11) A patient on an antibacterial therapy also consumes tyramine-containing food.

He

experiences palpitation, headache and hypertensive crisis. Which of the following antibacterial agent may this be due to a. Clarithromycin b. Minocycline c. Linezolid d. Daptomycin Ans: c (Goodman & Gilmans, the pharmacological basis of therapeutics, 12th edition, p-1538) Linezolid is a weak nonspecific inhibitor of monoamine oxidase. Patients receiving concomitant therapy with an adrenergic or serotonergic agent (including selective serotonin reuptake inhibitors [SSRIs]) or consuming >100 mg of tyramine a day may experience serotonin syndrome, characterized by palpitations, headache, or hypertensive crisis. Coadministration of these agents is best avoided if possible. However, in patients receiving SSRIs who acutely require linezolid therapy for short-term (10-14 days) treatment, co-administration with careful monitoring is reasonable because SSRIs generally require tapering to avoid discontinuation syndrome. Linezolid is neither a substrate nor an inhibitor of CYPs.
12) In the treatment of acute promyelocytic leukemia, all-trans retinoic acid acts as,

a. Differentiation agent b. Immunomodulator c. Chemoprotective agent d. Cytotoxic agent Ans: a (Ref: Goodman & Gilmans, the pharmacological basis of therapeutics, 12th edition,p1722)

Under physiological conditions, the RAR- receptor dimerizes with the retinoid X receptor to form a complex that binds ATRA tightly. ATRA binding displaces a repressor from the complex and promotes differentiation of cells of multiple lineages. In APL cells, physiological concentrations of retinoid are inadequate to displace the repressor. Pharmacological concentrations, however, are effective in activating the differentiation program and in promoting degradation of the PMLRAR- fusion gene.

ATRA also binds and activates RAR- and thereby promotes stem-cell renewal, perhaps through its effects on the microenvironment &this action may help restore normal bone marrow renewal.

13) The above pattern of arrhythmias are seen in, a. Hyperkalemia b. HOCM c. Digitalis intoxication d. Sick sinus syndrome Ans: c (See AI 2011, PGEI book, p-51) 14) Which among the following has least hypotensive side effect? a. Fluphenazine b. Trifluoperazine c. Thioridazine d. Haloperidol Ans: d >a (Ref: A short text book of psychiatry, 20th Ed, p-176) 15) Which of the following toxicities is unique to voriconazole among all azole antifungals? a. Hepatic failure b. Visual disturbances c. Rash d. Vomiting Ans: b (Goodman & Gilmans, the pharmacological basis of therapeutics, 12th edition,p-1581,
Katzung 12th edition, p-855)

Observed toxicities include rash and elevated hepatic enzymes. Visual disturbances are common, occurring in up to 30% of patients receiving intravenous voriconazole, and include blurring and changes in color vision or brightness. These visual changes usually occur immediately after a dose of voriconazole and resolve within 30 minutes. Photosensitivity dermatitis is commonly observed in patients receiving chronic oral therapy. (Katzung)

Although voriconazole is generally well tolerated, occasional cases of hepatotoxicity have been reported, and liver function should be monitored. Voriconazole, like some other azoles, causes a prolongation of the QTc interval, which can become significant in patients with other risk factors for torsades de pointes. Patients must be warned about possible visual effects. Transient visual or auditory hallucinations are frequent after the first dose, usually at night and particularly with intravenous administration. Symptoms diminish with time .Patients receiving their first intravenous infusion have had anaphylactoid reactions, with faintness, nausea, flushing, feverishness, and rash. In such patients, the infusion should be stopped. Rash has been reported in 5.8% of patients.

16) Regarding calcitonin in the management of osteoporosis

Assertion: it is indicated for the prevention of osteoporosis Reason: it acts by inhibiting osteoclastic activity. a. Both Assertion and Reason are true, and Reason is the correct explanation for Assertion b. Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion c. Assertion is true, but Reason is false d. Assertion is false, but Reason is true Ans: a (Katzung 12th edition, 774)

The principal effects of calcitonin are to lower serum calcium and phosphate by actions on bone and kidney. Calcitonin inhibits osteoclastic bone resorption. Although bone formation is not impaired at first after calcitonin administration, with time both formation and resorption of bone are reduced. In the kidney, calcitonin reduces calcium and phosphate reabsorption as well as reabsorption of other ions, including sodium, potassium, and magnesium. Tissues other than bone and kidney are also affected by calcitonin. Calcitonin in pharmacologic amounts decreases gastrin secretion and reduces gastric acid output while increasing secretion of

sodium, potassium, chloride, and water in the gut. Pentagastrin is a potent stimulator of calcitonin secretion (as is hypercalcemia), suggesting a possible physiologic relation between gastrin and calcitonin. In the adult human, no readily demonstrable problem develops in cases of calcitonin deficiency (thyroidectomy) or excess (medullary carcinoma of the thyroid). However, the ability of calcitonin to block bone resorption and lower serum calcium makes it a useful drug for the treatment of Paget's disease, hypercalcemia, and osteoporosis.

17) A 28-year-old man comes to the emergency department with complaints of 12 days of fever, malaise, cough, green sputum production, and dyspnea. He is a cigarette smoker and works in a restaurant. He has no significant past medical history and takes no medications. He is uncomfortable but alert with temperature of 39.2C, respiratory rate 28 cpm, blood pressure 110/70 mmHg, HR 105 beats/min, SaO2 on room air is 94%. His chemistry studies are normal. WBC count is 15,500/L. There are bronchial breath sounds in the right lower lobe, and chest radiograph shows consolidation in that area. Which of the following is the most appropriate antibiotic therapy? a. Azithromycin b. Ceftriaxone plus clarithromycin c. Fluconazole d. Piperacillin/tazobactam e. Vancomycin Ans: a (Harrisons 18th edition, c-257) The first patient is a candidate for outpatient therapy because of his CURB-65 score of 0. As shown below, an oral macrolide (azithromycin, clarithromycin) is the best choice. Respiratory fluoroquinolones may be used in the presence of co morbidities or recent antibiotics. The second patient has a CURB-65 score of 3 (age, respiratory rate, BUN) and merits consideration for inpatient therapy. Of the listed choices, a -lactam (ceftriaxone) plus a macrolide (clarithromycin) is best. A respiratory fluoroquinolone may also be used as a single agent unless the patient goes to the intensive care unit, when a -lactam should also be used. Fluconazole does not have a role for community-acquired pneumonia (CAP); it is used to treat candidal infections. Piperacillin/tazobactam is a consideration when Pseudomonas infection is considered likely, such as in patients with cystic fibrosis or bronchiectasis. Vancomycin is only

a consideration for CAP when epidemiologic considerations make methicillin-resistant Staphylococcus aureus a likely pathogen. 18) The following tracing depicts what phenomenon? a. Tachyphylaxis b. Vasomotor reversal of Dale c. Competitive, non-equilibrium type of antagonism d. Synergism

Ans: b (KDT 6th edition, p-123) Vascular 2 receptors are more sensitive than -receptor Rapid i.v. injection of Adr (in animals) produces a marked increase in both systolic as well as diastolic BP (at high concentration response predominates and vasoconstriction occurs even in skeletal muscles). The BP returns to normal within a few minutes and a secondary fall in mean BP follows. The mechanism is-rapid uptake and dissipation Concentration of Adr is reduced low concentrations are not able to act on receptors but continue to act on 2 receptors. When an blocker has been given, only fall in BP is seen-Vasomotor reversal of Dale.

19) Which of the following statement is not correct for vecuronium? a).It has high incidence of cardiovascular side effects b).It has short duration of NM block c).In usual doses the dose adjustment is not required in kidney disease. d). It has high lipophilic property Ans: a (Millers anesthesia, 7th edition, p- 1900) 20) A 55-year-old man with kidney stones has been placed on a diuretic to decrease calcium excretion. However, after a few weeks, he develops an attack of gout. Which diuretic was he taking? a. Furosemide. b. Hydrochlorothiazide. c. Spironolactone. d. Triamterene. Ans: b (Lippincotts 5th edition, p-289) Hydrochlorothiazide is effective in increasing calcium reabsorption, thus decreasing the amount of calcium excreted, and decreasing the formation kidney stones that contain calcium phosphate or calcium oxalate. However, hydrochlorothiazide can also inhibit the excretion of uric acid and cause its accumulation, leading to an attack of gout in some individuals. Furosemide increases the excretion of calcium, whereas the K+-sparing osmotic diuretics, spironolactone and triamterene, and urea do not have an effect.