomycin
Druginteraction:
Drugsmayinteract,butmostcanbecategorizedas
pharmacoKInetic(absorptiondistribution,metabolism,excretion),
phartnacodlmamla(aMitiveorantagonisticeffects),orcombined
interactions.
Eg:
Aminoglycosides,vancomycin,cyclosporineandothernephrotoxic
drugenhancetherenalimpairmentcausedbyamphotericinB
Allopurinolinhibitsthedegradationofi-mercaptopurineand
azathioprine;theirdosesshouldbereducedto?.
Enhanced'anticoagulantactionofwarfarin:
HighdosesoFsalicylateshavesynergistichypoprothrombinemic
action&alsodisplacewarfarinfromproteinbindingsite.

---

48.Adverseeffectsofmirtazapineis/are:
a)Insomnia
b)Sedation
c)Sexualdysfunction
d)Vomiting
e)Weightgain
CorrectAnswer-B:E
Ans.(B)Sedation(E)Weightgain
Mirtazapine
Importantadversedrugreactions
markedsedation
increasedappetite
weightgain
Somnolence(mostcommon)
Drymouth
Constipation
Dizziness
Myalgias
Increaseserumcholesterolconcentrationto20percent
Orthostatichypotension
Agranulocytosis

---

49.Firstpassmetabolismissignificant
problemindruggiventhrough:
a)Sublingualroute
b)Rectalroute
c)Intramuscularroute
d)Directlyintostomach
e)Directlyintolargeintestine
CorrectAnswer-D
Ans.D,Directlyintostomach
Allorallyadministereddru.gsareexposedtodrugmetabolizing
enzymesintheintestinalwallandliver(wheretheyfirstreach
throughtheportalvein).
Druggivendirectlyintothestomachandintestinestillhavetopass
throughfirstpassmetabolismintheintestinalwallandinliver.
Approximately50%ofthedrugthatitisabsorbedfromtherectum
willbypasstheliver,thusreducingthehepaticfirst-passeffect.
Presystemicmetabolismlnthcgutandlivercanbeavoidedby
administeringthedrugthroughsublingual,transdermalorparenteral
(i.v/i.m/intradermal/s.c)routes.
Theeventoffirstpassmetabolismdiffersfordlfierentdrugsandis
animportantdatennlnantoforalbioavallabiltty.
Thehepaticfirst-passeffectcanbeavoidedtoagreatextentbythe
useofsublingualtabletsandtransdermalpreparationsandtoa
lesserextentbytheuseoFrectalsuppositories.
Subltngu.alabsorptionprovidesdirectaccesstosystemicnotportal-
velns.

---

Thetranscanalrouteofiersthesameadvantage.

---

50.Allaretrueaboutplasmaproteinbinding
except:
a)Acidicdrugsgenerallybindtoplasmaalbuminandbasicdrugs
toa,acidglycoprotein
b)Plasmabindingdeterminesvolumeofdistribution
c)Moreplasmaproteinbindingmeansmorestorageinliver
d)Moreplasmaproteinbindingmeanslesspenetrationinvascular
membrane
e)Highdegreeofprotein.indinggenerallymakesthedruglong
acting
CorrectAnswer-C
Ans.C,Moreplasmaproteinbindingmeansmorestoragein
liver
Drugswhicharehighlyproteinboundorionizedremainlargely
withinthevascularcompartmentandhaveverylowvolumeof
distribution.
Acidicdrugsgenerallybindtoplasmaalbuminandbasicdrugstoa2
acidglycoprotein.
Albuminlsamajorcarrierforacidicdrugs.a1-acidglycoprotein
blindsbasicdrugs.
Clinicallysignificantimplicationsofplasmaproteinbinding:
Bindingofadrugtoplasmaproteinalsolimitsthedrug'sglomerular
fiLtration.
Drugtransportandmetabolismalsoarelimitedbybindingtoplasma
proteins.
Proteinbounddrugdoesnotcrossmembranes(exceptthrough

---

largeparacellularspaces,suchasincapillaries).
Tendtohavesmallervolumesofdistribution.
Boundfractionofdruginnotavailableforaction.
Plasmaproteinbindingthustantamountstotemporarystorageofthe
drug.
Highdegreeofproteinbindinggenerallymakesthedruglongacting,

---

51.Carbonicanhydraseinhibitors(S)is/are:
a)Acetazolamide
b)Amiloride
c)Nitrofurantoin
d)Topiramate
e)None
CorrectAnswer-A:D
Ans.(A)Acetazolamide(D)Topiramate
Carbonicanhydraseinhibitor:Topiramate,Acetazolamida,
methazolamide,dichlorphenamide
orallyinthetreatmentofglaucoma-Acetazolamida,methazolamide,
dichlorphenamide
Topicallyactivecarbonicanhydraseinhibitors-Dorzolamideand
brinzolamide.

---

52.Whichofthefollowingis/aretrueabout
pharmacodynamicsofdrugs:
a)Affinitymeanshowstronglydrugbindstoreceptor
b)Efficacymeansmaximaleffectbyadrug
c)Irreversibleantagonistmainlyformsionicbondswithreceptor
d)Agonistpotencydependsontwoparameters:affinityand
efficacy
e)Forantagonists,efficacyiszero
CorrectAnswer-A:B:D:E
Ans.A,Affinitymeanshowstronglydrugbindsto
receptorB,EfficacymeansmaximaleffectbyadrugD,Agonist
potencydependsontwoparameters:affinityandefficacy&
E,Forantagonists,efficacyiszero
Irreversiblecompetitive(non-equilibrium)antagonismoccurswith
drugsthatpossessreactivegroupsthatformcovalentbondswith
receptor.
ReceptorBlockAntagonisminvolvestwoimportantMechanisms
Reversiblecompetitiveantagonist
Irreversible,ornon-equilibrium,competitiveantagonism.
Drugsactingonreceptorsmaybeagonistsorantagonists.
Agonistpotencydependsontwoparameters:affinity(i.e.tendency
tobindtoreceptors)andefficacy(i.e.ability,oncebound,toinitiate
changesthatleadtoeffects).
Forantagonists,efficacyiszero.

---

53.Whichofthefollowingis/aretrueabout
Tacrolimus:
a)Amacrolidesantibiotic
b)Structuresimilartocyclosporine
c)Derivedfromafungus
d)Tcellinhibitor
e)Hirsutismlessevidentthancyclosporine
CorrectAnswer-A:D:E
Ans.(A)Amacrolidesantibiotic(D)Tcellinhibitor(E)Hirsutism
lessevidentthancyclosporine
Tacrolimus:
Immunosuppressantischemicallydifferentfromcyclosporine,but
hasthesamemechanismofaction100timesmorepotent.
MacrolideantibioticproducedbyStreptomycestsukubaensis(a
bacteria)
MOA:
InhibitionofhelperTcellsviacalcineurin.
BindstotheimmunophilinFK-bindingprotein(FKBP)
Therapeuticapplication,clinicalefficacyaswellastoxicityprofilaare
similartocyclosporine.
Hypertension,hirsutism,gurnhyperplasiaandhyperuricemiaare
lessmarkedthanwithcyclosporine,buttacrolimusismorelikelyto
precipitatediabetes,causeneurotoxicityalopeciaanddiarrhoea.
Doselimitingtoxicityisrenal.

---

54.TrueaboutLowmolecularweightheparin
(IAMB):
a)Anti-factorXaassaymonitoringrequiredineverypatient
b)ItincreasesaPTTmorethanUFH
c)Canbesafelygiveninrenalfailure
d)Toxicityistotallyreversedbyprotaminesulphate
e)InactivatefactorXaselectively
CorrectAnswer-E
Ans.E.InactivatefactorXaselectively
LowMolecularWeight(LMW)HeparinsandUFH
HeparinhasbeenfractionatedintoLMWforms(MW3000-7000)by
differenttechniques..
InactivateFactorXaselectively.
TheyactonlybyinducingaconformationalchangeinATIIIand,not
byprovidingascaffoldingforinteractionofATIIIwiththrombin.
Asaresult,LMWheparinshavesmallereffectonaPTTandwhole
bloodclottingtimethanunfractionatedheparin(UFH).
Eliminatedprimarilybyrenalexcretionarenottobeusedinpatients
withrenalfailure..
SinceaPTT/clottingtimesarenotprolonged,Laboratorymonitoring
isnotneeded.
Protaminedoesnotneutralizefondaparinuxanditonlypartially
reversestheanticoagulanteffectofLMWheparins.

---

55.TrueaboutMafenide:
a)Canpenetrateeschars
b)Doesn'tcauseburningsensationwhenappliedtorawsurface
c)Canbeusedorally
d)Maycausemetabolicacidosis
e)None
CorrectAnswer-D
Ans.D,Maycausemetabolicacidosis
Mafenide:
TypicalsulpHonamide.
Usedonlytotally-inhibitsavarietyofgram-positiveandgram-
negativebacteria.
Biggestlimitation-Producesburningsensationandseverepain
whenappliedtorawsurface.
Mainlyemployedforbuntdressingtopreventinfection,butnotto
heatalreadyinfectedcases.

---

56.Trueaboutcompetitiveantagonistsare?
a)Itdecreasesefficacyofagonist
b)Itdecreasespotencyofagonist
c)DRCisshiftedtorightside
d)Kmisincreased
e)Vmaxisreduced
CorrectAnswer-B:C:D
Ans.(B)Itdecreasespotencyofagonist(C)DRCisshiftedto
rightside(D)Kmisincreased
Competitiveinhibition:
kmisincreased.
V-maxremainsunchanged.
Competitiveantagonist:
1. Antagonistbindstothesamereceptorsasagonist
2. Antagonistresembleschemicallywiththeagonist
3. Thesamemaximalresponsecanbeobtained
4. Potencyisreduced(RightshiftofDRC)
5. KmisincreasedbutVmaxisunchanged
Noncompetitiveantagonist:
1. Bindstoanothersiteofreceptor
2. Doesnotresemble
3. Maximalresponseissuppressed
4. Efficacyisreduced(FlatteningofDRC)
5. KmisunchangedbutVmax.isreduced

---

57.Physiologicalantagonismisfoundin?
a)Isoprenalineandsalbutamol
b)Isoprenalineandadrenaline
c)Isoprenalineandpropranolol
d)Adrenalineandhistamine
e)Salbutamolandleukotrienes
CorrectAnswer-D:E
Ans.(D)Adrenalineandhistamine(E)Salbutamoland
leukotrienes
[RefKDTp.56]
Physiologicalantagonists:
Produceoppositeactionbyactingondifferentreceptors.
Histamine-bronchoconstriction&adrenaline-bronchodilation.
Leukotrienes-bronchoconstriction&salbutamol-bronchodilation.

---

58.Sideeffectofclozapineare?
a)Sedation
b)Seizures
c)Urinaryincontinence
d)Decreasedsalivation
e)None
CorrectAnswer-A:B:C
Ans.(A)Sedation(B)Seizures(C)Urinaryincontinence
[Ref:KDTp.429;Katzang/ep-497-498]
Sideeffectsofclozapine
Agranulocytosis
Urinaryincontinence
UnstableBP&Tachycardia
Hypersalivation(sialorrhoea)
Worseningofdiabetes
Weightgain
Seizures
Sedation

---

59.Whichistrueregardingnaltrexone-
a)Itisanopioidantagonist
b)Itisanopioidagonist
c)Usedinalcoholdependence
d)Usedtotreatopioiddependence
e)Usedasarespiratorystimulant
CorrectAnswer-A:C:D
Ans.(A)Itisanopioidantagonist(C)Usedinalcohol
dependence(D)Usedtotreatopioiddependence
[RefKDp.467;433,353]
Naltrexone:
Pureopioidantagonistdevoidofagonisticactivity.
RecommendedinalcoholdependencebyUS-FDAasadjuvantin
comprehensivetreatment.
Usedfor'opioidblockade'therapyofpost-addicts.
Usedtotreatacuteintoxicationandmaintenancetherapyofopioid
withdrawal.However,itcanprecipitatewithdrawalsymptoms.

---

60.Whichofthefollowingis/are
cholinomimetic(Cholinergic)drug(s)?
a)Pilocarpine
b)Neostigmine
c)Bethanechol
d)Donepezil
e)Methacholine
CorrectAnswer-A:C:E
Ans.(A)Pilocarpine(C)Bethanechol(E)Methacholine
[RefKDT7/ep.104;Katzung11*/ep.98]
Cholinergicdrugsmaybedividedinto:(i)Directlyacting,and(ii)
Indirectlyacting(anticholinesterase).
DirectlyActing:
Withmuscarinicaction:Acetylcholine,methacholine,carbachol,
bethanechol,pilocarpine,muscarine,arecholine
Withnicotinicaction:-Acetylcholine,carbachol,arecholine(these
threedrugshavebothmuscarinicandnicotiniceffects).
IndirectlyActing(Anticholinesterase):
Twotypes
Carbamates:Physostigmine,Pyridostigmine,Ambenonium,
Galantamine,Neostigmine,Edrophonium,Donepezil,rivastigmine.
Organophosphates:Echothiophate,Diazinon.

---

61.TrueaboutCarvedilol?
a)alblocker
b)31blocker
c)32blocker
d)Antioxidant
e)Usedinhypertension
CorrectAnswer-A:B:C:D:E
Ans.(A)alblocker(B)31blocker(C)32blocker(D)Antioxidant
(E)Usedinhypertension
Carvedilol:
1+2+1adrenoceptorblockerwith-blockingpropertyof1:9.
AntioxidantandantimitoticProPerty.
Producesperipheralvasodilationdueto-1blockadeaswellas
calciumchannelblockade(directeffect).
CardioprotectiveinCHF.
Causesorthostatichypotension.

---

62.Interferon-alphaisusedinthetreatment
of?
a)HepatitisB
b)HepatitisC
c)Multiplesclerosis
d)Chronicgranulomatousdisease
e)Multiplemyeloma
CorrectAnswer-A:B:C
Ans.(A)HepatitisB(B)HepatitisC(C)Multiplesclerosis
[Ref.KDTP.501,802;ClinicalpharmacologistP.712]
Usesofinterferon-are:
1. CML
2. Non-Hodgkin'slymphoma&cutaneousT-celllymphoma
3. Hairycellleukemia
4. Multiplemyeloma
5. AIDSrelatedKaposisarcoma
6. ChronicHepatitisB&C
7. HSV,HZV&CMVinfection
8. Rhinoviralcold
9. Condylomaacuminata(HPV)
10. Malignantmelanoma
11. Renalcellcarcinoma

---

63.Trueaboutbedaquilineis?
a)Nottobeusedinsinglelinetherapy
b)Tobeusedincaseofresistancetostreptomycin
c)Newuniqueantimicrobialintroduced
d)Bactericidaldrug
e)UsedinTBresistanttorifampicin&isoniazide
CorrectAnswer-A:C:D:E
Ans.(A)Nottobeusedinsinglelinetherapy(C)Newunique
antimicrobialintroduced(D)Bactericidaldrug(E)UsedinTB
resistanttorifampicin&isoniazide
[RefKatung14/ep.849;Lehn'sPharmacologyip.l081]
Bedaquiline(sirturo):
Newantituberculardrug
Treatmentofmulit-drugresistanttuberculosis
Worksfasterandbetterthanallotheranti-TBdrugs.
Tuberculocidal.
ByinhibitingATPsynthase.
Nocross-resistance.
PregnancycategoryBdrug.
Uses:
CombinationtherapyformultidrugresistanceTB(i.e.resistanceto
rifampicinandlNH).
NotapprovedfortreatmentoflatentTB,extrapulmonaryTBordrug-
sensitiveTB.
AdverseEffects:
ProlongationofQTinterval.
Hepatotoxicity.

---

---

64.ExtensivedrugresistanceTBisdefined
asresistanceto?
a)Amikacin
b)INH
c)Rifampicin
d)Pyrazinamide
e)Ciprofloxacin
CorrectAnswer-A:B:C:E
Ans.(A)Amikacin(B)INH(C)Rifampicin(E)Ciprofloxacin
[RefKDT7thep.776]
Multidrugresistance(MDR)andextensivedrugresistance
(XDR)TB:
MDRisdefinedasresistancetoINHandrifampinwithorwithout
resistancetootherdrugs.
XDRisdefinedasresistancetoINHandrifampicinaswellastoall
fluoroquinolonesandoneofinjectabledrugs(capreomycin,
kanamycin,amikacin).

---

65.Alternativetorifamicinbasedtreatmentof
leprosyinpatientwithhepatitis?
a)Clofazimine
b)Ofloxacin
c)Minocycline
d)Clarithromycin
e)Moxifloxacin
CorrectAnswer-A:B:C:D
Ans.(A)Clofazimine(B)Ofloxacin(C)Minocycline
(D)Clarithromycin
TheWorldHealthOrganization(WHO)andtheIndianAssociationof
leprologistshaverecommendedanalternativecombinationtherapy
ofClarithromycin,ofloxacinanilclofaziminetobeprescribedinsuch
cases.
Minocyclinecanbeusedasanalternativetoclarithromycin(i.e.,
minocycline,ofloxacin&clofazimine).

---

66.Anticancerdrug(s)whichdoes/donot
suppressbonemarrow?
a)5-FU
b)Cisplatin
c)Chlorambucil
d)Vincristine
e)Vinblastine
CorrectAnswer-D
Ans.D.Vincristine
[Ref:Katzungp.951-952]
Anticancerdrugswithbonemarrowsparingeffect:
Vintistine
Bleomycin
Asparaginase

---

67.Apatienthasplateletcount<1lakh,
hemoglobin8gm,whichofthefollowing
anticancerdrugcanbeusedinhim?
a)Cisplatin
b)Methotrexate
c)Vincristine
d)Vinblastin
e)Dleomycin
CorrectAnswer-C:D
Ans.(C)Vincristine(D)Vinblastin
Vincristineandbleomycinarebonemarrowsparingdrugs-canbe
usedinanemiaandthrombocytopenia.

---

68.Whichofthefollowingdrug(s)cancause
diarrhea?
a)Zinc
b)Ampicillin
c)Magnesiumhydroxide
d)Aluminiumhydroxide
e)None
CorrectAnswer-B:C
Ans.(B)Ampicillin(C)Magnesiumhydroxide
Drugscausingdiarrhea:
BroadspectrumantibioticsDigitalisLactose
OCP
clindamycin
Magnesiumantacids
Lincomycin
Purgative
Cocaine
Donepezil
Methyldopa
Reserpine
ColchicineGuanethidine
Misoprostol
Ticlopidine
AmPicillin

---

69.Selectivenorepinephrine(noradrenergic)
reuptakeinhibitor(s)is/are?
a)Fluoxetine
b)Desipramine
c)Imipramine
d)Doxepin
e)Amoxapine
CorrectAnswer-B:E
Ans.(B)Desipramine(E)Amoxapine
Selectivenoradrenergicreuptakeinhibitors(SNARIs)
Antidepressantswhichhavehighselectivityfornoradrenergic
reuptakeinhibitoroverserotoninreuptakeinhibition.
ThisgroupalsoincludestheTCAswithpredominantNAreuptake
inhibitoryaction.
Examplesare-Desipramine,Nortriptyline,protriptyline,
Amoxapine,Reboxetine,Atomoxetine,maprotiline.

---

70.ManagementofNSAIDstoxicityinclude-
a)Sodiumbicarbonate
b)Diazepam
c)Phenobarbitone
d)Hemodialysis
e)NH4C1
CorrectAnswer-A:B:C:D
Ans.(A)Sodiumbicarbonate(B)Diazepam(C)Phenobarbitone
(D)Hemodialysis
[Ref,Principlesofemergencymedicalcarep.301]
IbuprofenisthemostcommonlyusedNSAIDstakeninoverdose
followedbynaproxen.
Inacuteoverdose,activatedcharcoalcanbeusedas
mechanicalantidote.
VomitingshouldbeinducedbyIpecacsyrup,iftheingestion
occurredwithinminutesofarrival.
Fordehydrationoralorintravenousfluidshouldbegiven.
Metabolicacidosiswilloftenrespondtofluidresuscitation/IVsodium
bicarbonate.
ConvulsionsaremanagedwithIVbenzodiazepines(diazepam,
lorazepam).Phenobarbitoneissecondchoiceifconvulsionsarenot
controlledbyBZDs.
Protonpumpinhibitors(omeprazoleetc)canbegivenforpersistent
upperGISymptoms.
Intubationmayberequiredforairwayprotectionduetocomaor
prolongeduncontrolledconvulsionactivity.
ThiopentoneistheDOCintheseconditions.

---

---

71.Trueaboutfirstorderkineticsof
elimination-
a)Constantamountofdrugiseliminated
b)Rateofeliminationisnotrelatedtoplasmaconcentration
c)Clearanceremainsconstant
d)Halflifedecreaseswithdecreasedconcentration
e)None
CorrectAnswer-C
Ans.C.Clearanceremainsconstant
[RefKDTp.30]
Firstorderkinetics:
RateofeliminationisdirectlyproportionaltoPlasmaConcentration.
Clearanceremainsconstant-
Duetoincreasingplasmaconcentration,increasestherateof
eliminationproportionately.
(CL=rateofelimination/PlasmaConc).
Halfliferemainsconstant-
Duetotimerequiredtoreduceplasmaconcentrationtohalfissame
(rateofelimination
changeproportionatelywithplasmaconcentration).

---

72.Antibiotic(s)thatrequiredosereductionin
renalfailure?
a)Amikacin
b)AmphotericinB
c)Doxycycline
d)Rifampicin
e)Ceftriaxone
CorrectAnswer-A:B
Ans.(A)Amikacin(B)AmphotericinB
[Ref:EssentialsofPharmacologyp131]
Antimicrobialsgivenafterdosereduction:
Aminoglycosides
Ethambutol
Quinolones(exceptGrepa&trovafloxacin)
Cephalosporins(exceptcefoperazone&ceftriaxone)
Vancomycin
AmphotericinB
Antimicrobialscontraindicated:
Nitrofurantoin
Nalidixicacid
Cephalothin&cephaloridine
Tetracyclines(exceptdoxycycline)
Methanamine

---

73.Trueaboutsugamadexis/are-
a)ItisaSRBA
b)Usedtoreverserocuroniumblockade
c)UsedtoreverseNMblockade
d)UsetoreverseSchblockade
e)Usedinmalignanthyperthermia
CorrectAnswer-A:B:C
Ans.(A)ItisaSRBA(B)Usedtoreverserocuroniumblockade
(C)UsedtoreverseNMblockade
[RefKDTep.355;Essentialsofpharmacologyp.113]
Sugammadex:
Neuromuscularreversaldrug,
1stinanewclassofselectiverelaxantbindingagent(SRBA)or
steroidalmusclerelaxantencapsulators(SMRE).
Modifiedy-cyclodextrinwithhighaffinityforaminosteroidnon-
depolarizingmusclerelaxantsrocuroniumandvecuronium.
Usedtoreverseneuromuscularblockproducedbyrocuroniumand
vecuronium(rocuronium>vecuronium).
Actsbyformingacomplexwithmusclerelaxant(rocuroniumor
vecuronium).

---

74.13agonistsarepreferredoverother
sympathomimeticdrugsfor-
a)Asthma
b)Uterinerelaxation
c)Nasaldecongesents
d)Orthostatichypotension
e)Glaucoma
CorrectAnswer-A:B
Ans.(A)Asthma(B)Uterinerelaxation
Clonidineandmethyldopaareusedinhypertension.
Otherusesofclonidineare(i)preanaestheticmedication,(ii)
diarrheaindiabeticneuropathy,(iii)analgesic,(iv)withdrawal
syndromeofopoid,alcoholandnicotine,(v)prophylaxisofmigrain,
(vi)postmenopausalsyndrome,(vii)suppressiontestfor
pheochromocytoma,and(viii)fortreatmentofADHD.

---

75.Longacting13agonist(s)whichis/are
usedasonceadaydrug?
a)Salmeterol
b)Formoterol
c)Olodaterol
d)Vilanterol
e)Indacaterol
CorrectAnswer-C:D:E
Ans.C,OlodaterolD,Vilanterol&E,Indacaterol
Ref:Katzung13'h/ep.j40;Rang6Dale8'h/ep.348
Longactingbeta-1agonist
(8-12hrs)
Giventwicedaily
1. Salmeterol
2. Formoterol
3. Arformoterol
Ultra-longacting
(24hrs)
givenoncedaily
1. Indacaterol
2. Olodaterol
3. Vilanterol

---

76.Drugofchoiceforstrongyloides
stercoralis?
a)Mebendazole
b)Albendazole
c)Ivermectin
d)Levamisole
e)Diethylcarbamazine
CorrectAnswer-C
Ans.C.Ivermectin
Ref:K.D,T,Thlep,850iKatzung13th/ep.909;SatoskarPharma
24'ep.816;RangandDale|th/ep.573
Strongyloid-Ivermectin
Anaerobes-Metronidazole
AtypicalPneumonia(mycoplasma)-Erythromycin
Cholera-Doxycycline
Staphylococci-Penicillin
VRSA-Linezolid
P.Carinii(jiroveci)-Cotrimoxazole
Pseudomonas-
Antipseudomonalbeta-lactam+aminoglycoside
Streptococcus-Penicillin
Toxoplasma-Cotrimoxazole
ToxoplasmainpregnancySpiramycin.
Rheumaticfever-Benzathinepenicillin
TB-INHwithorwithoutrifamPicin
Rickettsia-TetracYclines

---

InfluenzaAandB-Osetamivir
Diphtheria-Penicillin/Erythromycin
Anthrax
Ciprofloxacin/Doxycycline+Pertussis-ErYthromYcin
HSV-AcYclovir
LePtosPirosis
Milder-Oralamoxicillin
Severe-IvPenicillinG
Lyme'sdisease-DoxycYcline
Syphilis-PenicillinG
Pertussis-ErYthromYcin
Actinomycosis-PenicillinG
Lymphogranulomavenereum-AzithromycinorDoxycycline
Legionella-Azithromycinorlevofloxacin
Plague-StrePtomYcin
Listeria-Ampicillin+Gentamicin
MAC-Azithromycin/clarithromycin
GroupB-streptococcus-Ampicillin
UTI-Cotrimoxazole
Endocarditis-Amoxicillin/Clindamycin
Babesiosis-Quinine+Clindamycin
Pvivax-Chloroquine
ChloroquineresistantPvivax-Artemisinincombinationtherapy
(ACT)

---

77.DOCformycoplasmais/are?
a)Doxycycline
b)Ceftriaxone
c)Azithromycin
d)Penicillin
e)Gentamycin
CorrectAnswer-A:C
Ans.A,Doxycycline&C,Azithromycin
Ref:Harrisonrgh/ep.1164
ForM.pneumoniaeinfections:
Azithromycin,clarithromycin,erythromycin,doxycycline,
levofloxacin,moxifloxacin,gemifloxacin(notciprofloxacinor
floxacin).
ForM.Hominis-
Doxycycline,clindamycin

---

78.Whichofthefollowingdyadofanti-HIV
drugandmechanismofactionis/are
correctlymatched?
a)Maraviroc-Entryinhibitor
b)Reltegravir-Intergaseinhibitor
c)Indinavir-Proteaseinhibitor
d)Nevirapine-Nonnucleosidereversetranscriptaseinhibitor
e)Darunavir-Fusioninhibitor
CorrectAnswer-B:C:D
Ans.B,Reltegravir-IntergaseinhibitorC,Indinavir-Protease
inhibitor&D,Nevirapine-Nonnucleosidereversetranscriptase
inhibitor
Antiretroviraldrugs
a)Nucleosidereversetranscriptaseinhibitors(NRTIs)-
Zidovudine,Didanosine,Zalcitabine,Stavudine,Iamivudine,
Abacadr,Emtricitabine
b)Nucleotidereversetranscriptaseinhibitor+Tenofovir
c)NonNucleosidereversetranscriptaseinhibitors(NNRTIS)-
Nevirapine,Efavirenz,Delavirdine,Etravirine,rilpivirine.
d)Proteaseinhibitors-
RitonavirIndinavir,NeIfnavb,Saquinavir,amprenavir,Lopinavir,
Fosamprenavir,Atazanavir,Darunavir,Tipranavir.
e)Fusioninhibitor-Enfuvirtide,Maraviroc.
f)Integraseinhibitors-Raltegravir,Elvitegravir.
g)CCR5receptorinhibitor-Maraviroc

---

79.Anti-influenzadrugwhichis/aregiven
throughinhalationroute?
a)Amantadine
b)Oseltamivir
c)Zanamivir
d)Rimantadine
e)None
CorrectAnswer-C
Ans.C.Zanamivir
[Ref:KDT7'/ep.S0l0.3;Park's24't'/e1t.169;Katzung13th/ep.862
63]
Anti-influenzadrugs
Amantadine,rimantadine,oseltamivirandzanamivir.
Onlyzanamivirisgivenbyparenteralroute(intranasdor
intravenous).allothersaregivenorally.
Zanamivirhaslowestoralbioavailabilitylowestt1/2(shortestacting).
Rimantadinehasmaximumplasmaproteinbinding,whileoseltamivir
hasminimumplasmaproteinbinding.
Rimantadinehasmaximummetabolism.

---

80.Truestatement(s)aboutalbendazole?
a)Undergoesfirst-passmetabolismintheliver
b)ActiveagainstbothlarvaandadultofNematodes
c)Absorptionincreaseswithfattymeal
d)Excretedintheurine
e)Thiabendazoleislesstoxicthanalbendazole
CorrectAnswer-A:B:C:D
Ans.A,Undergoesfirst-passmetabolismintheliverB,Active
againstbothlarvaandadultofNematodesC,Absorption
increaseswithfattymeal&D,Excretedintheurine
[Ref:Katzung13't'/ep.90E09;GoodmanandGilmatr'slI't'/ep.
1079;SatoskarPhanna24't'/ep.818]
Albendazole:
Broad-spectrumoralanthelmintic.
Actsbybindingtotubulinandtherebyinhibitingitspolymerization
Afteroraladministration,itiserraticallyabsorbed(increasedwitha
fattymeal)andthenrapidlyundergoesfirst-passmetabolisminthe
livertotheactivemetabolitealbendazolesulfoxide.
excretedintheurine.
Hasamiciilaleffectsinhydatiddisease,cysticercosis,ascariasis,
andhookworminfectionandovicidaleffectsinascariasis,
ancylostomiasis,andtrichuriasis.

---

81.Whichofthefollowingis/arenot5th
generationcephalosporin?
a)Cefoxitin
b)Cefoperazone
c)Ceftolozane
d)Ceftaroline
e)Ceftabiprole
CorrectAnswer-A:B
Ans.A,Cefoxitin&B,Cefoperazone
[Ref:KDT7/ep.26;Ketungp-779;Goodman&Gilman'sp.781;
Pharma241/ep.693]
First
Second
Third
Fourth
Fifth
Cefuroxime
Cefoxitin
Cefotaxime
Cephalothin Cefotetan
Cetizoxime
Ceftobiprole
Cefepime
Parenteral Cefazoline
Cefmetazole Ceftriaxone
Ceftaroline
Cefpirome
Cephapirin
Cefamendole Ceftazidime
Ceftolozane
Cefonicid,
Cefoperazone
ceforanide
Cefixime
Cephalexin
Cefaclor
Cefpodoxime
Cephradine
Cefuroxime proxetil
Oral
Cefadroxil
axetil
Cefdinir
Cephaloridine Cefprozil
Ceftibuten,
Ceftamet

---

82.Whichofthefollowingistrueabout
aminoglycosideassociatedacutekidney
injury?
a)Seeninaround10-20%ofpatientstreatedwiththedrug
b)Mayoccurwithin1weekofinitiationoftreatment
c)Occuronlyafter3weeksoftreatment
d)Interstitialnephritisoccur
e)Usuallydevelopswithin72hoursofinitiationoftreatment
CorrectAnswer-A:B
Ans.A,Seeninaround10-20%ofpatientstreatedwiththe
drug&B,Mayoccurwithin1weekofinitiationoftreatment
[Re/:KDf7e/dp.715;Katzungep.802]
Non-oliguricacutekidneyinjury(AKI)occursin10-30%ofpatients
onaminoglycosidetherapy.
AKTtypicallymanifestsafter5-7daysoftherapy.
Nephrotoxicity:
Neomycinismostnephrotoxic,whilestreptomycinisleast
nephrotoxic.
Nephrotoxicityisincreasedbyadvancedage,liverdisease,
hypokalemia,septicshock,concurrentuseofnephrotoxicdrugs
(amphotericinB,cisplatin,cyclosporine)andprolongedtherapy.

---

83.Whichofthefollowingistrueabout
antifungaldrugs?
a)Echinocandinshaveverylesssideeffects
b)Flucanazoleisfirstlinedrugforinvasiveaspergillosis
c)Oralfluconazolehas100%bioavailability
d)AmphotericinBisfungistatic
e)NephrotoxicityisdoselimitingsideeffectofamphotericinB
CorrectAnswer-A:E
Ans.A,Echinocandinshaveverylesssideeffects&
E,NephrotoxicityisdoselimitingsideeffectofamphotericinB
[RefKDTzh/ep.787-95]
EchinocandinsarewelltoleratedwithmildGIsideeffects.
Fluconazoleisnot1stlinedrugforaspergillosis.
Oralbioavailabilityoffluconazoleis94%.
Amphotericin-Bisfungicidalaswellasfungistatic
Themostimportantdoselimitingtoxicityisnephronicity.
Adverseeffectsincludeinfusionrelatedacutereactions(most
common),nephrotoxicity,anemia,cNStoricityAnd,
hypomagnesemiaInfusionrelatedacutereactioncanbeprevented
bypremedicationslikecorticosteroidsandantihistamines.
Itismanifestedbyazotemia,reducedGFR,RTA,hypokalemia,and
hypomagnesemia.

---

84.Drugsaffectingpurinesynthesis?
a)Azathioprine
b)Methotrexate
c)Fludarabine
d)6-Mercaptopurine
e)Capecitabine
CorrectAnswer-A:B:C:D
Ans,A,AzathioprineB,MethotrexateC,Fludarabine&D,6-
Mercaptopurine
[Ref:KDT7h/ep.858;Katzungp.928,931;Goodman&Gilmin'sI
tth/ep.1336,1346-48;SatoskarPharma24a'/ep.G29.]
Antimetabolites:
Drugsaffectintermediarymetabolismofproliferatingcells.
AllthesedrugsinterferewithnucleicacidsynthesisAct
on.S,phase.
Purineantagonists=Mercaptopurine,Thioguanine,
Azathioprine,FludarabineAndCladribine.
Pyrimidineantagonists=S-Fluorouracil,cytosinearabinoside
(cytarabine),capecitabine,Gemcitabine.
Folateantagonist=Methotrexate,pemetrexed.
Note:Tetrahydrofolateisrequiredforpurinesynthesisandits
formationisinhibitedbymethotrexate.
Methotrexateandpemetrexeddihydrofolatereductase(DHFRcse)
inhibitors.

---

85.Methotrexateaffects?
a)Purinesynthesis
b)Pyrimidinesynthesis
c)ConversionofDHFAtoTHFA
d)Polymerizationofmitotictubule
e)None
CorrectAnswer-A:C
Ans.A,Purinesynthesis&C,ConversionofDHFAtoTHFA
Methotrexateandpemetrexeddihydrofolatereductase(DIlFRcse)
inhibitors.
ThesedrugsalsoinhiUitttrymiapatesynthaseanddenovopurine
synthesis,whichcontributetomethotrexatetoxicity.

---

86.LongactingInsulinis/are?
a)Lispro
b)Detemir
c)Glargine
d)Isophane
e)Glulisine
CorrectAnswer-B:C
Ans.B,Detemir&C,Glargine
[Ref:KDTep-263:satashkarkhanna24e/ep'893]
RapidActingInsulin=Insulinlispro,Insulinaspart,Insulinglulisine.
Shortacting=Regular(soluble)insulin,semilenteinsulin'
Intermediateacting=Insulinzincsuspension(Lente),Neutral
protaminehagedorn(isophaneinsulin)
Longacting=Protaminezincinsulin,Insulinglargine,Insulindetemir

---

87.AmongACEinhibitors,whichofthe
followingis/areprodrug(s)-
a)Perindopril
b)Captopril
c)Lisinopril
d)Ramipril
e)Enalapril
CorrectAnswer-A:D:E
Ans.A,PerindoprilD,Ramipril&E,Enalapril
[RefKDTF/ep'23,501]
AllACEinhibitorsareprodrugsexceptcaptoprilandLisinopril.

---

88.Whichofthefollowinganti-tumordrug
havehighriskofgonadotoxicity?
a)Dactinomycin
b)Cyclophosphamide
c)Busulfan
d)Vinblastine
e)Ifosfamide
CorrectAnswer-B:C:E
Ans.B,CyclophosphamideC,Busulfan&E,Ifosfamide
[ReFK.D-t.P.859;]
Allalkylatingagentsarehighlygonadotoxic.
HighAlkylatingagents=Cyclophosphamide,ifosfamide,busulfan,
chlorambucil,melphalan,procarbazine.
Medium=Carboplatin,doxorubicin
Low=Vincaalkaloids(vincristine,vinblastine),methotrexate,
mercaptopurine,bleomycin,dactinomycin.

---

89.Adrenalinecanbeusedin?
a)Bronchialasthma
b)Allergicdisorder
c)Cardio-pulmonaryresuscitation
d)Anaphylaxis
e)Asanti-analgesicmedicine
CorrectAnswer-B:C:D
Ans.B,AllergicdisorderC,Cardio-pulmonaryresuscitation&
D,Anaphylaxis
Adrenalineisthedrugofchoiceforanaphylaxis(anaphylacticshock)
->anallergichypersensitivityreaction(Type-lhypersensitivity).
1stlinedrugusedincardiopulmonaryresuscitation.

---

90.Drug(s)causingQTintervalprolongation?
a)Amiodarone
b)Cisapride
c)Calciumgluconate
d)Magnesiumtherapy
e)Ketoconazole
CorrectAnswer-A:B
Ans.(A)Amiodarone&(B)Cisapride
[Ref:KDTVh/ep.528;Davison27d/ep.571]
DrugsthatprolongQ-Tinterval(havepotentialtoprecipitate
Torsadesdepointes)
Antiarrhythmics=Quinidine,procainamide,disopyramide,
propafenone,amiodarone
Antimicrobials=Quinine,mefloquine,artemisinin,halofantrine,
sparfloxacin,gatifloxacin
Antihistamines=Terfenadine,astemizole,ebastine
Antidepressants=Amitriptylineandothertricyclics
Antipsychotics=Thioridazine,risperidone
Prokinetic=Cisapride

---

91.Whichofthefollowingdrugsisexcreted
mainlybykidney?
a)Tetracycline
b)Rifampicin
c)Digoxin
d)Penicillin
e)Lithium
CorrectAnswer-A:C:D:E
Ans.(A)Tetracycline(C)Digoxin(D)Penicillin&(E)Lithium
[Ref:KDTp.695;Katzung13'h/ep,790]
Lithium=>95%renalexcret
Penicillin=Excretedbythekidney,10%byglomerularfiltrationand
90%bytubularsecretion.
Digoxin=Primarilyexcretedbykidney
Tetracyclines=Primarilyexcretedinurine,exceptfordoxycycline.
Rifampicin=Excretedmainlyinbile,someinurine;Urineand
secretionsmaybecomeorange-red.

---

92.Whichofthefollowingistruestatement(s)
aboutcodeine?
a)Usedasanti-tussiveagent
b)Analgesicpotencyisequivalenttomorphine
c)Causesrespiratorydepression
d)Partlymetabolizedtomorphine
e)Completelymetabolizedtomorphine
CorrectAnswer-A:C:D
Ans.(A)Usedasanti-tussiveagent(C)Causesrespiratory
depression&(D)Partlymetabolizedtomorphine
[Ref:KDT7/ep.474;Katzungljh/ep.545-49]
Codeine:
Codeineisapureopioidagonistwhichislesspotentthanmorphine
(1/l0sanalgesicaction).
Ithaspartialagonisticactivityonopioidreceptorswithalowceiling
effects.
Partlyconvertedtomorphineinthebody.
Itisusedasantitussive(drugsforcough)andantidiarrhealdrugs
Ceusasamedegreeofrespiratorydepressionasmorphine.

---

93.Allaretrueabouttamoxifenexcept:
a)Usedasadjuvanttherapyinestrogenreceptorpositivebreast
cancer
b)Noeffectonuterus
c)Pro-estrogeneffectonbone
d)Reduceschanceofosteoporosis
e)Reducescoronaryarterydiseases
CorrectAnswer-B:E
Ans.(B)Noeffectonuterus(E)Reducescoronaryartery
diseases
[Ref:KDT7th/312-15;Katzung13th/713;Harrison19th/2498]
Tamoxifen:
Approvalfortheprimaryprophylaxisofbreastcancerinhighrisk
women.
Reducestherecurrencerateofbreastcancerinipsilateralaswellas
contralateralbreast.
Associatedwithreducedriskofcancerinthecontralateralbreast.
Improvesthebonemassduetoantiresorptiveeffect.
Increasestheriskofthromboembolicevents.
Hypertglyceridaemia,deepveinthrombosis,ischemicheartdisease,
retinopathy&othercomplicationstobeobservedduringtamoxifen
therapy.

---

94.TrueaboutHyoscine:
a)Causemydriasis
b)Causemiosis
c)Usedformotionsickness
d)BetterBBBpenetrationthanatropine
e)Centralnervoussystemdepressant
CorrectAnswer-A:C:D:E
Ans.(A)Causemydriasis(C)Usedformotionsickness
(D)BetterBBBpenetrationthanatropine(E)Centralnervous
systemdepressant
Hyoscine(scopolamine):
Appliedtoeyestheyfreelypenetratecornea
HasbetterBBBpenetration
Shorterdurationofactionthanatropine.
Mosteffectivedrugformotionsickness
CNSdepressant.
Producesedationandamnesiaduringlabour(twilightsleep)
Causedefinitemydriasis&lossofaccommodation"
LiedetectorduringworldwarII

---

95.Truestatement(s)aboutRutin:
a)Hasanti-fibrinolyticaction
b)Hasanti-plateletaction
c)Antioxidantproperty
d)Acitrusflavonoidglycosidefoundinmanyplantsincluding
buckwheat
e)None
CorrectAnswer-B:C:D
Ans.(B)Hasanti-plateletaction(C)Antioxidantproperty(D)A
citrusflavonoidglycosidefoundinmanyplantsincluding
buckwheat
Rutin(Bioflavonoids):
Richestsourceisbuckwheat.
Plantglycosideclaimedtoreducecapillarybleeding.
Usedinadoseof60mgoralBD-TDSalongwithVit.Cwhichis
believedtofacilitateitsaction(supportbloodcirculation,asan
antioxidant,afldtotreatallergies,yiruses,orarthritisandother
inflammatoryconditions).
Strengthenstheliningofthebloodvesselsthroughoutthebody.
Helpstreathemorrhoids,internalbleeding.
Helpspreventhemorrhagicstrokes.
Stoptheformationofabloodclot(thrombosis).
Veryeffectivewithbloodclotsbecauseittreatsandpreventclotsin
botharteriesandveins
Mostpotentlyanti-thrombotic.
Anantioxidant.

---

96.Side-effect(s)ofZoledronicacidis/areall
except:
a)Flu-likesymptoms
b)Osteonecrosisofthejaw
c)Dizziness
d)Constipation
e)Renaltoxicity
CorrectAnswer-D
Ans.D.Constipation
Zoledronate:
Flu-likesymptomsduetocytokinereleaseattendthei.vinfusion
Nausea,vomiting,bodyache,dizzinessarecommon
Renaltoxicityhasbeenencountered
OsteonecrosisofJawisararecomplicationofi.vhighdose

---

97.Anti-microbialagentsactingonnucleic
acidareallexcept:
a)Acyclovir
b)Linezolid
c)Fluroquinolones
d)Streptomycin
e)Rifampin
CorrectAnswer-B:D
Ans.(B)Linezolid(D)Streptomycin
[Ref:KDT7th/689-90]
1. Inhibitcellwallsynthesis:Penicillins,Cephalosporins,Cycloserine,
Vancomycin,Bacitracin.
2. Causeleakagefromcellmembranes:Polypeptides-Polymyxins,
Colistin,Bacitracin.Polyenes-AmphotericinB,Nystatin,Hamycin
3. Inhibitproteinsynthesis:Tetracyclines,Chloramphenicol,
Erythromycin,Clindamycin,linemlid,
4. Causemisreadingofm-kNAcodeandaffectpermeability:
Aminoglycosides-Streptomycin,Gentamicin,etc.
5. InhibitDNAgyrase:Fluoroquinolones-Ciprofloxacinandothers
6. InterferewithDNAfunction:Rifampin
7. InterferewithDNAsynthesis:Acyclovir,Zidovudine
8. Interferewithintermediarymetabolism;Sulfonamides,Sulfones,
PAS,Trimethoprim,Pyrimethamine,Metronidazole

---

98.CNSstimulantsare:
a)Cocaine
b)Amphetamine
c)Cannabis
d)Dexamphetamine
e)MDMA(ecstasy)
CorrectAnswer-A:B:D:E
Ans.(A)Cocaine(B)Amphetamine(D)Dexamphetamine
(E)MDMA(ecstasy)
[Ref,KDT7th/486,452.]
Psychotogenic(Hallucinogens)drugsareCannabis,LSD,
mescaline,endocannabinoid.
CNSStimulant:
1. Convulsants:Strychnine,picrotoxin,bicuculline,pentyIenetetrazol
2. Analeptics:Doxapram
3. Psychostimulants:Amphetamine,Methylphenidate,atomoxetine,
modafinil,armodafinil,pemoline,cocaine&caffeine.

---

99.Drugcontraindicatedinpregnancy:
a)Sulfonamide
b)ACEinhibitors
c)Phenytoin
d)Ciprofloxacin
e)Furosemide
CorrectAnswer-B:C
Ans.(B)ACEinhibitors(C)Phenytoin
[Katzung10th/975]
ACEinhibitors-InAlltrimester,especiallysecondandthird-Renal
damage.
Phenytoin-InAlltrimester-FetaIhYdantoinsYndrome
Thalidomide-Firsttrimester=Phocomelia(shortenedorabsent
longbonesofthelimbs)andmanyInternalmalformations

---

100.Inwhichofthefollowingliverflukes,
triclabendazoleis/areused:
a)Clonorchissinensis
b)Opisthorchisviverrini
c)Fasciolahepatica
d)Fasciolagigantica
e)Opisthorchisfelineus
CorrectAnswer-C:D
Ans.(C)Fasciolahepatica(D)Fasciolagigantica
[Ref:Harriison19th/1428;I(DT7th/851]
Triclabendazoleishighlyeffectiveagainstadultsofthecommonliver
fluke(Fasciolahepatica)aswellasallimmaturestages.
AlsoeffectiveagainstFasciolagiganticaandFascioloidesmagna.
Noefficacyagainstroundwormsortapeworms.

---

101.Mechanismofactionofgabapentin
is/are:
a)EnhancesGABArelease
b)AgonistatGABAAreceptor
c)ActonNMDAreceptor
d)ProlongationofNa+ChannelInactivation
e)Inhibitionofvoltage-gatedCa2+channels
CorrectAnswer-A:E
Ans,.(A)EnhancesGABArelease(E)Inhibitionofvoltage-
gatedCa2+channels
[Ref:K.D.T7th/419-21;Katzung12th/41j;Harrison19th/2548,
2551-56]
Gabapentin:
MOA:
ModifythesynapticornonsynapticreleaseofGABA.
AnincreaseinbrainGABAconcentrationisobservedinpatients
receivinggabapentin.
GabapentinistransportedintothebrainbytheL-aminoacid
transporter.
Gabapentinbindsavidlytovoltage-gatedCa2+channels.
Gabapentinalsoactpresynapticallytodecreasethereleaseof
glutamate;thiseffectisprobablydependentonreducedPresynaptic
entryofCa2+viavoltage-activatedchannels.

---

102.Whichofthefollowingis/arefeaturesof
Triamcilonewithrespectto
hydrocortisone:
a)Florinatedatcarbonatom9
b)Notusedinoralform
c)Mineralocorticoidactivitypresent
d)Morepotentthanhydrocortisone
e)Glucocorticoidactivityis5timesofhydrocortisone
CorrectAnswer-D:E
Ans.(D)Morepotentthanhydrocortisone(E)Glucocorticoid
activityis5timesofhydrocortisone
[RefK.D.T7th/289;Katzung12th/700,703,712]
Triamcinolone:
SlightlymorePotentthanprednisolonebuthighlyselective
glucocorticoid;4-i2mg/dayoral;5-40mgi.m,intraarticular
injection.
Alsousedtopically

---

103.Whichofthefollowingis/aretrue
regardingmuscarianicactionexcept:
a)Miosis
b)Detrusormusclecontraction
c)Dicylomineisantimuscuarnicdrugusedforsmoothmuscle
relaxation
d)CardiacmuscuranicreceptorsarepredominantlyM3type
e)salivaryglandsecretion
CorrectAnswer-B:D
Ans.(B)Detrusormusclecontraction(D)Cardiacmuscuranic
receptorsarepredominantlyM3type
[RefKDT7th/100-103,117;Katzung12th/97-102]
CardiacmuscarinicreceptorsarepredominantlyM2type&mediate
vagalbradycardia.
Dicyclomine:
AntagonistofM1&M3(smoothmuscle)-
MuscarinicActions
Heart:
AttheA-Vnode&His-purkinjefibersrefractoryperiod(W)is
increased&conductionisslowed;PRinteryalinteases6partialto
completeA-Vblockmaybeproduced.
Eye:
Contractionofcircularmuscleofirismiosis
Contractionoftheciliarymusclespasmofaccommodation,
increasedoutflowfacility,reductioninintraoculartension(especially
inglaucomatouspatients

---

SmoothMuscle:
Peristalsisinureterisincreased.
Detrusormusclecontractswhilethebladdertrigone&sphincter
relaxesvoidingofbladder.
Glands:
Secretionfromallparasympatheticallyinnervatedglandsis
increasedviaM3&someM2receptors:sweating,salivation,
lacrimation,increasedtracheobronchial&gastricsecretion.

---

104.Diseasemodifyingdrug(s)usedin
treatmentofrheumatoidarthritis:
a)Neproxen
b)Nabumetone
c)Abatacept
d)Monoclonalantibodies
e)Methotrexate
CorrectAnswer-C:D:E
Ans.(C)Abatacept(D)Monoclonalantibodies(E)Methotrexate
[RefK.D.T7tW211-12,871-72;Katzungt2th/642;Goodman&
Gilman\11th/1942]
DiseasemodifyingAntl-rheumatoiddrugs(DMARDs)
NonBiologicalDrugs
Immunosuppressants:Methotrexate,Azathioprine,
Cyclosporine
Sulfasalazine
ChloroquineorHydroxychloroquine
Leflunomide
Biologicalagents
TNF-ainhibitors:Etanercept,Wiximab,Adalimumab
IL-1antagonists:Anakinra

---

105.Whichofthefollowingis/areteratogens:
a)Artemisinin
b)Aminoglycoside
c)Carbamezapine
d)Retinoicacid
e)Phenytoin
CorrectAnswer-B:C:D:E
Ans.(B)Aminoglycoside(C)Carbamezapine(D)Retinoicacid
(E)Phenytoin
[RefK.D.TTtlr/&g,8j1;Katzung10th/975;Katzung12th/1042-43;
G&G11th/;DruginPregnancy&LactationbyG.Briggs6th/339]
Teratogens:
Quinine:Continuestobethedrugofchoiceforseverefalciparum
during1sttrimesterofpregnancy,becausesafetyofartemisininsis
notyetProven.
Artesunate:Useislimitedinsecond6thirdtrimestersofpregnancy
onlywhenotherdrugsarefoundresistant.
Aminoglycosides:Avoidduringpregnancy:Riskoffoetal
ototoxicity.
ACEinhibitors:2.7foldhighermalformationrateinfetusexposed
forACEinhibitorsinthefirsttrimester..

---

106.Desmopressinis/areusedin:
a)Diabetesinsipidus
b)Esophagealvarices
c)HaemophiliaA
d)VonWillebranddisease
e)HemophilaB
CorrectAnswer-A:C:D
Ans.(A)Diabetesinsipidus(C)HaemophiliaA(D)Von
Willebranddisease
[Ref.K.D.T7th/596-97,616;Katzung12th/616,674,677;G&G
1fir/784-86]
Desmopressin:
SelectiveV2agonist.
Uses:
Diabetesinsipidus,bedwettinginchildren&nocturiainadults,renal
concentrationtest,Haemophilia&VonWillebranddisease.

---

107.Levetiracetamiscommonlyusedfor:
a)Juvenilemyoclonicepilepsy
b)Absenceseizure
c)GeneralisedTonicclonicseizure
d)Complexpartialseizure
e)ActthroughGABA
CorrectAnswer-A:C:D:E
Ans.(A)Juvenilemyoclonicepilepsy(C)GeneralisedTonic
clonicseizure(D)Complexpartialseizure(E)Actthrough
GABA
[RefKD-T7thl420-421]
Levetiracetam:
TreatmentofGeneralizedtonic-chronicseizure&simplepartial
seizures.
TreatmentofComplexpartialseizures.
Myoclonic&atonicseizures-unresponsivecase
Adjuvanttreatmentofpartialseizuresinadults&childrenforprimary
generalizedtonic-clonicseizure&forthemyoclonicseizuresof
juvenilemyoclonicepilepsy
Approvedasadjuvanttherapyforfocalonsetseizure.
Approvedasadjuvanttherapyforprimarygeneralizedtonic-clonic

---

108.Penicillinaseresistantpenicillinis/are:
a)Methicillin
b)Cloxacillin
c)Ampicillin
d)Dicloxacillin
e)Vancomycin
CorrectAnswer-A:B:D
Ans.(A)Methicillin(B)Cloxacillin(D)Dicloxacillin
[Ref,K.D.T7th/721]
Penicillinase-ResistantPenicillins:
Methicillin,cloxacillin,Dicloxacillin
Thesecongenershavesidechainsthatprotectthebeta-lactamring
fromattackbystaphylococcalpenicillinase.
Theironlyindicationisinfectionscausedbypenicillinaseproducing
staphylococci,forwhichtheyaredrugofchoice,acceptinareas
wheremethicillinresistantstaph.Aureus(MRSA)hasbecome
prevalent

---

109.Whichofthefollowingcondition
increasechanceofhyponatremiain
patienttreatedwithantidepressant:
a)Oldage
b)Lowweight
c)Coldclimate
d)Obesity
e)Femalesex
CorrectAnswer-A
Ans.(A)Oldage
[Ref.NirajAhuja7th/188.]
CasesofSSRl-associatedhyponatremia&thesyndromeof
inappropriateantidiuretichormonehavebeenseeninsomepatients,
especiallythosewhoareolderortreatedwithdiuretics.

---

110.TrueaboutJarisch-Hexheimerreaction:
a)Occurwithinhoursaftergivingpenicillin
b)Developonlyafter1weekofPenicillintherapy
c)Aggravationofsignsandsymptomsofsyphilis
d)Itoccurduetoallergytopenicillin
e)Mostcommoninsecondarysyphilis
CorrectAnswer-A:C:E
Ans.(A)Occurwithinhoursaftergivingpenicillin
(C)Aggravationofsignsandsymptomsofsyphilis(E)Most
commoninsecondarysyphilis
[Ref:K.D.f7th/720;CMDT201s/1460;Harison19th/1140;Neena
Khanna4th/206;G6G11th/1181;Ananthanarayan9th/377,384]
Jarisch-HerxheimerReaction:
Penicillininjectedinasyphiliticpatient(particularlysecondary
syphilis)mayproduceshiveringfever,myalgia,exacerbationof
lesions,evenvascularcollapse
Mayoccurafterinstitutionofchloramphenicoltherapyforsyphilis,
brucellosis&typhoidfever.
Thisisduetosuddenreleaseofspirochetallyticproducts&lastsfor
12-72hours
Itdoesnotrecur&doesnotneedinterruptionoftherapy
Aspirin&sedationaffordreliefofsymptoms

---

111.Incomparisontohaloperidol,clozapine
causes:
a)Weightgain
b)Agranulocytosis
c)Sedation
d)Severeextrapyramidalsymptoms
e)Lesseliptogenicpotential
CorrectAnswer-A:B:C
Ans.(A)Weightgain(B)Agranulocytosis(C)Sedation
[RefK.D.T7th/'M1;Katzung12th/509]
Haloperidol:
Producesfewerautonomiceffects,islessepileptogenic,doesnot
causeweightgain,jaundiceisrare
SevereextraPyramidalsyndrome.
Preferreddrugforacuteschizophrenia
Clozapine:
Producesfewornoextrapyramidalsymptoms;tardivedyskinesiais
rare&prolactinleveldoesnotrise.
Quitesedativesedation.
Higherincidenceofagranulocytosis.
Metaboliccomplicationslikeweightgain,hyperlipidemia&
precipitationofdiabetesisanothermajorlimitation.
Highdosescaninduceseizureseveninnon-epileptics.

---

112.Forwhichofthefollowingdrugbacteria
acquiredrugresistancebyinactivation
ordegradationbyenzyme:
a)Quninolones
b)Aminoglycosides
c)Vancomycin
d)Ampicillin
e)Chloramphenicol
CorrectAnswer-A:E
Ans.(A)Quninolones(E)Chloramphenicol
[Ref:KD.T7th/692-93;Ihtzung12th/792,816]
Drugdestroying:
Theresistantmicrobeselaborateanenzymewhichinactivatesthe
drug
Manyofaminoglycosides-resistantcoliformshavebeenfoundto
produceenzymeswhichadenylateacetatephosphorylatespecific
aminoglycosidesantibiotics.
ChloramphenicolacetyltransferaseisacquiredbyresistantE.coli,
H.influenzae&S.tyPhi.

---

113.Apersonwasonchemotherapyfor2
weekforsomemediastinaltumour.Now
hedevelopshighfrequencyhearingloss.
Mostprobablecauseofthisconditionis
useof:
a)Cisplatin
b)Etoposite
c)Doxorubicin
d)Methotrexate
e)None
CorrectAnswer-A
Ans.(A)Cisplatin
Ototoxicdrugs:
Cytotoxicdrugscausinghearinglossare-nitrogenmustard
(mechlorethamine),cisplatin&carboplatin.
Cisplatin:
Tinnitus,deafness,sensoryneuropathy&hyperuricemiaareother
problem
Carboplatin:
Nephrotoxicity,ototoxicity&neurotoxicityareIowascomparedto
cisplatin

---

114.Whichofthefollowingsarefeatureof
benzodiazepinewithdrawalexcept:
a)Anxiety
b)Increasedappetite
c)Hypersomnia
d)Baddreams
e)Tremor
CorrectAnswer-B:C
Ans.(B)Increasedappetite(C)Hypersomnia
[RefK.D.T7th/406;NirajAhuja7th/51]
Benzodiazepinewithdrawal:
Withdrawalsymptomsaregenerallymild;maybemoreintensein
caseofultrarapideliminationdrugs
Anxiety,insomnia,restlessness,malaise,lossofappetite,bad
dreamsisallthatoccursinmostcases
Agitation,Panicreaction,tremors&deliriumareoccasional;
convulsionsarerare
Characterizedbymarkedanxiety,irritability,tremors,insomnia,
vomitingweakness,automatichyperactivitywithpostural
hypotension(tseizures
Depression,transientpsychoticepisode,suicidalideation,
perceptualdisturbances&rarelydeliriumhavealsobeenreportedin
withdrawalperiod

---

115.Whichofthefollowingdrugismainly
excretedbykidney:
a)Tetracyclines
b)Doxycyclines
c)Ampicillin
d)Acyclovir
e)Rifampicin
CorrectAnswer-A:C:D
Ans.(A)Tetracyclines(C)Ampicillin(D)Acyclovir
[Ref:K.D.T7th/735,721;Katzung12th/794]
Ampicillin:Partlyexecutedinbile&reabsorbed-enterohepatic
circulationoccurs;primarychannelofexcretioniskidney.
Acyclovir:Primarilyexcretedunchangedinurine,bothby
glomerularfiltrationdttubularsecretion..
Tetracyclines:Primarilyexcretedinurinebyglomerularrtltration;
dosehastobereducedinrenalfailure;doxycyclineisanexception.
Rifampicin:Metabolizedinlivertoanactivelyacetylated.metabolite
whichisexcretedmainlyinbile,someinurine.

---

116.S/Eofclofaziamineincludes:
a)Icthyosis
b)Thrombocytosis
c)Skinpigmentation
d)Gastrointestinaldisturbances
e)Weightgain
CorrectAnswer-A:C:D
Ans.(A)Icthyosis(C)Skinpigmentation(D)Gastrointestinal
disturbances
Clofazimine:Sideeffects:
Ichthyosis
Pigmentation-Reddish-blackdiscolorationofskin,especiallyon
exposedparts.
Discolorationofhair&bodysecretionsmayalsooccur.
Conjunctivalpigmentationmaycreatecosmeticproblem.
Gastrointestinalsideeffects.

---

117.Fomepizolecanbeusedin:
a)Methanolpoisoning
b)Organophosphoruspoisoning
c)Ethyleneglycolpoisoning
d)Barbituratepoisoning
e)None
CorrectAnswer-A:C
Ans.(A)Methanolpoisoning(C)Ethyleneglycolpoisoning
[Ref:KDT7th/395-96;Katzung12th/398,400,1033]
Fomepizole:
Competitiveinhibitoroftheenzymealcoholdehydrogenase,foundin
theliver.
Thisenzymeplaysakeyroleinthemetabolismofethyleneglycol
andmethanol.
Fomepizoleismosteffectivewhengivensoonafteringestionof
ethyleneglycolormethanol.
Delayingtheadministrationoffomepizoleallowsforthegeneration
ofharmfulmetabolites

---

118.Notindicatedforanaerobiccolitis
treatment:
a)Metronidazole
b)Aminoglycoside
c)Amikacin
d)Piperacillin-tazobactam
e)Imipenem
CorrectAnswer-B
Ans.(B)Aminoglycoside
[Ref:KDT7th/838;Hanison19th/1101,18th/1338-39;Katzung
12th/904-05]
Treatmentofanaerobicintra-abdominalinfections:
Oral:
Moxifloxacin400mgevery24hour
IV:
Moderatetomoderatelysevereinfections
Ertapenem1gevery24hours
Ceftriaxone1gevery24hours(orciprofloxacin400mgevery12
hours,ifpenicillinallergic)plusmetronidazole500mgevery8hours
or
Tigecycline100mgoncefollowedby50mgevery12hoursor
Moxifloxacin400mgevery24hours
Severeinfections:
imipenem,0.5gevery6-8hours;meropenem1gevery8hours;
doripenem0.5gevery1hour;piperacillin/tazobactam
4.5gevery8hours

---

---

119.Whichofthefollowingdruginteractwith
Warfarin:
a)ACEinhibitor
b)Azithromycin
c)Fluconazole
d)Aspirin
e)Benzodiazepine
CorrectAnswer-C:D
Ans.(C)Fluconazole(D)Aspirin
[RefKDT7th/62i,503;Katzung12th/610]
DrugCausingEnhancedAnticoagulantActionofWarfarin:
Aspirin:inhibitplateletaggregationebcauseG.Ibleeding
Nevercephalosporins(ceftriaxone,cefoperazone):Cause
hypoprothrombinemia
BroadSpectrumantibiotics:Inhibitgutflora6reducevit.Kproduction
Longactingsulfonamide,indomethacin,phenytoin&probenecid:
Displacewarfarinfromplasmaproteinbinding.
Chloramphenicol,erythromycin,celecoxib,cimetidine,allopurinol,
amiodarone&metronidazole:Inhibitwarfarinmetabolism
Tolbutamide&phenytoin:Inhibitwarfarinmetabolism&viceversa.
Liquidparaffin(habitualuse):Reducevit.Kabsorption
DrugCausingReducedAnticoagulantActionofWarfarin:
Barbiturates(butnotbenzodiazepines),carbamazepine,rifampin,&
griseofulvin:InducethemetabolismoforalAnticoagulant.
OralcontraceptiveIncreasebloodlevelsofclottingfactors

---

120.Allofthefollowingistrueabout
hydroxyureaexcept:
a)Causemyelosuppression
b)Oralbioavailabilityisveryless
c)UsedinCML
d)Actasradiosensitizer
e)Usedinsicklecellanaemia
CorrectAnswer-B
Ans.B.Oralbioavailabilityisveryless
[Ref:KDT7th/868;Kntzung12th/582]
Hydroxyurea:
Hydroxyureaisananalogofureawhosemechanismofaction
involvestheinhibitionofDNAsynthesisbyinhibitingtheenzyme
ribonucleotidereductase,resultingindepletionofdeoxynucleoside
triphosphatepools.
ThisagentexertsitseffectsintheSphaseofthecellcycle.
Nearly100%oralbioavailability.
Mainlyusedinchronicmyelogenousleukemia,blastcrisisofacute
myeloidleukemia,psoriasis&sicklecellanaemia.
Myelosuppressionistheilose-limitingtoxicity.

---

121.Whichofthefollowingis/aretrue
regardingplasmaconcentrationtime
curveofadrug:
a)Peakconcentrationdeterminebioavailability
b)Intramuscularadministrationhavecurvedifferentfromoral
administration
c)Areaundercurvedeterminetherapeuticresponse
d)Bioavailabilityofanorallyadministereddrugcanbecalculated
bycomparingtheareaundercurveafteroral&afteri.v.
administration
e)Changesintherateofabsorptionandextentofbioavailability
caninfluenceboththedurationofactionandtheeffectiveness
ofthesametotaldoseofadrugadministeredindifferent
formulations
CorrectAnswer-B:D:E
Ans.(B)Intramuscularadministrationhavecurvedifferentfrom
oraladministration(D)Bioavailabilityofanorallyadministered
drugcanbecalculatedbycomparingtheareaundercurveafter
oral&afteri.v.administration(E)Changesintherateof
absorptionandextentofbioavailabilitycaninfluenceboththe
durationofactionandtheeffectivenessofthesametotaldose
ofadrugadministeredindifferentformulations
(Ref:KDT7th/16-17;Katzung12th/43-44)
Theareaunderthebloodconcentration-timecurve(areaunderthe
curve,orAUC)canbeusedtocalculatetheclearanceforfirst-order
elimination.

---

usedasameasureofbioavailability.
Bioavailabilityvariationassumespracticalsignificancefordrugswith
lowsafetymargin(iligoxin)orwheredosageneedsprecisecontrol
(oralhypoglycemics,oralhypocoagulants).

---

122.Allaretrueabouthydrochlorothiazide
except:
a)Causehyperglycemia
b)InhibitNa-Clsymport
c)Increasescalciumexcretioninurine
d)Causehyperuricaemia
e)Usedintreatmentofrenalstone
CorrectAnswer-C
Ans.C.Increasescalciumexcretioninurine
[RefKDT7th/5%-86;Katzung12th/260-61,270]
Hydrochlorothiazide:
InhibitsNa+-Cl-symportpredominantlyintheDCT.
EnhanceCa2+reabsorption&decreaseurinecalciumexcretion
(causeshypercalcemia).
Thiazidecausecarbohydrateintolerance&causepreciPitationof
diabetes
Toxicity:
Hypokalemicmetabolicalkalosisandhyperuricemia
ImpairedCarbohydrateTolerance.

---

123.APatientpresentedinemergencyroom
withseveremalaria.Hewasgiven
artusunateat0hr,12hr,24hr&then
onceadaytill3day.Whichofthe
followingstatement(s)is/arecorrect
regardingfurthermanagementofthe
patient
a)Patientmaylaterswitchedtooraldrugifpatientabletotolerate
b)Dextrosedripshouldbestarted
c)Artesunateshouldneverbegivensingly
d)Steriodisbeneficial
e)None
CorrectAnswer-A:B:C
Ans.(A)Patientmaylaterswitchedtooraldrugifpatientableto
tolerate(B)Dextrosedripshouldbestarted(C)Artesunate
shouldneverbegivensingly
[Ref:KDT7th/819-21;Park23rd/262-67;Harrison19th/1379-81,
18th/1698-1705]
Artemisininderivativesmustneverbegivenasmonotherapyfor
uncomplicatedmalaria.
Therapidlyactingdrugs,ifusedalone,canleadtothedevelopment
ofparasiteresistance
Whenthepatientisunconscious,thebloodglucoselevelshouldbe
measuredevery4-6hrs.

---

AllpatientsshouldreceiveacontinuousinFusionofdextrose,and
bloodconcentrationsideallyshouldbemaintainedabove4mmol/L.

---

124.ATTdrugwithsignificantrenalexcretion
is/are:
a)INH
b)Rifampicin
c)Pyrazinamide
d)Amikacin
e)Streptomycin
CorrectAnswer-A:C:D:E
Ans.(A)INH(C)Pyrazinamide(D)Amikacin(E)Streptomycin
[RefKDT7th/767;Katzung12th/841]
Rifampin:
Itismetabolizedinthelivertoanactivedeacetylatedmetabolite
whichisexcretedmainlyinbile,someinurine.
Urine&secretionsmaybecomeorange-red
INH:
Itisextensivelymetabolizedinliver;mostimportantpathwaybeing
N-acetylationbyNAT2.
Theacetylatedmetaboliteisexcretedinurine
Pyrazinamide:
Extensivelymetabolizedinliver&excretedinurine.
Pyrazinamidemetabolitesarerenallycleared.
Aminoglycosides(streptomycin&amikacin)arenotmetabolized.

---

125.Validdrugcombinationsare:
a)Sulfamethoxazole+trimethoprim
b)Penicillin+Tetracycline/chloramphenicol:Pneumococci
c)Piperacillin-Tazobactam
d)Enalapril-Hydrochlorothiazide
e)Ibuprofen&serratiopeptidase
CorrectAnswer-A:C:D:E
Ans.(A)Sulfamethoxazole+trimethoprim(C)Piperacillin-
Tazobactam(D)Enalapril-Hydrochlorothiazide(E)Ibuprofen&
serratiopeptidase
[RefKDT7th/698-99,725,61-62;Katzung12th/801]
Tazobactampharmacokineticsmatcheswithpiperacillinwithwhichit
hasbeencombinedforuseinsevereinfectionsLikeperitonitis,
pelvic/urinary/respiratoryinfectionscausedbybeta-lactamase
producingbacilli.
ACEinhibitors/ARBsareparticularlysynergisticwithdiuretics;this
combinationisverygoodforpatientswithassociatedCHForLVH.
Serratiopeptidaseisaproteolyticenzyme(protease)producedby
enterobacterSerratiasp.BrandnameNildol-SP(400+15)is
combinationofSerratiopeptidase&Ibuprofen(RoyalSapphire
RemediesTablet.

---

126.Whichofthefollowingstatementabout
protonpumpinhibitorsis/aretrue
except:
a)Hit&rundrug
b)Acidicmediumisessentialforactivity
c)ActonH+/K+ATPase
d)Formsanintegralcomponentofanti-H.pyloriregimens
e)Actbestinalkalinemedium
CorrectAnswer-E
Ans.E.Actbestinalkalinemedium
[RefKDT7thBa,651-52;Katzung12th/1085-89]
Hit&rundrugs:
Effectslastmuchlongerthanthedrugitself),e.g.,reserpine,
guanethidine,MAOinhibitors,omeprazole.
OneofthePPIsisanintegralcomponentofallanti-H.pylori
regimensalongwith2(tripledrug)or3(quadrupledrug)
antimicrobial.
SinceanacidicpHintheparietalcellacidcanaliculiisrequiredfor
drugactivation&sincefoodstimulateacidproduction,thesedrugs
ideallyshouldbegivenabout30minutesbeforemeals.
Protonpumpinhibitorsareadministeredasinactiveprodrugs.

---

127.Commonaction(s)ofepinephrine&
norepinephrineincludes:
a)Skinvasodilation
b)Bronchialmusclecontraction
c)IncreasesystolicBP
d)IncreaseHR
e)Renalvasoconstriction
CorrectAnswer-C:E
Ans.(C)IncreasesystolicBP(E)Renalvasoconstriction
[RefKDT7th/124-133;Gooilman&Gillmanllth/2z4-248;Ganong
25th/353-56]
Epinephrinecausebronchialmusclerelaxation(throughbeat-2
receptor)whereasnorepinephrinehasnoaetion(noactiononbeat-
2.
Bothepinephrine&norepinEphrineincreasesrenalvascular
resistance&thusreducerenalbloodflow.

---

128.Antibioticwhichactsthroughcellwall
inhibition:
a)Penicillin
b)Daptomycin
c)Aminoglycoside
d)Cephalosporin
e)Imipenam
CorrectAnswer-A:D
Ans.(A)Penicillin(D)Cephalosporin
[RefKDT7th/689-90;Katzungp803]
MechanismofActionofDrugs:
Inhibitcellwallsynthesis:Penicillins,Cephalosporins,Cycloserine,
Vancomycin,Bacitracin.
Causeleakagefromcellmembranes:Polypeptides-Polymyxins,
Colistin,Bacitracin.Polyenes-AmphotericinB,Nystatin,Hamycin.
Inhibitproteinsynthesis:Tetracyclines,Chloramphenicol,
Erythromycin,Clinda-mycin,Linezolid.
Causemisreadingofm-RNAcodeandaffectpermeability:
Aminoglycosides-Streptomycin,Gentamicin,etc.
InhibitDNAgyrase:Fluoroquinolones-Ciprofloxacinandothers.
InterferewithDNAfunction:Rifampin.
InterferewithDNAsynthesis:Acyclovir,Zidovudine.
Interferewithintermediarymetabolism:Sulfonamides,Sulfones,
PAS,Trimethoprim,Pyrimethamine,Metronida-zole.

---

129.TrueaboutamphotericinB:
a)Liposomalpreparationisavailable
b)Orallyabsorbed
c)Usedonlyinintravenousform
d)Proteinsynthesisinhibitor
e)None
CorrectAnswer-A
Ans.A.Liposomalpreparationisavailable
[Ref:KDT7th/787-89;Katzung12th/934,849-52,1066]
AMBisnotabsorbedorally,itcanbegivenorallyforintestinal
candidiasiswithoutsystemictoxicity.
Administeredi,v,assuspensionmadefromdeoxycholate(DOC),it
getswidelydistributedinthebody.
Itcanbealsoadministeredtopicallyforvaginitis,otomycosis
LiposomalAMB:
Ithasbeenproducedtoimprovetolerabilityofi.v.infusion,reduceits
toxicity&achievetargeteddelivery.
ItdeliversAMBparticularlytoreticuloendothelialcellsinliver&
spleen-especiallyvaluableforkalaazar&inImmunocompromised.

---

130.Peripheralneuropathyis/arecausedby:
a)Vincristine
b)Sulfonamide
c)Amiodarone
d)Paclitaxel
e)None
CorrectAnswer-A:C:D
Ans.(A)Vincristine(C)Amiodarone(D)Paclitaxel
[Ref:Harrison19th/2686-88,18th/3463-66;KDT7th/706]
Sulfonamidenotmentionedinlistofdrugscausingneuropathies

---

131.Whichoffollowingis/aretrueabout
metformin:
a)Causelacticacid
b)PPARyagonist
c)ContraindicatedinRenalfailure
d)Causehypoglycemia
e)GIdisturbancesarecommonsideeffect
CorrectAnswer-A:C:E
Ans.(A)Causelacticacid(C)ContraindicatedinRenalfailure
(E)GIdisturbancesarecommonsideeffect
[Ref.KDT7th/275-76;Katzung12th/757]
Metformin:
PPARyagonist(peroxisomeproliferator-activatedreceptorl)
Causelittleornohypoglycemia
ReportedtoimprovelipidprofilesintypeIIDm(decreasedLDL).
Contraindicatedinrenaldisease,alcoholism,hepaticdisease,or
conditionspredisposingtotissueanoxia(e.g.,chronic
cardiopulmonarydysfunction),becauseofanincreasedriskoflactic
acidosis,inducedbybiguanidedrugsinthepresenceofthese
diseases.

---

132.Whichoffollowingstatementistrue
aboutcanagliflozin:
a)SGLT-2inhibitor
b)BlocksNa/glucosesymport.
c)Causesglycosuria&polyuria
d)Increaseschanceofvaginalinfections
e)None
CorrectAnswer-A:C:D
Ans.(A)SGLT-2inhibitor(C)Causesglycosuria&polyuria
(D)Increaseschanceofvaginalinfections
[RefKDT7th/270:http://tvww.diabetesincontrol.eom]
Canagliflozin:
Antidiabeticdrugusedtoimproveglycemiccontrolinpatientswith
type2diabetes.
SGLT-2inhibitor.
?Sodium-glucoseco-transPorter-2(SGLT-2)inhibitorsareanew
groupoforalmedicationsusedfortreatingtype2diabetes
ProducesbeneficialeffectsonHDLcholesterolandsystolicblood
pressure,buttheseeffectsareoffsetbyincreasedLDLcholesterol.
Vaginalyeastinfectionsandurinarytractinfectionsarethemost
commonsideeffects
Canagliflozinislesseffectiveinpatientswithmoderaterenalfailure
endprobablyineffectiveinsevererenalfailureandtype1diabetics

---

133.WhichofthefollowingpairofGreceptor
iscorrectlymatchedwithitsaction:
a)Gi-Activationofcalciumchannel
b)Gq-Tcytoplasmiccalcium
c)Gs-Openingofcalciumchannel
d)Go-Openingofpotassiumchannel
e)Gt-Activationofpotassiumchannel
CorrectAnswer-B:C:D
Ans.B,Gq-TcytoplasmiccalciumC,Gs-Openingofcalcium
channel&D,Go-Openingofpotassiumchannel
[RefKDT7th/a5-49;Katzung31]
GsopenCa2+channelsinmyocardium6skeletalmuscle,whileGi
&GoopenK+channelinheart&smoothmuscleasweIIasinhibit
neuronalCa2+channel
GReceptor:
Gs:Adenylylcyclaseactivation,Ca2+channelopening
Gi:Adenylylcyclaseinhibition,K+channelopening
Go:Ca2+channelinhibition.
Gq:PhospholipaseCactivation

---

134.WhichofthefollowingCLASPhuman
experiment:
a)MaincenterfortheexperimentwasGeneva
b)MaincenterfortheexperimentwasTokoyo
c)MaincenterfortheexperimentwasinUnitedkingdom
d)Heparinlowdosegiven
e)Drugusedinexperimentsignificantlyreduceseclampsiain
subjects
CorrectAnswer-C
Ans.C.MaincenterfortheexperimentwasinUnitedkingdom
[Ref;http:/www.researchgate.net;
httP://www.ncbi.nlm,nih.gov/pubmed/7905809]
CLASPhumanexperiment:
Correspondenceto:CLASPCo-ordinatingCentre,Harkness
Building,RadcliffeInfirmary,OxfordOX26HE,UK-http://
www,researchgate.net
CLASP
Theimpactofaspirinonproteinuricpreeclampsiaanditsfetal
sequelaeinCLASPwascertainlysmallerthaninsomeprevious
reviews.
Theresultsofavailabletrialsdonotsupportthewidespreadroutine
prophylacticortherapeuticuseofantiplatelettherapyinpregnancy
amongallwomenjudgedtobeatriskofpre-eclampsiaorIUGR.
Overall,theuseofaspirinwasassociatedwithareductionofonly
12%intheincidenceofproteinuriapre-eclampsia,whichwasnot
significant.

---

NorwasthereanysignificanteffectontheincidenceofIUGRorof
stillbirthandneonataldeath.

---

135.Mineralocorticoidreceptors
antagonist(s)is/are:
a)Spironolactone
b)Triamterene
c)Epleroenone
d)Amiloride
e)Acetazolamide
CorrectAnswer-A:C
Ans.(A)Spironolactone&(C)Epleroenone
[RefKDT.Tth/578;Katzung12th/261-62]
PotassiumSparingDiuretics
Aldosteroneantagonists:Spironolactone,eplerenone
InhibitorsofrenalepithelialNa+channel:Triamterene,Amiloride
MOA:
Actbydirectpharmacologicantagonismofmineralocorticoid
receptors(spironolactone,eplerenone)orbyinhibitionofNatinflux
throughionchannelsintheluminalmembrane(amiloride,
triamterene).

---

136.TNF-ainhibitorsare:
a)Bevacizumab
b)Ranibizumab
c)Adalimumab
d)Infliximab
e)Etanercept
CorrectAnswer-A:B:D
Ans.(A)Bevacizumab(B)Ranibizumab(D)Infliximab
TNFalpha-inhibitor:Etanercept,infliximab,certolizumah,
golimumab,&Adalimumab.
MOA:
BindsTNF-alpha,aproinflammatorycytokine.
BlockingTNF-alphafrombindingtoTNFreceptorsoninflammatory
cellsurfacesresultsinsuppressionofdownstreaminflammatory
cytokinessuchasIL-1&IL-6andadhesionmoleculesinvolvedin
leukocyteactivationandmigration.
Anincreasedriskoflymphomaiscommontoeachoftheseagents.

---

137.UnwantedinteractionsofMAOinhibitors
occurwith:
a)Levodopa
b)Hydrochlorothiazide
c)Reserpine
d)Pethidine
e)None
CorrectAnswer-A:C:D
Ans.A,LevodopaC,Reserpine&D,Pethidine
NonSelectiveMAOInhibitors:Interactions:
Cheesereaction-
Varietiesofcheese,beer,wine,pickledmeat&fish,yeastextract
containlargequantitiesoftyramine,dopaetc.
InMAOinhibitedpatientscausehypertensivecrisis&
cerebrovascularaccidents.
Cold&coughremedies-Ephedrine.
Reserpine,guanethidine,tricyclicantidepressants
Levodopa:
Excitement&hypertension.
Antiparkinsoniananticholinergics:
Hallucinations&symptomssimilartothoseofatropinepoisoning
Barbiturates,alcohol,opioids,antihistamines:
Actionsofthesedrugisintensified&prolonged.Respirationmay
fail..
Pethidine:
Highfever,sweating,excitation,delirium,convulsions&severe

---

respiratorydepression.
Note:
HydrochlorothiazidedruginteractionsnotincludeMAO-Inhibitors

---

138.Trueaboutdoxorubicin:
a)Antineoplasticdrug
b)Alkylatingagent
c)TopoisomeraseIIIinhibitor
d)Anthracyclineantibiotic
e)Cardiotoxic
CorrectAnswer-A:D:E
Ans.(A)Antineoplasticdrug(D)Anthracyclineantibiotic
(E)Cardiotoxic
[RefKDT7th/867;Katzung13th/934-35]
Doxorubicin:
Anthracyclineantibiotichavingantitumoractivity
Itintercalateb/wDNAstrands&blockDNAaswellasRNA
synthesis.
TheyarealsocapableofcausingbreaksinDNAstrandsby
activatingtopoisomerase-2&generatingquininetypefreeradicals.
Cardiotoxicadverseeffect.

---

139.Whichofthefollowingis/aretrueabout
Sulfonylureaexcept:
a)Increaseinsulinsecretion
b)Causehypoglycemia
c)Causeweightloss
d)Disulfiram-likereactionafteralcoholintake
e)Safeinpregnancy
CorrectAnswer-C:E
Ans.C,Causeweightloss&E,Safeinpregnancy
[RefKDT7th/270-73;Katzung12th/754-5]
Sulfonylureas:
Provokeabriskreleaseofinsulinfrompancreas.
Hypoglycemiaisthemostcommonproblem.
MajorityofdiabeticsstartedonSUstendtogain1-3kg.
Flushing&disulfiram-likereactionafteralcoholoccurinsome
individualstakingSUs
Safetyduringpregnancyisnotestablished.

---

140.Trueaboutdaptomycin:
a)Causesdiarrheaasside-effect
b)Itisaglycopeptideantibiotic
c)Causemyopathy
d)Itcanbeusedorally
e)Excretionthroughkidney
CorrectAnswer-C:D
Ans.(C)Causemyopathy(D)Itcanbeusedorally
[RefKatzung13th/783-85;Goodman&Gilman11th/1197-98:
Harrison19th/961]
Daptomycin:
CycliclipopeptidefermentationproductofStreptomyces
roseosPorus.
Newly-approvedantibacterialagent,thefirstlipopeptideagenttobe
releasedontothemarket.
ItsspectrumofactivityislimitedtoGram-positiveorganisms,
includinganumberofhighlyresistantspecies(MRSA,VISA,VRSA,
VRE)
MOA:
Precisemechanismofactionisnotknown,butifappearstobindto
anddepolarizethecellmembrane,causingPotassiumeffluxand
rapidcelldeath.
Features:
Onlyadministeredintravenously.
Clearedrenally.
Approximately80%oftheadministereddoseisrecoveredinurine.
Cancausemyopathy,andcreatinephosphokinaselevelsshouldbe

---

monitored.

---

141.Weightgainisnotseenwith:
a)Clozapine
b)Risperidone
c)Olanzapine
d)SSRI
e)Zotepine
CorrectAnswer-D
Ans.(D)SSRI
[RefKDT7th/aal,442;Katzung12d/512,509]
ClozapineMetaboliccomplications(Major)-Weightgain,
hyperlipidemia&precipitationofdiabetes.
Olanzapinecausesweightgain.
Risperidonecausesweightgain&incidenceofnewonsetdiabetes
islessthanwithclompine
increasedappetite&weightgainisnoteilwithmostTCAs&
trazodone,butnotwithSSRIs,SNRIs&bupropion.
Zotepine:Weightgain,hyperglycemia&dyslipidemiaareLikelyas
withclozapine
Quetiapine:Weightgain&riseinbloodsugarismoderate.
Aripiprazole:Littletendencytoweightgain.

---

142.Whichofthefollowingis/aretrueabout
dobutamine:
a)Selective(32receptoragonist
b)Tventricularfillingpressure
c)Halflifeisabout2min
d)Dopaminereceptoragonist
e)None
CorrectAnswer-C
Ans.(C)Halflifeisabout2min
[R4KDf7th/134;Katzung12th/141-42,218,225;Goodman&
Gilman11th/251]
Dobutamine:
Derivativeofdopamine,butnotaDlotD2receptoragonist.
Hasactiononalpha&betareceptorsalso.
Yet,onlyprominentactionofclinicallyemployeddosesisincreased
forceofcardiaccontraction&outPut,withoutsignificantchangein
heartrate,peripheralresistance&BP.
Consideredtobearelativelyselectivebeta-1agonist.
Half-lifeofabout2minutes&onsetofactionisrapid.
UsedasaninotroPicagentinpumpfailureaccompanying
myocardialinfarction,cardiacsurgery&forshorttermmanagement
ofseverecongestiveheartfailure.

---

143.DrugsactiveagainstMRSA:
a)Vancomycin
b)Ceftriaxone
c)Linezolid
d)Piperacillin-tazobactam
e)Meropenam
CorrectAnswer-A:C
Ans.(A)Vancomycin(C)Linezolid
[RefKDT7th/731,757,6th/700,708,732,7i4;G6G11th/1132;
Kntzung13th/779,781;Harrison19th/961-62.18th/2134]
MRSA:
Vancomycinanddaptomycinarenowrecommendedasthedrugof
choiceforthetreatmentofMRSAinfections.
Imipenema,Dalfopristino/Quinpristin,Mupirocin,Teicoplaninaare
alsoeffectiveagainstMRSA
Ceftarolineisa5thgen.cephalosporinwithbactericidalactivity
againstMRSA(includingstrainswithreducedsusceptibilityto
vancomycinanddaptomycin)-Approvedforuseinnosocomial
pneumoniasandforskinandsofttissueinfections.
Otherdrugsare-Linezolid,daptomycin,Quinupristin/dalfopristin.

---

144.Whichofthefollowingis/aretrueabout
phenytoin-
a)InactivationbyLiverenzyme
b)CausesVitB12deficiency
c)Causesthiaminedeficiency
d)Gumhypertrophyiscommonestside-effect
e)InhibitorofCYP3A4/5
CorrectAnswer-A:D
Ans.(A)InactivationbyLiverenzyme(D)Gumhypertrophyis
commonestside-effect
[Ref:KDT7th/a13-15;Katzung13th/2100-N2;AtoZDrugFacts
2003byDaildS.Tatro;Goodman6Gilman11th/335;Hanison
l9ttt/2554'18th/893,888]
Phenytoin:
MetabolizedinliverbyhydroxylationinvolvingCYP2C9&2C19as
wellasbyglucuronideconjugation.
Megaloblasticanaemia:ltdecreasedfolateabsorption&increaseits
excretion.
ItinterfereswithmetabolicactivationofVitD&withcalcium
absorPtion/metabolism.
Gumhypertrophy:commonest(20%incidence)
PotentinducerofCYP2C8/9,CYP3A4/5&someotherCYPs.
ItcompetitivelyinhibitsCYP2C9/19

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145.Apersonhasgiven0.175gmoral
digoxinwithbioavailabilty70%.The
amountofdrugreachinginsystemic
circulationis:
a)0.175
b)0.175x0.7
c)0.175/7
d)0.175+0.7
e)0.175+1/0.7
CorrectAnswer-B
Ans.(B)0.175x0.7
[RdKDT7th/16,515;Katzungt2th/43]
Amountofdrugreachinginsystemiccirculation=drugdosegivenx
bioavailability
=0.175gmx70/100
=0.175gmx0.7

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146.TrueaboutPlacebo:
a)Itworksonlyinpsychiatricperson
b)Responseisbothobjective&subjective
c)Effectalsoseeninnormalperson
d)Itisaninertsubstance
e)None
CorrectAnswer-B:C:D
Ans.B,Responseisbothobjective&subjectiveC,Effectalso
seeninnormalperson&D,Itisaninertsubstance
[RefKDT7th/67;Katzung12th/72]
Placebo:
Aninertsubstancewhichisgiveninthegarbofamedicine.
Workbypsychodynamicratherthanpharmacodynamicmeans&
oftenproducesresponsesequivalenttotheactivedrug
Placebodoinducesphysiologicalresponses,e.g.,theycanrelease
endorphinsinbrain-causinganalgesia.
Substancescommonlyusedasplaceboarelactosetablets/capsules
&distilledwaterinjection.
Themanifestationofthisphenomenoninthesubjectistheplacebo
response(Latin,'Ishallplease')andmayinvolveobjective
physiologicandbiochemicalchangaaswellaschangesin
subjectivecomplaintsassociatedwiththedisease

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147.Trueaboutmorphine:
a)ActasantagonistonIAreceptorwithnoagonistaction
b)Activationinliver
c)Halflife4hr
d)Causemiosis
e)Clearancetimeisaround20hr
CorrectAnswer-B:D:E
Ans.(B)Activationinliver(D)Causemiosis(E)Clearancetime
isaround20hr
[Ref:KDT7th/469-75;Katzung13th/531-44;Goodman&Gilman
p62-66]
Morphine:
Primarilymetabolizedinliverbyglucuronideconjugation.
Morphine-6-glucuronideisanactivemetabolite(morepotentthan
morphineonpopioidrecePtors),whichcontributetoanalgesia.
AnothermetabolitemorPhine-3-glucuronidehasneuroexcitatory
proPerty.
Plasmahalflifemorphineaverages2-3hours
Effectofaparenteraldoselasts4-6hours.
EliminationisalmostcomPletein24hours.
MorphinestimulateEdingerWestphalnucleusof3rdnerveis
stimulatedproducingmiosis.
NomeiosisoccurontopicalaPPlicationofmorPhinetotheeye,
sincethisisacentralaction

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148.Treatmentofnocardiainfectionincludes:
a)Ampicillin
b)Floroquinolones
c)Azithromycin
d)Cotrimoxazole
e)Amikacin
CorrectAnswer-A:B:D:E
Ans.A,AmpicillinB,FloroquinolonesD,Cotrimoxazole&
E,Amikacin
[RefKDf7th/706,755;Hanisonlgth/1087]
Nocardiosis:
SulfonamidesareofvalueintreatinginfectionsduetoNocardiagrp.
Sulfisoxazoleorsulfadiazinemaybegivenindosagaof6-8gdaily
andiscontinuedforseveralmonthsafteraIImanifestationshave
resolved.
administrationofasulfonamidewith2ndgen.antibiotic(ampicillin,
erythromycin,ardstreptomycin)advised.
CoTrimoxazoleisusedinnocardiosis.

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