Pharm Imp. Shakil

PHARMACOLOGY
MOA= mechanism of action
DOC= drug of choice
ADR= adverse drug reaction
SN = short note
CCB = calcium channel blockers
GENERAL PHARM
Long questions:-
•describes various routes of drug administration with their examples. Write about the advantages and
disadvantages of each route (im ,iv,sc )
●describe all the types of Drug interactions (combined effect of drugs) with their examples
●Factors modifying the drug action
● Adverse drug effect-define, Classify & explain its all types in details
Notes (5mrks)
● Bioavailability (F) – define, factors affecting it, example, graph
● factors affecting absorption of a drug
● Volume of distribution of a drug (V) – formula,example , factors affecting it & its importance
● Prodrug –define, uses, example
● First pass metabolism - drugs having high first pass metabolism, routes which avoid it , significance
● Difference between first order & zero order kinetics- example, formula, graph
● Difference between loading & maintenance dose with their formula
Made by- ANKIT SUNIYAL(2K12) 1

● Indications & contraindications of therapeutic drug monitoring (TDM) with the examples. How it is
important for clinical effectiveness of the anti- epileptics?
● Two state receptor model
● Difference between drug potency and efficacy with graph
● Advantages and disadvantages of fixed dose combinations (FDCs) with examples
● Difference between tolerance and tachyphylaxis
● stages of clinical trial
● factors affecting compliance/adherence of a drug
● Clearance of drug
● Microsomal enzyme induction & inhibition – examples, significance
● Describe different types of antagonism with examples
● Essential medicine – define, example, significance
● Enteroheptic circulation, biotransformation, tubular secretion – define, what is the importance of

inhibiting these processes?
● Bioequivalence & its importance
● Plasma half-life & its significance
Distinction questions –
● Orphan drug
●plasma protein binding – examples, its importance
●how to prolong the drug action
●receptor occupation theory
● Placebo
● Mechanisms for the transport of drugs across the biological membranes

● Various phases of metabolism of drugs – explain & give examples
● Pharmacogenetics
●teratogenicity
CLINICAL Qs /EXTRA FACTS /POINTS FOR SPOTTERS/VIVA/CAL/PRACTICAL-
● Definition of receptor, agonist, antagonist, inverse agonist, partial agonist, ligand
● Drugs extracted from different plants and their use
● What are Drugs developed with the help of DNA technology
● Examples of the drugs which can be given as – intranasal, rectal suppository, vaginal suppository, and
as an eye drop
● Different gauge needles, their colour codes and at which angle inserted in various parental routes of
drugs
● Difference between pharmacopoeias, formulary, other book
● Difference between a drug and a medicine. Is human blood a drug?
● Difference between pharmacodynamics & pharmacokinetics
● functions of a receptor
● Dose response curve (DRC)
● Ethical considerations in clinical trials
● What is pharmacovigilance and where all in jipmer you see it
● explain category A & X of drugs used in pregnancy
● How pathological states influence drug action?
● Difference between phase 1 & 4 of clinical trials
*steady state is reached in 4-5 half lives

* 3 R of ethics of animal experimentation – reduce, refine, replace
*CDSCO approves new drug in India
*1 teaspoon = 5ml
* 1 fingertip unit (FTU)= 0.5gm , distal crease to fingertip , from 5 mm of nozzle
For front and back of hand =1FTUs
Face and neck= 2.5 FTUs
Entire arm & hand=4FTUs
Entire leg and foot= 8FTUs
*I.V line cannula = 18 gauge (green)
* Father of pharmacology – Oswald schmiedberg
Father of Indian pharmacology – col. Ramnath chopra
Father of modern pharmacology - Sir James black
ANS
Long questions:-
● classify adrenergic drugs and describe ADR, MOA and uses of 4 adrenergic drugs
● classify beta blockers. Describe their MOA, interactions, ADRs, uses & their contra indications
●describe the drugs used in open angle and closed angle glaucoma (MOA & examples).why beta blockers
are preferred over miotics in glaucoma?

Notes (5mrks)
● Uses of anti-ChEs (neostigmine)
● OP poisoning- clinical features & treatment. Why PAM-2 is ineffective in carbamate poisoning?
● General principles of treatment of poisoning
●classify anticholinergic drugs
● Difference between atropine and hyoscine (scopolamine). Why scopolamine is preferred for motion
motion sickenss than atropine? Why hyoscine patch is applied just behind the ears?
● Difference between physostigmine and neostigmine. Why physostigmine is preffered in atropine

poisoining?
●therapeutic uses of atropine or its substitutes
● Atropine poisoning- clinical features & its treatment
● Uses and ADR of selective beta 2 stimulants
● Uses and ADR of adrenaline. Why it is not given orally?
● give examples of pure alpha1 agonist and their use
● Uses and ADR of alpha blocker
● Uses and ADR of alpha agonists
●short note on prazosin -uses,adr,MOA
● Auto receptors, Mono amine oxidase – location in ANS, functions, use of inhibiting them
● Draw an adrenergic neuron and mark the site of action of drugs affecting it
● Treatment of myasthenia gravis
● write a short note on cardio selective beta blockers.
● short note on nasal decongestants

●stages in new drug development
●MOA of amphetamine & cocaine
● pheochromocytoma – patho and treatment
● Cholinesterase regenerators – examples, uses, ADR, how they differ?
● anti- muscarinic drug - examples, uses, ADR,
● pirenzepine
● edrophonium test
● Mushroom poisoning
● Muscarinic receptors – types, location, its agonists and antagonists
● Nicotinic receptors - types, location, its agonists and antagonists
● Why Ach is not used clinically
● smoking cessation – drugs used, how to use nicotine chewing gum
● Autonomic control of pupil & effect of various drugs on it (MOA) - CAL
● Light reflex pathway (CAL viva )
● Inhibition of pseudocholine
● NA reuptake inhibitors
● Effect of atropine on HR ,BP,EYE & GI
● Location and actions of various alpha & beta receptors
● How noradrenaline is given and what is its action and use?

● Vasomotor reversal of dale
● Can beta blockers be used for treatment of heart failure? Give reasons
● Difference between Adrenaline,nor adrenaline & isoprenaline.
●what is the effect of Adrenaline & nor adrenaline in CVS
● Why adrenaline is preferred for anaphylaxis shock not nor-adrenaline ?
● What is first dose effect – seen in prazosin
● Why prazosin do not cause tachycardia
● Why beta blockers are contraindicated in diabetes patients?
● Why propranolol is not used as anaesthetic agent, as it has potency equal to lignocaine?
● Beta blockers have the following properties - local anaesthetic action, lipid solubility, cardio selectivity
. What are the clinical implications of these properties?
● advantages of prostaglandins analogues over beta blockers in treatment of glaucoma
● why tropicamide is preferred as mydriatic agent in adults ,whereas it is atropine in children ?
● Why dobutamine is DOC for cardiogenic shock?
● Why salbutamol is preferred in acute asthma attack not salmeterol ?
● What is the peculiar property of phenoxybenzamine ,Atracurium ,dantrolene, lantanoprost , minoxidil

? And how it is used?
● DOC for chronic open angle glaucoma (propranolol vs timolol )
● MOA , uses & clinical indication for - endogenous catecholamine , indirect acting sympathomimetics ,
mixed acting sympathomimetics
● How nicotinic receptor agonist as well as antagonist can cause skeletal muscle relaxation?
● How alpha adrenergic receptor agonist as well as antagonist can be used for hypertension?
● Differentiate Ipratropium & tiotropium
● Differentiate Dopamine & Dobutamine
● Why atropine in eye is used as ointment not as a solution ?

● How reserpine causes depression & suicidal tendency?
*in India DOC for motion sickness is promethazine(25mg OD, 1hr before the trip ) as hyoscine is not
available
*ADR of phenylpropanolamine (PPA) – haemorrhagic and psychiatric problem
*phenylephrine decreases motility of cilia due to ischaemia. Never given in HTN patients. why ?
*No effect will be seen of NA in an isolated heart of frog as it is not attached to brain, therefore reflex
bradycardia won’t occur.
NOTE-
*Remember the proper format of prescription writing
*For CAL must read the questions given in pharm manual book and the questions appearing on the
screen after the CAL practical. Read the procedure and items used very carefully.
* For doctor patient communication-
Greet the patient, maintain eye contact, and be confident
Explain him/her the pathology of the disease, complication of the disease, the treatments available to
the disease, why you selected this drug ?, MOA of the drug, when and how to take the drug, ask about
any medication he/she is on, explain ADR of the drug, how to reduce the ADR, duration of the
treatment, what to do in case of acute attack of the disease, life style modifications to be done (non-
pharmacological methods like-selective diet, exercise ), pregnancy allowed or not during the medication
phase , when to come for follow up and In the last ask him/her whether he/she has any doubt or query .
*mention to maintain the seizure diary to an epilepsy patient and to carry sweet and a diabetic card to
DM patient.
* For OCP tell her the other benefits of OCPs and when she frequently misses the pills then you have to
change the method of contraception for her.
*sildenafil (Viagra) is contraindicated with nitrates.
*fungal infection can occur if the patient of asthma is not gargling with plain water after using MDI.
* read oleander , datura & OP poisoning

TYPE OF DATA
● Quantitative data (numerical) – data which could be counted or measured. E.g. height, weight, BP,
pulse ,heart rate
● Qualitative data (categorical) - data which are countable, but cannot be measured. E.g. religion,
gender, blood group, no. of births or deaths , writhing ,score , rank
ANALYSIS TYPE
● Mean- sum of data divided by no. of samples, calculated for Quantitative data
● Median - middle observation in the properly arranged (ascending or descending) data, calculated for
Qualitative data (rank, score)
● Mode – most frequent value in a series
DISTRIBUTION OF DATA
*Extreme value (outlier value) – when a single/group of values in a data (observations), which is
extremely small or large.
e.g. 1, 44, 55, 66, 77, 88 – here 1 is a outlier, as it is very small comparatively to the others
e.g. 1,2,3,4,5,6,7,8,97 - here outlier is 97 (extremely large value)
●Normal distribution (Gaussian) of data - where outlier is absent, all the data (observations) are in same
range or falls under symmetrical bell shaped curve.
In the presence of outlier graph becomes asymmetrical (non-normal), shifts to right or left
● Binomial – when only two outcomes are possible - e.g. either successful or failure
● Survival – e.g. either the patient live or die
DESIGN OF STUDY
●Paired – when only 1 group of subject is there to study. Eg. Before & after study
● Unpaired- when two or more than two groups of subjects are there to study

*Use the above basics to find out the statistical test using its table (annexure 6 of pharm record)
* (Trick – generally for biological parameters (quantitative data) are distributed normally & mean is
analysed, but not always)
●P value = chance of committing type1 error (false positive error), or mistakes done during a study
- It is expressed in decibel or in percentage, it do not give any info about type 2 error( false negative)
●Alpha = room left for mistakes during the study, generally we consider alpha to be 5 % = 0.05
- If P value is more than alpha in the results of study/report, then we declare the results as non-
significant because of increased errors
- Therefore usually P value less than 0.5, becomes significant

AUTACOIDS
Long questions:-
●classify NSAIDs, write about their MOA & ADR. How NSAIDs differ from opioids in their analgesic
property. Ways to reduce ADR of NSAIDs.
●ADR, contraindications, interactions & uses of aspirin. Write about the different doses of aspirin as
analgesic, anti-inflammatory & anti platelet.
Notes (5mrks)
●classifications of H1 anti histamines
●difference between 1st and 2nd generation H1 blockers
●ADR and uses of Promethazine and ways to reduce its ADR
●uses of H1 anti-histaminics
●drugs affecting 5HT system
● compare ergotamine & sumatriptan
●drug therapy of Migraine
●what are eicosanoids (prostaglandins) & their uses
●MOA of paracetamol toxicity (flowchart diagram) & its treatment, what is Rumack Mathew line
●diclofenac- MOA,adr,uses
● What drugs are used to treat gout. Why NSAIDs are preferred over colchicine in acute gout?
● short note on allopurinol & DOC for chronic gout
●colchicine- MOA , use & ADR
●Drugs for vertigo

●contraindication of antihistamines
●carcinoid syndrome & its treatment
●treatment of salicylate poisoning
●classify anti-rheumatoid drugs
● What are the non – pharmacological methods to reduce uric acid level
● What do you mean by ‘ autacoids ‘ ?
● define analgesics. Why nitrates and triptans are not called analgesics though they relieve chest &
migraine pain respectively?
● Locations & functions of different histamine receptors
● Role of histamine receptors on BP, cardiac output,HR
● Effect of histamine on an isolated heart of guinea pig- force of contraction & rate is increased
● Triple response
● Uses of histamine
●triphasic response of 5HT in CVS
●types of 5HT receptors, location, drugs acting on them
●what are different preparations of prostaglandins
●reye’s syndrome
● Why ibuprofen is not used as anti-platelet drug
● What is DMARDs & SAARDs
● Rationale behind adding probenecid with penicillin
● Best analgesic drug for dysmenorrhea, acute fracture pain , postherpetic neuralgia ?
● Contraindications for aspirin. Give reasons

● Rationale for combination of paracetamol & ibuprofen?
● Why drugs decreasing uric acid synthesis are contraindicated in acute gout?
* Main ADR of Infliximab Is reactivation of TB, to prevent it – take a chest X-ray and look for latent focus
*Doc for medical closure the patent ductus arteriosus is aspirin & to keep it patent is alprostadil
* Methotrexate is first choice in DMARD , while hydroxychloroquine is the safest DMARD in pregnancy
RESPIRATORY SYSTEM
Long questions:-
● Explain the role of steroids in asthma treatment .Give examples of inhalational steroids. What are the
advantages, disadvantages,MOA and ADR of inhalational steroid?
● Describe the stepwise guideline to treat asthma. Write a short note on treatment of status
asthmaticus.
Notes (5mrks)
●classify drugs for cough. Brief about antitussives
● classify drugs for asthma
●short note on mast cell stabilizers- ketotifen & sodium cromoglycate
●MOA of methylxanthines
●MOA of sympathomimetics (salbutamol) in asthma treatment
● Mucolytic agents – MOA, uses & ADR

●aspirin induced asthma
●compare terbutaline and sodium cromoglycate
●anti-IgE antibody therapy (omalizumab)
EXTRA FACTS /POINTS FOR SPOTTERS/VIVA/CLINICAL Qs -
●what do you mean by mucokinetics , mucolytics & expectorants
●why salbutamol is used in acute asthma attack not salmeterol?
●what is the ADR of long acting beta2 agonists, why they should be given in combination with inhaled
corticosteroids only?
●why not to use sedatives and antibiotics in asthma treatment
● List the mediators involved in pathogenesis of asthma?
● Why anti histamines are not effective in asthma treatment?
● Which Drug (SABA / LABA) to be preferred for acute & chronic asthma. Give reasons
● When should inhaled corticosteroids to be started in an asthma patient?
● Is mast cell stabilizer used in acute asthma attack? Justify
● How acute severe asthma is treated in a resource constraint setting without nebulizer/inhaler?
● Why anticholinergics are more effective for COPD than bronchial asthma ?
● Why dose of theophylline to be increased in children or smokers & to be decreased in

elderly/premature infants/neonates?
● If in pregnancy oral steroid is required, then why prednisolone is preferred?

ENDOCRINOLOGY
Long questions:-
● classify thyroid inhibitors. Write about MOA, uses, ADR of anti-thyroid drugs (thioamides)
● What are the different insulin preparations and their duration of action. Write a prescription of insulin
injection dose
● classify oral hypoglycaemic drugs. Write about MOA, ADR, advantages & dose titration of metformin
● classify corticosteroids. Write about their MOA, uses, ADR & contraindications. How to reduce ADRs of
steroids?
● classify OCPs with their compositions and examples. Write about their MOA, ADR, contraindications &
other benefits of them.
● classify uterine stimulants. Write about MOA, ADR and uses of oxytocin.
Notes (5mrks)
●examples and uses of GH inhibitors
●short note on bromocriptine (MOA, uses, ADR)
● list some gonadotropin analogues. Write about their uses and ADR
●dose titration and uses of L-thyroxine (thyroid hormone)
● short note on propylthiouracil. It’s MOA, ADR & Ways to reduce its ADR. Why methimazole is
preferred over propylthiouracil ?
●radioactive iodine- uses, MOA, advantages & disadvantages
●treatment of thyroid storm/thyrotoxicosis
● MOA and advantages of rapid acting insulin
●treatment of diabetic coma/ketoacidosis
●MOA & ADR of sulfonylureas

●MOA & ADR of thiazolidinedione/pioglitazone
●uses of testosterone
● uses, ADR and examples of anabolic steroids
● short note on clomiphene citrate (anti-estrogen) – MOA, uses and ADR
● short note on mifepristone (anti-progestin) – MOA, uses and ADR
● compare tamoxifen citrate and raloxifene (SERMs)–MOA,uses ,ADR
● Emergency pills/post coital pills
● tocolytics (uterine relaxants )– enumerate , indications ,MOA & ADR
●bisphosphonates – classify, MOA & ADR & ways to reduce its ADRs
●how cabergoline is better than bromocriptine
●synthesis, storage and secretion of thyroid hormone
●short note (treatment) on myxoedema coma
●advantages & disadvantages of anti-thyroid drugs with surgery/radioactive iodine
● uses of alpha glucosidase inhibitors
●short note on meglitinide
●glucocorticoids antagonist
●synthetic androgens
●hormone replacement therapy (HRT)
●compare oxytocin & methyl ergometrine

EXTRA FACTS /POINTS FOR SPOTTERS/VIVA/ CLINICAL Qs -
●What is a hormone
● When GnRH analogues to be given in pulsatile manner & when given continuously?
●example of drugs given intranasal
●what are goitrogens & what is goitrin
●what is thyroid escape and thyroid constipation
● why propylthiouracil is DOC in hyperthyroidism during 1 st trimester of preg & lactation only ?
●what is bolus insulin & basal insulin
● What are ultra-long acting insulin ?
●ADR of insulin injections (lipodystrophy )
●uses of insulin & what is acute insulin resistance
● What are the newer insulin delivery devices?
● how to prevent/arrest the corticosteroid induced osteoporosis
●examples of intra-articular injections
●alternate day therapy & mega dose pulse therapy of steroids
● Why glucocorticoids should not be stopped abruptly?
● Why not to discontinue steroids if the patient on steroid develops infection?
● How to withdraw steroids in longer therapy?
● Rationale for adding dutasteride with tamulosin in treatment of BPH?
● Why sildenafil is contraindicated with nitrates in CHD patients?
● what are pills & what are tablets ?
● How OCP helps in controlling menorrhagia ?
● how OCP protects against endometrial & ovarian cancer ?
● How OCP prevent PID & anaemia ?

● How OCP causes thromboembolism , MI, HTN & increased risk of cholestatic jaundice & gall stones ?
● What are biphasic & triphasic OCP ? Advantages of them? How they decrease breakthrough bleeding?
● Why tamoxifen is used in the treatment of breast cancer ?
● Drugs extracted from salmon fish
● Preparations of parathyroid analogues
●why alone PTH is not used in hypoparathyroidism
●manifestation of hypo and hyper parathyroidism
● How do you treat hyperkalaemia?
● Why beta blockers are contraindicated in diabetes?
● How to treat if the patient has taken high dose of alpha glucosidase inhibitors ?
● What are the antenatal use of steroids?
● Why progesterone is added to HRT (hormonal replacement therapy )?
● non- pharmacological ways to control DM ?
*ketoconazole can be used to treat cushing syndrome
*clomiphene can be used till 6cycles/months, after that it can cause ovarian cancer
*inject short acting insulin first and then long acting insulin, as there is risk of contamination of the vial
*insulin preparation in India is 40U/ml therefore syringe is of 40divisions, while in USA it is of 100
divisions
*iodides are fastest acting & can cause flaring up of acne
* A smooth peak less effect is seen in long acting insulin (glargine), it can’t be mixed with other insulin
preparations because of its acidic nature
*carton of pioglitazone comes with the black warning box saying myocardial infarction as its main ADR
* Intermediate/short acting insulin like NPH can cause hyper & hypo glycaemia due to their short
duration

* Dexamethasone suppression test is done to detect HPA axis function & to diagnose Cushing syndrome
PERIPHERAL (SOMATIC) NERVOUS SYSTEM
Long questions:-
● MOA of local anaesthetics (lignocaine). Advantages, contraindications and complications of spinal

anaesthesia
Notes (5mrks)
●difference between competitive block (d-TC) and depolarising block (SCh) {Train of four, double burst
stimulation}
●difference between phase 1 & 2 of depolarising block
●succinylcholine – MOA,ADR,uses,contraindications
●advantages and disadvantages of adding a vasoconstrictor (adrenaline) with local anaesthetics,

mention about its contraindication also.
●compare the difference and similarity between succinylcholine and mivacurium (doc for day care
surgery and best in burn patients)
●baclofen
●pancuronium
●compare centrally acting and peripherally acting muscle relaxants
● features of amide local anaesthetics with ester Las with examples
EXTRA FACTS /POINTS FOR SPOTTERS/VIVA/ CLINICAL Qs -

●what are the drugs causing malignant hyperthermia and its management
●compare features of general & local anaesthesia
●why amide linked local anaesthetics are long acting
●why a resting nerve is resistant to local anaesthetic blockade
● How calcium antagonises the action of local anaesthetics
● Why methlyparaben is avoided as preservative in local anaesthetic solution
● ADR of lignocaine and methods to reduce its ADR
● Rationale for adding sodium bicarbonate with lignocaine injection
● What is balanced anaesthesia
● Why succinylcholine is contraindicated in patients with nerve & muscle diseases?
*DOC for malignant hyperthermia –dantrolene
* Eutectic mixture of local anaesthesia (EMLA) - 2.5% prilocaine+2.5%lignocaine – only EMLA can
anaesthetise intact skin
*ADR of cocaine – perforation of nasal septum
CENTRAL NERVOUS SYSTEM
GA – general anaesthesia
Long questions:-
● Why benzodiazepines are better than barbiturates. Write about MAO, uses, ADR of benzodiazepines
(Diazepam)
● Name the first line of drugs used in different type of seizures epilepsy. MOA, ADR of phenytoin. Add a
note on treatment of generalised tonic-clonic status epilepticus in adults.

● classify anti- Parkinson drugs. Write a short note on MAO, ADR, interactions, and contraindications of
levodopa. What are the ways to reduce ADR of L-Dopa?
● classify antipsychotic drugs. MAO, ADR, uses of chlorpromazine (phenothiazine / perphenazine )
● List anti- maniac drugs. Write about MAO, ADR, uses, control of therapy,(plasma level monitoring )
interactions of lithium
●classify anti-depressants .MAO, ADR, interactions of TCAs (imipramine) . Add note on TCA poisoning
● What are the pharmacological action of morphine in CNS. What are its uses, ADR, MAO,
contraindications and different doses in adult and children via various routes?
Notes (5mrks)
●what is second gas effect & diffusion hypoxia. How to prevent diffusion hypoxia
● Advantages and disadvantages of propofol
●short note on preanesthetic medication
●short note on – thiopentone , halothane ,ketamine,N2O
●MOA of ethanol in CNS
● Treatment of methyl alcohol poisoning
● Alcohol withdrawal syndrome & its treatment
● Alcohol intoxication – features and treatment
● Disulfiram aversion therapy
●barbiturates – MOA,ADr,uses
●acute barbiturate poisoning
● MOA, examples, advantages and disadvantages of non- benzodiazepine hypnotics
● Benzodiazepine overdose
●valproate- MOA, ADR, uses & ways to reduce its ADRs
●carbamazepine - MOA, ADR, uses
● What are the advantages & disadvantages of combination of carbidopa and levodopa
● What are the drugs causing parkinsonism? Why L-Dopa is not useful in treatment of drug induced
Parkinsonism?
● Atypical antipsychotics- examples, MAO , ADR , uses
● Haloperidol
● SSRIs – MOA, examples, uses, ADR
● define anxiety and enumerate the drugs used for it ,DOC
● short note on buspirone – advantages and drawbacks
● Treatment of morphine poisoning and morphine withdrawal
● compare morphine, pethidine , pentazocine
● draw flowchart of metabolism of paracetamol at toxic doses
●conscious sedation
●complications of GA
● What are the general principles of symptomatic treatment with anti-epileptic drugs?
●neroleptanalgesia
●compare perphenazine (phenothiazine) and aripiprazole (atypical antipsychotics)
● compare TCA and SSRIs
●what are psycho-stimulants and cognition enhancers
● Minimum alveolar concentration (MAC) & blood gas partition coefficient
● Dopamine theory of schizophernia

EXTRA FACTS /POINTS FOR SPOTTERS/VIVA / CLINICAL Qs –
● Which stage of GA is most dangerous
● Rationale for adding oxygen with nitrous oxide as GA
● Why halothane Is used as i.v injection with propofol
● Why atropine premedication & succinyl choine injection is given after thiopentone injection
● Why succinylcholine and thiopentone injection not to be mixed in the same syringe
● Why propofol is preffered over thiopental for day care surgery?
● name some i.v anaesthetics
● Which drug to prefer for treatment of insomnia between diazepam or zolpidem ?
●what is dissociative anaesthesia & its advantages
● What are rape drugs
● effects of ethanol in CVS
● How alcohol causes cirrohosis
● Guidelines for safe alcohol drinking
● How alcohol contributes to obesity
● What is the difference between hypnotic and sedative
● classify the types of seizures
●why dopamine don’t cross BBB
● What are the uses of dopamine?
● What do you mean by ‘on-off’ effect
● How MAO-B inhibitors have the neuro-protective effect
● What are the guidelines for the treatment of parkinsonism
● What do you mean by neuroleptic drug
● differentiate psychoses, mania, schizophrenia, bipolar disorders

● How lithium induces goiter / hypothyroidism
●cheese reaction
● Difference between buspirone and bupropion
● What do you mean by term analgesics
● What are the different opioid receptors – actions and drugs acting on them
● classify opioids
● Why dopamine antagonists are used for the treatment of psychosis ?
●Why SSRIs are used for the treatment of depression ?
● How reserpine causes depression & suicidal tendency?
● define anxiety. What is its DOC ?
● How reserpine causes depression & suicidal tendency ?
● why barbiturates are absolutely contraindicated in acute intermittent porphyria ?
● Why d-penicillamine is not used initial treatment of Wilson’s disease ?
● Clozapine induced convulsions are reversible not agranulocytosis . why ?
● Why SSRIs to be started atleast 14 days after discontinuation of MAO inhibitors ?
● DOC for acute panic attack ?
● Why pethidine can result seizures in patients on MAO inhibitors or with renal failure ?
● how pethidine reduces shivering after anaesthesia ?
● Why morphine is contraindicated in head injury ?
● Why halothane is contraindicated in pheochromocytoma ?
● Why isoflurane is DOC in cardiac patients , choice for neurosurgery , for producing controlled
hypotension ?
● Why halothane is agent of choice in bronchial asthma, internal version/removal of placenta?
● Why N2O is contraindicated in pneumothorax & volvulus?

● Why sevoflurane not be used in closed circuit ?
● How to treat accidental injection of thiopentone in the arteries?
*all the stages of GA are seen with ether, because of its slow action
*DOC for GA in paediatric age group – sevoflurane
*accidental intra-arterial injection of thiopentone causes vasospasm and gangrene of arm
*DOC for day care/ambulatory surgery – propofol
* Fentanyl also comes in lollipop preparation for children
*benzodiazepine /diazepam not to be used during exams as it causes antero -postero grade amnesia
*main ADR of valproate – fulminant hepatitis
*carbamazepine causes steven Johnson syndrome
*phenytoin causes gum hypertrophy ,hirsutism nystagmus
*DOC for neuralgic pain due to diabetic neuropathy & post-herpetic neuralgia - gabapentin
* DOC for trigeminal related neuralgia & partial seizure– carbamazepine
*ADR of vigabatrin – visual field contraction
* Ropinirole & Pramipexole used for restless leg syndrome and main ADR is sleep attacks
*DOC for drug caused parkinsonism - trihexyphenidyl
*SSRIs causes suicidal tendency in the age group of less than 25 years
* Drugs to be locked are (lock and key drug) – ketamine, morphine and diazepam also
*DOC lithium induced renal diabetes insipidus – amiloride(thiazide)
* akathsia is the most common extrapyramidal ADR , while acute muscular dystonia is the earliest ADR
of antipsychotics
*xenon is very close to ideal inhalational anaesthetic

CARDIOVASCULAR SYSTEM & KIDNEY
Long questions:-
● ACE inhibitors – MOA, ADRs, uses, advantages
●Digoxin- MOA, effects on heart, ADRs, treatment of digoxin toxicity, contraindications & interactions,
uses
● Drugs used in treatment of CHF, MOA of them in treating CHF.
● classify anti-angina drugs. MOA of nitrates, How it reduces angina pain? Its merits & demerits, uses ,
ADR and ways to reduce its ADR, interactions.
● classify anti-hypertensive drugs. Guidelines for treatment of hypertension (JNC) . List the anti-
hypertensive drugs to be avoided and to be selected during pregnancy.
Notes (5mrks)
●merits and demerits of losartan (how ARBs differs from ACE inhibitors)
●how and when to use beta blockers in treatment of CHF
●classification of antiarrhythmic drugs
● amiodarone – MAO,uses , ADR , interactions
● SN on adenosine
● AV- nodal blockers
● Calcium channel blockers (CCBs)– pharmacological actions, MOA, ADRs,uses
● list various drug combinations used in treatment of classical angina & severe & resistant cases of
angina. Write the rationale of them
● SN on nicorandil/minoxidil – MOA, uses & ADR
● Drug therapy of myocardial infarction (MI) including its prophylaxis
● Clonidine – MOA , uses ,ADR
● Treatment of hypertensive emergencies

● loop diuretics (furosemide) – MOA , uses , ADRs, ways to reduce its ADRs
● chlorothiazide (thiazide ) – MOA, uses , ADRs
● Potassium sparing diuretics - MOA, uses , ADRs
● Desmopressin – MOA , uses , ADRs
●amrinone
● compare verapamil , nifedipine & diltiazem
● compare furosemide & thiazide
● Acetazolamide
● Mannitol
● compare propranolol & clonidine
● How ACE inhibitors acts in treatment of CHF patients
● Why ACE inhibitors cause cough & angioedema?
●comment on combination of ARBs with ACE inhibitors
●Tarsades de pointes
●choice of drug for PSVT, AF, AFI, VF, supraventricular arrhythmia
● What are the different preparations of nitrates
● Cyanide poisoning & its treatment
● Why nifedipine is not a antiarrhythmic drug, while all other CCBs are?
● Why nifedipine can be given safely with beta blockers & digoxin, but not other CCBs?

● Why pentazocine & pethidine is not used in relieving the pain of angina?
● Why phosphodiesterase inhibitors should not be prescribed with nitrates ?
● Is amlodipine & atenolol a FDC?
● How diuretics help in congestive heart failure?
● What are the desirable properties of thiazide (diuretics ) as anti-hypertensive drugs ?
● What are the non- pharmacological methods to control HTN?
● Rationale for adding hydroclorothiazide with metoprolol
● Why furosemide is preferred in treatment of acute pulmonary edema ?
● What do you mean by “ Lasix”
● Why thiazides are used in treatment of diabetes insidipus ?
● Why desmopressin is used in treatment of haemophilia ?
● List all the vasodilators
● Why digitalis is contraindicated in WPW syndrome ?
● Why earliest ADR appearing of digitalis is nausea & vomiting?
● inotropic are never used in treatment of right sided heart failure, while phosphodiesterase inhibitors
can be, why?
● Why beta blockers are contraindicated in decompensated heart failure?
● Why carbonic anhydrase (acetazolamide) should not be used in liver disease?
● Why loop diuretics are Diuretics of choice in patients with moderate to severe renal failure?
● Why thiazides can be used in patient with hypercalciurea or recurrent calcium stones in kidney ?
*hydralazine causes coronary steal syndrome
* Digitalis can cause any type of arrhythmia except mobitz type2 heart block & atrial flutter
* Digitalis induced ventricular arrhythmia, lignocaine is the DOC

*nifedipine , verapamil (CCBs) causes ankle edema
* nitrates increases blood flow in ischaemic areas while dipyridamole decreases causing coronary steal
* DOC in hypertensive emergency in clonidine withdrawl & cheese reaction – phentolamine and
tolazoline
*hydralazine causes SLE (lupus)
*sodium nitroprusside is photosensitive, therefore stored in dark bottle
* DOC for hypertensive emergency is i.v CCBs ( nicardipine ,clevidipine ) , hydralazine is used in
eclampsia
*furosemide decreases calcium level, while thiazide increases
* amiodarone causes pulmonary fibrosis , hyper & hypo thyroidism , keratopathy
*captopril causes angioedema
BLOOD
Long questions:-
● factors facilitating & impending the iron absorption. Write about various preparations & its ADRs. Add
a note about iron poisoning & its treatment
● classify anticoagulants. Write MAO, uses,ADRs, advantages & disadvantages of low molecular weight
(LMW) heparins.
● classify hypolipidaemic drugs. Examples, MOA, uses & ADR of statins
Notes (5mrks)
●Parental iron
●Erythropoietin – MOA, uses, ADRs
●Warfarin – MOA, uses, Dose regulation, Drug interactions, ADR & management of warfarin overdose
● compare warfarin & heparin

●Fibronolytics (streptokinase) – MOA, uses,dose, advantages and disadvantages
● Anti- fibronolytic agents (EACA , tranexamic axid) –MOA, uses, ADR
● Antiplatelet drug (aspirin) – MOA, uses, doses & ADR
●Abciximab
● Fibrates (Gemfibrozil ) – MOA, uses & ADRs
● Nicotinic acid (niacin) - MOA, uses & ADRs
● Treatment based on raised TG levels
● compare clopidogrel & prasugrel
● Treatment based on LDL-CH & low HDL-CH
● Dextran
● compare unfractionated heparin (UFH) & LMWH
●various preparations of vitamin B12 & folic acid
● Why dose of heparin to be increased for patients on erythropoietin
●Why patient on warfarin should not take egg, meat, green leafy vegetable
● Choice of antiplatelets in -prophylaxis of MI
-STEMI with MI/stroke/arterial disease
-peptic ulcer + NSTEMI /ACS
- Percutaneous coronary intervention / ACS
● Interpretation of plasma lipid levels (total cholesterol, LDL, HDL,TGs )

● Can we give a combination therapy of gemfibrozil + statin?
● Combination of ezetimibe + low dose statin?
● combination of bezafibrate & statins ?
● If the cause of megaloblastic anemia is unknown then folic acid alone should not be given. Why ?
*warfarin can cause purple toe syndrome & contradi syndrome in fetus (during pregnancy)
*warfarin do not need TDM , but monitoring is required
*LMWH do not need monitoring because of long half-live & predicable response
*statins generally causes muscle pain
*pravastatin have the least ADR & drug/food interactions
* vit. K is involved in activating clotting factors & anti-clotting proteins (protein C)
GASTROINTESTINAL SYSTEM
Long questions:-
●classify drugs used in treatment of peptic ulcer. Examples , uses , MOA, pharmological actions & ADRs
of H2 blockers
●classify anti-emetics . write about , uses , MOA & ADRs of metoclopramide
● classify Laxatives. Examples , preparations, MOA, ADRs , indications & contraindications of osmotic
purgatives
Notes (5mrks)
●compare ranitidine & famotidine
●proton pump inhibitors (PPIs) - Examples , uses , MOA, pharmological actions & ADRs
● Anti-pylori regimen ( triple therapy )
● Similarities & dissimilarities between metoclopramide & Domperidone

● Drugs used in treatment of GERD
● Chemotherapy induced nausea and vomiting ( CINV)
● Odansetron
● Stimulant purgative (Bisacodyl)
● Composition & MOA of ORS
● Antimicrobial therapy of diarrhoea – indications & drugs used
● Probiotics
● Non- specific anti-diarrhoeal drugs – examples, MOA, indications
● Drugs for IBD – indications, examples, MOA
● Gall stone dissolving drugs
● Aprepitant (NK1 receptor antagonist)
● liquid paraffins – MOA, uses, ADRs & disadvantages
●drugs causing peptic ulcer
●what is Cushing, curling & apthous ulcer?
●why famotidine safe to take before alcohol but not ranitidine?
● Why anta acids should not to be used for long durations?
● Comment on FDC of mag. Hydrox. + Alum
● Why Sucralfate/CBS and H2 bocker to be never given together?
● name some emetic drugs?

● Why ondansetron is ineffective in motion sickness?
● why odansetron is used in CINV ?
● Why hyoscine patch is preferred to be applied behind ear pinna ?
● How lactulose acts in hepatic coma?
● Why bisacodyl is generally giv&en as anal suppository?
● difference between laxative , purgative & cathartics
● why zinc is generally given ORS ?
● why sulfasalazine is used as disease modifying drug in rheumatoid arthritis & ulcerative colitis ?
● Why loperamide is contraindicated in children less than 4 years ?
● indications of opioids (loperamide) in GI
●Role of intravenous fluids in treatment of diarrhoea
● MOA, how and when to administer omeprazole, bisacodyl
● Which therapy to prefer for H.pylori – triple vs quadruple therapy. Justify
● Which drug to prefer for NSAID induced peptic ulcer – misoprostol vs omeprazole? Justify
● explain the pharmacological use of anti-ulcer drugs in H.Pylori infection
● How acid suppressing agents ( H2 blockers , PPIs) can cause tolerance & rebound hyperacidity ?
*PPIs shows high risk of hip fracture in long term use
*PPIs are DOC for NSAID induced ulcer, while misoprostol is the most specific drug
* DOC for morning sickness – Doxylamine + pyridoxine
* DOC for motion sickness – Hyoscine , since it is not available in India , therefore Promethazine is used
* Metoclopramide is used in gastroparesis/stasis of diabetes patient, can cause extrapyramidal ADRs

(drug induced Parkinsonism)
* osmolarity of ORS = 245mOsm/L

ANTI-MICROBIAL, CHEMOTHERAPY & MISC
Long questions:-
● classify Fluoroquinolones. Write about MAO,uses, spectrum,ADR , interactions &contraindications of

ciprofloxacin
● classify cephalosporins. Write about MOA, uses and ADR of 1st, 2nd and 3rd generation cephalosporins.
Write about advantages and disadvantages of 3rd generation cephalosporins
●classify tetracyclines . Write about their MOA, ADR and uses
● classify aminoglycosides. Write about their common properties, MOA, ADR, uses & precautions
● classify anti-malarial drugs. Write about chemoprophylaxis and treatment of malaria
● What are the general & specific toxicity of anti-cancer drugs and how to ameliorate them?
● classify anti-fungal drugs. Write MOA, uses, ADRs of amphotericin B. ways to reduce its ADR. What are
the advantages of L-AMB?
Notes (5mrks)
●Drug resistance- types, example, mechanism and prevention of drug resistance
●advantages and disadvantages of antimicrobial combination
● sulfonamides – classify, MOA, uses, ADR and ways to reduce its ADR
●cotrimoxazole - MOA, uses,spectrum, ADR , its different preparations
●beta lactamase inhibitors
●classify synthetic penicillins . Write about penicillinase resistant penicillins
● penicillins – MOA, uses, spectrum, ADR, merits & demerits
● compare ampicillin and amoxicillin
● compare tetracycline and chloramphenicol. What is gray baby syndrome?
● compare erythromycin and azithromycin

● Merits & demerits of azithromycin
●treatment and prophylaxis of UTI (complicated & uncomplicated)
● Treatment & preferred drugs for community acquired pneumonia
● Treatment of nosocomial infection due to Pseudomonas
● Isoniazid – MOA, uses, ADR,
● Rifampicin - MOA, uses, ADR,
● What is the rationale & advantages of drug combinations in the treatment of TB
● Treatment of TB (DOTS)
● Role of steroids in treatment of TB
● short note on Dapsone or clofazimine
● difference between tuberculoid and lepromatous leprosy and their treatment
● What are types of lepra reactions and their treatment
● short note on other topical antifungals
● short note on azoles (keto /fluca)
● Treatment of hepatitis B & C
● short note on Acyclovir or oseltamivir
● Retroviral protease inhibitors (PIs) – role, advantages and disadvantages in HIV regimen
● compare zidovudine with nevirapine
●post exposure prophylaxis of HIV
● Regimen and guidelines for HAART therapy
● Short note chloroquine & its other uses
● SN on metronidazole
● cinchonism

● artemisinin based combination therapy (ACT) – examples, rationale for adding short & long acting
drugs and advantages of ACT
●classify anti-amoebic drugs and write a short note on metronidazole
● Treatment of different form of amoebic infections
●Drugs for Trichomonasis
● short note on albendazole
● DEC
●ivermectin
● compare vinblastine and vincristrine
●folinic acid rescue/Leucoronin rescue
●cyclophosphamide / Alkylating agents
●platinum coordination complexes
●Methotrexate
● Paclitaxel (Taxanes)
●Anthracyclin antibiotics
●short notes on cyclosporine
●Tacrolimus
● Treatment of scabies/Pediculosis
● short note on d-Penicillamine
● short note on antibiotic abuse
● Super infection
● Principle for surgical chemoprophylaxis

●what all are the drugs acting against pseudomonas
● Quinolones
● monobactams
● carbapenems – big guns , not to be used as monotherapy , as it can cause resistance
●streptogramins
● vancomycin
● Treatment of onchomycosis
●compare Pyrantel pamoate & Piperazine
●Immunostimulants
● Treatment of resistant TB/MDR TB (DOTS PLUS)
● Alternative treatment in case of dapsone/rifampicin resistant leprosy
● Treatment of MAC infection
● What all combinations to be avoided in antiretroviral treatment
● Adjuvant chemotherapy & Neoadjuvant chemotherapy
●classify antimicrobials based on their bactericidal and bacteriostatic action
●what is minimum inhibitory concentration (MIC), MBC and post- antibiotic effect
●what is time dependent killing and concentration dependent killing
● factors affecting choice of antimicrobial agent
● Why penicillin is non- toxic to man and why it’s not effective in G(-) bacteria
● When to use bactericidal drug and when to use bacteriostatic drug?

● Rationale for adding imipenem with cilastatin
● Rationale for adding clavulanic acid with amoxicillin
●Rationale for adding probenecid with penicillin
● Rationale for Whitfield Ointment as a FDC
● Rationale for adding trimethoprim with sulfamethoxazole
●what are the drugs used in MRSA (methicillin resist.) and VRSA (vancomycin resist.)
● Comment on combination of ampicillin and cloxacillin
● Why ampicillin/penicillin is contraindicated with OCPs
● why ampicillin to be avoided in viral illness specially EBV
● Why tetracyclines are not given with milk & are contraindicated in pregnancy?
● why all the tetracyclines are contraindicated in renal failure patients , but not doxycline ?
● Which drug causes interstitial nephritis
●gray baby syndrome
● why P.falciparum don’t show relapse ?
● Why aminoglycosides can’t be used in abscess & anaerobes ?
● Most of the protein synthesis inhibitors are bacteriostatic, then aminoglycosides are bactericidal?
● why aminoglycoside induced nephrotoxicity is usually reversible , but not ototoxicity ?
● give reasons for the post antibiotic effect of aminoglycosides?
● What are the advantages of once a day dosing of aminoglycosides
● Red man syndrome and its treatment
● Why ethambutol is still used in treatment of TB, as it causes optic neuritis
● What do you mean by MDR-TB, XDR-TB & TDR-TB
● What are the advantages of L-AMB (ampho.B)
● What are the drugs showing disulfiram like actions

● Rationale for adding flucytosine and ampho.B
● Rationale for adding lopinavir with ritonavir
● Why quinine is infused with 5% dextrose?
●why metronidazole is ineffective against aerobes?
●for pseudomembranous entercolitis metronidazole is preferred over vancomycin,why ?
●why albendazole is now preferred over praziquantel for neurocysticercosis ? And why glucocorticoids is
added with albendazole to treat neurocysticercosis ?
● Treatment of filariasis and what is mass drug administration (MDA) ?
●drugs used in treatment of various leishmaniasis & sleeping sickness
●treatment of herpes zoster, avian influenza, hook worm, chicken pox
●treatment of rheumatic fever & syphilis
● Treatment of syphilis in penicillin sensitive patient
● Between miconazole and griseofulvin which drug to use for tinea corporis ?
● Why cancer chemotherapy is given as cycles with intervening short periods of no treatment?
● Why we do sequential scheduling of cell cycle specific & nonspecific agents in a chemotherapy cycle?
● list some topical antibiotics & their clinical use
*father of chemotherapy- Paul Ehrlich
*only amino glycosides are the drugs acting on proteins (30s) and are bactericidal in action
*1MU of penicillin =0.6 gm.
* Most of 3rd gen cephalosporins are resistant to beta lactamase except – cefoperazone
* Milk, iron & antacids decrease absorption of tetracyclines
* Aminoglycosides shows synergism with cell wall inhibitors as they increase its transport, but shouldn’t
be mixed in same syringe.

*Griseofulvin is given orally for dermatophysis & not effective in P.versicolor
*DOC of tularemia - streptomycin
*DOC for surgical prophylaxis - cefazolin
*DOC for CMV – ganciclovir
*DOC avian influenza/bird flu – oseltamivir
*Foscarnet is used in acyclovir/ganciclovir resistant patients
*for CMV retinitis fomivirsen is injected monthly-weekly into vitreous humor
*amantadine is anti-influenza drug but has anti-parkinson effect also
*all NRTIs can cause Steven Johnson reaction (hypersensitivity reactions)
*chloroquine can cause bull’s eye maculopathy
*Demeclocycline (tetracycline) inhibits ADH release therefore it is used in SIADH treatment
*Pentamidine used in treatment of Trypanosomiasis can cause hypo & hyper glycemia ,also some
floroquinones like gatifloxacin
*albendazole and Praziquantel are contraindicated in ocular cycsticercosis (no drugs to be given , as
blindness can occur due to drug reaction)
*Daunorubicin is orange in color and can cause cardiotoxicity , which could be treated by Dexrazoxane
*abacavir can cause increase risk of MI , therefore screening of HLA B 5701 allele testing to be done
*diloxanide furate is DOC for asymptomatic intestinal amoebiasis
*DOC for CML & GIST-Imatinib
*DOC for choriocarcinoma – Mtx
*Paclitaxel & Sirolimus is given in drug eluting stents in coronary angioplasty
*isotretinoin- used in treatment of cystic acne, corrects abnormal keratinization
*oral chelating agents are – succimer,Penicillamine,Deferiprone
*fluoroquinolones causes tendon rupture

Pharm Imp. Shakil

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PHARMACOLOGY

MOA= mechanism of action

DOC= drug of choice

ADR= adverse drug reaction

CCB = calcium channel blockers

●Factors modifying the drug action

● Bioavailability (F) – define, factors affecting it, example, graph

● factors affecting absorption of a drug

● Prodrug –define, uses, example

● Difference between loading & maintenance dose with their formula

Made by- ANKIT SUNIYAL(2K12) 1

● Two state receptor model

● Difference between drug potency and efficacy with graph

● Advantages and disadvantages of fixed dose combinations (FDCs) with examples

● Difference between tolerance and tachyphylaxis

● stages of clinical trial

● factors affecting compliance/adherence of a drug

● Microsomal enzyme induction & inhibition – examples, significance

● Describe different types of antagonism with examples

● Essential medicine – define, example, significance

● Enteroheptic circulation, biotransformation, tubular secretion – define, what is the importance of

● Bioequivalence & its importance

● Plasma half-life & its significance

●plasma protein binding – examples, its importance

●how to prolong the drug action

●receptor occupation theory

● Mechanisms for the transport of drugs across the biological membranes

Made by- ANKIT SUNIYAL(2K12) 2

CLINICAL Qs /EXTRA FACTS /POINTS FOR SPOTTERS/VIVA/CAL/PRACTICAL-

● Definition of receptor, agonist, antagonist, inverse agonist, partial agonist, ligand

● Drugs extracted from different plants and their use

● What are Drugs developed with the help of DNA technology

● Difference between pharmacopoeias, formulary, other book

● Difference between a drug and a medicine. Is human blood a drug?

● Difference between pharmacodynamics & pharmacokinetics

● Dose response curve (DRC)

● Ethical considerations in clinical trials

● What is pharmacovigilance and where all in jipmer you see it

● explain category A & X of drugs used in pregnancy

● How pathological states influence drug action?

● Difference between phase 1 & 4 of clinical trials

*steady state is reached in 4-5 half lives

Made by- ANKIT SUNIYAL(2K12) 3

*CDSCO approves new drug in India

* 1 fingertip unit (FTU)= 0.5gm , distal crease to fingertip , from 5 mm of nozzle

For front and back of hand =1FTUs

Face and neck= 2.5 FTUs

Entire arm & hand=4FTUs

Entire leg and foot= 8FTUs

*I.V line cannula = 18 gauge (green)

* Father of pharmacology – Oswald schmiedberg

Father of Indian pharmacology – col. Ramnath chopra

Father of modern pharmacology - Sir James black

Made by- ANKIT SUNIYAL(2K12) 4

● Uses of anti-ChEs (neostigmine)

● General principles of treatment of poisoning

●classify anticholinergic drugs

● Difference between physostigmine and neostigmine. Why physostigmine is preffered in atropine

●therapeutic uses of atropine or its substitutes

● Atropine poisoning- clinical features & its treatment

● Uses and ADR of selective beta 2 stimulants

● Uses and ADR of adrenaline. Why it is not given orally?

● give examples of pure alpha1 agonist and their use

● Uses and ADR of alpha blocker