Pharmacology Test


Test Information Test Name Pharmacology including Pharmacogenetics Total Questions 200

Test Type Examination Difficulty Level Difficult

Total Marks 600 Duration 120minutes

Test Question Language:- ENGLISH

(1). The receptors for noradrenaline, adrenaline, dopamine all belong to which category -

a. Seven-pass receptors

b. Ligand-gated receptors

c. Four-pass receptors

d. Single-pass receptors

Solution. Ans-1: (a) Seven-pass receptorsRef:Read the text belowSol: Catecholamines(adrenaline, noradrenaline and dopamine) act through G protein coupled receptors which belong to a largesuperfamily of seven pass transmembrane protein (also k/a serpentine receptors). These proteins span the cell membrane seve times.

Answer. a


(2). In erectile dysfunction, which of the following drug is not used?

a. Apomorphine

b. Phenylephrine

c. Sildenafil

d. Papaverine

Solution. Ans-2: (b) PhenylephrineRef:Read the text belowSol:List of drugs causing erectile dysfunction

Classification Drugs

Diuretics ThiazidesSpironolactone

Antihypertensives

Calcium channel blockersMethyldopaClonidineReserpine-BlockersGuanethidine

Cardiac/anti-hyperlipidemicsDigoxinGemfibrozilClofibrate

AntidepressantsSelective serotonin reuptake inhibitorsTricyclic antidepressantsLithiumMonoamine oxidase inhibitors

Tranquilizers ButyrophenonesPhenothiazinesH2 antagonists

RanitidineCimetidine

Hormones

ProgesteroneEstrogensCorticosteroidsGnRH agonists5-Reductase inhibitorsCyproterone acetate

Cytotoxic agentsCyclophosphamideMethotrexateRoferon-A

Anticholinergics DisopyramideAnticonvulsants

RecreationalEthanolCocaineMarijuana

Answer. b


(3). A73-year-old patient has heart failure that has worsened over the past 12 months. Which of the following drugs is likely to slowprogression even though it has no direct positive or negative effects on cardiac contractility?

a. Digoxin

b. Dobutamine

c. Losartan

d. Nesiritide

Solution. Ans-3: (c) LosartanRef:Read the text belowSol: Losartan, an AT1 angiotensin receptor antagonist, has been shown to slow the progression of heart failure, in common with theACE inhibitors, beta blockers, and spironolactone, which also slow progression of this disease. Positive inotropic agentssuch as digoxin and dobutamine do not slow progression although they may be useful for reducingsymptoms. Nesiritide is a peptide that causes vasodilation and sodium diuresis and may have value in acute but not chronic failure.

Answer. c

(4). Which of the following drugs is associated with discoloration of the skin, photosensitivity, thyroid dysfunction, and pulmonarycomplications?

a. Amiodarone

b. Diltiazem

c. Ibutilide

d. Lidocaine

Solution. Ans-4: (a) AmiodaroneRef:Read the text belowSol: Amiodarone is a large, insoluble molecule that deposits in skin(and the cornea) and causes photosensitivity. It contains two iodine atoms, which may be responsible for binding to thyroid receptors and the observed thyroid problems. It is associated with pulmonary fibrosis (sometimes fatal), but the mechanism is unknown. In spite of these adverse effects, it is extremely useful in arrhythmia treatment. Diltiazem is associatedwith constipation and cardiac depression; ibutilide with torsade de pointe arrhythmia,lidocaine withconvulsions, and procainamide with torsade de pointe arrhythmia and drug-induced lupus.

Answer. a

(5). Which of the following drugs causes hyperchloremic metabolic acidosis and may cause hyperammonemia in a patient with cirrhosis?

a. Acetazolamide

b. Amiloride

c. Furosemide

d. Hydrochlorothiazide

Solution. Ans-5: (a) AcetazolamideRef:Read the text belowSol: Acetazolamide acts in the proximal tubule to block carbonic anhydrase, greatly increasing bicarbonate excretion and alkalinizingthe urine while causing metabolic acidosis. In cirrhosis, ammonia is excreted in larger amounts because urea production in the liver is limited. If an acid urine (necessary for converting ammonia to ammonium ion) cannot be produced, the ammonia is promptlyreabsorbed,causing hyperammonemia and hepatic encephalopathy. None of the other drugs causes hyperammonemia in cirrhotic patients.

Answer. a


(6). Serotonin (5-HT) is one of several mediators of the signs and symptoms of carcinoid tumor.When released from this neoplasm, most ofthe manifestations of 5-HT are the result of activation of the 5-HT2 receptor. These manifestations are therefore likely

a. Bronchospasm

b. Constipation

c. Skeletal muscle weakness

d. Tachycardia

Solution. Ans-6: (a) BronchospasmRef:Read the text belowSol: 5-HT2 receptors mediate smooth muscle contraction and thus cause bronchospasm and diarrhea, not constipation. Skeletal muscle and cardiac muscle are relatively insensitive to 5-HT. Peptic ulceration is not mediated in part by 5-HT; the autacoid actually reduces acid secretion.

Answer. a

(7). Which of the following drugs is useful in asthma because it stabilizes mast cells?

a. Albuterol

b. Cromolyn

c. Ipratropium

d. Salmeterol

Solution. Ans-7: (b) CromolynRef:Read the text belowSol: Cromolyn is a prophylacticagent for asthma that appears to stabilize mast cells. Albuterol is a shorter acting beta-2-selective agonist that is used for acute, not prophylactic, therapy. Ipratropiumis an antimuscarinic drug. Salmeterolhas a long duration beta-2-agonist action that appears to have an anti-inflammatory action and is useful in prophylaxis ofasthmatic attacks. It has a slow onset of action that makes it useless in treating acute attacks.

Answer. b


(8). Which of the pairs is incorrect

a. V1-smooth muscles

b. V2-distal nephron

c. V3-anterior pituitary

d. V4-CNS

Solution. Ans 8: (d) V4-CNSRef:Read the text belowSol:Vasopressin Receptors There are at least three kinds of vasopressin receptors: V1A, V1B, and V2. All are G protein-coupled. The V1A and V1B receptors act through phosphatidylinositol hydrolysis to increase the intracellular Ca2+ concentration. The V2 receptors act through Gs to increase cyclic adenosine 3',5'-monophosphate (cAMP) levels. The mechanism by which vasopressin exerts its antidiureticeffect is activated by V2 receptors and involves the insertion ofproteins called water channels into the apical (luminal) membranes of the principal cells of the collecting ducts. Movement of water across membranes by simple diffusion is now known to be augmented by movement through waterchannels called aquaporins, and to date 13 (AQP0AQP12) have been identified and water channels are now known to beexpressed in almost all tissues in the body. The vasopressin-responsive water channel in the collecting ducts is aquaporin-2. These channels are stored in endosomes inside thecells, and vasopressin causes their rapid translocation to the luminal membranes. V1A receptors mediate the vasoconstrictor effect of vasopressin, and vasopressin is a potent stimulator of vascular smoothmuscle in vitro. However, relatively large amounts of vasopressin areneeded to raise blood pressure in vivo, because vasopressin also acts on thebrain to cause a decrease in cardiac output. The site of this action is the area postrema, one of the circumventricular organs. Hemorrhage is a potent stimulus for vasopressin secretion, and the blood pressure fall after hemorrhage is more markedin animals that have been treated with synthetic peptides that block the pressor action of vasopressin. V1A receptors are also found in the liver and the brain. Vasopressin causes glycogenolysis in the liver, and, as noted above, it is aneurotransmitter in the brain and spinal cord. The V1B receptors (also called V3 receptors) appear to be unique to the anterior pituitary, where they mediate increasedadrenocorticotropic hormone (ACTH) secretion from the corticotropes.

Answer. d


(9). Drug used in estrogen positive breast cancer

a. Tamoxifen

b. Cyproterone acetate

c. Flutamide

d. Fluoxetine

Solution. Ans 9: (a) TamoxifenRef:Read the text belowSol:Adjuvant Regimens in breast cancer In general, premenopausal women for whom any form of adjuvant systemic therapy is indicated should receive multidrugchemotherapy. The antiestrogen tamoxifen improves survival in premenopausal patients with positive estrogen receptors and should be addedfollowing completion of chemotherapy. Prophylactic castration may also be associated with a substantial survival benefit (primarily in estrogen receptorpositivepatients)Approaches to Adjuvant Therapy

Age Group Lymph NodeStatusEndocrine

Receptor (ER)Status

Tumor Recommendation

Premenopausal Positive Any Any Multidrug chemotherapy + tamoxifen if ER-positive +trastuzumab in HER-2/neu positive tumors

Premenopausal Negative Any>2 cm, or 12 cm withother poor prognosticvariables

Multidrug chemotherapy + tamoxifen if ER-positive +trastuzumab in HER-2/neu positive tumors

Postmenopausal Positive Negative Any Multidrug chemotherapy + trastuzumab in HER-2/neupositive tumorsPostmenopausal Positive Positive Any Aromatase inhibitors and tamoxifen with or withoutchemotherapy + trastuzumab in HER-2/neu positive tumors

Postmenopausal Negative Positive>2 cm, or 12 cm withother poor prognosticvariables

Aromatase inhibitors and tamoxifen + trastuzumab in HER-2/neu positive tumors

Postmenopausal Negative Negative>2 cm, or 12 cm withother poor prognosticvariables

Consider multidrug chemotherapy + trastuzumab in HER-2/neu positive tumors

The first decision is whether chemotherapy or endocrine therapy should be used. While adjuvant tamoxifen improves survival regardless of axillary lymph node status, the improvement in survival is modest forpatients in whom multiple lymph nodes are involved. For this reason, it has been usual to give chemotherapy to postmenopausal patients who have no medical contraindications andwho have more than one positive lymph node; tamoxifen is commonly given simultaneously or subsequently. For postmenopausal women for whom systemic therapy is warranted but who have a more favorable prognosis, tamoxifen may beused as a single agent. Large clinical trials have shown superiority for aromatase inhibitors over tamoxifen alone in theadjuvant setting. Other adjuvant treatments under investigation include the use of taxanes, such as paclitaxel and docetaxel, and therapy based onalternative kinetic and biologic models. In such approaches, high doses of single agents are used separately in relativelydose-intensive cycling regimens.

Answer. a


(10). SERM used for osteoporosis

a. Raloxifen

b. Estrogen

c. Cyproterone acetate

d. Fluoxetine

Solution. Ans 10: (a) RaloxifenRef:Read the text belowSol:Drugs Used to Treat OsteoporosisBisphosphonates These analogs of pyrophosphate, including etidronate, risedronate, alendronate, ibandronate, pamidronate, tiludronate, andzoledronic acid, comprise an important drug group used for the treatment of disorders of bone remodeling, such asosteoporosis and Paget's disease, as well as for treatment of bone metastases and hypercalcemia of malignancy. In addition, alendronate, risedronate,and ibandronate have been approved for the prevention and treatment of osteoporosis. Zoledronic acidis also approved for the treatment of postmenopausal osteoporosis. The bisphosphonates decrease osteoclastic bone resorption via several mechanisms, including1) Inhibition of the osteoclastic proton pump necessary for dissolution of hydroxyapatite, 2) Decrease in osteoclastic formation/activation,3) Increase in osteoclastic apoptosis (programmed cell death), and4) Inhibition of the cholesterol biosynthetic pathway important for osteoclast function.Selective estrogen-receptor modulators Estrogen replacement is an effective therapy for the prevention of postmenopausal bone loss. When initiated in the immediatepostmenopausal period, estrogen therapy prevents osteoporosis and reduces the risk of hip fracture. Raloxifeneis a selective estrogen-receptor modulator approved for the prevention and treatment of osteoporosis. It increases bone density without increasing the risk of endometrial cancer. In addition, raloxifene may reduce the risk of invasivebreast cancer. Raloxifeneis a first-line alternative for postmenopausal osteoporosis in women who are intolerant to bisphosphonates. Raloxifene reduces serum total and low-density lipoprotein cholesterol concentrations. The risk of venous thromboembolism appears to be comparable to that with estrogen. Other adverse effects include hot flashes and legcramps.Calcitonin Salmon calcitonin, administered intranasally, is effectiveand well tolerated in the treatment of postmenopausal osteoporosis. The drug reduces bone resorption, but it is less effective than the bisphosphonates. A unique property of calcitonin is the relief of painassociated with osteoporotic fracture. Therefore, calcitonin may be beneficial in patients who have recently suffered a vertebral fractureTeriparatide Teriparatideis a recombinant segmentof human parathyroid hormone that is administered subcutaneously for the treatment ofosteoporosis. Parathyroid hormone given continuously leads to dissolution of bone, but when it is given subcutaneously once daily, bone formationis the predominant effect. It increases spinal bone density and decreases the risk of vertebral fracture. Teriparatideis the first approved treatment for osteoporosis that stimulates bone formation. Other drugs approved for this indication inhibit bone resorption. It is also effective in the treatment of glucocorticoid-induced osteoporosis. Teriparatide has been associated with anincreased risk of osteosarcoma in rats.

Answer. a


(11). One of the many mechanisms of adverse events is its increased binding to secondary targets, usually proteins. With respect to theprimary target, the secondary target -

a. Should have a similar primary structure

b. Should have a absolutely identical secondary structure

c. Should have similar binding sites

d. Should be present in the same tissue as the primary target

Solution. Ans-11 (c) Should have similar binding sitesRef: Read the text belowSol: A very common mechanism of adverse reactions caused by drugs is binding to non-target proteins. These non-target proteins may be receptors or enzymes located in different organs as compared to the target organ (option 4)(For e.g. Opioids act on receptors in CNS for therapeutic effects, but effects on receptors in GIT can cause constipation as a side effect). The essence of these non-target proteins is that they share binding sites for the drug with the target protein of the drug (option3). This binding site is a function of the tertiary structure of the protein. Hence, proteins with different primary and secondary structures (option 1 and 2) but with similar binding sites or similartertiary structures can also act as non-target proteins (e.g. V1 and V2 receptors have different structures but share the same binding site;hence, both are acted upon by desmopressin).

Answer. c

(12). Which of the following is known as 'suicide enzyme'?

a. 5-Lipoxygenase

b. Cyclo-oxygenase

c. 5'-nucleotidase

d. Thromboxane synthase

Solution. Ans 12: (b) Cyclo-oxygenaseRef Read the text belowSol:: Some clinical examples of suicide inhibitors include: Aspirin, which inhibits cyclooxygenase 1 and 2 enzymes. Penicillin, which inhibits DD-transpeptidase from building bacterial cell walls. Sulbactam, which prohibits penicillin-resistant strains of bacteria from metabolizing penicillin. Allopurinol, which inhibits uric acid production by xanthine oxidase in the treatment of gout. AZT(zidovudine) and other chain-terminating nucleosideanalogues used to inhibit HIV-1reverse transcriptasein thetreatment of HIV/AIDS. Eflornithine, one of the drugs used to treat sleeping sickness, is a suicide inhibitor of ornithine decarboxylase. Sarin is a suicide inhibitor of acetylcholinesterase. 5-fluorouracil acts as a suicide inhibitor of thymidylate synthase during the synthesis of thymine from uridine. This reaction is crucialfor the proliferation of cells, particularly those that are rapidly proliferating (such as fast-growing cancer tumors). By inhibiting this step,cells die from a thymineless death because they have no thymine to create more DNA. This is often used in combination withMethotrexate, a potent inhibitor of dihydrofolate reductase enzyme. Exemestane, a drug used in the treatment of breast cancer, is an inhibitor of the aromatase enzyme. Selegiline,[1]although in the attached reference the compound is called a 'suicide inactivator' (not inhibitor).

Answer. b


(13). Which of the following statements describes the major difference between zolpidem and older hypnotics such as barbiturates andbenzodiazepines?

a. Associated with thrombocytopenia

b. Does not act on chloride channels in the CNS

c. Has significant anticonvulsant activity

d. Reduced addiction liability

Solution. Ans-13: (d) Reduced addiction liabilityRef:Read the text belowSol: Zolpidem has greatly reduced addiction liability compared to barbiturates and benzodiazepines even though it does act onchloride channels. Zolpidem does not havemajor anticonvulsant actions, a longer duration of action, or thrombocytopenic toxicity.

Answer. d

(14). Which of the following drugs is used in cerebral palsy to reduce skeletal muscle spasticity by an action on cholinergic nerve endings?

a. Baclofen

b. Botulinum toxin

c. Dantrolene

d. Diazepam

Solution. Ans-14: (b) Botulinum toxinRef:Read the text belowSol: Botulinum toxin actson cholinergic nerve endings (including skeletal muscle motor nerve endings) to reduce acetylcholine release. Baclofen acts in the CNS to activate GABAB receptors; some sedation may result. Dantroleneacts within the skeletal muscle cell to reduce calcium release from the sarcoplasmic reticulum; reduction of muscle spasmresults without central nervous system depression. Diazepam facilitates GABAergic transmission in the brain and spinal cord; it does not act on cholinergic transmission.

Answer. b

(15). Which of the following drugs is most likely to cause parkinsonian adverse effects?

a. Clozapine

b. Fluphenazine

c. Haloperidol

d. Olanzapine

Solution. Ans-15: (c) HaloperidolRef:Read the text belowSol: Haloperidol is a verypotent and efficacious antipsychotic but also manifests the highest incidence of extrapyramidal effects. Clozapine, olanzapine, and quetiapineare newer, atypical antipsychotic agents with much lower incidence of extrapyramidaltoxicity.

Answer. c


(16). Apatient has been treated for bipolar disorder for several months. Which of the following is a common adverse effect of lithiumcarbonate?

a. Dry mouth

b. Hyperthyroidism

c. Leukopenia

d. Nephrogenic diabetes insipidus

Solution. Ans-16: (d) Nephrogenic diabetes insipidusRef:Read the text belowSol: Nephrogenic diabetes insipidus is a common adverse effect of lithium at therapeutic dosage. Dry mouth and other anticholinergic toxicities are common with tricyclic antidepressants and some phenothiazines. Lithium may induce hypothyroidism, but not hyperthyroidism Similarly, lithium increases rather than decreases white blood cell count

Answer. d

(17). Methadone has been used in opioid addiction maintenance clinics with partial success. Its ability to reduce the use of heroin andmorphine by recovering addicts can be ascribed to which of the following mechanisms?

a. Agonist effects at central dopamine d2 receptors

b. Antidepressant effects at serotonin (5-ht) receptors

c. Antagonist actions at the mu opioid receptor

d. Long-lasting saturation of the mu opioid receptor and development of tolerance

Solution. Ans-17: (d) Long-lasting saturation of the mu opioid receptor and development of toleranceRef:Read the text belowSol: Methadone is a typical strong agonist at opioid mu receptors and differs from morphine chiefly in its long duration of binding tothe receptor and long elimination half-life. It therefore produces a prolonged opioid effect that causes tolerance to the euphoric action of short-acting heroin andmorphine.Methadone has no opioid antagonist action nor does it act on metabolic pathways, serotonin receptors, or dopamine receptors).

Answer. d

(18). Which of the following drugs has opioid antagonist actions and also reduces nicotine and alcohol craving in persons dependent on thosedrugs?

a. Bupropion

b. Flumazenil

c. Nalbuphine

d. Naltrexone

Solution. Ans-18: (d) NaltrexoneRef:Read the text belowSol: Naltrexone is a very long-acting opioid antagonistthat has also been shown to reduce craving and dependence in smokers andalcoholics. The mechanisms for the latter effects are not fully understood. Bupropion is an antidepressantthat has some efficacy in tobacco dependence. It is not an opioid antagonist. Flumazenil is a benzodiazepineantagonist that is useful in BDZ overdose. It has no opioid antagonist effect. Nalbuphine is an opioid partial agonistthat has analgesic effects but can also antagonize the actions of strong agonists likemorphine.

Answer. d


(19). A known drug abuser is in restraints, combative, and hallucinating. His blood pressure, heart rate, and body temperature areelevated.Pupils are dilated and demonstrate both horizontal and vertical nystagmus. Which of the following drugs would cause th

a. Amphetamine

b. Heroin

c. Phencyclidine

d. Scopolamine

Solution. Ans-19: (c) PhencyclidineRef:Read the text belowSol: Phencyclidine, an NMDA receptor antagonist, is a more violent hallucinogen than most other drugs in this class (LSD, mescaline,scopolamine). It causes sympathetic discharge and muscle twitching; nystagmus is very common. Amphetamine is a sympathomimetic stimulant that can produce hallucinations or toxic psychosis in overdose, but is not usuallyassociated with nystagmus. Heroin is a depressant drug and does not present with combative stimulation. Pupils are constricted by opioidsScopolamine similarly does not usually cause combativeness or nystagmus.

Answer. c

(20). Which of the following antifungal drugs is strongly associated with drug interactions resulting from inhibition of CYP 3A4?

a. Amphotericin B

b. Caspofungin

c. Fluconazole

d. Ketoconazole

Solution. Ans-20: (d) KetoconazoleRef:Read the text belowSol: Ketoconazole is a potent inhibitor of the cytochrome P450 enzyme, CYP 3A4. Because CYP 3A4 is involvedin the metabolism of almost 50% of the drugs in use, ketoconazole is implicated in manypharmacokinetic drug interactions. Amphotericin B causes nephrotoxicityand may therefore interfere with the excretion of other drugs. Caspofunginappears to be free of most drug interactions. Fluconazole although a member of the same (azole) group as ketoconazole, is much less potent as a CYP 3A4 inhibitor and isassociated with far fewer drug interactions.

Answer. d


(21). Which of the following injections is available for subcutaneous administration?

a. Albuterol

b. Terbutaline

c. Metaproterenol

d. Pirbuterol

Solution. Ans 21: (b) TerbutalineRef Read the text belowSol: Terbutaline Sulfate Injection, USP is indicated for the prevention and reversal of bronchospasm in patients 12 years of age andolder with asthma and reversible bronchospasm associated with bronchitis and emphysema.Contraindications1. Prolonged TocolysisTerbutaline sulfate has not been approved and should not be used for prolonged tocolysis (beyond 48-72 hours). In particular,Terbutaline sulfate should not be used for maintenance tocolysis in the outpatient or home setting2. HypersensitivityTerbutaline sulfate injection is contraindicated in patients known to be hypersensitive to sympathomimetic amines or any component ofthis drug product.

Answer. b

(22). A drug being developed as an antiarrhythmic agent was studied in the laboratory using microelectrode techniques for measuring thetransmembrane potential. The results of this study are shown in Fig. Which of the following standard antiarrhythmic agents does the newdrug most resemble?

a. Adenosine

b. Ibutilide

c. Lidocaine

d. Procainamide

Solution. Ans-22: (b) IbutilideRef: Read the text belowSol : The recorded transmembrane potential indicates that the new drug has no effect on the upstroke velocity but prolongs the actionpotential duration of the ventricular muscle fiber. This effect is characteristic of blocking potassium (IK) channels that open during repolarization, actions shown by group IIIantiarrhythmic drugs such as ibutilide. Adenosine hyperpolarizes AV nodal cells and blocks propagation of impulses through this partof the heart. It does not prolong the action potential. Lidocaine is a group IB drug and slows upstroke velocity of the action potential in susceptiblecells but shortens, rather than prolongs, the action potential duration. Procainamide is a group IA drug that slows upstroke velocityas well as prolonging the action potential.

Answer. b


(23). Time dependent killing and prolonged post-antibiotic effect is seen with -

a. Fluoroquinolones

b. Beta lactam antibiotics

c. Clindamycin

d. Erythromycin

Solution. Ans 23: (a) FluoroquinolonesRef Read the text belowSol: With Concentration Dependant Killing (CDK) Aminoglycoside Fluroquinolones Metronidazole Chloramphenicol StreptograminsWith TIME Dependant Killing (TDK) (penicillins, cephalosporins, carbapenems, monobactams), clindamycin, macrolides(erythromycin, clarithromycin), oxazolidinones (linezolid) Beta-lactam Vancomycin Macrolide ClindamycinPOST ANTIBIOTIC EFFECT PAE All antimicrobial---- Gm+ve Org ONLY Aminoglycoside Quinolone Rifampicin-----Gm-ve also Carbapenem Azithro&Clarithro PAEs of the fluoroquinolones (ciprofloxacin, ofloxacin, levofloxacin, moxifloxacin andgarenoxacin) were 25 h. The macrolide (erythromycin, clarithromycin and telithromycin) PAEs were 14 h,and that ofclindamycin was 2 h. The PAEs induced by tetracycline and minocycline were 13 h. The PAEs induced by the -lactams(penicillin G, amoxicillin and ceftriaxone), vancomycin, linezolid and chloramphenicol were 12 h. The PAE induced byrifampicin was 45 h. Quinupristin/dalfopristin had the longest PAE, lastingfor 78 h.

Answer. a

(24). Which of the following opioid receptors is responsible for dysphoric effects?

a. Mu

b. Kappa

c. Delta

d. Sigma

Solution. Ans 24: (b) KappaRef Read the text belowSol: Mu and delta receptor-P- Physical dependenceM- MiosisC- ConstipationA- AnalgesiaR- Respiratory depressionE- EuphoriaS- Sedation Kappa receptor-D- DysphoriaM- MiosisA- AnalgesiaR- Respiratory depreD- DiuresisS- Sedation

Answer. b


(25). A drug 'X' belongs to the anticholinergic drug group. It is primarily used in pre anesthetic medication and also during surgery. Which ofthe following can be 'X' ?

a. Glycopyrrolate

b. Pipenzolate methyl bromide

c. Isopropamide

d. Dicyclomine

Solution. Ans-25: (a) GlycopyrrolateRef: KDTs - 110Sol :Glycopyrrolate is used to reducethe secretions (to prevent reflex bronchospasm) during anaesthesia.In anesthesia, glycopyrrolate injection can be used as a preoperative medication in order to reduce salivary, tracheobronchial,and pharyngeal secretions, as well as decreasing the acidity of gastric secretion.It is also used in conjunction with neostigmine, a neuromuscular blocking reversal agent, to prevent neostigmine's muscarinic effectssuch as bradycardia.

Answer. a

(26). All of the following mydriatics produce cycloplegia except

a. Phenylephrine

b. Tropicamide

c. Cyclopentolate

d. Homatropine

Solution. Ans-26: (a) PhenylephrineRef: KDTs - 113, 114Sol :Anticholinergic agentsproduce both cycloplegia as well as mydriasis whereas sympathomimetics cause mydriasis withoutinducing cycloplegia.

Answer. a

(27). Which of the following drugs shows the phenomenon of vasomotor reversal of Dale after administration of an adrenergic blocker ?

a. Adrenaline

b. Noradrenaline

c. Isoprenaline

d. All of the above

Solution. Ans-27: (a) AdrenalineRef: KDTs - 123Sol :Vasomotor reversal of dale is seen with adrenaline.When this drug is infused quickly, initially there is rise in blood pressure (due to sitmulation of receptors) followed byprolonged fall (2 action). blocking drugs inhibit the initial rise and only fall in blood pressure is recorded.This is known as vasomotor reversal.Nor adrenaline has no 2 activity and isoprenaline lacks activity, therefore cannot demonstrate this phenomenon.

Answer. a


(28). A drug has a volume of distribution of 40 L, half life of 1 day, the total body clearance of the drug is :

a. 8 ml/min

b. 10 ml/min

c. 19 ml/min

d. 29 ml/min

Solution. Ans-28: (c) 19 ml/minRef: Read the text belowSol :Clearance, theoretically, is the volume of plasma that is cleared off all drugs in a unit time.

Answer. c

(29). Which of the following is a prodrug ?

a. Methyl-dopa

b. Captoril

c. Atropine

d. Adrenaline

Solution. Ans-29: (a) Methyl-dopaRef: Read the text belowSol :-Methyldopa is a prodrugi.e. inactive as such but gets converted in the body into an active metabolite, a-methyl nor-epinephrine.

Answer. a


(30). Vasopressin antagonists act on which part of the nephron?

a. Proximal convoluted tubule

b. Distal convoluted tubule

c. Cortical collecting tubule

d. Medullary collecting duct

Solution. Ans 30: (d) Medullary collecting ductRef Read the text belowSol: A vasopressin receptor antagonist (VRA) is an agent which interferes with action at the vasopressin receptors. Most commonlyVRAs are used in the treatment of hyponatremia, especially in patients with congestive heart failure, liver cirrhosis or SIADHVasopressin has two effects by which it contributes to increased urine osmolarity (increased concentration) and decreased waterexcretion. These are:1.Increasing the water permeability of distal tubule and collecting duct cells in the kidney, thus allowing water reabsorption andexcretion of more concentrated urine, i.e., antidiuresis. in2.Increasing permeability of the inner medullary portion of the collecting duct to urea by regulating the cell surface expression of ureatransporters,[4] which facilitates its reabsorption into the medullary interstitium as it travels down the concentration gradient created byremoving water from the connecting tubule, cortical collecting duct, and outer medullary collecting duct.

Answer. d

(31). Which of the following is an enzyme inducer ?

a. Erythromycin

b. Pyrimethamine

c. Pyrizinamide

d. Rifampicin

Solution. Ans-31: (d) RifampicinRef: Read the text belowSol :Pentamidine, an antimicrobial agent, is not a hepatic enzyme inducer.Antiepileptics (Phenobarbitone, Phenytoin, Primidone), antituberculars (rifampicin, INH), Phenylbutazoneand chr. Alcoholism and smoking are potent enzyme inducers.

Answer. d

(32). Pharmacogenetics is important in the metabolism of

a. Rifampicin

b. Isoniazid

c. Digitalis

d. Propranolol

Solution. Ans-32: (b) IsoniazidRef: Read the text belowSol :Pharmacogenetics is important in the metabolism of isoniazid (INH).INH is mainly metabolized by acetylation. The rate of acetylation shows genetic variation.There are either.Fast acetylators (30 40% of Indians) orSlow acetylators (60 70% of Indians).

Answer. b


(33). Which of the following is wrong regarding treatment with iodine?

a. It causes acute inhibition of synthesis of diodotyrosine and diodothyronine

b. It also inhibits the release of thyroid hormones

c. Its use is contraindicated in hyperthyroidism

d. It causes iodism

Solution. Ans 33: (c) Its use is contraindicated in hyperthyroidismRef Read the text belowSol: Potassium iodideis usually used to treat acute thyrotoxicosis, usually as a saturated solution of potassium iodide called SSKI. It isalso used to block uptake of iodine-131 in the thyroid gland (see isotopes section above), when this isotope is used as part ofradiopharmaceuticals (such as iobenguane) that are not targeted to the thyroid or thyroid-type tissues. It causes acute inhibition of synthesis of diodotyrosine and diodothyronine It also inhibits the release of thyroid hormones

Answer. c

(34). Which of the following is useful in rheumatoid arthritis because it binds tumor necrosis factoralpha (TNF-alpha)?

a. Leflunomide

b. Infliximab

c. Methotrexate

d. Paclitaxel

Solution. Ans-34: (b) InfliximabRef:Read the text belowSol: Infliximab is a chimeric monoclonal antibodythat binds TNF-alpha and is useful in rheumatoid arthritis, ulcerative colitis, andseveral other immune diseases. Leflunomide inhibits ribonucleotidesynthesis and thereby reduces T-cell proliferation. Methotrexate is an antimetabolitethat inhibits cell proliferation. It is useful in rheumatoid arthritis.Paclitaxel is a microtubule-binding agent that is cytotoxic in certain neoplasms and slows restenosis in coronarystents. It isnot used in autoimmune diseases.

Answer. b

(35). Which of the following agents used to prevent organ transplant rejection is most likely to cause significant decrease in creatinineclearance?

a. Antilymphocyte globulin

b. Cyclosporine

c. Mycophenolate mofetil

d. Prednisone

Solution. Ans-35: (b) CyclosporineRef:Read the text belowSol: Cyclosporine and tacrolimus are associated with nephrotoxicity as a major adverse effect. Antilymphocyte globulin is associated with foreign protein reactions, including anaphylaxis. Mycophenolate mofetil causes GI disturbances and myelosuppression. Prednisone causes a variety of chronic toxicities conveniently summarized as Cushingoid effects but has little acute toxicity.

Answer. b


(36). Which of the following antidiabetic agents acts on the peroxisome proliferator-activated receptor-gamma (PPAR-gamma) nuclearreceptor?

a. Acarbose

b. Glyburide

c. Insulin lispro

d. Pioglitazone

Solution. Ans-36: (d) PioglitazoneRef:Read the text belowSol: The glitazone drugs (pioglitazone, rosiglitazone) reduce insulin resistance in peripheral tissues by activating the PPAR-gammareceptor, which promotes glucose uptake and utilization. Acarbose interferes with the action of intestinal alpha-glucosidases and reduces absorption of glucose. Glyburide and other sulfonylurea hypoglycemic drugs block the ATP-activated potassium channel in pancreatic cells and causeincreased insulin release. Insulin lispro is a modified insulin with rapid onset and offset of action. All insulins act by causing insertion of glucose transportersinto cell membranes and several other mechanisms.The mechanism of action of metformin and similar biguanide antidiabetic drugs is still unclear but may involve reduction ofglucagon release, stimulation of glycolysis in peripheral tissues, or decreased hepatic and renal gluconeogenesis.

Answer. d

(37). Which of the following mechanisms most accurately describes the blocking action of methimazole?

a. Iodine uptake by the thyroid

b. Organification of iodine in the thyroid

c. Peripheral conversion of T4 to T3

d. Peripheral thyroxine (T4) and T3 receptors

Solution. Ans-37: (b) Organification of iodine in the thyroidRef:Read the text belowSol: Methimazole (and other thioamides) act primarilyby inhibiting thyroid peroxidase, the critical enzyme in iodine organification. They also inhibit coupling of iodotyrosines in thyroglobulin. They do not block iodine uptake by the gland. Block of iodine uptake by the thyroid is a property of antithyroid anions such asthiocyanate (SCN) and perchlorate (ClO4 ). Inhibition of peripheral conversion of T4 to T3 is the mechanism of beta blockers and iodine-containing radio-opaquedrugs such as ipodate. Block of peripheral thyroid receptors is not a mechanism of any currently available drug.

Answer. b


(38). The increased risk of blood clots in women who use certain combined estrogen/progestin birth control pills is well established. Which ofthe following best explains this association?

a. Impaired glucose tolerance

b. Increased Factor II, VII, IX, and X levels produced by estrogens

c. Increased plasminogen levels produced by progestins

d. Increased thyroxine-binding globulin

Solution. Ans-38: (b) Increased Factor II, VII, IX, and X levels produced by estrogensRef:Read the text belowSol: Increased clotting factor synthesis (and decreased antithrombin III synthesis) caused by estrogens are the major factorsresponsible for increased incidence of thromboembolic phenomena. Glucose tolerance is impaired in some women by progestins andwould not be expected to affect clotting. Plasminogen is increased by estrogens, not progestins, but would decrease clotting. Thyroxine-binding globulin is also increased by estrogen, but would have little effect on clotting.Triglycerides are increased by estrogens and would have little or no effect on clotting.

Answer. b

(39). Which of the following drugs is considered afirst-line agent in the chronic treatment of rheumatoid arthritis and in the treatment ofchoriocarcinoma?

a. Cyclosporine

b. Hydroxychloroquine

c. Methotrexate

d. Sulfasalazine

Solution. Ans-39: (c) MethotrexateRef:Read the text belowSol: Methotrexate in very low dosagehas proven effective in slowing the progression of rheumatoid arthritis and has low toxicity. It is also one of the most effective (in much higher dosage) antimetabolite cancer chemotherapeutic drugs used inchoriocarcinoma. Cyclosporine is not used in either condition but is a first-line drug in transplant immunopharmacology. Hydroxychloroquine is a disease-modifying antirheumatoid arthritis drug, but has no efficacy in the treatment of cancer. It is moretoxic and less effective in rheumatoid arthritis than methotrexate. Sulfasalazine is also effective in slowing the progression of joint damage in rheumatoid arthritis but has no efficacy incancer.

Answer. c

(40). Which of the following laxatives acts osmotically to increase the water content of the stool?

a. Cascara

b. Docusate

c. Glycerine

d. Magnesium hydroxide

Solution. Ans-40: (d) Magnesium hydroxideRef:Read the text belowSol: Magnesium hydroxideis an osmotic laxative that retains water in the lumen of the colon. Cascara is a naturally occurring plant product that stimulates the bowel and causes evacuation within 612 hours when given orally. Docusate is a stool-softeningagentthat acts entirely within the lumen. Glycerine given by suppository, is a stool softener.

Answer. d


(41). Which of the following drugs binds to, and prevents disassembly of, microtubules?

a. Busulfan

b. Cisplatin

c. Mercaptopurine

d. Paclitaxel

Solution. Ans-41: (d) PaclitaxelRef:Read the text belowSol: Paclitaxel is a plant alkaloidthat interferes with microtubule disassembly. Busulfan and cisplatin are alkylatingagents that interfere with DNAmobilization and replication. Mercaptopurine is an antimetabolitethat interferes with purine synthesis. Vinblastine and vincristineand vinorelbine are mitotic poisons that prevent cancer cell division by interfering with microtubuleassembly and thus immobilizing the mitotic spindle apparatus.Their indications and toxicities are quite different from those of paclitaxel

Answer. d

(42). Which of the following drugs blocks the action of angiotensin II at the AT1 receptor?

a. Bradykinin

b. Enalapril

c. Losartan

d. Ondansetron

Solution. Ans-42: (c) LosartanRef:Read the text belowSol: Losartan and severalother drugs block the action of angiotensin II at its primary cardiovascular target, the AT1 receptor. They are therefore useful in hypertension and heart failure. Bradykinin (choice A) is a vasodilator peptide. It is not therapeutically useful because of undesirable side effects. Enalapril is an ACE inhibitorand reduces the production of angiotensin II from angiotensin I. Ondansetron is a 5-HT3 receptorantagonist used to prevent chemotherapy-induced and postoperative vomiting.

Answer. c

(43). Resistance to which of the following drugsoccurs when the bacterium expresses higher quantities of a drug-efflux pump?

a. Amoxicillin

b. Clarithromycin

c. Doxycycline

d. Gentamicin

Solution. Ans-43: (c) DoxycyclineRef:Read the text belowSol: Resistance to tetracyclinessuch as doxycycline is associated with production of an efflux pump or alteration of the 30S ribosomal-binding site. Resistance to beta lactams such as amoxicillinusually results from production of beta lactamase. Macrolides such as clarithromycinerythromycin, and azithromycin bind to the 50S ribosome in susceptible organisms and preventprotein synthesis. Simple methylation of the binding site prevents the bacteriostatic action of these drugs and many bacteria have such mutation. Resistance to aminoglycosidessuch as gentamicin is usually due to synthesis of inactivating enzymes by the bacteria.

Answer. c


(44). Which of the following trials can be performed to determine the maximal tolerated dose of a drug?

a. Case control

b. Phase II - RCT

c. Phase I

d. Phase VI - RCT

Solution. Ans 44: (c) Phase IRef Read the text belowSol: Maximum Tolerated Dose (MTD) Highest dosage of a drug, drug combination or other treatment modality that patients can safelytolerate. Usually determined by Phase I Trial. PHASE I CLINICAL TRIAL Initial exposure of human to investigational drug Healthy male volunteers Single site by clinical pharmacologist Small no ( 2025) Mainly for toxicity & PK, not for efficacy Non blinding / Open Begin with 1/5 or 1/10th of maximum tolerable dose in animals Phase I trail for anticancer done in pts PHASE IIEarly phase 20200 Use / side effects To establish a dose range Single blind (subject)Late phase 50300 Double blind (randomized/controlled) Safety & efficacy specific disease compare with existing drug PHASE III CLINICAL TRIAL 250-1000 patients Confirmation of effective doses Safety / efficacy Minimize errors of phase I & II Multicentric Double blind Cross over More than 5 yrs Statistical evaluation PHASE IV CLINICAL TRIAL Post marketing surveillance No fixed duration Exposure of drugs to a wider population Different formulation/ dosage forms/ duration/ drug interaction/ drug comparison studies Detection of unknown ADR / Side effectsPhase 0- Microdosing studies

Answer. c


(45). Ritonavir inhibits all of the following except -

a. Amiodarone

b. Phenytoin

c. Cisapride

d. Midazolam

Solution. Ans 45: (b) PhenytoinRef Read the text belowSol: The proposed mechanism involves ritonavir induction of phenytoin metabolism via CYP450 2C9 Titonavir is the mostpotent enzyme inducer of CYP3A4, so it it inhibits the metabolism of Amiodarone Cisapride Midazolam

Answer. b

(46). One of the concerns of drug designing is to -

a. Decrease the binding affinity of the drug to target protein

b. Increase the binding affinity of the drug to non-target proteins

c. Increase the number of interactions of the drug with the target protein

d. Decrease the potency of the drug

Solution. Ans 46: (c) Increase the number of interactions of the drug with the target proteinRef Read the text belowSol: Active site identification is the first step in drug designing program. It analyzes the protein to find the binding pocket, derives key interaction sites within the binding pocket, and then prepares thenecessary data for Ligand fragment link.The basic inputs for this step are the 3D structure of the protein and a pre-docked ligand in PDB format, as well as their atomicproperties

Answer. c

(47). Epinephrine causes hyperglycemia by

a. Increased glucagon

b. Decreased insulin secretion

c. Increased glucocorticoids

d. Increased thyroxine

Solution. Ans-47: (a) Increased glucagonRef: KDTs - 124Sol:Epinephrine from the adrenal medulla acts via beta-adrenergic receptors, whereas norepinpherine is released from nerveendings and acts on alpha2-adrenergic receptors.Norepinephrine and epinephrine have somewhat opposing effects on insulin release (norepinephrine inhibits, epinephrinestimulates), but the net effect of both is increased blood glucose.This occurs via stimulation of glycogenolysis and release of glucose from hepatocytes (epinephrine), and indirectly through inhibition ofinsulin release (norepinephrine), and release of growth hormone (epinephrine) and ACTH (which increases cortisol).

Answer. a


(48). All of the following effects are seen with cholinergic muscarinic receptor stimulation except

a. Sweating

b. Rise in blood pressure

c. Bradycardia

d. Urination

Solution. Ans-48 (b) Rise in blood pressureRef: KDT - 129Sol:Stimulation of muscarinic receptors decreases blood pressure.. Comparison of typesType Function

M1 EPSP in autonomic ganglia secretion from salivary glands and stomach In CNS (memory?) [8]

M2

slow heart rate reduce contractile forces of atrium reduce conduction velocity of AV node In CNS homotropic inhibition

M3

smooth muscle contraction Increase intracellular calcium in vascular endothelium increased endocrine and exocrine gland secretions, e.g. salivary glands and stomach In CNS Eye accommodation vasodilation induce emesis

M4 Activation of M4 causes decreased locomotion [8]

In CNSM5 In CNS

Answer. b

(49). Which of the following antitubercular agents is a strong inducer of hepatic cytochrome P450?

a. Ethambutol

b. Isoniazid

c. Rifampin

d. Streptomycin

Solution. Ans-49: (c) RifampinRef:Read the text belowSol: Rifampin selectivelyinhibits bacterial DNA-dependent RNA polymerase. It is very useful in treating mycobacterial infectionssince it can penetrate cells and kill intracellular organisms. It is one of the most potent inducers of cytochrome P450 known, leading to increased hepatic clearance of many other drugsincluding the oral anticoagulants, cyclosporine, propranolol, digitoxin, corticosteroids, and oral contraceptives. Ethambutol is often combined with isoniazid in antitubercular regimens. Clearance is primarily via renal excretion. Isoniazid is the mostwidely used antitubercular agent. It functions by inhibiting mycolic acid biosynthesis.

Answer. c


(50). A 35-year-old woman with hypertension is planning to become pregnant. Which of the following is contraindicated in pregnancy?

a. Clonidine

b. Hydralazine

c. Hydrochlorothiazide

d. Losartan

Solution. Ans-50: (d) LosartanRef:Read the text belowSol: Losartan causes renal damagein the fetus, and renal impairment in renovascular disease. It is contraindicated in pregnancy. Clonidine causessome sedation and rebound hypertension when stopped suddenly, but is not contraindicated in pregnancy. Hydralazine causes a reversibletype of lupus erythematosus.Hydrochlorothiazide may cause hypokalemia, dilutional hyponatremia, elevated lipids, hyperuricemia, and glucoseintolerance.

Answer. d

(51). A35-year-old opera singer has been treated for hypertension with enalapril. Although his blood pressure has been reduced, he complainsthat he is now unable to perform because of a dry cough. Which of the following acts by a similar but not identical mechanism and ismuch less likely to cause cough?

a. Captopril

b. Clonidine

c. Losartan

d. Prazosin

Solution. Ans-51: (c) LosartanRef:Read the text belowSol: Losartan, an AT1 receptor-blocking agent, has effects in hypertension similar to those of ACE inhibitors but causes a much lowerincidence of cough. Captopril and other ACE inhibitorscause a dry cough in 520% of patients. This may be due to accumulation of bradykinin as aresult of ACE inhibition; ACE also metabolizes bradykinin. The cough disappears with cessation of ACE inhibitor treatment. Pretreatment with aspirin reduces its frequency and severity in some patients. Clonidine the centrally acting alpha- 2-receptor agonist, produces sedation and xerostomia but not cough. The alpha-1-receptor antagonist prazosin produces postural hypotension but not cough. The betablocker propranolol may produce a variety of side effects including precipitating heart failure and asthma in susceptiblepatients.It does not cause cough. Propranolol has been used by musicians to control palpitations associated with stage fright.

Answer. c

(52). Which of the following is the muscle relaxant of choice in renal failure ?

a. Rapacurium

b. Pancuronium

c. Atracurium

d. Rocuronium

Solution. Ans-52: (c) AtracuriumRef:Read the text belowSol:Atracurium The unique feature of atracurium is inactivation in plasma by spontaneous non enzymatic degradation (Hofmann elimination) inaddition to that by cholinesterases. Consequently its duration of action is not altered in patients with hepatic / renal insufficiency or hypodynamic circulation. Hemodynamically it is almost neutral, though histamine release may occur.Therefore it is the agent of choice in renal failure

Answer. c


(53). The mydriatic having the fastest and shortest action is

a. Atropine

b. Homatropine

c. Tropicamide

d. Cyclopentolate

Solution. Ans-53: (c) TropicamideRef: KDT 111Sol: Tropicamide is an antimuscarinic drug that produces short acting mydriasis (dilation of the pupil) and cycloplegia when applied aseye drops. It is used to allow better examination of the lens, vitreous humor, and retina. Due to its relatively short duration of effect (48 hours), it is typically used during eye examinationssuch as the dilatedfundus examination, but it may also be used before or after eye surgery. Cycloplegic drops are often also used to treat anterior uveitis, decreasing risk of posterior synechiae and decreasing inflammation inthe anterior chamber of the eye

Answer. c

(54). What is the most dangerous effect of belladonna in very young children?

a. Dehydration

b. Hallucination

c. Hypertension

d. Hyperthermia

Solution. Ans-54: (d) HyperthermiaRef: KDTs - 113Sol:Atropa belladonna contains anticholinergic principles like atropine and hyoscine.Atropine antagonises central muscarinic receptors (remember, the parasympathetic nervous system is made up of muscarinic andnicotinic receptors). This muscarinic receptor antagonising alters temperature regulation in the hypothalamus the mechanism howit works is unfortunately not understood. But is is known that it reduces blood flow to the skin, thus reducing the ability for thebody to lose heat and increasing body temperatureAtropine is contra-indicatedin children due to the risk of hyperthermia.

Answer. d

(55). Second generation anti-histaminics used in allergic rhinitis are all of the following except

a. Azelastine

b. Fexofenadine

c. Chlorpheniramine maleate

d. Desloratidine

Solution. Ans-55: (c) Chlorpheniramine maleateRef:read the text belowSol:The second generation antihistaminics are non sedative.These include.TerfenadineAstemizoleLoratidineCetirizineAzelastineFexofenadineDesloratidine

Answer. c


(56). Anti-vertigo drug which modulates calcium channels and has prominent labyrinthine suppressant property is

a. Cyproheptadine

b. Cinnarizine

c. Clemastine

d. Cetrizine

Solution. Ans-56: (b) CinnarizineRef: KDT--160Sol: Cinnarizine(Stugeron, Stunarone) is an antihistamine which is mainly used for the control of nausea and vomiting due to motionsickness. It acts by interfering with the signal transmission between vestibular apparatus of the inner ear and the vomitingcentre of thehypothalamus. The disparity of signal processing between inner ear motion receptors and the visual senses is abolished, so that the confusionof brain whether the individual is moving or standing is reduced. Vomiting in motion sickness isactually a physiological compensatory mechanism of the brain to keep the individual from moving sothat it can adjust to the signal perception.[citation needed] Cinnarizine could be also viewed as a nootropic drug because of its vasorelaxating abilities (due to calcium channel blockage),which happen mostly in brain. It is also effectively combined with other nootropics, primarily Piracetam; in such combination each drug potentiate the other inboosting brain oxygen supply.

Answer. b

(57). SLE-like reactions are caused by all of the following except -

a. Isoniazid

b. Penicillin

c. Hydralazine

d. Griseofulvin

Solution. Ans 57: (b) PenicillinRef Read the text belowSol: Several broad drug categories have been linked to DILE, including the following: Antiarrhythmics - Procainamide and quinidine Antibiotics Minocyclineand isoniazid Antifungals - Griseofulvin and voriconazole Anticonvulsants - Valproate, ethosuximide, carbamazepineand hydantoins Hormonal therapy - Leuprolide acetate Antihypertensives - Hydralazine, methyldopa, and captopril Anti-inflammatories - Penicillamine and sulfasalazine Antipsychotics - Chlorpromazine Cholesterol-lowering agents - Lovastatin, simvastatin(DISCLE), atorvastatin, and gemfibrozil Biologics - Interleukins (eg, IL-2), interferons (eg, alfa, beta, gamma), and TNF- (etanercept, infliximab, adalimumab) Inhalers - Tiotropium bromide inhaler Other drug categories - Ophthalmic timolol

Answer. b


(58). Most specific drug for the treatment of peptic ulcer disease due to chronic use of aspirin is

a. Omeprazole

b. Misoprostol

c. Pirenzipine

d. Ranitidine

Solution. Ans-58: (b) MisoprostolRef: KDT-633, 634Sol: Misoprostol is approved for use in the prevention of NSAID-induced gastric ulcers. It acts upon gastric parietal cells, inhibiting the secretion of gastric acid via G-protein coupled receptor-mediated inhibition ofadenylate cyclase, which leads to decreased intracellular cyclic AMP levels and decreased proton pumpactivity at the apicalsurfaceof the parietal cell. Because other classes of drugs, especially H2-receptor antagonists and proton pump inhibitors, are more effective for thetreatment of acute peptic ulcers, Misoprostol is only indicated for use by people who are both taking NSAIDs and are at high risk forNSAID-induced ulcers, including the elderly and people with ulcer complications. Misoprostol is sometimes co-prescribed with NSAIDs to prevent their common adverse effect of gastric ulceration(e.g. with Diclofenacin Arthrotec).

Answer. b

(59). Mebendazole may be used for treatment of all of the following conditions except:

a. Enterobiasis

b. Ascariasis

c. Hook worm disease

d. Strongyloidiasis

Solution.

Answer. d


(60). The blood culture from a patient of febrile neutropenia has grown pseudomonas aeruginosa,it was found to be a producer of extendedspectrum beta lactamase enzyme. The best choice of antimicrobial therapy should be:

a. Ceftazidime + Amikacin

b. Aztreonam + Amikacin

c. Cefpirome + Amikacin

d. Imipenem + Amikacin

Solution. Ans-60: (d) Imipenem + AmikacinRef:Read the text belowSol:CARBAPENEMSCarbapenems are synthetic that differ from the penicillins in that the sulfur atom of the thiazolidine ring has been externalized andreplaced by a carbon atom.Imipenem is the only drug of this group currently available.Antibacterial spectrum:1. Imipenem/cilastatin is the broadest spectrum -lactam antibiotics preparation currently available.2. Imipenem resists hydrolysis by most -lactam antibiotics3. The drug plays a role in empiric therapy since it is active against penicillinase-producing grampositive and gram-negativeorganisms, anaerobes, an pseudomonas aeruginosa,although other pseudomonas strains are resistant.

Answer. d

(61). A patient with cancer received extreme degree of radiation toxicity. Further history revealed that the dose adjustment of a particulardrug was missed during the course of radiotherapy. Which of the following drugs required a dose adjustment in that patient duringradiotherapy in order to prevent radiation toxicity:

a. Vincristine

b. Dactinomycin

c. Cyclophosphamide

d. 6-Mercaptopurine

Solution. Ans-61: (b) DactinomycinRef:Read the text belowSol:

Answer. b


(62). Gentamycin, obtained from Micromonospora purpura, has become the most commonly used aminoglycoside for acute infections; but isineffective against: -

a. Klebsiella

b. Strep.pyogenes

c. Proteus

d. Pseudomonas

Solution. Ans-62: (b) Strep.pyogenesRef:Read the text belowSol: Gentamicin has a broader spectrum of action: effective against Ps. aeruginosa and most strains of Proteus, E. coli, Klebsiella,Enterobacter, Serratia.It is ineffective against M.tuberculosis, Strep. pyogenes and Strep. pneumoniae, but inhibits many Strep.faecalis and someStaph.aureus.

Answer. b

(63). Which of the following antimicrobials needs dose reduction even in mild renal failure

a. Ciprofloxacin

b. Carbenicillin

c. Cefotaxime

d. Ethambutol

Solution. Ans-63: (d) EthambutolRef: Read the text belowSol:Aminoglycosids, Amphotericin B, cephalosporins, vancomycin, flucytosineand ethambutol require dose reduction even in mildrenal failure.

Answer. d

(64). Pneumococcal resistance to penicillin G is mainly acquired by

a. Conjugation

b. Transduction

c. Transformation

d. All of the above

Solution. Ans-64: (c) TransformationRef: Read the text belowSol:Acquisition of antibiotic resistanceby Transduction is common in Staphylococcal and that of by Transformation in Pneumococcusand Neisseria.Vancomycin resistance in enterococci and staphylococcusis mediated by conjugative plasmid.

Answer. c


(65). Which of the following is active against atypical mycobacteria

a. Clarithromycin

b. Rifabutin

c. Ciprofloxacin

d. All of the above

Solution. Ans-65: (d) All of the aboveRef: Read the text belowSol:Most atypical Mycobacteriaare resistant to the usual antitubercular drugs, though pulmonary disease caused by M. avium complexor M. Kansasii may respond to prolonged treatment with Rifampicin, Isoniazid and Ethanbutol.Various combination of drugs that are used are :RifabutinClofazimineQuinolonesNewer macrolides like Clarithromycin.

Answer. d

(66). Photo toxicity is caused by all, except

a. Tetracycline

b. Atenolol

c. Quinolones

d. Amiodarone

Solution. Ans-66: (b) AtenololRef: Read the text belowSol:A phototoxic substance is a chemical compound which becomes toxic when exposed to light. Some medicines: tetracycline antibiotics, sulfonamides, amiodarone, quinolones Many cold pressed citrus essential oilssuch as bergamotoil Some plant juices: parsleyand hogweedOthers: psoralen

Answer. b

(67). Best for systemic aspergillus infection is

a. Ketoconazole

b. Itraconazole

c. Fluconzole

d. Flucytocine

Solution. Ans-67: (b) ItraconazoleRef: KDT-722Sol:Itraconazole is a newer orallyactive triazole antifungal having a broader spectrum of activity than ketoconazole and fluconazole.It is preferred over ketoconazole for most systemic mycosis.Fluconazole is not effective against aspergillosis

Answer. b


(68). Which of the following cephalosporins is active against Pseudomonas aeruginosa ?

a. Ceftriaxone

b. Cephalothin

c. Ceftazidime

d. Cefotaxime

Solution. Ans-68: (c) CeftazidimeRef: KDT706Sol: Ceftazidimeis a third-generation cephalosporin antibiotic. Like other third-generation cephalosporins, it has broad spectrumactivity against Gram-positiveand Gram-negativebacteria. Unlike most third-generation agents, it is active against Pseudomonas aeruginosa, however it has weaker activity againstGram-positive microorganisms and is not used for such infections Ceftazidime is usuallyreserved for the treatment of infections caused by Pseudomonas aeruginosa. It is also used in the empiricaltherapy of febrile neutropenia, in combination with other antibiotics. It is usually given IV or IMevery 812 hours (2 - 3 times a day), with dosage varying by the indication, infection severity,and/or renal function of the recipient. Ceftazidine is first line treatment for the rare tropical infection, melioidosis

Answer. c

(69). Which of the following antitubecular drug is contraindicated in pregnancy ?

a. Rifampicin

b. Ethambutol

c. Pyrazinamide

d. Streptomycin

Solution. Ans-69: (d) StreptomycinRef: Read the text below.Sol:Streptomycincan cause fetal harm when administered to a pregnant woman.Because streptomycin readily crosses the placental barrier, caution in use of the drug is important to prevent ototoxicity in thefetus.If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of thepotential hazard to the fetus.

Answer. d

(70). Which of the following is a Rho-kinase inhibitor?

a. Fasudil

b. Nicorandil

c. Amiloride

d. Ranolazine

Solution. Ans 70: (a) FasudilRef Read the text belowSol: Fasudil Hydrochloride(INN) is a potent Rho-kinase inhibitor and vasodilator. Since it was discovered, it has been used for the treatment of cerebral vasospasm, which is often due to subarachnoid hemorrhage, as well as to improve the cognitive decline seen in stroke victims. It has been found to be effective for the treatment of pulmonaryhypertension. It was demonstrated in February 2009 that Fasudil could also be used to enhance memoryand improve the prognosis ofAlzheimerspatients

Answer. a


(71). Which of the following vasopressors would be preferred in a patient with aortic stenosis?

a. Ephedrine

b. Dopamine

c. Dobutamine

d. Phenylephrine

Solution. Ans 71: (d) PhenylephrineRef Read the text belowSol: Phenylephrine iscommonly recommended as the most appropriate first-line treatment for hypotension in the patient with aorticstenosis.The rationale is 3-fold: (a) if left ventricular (LV) afterload is relatively fixed by the stenotic valve, increasing peripheral vascularresistance will have less of an effect on myocardial work than it would on an unloaded left ventricle;(b) increases in diastolic blood pressure will presumably increase CPP, and thus myocardial DO2 ; and (c) reflexive bradycardiareducesmyocardial consumption of oxygen

Answer. d

(72). Lithium potentiates the action of non-depolarizing muscle relaxants. How many days before administration of the muscle relaxant shouldlithium be stopped?

a. 1 day

b. 2 days

c. 3 days

d. 4 days

Solution. Ans 72: (a) 1 dayRef Read the text belowSol: Lithium should be stopped 24 hours before major surgery, but the normal dose can be continued for minor surgery if fluids andelectrolytes are carefully monitored

Answer. a

(73). Orphan drugs are -

a. Drugs for orphans

b. Drugs for treating rare diseases

c. Rare drugs for treating common diseases

d. Drugs that are used very rarely

Solution. Ans 73: (b) Drugs for treating rare diseasesRef Read the text belowSol: An orphan drug is a pharmaceutical agent that has been developed specifically to treat a rare medical condition, the conditionitself being referred to as an orphan disease. In the US and EU it is easier to gain marketing approval for an orphan drug, and there may be other financial incentives, such asextended exclusivity periods, all intended to encourage the development of drugs which might otherwise lack a sufficientprofit motive. The assignment of orphan status to a disease and to any drugs developed to treat it is a matter of public policy in many countries, andhas resulted in medical breakthroughs that may not have otherwise been achieved due to the economics of drug research anddevelopment.

Answer. b


(74). Pripaism is seen in poisoning due to -

a. Sea snake

b. Rattle snake

c. Spanish fly

d. Scorpion

Solution. Ans 74: (c) Spanish flyRef Read the text belowSol: Causes of priapism- The causative mechanisms are poorly understood but involve complex neurological and vascular factors. Priapism may be associatedwith haematologicaldisorders, especially sickle-cell disease, sickle-cell trait, and other conditions such as leukemia,thalassemia, and Fabry's disease, and neurologic disorderssuch as spinal cordlesions and spinal cord trauma (priapism hasbeen reported in hanging victims; see death erection). Priapism may also be associated with glucose-6-phosphate dehydrogenase deficiency, which leads to decreased NADPH levels.NADPH is a co-factor involved in the formation of nitric oxide, which may result in priapism. Raised levels of adenosine may also contribute to the condition by causing blood vessels to dilate, thus influencing blood flow into thepenis. Sickle cell diseaseoften presents special treatment obstacles. Hyperbaric oxygen therapy has also been used with success in somepatients. Priapism is also found to occur in extreme cases of rabies. Priapism can also be caused by reactions to medications. The most common medications that causepriapism are intra-cavernous injections for treatment of erectile dysfunction(papaverine, alprostadil). Other groups reported are antihypertensives, antipsychotics (e.g., chlorpromazine, clozapine), antidepressants(most notably trazodone), anticoagulants, cantharides (Spanish Fly) and recreational drugs (alcohol, heroin and cocaine). Priapism hasalso been linked to achalasia.[citation needed] Priapism is also known to occur from bites of the Brazilian wandering spider and the black widowspider.[citation needed] PDE-5 inhibitors have been evaluated as preventive treatment for recurrent priapism.[7][8]

Answer. c

(75). A young male is brought to the emergency department with nausea, vomiting and breathlessness 2 hours after insecticide ingestion. Onexamination, there is pin-point pupils and kerosene-like smell emitting from the patient. Which of the following is not correct regardingthe management of this patient?

a. Activated charcoal has no proven therapeutic role

b. Atropine is the antidote of choice

c. Cholinesterase levels do not have prognostic significance

d. Atropine reverses respiratory muscle weakness

Solution. Ans 75: (d) Atropine reverses respiratory muscle weaknessRef Read the text belowSol: Atropine does not have effect nicotinic receptor

Answer. d


(76). Which of the following pairs of drugs is correctly matched with its mechanism of action?

a. Pilocarpine - increased uveoscleral outflow

b. Latanoprost- carbonic anhydrase inhibitor

c. Brimonidine - decreased aqueous formation

d. Betaxolol - increased trabecular outflow

Solution. Ans 76: (c) Brimonidine decreased aqueous formationRef Read the text belowSol: AGENTS DECREASING SECRETIONBeta blockers-TimololBetaxololCarteololLevobunololMetipranolol Selective 2AgonistsApraclonidine(Lid lag)Brimonidine(anterior uveitis) Carbonic anhydraseinhibitorAcetazolamide(oral)DorzolamideBrinzolamideAGENTS ENHANCING OUTFLOWTrabecular outflow Cholinomimetics - Pilocarpine (direct acting, short acting) , ecothiophate, demacarium- long acting- ADR- Cataract Uveoscleral outflow Prostaglandin F2 - Latanoprost, bimatoprost (eyelash) and unoprostoneNon selective agonists Epinephrine Dipevefrine

Answer. c

(77). Ocreoplasmin is a recombinant protease that is used for the treatment of -

a. Retinal breaks

b. Diabetic macular edema

c. Vitreo-macular adhesions

d. Sub-macular bleed

Solution. Ans 77: (c) Vitreo-macular adhesionsRef Read the text belowSol: Ocriplasmin(trade name Jetrea) is a recombinant protease with activity against fibronectin and laminin, components of thevitreoretinal interface. It is used for treatment of symptomatic vitreomacular adhesion, for which it received FDA approval on 17 October 2012.It works by dissolving the proteins that link the vitreous to the macula, resulting in posterior detachment of the vitreous from theretina

Answer. c


(78). Which of the following is not true about methanol poisoning?

a. The toxic level of methanol is 1.25 mL/kg

b. Formic acid is responsible for the toxic effects

c. Patient has obscured, snowy vision

d. Fomepizole competitively inhibits aldehyde dehydrogenase enzyme

Solution. Ans 78: (d) Fomepizole competitively inhibits aldehyde dehydrogenase enzymeRef Read the text belowSol: Median lethal dose istypically 100 mL (4 fl oz) (i.e. 12 mL/kg body weight of pure methanol). Reference dose for methanol is0,5 mg/kg/day. Fomepizole competitively inhibits alcohol dehydrogenase

Answer. d

(79). Which of the following intravenous anesthetic agents is contraindicated in epileptic patients posted for general anesthesia?

a. Ketamine

b. Thiopentone

c. Propofol

d. Midazolam

Solution. Ans 79: (a) KetamineRef Read the text belowSol: Thiopental in particular is aproven medication in the treatment of status epilepticus. Methohexital can increase ictal activity, andseizures have been described in patients who received doses sufficient to produce burst suppression of the EEG Results from studies on theanticonvulsant effects of propofol have been mixed; some data even suggest it has proconvulsant activitywhen combined with other drugs. However, propofol has been shown to suppress seizure activity in experimental models and has beenused for the treatment of status epilepticus in humans (Parviainen et al The effects of ketamine on seizure activity appear mixed, without either strong pro- or anticonvulsant activity. Emergence delirium,characterized by hallucinations, vivid dreams, and delusions, is a frequent complication of ketamine that can result in serious patientdissatisfaction and can complicate postoperative management. Delirium symptoms are most frequent in the first hour after emergenceand appear to occur less frequently in children. Benzodiazepines reduce the incidence of emergence delirium

Answer. a


(80). A patient posted for surgery has raised intracranial tension. Which of the following anesthetics would be preferred in him?

a. Halothane

b. Isoflurane-

c. Sevoflurane

d. Desflurane-

Solution. Ans 80: (c) SevofluraneRef Read the text belowSol: Halothane-This can result in an increase in intracranial pressure, especially in patients with space-occupying intracranial masses,brain edema, or preexisting intracranial hypertension. ContraindicationsHistory of unexplained jaundice following previousexposure to halothane.Patients who have developed malignant hyperthermia with prior use.Patients with increased intracranialpressure. Isoflurane-There is a modest risk of an increase in intracranial pressure in patients with preexisting intracranial hypertension Desflurane- desflurane producesan increase in cerebral blood flow and can increase intracranial pressure in patients with poorintracranial compliance While sevoflurane can increase intracranial pressure in patients with poor intracranial compliance, the response to hypocapnia ispreserved during sevoflurane anesthesia, and increases in intracranial pressure can be prevented by hyperventilation All volatile anaesthetics cause a dose dependent increase in cerebral blood flow thorugh direct vasodilation, and therebyincreases intracranial pressure.Sevoflurane has less influence on CBF and ICP than isoflurane , desoflurane. Halothane has highest influence on CBF andICP.

Answer. c

(81). Suxamethonium is available as a clear, colourless liquid. The shelf-life of suxamethonium is

a. 6 months

b. 1 year

c. 2 years

d. 6 years

Solution. Ans 81: (c) 2 yearsRef Read the text belowSol: Pharmaceutical particulars Sodium Acetate B.PWater for Injections BP

Incompatibilities Suxamethonium should not be mixed in the same syringe with any other agent especially thiopentone.

Shelf life Unopened : 18 months

Special precautions for storage

Protect from light.Store at 2 - 8C.Do not freeze.

Nature and contents of container 2ml, clear One point cut (OPC) glass ampoules, glass type 1 Ph.Eur. borosilicate glass, packed in cardboard cartons to contain 10 x2ml ampoules.

Answer. c


(82). Which of the following is used as an anti-carving agent in patients of alcohol dependence?

a. Acamprosate

b. Disulfiram

c. Buprenorphine

d. Clonidine

Solution. Ans 82: (a) AcamprosateRef Read the text belowSol: Anti craving drugs-NaltrexoneAcamprostateSerotonin Reuptake InhibitorsOndansetronTopiramate, BaclofenRimonabant, a CB1 receptor antagonist

Answer. a

(83). Which fluoroquinolone is highly active against Mycobacterium leprae and is being used in alternative multidrug therapy regimens

a. Norfloxacin

b. Ofloxacin

c. Ciprofloxacin

d. Lomefloxacin

Solution. Ans-83 (b) OfloxacinRef: KDTs 6th Ed. Pg. 756Sol:Single lesion single dose treatment of leprosy utilizes ROM therapy.R : rifampicinO : OfloxacinM : Minocycline

Answer. b

(84). The fastest acting schizontocidal drug among the following is

a. Artemether

b. Mefloquine

c. Chloroquine

d. Proguanil

Solution. Ans-84: (a) ArtemetherRef: KDT-792Sol:Artemisinin derivativeslike dihydroartemisinin, arteether and artemether etc. are fastest acting antimalarial drugs.

Answer. a


(85). All of the following antibiotics act by interfering with cell wall formation except

a. Ceftriaxone

b. Vancomycin

c. Cycloserine

d. Clindamycin

Solution. Ans-85 (d) ClindamycinRef: KDTs 6th Ed. Pg. 668Sol:Drugs inhibiting the cell wall formation are :Lactams (like penicillins and cephalosporins)Vanconycin , CycloserineBacitracin , FosfomycinClindamycin acts by inhibiting the protein synthesis

Answer. d

(86). The persistent suppression of bacterial growth that may occur after limited exposure to some antimicrobial drug is called

a. Time dependent killing

b. Post antibiotic effect

c. Concentration dependent killing

d. Sequential blockade

Solution. Ans-86: (b) Post antibiotic effectRef: Katzung -- 756Sol:Time dependent killing kinetics is shown by aminoglycosides. Here, the killing activity depends upon the length of time, plasmaconcentration is above MIC. Concentration dependent killing is shown by lactam drugs.Here, killing activity depends upon the ratio of plasma concentration to MIC.Post antibiotic effects is the suppression of bacterial growth after limited exposure to antibiotic.

Answer. b

(87). A folic acid antagonist useful as an anti-neoplastic and immunosuppressant agent is

a. Cyclosporine

b. Azathioprine

c. Doxorubicin

d. Methotrexate

Solution. Ans-87: (d) MethotrexateRef: KDT--772Sol:Methotrexate is an anti-folateagent that inhibitis DHFR reductase and may result in megaloblastic anemia.Methotrexate is commonly used (generally in combination with misoprostol) to terminate pregnancies during the early stages (i.e., asan abortifacient). It is also used to treat ectopic pregnancies

Answer. d


(88). Tamoxifen is used to treat some breast cancers because of its ability to

a. Utilize its androgenic properties in retarding tumor growth

b. Prevent estrogen synthesis by the ovary

c. Enhance glucocorticoid treatment

d. Act as an estrogen antagonist

Solution. Ans-88: (d) Act as an estrogen antagonistRef: Read the text below.Sol: Tamoxifen is an estrogen antagonist used in the treatment of breast cancer. Postmenopausal women with metastases to soft tissue and whose tumors contain an estrogen receptor are more likely to respondto this agent.Little benefit is derived from tamoxifen if the tumor does not have estrogen receptors.

Answer. d

(89). An effective antidiarrheal agent that inhibits peristaltic movement is

a. Clonidine

b. Bismuth subsalicylate

c. Oral electrolyte solution

d. Diphenoxylate

Solution. Ans-89: (d) DiphenoxylateRef: Read the text below.Sol: Diphenoxylate is a piperidine opioidthat is related to meperidine. It inhibits peristalsis and, hence,increases the passage time ofthe intestinal bolus. It is combined with atropine to discourage use as a street drug. Atropine has little effect on peristalsis.Clonidine, bismuth subsalicylate, and rehydration therapy are all useful in some types ofdiarrhea, but none of them inhibit peristalsis.

Answer. d

(90). The steatorrhea of pancreatic insufficiency can best be treated by

a. Misoprostol

b. Bile salts

c. Pancrelipase

d. Secretin

Solution. Ans-90: (c) PancrelipaseRef: Read the text below.Sol: Pancrelipase is an alcoholicextract of hog pancreas that contains lipase, trypsin, and amylase. It is effective in reducing the steatorrhea of pancreatic insufficiency. None of the other drugs mentioned have significant action in the digestion of fats.

Answer. c


(91). A reduction in insulin release from the pancreas may be caused by which of the following diuretics?

a. Triamterene

b. Chlorothiazide

c. Spironolactone

d. Acetazolamide

Solution. Ans-91: (b) ChlorothiazideRef: Read the text below.Sol: An adverse reaction that is reported to occur occasionally with the thiazides, such as chlorothiazide, is hyperglycemia. In addition, hyperglycemia may occur with thiazide-related compounds (chlorthalidone and metolazone) and the high-ceilingdiuretics (ethacrynic acid, furosemide, and bumetanide). The proposed mechanism for the elevation in blood glucose appears to be related to a decrease in insulin release from thepancreas. In addition, increased glycogenolysis,decreased glycogenesis, and a reduction in the conversion of proinsulin to insulin may alsobe involved in the hyperglycemic response.Diazoxide, a nondiuretic thiazide, is given to treat hypoglycemia in certain conditions.However, diazoxide is used more often to controlhypertensive emergencies

Answer. b

(92). Which of the following agents is a selective dopamine receptor (D2) agonist?

a. Fluphenazine

b. Bromocriptine

c. Promethazine

d. Haloperidol

Solution. Ans-92: (b) BromocriptineRef: Read the text below.Sol: Central dopamine receptorsare divided into D1 and D2 receptors. Antipsychotic activity is better correlated to blockade of D2receptors. Haloperidol, a potent antipsychotic, selectively antagonizes at D2 receptors. Phenothiazine derivatives, such as chlorpromazine,fluphenazine, and promethazine, are not selective for D2 receptors. Bromocriptine, a selective D2 agonist, is useful in the treatment of parkinsonism and hyperprolactinemia. It produces fewer adverse reactions than do nonselective dopaminereceptor agonists.

Answer. b

(93). In comparing the following neuroleptics, which is most likely associated with constipation, urinary retention, blurred vision, and drymouth?

a. Chlorpromazine

b. Clozapine

c. Olanzapine

d. Sertindole

Solution. Ans-93: (a) ChlorpromazineRef: Read the text below.Sol: The phenothiazines as a class are the most potent anticholinergics of the neuroleptics. Tolerance to their anticholinergic effectsoccurs in most patients. Cholinomimetic agentsmay be used to overcome symptoms that persist.

Answer. a


(94). A patient exhibiting multiple facial tics, aggressive outbursts of behavior, and spontaneous repetitive foul language is best treated withwhich of the following agents?

a. Levodopa

b. Clozapine

c. Thioridazine

d. Haloperidol

Solution. Ans-94: (d) HaloperidolRef: Read the text below.Sol: Tourettes syndromeis effectively treated with haloperidol, a high-potency antipsychotic. If patients are unresponsive or do not tolerate haloperidol, they might be switched to pimozide.

Answer. d

(95). Which of the following is an antidepressant agent that selectively inhibits serotonin (5-HT) uptake with minimal effect on norepinephrineuptake?

a. Protriptyline

b. Maprotiline

c. Fluoxetine

d. Desipramine

Solution. Ans-95: (c) FluoxetineRef: Read the text below.Sol: The tricyclics and secondgeneration antidepressants act by blocking serotonin or norepinephrine uptake into the presynapticterminal. Fluoxetine selectively inhibits serotonin uptake with minimal effects on norepinephrine uptake. Protriptyline, maprotiline, desipramine, and amoxapine have greater effect on norepinephrine uptake.

Answer. c

(96). Carbidopa is useful in the treatment of Parkinson's disease because it

a. Is a precursor of levodopa

b. Is a dopaminergic receptor agonist

c. Prevents peripheral biotransformation of L-dopa

d. Prevents a breakdown of dopamine

Solution. Ans-96: (c) Prevents peripheral biotransformation of L-dopaRef: Read the text below.Sol: Carbidopa is an inhibitor of aromatic L-amino acid decarboxylase. It cannot readily penetrate the central nervous system (CNS) and, thus, decreases the decarboxylation of L-dopa in the peripheraltissues. This promotes an increased concentration of L-dopa in the nigrostriatum, where it is converted to dopamine.In addition, the effective dose of L-dopa can be reduced.

Answer. c


(97). Successful treatment with single drug in Hodgkin's disease has been seen with:

a. Procarbazine

b. Mithramycin

c. Mechlorethamine

d. Radiophosphorus

Solution. Ans-97: (c) MechlorethamineRef:Read the text belowSol: Mechlorethamine is used primarily in the treatment of Hodgkins disease as part of the MOPP regimen (Mechlorethamine,Oncovin, Prednisone, Procarbazine) Is also useful in the treatment of some solid tumors.

Answer. c

(98). Of the patients who are allergic to penicillin, what percentage will have an allergic reaction when given cephalosporin?

a. Fewer that 1%

b. 5 to 15 %

c. 2 to 5 %

d. 1 to 2 %

Solution. Ans-98: (b) 5 to 15 %Ref:Read the text belowSol: The cephalosporins should be avoided or used with caution in individuals allergic to penicillins (about 5 to 15% show cross-sensitivity). In contrast, the incidence of allergic reactions to cephalosporins is 1-2% in patients without a history of allergy topenicillins.

Answer. b


(99). A 60 years old female patient presents with microbial infection,decision is made to treat her with antibiotics as an outpatient. Routinebiochemistry tests reveals creatinine clearance of 28/ml/ min.Drug least likely to require a dosage adjustment is:

a. Acyclovir

b. Cephalexin

c. Metronidazole

d. Vancomycin

Solution. Ans-99: (c) MetronidazoleRef:Read the text belowSol:ANTIMICROBIAL NEEDING DOSE REDUCTION IN RENAL FAILURE

Answer. c

(100). An immunocomprom

Documents

Pharmacology Test