General Pharmacology
A 42-year-old man with a history of motion sickness planned a cruise trip to the Andaman and Nicobar Islands. To make his journey enjoyable and mitigate nausea and vomiting during travel, the doctor has prescribed him drug X. The most appropriate route of administration of the drug X, which ensures a prolonged effect exceeding 48 hours, would be
A. Oral route
B. Intramuscular route.
C. Transdermal route.
D. Intravenous route.
A 63-year-old female, a known case of bronchial asthma, presented to the emergency room with increasing breathlessness, cough, and fever. Her RR was 30 breaths per minute, her pulse rate was 108 beats per minute, and on inspection, the accessory muscles of respiration were working. The clinician diagnosed status asthmaticus. Utilizing your pharmacokinetic knowledge, indicate the most appropriate route for the given scenario.
A. Inhalational route.
B. Intramuscular route.
C. Transdermal route.
D. Intravenous route.
Suppose you are a pediatrician running a private hospital who received a 5-year-old unconscious child brought by the parents with a history of fever and repeated convulsions. You made a diagnosis of febrile convulsions and planned to administer diazepam. Which administration route do you prefer for diazepam?
A. Oral route.
B. Intramuscular route.
C. Rectal route.
D. Intravenous route
A 10-year-old boy with a history of severe nausea, vomiting, and diarrhea was admitted to the emergency ward. He was moderately dehydrated and hence infused with intravenous fluids to replenish fluid loss. Which among the following is a false statement about the intravenous route?
A. Hypertonic fluids and pharmaceuticals with gastric irritant properties may be delivered by this route.
B. There is a risk of infection if proper aseptic precaution is not taken before administration of the drug.
C The route has 100% bioavailability.
D. The route is more suitable for suspension and oily formulations.
A patient experiencing acute angina is being prescribed glyceryl trinitrate sublingually, as it has high first-pass metabolism. Which of the following statements accurately describes the first-pass metabolism?
A. The drugs taken orally will not exhibit first-pass metabolism.
B. The alternate word for first-pass metabolism is pre-systemic circulation.
C. In liver disorders, the bioavailability of a drug with high first-pass metabolism will be lower.
D. If the drug has high first-pass metabolism, the oral route is obsolete even with higher doses.
Mrs. XYZ, a 28-year-old primigravida, received the tetracycline antibiotic for Mycoplasma pneumonia in the third trimester. Which of the following fetal anomalies are expected in the baby after delivery?
A. Phocomelia.
B. Cleft Palate.
C. Spina bifida.
D. Discolored and deformed teeth.
A pregnant woman received analgesics during labor, and the baby was born with respiratory depression after a normal vaginal delivery. Which possible drug causes this teratogenic effect?
A. Morphine.
B. Diclofenac Sodium.
C. Diazepam.
D. Ketorolac.
The patient diagnosed with Parkinsonism was prescribed levodopa- a prodrug of dopamine.
The following statement is false about a prodrug.
A. A prodrug is an inactive compound that gets metabolized in the body into an active form.
B. It enhances the bioavailability.
C. A prodrug produces a longer duration of action.
D. It can potentiate the adverse effects.
Parkinsonism is a movement disorder caused by a deficiency of dopamine in the substantia nigra. For its treatment, instead of dopamine, levodopa is used. Because-
A. Levodopa is a prodrug and lipid-soluble compound that crosses the blood-brain barrier and is metabolized to dopamine.
B. Dopamine can cross the blood-brain barrier but induces high toxicity.
C. Levodopa directly binds to the dopaminergic receptor.
D. Levodopa is a water-soluble compound that crosses the blood-brain barrier easily.
A recently married couple planned not to have a baby for a couple of years and consulted a gynecologist for contraceptive methods. The doctor prescribed oral contraceptives for a female partner. A month later, she was diagnosed with active pulmonary TB, for which she was initiated on an anti-TB regimen that contains rifampicin. After 2 weeks of starting the rifampicin-containing regimen, the patient became pregnant. The reason for the failure of contraception is
A. Rifampicin inhibited the enzyme that reduced the therapeutic concentration of OC pills, leading to therapeutic failure.
B. Rifampicin-containing regimen displayed the OC pills from the plasma binding site, leading to poor concentration
C. Rifampicin induced the enzyme that reduced the therapeutic concentration of OC pills, leading to therapeutic failure.
D. Rifampicin reduced the absorption of OC pills.
A 65-year-old male with known COPD was on inhaled beta agonist, corticosteroid, and theophylline therapy. As the patient had bacillary dysentery, he was asked to take Ciprofloxacin 500 mg twice a day. After 6 hours of ciprofloxacin consumption, the patient started complaining of gastric upset, palpitations, and tremors. The possible reason for these symptoms is
A. Ciprofloxacin inhibited the enzyme that increased the therapeutic concentration of theophylline, causing side effects.
B. Ciprofloxacin-containing regimen displayed theophylline from the plasma binding site, leading to higher concentration.
C. Ciprofloxacin induced the enzyme that increased the therapeutic concentration of theophylline, causing side effects.
D. Ciprofloxacin increased the metabolism of theophylline, which led to theophylline toxicity.
A 24-year-old primigravida diagnosed with premature labor. The gynecologist recommended a medication to avoid neonatal jaundice. The most probable drug could be.
A. Phenobarbitone.
B. Diazepam.
C. Dexamethasone.
D. Salbutamol.
Adrenaline and histamine are nullifying each other’s action by acting on α1 and H1 receptors, respectively. This explains which antagonism type?
A. Physical.
B. Chemical.
C. Physiological.
D. Pharmacological.
A 30-year-old female undergoing a cesarean section under spinal anesthesia developed hypotension. The anesthetist administered an injection of ephedrine 10 mg IV, which raised blood pressure to a normal level. After 15 minutes, the patient developed recurrent hypotension, for which 10 mg of intravenous ephedrine was repeated 2-3 times over a short period of time. Despite intravenous ephedrine, blood pressure hardly rises this time. This phenomenon is called—
A. Tachyphylaxis.
B. Tolerance.
C. Antagonism.
D. Synergism.
To avoid this phenomenoon, what would be the best choice of the drug?
A. High dose of Ephedrine
B. Adrenaline
C. Phenylephrine
D. Hydrocortisone
If 40% of Drug A is eliminated at every unit time and the plasma half-life of the drug is a constant, then the drug follows ———order kinetics.
A. First
B. Zero
C. Mixed
D. First and Zero
A patient with septic shock was started on a noradrenaline (2 mg/ml) infusion. The plasma half-life of noradrenaline is 2 minutes. How much time will it take to reach a steady-state plasma concentration where the rate of administration is equivalent to the rate of elimination?
A. 4 minutes
B. 6 minutes
C. 10 minutes
D. 12 minutes
A 33-year-old male admitted to the General Medicine ward for pneumonia developed anaphylactic shock after administration of injection Cefotaxime. You are a CRMI posted in the department want to report this ADR. Which of the following statements is correct regarding ADR reporting?
A. A CRMI cannot report the ADR.
B. A CRMI can report this ADR.
C. Only the doctor in charge has to report ADR.
D. This ADR must only be reported by the on-duty staff nurse.
A 55-year-old male diagnosed with Parkinsonism was initiated with a fixed-dose combination of levodopa and carbidopa. Which of the following is NOT correct for FDC?
A. Both drugs should have similar pharmacokinetic properties (t1/2, Avd).
B. The combination enhances the efficacy through synergistic action.
C. The combination does not prevent drug resistance in infectious diseases.
D. The FDC improves compliance.
If a drug A has an LD50 of 20 mg and an ED50 of 10 mg. Among the following, which statement is not true about the therapeutic index?
A. The therapeutic index of drug A is 2.
B. Drug A has a good margin of safety.
C. Drug A has a narrow margin of safety.
D. Therapeutic drug monitoring is not required for Drug A.
Answers: C, A, C, D, B, D, A, D, A, C, A, A, C, A & C, A, C, B, C, C.
Drugs acting on ANS
A 45-year-old male was brought to the casualty with an alleged history of consumption of pesticides. On examination, he was semiconscious and had increased salivation and lacrimation. He experienced 3-4 episodes of vomiting with HR of 50 per minute and BP of 90/70 mmHg. His pupils were pinpoint and reacting to light. The diagnosis of Organophosphorus poisoning was made. Which among the following is an antidote used for the management of OP poisoning?
A. Atropine.
B. Physostigmine.
C. Adrenaline.
D. Neostigmine.
A 35-year-old female developed a sudden onset of breathlessness, facial puffiness, and hypotension after administration of injection ceftriaxone, prescribed for pneumococcal pneumonia. The drug of choice in a given condition is-
A. Intramuscular Adrenaline.
B. Intravenous Atropine.
C. Nebulized levo-salbutamol.
D. Intravenous noradrenaline.
The patient with myasthenia gravis was commenced on oral neostigmine therapy, which showed improvement in muscle weakness. Following the doubling of the dose of neostigmine to achieve rapid recovery, the patient complained of the recurrence of muscle weakness and reported breathlessness. This occurred as a result of –
A. Inadequate absorption of neostigmine.
B. Cholinergic crisis.
C. Myasthenic crisis.
D. Inadequate cholinergic therapy.
In ophthalmic OPD, for precise assessment of refractive error and induce ciliary paralysis, the most appropriate antimuscarinic agent would be-
A. Atropine
B. Scopolamine
C. Homatropine
D. Tropicamide
For the diagnosis of pheochromocytoma, which urinary marker has the highest sensitivity and reliability?
A. Random urinary vanillylmandelic acid (VMA)
B. 24-hour urinary fractionated metanephrines
C. 24-hour urinary vanillylmandelic acid (VMA)
D. 24-hour urinary Noradrenaline level
The edrophonium test is useful for the diagnosis of myasthenia gravis. Administration of 1-2 mg of IV edrophonium shows improvement in muscle strength in patients with myasthenia gravis. Edrophonium is a short-acting reversible anticholinesterase, and its action lasts for only 5 minutes. The short duration of action of Edrophonium is because-
A. It forms a complex with the anionic site of the cholinesterase enzyme.
B. It forms a complex with the esteratic site of the cholinesterase enzyme.
C. It forms a complex with both the anionic and the esteratic sites of the cholinesterase enzyme.
D. It does not form a complex with any of the sites of the cholinesterase enzyme.
A 55-year-old female presented to the ER with a history of sudden onset of right-sided ocular pain with headache. On ophthalmic examination, the visual acuity was reduced, the peripheral field of vision was diminished, and right-sided intraocular pressure was noted as 36 mmHg. She was diagnosed with acute angle-closure glaucoma. The drug that is to be administered parenterally to terminate the acute attack is-
A. Mannitol (20%)
B. Timolol (0.5%)
C. Physostigmine (5%)
D. Latanoprost (0.005%)
Scopolamine is the preferred drug in patients with motion sickness. The rationale is-
A. It possesses CNS depressant property with M1 blocking action in the labyrinths.
B. It has a faster onset of action.
C. It possesses H1 blocking action.
D. It suppresses the vomiting centre.
Cardio-selective β blockers such as metoprolol, bisoprolol, nebivolol, and carvedilol are considered standard therapy in the management of mild to moderate heart failure patients. Identify the statement that contradicts the use of the above drugs in the management of CCF.
A. Prolongs the life of the patient.
B. Retards the progression of the disease.
C. Promote cardiac remodeling.
D. Antagonize the deleterious effects of sympathetic stimulation.
State true or false. Dipivefrine eye drops, when given topically to patients with glaucoma, reduce intraocular pressure by increasing uveoscleral outflow (α2-mediated action) and reducing the synthesis of aqueous formation. (β-mediated action)
A. True.
B. False
A patient with a diagnosed case of benign prostatic hypertrophy developed the first-dose effect (postural hypotension) after oral administration of prazosin. What would be the best strategy to minimize this side effect?
A. Prefer sustained-release formulation.
B. Choose alternative drugs that possess a lesser hypotensive effect.
C. Use a combination of prazosin and dopamine to counteract hypotension.
D. Start prazosin with a lower dose and preferably at night.
A 45-year-old man undergoing herniorrhaphy developed hypotension after spinal anaesthesia. Which among the following is the drug of choice to treat hypotension due to spinal anaesthesia?
A. Ephedrine hydrochloride.
B. Noradrenaline.
C. Mephentermine
D. Amphetamine
Answer keys:
A-Atropine, A-Intramuscular adrenaline, B-Cholinergic crisis, D-Tropicamide, B-24-hour urinary fractionated metanephrines, A-It forms a complex with the anionic site of the cholinesterase enzyme, A-Mannitol 20%, A-It possesses CNS depressant property with M1 blocking action in the labyrinths, C-Promote cardiac remodelling, A-True, D-Start prazosin with a lower dose and preferably at night, D-Mephentermine.