Pharmacology
 Clarence is the volume of plasma that gets filtered
GENERAL PHARMACOLOGY
 Dose response curve is the relationship between
log of dose and response.
 Slope indicates safety, X-axis indicates potency and
height indicates efficacy.
 Teratogens are drugs that cause teratogenicity;
thalidomide is one of the very potent teratogens
(Phocomelia).
 Enalapril is a pro-drug.
 Pharmacodynamics deals with Mechanism of ac-
tion of a drug.
 Therapeutic index of a drug signifies safety mar-
gin.
 First pass metabolism is maximum with oral route.
 First order kinetics: Elimination of the drug is pro-
portional to the serum concentration.
 Orphan drugs are Drugs to treat rare diseases usu-
ally.
 MC mode of drug transport is passive diffusion.
 Vd (Volume of distribution) is hypothetical vol-
ume in which the drug is distributed in patient
body.
 Vd = dose administered/plasma concentration.
 Clarence (CL) = rate of elimination/plasma con-
centration.
 Kinetics of elimination
Zero order (amount constant)
First order (fraction constant)
of the drug in unit time.
 Half-life time taken by the drug to reduce its con-
centration by half.
 It can tell about total duration of drug action and
time to achieve plasma steady state concentration.
 Both half-life and CL remain constant in first order
kinetics while both change in zero order.
RESPIRATORY PHARMACOLOGY
 Dry cough is suppressed (codeine, dextro-
methorphan), while wet cough is encouraged
(with expectorant).
 Bromhexine is MC mucolytics – rhinorrohea/lacri-
mation is MC side effect.
 DOC of acute bronchial asthma is inhaled beta-2
agonist (Salbutemol).
 Corticosteroids are used for maintenance treat-
ment of asthma.
 Theophylline is a methylxanthines (inhibits PDE);
increases cAMP in smooth muscles – it is a bron-
chodilator used for poorly controlled asthma.
 MC side effect of theophylline is tremor, seizures,
hyperreflexia occurs in high doses.
 DOC for apnea in newborn – theophylline.
 Cromoglycate sodium is a mast cell stabilizer (not
absorbed orally).
 Zileuton, zafirlukast, montelukast (not used in
acute asthma) are used for aspirin induced asthma
but DOC are corticosteroids.
6.1
 MIST ALL IN ONE FOR FMGE
 Ketotifen is serotonin antagonist used for asthma
prevention.
RENAL DRUGS
 Thiazides (Act on DCT) are DOC for hypertension
as they act slowly and conserve calcium (useful in
osteoporosis) and they are DOC for diabetes in-
sipidus, Liddle’s syndrome, idiopathic
hypercalciuria.
 Thiazides (Hydrochlorthiazide is MC used) except
Pharma
metolazone and indapamide (undergo entero-
hepatic circulation) are unsafe in renal failure.
 Furosemide [Act on Loop of Hanle (Na+K+2Cl–)] is
the fastest acting (also called high ceiling diuretic).
 Hypokalemia is MC precipitating factor of digoxin
toxicity (hyperkalemia prevents it).
 Spironolactone (K+ sparing diuretic) is DOC for re-
fractor ascites; MC side effect is hyperkalemia.
 SIADH – Drugs used are Conivaptan, and
Tolavaptan.
 Mannitol is osmotic diuretic and is DOC for brain
edema (not in intracerebral hemorrhage).
 It can cause hyperkalemia, pulmonary edema and
CI in established renal failure. This is because it
can cause expansion of plasma volume.
 Demeclocycline and lithium are ADH associated
cAMP antagonists, used in syndrome of inappro-
priate ADH secretion (also called as anti-diuretic).
ENDOCRINAL DRUGS
 GnRH analogues (naferlin, goserlin, buserlin) are
DOCs to suppress gonadotropin secretions in pre-
cocious puberty, porstatic cancer, endometriosis
and fibroid uterus.
 Bromocriptine (partial agonist of D1 receptors) is
DOC for suppression of wanted lactation,
hyperprolactinemia, acromegaly (cabergoline in
pregnancy).
 Somatrem/somatropin are growth hormone ana-
logues used in short stature patients, e.g., Turner’s
syndrome (XO).
6.2
 Cosyntropin (ACTH analogue) is DOC for infantile
spasm.
 Menotropins (FHS and LH) are used in hypogonadal
states.
 Oxytocin is used to induce or augment labour; CI
renal failure, or hypertension with IHD.
 Desmopressin (V2 agonist) is DOC for craniogenic
diabetes insipidus; also useful in hemophilia and
Von Willebrand’s disease.
 Dexamethasone has maximum topical activity
while hydrocortisone has no topical activity.
 Dexamethasone/betamethasone are longest act-
ing Glucocorticoids (act for >24-36 hours); have no
salt retaining activity but have maximum anti-in-
flammatory activity.
 Des-oxy-corticosterone acetate (DOCA) has no glu-
cocorticoids and is pure mineralocorticoid.
 T4 (levothyroxine) are DOCs for myxedema, cre-
tinism.
 Thioamides (propylthiouracil, carbimazole, methi-
mazole) are antithyroid drugs acting by inhibiting
thyroid hormone synthesis (thyroid peroxides).
 Propylthiouracil is most potent anti-thyroid drug
(DOC for hyperthyroidism in pregnancy and thy-
roid storm).
 MC serious side effect of anti-thyroid drugs is
agranulocytosis (indicated by sore throat or fever-
withdraw the drug).
 Lugol’s iodine acts by inhibiting release of thyroid
hormones (DOC for making gland firm before sur-
gery).
 Radioactive iodine (I131 acts by delivering beta and
gamma rays); destroys thyroid gland and is CI in
young patients.
 Insulin is a polypeptide with mol. weight (5000)
acting by tyrosine kinase receptors
(autophosphorylation receptors) – Banting and
Best discovered it.
 Inhibits phosphoenol carboxykinase, phosphory-
lase (muscle and liver); stimulates hexokinase and
Lipoprotein Lipase (LPL).
 MC side effect is hypoglycemia, beta-blockers can
cause silent hypoglycemia.
 PHARMACOLOGY
 Human insulin causes lipoatrophy of skin; zinc is
added to insulin to increase shelf-life and stabil-
ity of solution.
 Insulin lispro is shortest acting while insulin
Glargine is longest acting.
 Insulin Glargine is Peakless insulin.
 Sulphonylureas increase insulin release also in-
crease insulin sensitivity.
 Chlorpropamide – S/E (hypoglycemia is most
likely, causes SIADH, disulfiram like reaction).
 Bigunides (Metformin and phenformin) act by in-
hibiting hepatic output of glucose (inhibit glyco-
genolysis).
 Metformin causes less lactic acidosis, does not
cause hypoglycemia, and is DOC for obese diabetic
patients. (MC – S/E – dyspepsia).
 Acarbose is alpha-glucosidase inhibitor, hypogly-
cemia is a mild problem.
 Thiazolidinediones (troglitazone, pioglitazone)
are insulin sensitizers.
 Meglitinide derivatives act in same manner as
sulfonylureas.
GASTROINTESTINAL DRUGS
 Apomorphine is used to produce vomiting in poi-
soning via parenteral route, while ipecacuanha via
oral route.
 Induction of vomiting is contraindicated in kero-
sene poisoning, acid and alkali poisoning – due to
fear of aspiration and perforation.
 Metoclopramide is MC used antiemetics but is D2
blocker, therefore causes hyperprolactinemia, and
extrapyramidal side effects.
 Domperidone blocks D2 receptors only in CTZ cen-
ter and not in basal ganglia, therefore does not
cause EPS (can even be used in Parkinson patients).
 Cisapride is a promotility (prokinetic or motility
enhancing) drug with no antiemetics activity.
 Cisapride given with enzyme inhibitors such as
erythromycin, azoles, ciprofloxacin can cause torsa
de depointes.
 Mosapride, itopride etc. are free from torsades
de pointes.
 Cimetidine is the oldest and most toxic H2 blocker
(causes gynecomastia and taste disturbances-
dysgusia-ACE I also cause it).
 Ranitidine is free from gynaecomastia.
 Antacids are fast acting anti-ulcer drugs but re-
lapse rate is high-aluminum containing antacids
cause constipation and intestinal obstruction.
 Aluminum phosphate is used as a phosphate
binder in CRF.
Pharma
 Magnesium oxide (milk of magnesia) cause diar-
rhea.
 Omeprazole, rabeprazole, esomeprazole,
pantoprazole etc., drugs are PPIs and are DOCs for
all acid related conditions (e.g., dyspepsia, ulcers,
reflux esophagitis, Zollinger Ellison’s syndrome).
Except stress induced ulcer (DOC-H2blocker-
Ranitidine).
 Misoprostol (PGE1) is an ulcer protective drug; pre-
viously, it was DOC for NSAID induced ulcers now
PPIs are DOCs.
 Bismuth subcitrate, deglycyrrhized liquorice (has
mineralocorticoid effect aldosterone like effect)
are ulcer healing drugs; bismuth has anti-H. pylori
activity but can cause encephalopathy and osteod-
ystrophy.
 Clarithromycin + Amox/MTz + PPI are combination
therapy (triple therapy) for eradication of H. py-
lori.
 Loperamide (a synthetic opioid-LOMOTIL) is the
DOC for functional diarrhoea (non-infectious, e.g.,
travelers diarrhea) – it is free from disadvantages
of opioids, e.g., respiratory depression as it does
not enter BBB.
 Physillium, bran are bulk laxatives – form bulk in-
duce laxative effect.
 Lactulose is osmotic laxative – used in hepatic en-
cephalopathy.
 PEG (polyethylene glycol) solution is used to clean
bowel for colonoscopies.
 Colestipol/cholestyramine are used for bile acid
induced diarrhea.
6.3
 MIST ALL IN ONE FOR FMGE
 DOSSS (dioctyl sodium sulfosuccinate) is deter-
gent like drug for used for softening stool-
bisacodyl also has similar effect.
 Co-trimoxazole/fluoroquinolones are antibiotics
used in Shigella dysentery; otherwise antibiotics
are avoided in diarrheas.
 Daptomycin (Protein synthesis inhibitor),
triglycline (Antibiotic of tetracycline class),
delbavancin (long acting antibiotic), vancomycin,
linezolid, teichoplanin, cotrimoxazole,
ciprofloxacin, streptogramins (dalfoprisin+
quinupristin) ceftipiribole (5th generation cepha-
Pharma
losporin) are antibiotics against MRSA.
 DOC for irritable bowel syndrome – SSRI.
Lubiprostone
CARDIOVASCULAR DRUGS
 Nitrates are the DOC of initial choice for all sorts
of angina pain.
 Nitrates act by delivering NO (Nitric Oxide) and
are mainly venodilators.
 Beta-blockers are contraindicated in variant an-
gina (would cause unopposed vasospasm).
 MC side effect of nitrates is headache or postural
hypotension (tolerance develop with nitrates on
regular use).
 DOC for hypertension with BPH is Terazocin/
Prazocin. Prazocin is also DOC for scorpion sting.
 DOC for hypertension with diabetes/nephropa-
thy or normal renin hypertension is ACE inhibits
(MC side effect – cough, also cause hyperkalemia,
CI in bilateral renal artery stenosis).
 ACE inhibitors are now initial DOC for compensa-
tory heart failure and contraindicated in pregnancy.
 Alpha-blockers of selective type (Prazocin,
Terazocin) do not cause reflex tachycardia (non-
selective type, e.g., phentolamine cause it).
 Quinidine can increase plasma levels of digoxin.
 Procainamide is MC drug causing drug induced SLE
(kidney is not involved).
 Amiadarone is the most efficacious, broadest spec-
trum and longest-acting (t½ = 70 days) anti-arrhyth-
6.4
mic drug. Its one of the side effect is pulmonary
fibrosis – it also causes hypothyroidism and hy-
perthyroidism.
 Sotalol is beta-blocker with K+ channel blocking
activity.
 Adenosine is the shortest acting anti-arrhythmic
drug (<10 seconds) and is DOC for paroxysmal su-
praventricular tachycardia.
 Digoxin (t½ = 24-36 h) is MC used cardiac glyco-
side, excreted unchanged from kidney. Therefore,
CI in renal failure. Digitoxin (t½ = 165 h) under-
goes enterohepatic circulation and is safe in renal
failure (CI in hepatic failure).
 Digoxin acts by inhibiting Na+K+ATPase and there-
fore increases cardiac contractility; heart rate is
not increased (rather, decreased due to AV block).
 Digoxin is CI in obstructive cardiomyopathy, aortic
stenosis, ventricular tachycardia and partial heart
block (it is safe in full heart block).
 MC precipitating factor of digoxin toxicity is hy-
pokalemia (hyperkalemia is protective).
 DOC for digoxin toxicity is potassium (CI in over-
dose).
 DOC for overdose of digoxin toxicity is DIGIBAND
(Fc fragment of digoxin binding antibody).
 Esmolol is shortest acting beta-blocker (t½ = <10
minutes); metabolized in plasma therefore is safe
in renal/hepatic failure (Nadolol is longest acting
beta-blocker).
 ANS (Nadolol, Atenolol, Sotalol) are water soluble
beta-blockers and are excreted unchanged
through kidney (CI in renal failure).
 PALM (Propranolol, Pindolol, Acebutolol,
Labetalol, Metoprolol) are beta-blockers with lo-
cal anesthetic activity.
 MC side effect of beta-blockers is bradycardia, they
can also cause AV nodal block, depression, sui-
cidal tendencies, nightmares, hyperlipidemia,
impotence and worsening of asthma, diabetes
and peripheral vascular disease. All non-selective
blockers (propranolol, sotalol, nadolol and
timolol) are CI in pregnancy while cardioselective
(atenolol, metoprolol, bisoprolol, betaxolol and
esmolol) are safe in pregnancy.
 PHARMACOLOGY
 Beta-blockers with ISA (alprenolol, oxprenolol,
pindolol, carteolol, celiprolol, penbutolol) have
no adverse effect on lipid profile and they do not
cause bradycardia.
 Carvedilol (antioxidant property), labetalol (DOC
for aortic dissection) and dilevalol are combined
acting beta blockers. Carvedolol is the DOC for
cardioprotection in CHF.
 Statins are MC used hypolipidemic drugs and DOC
for hypercholesterolemia (others are fibric acid
derivatives–clofibrate, fenofibrate, niacin, bile
acid derivatives – cholestyramine, colestipol).
 Colestipol – DOC for hypertriglyceridemia.
 Statins (Atorvastatin, Lovastatin (prodrug),
Simvastatin (prodrug), pravastatin) are inhibitors
of HMG CoA reductase (LDL receptor
overexpression occurs – seen also with bile acid
binding resins).
 MC side effect of statins is increase in CPK (10%
cases), many have muscle pain or myoglobinuria.
 MC side effect of nicotinic acid is flushing – also
causes hyperuricemia (only drug to increase HLD
levels).
 Esmolol is the shortest acting beta-blocker.
 Calcium channel blocker causing cerebral vasodi-
latation is nimodipine and DOC for SAH.
 ACE inhibitors are contraindicated in Renal artery
stenosis.
 DOC for paroxysmal supraventricular tachycardia
is adenosine.
 Recommended step in salicylate toxicity is Alka-
line diuresis.
 Both arteriolar and venodilator drug is Sodium ni-
troprusside.
 Dopamine, in renal doses, in shock leads to Dila-
tation of renal vasculature.
 Furosemide mechanism of action in LVF is inhibi-
tor of Na+K+Cl– ion symport and venodilation.
 Metoprolol is preferred over Propranolol as it is
more potent in blocking beta-1 receptors.
AUTONOMIC NERVOUS SYSTEM
 Botulinum toxin reduces release of acetylcholine.
 Acetylcholine is metabolized by AchEsterase.
 Bethanechol (direct acting cholinomimetic) is used
in Hirshprung’s disease, achalasia cardia and post-
operative urinary retention.
 Neostigmine is DOC for post-operative recovery
from non-depolarizing blockers, cobra bite and
paralytic ileus and postop retention of urine.
 DOC for organophosphate poisoning is atropine;
Pharma
cholinesterase re-activators, e.g., pralidoxime,
obidoxime can also be used.
 Atropine is C.I. in amanita muscaria poisoning.
 Glycopyrrolate is atropine substitute specially use-
ful for older patients undergoing surgery as it is
more cardiostable.
 DOC for myasthenia gravis – pyridospigmire.
 Hyosine butylbromide (Buscopan) is used com-
monly as anticholinergic drug for abdominal pain
of spasmodic type.
 Dicyclomine has both antiemetics and anti-mo-
tion sickness property.
 Hyoscine (levo-scopolamine) is DOC for motion
sickness and has amnesic properties (was used
post world war-2 to produce amnesia).
 DOC for angioedema, anaphylactic shock, cardiac
arrest – Adrenaline.
 Dobutamine (beta1 agonist-does not act on dopam-
ine receptors) is DOC for pump failure (e.g., fol-
lowing AMI, heart surgery) and cardiogenic shock.
 Phenylephrine is the drug that produces mydria-
sis without cycloplegia.
 DOC for postural hypotension – Midodrine.
 DOC for attention deficit hyperkinetic disorders –
Methylphenidate.
 DOC for nocturnal enuresis due to its water reten-
tion property – Desmopressin.
 DOC for hypotension induced by spinal anesthe-
sia – Ephedrine.
 Alpha-blockers are of two types (selective and
non-selective).
6.5
 MIST ALL IN ONE FOR FMGE
 Prazocin, terazocin are selective alpha1 blockers
that do not cause reflex tachycardia as they do not
increase release of norepinephrine.
 First dose hypotension is MC side effect of alpha
blockers; they do not increase lipid levels like beta-
blockers rather reduce them.
DRUGS FOR CENTRAL NERVOUS
SYSTEM DISEASES
 Diazepam is MC used sedative and hypnotic with
t½-100; it is DOC for febrile seizures. Drug induced
Pharma
hyperactivity, picrotoxin poisoning, prevention of
seizures due to lidocaine, emergence delirium
due to ketamine and excitement of mania-
flumazenil is antidote of diazepam.
 LEO (Lorazepam, Estazolam, Oxazapam) are short
acting benzodiazepines.
 Benzodiazepines cause anterograde amnesia
(head injury causes retrograde amnesia).
 Cholordiazepoxide (high dose) is DOC for alcohol
withdrawal from alcohol; diazepam is however for
delirium tremons.
 Flunitrazepam is date rape drug; chloral hydrate
(dry wine), ketamine and GHB are other drugs for
same purpose.
 Phenytoin acts by inhibiting depolarizing shift in
neurons; MC side effect is gum hypertrophy; oth-
ers are hirsutism, osteomalacia, megaloblastic
anemia (do MCV testing), pseudolymphoma and
hypersensitivity (discontinue the drug).
 Carbamazepine is DOC for neuralgias (trigeminal)
and partial seziure; MC side effect is rash (10%),
leukopenia and hepatitis.
 Valproic acid is broadest spectrum antiepileptic
drug; DOC for GTCS, a kinetic, atonic, myclonic and
mixed epilepsies; causes hepatotoxicity mainly in
children, weight gain.
 Phenobarbitone is CI in acute intermittent por-
phyria.
 Buspirone is a non-sedative anxiolytic drug that is
devoid of properties possessed by diazepam such
as muscular relaxation, amnesia, sedation, anti-
6.6
convulsant action etc. Its main drawback is that it
takes two weeks to start its action therefore is
used in maintenance of patients with generalized
anxiety disorders rather than in acute phase.
 Thiopentone is highly lipid soluble (MC inducing
agent), barbiturate that undergoes redistribution.
 Donepazil is the DOC for Alzhiemer’s disease, a
organic brain disease (MC cause of dementia); oc-
curs due to acetylcholine deficiency.
 Levodopa is most effective anti-parkinson drug,
only drug that lowers mortality and is DOC.
 Amantidine (also an antiviral drug – Influenza A2)
enhances dopamine transmission (MC side effect
is ankle edema) – CI in renal failure and epilepsy.
 Morphine was isolated by Serturner from poppy
plant it is analgesic and antitussive.
 Pethidine is synthetic opioid that has anticholin-
ergic property (causes mydriasis) while other opio-
ids cause meiosis.
 Pethidine gets accumulated in renal failure caus-
ing hyperreflexia and seizures; this is known as
norpethidine syndrome.
 Buprenorphine is the longest acting opioid that
has alcohol anti-craving properties (methadone is
DOC for opioid detoxtification).
 Naloxone (most potent opioid antagonist) is DOC
for opioid toxicity.
 Morphine is 2nd DOC for acute pulmonary edema
(DOC is furosemide).
 Opioids do not have anti-inflammatory properties
but are useful in severe pain of visceral origin as
they work by reducing the release of substance P
from spinal cord’s substantia gelatinosa.
 Histamine’s maximum amount is found in lung
mast cells (90% of body’s histamine is present
there).
 Older anti-histaminics are better for urticaria and
itching due to their anticholinergic effects while
newer ones are better for sneezing and common
cold etc.
 Cetrizine is a metabolite of Promethazine but is
devoid of sedative effect at usual therapeutic
doses (in some it produces sedation).
 PHARMACOLOGY
 Promethazine (phenargan) is DOC for drug induced
extrapyramidal disturbances.
 Sumatriptan, a 5-HT1b/1d partial agonist is the DOC
for acute attack of migraine; propranolol is DOC
for prevention of migraine.
 Sumatriptan can cause vasospasm, therefore is
contraindicated in hypertension, angina and pe-
ripheral vascular diseases patients.
 Disulfiram (metronidazole has disulfiram like ef-
fect) has is alcohol dehydrogenase inhibitor and
useful to prevent alcohol relapse.
 Legal limit of alcohol – level below 0.003 gm/dl is
permissible and more than 0.4 gm/dl is fatal.
 Ethylene glycol poisoning shows presence of ox-
alate crystals in urine.
 Fomepizole/ethanol are DOC for methyl alcohol
poisoning (causes blindness due to optic atrophy)
and ethylene glycol poisoning.
ANTIBIOTICS
 Tetracyclines cause deformities of bones and teeth
(maximum damage between, 3-6 years) – CI, preg-
nancy lactation and children below 8 years.
 Doxycycline and demeclocycline cause photosen-
sitivity.
 Chloramphenicol causes grey baby syndrome
which occurs due to defective glucoronidation.
 Erythromycin is MC used macrolides that causes
diarrhea and hepatitis (more in pregnant women-
specially estolate salt); acts on motilin receptors,
increase intestinal motility.
 Fluroquinolones such as ciprofloxacin (has anti-
pseudomonal activity) are used in typhoid fever
but damage growing cartilages; therefore are
avoided in children <17 year age.
 Gatifloxacin and sparfloxacin prolong QT interval
and trofloxacin cause hepatitis.
 Levofloxacin and pefloxacin cause photosensitiv-
ity.
 Sulphonamides are contraindicated in newborns
because they cause jaundice due to albumin dis-
placement.
 Vancomycin is DOC for MRSA, causes ototoxicity,
nephrotoxicity, MC side effect is red man syn-
drome.
 Cotrimoxazole act by sequential blockade, and is
the DOC for pneumocystis carinii, Whipple’s dis-
ease and nocardiosis.
 Spiramycin is DOC for toxoplasmosis in pregnancy.
 Sulfadiazine + pyrimethamine is DOC in non-preg-
nant women for toxoplasmosis.
 Fluoroquinolones inhibit DNA gyrase
(topoisomerase-2), and damage cartilages (C/I
Pharma
children <17 year).
 Levofloxacin and Pefloxacin cause photosensitiv-
ity.
 Methicillin causes interstitial nephritis, acid labile.
 Methoxypenicillin (Penicillin V) is acid stable,
given orally.
 Penicillins are excreted unchanged by tubular se-
cretion.
 Probenacid can be given to prolong penicilin du-
ration.
 Ampicillin causes rashes in patients with infec-
tious mononucleosis and with allopurinol.
 MC side effect of ampicillin is diarrhea.
 Ampicillin is DOC for listeria meningitis.
 Imipenem is DOC for enterobacter and broad spec-
trum antibiotic of penicillin class.
 Ceftriaxone is the longest acting cephalosporine
and is DOC for H. influenza, meningitis (except
listeria), gonorrhea and typhoid fever.
 Aminoglycosides are ototoxic and nephrotoxic –
Gentamicin is most nephrotoxic, while strepto-
mycin is most vestibulotoxic antibiotic.
 Aminoglycosides cause misreading of t-RNA-
amino acid complex and premature termination
of chain elongation.
 Amphotericin-B is DOC for invasive or systemic
fungal infections; causes hypokalemia, nephrotox-
icity and hypersensitivity (test dose is needed).
 Itraconazole is DOC for blastomycosis and
fluconazole for coccidial meningitis (can cause
hypokalemia).
6.7
 MIST ALL IN ONE FOR FMGE
 Griseofulvin (inhibits microtubules) is DOC for
tinea capitis, due to low efficacy, its been replaced
by terbinafine in onychomycosis.
 Nevaripine and Zidovudine is used to reduce ma-
ternal to fetal transmission.
 Efavirenz+Lamividuine+tenafovir is used follow-
ing accidental needle injury while drawing blood
from HIV positive patient.
 Lamividuine does NOT cause neuropathy while
Stavudine (MC drug), zalcitabine, diadanosine
cause peripheral neuropathy. Indinavir causes re-
Pharma
nal stones.
 HIV Protease inhibitors (Nelfinavir, saquinavir,
amprenavir, lopinavir, ritonavir and indinavir etc.)
should not be used with Rifampin.
 Rifabutin can safely be used with HIV protease
inhibitors.
 MC side effect of zidovudine is anemia (avoid with
paracetamol).
 Chloroquine is DOC for malaria in pregnancy and
vivax malaria.
 Artesunate is for treatment of plasmodium
falciparum malaria.
 Mefloquine prolongs QT interval and is contrain-
dicated in heart block, psychiatric and epileptic
patients.
 Artemisinin derivatives (artether, artemether) are
fastest acting anti-malarial drugs used in severe
and resistant malaria.
 Metronidazole is DOC for giardiasis, amoebiasis
(hepatic and intestinal), trichomonas vaginalis and
gardenella vaginalis (MC–S/E nausea, metallic
taste, disulfiram like reaction).
 Paromomycin is DOC for asymptotic cyst passers.
 Emetine/Dehydroemetine are used in serious
cases with hepatic Amoebiasis but are cardiotoxic.
 INH is most rapidly acting ATT, acts on both intra
and extracellular bacteria; peripheral neuropathy
(prevented by B6) is MC side effect, also hepatitis.
 Rifampin is slowly acting ATT, acts on intermittent
growers and spurters – can sterlize cavities, cause
orangish red colouration, inhibits DNA dependent
RNA polymerase cause hepatitis.
6.8
 If given once a month or fortnightly, Rifampin pro-
duces more S/E such as cutaneous syndrome, ab-
dominal syndrome, flu like syndrome.
 Ethambutol is not metabolized, excreted un-
changed, causes interference of red-green vision
(optic neuritis – MC serious S/E) and is CI in chil-
dren below 6 years.
 Pyrizinamide causes hepatitis, hyperuricemia (as-
pirin can be used) and is slowly acting bactericidal
ATT – has cavity sterilizing activity.
 Streptomycin is bacteriocidal ATT with ototoxicity
and nephrotoxicity.
 Dapsone is used for leprosy, anemia (mostly
hemolytic) is MC side effect; also methemoglo-
binemia, megaloblastic anemia (as it is antifolate
drug). DOC for leprosy is rifampicin.
 Melarsoprol is DOC for CNS stage of African trypa-
nosomiasis.
 Suramin is DOC for hemolymphatic stage of Afri-
can trypanosomiasis.
 Nifurtimox is DOC for American trypanosomiasis.
 Amphotericin-B is DOC for leishmaniasis (both vis-
ceral and cutaneous).
 Pentamidine is used in resistant cases with vis-
ceral leishmaniasis; but causes hypotension, and
pancreatitis (diabetes may be permanent).
 Miltefostine is also effective drug against leish-
maniasis.
 Albendazole is DOC for all nematodes helminthic
infections except strongyloides (ivermectin is
DOC), W. Bancrofti (DEC is DOC) and Oncocerchiasis
(ivermectin is DOC).
 Albendazole is the DOC for neurocysticercosis.
Though, praziquantel can also be used but is not
the DOC.
ANTICANCER AND
IMMUNOSUPRESSIVE
DRUGS AND TOXICOLOGY
 Alkylating agents form covalent bonds, are radio-
mimetic agents.
 PHARMACOLOGY
 Doxorubicin is broadest spectrum anticancer drug,
causes cardio toxicity (Dexrozoxane is DOC).
 Cyclophosphamide causes hemorrhagic cystitis
(MESNA is DOC).
 Bleomycin (MC – S/E pulmonary fibrosis) causes
minimal bone marrow suppression (Imatinib –
DOC for CML) causes maximum suppression.
 Vinca-alkaloids (Vincristine and Vinblastine)
cause peripheral neuropathy.
 Cyclosporine is MC immunosuppressive drug, acts
by binding to cyclophilins and reduces expression
of IL-2.
 Azathioprine, given with allopurinol should be
used in reduced doses to avoid bone marrow tox-
icity.
 L-asparginase causes pancreatitis and hypersen-
sitivity reactions.
 Amifostine is DOC for reducing anti-cancer drug
associated toxicity.
 Dimercaprol (BAL) has two SH groups, which in-
teract with sulfhydryl containing enzymes in the
body – CI in iron and cadmium poisoning.
 EDTA is used in lead intoxication but not in Hg poi-
soning.
 Penicillamine is used for copper, lead, mercury,
zinc and is DOC for Wilson’s disease; also DOC for
cystinuria.
 Desferrioxamine (1 gm for 85 mg) is obtained from
actinomycetes-iron chelator – MC side effect is
hypotension on IV injection.
 Deferiprone-new iron chelator for patients with
multiple blood transfusion.
 MC Anticancer drug used – Cisplatin.
NON-STEROIDAL ANTI-INFLAMMATORY
DRUGS, ANTIGOUT, DMARDS
AND AUTACOIDS
 Aspirin is most commonly used NSAID, it has anal-
gesic, antipyretic, anti-inflammatory, anti-plate-
let and uricosuric actions.
 Aspirin is longest acting anti-platelet drug acting
for more than 72 hours; its antiplatelet in low
doses.
 In aspirin poisoning; metabolic acidosis is seen in
children while metabolic alkalosis is seen in adults.
 Sodium bicarbonate is used to treat aspirin poi-
soning.
 N-acetyl cysteine is used to treat paracetamol poi-
soning.
 Aspirin is contraindicated in ulcer patients, bleed-
Pharma
ing disorders, patients with nasal polyp, asthma
and children with viral fever (Due to fear of Reye’s
syndrome metabolic encephalopathy).
 Ibuprofen is safest oldest NSAID causes toxic am-
blyopia.
 Indomethacin is most toxic NSAID; MC side effect
is frontal headache (50% cases); it is DOC for
ankylosing spondylitis, acute gout, post-coital
headache, Barter’s syndrome and closure of PDA
– it is contraindicated in drivers, machinery op-
erators, hematological, neurological and psychi-
atrically ill patients.
 COX-2 inhibitors (Celecoxib, Rofecoxib,
Valdecoxib, Parecoxib etc.) are safer newer NSAID
with less likelihood of symptomatic GI side effects
such as dyspepsia, ulcer, heartburn etc.
 H. pylori is MC cause of peptic ulcers; NSAIDs are
2nd MC cause – NSAID induced ulcers are H. pylori
negative.
 PGE2 is a bronchodilator prostaglandin.
 PGE1 (Misoprostol) used in ulcer prevention and
maintenance of patency of ductus arteriosus but
causes diarrhoea as MC side effect.
 PGF2 alpha is a vasoconstrictor of pulmonary ves-
sels, and is also used in post-partum hemorrhage
and 2nd trimester abortions.
 Probenacid and Sulfinpyrazone are uricosuric
drugs.
 Allopurinol (Xanthine oxidase inhibitor) is used
in chronic gout, hyper-uriacemia due to antican-
cer drugs, and those with gout and renal failure.
6.9
 MIST ALL IN ONE FOR FMGE
 Methotrexate is MC used DMARD; bone marrow
suppression and hepatic fibrosis are MC side ef-
fects; it is DHFR inhibitor, anti-folate.
 Cyclosporine, an immunosuppresive drug is used
as DMARD, causes hepato, nephrotoxicity but
does not suppress bone marrow.
COAGULANT-ANTI-COAGULANTS
 Vitamin K is DOC for warfarin overdose, aspirin
poisoning used with fresh frozen plasma and acts
Pharma
by increasing synthesis of factor 2, 7, 9, 10.
 MC side effect of vitamin K is flushing (K3 MC used)
K1, K3, C/I in newborn due to hemolytic jaundice.
 Warfarin is MC used oral anticoagulant, acts by in-
hibiting synthesis of factor 2, 7, 9, 10.
 MC side effect is bleeding but also cause fat and
breast necrosis which is more common in patients
with protein C or proteins S deficiency.
 Anticoagulants (both heparin and warfarin) cause
osteopenia and osteoporosis because they inhibit
carboxylation of protein osteonectin.
 Heparins (hepa: greek from liver – discovered by
McLean) are of 3 types physiological (e.g.,
danapranoid), low molecular weight (Mol. wt.
<5000) (e.g., enoxaparin, tinzaparin, dalteparin)
and high molecular weight (Mol. wt. > 10,000, e.g.,
Hirudin).
 MC side effect of heparins is bleeding; MC initial
manifestation is hematuria; long term side effects
include clotting, thrombocytopenia, osteoporosis,
alopecia.
 Heparin damages the platelets therefore the in-
jured platelets clot together leading to formation
of clot (white clot – as it is formed only by plate-
lets).
 LMWH are better because of better pharmacoki-
netics, once a day daily dosing, less chance of
bleeding or clotting leading to embolism.
 DOC for heparin overdose is protamine sulphate,
which is a basic LMWH heparin by itself (1 mg-100
IU of heparin).
6.10
 Fibrinolytic inhibitors (also called as antiplasmin
drugs) such as tranexamic acid, epsilon
aminocaproic acid, and aprotinin are used in mas-
sive bleeding.
 Thrombolytic drugs such streptokinase (DOC for
AMI) act by converting plasminogen to plasmin,
which intern degrades clots.
 MC side effect of streptokinase is hypotension-
antibodies can reduce its effectiveness.
 Urokinase and t-PA are direct plasminogen activa-
tors (do not evoke antibodies), anistreplase is long-
est acting (1-2 hours), streptokinase (20 min) and
alteplase, retiplase (<10 min).
 Bleeding is MC side effect – intracranial hemor-
rhage is most serious complication, they are con-
traindicated in-active bleed (e.g., ulcer).
MISCELLANEOUS POINTS
 Paracetamol inhibit – COX-3.
 Neutropenia after treatment of cancer can be
treated by – Filgrastin.
 Drug of choice for E. faecalis – Ampicillin.
 Antidepressant drug which is used for smoking
cessation – Bupropion.
 100% bioavailability is achieved through which
route – Intravenous.
 Side effect of which medicine can cause tremors –
Salbutamol.
 Which of the following is the Long acting bron-
chodilator – Formetrol.
 Aerosol drug used for RSV – Ribavarin.
 Which Anti-epileptic drug has high teratogenic
potential – Valproate.
 Most potent opioid is – Fentanyl.
 Most cardiotoxic anticancer drug – Anthracyclines
(Doxorubicin and daunorubicin are chemically
anthracyclines).
 Chemoprophylaxis of choice in a person who is on
a journey to endemic malaria region – Doxycycline
(DOC for short term chemoprophylaxis is doxycy-
cline and long term is mefloquine).
 PHARMACOLOGY
 Therapeutic drug monitoring is done for – Pheny-
toin.
 Oral direct thrombin inhibitor – Dabigatran.
 Which anti-asthma drug is avoided with Erythro-
mycin – Theophylline (Theophylline is metabo-
lized by microsomal enzymes and erythromycin
inhibits these enzymes, which can result in theo-
phylline toxicity).
 A patient after heart valve replacement will re-
quire follow up treatment with – Warfarin.
 Monoclonal antibody used in cancer is – Rituximab.
 Hydrochlorothiazide works by inhibiting – Na+ Cl
pump in – early DCT.
 Morphine is used in Acute left ventricular failure.
 Prolactin secretion is stimulated by TRH.
 GH secretion is inhibited by Hyperglycemia.
 Mechanism of action of allopurinol is inhibition of
Xanthine oxidase enzyme.
 Sodium cromoglycate is a mast cell stabilizer.
 Danazol is androgen derivative.
 Thalidomide is useful in treatment of type II lepra
reaction.
 Statins acts by inhibiting HMG-CoA reductase.
 Drug of choice for thyroid storm is Propylthiou-
racil.
 Muscle relaxant safe in renal failure patient is
Atracurium.
 Cimetidine, Omeprazole causes gynecomastia.
 Drug causing toxic optic neuropathy is Ethambu-
tol.
 Drug contraindicated in narrow angle glaucoma is
atropine.
 Sibutramine is used for Obesity.
 Zonal hepatic necrosis is associated with Acetami-
nophen.
 Methanol toxicity causes blindness due to the for-
mation of Formic acid.
 Disulfiram like reaction is commonly caused by
Metronidazole.
 Sterile pyuria may occur due to Paracetamol.
 Half-life of albumin is 20 days.
 Nicotinic acid is used for treatment of hypercho-
lesterolemia.
 Orally administered drug in a single dose, for sca-
bies is ivermectin.
 Antibiotics is not given in anaphylactic shock.
 High 1st pass metabolism: Nill by mouth, Nitrates,
imipramine, lignocaine, beta-blocker, Morphine,
hydrocortisone, testosterone, verapamil.
 Hemodialysis c/b done in following drug toxici-
ties – BLAST-Barbiturates, Lithium, Alcohol, Sali-
Pharma
cylates, Theophyline.
 Hemodialysis cannot be done in following drug
toxicities – BODY: Benzodiazepine, Organophos-
phate, Digitalis, Kerosine.
 DOC in PIH-Labetalol
 DOC for Atropine/datura/belladonna poisoning –
Physostigmine.
 Donepezil, tacrine, rivastigmine and galantamine
are useful in Alzheimer's disease.
 DOC for prophylaxis of migrane, performance anxi-
ety, akathesia – Propanalol.
 Propanalol can cause precipitation of bronchial
asthma, hypoglycemia, PVD, impotency.
 Ionotropic drugs act on – B1 receptor.
 Dobutamine act on – B1 receptor.
 Antipsychotic act on – D2 receptor.
 Dopamine act on – D1 receptor.
 DOC for acute pulmonary oedema – Furosemide.
 DOC for lidocaine poisoning – Diazepam.
 Antidote for BZD poisoning – Flumazenil
 H1 blocker are useful in antiallergic.
 DOC for epilepsy in pregnancy – if she is already
taking any anti epileptic – continue the same drug
with minimum possible dose. If she has to start in
pregnancy Lamotrigine > Phenobarbitone.
 DOC for anxiety disorder – SSRI.
 Side effect of SSRI – Nausea, vomiting, diarrhea
and sexual dysfunction.
 MAO inhibitor can lead to – Cheese reaction.
6.11
 MIST ALL IN ONE FOR FMGE
 DOC for cheese reaction – Phentolamine.
 MC side effect of TCA – Anticholinergic.
 Highly potent topical antipsychotic having anticho-
linergic sedation as side effect – Haloperidol.
 DOC for aspirin poisoning – Acetylcystine.
 N-acetyl cysteine is antidote for – Acetaminophen.
 Antipseudomonal drug of penicillin class –
Piperacilline.
 Non nucleoside reverse transcriptase inhibitor –
END-Efavirenz, Nevirapine, Delaveridine.
Pharma
 Nucleoside reverse transcriptase inhibitor – LAST-
Leduvidine, Abacavir, Stavudine, Tenofovir.
 Resistance to drug I TB develop by – Mutation.
 Dose of chloroquine in vivax malaria – 300 mg
weekly.
 Beta lactamase inhibitor are – Clavulanic acid,
sulbactam, tazolobactum.
 DOC for irritable bowel syndrome – Lubiprostone.
 Cholinergic drugs are C/I in bronchial asthma.
 Beta blocker C/I in asthma: Propanalol.
 Statin having longest half life: Rosuvastatin.
 Exenatide and Sitagliptin are new drugs for DM.
 Lepirudin is used in heparin induced thrombocy-
topenia.
 Heparin is safest anticoagulant in pregnancy.
 Diuretics are contraindicated in pregnancy in-
duced hypertension due to hypoperfusion.
 Levodopa is contraindicated in glaucoma.
 Ratio of sulfamethoxazole and trimethoprim in
cotrimoxazole is 5:1.
 Acetazolamide inhibits carbonic anhydrase.
 Azathioprine affects T cells.
 Drug used for hypotension during spinal anaes-
thesia is ephedrine.
 Steroids are not used in septic shock.
 Oxybutynin is indicated in urinary frequency.
 Rx of glioblastoma multiforme is temozolomide.
 Atropine is used in AV block due to digitalis toxic-
ity.
 Zinc is used in sunscreen.
6.12
 Maximum glucocorticoid activity is in dexametha-
sone.
 Morphine acts strongly on Mucopoid receptors.
 Dobutamine acts on beta adrenergic receptors.
 Indomethacin is used for closure of PDA.
 Anti TB contraindicated in pregnancy is strepto-
mycin.
 DOC for toxoplasmosis is pregnancy is spiramycin.
 DOC for candidiasis in pregnancy is topical
clotrimazole/nystatin/tolnaftate.
 DOC for asthma in pregnancy is short acting beta 2
agonist.
 Chemotherapeutic agent acting as immuno modu-
lator is levamisole.
 Pirenzepine and Telenzepine are anti-cholinergics
used to treat peptic ulcer disease.
 Strongest cycloplegic is atropine.
 Warning symptoms of hypoglycemia are palpita-
tions, tremors, sweating.
 DOC and TOC for attention deficit hyperactivity
disorder is methyl phenidate.
 Longest acting nitrate is Pentaerythrital Tetra Ni-
trate.
 Bradycardiac agent is ivabradine.
 Rosiglitazone causes myocardial infarction.
 Oral DOC for typhoid is ciprofloxacin.
 Overall DOC for typhoid is ceftriaxone.
 DOC for bird flu and swine flu is oseltamivir.
 DOC for Kala Azar is liposomal amphotericin B IV
single dose.
 DOC for Nematodes is Albendazole.
 DOC for Tapeworms is Praziquantal.
 DOC for peptic ulcer due to all causes is Proton
pump inhibitor.
 Potassium sparing diuretics are spironolactone and
epleronone.
 Ethambutol causes red green colour blindness in
children <6 years.
 Artesunate is fastest acting artemisins.
 DOC as DMARDs is methotrexate.
 PHARMACOLOGY
 TOC for warfarin induced bleeding tendancy is
fresh frozen plasma.
 DOC for acute attack of asthma is salbutamol.
 DOC for mountain sickness is acetazolamide.
 Investigational new drug application is written
before phase I trial.
 Orphan drugs are to treat rare diseases.
 Directly acting parasympathomimetic drug is pilo-
carpine.
 DOC for organophosphate poisoning is atropine.
 MC sign of atropinisation is mydriasis.
 DOC for anaphylactic shock is Adrenaline I/M
1:1000.
 Tamsulosin is 1A blocker used to treat BHP in
normotensive patient.
 Drugs used to treat postprandial hyperglycemia
are meglitinides.
 Mineralocorticoid with maximum glucocorticoid
activity is fludrocortisone.
 Glucocorticoid with maximum mineralocorticoid
activity is hydrocortisone.
 DOC for huntington’s chorea is tetrabenazine.
 DOC for acute mania is sedatives.
 DOC for prophylaxis of mania is lithium.
Pharma
 Longest SSRI is fluoxetine.
 Mood stabilizer Lithium.
6.13
 MIST ALL IN ONE FOR FMGE
RECENT YEAR QUESTIONS–1
Q. 1. The basic purpose of adding low dose proges-
terone in combined oral contraceptive pill is:
(a) To improve efficacy of contraception
(b) To reduce risk of cancer
(c) To improve compliance
(d) To prevent anemia
Q. 2. A 29 year old lady, who is a smoker is on nico-
tine therapy for deaddiction. She now requires
alternative therapy for the same, which of the
Pharma
following drug is useful:
(a) Flumazenil (b) Acamprosate
(c) Varenicline (d) Naltrexone
Q. 3. A patient suffering from Bronchial asthma
comes to you in hospital. All of the following
drugs or treatment modalities can be a part of
his management except:
(a) I.V. hydrocortisone
(b) Nebulisation by salbutamol
(c) Oxygen therapy
(d) I.V. Magnesium sulfate
Q. 4. A patient with bladder cancer on chemo-
therapy drugs, developed Tumour lysis syn-
drome and having very high level of serum
uric acid. Which of the following drugs can be
given to prevent kidney damage in this pa-
tient?
(a) Febuxostat (b) Allopurinol
(c) Mannitol (d) Rasburicase
Q. 5. A 28 year old female with first trimester preg-
nancy comes to you in hospital with high level
of T3 and T4. Which of the following drugs is
most appropriate to use?
(a) Carbimazole (b) Propylthiouracil
(c) Potassium Iodide (d) Propranolol
Q. 6. A 29 year old female with history of
hypercoagulative disorder visiting OPD for an-
ticoagulation treatment. Which of the follow-
ing drug should be avoided in first trimester
of pregnancy?
(a) Apixaban
6.14
(b) Unfractionated heparin
(c) Warfarin
(d) Low molecular weight heparin
Q. 7. Choose the best treatment for pneumonia
caused by legionella infection:
(a) Erythromycin (b) Azithromycin
(c) Vancomycin (d) Tigecycline
Q. 8. A patient suffering from Bladder cancer is on
chemotherapy taking multiple anti cancer
drugs. As cancer is not responding to the low
dose therapy, there is a need to increase the
dose of chemotherapy agents. Which of the
following drug requires monitoring of organ
function with the increasing dose?
(a) Methotrexate (b) Cisplatin
(c) Ifosfamide (d) gemcitabine
Q. 9. A young male patient suffering from mania
and on mood stabilizing drug treatment. He
also has family history of Bipolar disorder in
father and his genetic testing shows positivity
for recessive inheritance of genes involved in
mania. Which of the following mood stabilizer
he must be taking for mania prophylaxis?
(a) Valproate (b) Lithium
(c) Carbamazepine (d) Olanzapine
Q. 10. A female patient of NSTEMI taking Aspirin.
One antiplatelet drug is added to the above
treatment which is ADP receptor inhibitor to
prevent future complications. Which of the
following is the most suitable drug with above
mechanism of action?
(a) Warfarin (b) Heparin
(c) Clopidogrel (d) Streptokinase
Q. 11. A patient of NSTEMI taking Aspirin tablet 325
mg as a drug to prevent future complications.
What is the Mechanism of action of Aspirin
here?
(a) Fibrinolytics by converting plasminogen
to plasmin
(b) Anticoagulant by inhibiting conversion of
vit K dependent clotting factors to their
active form
 PHARMACOLOGY
(c) Antiplatelet by inhibition of cyclo-
oxygenane-1 enzyme
(d) Hypolipidemic by inhibiting HMG CoA
reductase enzyme
Q. 12. A young male patient who has a history of
smoking comes to you with frequent episodes
of blue discoloration of finger tips. What is
the best drug treatment advised to this pa-
tient?
(a) Calcium channel blocker
(b) Beta blockers
(c) Nitroprusside
(d) prazosin
Q. 13. A female is taking tamoxifen for the treatment
of her ER positive breast cancer. Which of the
following is the important and significant side
effect of Tamoxifen use?
(a) Cancer in opposite breast
(b) Osteoporosis
(c) Endometrial carcinoma
(d) infertility
Q. 14. A patient who has just recovered from COVID-
19 infection comes to you in OPD with black
discolouration material in nose and posterior
part of buccal cavity. He also gives history of
using high dose steroid therapy during his
treatment of COVID-19. Which of the follow-
ing is most suitable drug for his treatment?
(a) Fluconazole (b) Amphotericin B
(c) Itraconazole (d) Posaconazole
Q. 15. A patient is suffering from HTN crisis with BP
240/140 and having associated cerebral edema.
All of the following drugs can be given to this
patient except:
(a) Labetalol (b) Nicardipine
(c) Nitroprusside (d) Mannitol
Q. 16. A patient found roadside in an unconscious
state having pin point pupil, HR 54/min and BP
90mmHg. His history reveals he is a drug ad-
dict. Which of the following drug he must have
consumed:
(a) Cocaine (b) Morphine
(c) Amphetamine (d) Haloperidol
Q. 17. A person came with snake bite 8 hours ago. He
has already been given 10 vials of antivenom
at local hospital. Following is the next step if
patient dosen’t recover and signs of neuro
paralysis prevails:
(a) Aspirin
(b) Neostigmine + atropine
(c) IV hydrocortisone
(d) Anti coagulation therapy
Q. 18. A patient with long history of CHF with main-
Pharma
tained EF and no signs of hypervolemia comes
to you log QRS waves in ECG and cardiac wall
hypertrophy. Which of the following drug is
best to be started to prolong survival?
(a) Digoxin (b) Lisinopril
(c) Furosemide (d) Atenolol
Q. 19. A patient with hyperglycemia and positive
ketone bodies in urine comes to you in hospi-
tal with altered sensorium. Which of the fol-
lowing drug therapy is most suitable to start?
(a) Metformin
(b) Potassium chloride
(c) Insulin with IVF
(d) Ringer lactate
Q. 20. LD50 in an animal experiment stands for:
(a) 50% of animal mortality in an experiment
after exposure to drug
(b) 50% effect of the drug in animal samples
(c) Death of 50 animals in an experiment
(d) 50% reduction of infection in the given
population of animals
Q. 21. A tourist has visited an Indian village and de-
veloped abdominal pain, nausea and mild di-
arrhea. Which of the following is the most suit-
able drug to use in this patient for symptom-
atic relief?
(a) Loperamide (b) Rifaximin
(c) Octreotide (d) Zinc
Q. 22. Which of the following NSAID drug is useful
for the treatment of rheumatoid arthritis:
(a) Paracetamol (b) Ketorolac
6.15
 MIST ALL IN ONE FOR FMGE

(c) Triamcinolone (d) Sulfasalazine (d) Extremely drug-resistant TB

Q. 23. Which of the following statement is incorrect?
(a) Carbamates bind to Ach esterase
irreversibly
(b) Atropine is used as an antidote of OP
poisoinig
(c) Pralidoxime has its role in reversal of
enzyme in carbamate poisoining
(d) Timing of ageing is important marker for
management of poisoning
Q. 24. A 70 year old Parkinson patient who also suf-
Pharma
Q. 2. A patient with BP 220/110 mmHg, presented
with unilateral hemiparesis presented in a
hospital emergency. CT scan of the brain shows
no hemorrhage. Which is the most appropri-
ate management of this patient?
(a) Conservative
(b) Fibrinolytics
(c) Intravenous labetalol
(d) Sublingual nifedipine
Q. 3. Which of the following drug can cause gyneco-

fers from constipation and open angle glau- mastia in men and menstrual irregularities in
coma comes to you for follow up. Which of women?
the following drug should be avoided in this (a) Spironolactone (b) Propranolol
patient? (c) Misoprostol (d) Oxytocin
(a) Levodopa (b) Trihexyphenydyl Q. 4. Which of the following drug is used for the
(c) Pramipexole (d) Selegiline treatment of mountain sickness?
Q. 25. Which of the following drug shows both opioid (a) Acetazolamide
related and non-opioid related actions in hu- (b) Hydrochlorothiazide
man body? (c) Spironolactone
(a) Buprenorphine (b) Codiene (d) Salbutamol
(c) Tramadol (d) sufentanyl Q. 5. A young boy has a history of fast blinking and
Q. 26. Which of the following is not a side effect of staring at something for around 20 seconds.
lamotrigine? ECG shows less than 3 Hz spike and wave pat-
(a) Sedation (b) Drug allergy tern. Which of the following drug should be
(c) Suicidality (d) Weight gain used for treatment?
Q. 27. A patient with glaucoma and also suffering (a) Topiramate (b) Sodium valproate
from Bronchial Asthma. Which of the follow- (c) Diazepam (d) Carbamazepine
ing anti glaucoma drug should be avoided in Q. 6. A patient is taking cisplatin-based chemo-
this patient? therapy for the treatment of ovarian cancer.
(a) Timolol (b) Pilocarpine Which of the following drug should be used
(c) Latanoprost (d) Brimonidine to prevent nausea and vomiting post chemo-
therapy?
(a) Domperidone (b) Cisapride
RECENT YEAR QUESTIONS–2 (c) Palonosetron (d) Metoclopramide
Q. 1. Tuberculosis in which mycobacterium is resis- Q. 7. A 55-year patient with type 2 DM is controlled
tant to rifampicin, isoniazid, kanamycin, and on oral hypoglycaemic drugs. This patient pre-
levofloxacin. This tuberculosis is referred to sented to the hospital with Hypoglycemia.
as? Which of the following drugs has the maxi-
(a) MDR TB mum risk of Hypoglycemia in this patient?
(b) Rifampicin resistant TB (a) Metformin (b) Vildagliptin
(c) Extensively drug-resistant TB (c) Voglibose (d) Glipizide

6.16
 PHARMACOLOGY

Q. 8. A young male patient presented to emergency
with head trauma due to RTA and developed
seizures during a hospital stay. CT scan re-
vealed the presence of cerebral edema. Which
of the following is the diuretic of choice for
cerebral edema in this patient?
(a) Spironolactone (b) Mannitol
(c) Furosemide (d) Thiazides
Q. 9. Which of the following drug is used for MTP?
(a) Mifepristone followed by misoprostol
within 48 hours
Q. 13. A person presented to emergency in a coma-
tose state after consuming some unknown
poison With Excessive sweating, bradycardia,
and hypotension. Which drug is most appro-
priate for the treatment of this patient?
(a) Neostigmine (b) Atropine
(c) Pralidoxime (d) N-acetylcysteine
Q. 14. A man suffering from P. falciparum malaria
presented with a comatose state and altered
sensorium. Which drug is most suitable for the
treatment?

Pharma
(a) Sulfadoxine pyrimethamine
(b) Mifepristone followed by methotrexate
(b) Artesunate
within 48 hours
(c) Quinine
(c) Methotrexate followed by misoprostol
(d) Primaquine
within 48 hours
Q. 15. Mechanism of action of doxycycline is?
(d) Mifepristone followed by Dinoprost
(a) DNA gyrase inhibitor
Q. 10. Which of the following statements about the (b) Cell wall inhibitor
Aripiprazole is most correct? (c) Protein synthesis inhibitor
(a) D2 and 5HT 1A partial agonist with fewer (d) RNA polymerase inhibitor
EPS and weight gain
Q. 16. A 50-year-old female suffering from breast
(b) D2 and 5HT 1A partial agonist with more cancer with an ejection fraction of 25% on
EPS and weight gain Echo. Which of the following drug should be
(c) D2 antagonist and 5HT2 agonist with avoided in this patient?
fewer EPS and weight gain (a) Doxorubicin (b) Irinotecan
(d) D2 and 5HT2 antagonist with fewer EPS (c) Cyclophosphamide
and weight gain (d) Methotrexate
Q. 11. A 56-year-old patient who is a known case of Q. 17. Which of the following TB drug should not be
hypertension was being treated with is pre- used in pregnancy?
sented with a cough which is not been speci- (a) Kanamycin (b) Isoniazid
fied due to infective cause. Which of the fol- (c) Moxifloxacin (d) Linezolid
lowing drug may be responsible for this prob- Q. 18. What is the mechanism of action of alteplase?
lem? (a) Increase the level of plasmin
(a) Lisinopril (b) Losartan (b) Inhibition of factor V and VIl
(c) Propranolol (d) Amlodipine (c) Inhibition of factor Ill and V
Q. 12. A patient with chronic obstructive pulmonary (d) Activation of anti-thrombin Ill
disease is on salmeterol therapy but there is Q. 19. A patient with COPD is on salmeterol and still
no improvement. Which of the following drug experiencing dyspnea on exertion. The choice
should be added to the regimen? Inhaled Cor- of drug that will be given next is?
ticosteroids (a) Systemic steroids
(a) Tiotropium (b) Oxygen therapy (b) Roflumilast
(c) Salbutamol (d) Atropine (c) Tiotropium (d) Salbutamol

6.17
 MIST ALL IN ONE FOR FMGE

RECENT YEAR QUESTIONS–3 (a) D has more efficacy than A

(b) A is more potent than C
Q. 1. Which of the following longest acting? (c) B is most efficacious out of all
(a) Sildenafil (b) Tadalafil (d) C is more potent than B
(c) Verdenafil (d) Avanafil Q. 8. What’s deficient in Parkinson- tremor, rigid-
Q. 2. Gray hair after medicine ity, Defect in substantia nigra?
(a) Hydroxycholoroquine (a) Dopamine (b) Gaba
(b) Leflumide (c) Serotonin (d) Glycine
(c) sulfodalazine Q. 9. Which is not given in preventing clots?
(d) Minoxidil (a) Warfarin (b) Aspirin
Q. 3. Diogixin causing ventricular extrasystole. (c) Clopidogrel (d) Atorvastatin
Pharma

Treatment is: Q. 10. Lady is pregnant recently, 1st trimester, come

(a) Lignocaine (b) Atropine for check up. She has history of DVT and al-
(c) Procainamide (d) Dofetilide ready on anticoagulant therapy:
Q. 4. Bronchodialators are all, except: (a) Add vitamin K
(a) Ipratropium (b) Salbutamol (b) Shift to heparin
(c) Theophylline (d) hydrocortisone (c) Continue with warfarin
Q. 5. Pt given oxytocin, instead IV infusion gave (d) Stop anticoagulation therapy
bolus. Side effects: Q. 11. Patient suffering from Meningitis with CSF
(a) Hypoglycemia (b) Hyperglycemia analysis finding Lymphocytes 100, Glucose
(c) Hypotension (d) Hypertension low. Protein 4+. What’s best therapy can be
Q. 6. Which doesn’t need dose adjustment in renal started?
failure? (a) Ceftriaxone
(a) Sitagligliptin (b) Vildagliptin (b) Antitubercular therapy
(c) Allogliptin (d) Linagliptin (c) Acyclovir
Q. 7. Below is the graph showing the effect of four (d) Amphotericin B
inotropes on stroke volume. Efficacy and po- Q. 12. Head trauma, no bleeding, no hematoma, ICP
tency graph increasing rapidly. Treatment?
(a) Prednisone (b) Furosemide
(c) Mannitol (d) Thiazide
Q. 13. Best drug for Cerebral malaria
(a) Artesunate (b) Quinine
(c) Arteether (d) Primaquine
Q. 14. Patient suffering from Chronic otitis media.
Antibiotic avoided is:
(a) Ampicllin (b) Ofloxacin
(c) Moxifloxacin (d) ceftazidime
Q. 15. Lithium toxicity in pregnant with Family his-
tory of down syndrome:
(a) Ebstein anomaly
(b) Choanal atresia

6.18
 PHARMACOLOGY

(c) Cleft lip Q. 6. A patient presented with hospital acquired

(d) Valvular heart defects pneumonia. On testing he was found to be
Q. 16. Drug to close the PDA, gestational age was allergic to Penicillin G. Which of the following
drug is likely to be safe in this patient?
mentioned – indomethacin, Belladonna poi-
soning treatment of choice: (a) Methicillin (b) Cefotitan
(c) Imipenam (d) Aztreonam
(a) Physostigmine (b) Pyridostigmine
(c) Pilocarpine (d) Neostigmine Q. 7. A new drug is introduced in the market after
which phase of clinical trial?
Q. 17. Drug use in test to Differentiate between cho-
(a) I (b) II
linergic crisis from myasthenia gravis: (c) III (d) IV
(a) Edrophonium (b) Neostigmine
Q. 8. A 65-year-old patient presented with dribbling
(c) Bethanechol (d) Pyridostigmine

Pharma
of urine with urgency. He was started on
Q. 18. Treatment of choice for iron toxicity: prazosin therapy, but started developing pos-
(a) Deferoxamine (b) Deferasirox tural hypotension. Which of the following is
(c) Deferiprone (d) Penicillamine the better alternative drug for this patient?
(a) Tamsulosin
(b) Phenoxybenzamine
RECENT YEAR QUESTIONS–4 (c) Terazosin (d) Timolol
Q. 1. Which of the following is a SERM? Q. 9. A mother is suspected to have a premature
(a) Ethyl estradiole (b) Tamoxifene delivery. Which of the following drug could
(c) Anastrozole (d) None be helpful to attain the lung maturity before
Q. 2. Which among the following is a monoclonal birth?
antibody used for treatment of cancer? (a) Aspirin
(b) Dexamethasone
(a) Cisplatin
(c) MgSO4 (d) NSAID
(b) Rituximab
(c) C Vincristine Q. 10. Ibuprofen may increase serum uric acid. What
is the mechanism for this action?
(d) Cyclophosphamide
(a) Inhibit reabsorption of uricacid
Q. 3. A patient was taking Theophylline for Bron- (b) Increase production of uric acid
chial asthma. After starting another drug, (c) Activation of COX
symptoms of theophylline toxicity started ap- (d) Inhibit the secretion of uric acid
pearing. Which is the likely drug to cause theo-
Q. 11. All of the following conditions get worsened
phylline toxicity? after timolol maleate 0.5% administration ex-
(a) Rifampicin (b) Erythromycin cept:
(c) Valproate (d) Phenobarbitone (a) Bronchial asthma
Q. 4. Antidote used for heparintoxicity (b) Hypertension
(a) Vitamin K (c) Depression
(b) Protamine sulphate (d) Diabetes/Glaucoma
(c) Ascorbic acid (d) N acetylcysteine Q. 12. A patient presented with shock in emergency.
Q. 5. Find out the best treatment for the given con- Which drug you would be giving after stabiliz-
dition: ing the patient?
(a) Valcyclovir (b) Imipenam (a) Adrenaline (b) Dobutamine
(c) Carbapenam (d) Penicillin (c) Adenosine (d) Isoprenaline

6.19
 MIST ALL IN ONE FOR FMGE
RECENT YEAR QUESTIONS–5
Q. 1. A female presented with burning micturition
and symptoms of UTI. Which
fluoroquinolones is least likely to be effec-
tive?
(a) Ofloxacin (b) Moxifloxacin
(c) Ciprofloxacin (d) Levofloxacin
Q. 2. A patient with heart disease presented with
breath lessness the features of the patient
shown in images. Which of the following is
Pharma
used to treatment of oedema for this patient?
(a) ACE Inhibitor
(b) Na – K – 2Cl symporter inhibitor in loop of
Henle
(c) Na – Cl symporter inhibitor in DCT
(d) Aldosterone in DCT
Q. 3. A patient with pancreatic carcinoma is on mor-
phine for treatment of pain. After a few days,
the pain is not relieved as much as earlier.
What can be the likely reason for this?
(a) Decrease in absorption of morphine
(b) Pain intensity has increased
(c) Opioid receptors are up regulated
(d) Desensitization of Opioid receptors
Q. 4. Regular monitoring of visual acuity and fun-
dus examination is required with the patient
is being treated with the following DMARD?
(a) Hydroxychloroquine
(b) Methotrexate
(c) Sulfasalazine
(d) Leflunomide
Q. 5. A female patient presented with pain and red-
ness in great toe. Serum uric acid level is 9.4
mg/dL. The physician prescribed a drug for the
treatment. Which of the following enzyme is
inhibited by this drug?
6.20
(a) Xanthineoxidase
(b) Thymidylate synthase
(c) Phosphoribosyl transferase
(d) DHFR
Q. 6. A patient on anticancer therapy developed
infection. Total leucocytes count of this pa-
tient was 2000/mm3, which of the following
drug is effective?
(a) Oprelvekin (b) Filgrastim
(c) Erythropoietin (d) Romiplostim
Q. 7. A person presents with acute chest pain. Ni-
troglycerine was given sublingually and the
pain relieved within 5 minutes. What is the
mechanism of the drug?
(a) Release of nitricoxide
(b) Release of Endothelin
(c) Calcium channel Blocker
(d) Beta channel Blocker
Q. 8. A 60-year-old man present to OPD with low
backache. His PSA levels are 100 ng/ml. Which
of the following drug is indicated?
(a) Somatostatin (b) Goserelin
(c) Terlipressin (d) Testosterone
Q. 9. A patient with resting tremor was diagnosed
to be of parkinsonism. Which of the following
therapy is not indicated?
(a) Pramipexole (b) Rivastigmine
(c) Dee Brain Stimulation
(d) Levo-dopa + Carbi –dopa
Q. 10. A Pregnant female presented with burning
micturition. A diagnosis of cystitis was made.
Which of the following drug will be useful for
the treatment?
(a) Amoxycillin (b) TMP – SMX
(c) Ciprofloxacin (d) Doxycycline
Q. 11. A patient has pain in facial nerve distribution
while chewing and speaking, which of the fol-
lowing drug should be given for treatment?
(a) Lamotrigine (b) Phenobarbitone
(c) Haloperidol (d) Carbamazepine
Q. 12. Which of the following is a true statement re-
garding a liskiren?
 PHARMACOLOGY

(a) It is contraindicated in diabetes mellitus Q. 16. A child presented to emergency with GTCS for
(b) It is indirectly increase renin levels 30 minutes. Airway has been secured but the
(c) It is given in pregnancy child is still having seizures. What is initial
(d) It increases the aldosterone levels treatment to control the seizures?
(a) Valproate (b) Diazepam
Q. 13. Which of the following drug is used as radio
(c) Phenobarbitone (d) Levetiracetam
sensitizer in head and neck cancers?
(a) Cisplatin (b) Amifostine Q. 17. A Person from non-endemic area visited India
and was given prophylaxis for malaria. How
(c) Paclitaxel (d) Doxorubicin
long the person should continue after travel-
Q. 14. A 20-year male is on low dose of oral steroid ling from India?
therapy for the last 10 years, now he develops (a) 7 days (b) 15 days
progressive loss of vision in both the eyes.

Pharma
(c) 4 weeks (d) 4 months
What is the reason?
Q. 18. A child took several iron tablets. What is the
(a) Glaucoma antidote for poisoning?
(b) Cystoid macular edema (a) BAL (b) EDTA
(c) Cataract (c) Penicillamine (d) Desferrioxamine
(d) Retinal detachment Q. 19. Adrenaline acts via beta 2 receptors cause
Q. 15. For the treatment of acute migraine attack, a bronchodilatation where histamines act on H1
patient took some medicines. After that he receptors to cause bronchoconstriction. Which
develops change in color vision and numbness type of antagonism it is?
in the tip of the thumb. What is likely drug (a) Physical (b) Chemical
responsible and its treatment? (c) Pharmacological (d) Physiological
(a) Sumatriptan and sodium nitroprusside Q. 20. A person having a history of angina and heart
(b) Dihydro ergotamine and sodium rate of 90 bpm and tense personality devel-
nitroprusside oped BP of 150/125. The preferred drug for
(c) Propranolol and Nitroprusside treatment of hypertension?
(d) Propranolol and Phenoxybenzamine (a) Enalapril (b) Amlodipine
(c) Atenolol (d) Thiazides

ANSWER KEYS
Recent Year Questions–1
1. (b) 2. (c) 3. (d) 4. (d) 5. (b) 6. (c) 7. (b) 8. (c) 9. (b) 10. (c)
11. (c) 12. (a) 13. (c) 14. (b) 15. (c) 16. (b) 17. (b) 18. (b) 19. (c) 20. (a)
21. (a) 22. (b) 23. (c) 24. (b) 25. (c) 26. (d) 27. (a)

Recent Year Questions–2

1. (d) 2. (c) 3. (a) 4. (a) 5. (b) 6. (c) 7. (d) 8. (b) 9. (a) 10. (a)
11. (a) 12. (a) 13. (b) 14. (b) 15. (c) 16. (a) 17. (a) 18. (a) 19. (c)

Recent Year Questions–3

1. (b) 2. (a) 3. (a) 4. (d) 5. (c) 6. (d) 7. (b) 8. (a) 9. (d) 10. (b)
11. (a) 12. (c) 13. (a) 14. (a) 15. (a) 16. (a) 17. (a) 18. (a)

6.21
 MIST ALL IN ONE FOR FMGE

Recent Year Questions–4

1. (a) 2. (b) 3. (b) 4. (b) 5. (a) 6. (d) 7. (c) 8. (a) 9. (b) 10. (a)
11. (a) 12. (a)

Recent Year Questions–5

1. (b) 2. (b) 3. (d) 4. (a) 5. (a) 6. (b) 7. (a) 8. (b) 9. (b) 10. (a)
11. (d) 12. (b) 13. (c) 14. (c) 15. (b) 16. (b) 17. (c) 18. (d) 19. (d) 20. (c)
Pharma

6.22