Conceptual Review of Pharmacology

 Image-based Questions
1. A 25-years-old patient presented with a swelling near 4. The procedure in the diagram given below is used for
distal interphalyngeal joint associated with pain on synthesis of
movement. What is the recent drug approved for this
condition seen in the picture?

/e
a. Doxorubicin b. Zolendroic acid
c. Denosumab d. Teriparatide

y ,3
2. A male presented with a dark colored lesion with irregular
borders on his back as seen in the picture. All of the
og
following are part of non-surgical management, except: a. Tyrosine kinase inhibitors
b. Monoclonal antibodies
c. Both
d. None
ol
ac
m

5. A patient presented with the streaks of hyperpigmenta-

ar

a. Ipilimumab b. Vemurafenib tion after starting a chemotherapeutic agent. Which of

c. Denileukin diftitox d. Aldesleukin the following drugs might have done it?
Ph

3. A patient presented with deep and boring pain in the hip

area, but on examination no mass was detected. An x-ray
was advised which came out as the picture given. Which of
the following drug is used for treatment of this condition?
Image-based Questions

a. Hydroxyurea
b. Cisplatin
a. Paclitaxel b. Doxorubicin c. Bleomycin
c. Etoposide d. Asparginase d. Methotrexate

408
 Anticancer Drugs
6. Which of the following anticancer drug is not given with 8. A patient presented with the side effect given in the
the equipment in the picture? picture. Which of the following anticancer was prescribed
to the patient?

a. Hydroxyurea b. Cyclophosphamide a. Capecitabine b. Methotrexate

c. Cladribine d. Cisplatin c. Cisplatin d. Etoposide

/e
7. The drug in the picture is used with all anticancer drugs in 9. A patient presented with complaints of exertional
the options, except: dyspnea and nonproductive cough. History confirmed use

,3
of a drug for treatment of Hodgkin’s disease before one
year. Which of the following drug might have caused the
finding seen on X-ray given.

y
og
ol
ac
m

a. Methotrexate b. 5-FU
c. Pemetrexed d. Hydroxyurea a. Doxorubicin b. Bleomycin
c. Vinvlastine d. Dacarbazine
ar

10. The drug in the picture is used to prevent chemotherapy

Ph

induced:

Image-based Questions

a. Pulmonary fibrosis
b. Bone marrow suppression
c. Nephrotoxicity
d. Cystitis

409
 Answers and Explanations to Image-based Questions
Conceptual Review of Pharmacology

1. Ans. (c)  Denosumab 6. Ans. (d)  Cisplatin

(Ref: http://www. fda.gov/ NewsEvents/ Newsroom/Press
Announcements/ucm356528.htm)
•• The picture depicts a patient of giant cell tumor, which pres-
ents as swelling near the joints with movement restrictions.
•• Denosumab has been approved in 2013 for treatment of
giant cell tumor by FDA.
2. Ans. (c)  Denileukin diftitox
(Ref: CMDT 2015/P2599)
•• This is a case of malignant melanoma, which is most com-
monly located on upper back side of males and lower limbs
in females.
•• Ipilimumab, vemurafenib and high dose aldesleukin are
(Ref: Goodman Gilman 12th E/P1689)
•• Cisplatin is inactivated by aluminum and hence it is not
used with equipments made up of aluminum.
•• The equipment in the picture is aluminum needle.
7. Ans. (d)  Hydroxyurea
(Ref: Goodman Gilman 12th E/P1691, 1697)
•• The drug in the picture leucovorin is used along with
methotrexate and pemetrexed to prevent toxicity.
•• It is used to 5-FU to increase its sensitivity or anticancer
effect.
8. Ans. (a)  Capecitabine

/e
first-line drugs for treatment of malignant melanoma. (Ref: Goodman Gilman 12th E/P1698)
•• Denileukin diftitox is used for treatment of cutaneous T-cell
lymphoma. •• This is a case of hand and foot syndrome, which presents

,3
with desquamation and erythema of palms and soles.
3. Ans. (b)  Doxorubicin •• Among the drugs in options, capecitabine commonly causes
this side effect.
(Ref: CMDT 2015/P1599)

y
•• This is a classic case of osteosarcoma with sunray appearance 9. Ans. (b)  Bleomycin
and codman triangle.
og
(Ref: Goodman Gilman 12th E/P1717)
•• First-line drugs for osteosarcoma are ifosfamide, doxorubi-
cin, cisplatin amd methotrexate. •• This is a case of pulmonary fibrosis, that can be seen up to
two years after discontinuation of bleomycin.
ol
4. Ans. (b)  Monoclonal antibodies •• It is a common complication associated with bleomycin, as
the enzyme bleomycin hydrolase to metabolize bleomycin is
(Ref: Goodman Gilman 12th E/P1745) sparse in lungs also.
ac

•• The procedure mentioned in the picture is hybridoma,

which is used to produce monoclonal antibodies. 10. Ans. (d)  Cystitis
m

(Ref: Goodman Gilman 12th E/P1684)

5. Ans. (c)  Bleomycin
•• The drug in the picture, mesna is used to prevent hemor-
(Ref: Goodman Gilman 12th E/P1717) rhagic cystitis associated with ifosfamide and cyclophos-
ar

•• The streaks of hyperpigmentation seen on the back is called phamide.

Answers and Explanations to Image-based Questions

as flagellate dermatitis.
•• It is a common complication associated with bleomycin, as
Ph

the enzyme bleomycin hydrolase to metabolize bleomycin

is sparse in skin.

410
 Anticancer Drugs
  Annexures
Drug of Choice CML Imatinib
GIST
ALL Regimen of choice: VPAD Hypereosinophilic Syndrome
V: Vincristine Dermatofibrosarcoma
P: Prednisolone Protuberans
A: Asparginase
D: Daunorubicin CML resistant to Imatinib Ponatinib
Nilotinib
AML Daunorubicin or Idarubicin Bosutinib
(+) Dasatinib
Cytarabine (Ara C)
Multi TK resistant (≥2) CML Omacetaxine
Anal ca ↑5 FU

/e
(+) Colorectal ca •• Drug of choice: 5 FU
Mitomycin •• Regimen of choice:
 FOLFOX – Folinic acid + 5

,3
FU + Oxaliplatin
Bladder cancer Cisplatin
 FOLFIRI – Folinic acid + 5
(+)
FU + Irinotecan
Gemcitabine

y Esophageal Ca Cisplatin + 5 FU
Brain tumor Temozolomide
og
or
Carboplatin + Paclitaxel
Breast cancer •• ER/PR Positive
 Premenopausal:
ol
Gastric ca 5FU or Docetaxel
Tamoxifen
plus
 Postmenopausal:
ac

Cisplatin or Oxaliplatin
Aromatase inhibitors
•• Her 2 positive: Trastuzumab
•• Tamoxifen or Aromatase Hairy Cell Leukemia Cladribine
m

inhibitor resistant:
Fluvestrant Hepatocellular carcinoma Sorafenib
•• Metastatic: Aromatase
ar

inhibitors Hodgkin’s disease Regimen of choice: ABVD

A: Adriamycin (Doxorubicin)
B: Bleomycin
Ph

Carcinoid tumors Octreotide

V: Vincristine
Carcinomatous Meningitis Methotrexate (Intrathecal) D: Dacarbazine

Cervical cancer Cisplatin Kaposi sarcoma Doxorubicin

Or
Daunorubicin
Choriocarcinoma Methotrexate
Lung cancer Non-Small cell
CLL Regimen of choice: FCR
•• Cisplatin plus Vinorelbine
F: Fludarabine
Plus Etoposide
C: Cyclophosphamide
or Gemcitabine
R: Rituximab
(Squamous)
Monotherapy: Drug of Choice
or Pemetrexed
Ibrutinib
(Non-squamous)
Or
Small cell
Annexures

Obinutuzumab
•• Cisplatin plus Etoposide
Or
Chlorambucil

411
 Malignant Melanoma BRAF Negative: PD-1 Inhibitors Prostate cancer GnRH agonists or antagonists
Conceptual Review of Pharmacology

like
Pembrolizumab/Nivolumab Renal Cell cancer Anti VEGFR drugs
BRAF Positive: BRAF inhibitors (Bevacizumab, Sunitinib,
like Sorafenib)
Vemurafenib/Dabrafenib or
Mtor inhibitors (Temsirolimus)
Mesothelioma Pemetrexed
Testicular cancer
Multiple Myeloma Lenalidomide Dysgerminoma Regimen of choice: BEP
Plus B: Bleomycin
Dexamethasone E: Etoposide
P: Platinum compound
Myelodysplasia Azacitidine (Cisplatin)
Myelodysplasia with 5q Lenalidomide
syndrome (Anemia) Thyroid cancer I131
Or
VEGFR inhibitors like

/e
Non-Hodgkin’s lymphoma •• Drug of choice: Rituximab
Sunitinib/Sorafenib/Lenvatinib
•• TOC for high/intermediate
grade NHL: CHOP – R

,3
C – Cyclophosphamide Waldenstrom Rituximab
H – Hydroxy doxorubicin Macroglobulinemia
O – Oncovin (Vincristine)
New Drugs

y
P – Prednisolone
R – Rituximab
og Drugs Mechanism of Action Uses
•• TOC for low grade NLH: FCR
F – Fludarabine Avelumab Anti PD1 (Programmed Metastatic Merkel cell
C – Cyclophosphamide Death ligand 1) Ab carcinoma
ol
R – Rituximab
Abemaciclib Cyclin dependent ER/PR positive
kinase 4 and 6 inhibitor advanced or metastatic
Neuroblastoma C – Cyclophosphamide and
ac

breast cancer as
Cisplatin monotherapy or along
Plus with fluvestrant
D – Doxorubicin
m

Acalabrutinib Bruton’s tyrosine Mantle cell lymphoma

Plus
kinase inhibitor in patients who have
E - Etoposide
received at least one
ar

prior therapy
Osteosarcoma A combination of two drugs
given below Brigatinib Multikinase inhibitor Advanced ALK-positive
Ph

High dose methotrexate with including ALK metastatic nonsmall

leucovorin (anaplastic lymphoma cell lung cancer
Cisplatin kinase)
Doxorubicin Inotuzumab Anti CD-22 MAb Relapsed or refractory
Ifosfamide ozogamicin B-cell precursor acute
lymphoblastic leukemia
Ovarian cancer Platinum compound (Cisplatin
Midostaurin Multikinase inhibitor •• AML: Along with
or Carboplatin)
including FLT3 kinase TOC (Cytarabine +
Plus
Daunorobicin) in FLT3
Taxane (Paclitaxel or Docetaxel)
mutation positive
cases.
Paget’s Disease Zolendroic acid •• Aggressive systemic
Mastocytosis
Pancreatic cancer Gemcitabine •• Systemic
Mastocytosis with
Annexures

Pheochromocytoma Averbuch’s Protocol: VCD hematological

(Malignant) V – Vincristine neoplasm
C – Cyclophosphamide •• Mast cell leukemia
D – Dacarbazine
Contd…

412
Drugs Mechanism of Action Uses •• Taxanes (Nab paclitaxel > Paclitaxel):

Anticancer Drugs
Neratinib Inhibitor of HER 1, Trastuzumab resistant Sensory
2 and 4 tyrosine kinase breast cancer •• Epothilones (Ixabepilone): Sensory
B: Bortezomib
Niraparib Poly ADP-Ribose Ovarian, fallopian tube
Polymerase (PARP) and primary peritoneal SIADH Vincristine: Most common cause
inhibitor cancer resistant to Cyclophosphamide
cisplatin Raynaud’s disease Mnemonic: Blood Vessels Can Not Pass
Ribociclib CDK (Cyclin Dependent ER +ve post- blood
Kinase) 4 and 6 menopausal breast Blood: Bleomycin
inhibitor cancer along with Vessels: Vinblastine
aromatase inhibitors Can: Cisplatin
Not: Nilotinib
Olaratumab Anti PDGFR-alpha Ab Soft tissue sarcoma Pass blood: Ponatinib
Venetoclax Antiapoptotic protein CLL with 17-p deletion Hand and foot Capecitabine > 5FU
bcl-2 inhibitor syndrome Doxorubicin
Talimogene Genetically modified Unresectable recurrent Gemcitabine
laherparepvec oncolytic virus melanoma VEGFR TK inhibitors: Sunitinib, sorafenib,

/e
Sonidegib Hedgehog pathway Locally advanced basal pazopanib
inhibitor cell carcinoma\ Vesication Mechlorethamine

,3
Dinutuximab Anti GD2 ganglioside High risk Nitrosoureas
monoclonal Ab neuroblastoma Dactinomycin
Doxorubicin and daunorubicin
Idelalisib Inhibits Relapsed CLL Vinca alkaloids

y
phosphoinositide-3 Follicular B-cell NHL
Mucositis Mnemonic: HAD Mucositis
kinase (PI3K) delta, Small lymphocytic
og
expressed primarily in lymphoma H: Hydroxyurea
blood-cell lineages A: Alkylating agents
D: Dactinomycin, Doxorubicin and
ol
Daunorubicin
Anticancer Drugs Side-effects Mucositis: Metabolites antagonists like
ac

5-FU, Cytarabine and Methotrexate

Hemorrhagic cystitis Ifosfamide > Cyclophosphamide
Diarrhea 5-FU
Nephrotoxicity Cisplatin Capecitabine
m

Hepatotoxicity 6-MP, 6-TG Irinotecan

Methotrexate on long term use Tyrosine kinase inhibitors (Imatinib,
BCR-ABL TK inhibitors (Imatinib, dasatinib,
ar

sunitinib, sorafenib etc.)

nilotinib)
Flu like symptoms Dacarbazine
Dacarbazine
Gemcitabine
Ph

Cardiotoxicity Mnemonic: FAT Cardio

Alopecia Anthracyclines
F: 5-FU Causes coronary vasospasm and
precipitates ischemia Dactinomycin
A: Anthracyclines, Maximum with Topoisomerase inhibitors (Etoposide and
doxorubicin and daunorubicin Irinotecan)
T: Trastuzumab Alkylating agents
Cardio: Cyclophosphamide at high doses Radiation recall Mnemonic: D
Pulmonary fibrosis Bleomycin: Most common cause syndrome D: Dactinomycin
Busulfan and other alkylating agents D: Doxorubicin
Neuropathy Mnemonic: PCMB D: Daunorubicin
P: Pyrimidine analogs: Fludarabine and Radiation Mnemonic: Count FGHI
Nelarabine toxicity due to Count: Cisplatin and oxaliplatin
C: Cisplatin and Oxaliplatin (sensory and radiosensitization Mitomycin-C
motor) F: 5-FU
M: M phase specific drugs
Annexures

G: Gemcitabine
•• Vinca alkaloids (Vincristine > Vinorelbine
H: Hydroxyurea
> Vinblastine): Sensory, motor and
autonomic or mixed I: Irinotecan
Contd... Contd…
413
 Secondary leukemia: Alkylating agents Toxicity Antidote
Conceptual Review of Pharmacology

AML is the most Platinum compounds Anthracyclines induced Dexrazoxane

common type seen Topoisomerase II inhibitors (Etoposide) cardiotoxicity and vesication
with all, except Mitoxantrone
mitoxantrone which 6-MP Cyclophosphamide and Mesna
causes PML. Drug Fludarabine ifosfamide induced hemorrhagic
induced leukemia cystitis
has poorer prognosis Hyperuricemia due to tumor Allopurinol
as compared to de- lysis syndrome Rasburicase
novo leukemia. Mucositis associated with Palifermin (recombinant
Hemolytic uremic Mitomycin chemotherapy keratinocyte growth factor)
syndrome Gemcitabine Neutropenia Filgrastim
Thrombocytopenia Oprelevkin
Antidotes for Anticancer Drugs Associated
Toxicity
Anemia Epoetin alfa
Darbepoetin alfa

/e
Toxicity Antidote
Hand and foot syndrome Pyridoxine Irinotecan induced delayed High dose loperamide
diarrhea

,3
Methotrexate associated Leucovorin (Folinic acid) or
mucositis and bone marrow Folic acid Mechlorethamine associated Thiosulphate
suppression vesication
Note: Denosumab and zoledronic acid can be used for treatment

y
Pemetrexed associated Leucovorin (Folinic acid) or
mucositis and bone marrow Folic acid + Vitamin B12 of osteolytic bone metastasis.
og
suppression
Contd…
ol
ac
m
ar
Ph
Annexures

414

Multiple Choice Questions
NONCELL CYCLE SPECIFIC
ANTICANCER DRUGS
1. Most common agent associated with agranulocytosis is c. 300 d. 400
(Recent Question 2017)
a. Steroids b. Alkylating agents
c. Paracetamol d. Endotoxemia
2. The most common side effect of cancer chemotherapy is
nausea with or without vomiting. The anticancer drugs vary
in their ability to cause nausea and vomiting. Which of the
following anti-cancer drugs is least likely to cause nausea
and vomiting? (AIIMS May 2014)
a. Chlorambucil b. Cisplatin
c. Doxorubicin d. Daunorubicin
3. All of the following are true regarding ifosfamide except: 14. Anticancer drug leading to HUS as a toxicity is:
 (AIIMS May 2011)
a. Metabolised by cytochrome p450 enzymes
b. Less neurotoxic than cyclophosphamide c. Mitomycin C d. Cyclophosphamide
y
c. Chloracetaldehyde is the metabolite of ifosfamide
d. It is a nitrogen mustard
og
4. Hemorrhagic cystitis is caused by: a. Inhibits DNA-dependent RNA synthesis
 (AIIMS Nov 2010, Recent Question 2016)
a. Cyclophosphamide b. 6 Mercaptopurine
ol
c. 5 Fluorouracil d. Busulfan
5. Which of the following can be given orally? 16. Histopathology of doxorubicin toxicity shows? 
ac
 (AIIMS May 2009)
a. Cytosine arabinoside b. Cisplatin
c. Doxorubicin d. Mesna
m
6. Most emetogenic anticancer drug is: (AIIMS May 2009)
a. Cisplatin
b. Carboplatin
ar
c. High dose cyclophosphamide
d. High dose methotrexate
Ph
7. Ifosfamide belongs to which group of anticancer drugs? 
a. Alkylating agents (AIIMS Nov 2008; AI 2009; DNB 2008)
b. Antimetabolites
c. Mitotic inhibitors
d. Topoisomerase inhibitors
8. Which of the following chemotherapeutic agents is associat-
ed with secondary leukemia? (AIIMS May 2006)
a. Vinblastine b. Paclitaxel
c. Cisplatin d. Bleomycin
9. Which of the following drugs is associated with untoward
side effect of renal tubular damage? (AIIMS May; 2006)
a. Cisplatin b. Streptozocin
c. Methysergide d. Cyclophosphamide
10. Sustained neutropenia is seen with: (AIIMS May 2008)
a. Vinblastine
b. Cisplatin
c. Carmustine
d. Cyclophosphamide
Anticancer Drugs
11. Dose of cisplatin in head and neck squamous cell carcinoma
in mg/m2 (Recent Question Dec 2016)
a. 100 b. 200
12. Double Platin based therapy is used for
a. Wilm’s tumor  (Recent Question Dec 2016)
b. Hodgkin’s lymphoma
c. Non-hodgkin’s lymphoma
d. Lung cancer
13. Secondary leukemia associated with anti-cancer drugs
develop at? (Recent Question Dec 2016)
a. 3months b. 1year
/e
c. <7 years d. <10 years
,3
(Recent Question Dec 2016)
a. Paclitaxel b. Vinorelbine
15. Mechanism of action of actinomycin D is:
(Recent Question 2016)
b. Activates DNA-dependent RNA synthesis
c. Inhibits RNA-dependent DNA synthesis
d. Activates RNA-dependent DNA synthesis
a. Vacuolar degeneration of the myofibrils
b. Muscle spindle whorls  (Recent Question 2016)
c. Hyalinization of the bundles of muscles
d. Apoptosis of muscles
17. Sunder, a young male was diagnosed as suffering form a/c
myeloid leukemia. He was started on induction chemother-
apy with doxorubicin based regimen. Induction was suc-
cessful. Two months later, he presents to OPD with swelling
of both feet and breathlessness on climbing stairs. He also
complains that he had to wake up many times because of
breathlessness. Which of the following is most likely respon-
sible for the patients symptoms?
a. Restrictive cardiomyopathy  (Recent Question 2016)
b. Hypertrophic cardiomyopathy
c. Dilated cardiomyopathty
d. Pericardial fibrosis
18. Most emetogenic anticancer drug is:(Recent Question 2016)
Multiple Choice Questions
a. Cisplatin
b. Carboplatin
c. High dose cyclophosphamide
d. High dose methotrexate
19. A 35 year old patient is having carcinoma lung with a past
history of lung disease. Which of the following drugs should
not be given? (Recent Question 2016)
a. Vinblastine b. Bleomycin
c. Mithramycin d. Adriamycin
415
 20. Which of the following antineoplastic drugs should not be 34. Which of the following anticancer drug causes hemolytic
Conceptual Review of Pharmacology

administered to a chronic alcoholic patient due to risk of uremic syndrome: (Recent Question 2016)
development of disulfiram like reaction? a. Vincristine b. Vinblastine
(Recent Question 2016) c. Cisplatin d. Mitomycin
a. Dacarbazine b. Procarbazine 35. Pulmonary fibrosis is a complication of:
c. Melphalan d. Hydroxyurea (Recent Question 2016)
21. Alkylating agents are all except (Recent Question 2016) a. Methotrexate b. Doxorubicin
a. Buslfan b. Carmustine c. Cisplatin d. Busulfan
c. Dacarbazine d. Etoposide 36. Anticancer drug causing nephrotoxicity:
22. Nitrosoureas used in the treatment of cancer are (Recent Question 2016)
 (Recent Question 2016) a. Imitanib b. Irinotecan
a. Carmustine b. 5FU c. fosfestrol d. Cisplatin
c. Methotrexate d. Cisplatin
23. An antibiotic not acting on tubulin is: (Recent Question 2016)
a. Bleomycin b. Colchicine CELL CYCLE SPECIFIC ANTICANCER DRUGS
c. Paclitaxel d. Vincristine
24. Which antineoplastic drug has a very high cardiac toxicity? 37. All of the following are G2 phase inhibitors except

/e
 (Recent Question 2016) (AIIMS May 2016)
a. Bleomycin b. Actinomycin-D a. Paclitaxel b. Etoposide
c. Doxorubicin d. Mitomycin-C c. Topotecan d. Daunorubicin

,3
25. Cyclophosphamide is? (Recent Question 2016) 38. Wrong about paclitaxel: (AIIMS Nov 2014)
a. Alkylating agent b. Antitumor antibiotic a. Derived from E.coli
c. Monoclonal antibody d. Antimet abolites b. Causes stabilization of microtubules

y
c. Most important toxicity is bone marrow suppression
26. Most characteristic side effect of adriamycin is? d. Used in breast, ovarian & other genital malignancy
og
 (Recent Question 2016)
39. Which of the following medications is essential for
a. Nephrotoxicity b. Neurotoxicity
ameliorating the toxicity of pemetrexed? 
c. Cardiotoxicity d. Hemorrhagic cystitis
a. Folinic acid and vitamin B6  (AIIMS May 2014)
ol
27. Anti-neoplastic which is not an antibiotic? b. Folic acid and vitamin B12
(Recent Question 2016) c. Vitamin B6 and Vitamin B12
ac

a. Azathioprine b. Bleomycin d. Folic acid and dexamethasone

c. Mitomycin d. Doxorubicin
40. Methotrexate is used for the management of all of these
28. All are alkylating agent used in chemotherapy except:  conditions except: (AIIMS May 2011)
m

(Recent Question 2016) a. Rheumatoid arthritis b. Psoriasis

a. Melphalan b. Busulfan c. Sickle cell anemia d. Organ transplantation
c. Cladribine d. Cyclophosphamide
ar

41. Which of the following drug is used for the treatment of

29. All are example of alkylating agents except? sickle cell anemia? (AIIMS May 2011)
(Recent Question 2016) a. Hydroxyurea b. Cisplatin
Ph

a. Bleomycin b. Busulfan c. Paclitaxel d. Carboplatin

c. Procarbazine d. Melphalan
42. Methotrexate resistance is due to: (AIIMS Nov 2010,
30. Alkylating agent used in chemotherapy: a. Depletion of folate  Recent Question 2016)
(Recent Question 2016) b. Overproduction of DHFRase
a. Mechlorethamine b. Procarbazine c. Overproduction of Thymidylate kinase
c. Cyclophosphamide d. All of the above d. Decreased DHFRase
31. True about Cyclophosphamide: (Recent Question 2016) 43. A pregnant woman of > 35 weeks gestation has SLe. All of
a. Antimetabolites the following drugs are used in treatment except:
b. Alkylating agent (AIIMS May 2010)
Multiple Choice Questions

c. Platinum compound a. Methotrexate b. Sulfasalazine

d. Topoisomerase inhibitors c. Prednisolone d. Chloroquine
32. First-line chemotherapy for cancer cervix: 44. Cerebellar toxicity is seen with: (AIIMS May 2009)
(Recent Question 2016) a. Cisplatin b. Cytarabine
a. Cyclophosphamide b. Lomustine c. Bleomycin d. Actinomycin D
c. Vincristine d. Cisplastin 45. Which of the following anticancer drug is excreted by
33. Most widely used anti CA drug: (Recent Question 2016) lungs? (AIIMS Nov 2008)
a. 5 FU b. Methotrexate a. 5-Fluorouracil b. Cyclophosphamide
c. Cisplatin d. All c. Doxorubicin d. Cisplatin

416
 46. Which of the following is an anti-metabolite? 58. All of the following anticancer drugs are Cell cycle NON-
(AIIMS May, 2007)
a. Methotrexate b. Cyclosporine
c. Etoposide d. Vinblastine
47. The new drug pemetrexed useful in breast cancer belongs to
which of the following category of the drugs? a. Antimetabolite b. Direct DNA chelating agent
 (AIIMS Nov 2005)
a. Antitumor agent b. Alkylating agent
c. Hormonal agent d. Antimetabolite
48. Pemetrexed is drug of choice for c. Allopurinol d. Mercaptopurine
 (Recent Question Dec 2016)
a. Small cell carcinoma b. Mesothelioma
c. Non small cell carcinoma d. Breast cancer
49. Most common chemo used in Epithelial Ovarian cancers? c. Vincristine d. Cyclophosphamide
(Recent Question Dec 2016)
a. Paclitaxel b. Dactinomycin
c. Cyclophosphamide d. Methotrexate
50. Which antineoplastic is cell cycle s phase inhibitor c. VitBu d. Mesna
(Recent Question Dec 2016)
a. Vincristine b. 5FU
c. Paclitaxel d. Cyclophosphamide
51. Antidote for methotrexate poisoning is c. Vincristine d. 6-thioguanine
 (Recent Question Dec 2016)
y
a. Folic acid b. Folinic acid
og
c. Pyridoxine d. Vitamin B-12
52. The antimetabolite ‘X’ inhibits DNA polymerase and is one
of the most active drugs in the treatment of leukemia. 65. Methotrexate mechanism of action: (Recent Question 2016)
ol
Although myelosuppression is dose limiting, the drug
may also cause cerebellar dysfunction including ataxia and
dysrthria: (Recent Question 2016)
ac
a. Blemycin b. Cytarabine
c. Meracptopurine d. Methotrxate
53. Hydroxyurea mechanism of action in cancer is by inhibiting
m
the enzyme – (Recent Question 2016)
a. Ribonucleoside diphosphate reductase
ar
b. Ribonucleotide oxidase
c. DNA lyase
d. DNA synthetase
Ph
54. Gemcitabine is used mainly in which cancer
(Recent Question 2016)
a. Colorectal b. Breast
c. Pancreatic d. Cranipharyngioma
55. Microtubule formation is inhibited by?
(Recent Question 2016)
a. Paclitaxel b. Vincristine
c. Etoposide d. Irinotectan
56. Methotrexate resistance is due to? (Recent Question 2016)
a. Increased concentrations of intracellular DHFR through
gene amplification
b. Failure of efflux pumps
c. Bacterial modification
d. Increased synthesis of poly glutamates
57. Which is not a antimetabolite? (Recent Question 2016)
a. Methotrexate b. 5 Fluorouracil
c. Gemcitabine d. Vinca alkaloids
Anticancer Drugs
specific EXCEPT: (Recent Question 2016)
a. Doxorubacin b. Vincristine
c. Mitomycin-C d. Cyclophosphamide
59. Mechanism of action of 5-FU is? (Recent Question 2016)
c. Anti-mitotic d. Topoisomerase inhibitor
60. Which is a purine antagonist? (Recent Question 2016)
a. 5 FU b. Methotrexate
61. Which antineoplastic agent is an antifolate drug?
 (Recent Question 2016)
a. Methotrexate b. Adriamycin
62. Drug used to counteract methotrexate toxicity?
 (Recent Question 2016)
a. Folinic acid b. Folic acid
/e
63. The drug of choice in choriocarcinoma is?
(Recent Question 2016)
,3
a. Methotrexate b. Actinomycin-D
64. Which of the following drug is a NOT a purine analogue:
 (Recent Question 2016)
a. 6 Mercaptopurine b. Cladribine
c. Cytarabine d. Fludarabine
a. Inhibit dihydrofolate Reductase
b. Stimulate dihydrofolate Reductase
c. Inhibit tetrahydrofolate reductse
d. Stimulate tetrahydrofolate reductse
66. Which of the following anti neoplastic drug causes hepato-
toxicity:  (Recent Question 2016)
a. 6- mercaptopurine b. 5- flurouracil
c. Doxorubicin d. Etoposide
67. NOT used in treatment protocol of hodgkin’s lymphoma:
 (Recent Question 2016)
a. Vincristine b. Vinblastine
c. Bleomycin d. Adriamycin
68. Which of the following anticancer drug causes peripheral
neuropathy: (Recent Question 2016)
a. Methotreaxate b. Vincristine
c. Cytarabine d. Etoposide
MISCELLANEOUS ANTICANCER DRUGS AND MCQS
69. A girl with APML was treated and during treatment she
developed tachypnea, fever, pulmonary infiltrate. what is
Multiple Choice Questions
the treatment of choice? (AIIMS May 2017)
a. Dexamethosone b. Cytarabine
c. Doxorubicin d. Methotrexate
70. All are true about rituximab except: (AIIMS Nov-2014)
a. Has dose independent pharmacokinetics
b. Most common side effect is infusion reaction
c. First FDA drug approved for resistant lymphomas
d. Chimeric monoclonal antibody against CD-20 B cell
antigen
417
 71. Most common dose-limiting toxicity of cancer chemotherapy
Conceptual Review of Pharmacology
is: (AIIMS May 2010)
a. Gastrointestinal toxicity b. Neurotoxicity
c. Bone marrow suppression d. Nephrotoxicity 83. Which of the following drugs act by inhibiting tyrosine
72. Cetuximab (an EGFR antagonist) can be used in:
a. Palliation in head and neck cancer (AIIMS May 2009)
b. Anal canal carcinoma
c. Gastric carcinoma
d. Lung carcinoma
73. Imatinib is used in the treatment of: (AIIMS May 2008)
a. Chronic myelomonocytic leukemia
b. Myelodysplastic syndrome
c. Acute lymphoid leukemia
d. Gastrointestinal stromal tumors
74. Rituximab is used in all except: (AIIMS May 2008)
a. Non-Hodgkin lymphoma a. Anti-VEGF antibody b. Histone decyclase inhibitor
b. Paroxysmal nocturnal hemoglobinurea
c. Rheumatoid arthritis
d. Systemic lupus erythematosis
75. A 56-year-old female presented with breast carcinoma and
she was prescribed herceptin (trastuzumab). Which of the
following statements regarding this drug is true?
 (AIIMS Nov 2008)
a. It is an antibody produced entirely from mouse containing
y
no human component c. IL 6 d. IL 8
og
b. It is a monoclonal antibody produced by injecting her-2
antigen
c. It is a polyclonal antibody
d. It is a monoclonal antibody containing only human
ol
component
76. Mechanism of action of imatinib mesylate is: 
ac
a. Increase in metabolism of P glycoprotein
b. Blocking the action of P glycoprotein  (AIIMS May 2007)
c. Blocks the action of chimeric fusion protein of bcr-abl
m
d. Noncompetitive inhibition of ATP binding site
77. The drug imatinib acts by the inhibition of: b. Used in metastatic breast cancer
 (AIIMS May 2006)
ar
a. Tyrosine kinase b. Glutathione reductase
c. Thymidylate synthetase d. Protein kinase
Ph
78. Drug of choice for chemotherapy induced early and late
onset nausea and vomiting is (Recent Question Dec 2016)
a. Aprepitant b. CB receptor agonist
c. Promethazine d. TCA
79. The dose of human series rabies Immunoglobulin is a. Melphalan b. Thalidomide
(Recent Question Dec 2016)
a. 20 IU/kg b. 40IU/kg
c. 60 IU/Kg d. 80 IU/Kg
80. Drugs not used for Imatinib resistant CML? c. Chlorambucil d. Vincristine
Multiple Choice Questions
(Recent Question Dec 2016)
a. Bosutinib b. Ponatinib
c. Omacetaxine d. Bortezomib
81. Dronabinol is an orally active cannabinoid, which is used in
management of chemotherapy induced nausea and vomit-
ing. Which of the following parameters is to be monitored
in a patient taking dronabinol? (Recent Question 2016)
a. Blood pressure b. Respiratory rate
c. Temperature d. Urine output
418
82. Drug of choice for CML is: (Recent Question 2016)
a. Imatinib b. Rituximab
c. Vincristine d. Bleomycin
Kinase activated by EGF receptor as well as HER2?
 (Recent Question 2016)
a. Imatinib b. Gefitinib
c. Erlotinib d. Lapatinib
84. Drug that is radioprotective is: (Recent Question 2016)
a. Paclitaxel b. Vincristine
c. Etoposide d. Amifostine
85. Bevacizumab is used in (Recent Question 2016)
a. Carcinoma colon b. Liver carcinoma
c. Renal cell carcinoma d. Pancreatic carcinoma
86. Bevacizumab is (Recent Question 2016)
c. Proteosome inhibitor d. Her2 neu inhibitor
/e
87. Which of the following anticancer drugs are competitive
inhibitors of tyrosine kinase (Recent Question 2016)
a. Imatinib and suntinib b. Letrozole
,3
c. Bicalutamide d. Fulvestrant
88. Tocilizumab is antibody against (Recent Question 2016)
a. IL 2 b. IL 4
89. Cardiomyopathy is caused by which monoclonal Antibody?
 (Recent Question 2016)
a. Tratuzumab b. Infliximab
c. Eternacept d. Adalimumab
90. Drug of choice for neutropenia due to cancer chemotherapy
is: (Recent Question 2016)
a. Vitamin B12 b. IL11
c. Filgrastim d. Erythropoietin
91. Trastuzumab all are true except: (Recent Question 2016)
a. Shows better response in combination with paclitaxel
c. Causes upregulation of HER2/neu
d. Do not causes bone marrow toxicity
92. Rituximab is antibody against? (Recent Question 2016)
a. CD20 b. VEGF
c. EGFR d. IL-2
93. Which of the following is NOT used in treatment for
Multiple myeloma: (Recent Question 2016)
c. Zolendronic acid d. Methotrexate
94. Drugs which do not suppress bone marrow (PGI Nov 2017)
a. 5FU b. Cisplatin
e. Vinblastine
95. Drugs affecting purine synthesis: (PGI May 2017)
a. Azathioprine b. Methotrexate
c. Fludarabine d. 6-Mercaptopurine
e. Capecitabine
96. Methotrexate affects: (PGI May 2017)
a. Purine synthesis b. Pyrimidine synthesis
c. Conversion of DHFA to THFA
d. Polymerization of mitotic tubule
 97. Which of the following anti-tumor drug have high risk of
gonadotoxicity: (PGI May 2017)
a. Dactinomycin b. Cyclophosphamide
c. Busulfan d. Vinblastine
e. Ifosfamide
98. A person was on chemotherapy for 2 week for some medias-
tinal tumor. Now he develops high frequency hearing loss.
Most probable cause of this condition is use of:
a. Cisplatin b. Etoposite (PGI June 2015)
c. Doxorubicin d. Methotrexate
99. All of the following is true about hydroxyurea except:
a. Cause myelosuppression  (PGI Nov 2014)
b. Oral bioavailability is very less
c. Used in CML
d. Act as radiosensitizer
e. Used in sickle cell anaemia
100. True about doxorubicin: (PGI May 2014)
a. Antineoplastic drug b. Alkylating agent
c. Topoisomerase III inhibitor
d. Anthracycline antibiotic e. Cardiotoxic
101. Side effect of cisplatin is/are : (PGI May 2014)
a. Ototoxic b. Nephrotoxic
c. Cardiotoxic d. Neurotoxic
y
e. Retinopathy
og
102. Which of the following is/are small molecule tyrosine kinase
inhibitor: (PGI Nov 2013)
a. Sirolimus b. Imatinib
ol
c. Erlotinib d. Nilotinib
e. Bevaclizumab
ac
103. Alkylating agent(s) is/are: (PGI May 2012)
a. Methotrexate b. Busulfan
c. Doxorubicin d. Daunorubicin
e. Chlorambucil
m
104. Toxicity of MOPP regimen for Hodgkin’s disease includes: 
a. Sterility  (PGI Nov 2011)
ar
b. Bone hyperplasia
c. Sensory & motor neuropathy
Ph
d. Cardiotoxicity
e. Secondary malignancy
105. True statement regarding anticancer drugs : (PGI Nov 2011)
a. Bleomycin chelate Zn
b. Doxorubicin- nephrotoxicity is main adverse effect
c. Vincristine is more myelotoxic while vinblastine is more
neurotoxic
d. Acrolein is toxic form of Cyclophosphamide
e. Pentostatin- inhibit adenosine deaminase
106. Drugs used in chemotherapy induced nausea & vomiting:
 (PGI Nov 2010)
a. Dexamethasone b. Ondansetron
c. Palonosetrone d. Mitoxantrone
e. Metoclopramide
107. Epilation agents are: (PGI Nov 2010)
a. Methotrexate b. Vincristine
c. 5-FU d. Cisplatin
e. Adriamycin
108. Antifolate cancer drugs are: (PGI Nov 2009)
Anticancer Drugs
a. Methotrexate b. Azathioprine
c. Cyclosporin d. Vincristne
e. Cisplatin
109. Which of the following statement(s) is/are true regarding
anticancer drugs: (PGI Nov 2009)
a. Cell cycle non specific agents- can act on any phase of cycle
including G0
b. Mitosis during cell division – devoted to DNA replication
c. No mitotic activity –G0 phase
d. Cytarbine act on S phase of cell cycle
e. Cyclophosphamide is cell cycle specific
110. Alkylating agent(s) is/are: (PGI June 2009)
a. Isosfamide b. Chlorambucil
c. Paclitaxel d. Nitrosoureas
e. Cytarabine
111. Correct pair(s), of drug & Mechanism of action is/are: 
/e
a. Erlotinib-Human EGFR 1 monoclonal Ab
b. Trastuzumab-Human EGFR 1monoclonal Ab
(PGI June 2009)
,3
c. Cetuximab – Angiogenesis inhibitor 
d. Rituximab-Anti CD 24 monoclonal Ab
e. Omalizumab-IgG monoclonal Ab
112. Anticancer antibiotics are : (PGI Dec 2008)
a. Bleomycin b. Spiramycin
c. Mitomycin d. ActinomycinD
e. Tetracycline
113. Mechanism of action of Methotrexate in rheumatoid
arthritis is: (PGI June 2008, Dec 2007)
a. Decreased Folate synthesis
b. Decreased thymidylate synthesis
c. Decreased purine synthesis
d. Increased purine synthesis
114. Mucositis is caused by: (PGI Dec 2006)
a. 5-Fu b. Methotrexate
c. Paclitaxel d. Cisplatin
e. Etoposide
115. Drugs causing predominant sensory neuropathy:
 (PGI Dec 2006)
a. Cisplatin b. Pyridoxin excess
c. GB syndrome d. Suramine
116. True about alkylating agents:  (PGI Dec 2005)
a. Dose limiting mucosities
b. Dose limiting Myelosuppression
c. DNA damage (cross linking of DNA)
d. Secondary carcinoma are common
e. Act on Selective ‘S’ phase
Multiple Choice Questions
117. A new drug approved for treatment of FLT-3 mutation AML
is (JIPMER 2017)
a. Midostaurin b. Nivolumab
c. Cabozantinib d. Dupilumab
118. Mechanism of action of bortezomib is (JIPMER 2017)
a. Proteasome inhibitor
b. NFK-β stimulation
c. Tyrosine kinase inhibition
d. Janus kinase inhibition
419
 119. Ibrutinib is not used for (JIPMER 2017)
Conceptual Review of Pharmacology
a. NHL
b. Waldenstorm macroglobulinemia
c. Hairy cell leukemia
d. CLL
120. Anticancer drug causing noncardiogenic pulmonary edema
is (JIPMER 2017)
a. L-Asparginase b. Cytosine Arabinoside
c. 6 MP d. Azathioprine
121. Which of the following drug causes aseptic meningitis? 133. Nephrotoxicity is a side effect of (APPG 2010)
a. Intrathecal dexamethasone  (JIPMER 2014)
b. Cisplatin
c. Intrathecal methotrexate
d. Doxorubicin
122. Drug used in neoadjuvant chemotherapy in Ca Esophagus
is: (JIPMER 2013)
a. 5FU+Cisplatin b. Cisplatin
c. Adriamycin d. Mitomycin c
123. Imatinib mesylate is used in the treatment of: a. Infliximab b. Rituximab
a. GIST  (JIPMER 2011)
b. Seminoma
c. MALT
d. Zollinger Ellison syndrome
y
124. Methotrexate is an example for which of the following class
drugs?
og
(JIPMER 2010)
a. Altibiotic b. Alkylating agent
c. Biologic response modifier d. Folic acid analogue
125. Which of the following is a cardiotoxic anticancer drug? a. Vinca alkaloids b. Nitrogen mustards
ol
(JIPMER 2008)
a. Bleomycin b. Doxorubicin
ac
c. 5FU d. Dactinomycin
126. Drug of choice for treatment of gastrointestinal stromal
tumors is: (JIPMER 2007)
m
a. Rituximab b. Imatinib mesylate
c. Anagrelide d. Denileukin difititox
ar
127. A 40 year old woman was on chemotherapy for 6 months for
Ovarian carcinoma. Now she presented with a progressive
bilateral Sensorineural hearing loss. The Drug responsible
Ph
for his includes (NIMHANS 2013)
a. Cisplatin b. Doxorubicin
c. Cyclophosphamide d. Paclitaxel
128. Which is a true match? (NIMHANS 2011)
a. Carmustine-Alkylator
b. Etoposide-Anitumor antibiotic
c. Vincristine-Alkylator
d. Cisplatin-Antimetabolite
129. Which one of the following is not correct about Adverse
Multiple Choice Questions
effects of anticancer drugs? (NIMHANS 2010)
a. Daunorubicin-Cardiotoxicity
b. Bleomycin-Pulmonar fibrosis
c. Cisplatin-Hepatotoxicity
d. Vincristine-Neuropathy
130. Which of the following is a neurokinin receptor antagonist?
 (APPG 2014)
a. Granisteron b. Apripitant
c. Metaclopramide d. Trimethobenzamide
420
131. Hemorrhagic cystitis is a dreaded complication associated
with (APPG 2013)
a. Clobazam b. Cyclosporin A
c. Cycloserine d. Cyclophosphamide
132. This anticancer agent which produces a type of megaloblas-
tosis that is unresponsive to both vitamin B12 and folic acid
 (APPG 2012)
a. Mechlorethamine b. Cladribine
c. Hydroxyurea d. Temozolomide
a. Cisplatin b. Buslphan
c. Methotrexate d. Adriamycin
134. The drug that does not cause Raynaud’s disease
 (APPG 2005)
a. Vincristine b. Bleomycin
c. Vinblastine d. Cisplatin
135. Monoclonal antibody that targets the CD-20B lymphocytes
/e
is (TNPG 2014)
c. Cetuximab d. Adalimumab
,3
136. Methotrexate inhibits (TNPG 2012)
a. Glutathione reductase
b. Alanine transferase
c. Dihydrofolate Reductase [DHFR]
d. Adenine deaminase
137. One of the following drugs bind with tubulin & arrest the
cell cycle in metaphase (TNPG 2012)
c. Antimetabolites d. Alkylating agent
138. Which of the following is Tyrosine Kinase inhibitor
 (TNPG 2011)
a. Infliximab b. Imatinib
c. Ibutilide d. Idoxuridine
139. All are correctly paired except (TNPG 2009)
a. Cyclophosphamide-cystitis
b. Busulphan-pulmonary fibrosis
c. Paclitaxel-Neurotoxicity
d. Vincristine-Bone marrow suppression
140. True regarding methotrexate area A/E (TNPG 2009)
a. Folinic acid enhance its anti-cancer activity
b. Used in psoriasis
c. Inhibits Dihydrofolate Reductase (DHFR)
d. Non-proliferative cells are resistant
141. The chemotherapeutic agent of choice for CA. Oesophagus
 (TNPG 2009)
a. Cyclophosphamide b. Mercaptopurine
c. Cisplatin d. Vincristine
142. The drug for methotrexate toxicity is (TNPG 2002)
a. Mesna b. Folic acid
c. Folinic acid d. Acetyl cysteine
143. One of the following drugs is cardiotoxic (TNPG 2001)
a. Paclitaxel b. Vinblastine
c. Adriamycin d. Methotrexate
144. Pulmonary fibrosis is caused by: (WBPG 2012)
a. Bleomycin b. Mitomycin
c. Azithromycin d. Kanamycin
 145. Mechanism of action of imatinib include: (WBPG 2012) 152. Not an antineoplastic antibiotic: (WBPG 2009)

a. It causes up gradation of tyrosine kinase
b. Direct inhibitor of JAK/STAT pathway
c. Inhibitor of cyclin D
d. BCR ABL tyrosine kinase inhibitor
146. Which one of the following is the best radiosensitizer?
 (WBPG 2011)
a. Cisplatin b. Doxorubicin
c. Cyclophosphamide d. Gemcitabine
147. Drug used for the treatment of GIST is: (WBPG 2010)
a. Gemcitabine b. Imatinib
c. Cyclophosphamide d. Methotrexate
148. Which drug is not Cardiotoxic: (WBPG 2010)
a. Cyclophosphamide b. 5-FU
c. Adriamycin d. Cisplatin
149. Not an early S/E methotrexate: (WBPG 2009)
a. Hepatic fibrosis b. Myelosupression
Anticancer Drugs
a. Actinomycin D b. Doxorubicin
c. Bleomycin d. Spiramycin
153. Complication of Hydroxyurea: (WBPG 2009)
a. Leg ulcer
b. Flagellate hyperpigmentation
c. SLE
d. Flagellate depigmentation
154. Sideroblastic anemia is caused by all except: (WBPG 2007)
a. Paracetamol b. Phenacetin
c. Cyclophosphamide d. Pyrazinamide
155. Which of the following causes peripheral neuritis:
a. Methotrexete b. Vincristine (WBPG 2007)
c. Busulphan d. Cyclophosphamide
156. Leucovorin rescue is related to- (WBPG 2006)
a. MTX. toxicity
b. Cyclophosphamide toxicity

/e
c. Nausea d. Stomatitis c. Oncovin toxicity
150. Avastin (Bevacizumab) is used in: (WBPG 2009) d. Cisplatin toxicity
a. Diabetic retinopathy b. Glaucoma 157. Commonly used medical treatment in unruptured tubal

,3
c. Diabetic nephropathy d. Neuropathy pregnancy- (WBPG 2006)
151. Mechanism of action of TAXANES is: (WBPG 2009) a. Methotrexate b. Potassium hydroxide
a. Depolymerization of microtubules c. Actinomycin d. Mifepristone

y
b. Increase polymerization of microtubules 158. All causes myelosuppression except: (WBPG 2005)
c. Inhibitor of topoisomerase I
og a. Docetaxel b. Vincristine
d. Inhibitor of topoisomerase II c. Methotrexate d. Irinotecan
ol
Practice Questions & Answers from 159 to 188 are given at the end of the chapter.
ac

Answers and Explanations to Multiple Choice Questions

m

1. Ans. (b)  Alkylating agents 3. Ans. (b)  Less neurotoxic than cyclophosphamide
ar

Answers and Explanations to Multiple Choice Questions

(Ref: Harrison 19 E/P417)
th
(Ref: Goodman Gilman 12th E/P1682
•• Most common cause of agranulocytosis is iatrogenic i.e. •• Ifosfamide is the most neurotoxic alkylating agent, which is
Ph

drug induced. caused by the metabolite chloracetyldehyde.

•• Most common drugs causing agranulocytosis are anticancer
drugs which inhibit cell cycle like alkylating agents and
antimetabolites like methotrexate, 5-FU and 6-MP.
2. Ans. (a) Chlorambucil
(Ref: Goodman Gilman 12th E/P1684
Severity of nausea and vomiting with anticancer drugs
•• Neurotoxicity presents as seizures, ataxia and coma.
4. Ans. (a)  Cyclophosphamide
(Ref: Goodman Gilman 12th E/P1683)
•• Hemorrhagic cystitis is caused by ifosfamide (at normal
doses) > Cyclophosphamide(at high doses only).
•• Mesna is used for prophylaxis of hemorrhagic cystitis.

5. Ans. (d)  Mesna

Maximum Minimum
Cisplatin (most emetogenic) Chlorambucil (Ref: Goodman Gilman 12th E/P1684)
Carmustine Busulfan Mesna for prophylaxis of hemorrhagic cystitis
Anthracyclines Bleomycin •• The dose of mesna is 60% of ifosfamide dose (if ifosfamide
High dose Fludarabine dose is 100 mg, then cyclophosphamide dose will be 60 mg),
cyclophosphamide Vinka alkaloids given in 3 divided doses.
Dacarbazine Monoclonal antibodies •• First 20% dose is given along with ifosfamide by bolus IV
Mechlorethamine route.

421
 •• Second and third 20% dose can be given by IV route (after Drugs Causing Leukemia Duration
Conceptual Review of Pharmacology

4 and 8 hours) or oral route (after 2 and 6 hours) only if Secondary Leukemia Type After which
ifosfamide dose is ≤ 2 g/m2. Leukemia is
6. Ans. (a)  Cisplatin seen
Alkylating agents AML due to 4 years
(Ref: Goodman Gilman 12th E/P1689
deletions in
chromosome
7. Ans. (a)  Alkylating agents
5 or 7
(Ref: Goodman Gilman 12th E/P1683 Cisplatin AML 4 years
Alkylating Agents Topoisomerase II AML due to 2-3 years
inhibitors translocations
Nitrogen Mustards Nitrosoureas Methylating Miscellaneous
Agents
of MLL (Mixed
Lineage
Cyclophosphamide Carmustine Procarbazine Busulfan Leukemia) gene
Ifosfamide Lemustine Dacarbazine Altretamine in 11q23
Mechlorethamine Semustine Temozolomide Thiotepa
Chlorambucil Streptozocin Trabectedin 14. Ans. (c)  Mitomycin C

/e
Melphalan
(Ref: Goodman Gilman 12th E/P1718)
Bendamustine
Hemolytic uremic syndrome

,3
8. Ans. (c)  Cisplatin •• Mitomycin-C
•• Gemcitabine
(Ref: Goodman Gilman 12th E/P1689

y
15. Ans. (a)  Inhibits DNA-dependent RNA synthesis
Drugs Causing Secondary Leukemia
og (Ref: Goodman Gilman 12th E/P1712
Alkylating agents •• Actinomycin binds with DNA and drug DNA complex
Platinum compounds inhibits DNA polymerase.
Topoisomerase II inhibitors (Etoposide) •• Thus it inhibits DNA dependent RNA synthesis.
ol
Mitoxantrone
6-MP 16. Ans. (a)  Vacuolar degeneration of the myofibrils
ac

Fludarabine (Ref: Goodman Gilman 12th E/P1714

Electron microscopy features of doxorubicin cardiotoxicity
9. Ans. (a)  Cisplatin
•• Vacuolar degeneration of myofibrils
m

(Ref: Goodman Gilman 12th E/P1689 •• Mitochondrial changes

Cisplatin Toxicity
ar

17. Ans. (c)  Dilated cardiomyopathy

Answers and Explanations to Multiple Choice Questions

• Nephrotoxicity • Ototoxicity
(Ref: Goodman Gilman 12th E/P1714
• Neurotoxicity • Most emetogenic
Ph

Doxorubicin cardiotoxicity
10. Ans. (c)  Carmustine •• Acute: Pericarditis-myocarditis syndrome, arrhythmia and
ST and T wave changes in ECG.
(Ref: Goodman Gilman 12th E/P1686 •• Chronic: Dilated cardiomyopathy
Sustained neutropenia is seen with:
•• Carmustine 18. Ans. (a)  Cisplatin
•• Lemustine
(Ref: Goodman Gilman 12th E/P1689
•• Semustine

11. Ans. (a)  100 19. Ans. (b)  Bleomycin

(Ref: Goodman Gilman 12th E/P1689) (Ref: Goodman Gilman 12th E/P1717
Anticancer drugs causing pulmonary fibrosis
12. Ans. (d)  Lung cancer •• Bleomycin
(Ref: Goodman Gilman 12th E/P1689) •• Busulfan
•• Other alkylating agents like temozolomide
13. Ans. (c)  < 7 years
20. Ans. (b)  Procarbazine
(Ref: Goodman Gilman 12th E/P1682)
(Ref: Goodman Gilman 12th E/P1687

422
 Side-effects of procarbazine 31. Ans. (b)  Akylating agent

Anticancer Drugs
•• Disulfiram like reaction
•• Neurotoxicity (Ref: Goodman Gilman 12th E/P1682)
•• Bone marrow suppression
•• Cheese reaction 32. Ans. (d)  Cisplatin

21. Ans. (d)  Etoposide (Ref: Goodman Gilman 12th E/P1689)

Cisplatin is first-line drug in urogenital cancers:
(Ref: Goodman Gilman 12th E/P1682
•• Bladder cancer
•• Ovary cancer
22. Ans. (a)  Carmustine
•• Testicular cancer
(Ref: Goodman Gilman 12th E/P1686 •• Cervical cancer

Nitrosoureas 33. Ans. (c)  Cisplatin

Carmustine (Ref: Goodman Gilman 12th E/P1689)
Lemustine
Semustine Cisplatin is most widely used anticancer drug because of its
Streptozocin huge spectrum of activity. It is first-line drug in
•• GIT cancers

/e
23. Ans. (a)  Bleomycin •• Lung cancer
•• Urogenital cancers

,3
(Ref: Goodman Gilman 12th E/P1717) •• Head and neck cancer
•• Colchicine inhibits microtubules and is used for treatment
of acute gout due to its anti-inflammatory effect. 34. Ans. (d)  Mitomycin
•• Paclitaxel and vincristine are Ans. (M)  phase specific drugs

y
(Ref: Goodman Gilman 12th E/P1718)
which act on microtubules.
Hemolytic uremic syndrome is seen with:
og
24. Ans. (c)  Doxorubicin •• Mitomycin
•• Gemcitabine
(Ref: Goodman Gilman 12th E/P1714)
ol
Cardiotoxic anticancer drugs 35. Ans. (d)  Busulfan
•• Anthracyclines (Maximum with doxorubicin and daunoru- (Ref: Goodman Gilman 12th E/P1685)
ac

bicin)
Anticancer drugs causing pulmonary fibrosis:
•• Trastuzumab
•• Bleomycin: Most common cause
•• High dose cyclophosphamide
•• Alkylating agents like busulfan and temozolomide
m

25. Ans. (a)  Alkylating agent

36. Ans. (d)  Cisplatin
(Ref: Goodman Gilman 12th E/P1682)
ar

(Ref: Goodman Gilman 12th E/P1689)

Answers and Explanations to Multiple Choice Questions

26. Ans. (c)  Cardiotoxicity Cell cycle specific anticancer drugs
Ph

(Ref: Goodman Gilman 12th E/P1714) 37. Ans. (a)  Paclitaxel

(Ref: Goodman Gilman 12th E/P1707)
27. Ans. (a)  Azathioprine
•• Paclitaxel acts on microtubules and hence is an M phase
(Ref: Goodman Gilman 12th E/P1712-16) specific drug.
•• Azathioprine is a prodrug of anticancer drug 6-MP used as •• Daunorubicin an antitumor antibitotic inhibits G2 and S
an immunodmodulator. phase.
•• Etoposide and topotecan are S phase inhibitors and hence
28. Ans. (c)  Cladribine automatically G2 phase is inhibited which comes after S
phase.
(Ref: Goodman Gilman 12th E/P1682)
38. Ans. (b)  Causes stabilization of microtubules
29. Ans. (a)  Bleomycin
(Ref: Goodman Gilman 12th E/P1707)
(Ref: Goodman Gilman 12th E/P1682)
•• Paclitaxel stimulates β-tubulin and promotes microtubule
polymerization.
30. Ans. (d)  All of the above
•• The source of paclitaxel was yew tree, but as the source is
(Ref: Goodman Gilman 12th E/P1682) limited, now a days paclitaxel is synthesized by genetic
engineering in E.coli.

423
 39. Ans. (b)  Folic acid and vitamin B12 46. Ans. (a)  Methotrexate
Conceptual Review of Pharmacology

(Ref: Goodman Gilman 12th E/P1689) (Ref: Goodman Gilman 12th E/P1690)
•• Bone marrow suppression is more severe with pemetrexed Antimetabolites
and hence apart from leucovorin or folic acid, an injection •• Antifolate drugs: Methotrexate and Pemetrexed
of vitamin B12 is given with the first dose of pemetrexed. •• Pyrimidine analogs
•• Purine analogs
40. Ans. (c)  Sickle cell anemia
47. Ans. (d)  Antimetabolite
(Ref: Goodman Gilman 12th E/P1693)
(Ref: Goodman Gilman 12th E/P1692)
Uses of Methotrexate

Neoplastic Uses (Due to
Inhibition of DNA Synthesis)
Choriocarcinoma: Drug of
choice
Osteosarcoma: High doses of
methotrexate with leucovorin
Non Neoplastic Uses (Due to 48. Ans. (b)  Mesothelioma
Inhibition of Purine Synthesis) (Ref: Goodman Gilman 12th E/P1691)
Rheumatoid arthritis: DMARD
of choice 49. Ans. (a)  Paclitaxel
Ectopic pregnancy: Used with
(Ref: CMDT 2017/P1623)
misoprostol

/e
rescue GVHD
50. Ans. (b)  5FU
Non-Hodgkin) s lymphoma Psoriasis
ALL: For remission and Multiple sclerosis (Ref: Goodman Gilman 12th E/P1695)

,3
consolidation Wegener) s granulomatosis
Crohn) s disease 51. Ans. (b)  Folinic acid

y
41. Ans. (a)  Hydroxyurea (Ref: Goodman Gilman 12th E/P1694)
•• Myelosuppression and mucositis are common side-effects
og
(Ref: Goodman Gilman 12th E/P1721) seen due to inhibition of DNA synthesis.
Uses of hydroxyurea •• These side-effects can be prevented by leucovorin (folinic
•• Sickle cell anemia acid, active form of folic acid) or folic acid.
ol
•• Essential thrombocythemia •• Leucovorin or folinic acid is more preferred as compared to
•• Polycythemia vera folic acid.
•• CML
ac

52. Ans. (b)  Cytarabine

42. Ans. (b)  Overproduction of DHFRase
(Ref: Goodman Gilman 12th E/P1700)
m

(Ref: Goodman Gilman 12th E/P1692) •• The drug in the question is cytarabine which is metabolized
Resistance mechanisms of methotrexate related to DHFR into Ara-CTP, which competitively inhibits DNA polymerase.
•• DHFR enzyme induction •• Cerebellar dysfunction including ataxia and dysarthria are
ar
Answers and Explanations to Multiple Choice Questions

•• DHFR gene amplification: Increases DHFR synthesis seen with cytarabine at high doses or intrathecal use.
•• DHFR gene mutation: Alters structure of DHFR •• Myelosuppression is the dose limiting t.
Ph

53. Ans. (a)  Ribonucleotide diphosphate reductase

43. Ans. (a)  Methotrexate
(Ref: Goodman Gilman 12th E/P1721)
(Ref: Goodman Gilman 12th E/P1694)
Drugs inhibiting RNR (Ribonucleotide diphosphate reduc-
•• Methotrexate is absolutely contraindicated in pregnancy
tase)
due to teratogenic effects.
•• Hydroxyurea
44. Ans. (b)  Cytarabine •• Gemcitabine
•• Purine analogues: Fludarabine, cladribine, clofarabine and
(Ref: Goodman Gilman 12th E/P1694) pentostatin
Neurotoxicity with cytarabine
•• Cerebellar toxicity: Ataxia and dysarthria 54. Ans. (c)  Pancreatic
•• Cerebral toxicity: Seizure, dementia and coma (Ref: Goodman Gilman 12th E/P1700)
45. Ans. (a)  5-Fluorouracil Drugs used for treatment of pancreatic cancer
•• Gemcitabine: Drug of choice
(Ref: Goodman Gilman 12th E/P1694) •• Streptozocin
•• 5-FU is metabolized by liver, but mainly excreted by lungs •• Erlotinib
as CO2. •• Sunitinib
•• Everolimus

424
55. Ans. (b)  Vincristine 65. Ans. (a)  Inhibit dihydrofolate reductase

Anticancer Drugs
(Ref: Goodman Gilman 12th E/P1705) (Ref: Goodman Gilman 12th E/P1690)
Drugs acting on microtubules
•• Vinka alkaloids: Inhibit microtubule polymerization 66. Ans. (a)  6-mercaptopurine
•• Taxanes: Stimulate microtubule polymerization (Ref: Goodman Gilman 12th E/P1702)
•• Epothilones: Stabilize microtubules
Hepatotoxic anticancer drugs
•• Estramustine: Inhibits microtubule polymerization
•• 6-MP, 6-TG
•• Methotrexate
56. Ans. (a) Increased concentrations of intracellular DHFR
•• BCR-ABL TK inhibitors (Imatinib, dasatinib, nilotinib)
through gene amplification •• Dacarbazine
(Ref: Goodman Gilman 12th E/P1692) •• Busulfan

57. Ans. (d)  Vinca alkaloids 67. Ans. (a)  Vincristine

(Ref: Goodman Gilman 12th E/P1690) (Ref: Goodman Gilman 12th E/P1706)
ABVD regimen for Hodgkin)  s disease
58. Ans. (b)  Vincristine A: Adriamycin

/e
(Ref: Goodman Gilman 12th E/P1672) B: Bleomycin
V: Vinblastine
•• Vincristine is an Ans. (M)  phase specific anticancer drug.
D: Dacarbazine

,3
59. Ans. (a)  Antimetabolite
68. Ans. (b)  Vincristine
(Ref: Goodman Gilman 12th E/P1695)
(Ref: Goodman Gilman 12th E/P1706)

y
60. Ans. (d)  Mercaptopurine Anticancer drugs causing neuropathy
og
(Ref: Goodman Gilman 12th E/P1701) •• M phase specific drugs
Purine analogs/antagonists: ƒƒ Vinka alkaloids: Vincristine > Vinorelbine > Vinblastine
•• 6-MP and 6-TG ƒƒ Taxanes: Nab paclitaxel > Paclitaxel
ol
•• Fludarabine ƒƒ Epothilones: Ixabepilone
•• Pentostatin •• Platinum compounds: Cisplatin and Oxaliplatin
ac

•• Cladribine •• Pyrimidine analogs: Fludarabine and Nelarabine

•• Clofarabine
69. Ans. (a)  Dexamethasone
61. Ans. (a)  Methotrexate
m

(Ref: Harrison 19th E/1686-87)

(Ref: Goodman Gilman 12th E/P1691)
•• Patient of APML when treated with retinoic acid can
ar

develop pulmonary syndrome charcetrized by fever,

Answers and Explanations to Multiple Choice Questions

62. Ans. (a)  Folinic acid
dyspnea, pulmonary infiltrates, chest pain, fluid retention
(Ref: Goodman Gilman 12th E/P1691) and hypoxemia.
Ph

•• Folic acid or Folinic acid (leucovorin) can be used to prevent •• The treatment of choice for same is dexamethasone.
toxicity of antifolate drugs like bone marrow suppression
and mucositis. 70. Ans. (a)  Has dose-independent pharmacokinetics
•• Glucarpidase is used with methotrexate in case of renal (Ref: Goodman Gilman 12th E/P1746, Monoclonal Antibodies
impairement, as it metabolizes methotrexate into inactive Pharmacokinetics and Pharmacodynamics: Wang W, Wang EQ,
metabolites excreted by liver. Balthasar JP)
Metabolism and elimination of monoclonal antibodies
63. Ans. (a)  Methotrexate
•• Most of the MABs are eliminated by receptor mediated
(Ref: Goodman Gilman 12th E/P1693) endocytosis (intracellular uptake by the receptors on which
Drugs used for choriocarcinoma they act) followed by intracellular catabolism. Hence as the
•• Methotrexate: Drug of choice dose will increase receptor saturation will gradually decrease
•• Actinomycin D uptake of drug and elimination, which is known as non-
linear/first order/dose dependent elimination kinetics. E.g.
64. Ans. (c)  Cytarabine
Rituximab, trastuzumab, gemtuzumab, panitumumab etc.
(Ref: Goodman Gilman 12th E/P1701-04) •• However only few MAbs are removed by phagocytosis and
•• Cytarabine is a pyrimidine analogue. hence they display linear/zero order/dose independent
elimination kinetics. E.g. Omalizumab and denosumab.

425
 71. Ans. (c)  Bone marrow suppression 81. Ans. (a)  Blood pressure
Conceptual Review of Pharmacology

(Ref: Harrison 19th E/103e-23) (Ref: Goodman Gilman 12th E/P1345)

•• Most common side effect: Nausea and vomiting. Dronabinol has central sympathomimetic action which causes
•• Most common dose limiting toxicity: Bone marrow suppression. •• Tachycardia
•• Hypotension: BP should be monitored.
72. Ans. (a)  Palliation in head and neck cancer
82. Ans. (a)  Imatinib
(Ref: Goodman Gilman 12th E/P1736)
Head and neck cancer treatment (Ref: Goodman Gilman 12th E/P1732)
•• TOC: 5-FU + Cisplatin CML treatment
•• Metastatic or recurrent: Cetuximab •• DOC: Imatinib
•• Imatinib resistance: Nilotinib, Bosutinib, Ponatinib, Dasat-
73. Ans. (d)  Gastrointestinal stromal tumor inib
(Ref: Goodman Gilman 12th E/P1732) •• Multi TK resistance: Omacetaxine
GIST treatment 83. Ans. (d)  Lapatinib
•• DOC: Imatinib
•• Imatinib resistance: Sunitinib (Ref: Goodman Gilman 12th E/P1737)

/e
•• Sunitinib resistance: Regorafenib •• Lapatinib is a dual TK inhibitor i.e. Her-1 (EGFR) and Her-2.

74. Ans. (b)  Paroxysmal nocturnal hemoglobinuria 84. Ans. (d)  Amifostine

,3
(Ref: Goodman Gilman 12th E/P1746) (Ref: Harrison 19th E/P622
Uses of Rituximab: •• Amifostine is primarily a radioprotectant, that acts by scav-

y
CLL enging free radicals and by protecting and repairing DNA.
NHL •• Apart from radioprotective indication it is also approved by
og
Multiple sclerosis FDA to prevent nephrotoxicity associated with cisplatin.
Rheumatic arthritis
SLE 85. Ans. (c)  Renal cell carcinoma
Autoimmune haemolytic anemia
ol
(Ref: Goodman Gilman 12th E/P1739)
75. Ans. (b)  It is a monoclonal antibody produced by injecting DOC for renal cell cancer
ac

her-2 antigen •• Bevacizumab

  Or
(Ref: Goodman Gilman 12th E/P1737) •• Sunitinib
m

•• Trastuzumab and pertuzumab are anti Her-2 monoclonal

antibodies produced by injecting Her-2 antigen. 86. Ans. (a)  Anti-VEGF antibody
(Ref: Goodman Gilman 12th E/P1732)
ar

76. Ans. (c)  Blocks chimeric fusion of bcr-abl

Answers and Explanations to Multiple Choice Questions

Anti VEGFR antibodies:

(Ref: Goodman Gilman 12th E/P1732) •• Bevacizumab
Ph

•• Imatinib is a bcr-abl tyrosine kinase inhibitor. •• Ranibizumab

•• It is drug of choice for treatment of CML and GIST. •• Ramucirumab

77. Ans. (a)  Tyrosine kinase 87. Ans. (a)  Imatinib and sunitinib
(Ref: Goodman Gilman 12th E/P1732) (Ref: Goodman Gilman 12th E/P1732)

78. Ans. (a)  Aprepitant 88. Ans. (c)  IL-6

(Ref: Goodman Gilman 12 E/P1814)
th
(Ref: Harrison 19th E/P2147)
•• Lapatinib is IL-6 antagonist approved for treatment of
79. Ans. (b)  40 IU/Kg rheumatoid arthritis.
(Ref: WHO)
89. Ans. (a)  Trastuzumab
Dose of immunogobuin in rabies
•• Human series – 40 IU/Kg (Ref: Goodman Gilman 12th E/P1737)
•• Equine series - 20 IU/Kg
90. Ans. (c)  Filgrastim
80. Ans. (d)  Bortezomib
(Ref: CMDT 2015/P1647)
(Ref: CMDT 2017/P1622)

426
 •• Neutropenia and opportunistic infections can be commonly •• Methotrexate inhibits dihydrofolate reductase (DHFR) and

associated with anticancer therapy.
•• Drug of choice to prevent neutropenia is filgrastim.
91. Ans. (c)  Causes upregulation of Her2/neu
(Ref: Goodman Gilman 12th E/P1737)
92. Ans. (a)  CD20
(Ref: Goodman Gilman 12th E/P1745)
93. Ans. (d)  Methotrexate
(Ref: Harrison 19th E/P716)
Drugs used in multiple myeloma:
•• Lenalidomide along with dexamethasone is the treatment of
choice for multiple myeloma. Thalidomide though can be
used, is less preferred than lenalidomide.
Anticancer Drugs
thereby inhibits conversion of DHFA to THFA.
•• Since THFA is required for synthesis of purine, methotrexate
also inhibits purine synthesis.
97. Ans. (b)  Cyclophosphamide, (c) Busulfan, (e) Ifosfamide
(Ref: GOODMAN Gilman 12th E/P1683)
Gonadotoxicity is maximum with alkylating agents and hence
options a, c and e are answers as these are only alkylating agents
in options.
98. Ans. (a)  Cisplatin
(Ref: Goodman Gilman 12th E/P1689)
99. Ans. (b)  Oral bioavailability is less
(Ref: Goodman Gilman 12th E/P1721)

/e
•• Bortezomib is used in case of resistant cases.
•• Melphalan is less preferred now a days, though it can be 100. Ans. (a)  Antineoplastic drug, (d) Anthracycline antibiotic,
used in combination with dexamethasone and newer agents (e) Cardiotoxic

,3
like bortezomib and lenalidomide. (Ref: Goodman Gilman 12th E/P1714)

94. Ans. (b)  Cisplatin, (d) Vincristine

101. Ans. (a)  Ototoxic, (b) Nephrotoxic, (d) Neurotoxic

y
(Ref: CMDT 2018/P1677-84) (Ref: Goodman Gilman 12th E/P1689)
og
•• Most anticancer drugs which act on cell cycle cause bone
marrow suppression and it is the most common dose 102. Ans. (b)  Imatinib, (c) Erlotinib, (d) Nilotinib
limiting toxicity of anticancer drugs.
(Ref: Goodman Gilman 12th E/P1732)
ol
•• However some anticancer drugs which are bone marrow
sparing are
ƒƒ Cisplatin 103. Ans. (b)  Bususlfan, (e) Chlorambucil
ac

ƒƒ Vincristine (Ref: Goodman Gilman 12th E/P1682)

ƒƒ Bleomycin
104. Ans. (a)  Sterility, (c) Sensory & motor neuropathy,
m

95. Ans. (a)  Azathioprine, (b) Methotrexate, (c) Fludarabine,

(e) Secondary malignancy
(d) 6-Mercaptopurine
(Ref: Goodman Gilman 12th E/P1687)
ar

(Ref: Goodman Gilman 12th E/P1701-05)

Answers and Explanations to Multiple Choice Questions

MOPP regimen
•• Purine synthesis is inhibited by purine analog anticancer
•• MOPP is an older regimen used for treatment of Hodgkin)
drugs like
Ph

slymphoma, which has been replaced by ABVD regimen.

ƒƒ 6-Mercaptopurine
•• The drugs in MOPP regimen and their toxicities are
ƒƒ 6-Thioguanine
ƒƒ Mechlorethamine: Secondary leukemia, sterility
ƒƒ Fludarabine
ƒƒ Oncovin (Vincristine): Peripheral neuropathy, SIADH
ƒƒ Cladribine
ƒƒ Procarbazine: Disulfiram like reaction
ƒƒ Pentostatin
ƒƒ Prednisolone: Steroid related side-effects
•• Azathioprine is an immunomodulator, which is a prodrug
of 6-Mercaptopurine and hence also inhibits purine 105. Ans. (d)  Acrolein is toxic form of Cyclophosphamide, (e)
synthesis. Pentostatin-inhibit adenosine deaminase
•• Methotrexate inhibits activation of folic acid in to DHFA
which is required for purine synthesis and hence it also (Ref: Goodman Gilman 12th E/P1683 and 1704)
inhibits purine synthesis.
106. Ans. (a) Dexamethasone, (b) Ondansetron, (c) Palonose-
•• Mycophenolate mofetil is an immunomodulator
tron, (e) Metoclopramide
which inhibits purine synthesis by inhibiting inosine
monophosphate dehydrogenase. (Ref: Goodman Gilman 12th E/P1689)

96. Ans. (a)  Purine synthesis, (c) Conversion of DHFA to THFA 107. Ans. (e)  Adriamycin
Ref: Goodman Gilman 12th E/P1692 (Ref: Harrison 19th E/P103e-25)

427
 Anticancer drugs causing maximum alopecia 115. Ans. (a)  Cisplatin, (b) Pyridoxin excess
Conceptual Review of Pharmacology

•• Anthracyclines
•• Alkylating agents (Ref: Goodman Gilman 12th E/P1689)
•• Topoisomerase inhibitors
Anticancer Drugs Causing Neuropathy
108. Ans. (a)  Methotrexate
M phase specific drugs
(Ref: Goodman Gilman 12th E/P1692)
•• Vinka alkaloids (Vincristine > Vinorelbine > Vinblastine):
Sensory, motor and autonomic or mixed
109. Ans. (a) Cell cycle non specific agents- can act on any
•• Taxanes (Nab paclitaxel > Paclitaxel): Sensory
phase of cycle including G0, (b) Mitosis during cell division
•• Epothilones (Ixabepilone): Sensory
– devoted to DNA replication, (c) No mitotic activity –G0
Platinum compounds (Cisplatin and Oxaliplatin: Sensory and
phase, (d) Cytarbine act on S phase of cell cycle
motor
(Ref: Goodman Gilman 12th E/P1672) Pyrimidine analogs: Fludarabine and Nelarabine
Bortezomib
110. Ans. (a)  Isosfamide, (b) Chlorambucil, (d) Nitrosoureas
(Ref: Goodman Gilman 12th E/P1682) 116. Ans. (a) Dose limiting mucositis, (b) Dose limiting
Myelosuppression, (c) DNA damage (cross linking of DNA)

/e
111. None
(Ref: Goodman Gilman 12th E/P1732-40) 117. Ans. (a)  Midostaurin

,3
•• Erlotinib: Anti EGFR TK inhibitor (Ref: https://www.centerwatch.com/drug-information/fda-
•• Trastuzumab: Anti Her-2 MAb approved-drugs/drug/100200/rydapt-midostaurin)
•• Cetuximab: Anti EGFR MAb Midostaurin is a multikinase inhibitor approved by FDA in
•• Rituximab: Anti CD20 MAb

y
2017 for treatment of four disorders.
•• Omalizumab: Anti Ig E MAb •• Acute Myelogenous Leukemia (AML) which is FLT-3
og
mutation positive – Midoastaurin is to be combined with the
112. Ans. (a)  Bleomycin, (c) Mitomycin, (d) Actinomycind
standard drugs for AML i.e. cytarabine and daunorubicin.
(Ref: Goodman Gilman 12th E/P1712) •• Aggressive Systemic Mastocytosis (ASM)
ol
•• Mast Cell Leukemia
113. Ans. (c)  Decreased purine synthesis •• Systemic mastocytosis with associated hematological
neoplasm (SM-AHN)
ac

(Ref: Goodman Gilman 12th E/P1693)

Uses of methotrexate 118. Ans. (a)  Proteasome inhibitor
Neoplastic uses (Due to Non neoplastic uses (Due to (Ref: Goodman Gilman 12th E/P1742)
m

inhibition of DNA Synthesis) Inhibition of Purine Synthesis)

•• Proteasome is responsible for stimulating cell survival
Choriocarcinoma: Drug of Rheumatoid arthritis: DMARD mechanisms by increasing NF-kβ activity. Hence proteasome
ar

choice of choice inhibitors decrease NF-kβ which leads to cell apoptosis.

Answers and Explanations to Multiple Choice Questions

Osteosarcoma: High doses of Ectopic pregnancy: Used with •• Bortezomib and carfilzomib are the drugs in this class,
methotrexate with leucovorin misoprostol indicated for treatment of drug resistant multiple myeloma
Ph

rescue GVHD and mantle cell lymphoma.

Non-Hodgkin) s lymphoma Psoriasis
•• Most common side-effect is thrombocytopenia followed by
ALL: For remission and Multiple sclerosis
peripheral neuropathy and fatigue.
consolidation Wegener) s granulomatosis
Crohn) s disease
119. Ans. (c)  Hairy cell leukemia
114. Ans. (a)  5-Fu, (b) Methotrexate, (c) Paclitaxel (Ref: CMDT 2018/P538, 546)
(Ref: CMDT 2015/P1647)
120. Ans. (b)  Cytosine arabinoside
Anticancer Drugs Causing Mucositis
•• Alkylating agents (Ref: Nelson’s Pulmonary Manifestation of Pulmonary Diseases/
•• 5-FU P66
•• Cytarabine Noncardiogenic pulmonary edema can be seen with anticancer
•• Paclitaxel drugs like
•• Methotrexate
•• Cytarabine (Cytosine arabinoside)
•• Dactinomycin
•• Doxorubicin and daunorubicin •• Methotrexate
•• Hydroxyurea •• Cyclophosphamide

428
 Uses of ibrutinib 133. Ans. (a)  Cisplatin

Anticancer Drugs
•• Chronic lymphocytic leukemia
•• Waldenstorm macroglobulinemia – A form of low grade (Ref: Goodman Gilman 12th E/P1689)
NHL.
134. Ans. (a)  Vincristine
121. Ans. (c)  Intrathecal methotrexate
•• Bleomycin
(Ref: Goodman Gilman 12th E/P1694) •• Vinblastine
Intrathecal administration can cause neurotoxicity in the form •• Tyrosine kinase inhibitors (Nilotinib and Ponatinib)
of •• Cisplatin (rare cause)
•• Arachnoiditis
135. Ans. (b)  Rituximab
•• Meningismus
•• Seizures. (Ref: Goodman Gilman 12th E/P1745)

122. Ans. (a)  5FU+Cisplatin 136. Ans. (c)  Dihydrofolate Reductase [DHFR]
(Ref: Goodman Gilman 12th E/P1689) (Ref: Goodman Gilman 12th E/P1689)

123. Ans. (a)  GIST 137. Ans. (a)  Vinca alkaloids

/e
(Ref: Goodman Gilman 12th E/P1734) (Ref: Goodman Gilman 12th E/P1705)

,3
124. Ans. (d)  Folic acid analogue 138. Ans. (b)  Imatinib
(Ref: Goodman Gilman 12th E/P1690) (Ref: Goodman Gilman 12th E/P1732)

y
125. Ans. (b)  Doxorubicin 139. Ans. (d)  Vincristine – Bone marrow suppression
og
(Ref: Goodman Gilman 12th E/P1714) (Ref: Goodman Gilman 12th E/P1706)
126. Ans. (b)  Imatinib mesylate
140. Ans. (a)  Folinic acid enhance its anticancer activity
ol
(Ref: Goodman Gilman 12th E/P1734)
(Ref: Goodman Gilman 12th E/P1691)
Folic acid and Leucovorin use with anticancer drugs:
ac

127. Ans. (a)  Cisplatin

•• Methotrexate/Pemetrexed – To decrease toxicity.
(Ref: Goodman Gilman 12th E/P1689) •• 5-FU – To increase anticancer effect.
m

128. Ans. (a)  Carmustine-Alkylator 141. Ans. (c)  Cisplatin

(Ref: Goodman Gilman 12th E/P1686) (Ref: Goodman Gilman 12th E/P1689)
ar

Carmustine is a nitrosourea group of alkylating agent.

Answers and Explanations to Multiple Choice Questions

142. Ans. (c)  Folinic acid
129. Ans. (c)  Cisplatin-Hepatotoxicity
Ph

(Ref: Goodman Gilman 12th E/P1691)

(Ref: Goodman Gilman 12th E/P1689)

130. Ans. (b)  Aprepitant 143. Ans. (c)  Adriamycin

(Ref: Harrison 19th E/P103e-25) (Ref: Goodman Gilman 12th E/P1714)

131. Ans. (d)  Cyclophosphamide 144. Ans. (a)  Bleomycin

(Ref: Goodman Gilman 12th E/P1683) (Ref: Goodman Gilman 12th E/P1682)

132. Ans. (c)  Hydroxyurea 145. Ans. (d)  BCR-ABL Tyrosine kinase inhibitor

(Ref: Harrison 19th E/P649 (Ref: Goodman Gilman 12th E/P1732)

Some drugs cause megaloblastic anemia because of inhibition
146. Ans. (d)  Gemcitabine
of DNA replication and not deficiency or abnormality of folic
acid or cobalamin and hence won)  t respond to these. These are: (Ref: Goodman Gilman 12th E/P1701)
•• Hydroxyurea
•• Cytarabine Radiosensitizing Anticancer Drugs
•• 6-MP •• 5-FU

429
 •• Gemcitabine 151. Ans. (b)  Increased polymerization of microtubules
Conceptual Review of Pharmacology

•• Hydroxyurea
•• Mitomycin-C (Ref: Goodman Gilman 12th E/P1707)
•• Cisplatin
152. Ans. (d)  Spiramycin
147. Ans. (b)  Imatinib (BCR-ABL Tyrosine kinase inhibitor)
(Ref: Goodman Gilman 12th E/P1713-14)
(Ref: Goodman Gilman 12th E/P1732)
153. Ans. (a)  Leg ulcer
148. Ans. (d)  Cisplatin
(Ref: Goodman Gilman 12th E/P1722)
(Ref: Goodman Gilman 12th E/P1689, 1698 and 1714) •• Painful leg ulcers can be seen with hydroxyurea, specifically
in eldely patients.
Cardiotoxic Anticancer Drugs
•• Flagellate hyperpigmentation is streaks of pigmentation
•• Anthracyclines: Maximum with doxorubicin and daunoru- seen with bleomycin.
bicin
•• Trastuzumab 154. Ans. (c)  Cyclophosphamide
•• 5-FU: Causes coronary vasospasm and precipitate ischemia.
•• Cyclophosphamide: At high doses (Ref: Goodman Gilman 12th E/P1681)

/e
149. Ans. (a)  Hepatic fibrosis 155. Ans. (b)  Vincristine
(Ref: Goodman Gilman 12th E/P1706)

,3
(Ref: Goodman Gilman 12th E/P1694)
•• Hepatic fibrosis/cirrhosis is seen on low dose, long term use
as in case of psoriasis and rheumatoid asrthritis. 156. Ans. (a)  Methotrexate toxicity

y
(Ref: Goodman Gilman 12th E/P1691)
150. Ans. (a)  Diabetic retinopathy
og
(Ref: Goodman Gilman 12th E/P1739) 157. Ans. (a)  Methotrexate

Uses of Bevacizumab (Ref: Goodman Gilman 12th E/P1691)

ol
•• Renal cell cancer
158. Ans. (b)  Vincristine
•• Diabetic retinopathy
•• Deafness associated with NF-II.
ac

(Ref: Goodman Gilman 12th E/P1706)

m
ar
Answers and Explanations to Multiple Choice Questions

Ph

430

Practice Questions
159. Which of the following drug is given by rapid IV infusion?
a. Ara-C b. Mechlorethamine
c. Amphotericin B d. Cisplatin
Ans. (b)  Mechlorethamine
(Ref: Harrison 19th E/P103e-8)
160. Raltitrexed can be used for treatment of:
a. Osteosarcoma b. Mesothelioma
c. ALL d. Cutaneous T cell lymphoma
Ans. (d)  Cutaneous T cell lymphoma
Anticancer Drugs
166. Which of the following is a specific drug to prevent
chemotherapy induced mucositis?
a. Leucovorin b. Pyridoxine
c. Palifermin d. Cobalamin
Ans. (c)  Palifermin
(Ref: CMDT 2015/P1646)
167. All of the following drugs can cause alopecia except:
a. Doxorubicin b. Cyclophosphamide
c. Etoposide d. Methotrexate
Ans. (d)  Methotrexate

/e
(Ref: Goodman Gilman 19th E/P1691)
(Ref: Harrison 19th E/P103e-11)
161. A patient of testicular cancer was prescribed ifosfamide at

doses of 1200 mg/day for 5 days. What is the dose of mesna that
should be given?
a. 1200 mg/day b. 600 mg/day
c. 300 mg/day d. 2400 mg/day
,3
168. Regimen of choice for low grade Non-Hodgkin’s lymphoma is:
a. CHOP-R b. MOPP
c. FCR d. ABVD

y
Ans. (a)  CHOP-R
Ans. (b)  600 mg/day
og
(Ref: CMDT 2015/P1597)
(Ref: Goodman Gilman 12th E/P1684)
169. All are used for prevention of chemotherapy induced nausea
•• Dose of mesna is 60% of the dose of ifosfamide, which and vomiting except:
ol
comes to 720 mg in this case. a. Domperidone b. Dexamethasone
•• 600 is the closest option and best answer. c. Haloperidol d. Metoclopromide
ac

162. Mesna is given for prophylaxis of hemorrhagic cystitis by:

a. Oral route b. IV route Ans. (a)  Domperidone
c. Both d. None (Ref: CMDT 2015/P1645)
m

Ans (c)  Both 170. Which of the following anticancer drug can cause cheese
reaction?
(Ref: Goodman Gilman 12th E/P1684)
ar

a. 5-FU b. Cyclophosphamide
163. Neurotoxicity caused by cisplatin affects: c. Hydroxyurea d. Procarbazine
a. Sensory fibers b. Motor fibers
Ph

c. Autonomic fibers d. Both a and b Ans. (d)  Procarbazine

(Ref: Harrison 19th E/P103e-9)
Ans. (d)  Both a and b
171. Coasting effect can be seen with:
(Ref: Goodman Gilman 12th E/P1684)
a. Methotrexate b. Doxorubicin
164. Neurotoxicity caused by vincristine affects: c. Cisplatin d. L-Asparginase
a. Sensory fibers b. Motor fibers
c. Autonomic fibers d. All of the above Ans. (c)  Cisplatin
(Ref: Goodman Gilman 19th E/P1689)
Ans. (d)  All of the above
172. Cisplatin can be inactivated by which metal:
(Ref: CMDT 2015/P1648)
a. Steel
Practice Questions

165. Which of the following drugs can cause trigeminal neuralgia? b. Platinum
a. Cyclophosphamide b. Methotrexate c. Aluminium
c. Vincristine d. Doxorubicin d. Copper

Ans. (c)  Vincristine Ans. (c)  Aluminium

(Ref: CMDT 2015/P1648) (Ref: Goodman Gilman 19th E/P1689)

431
 173. Oxaliplatin has synergism with: 181. When given along with allopurinol, the dose of 6-MP is
Conceptual Review of Pharmacology

a. Methotrexate b. Leucovorin decreased by

c. 5-FU d. Hydroxyurea
Ans. (c)  5-FU
(Ref: Goodman Gilman 19th E/P1690)
174. Leucovorin is given along with 5-FU to:
a. Decrease toxicity b. Increase sensitivity
c. Increase metabolism d. Decrease metabolism
Ans. (b)  Increase sensitivity
(Ref: Harrison 19th E/103e-14)
175. AVBD regimen is used for treatment of:
a. NHL b. Hodgkin’s disease
c. CLL d. AML
Ans. (b)  Hodgkin’s disease
a. 15% b. 25%
c. 50% d. 75%
Ans. (d)  75%
(Ref: Goodman Gilman 19th E/P1702)
182. Bone marrow suppression is not seen with:
a. Vinblastine b. Vincristine
c. Vinorelbine d. Cisplatin
Ans. (b)  Vincristine
(Ref: Goodman Gilman 19th E/P1706)
183. Cremophor vehicle is used for injecting:
a. Paclitaxel b. Nab-Paclitaxel
c. Docetaxel d. Cabazitaxel

/e
Ans. (a)  Paclitaxel
(Ref: CMDT 2015/P1597)
(Ref: Goodman Gilman 19th E/P1707)

176. Which of the following antibiotic can cause secondary
leukemia?
a. Doxorubicin b. Daunorubicin
c. Mitoxantrone d. Epirubicin
,3
184. Drug of choice for imatinib resistant GIST is:
a. Regorafenib b. Sunitinib
c. Sorafenib d. Axitinib

y
Ans. (c)  Mitoxantrone
og Ans. (b)  Sunitinib
(Ref: Harrison 19 E/P103e-13)
th
(Ref: Harrison 19th E/P536)
177. Cardiotoxicity of doxorubicin can be potentiated by all, except: 185. Most common side-effect of bortezomib is:
ol
a. Trastuzumab b. Cyclophosphamide a. Myelosuppression b. Neuropathy
c. Radiotherapy d. Methotrexate c. Mucositis d. Fatigue
ac

Ans. (d)  Methotrexate Ans. (b)  Neuropathy

(Ref: CMDT 2015/P1649) (Ref: Goodman Gilman 19th E/P1743)
m

178. All are used in testicular tumor except: 186. Mitotane has selective affinity for cells of:
a. Etoposide b. Cisplatin a. Adrenal medulla b. Adrenal cortex
ar

c. Mitoxantrone d. Bleomycin c. Both d. None

Ans. (c)  Mitoxantrone Ans. (b)  Adrenal cortex

Ph

(Ref: CMDT 2015/P1598) (Ref: Goodman Gilman 19th E/P1719)

179. Flagellate dermatitis is a side-effect of: 187. Stevens Jhonson syndrome is a side-effect of:
a. Hydroxyurea b. Bleomycin a. Rituximab b. Lapatinib
c. Cisplatin d. Mitoxantrone c. Trastuzumab d. Ofatumumab

Ans. (b)  Bleomycin Ans. (a)  Rituximab

(Ref: Goodman Gilman 19 E/P1717)
th
(Ref: Goodman Gilman 19th E/P1747)
180. Resistance to 5-FU can be seen because of all, except: 188. Which of the following is drug of choice for kaposi sarcoma?
a. Thymidilate synthase induction a. Methotrexate b. Doxorubicin
b. Increased metabolism of 5FU c. Hydroxyurea d. IFN alpha
Practice Questions

c. Thymidilate synthase gene amplification

d. Decreased activation of 5-FU Ans. (b)  Doxorubicin
(Ref: CMDT 2015/P1599)
Ans. (a)  Thymidilate synthase induction
(Ref: Goodman Gilman 19th E/P1697)

432