Model Paper 1 Therapeutics

PHARMACOTHERAPEUTICS
MODEL PAPER – 1
Syllabus to be covered in
this module are-
Chapter-1 Pharmacotherapeutics-
Introduction
Chapter-2 (A) Cardiovascular System
Chapter-2 (B) Respiratory System
Chapter-2 (C) Endocrine System
Chapter-2 (D) Central Nervous System
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Questions
Long Questions-
Ques.1 Define Pharmacotherapeutics. What are scope and objectives of pharmacotherapeutics.
Ques.2 Discuss in detail about Rational Use of Medicines.
Ques.3 Discuss in detail about Cardiovascular System.
Ques.4 Discuss in detailed about Respiratory System.
Ques.5 Discuss in detailed about Endocrine System.
Ques.6 Discuss in detailed about Central Nervous System.
Ques.7 Prepare notes on stroke.
Ques.8 What is hyperlipidaemia. Give its types and treatment.
Ques.9 Give the etiology of the following diseases
a) Congestive Heart Failure
b) Epilepsy
c) Alzheimer’s Disease
d) Epilepsy
e) Hyperlipidaemia
f) Diabetes
g) COPD
Short Questions
Ques.1 Define Evidence Based Medicine. Mention the Evidence Based Medicines (EBM) Process.
Ques.2 What are the advantages and disadvantages of Standard Treatment Guidelines (STGs).
Ques.3 Write a short note on Congestive Heart Failure.
Ques.4 What is COPD. Give its signs & symptoms.
Ques.5 Define Asthma. Mention the diagnostic tests for asthma.
Ques.6 What is diabetes mellitus. Mention the non-pharmacological treatment of diabetes mellitus.
Ques.7 Give the clinical manifestations of hyperlipidaemia.
Ques.8 Mention the types of seizures.
Ques.9 Define Parkinson’s Disease. Give its pharmacological treatment.
Ques.10 What is Alzheimer’s Disease. Give its pathophysiology.
Ques.11 What is migraine? What are the symptoms of migraine.
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Long Answers
Ques.1 Define Pharmacotherapeutics. What are scope and objectives
of pharmacotherapeutics.
Ans.
 Pharmacotherapy is the use of pharmaceuticals (drugs) to treat disease.
 As pharmacotherapy specialists’ pharmacists have responsibility for direct patient care.
 They often functioning as a member of a multidisciplinary team, and acting as the primary
source of drug-related information for other healthcare professionals.
Scope of Pharmacotherapeutics-
 Provides knowledge and skills required for the quality use of medicine.
 Covers pathophysiology and therapeutic of disease.
 Selection of the most appropriate drug, dose, dosage form and duration of action and route of
administration.
 Pharmacokinetic and pharmacodynamic of drugs alter with the disease state and patient condition
and concurrently administered drugs.
Objectives-
 Provide complete pathophysiology of selected disease states and the rationale for drug therapy.
 The therapeutic approach to management of these diseases.
 The importance of preparation of individualized therapeutic plans based on diagnosis.
 Needs to identify the patient-specific parameters relevant in initiating drug therapy, and
monitoring therapy (including alternatives, time-course of clinical and laboratory indices of
therapeutic response and adverse effects).
 Minimize adverse effects.
Ques.2 Discuss in detail about Rational Use of Medicines.

Ans- Rational Use of Medicines-
 Medication is an essential key in healthcare delivery. The purposes of its use like disease cure or
prevention, symptom relive and pain palliation can be achieved when it is used properly.
 Irrational use of medicines is a major problem worldwide WHO estimates that more than half of
all medicines are prescribed, dispensed, or sold inappropriately, and that half of all patients fail to
take them correctly.
 Irrational drug use results in adverse drugs reactions (ADRs), drug-drug interactions, morbidity,
mortality poor outcome of cure control, prevention of disease. antimicrobial resistance financial
loss and non-adherence of patients to the treatment.
Common Irrational use of Drugs
 The use of drugs with doubtful or unproven efficacy.
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 The use of the wrong drug for a specific condition requiring drug therapy.
 The use of drugs when no drug therapy is indicated.
 The use of correct drugs with incorrect administration, dosages, and duration.
 The use of unnecessarily expensive drugs.
Reason for Irrational Use of Drugs-

 Lack of information
 Poor communication between health professional & patient
 Faulty & inadequate training & education of medical graduates
 Lack of diagnostic facilities/Uncertainty of diagnosis
 Poly-pharmacy
 Patient demand
 Promotional activities of pharmaceutical industries.
ADHERENCE DIAGNOSIS
FOLLOW UP
DRUG USE
PROCESS
DISPENSING PRESCRIBING
Rational use of drugs, especially rational prescribing, should meet certain criteria as follows
 1. Appropriate indication: The decision to prescribe drug(s) is entirely based on medical
rationale and the drug therapy is an effective and safe treatment
 2. Appropriate drug: The selection of drugs is based on efficacy, safety, suitability, and cost
considerations for the patient.
 3. Appropriate patient: No contraindications exist, the chance of adverse reactions is minimal
and the drug is acceptable to the patient.
 4. Appropriate patient information: Patients are provided with relevant, accurate, important and
clear information regarding their conditions and the medication(s) that are prescribed.
 5. Appropriate evaluation and monitoring: The anticipated and unexpected effects of
medications are appropriately monitored and interpreted.
Ques.3 Discuss in detail about Cardiovascular System.
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Ans- Cardiovascular System-
 The cardiovascular system consists of heart and blood vessels. It supplies oxygen and nutrients to
various organs and tissue of the body. The scientific study of the normal heart and the associated
diseases is known as cardiology. The heart is the most important muscle in the body. The heart
beats about 100,000 times every day.
 The heart is really a pump or two pumps in one. The right side of the heart receives blood from the
body and pumps it to the lungs. The left side does the opposite i.e., it receives blood from the
lungs and pumps it around the body.
Location of Heart
 It is located in mediastinum. It is located above to the superior surface of diaphragm, anterior to
the vertebral column, posterior to the sternum and somewhat left of the midline
 The heart is cone shaped organ lying on its side.
Covering of Heart
Heart is covered by pericardium which is a double-walled (Parietal and visceral layers) sac and protects
and anchors the heart.
The wall of the heart consists of
Epicardium: It is the modification of visceral layer of the serous pericardium.
Myocardium: Cardiac muscle layer forming the bulk of the heart.
Endocardium: Endothelial layer of the inner myocardial surface
There is different vessel which is responsible for the movement of blood through the heart
1. Pulmonary arteries: carry blood from the right side of the heart to the lungs
2. Pulmonary veins: The veins do the opposite job of pulmonary arteries and collects the oxygenated
blood from the lungs and carry it back to left atrium
3. Superior and inferior vena cava: The vena cava is the largest vein in the body. The superior vena
cava carries blood from the head, neck, arms and chest while the inferior vena cava carries blood from the
legs, feet and organs in the abdomen and pelvis
4. Aorta: The aorta is the largest artery in the body. It brings oxygenated blood from the left ventricle to
the rest of the body.
BLOOD CIRCULATION
Systemic circulation: The left ventricle ejects blood into the aorta, Blood then flows into systemic
arteries, arterioles, capillaries, venules, and veins, which carry it back to the right atrium.
Pulmonary circulation: The right ventricle ejects blood into the pulmonary trunk, then flows into
pulmonary arteries, pulmonary capillaries, and pulmonary veins, which carry it back to the left atrium.
Coronary circulation: Coronary arteries are responsible for the blood supply to the heart muscle. The
main function of heart to pump blood throughout the body. The contraction of cardiac muscle of
myocardium is responsible for this pumping action.
Stroke volume: It is the volume of blood ejected from each ventricle during one beat.
Cardiac output: It is the volume of blood from heart in one minute.
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Ques.4 Discuss in detailed about Respiratory System.
Ans- Respiratory System-
 The respiratory system consists of the nose, pharynx, larynx, trachea, bronchi, and lungs. The nose
can be divided into external and internal portions.
 The external nose is the visible portion of the nose on the face. It consists of a framework of bone
and hyaline cartilage which is covered with muscle and skin and lined by a mucous membrane
Nostrils or external nares are two openings of external nose.
 The internal nose is a large cavity that lies inferior to the nasal bone and superior to the mouth. It
is lined with muscle and mucous membrane.
 The space within the internal nose is called the nasal cavity which is divided by a septum
Posteriorly internal nose merges with the pharynx through two openings called the internal nares.
Lungs Volumes and Capacities

 Lung’s volumes exchanged during breathing and the rate of respiration are measured with a
spirometer Lung volume measured by spirometry include tidal volume, minute ventilation,
alveolar ventilation rate, inspiratory reserve volume, expiratory reserve volume, and FEV 1.0.
 Other lung volumes include anatomic dead space, residual volume, and minimal volume.
 The normal respiration rate for an adult at rest is 12 breaths per minute.
 Tidal volume (TV) is the volume of air moved into or out of the lungs during a normal breath
(inhalation and exhalation). In a healthy adult, it is approximately 500 ml or 7 mg kg of body mass
The common problems of respiratory system are asthma, Chronic obstructive pulmonary disease
(COPD).
 Emphysema, Pneumonia, Tuberculosis Pulmonary Edema, Influenza, Severe acute respiratory
syndrome (SARS) and lung cancer.
Ques.5 Discuss in detailed about Endocrine System.
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Ans- Endocrine System-
 Two body systems are responsible for sending and receiving sensory information and coordinating
body responses. These are the nervous system and the endocrine system. Together, they are
sometimes referred to as the neuro-endocrine system.
 The endocrine system regulates body activities by releasing hormones (chemical messengers) into
the bloodstream, where they are carried throughout the entire body.
 Hormonal responses may be almost instantaneous (sudden) or may occur days later. There is a
wide variety of hormonal effects.
HORMONE FUNCTIONS-
 Regulate the chemical composition and volume of the internal environment (extracellular fluid).
 Help regulate metabolism and energy balance.
 Helps to regulate contraction of smooth and cardiac muscle fibres and secretion by glands.
 Help maintain homeostasis, despite disruptions, such as infection, trauma, emotional stress,
dehydration, starvation, haemorrhage, and temperature extremes.
Exocrine & Endocrine Glands-
The body contains two kinds of glands.
 Exocrine glands secrete their products into body ducts, which carry the products into body
cavities, the lumen of an organ, or the outer surface of the body.
 Endocrine glands secrete their products (hormones) into the extracellular space around the
secretory cells. The secretions diffuse into the capillaries and are carried throughout the body by
the circulatory system.
DIABETES MELLITUS-
 Diabetes mellitus (DM) is derived from the Greek word diabetes which means to pass and the
Latin word mellitus which means sweet.
 DM is a metabolic disorder of carbohydrate, fat and protein that is characterized by hyperglycemia
and glucose intolerance. It occurs as a result of absolute or relative deficiency of insulin that
results in metabolic and vascular abnormalities.
THYROID DISORDERS
 The thyroid gland which is situated in the lower neck. Thyroid gland consists follicular cells and
parafollicular cells. The follicles of thyroids gland synthesize, store and release.
 Two hormones i.e., thyroxine (T4) and 3,5,3 triiodothyronine (T). These hormones are essential
for normal growth and development and play an important role in energy metabolism.
Ques.6 Discuss in detailed about Central Nervous System.

Ans- Central Nervous System-
The central nervous system is composed of two major interconnected organs:
 The Brain
 The Spinal Cord
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 These organs work together to integrate and coordinate sensory and motor information for the
purposes of controlling the various tissues, organs, and organ system of the body.
 The central nervous is responsible for higher neural functions such as memory, learning and
emotions.
 Structural disorders such as brain or spinal cord injury, Bell's palsy, cervical spondylosis carpal
tunnel syndrome, peripheral neuropathy, and Guillain-Barre syndrome.
 Functional disorders such a headache, dizziness, neuralgia and epilepsy.
 Degenerative disorders such as Alzheimer disease, Parkinson disease, Huntington chorea
multiple sclerosis and amyotrophic lateral sclerosis (ALS).
 Vascular disorders, such as stroke, transient ischemic attack (TIA), subarachnoid hemorrhage
and subdural hemorrhage.
 Infections, such as meningitis, encephalitis, and polio
EPILEPSY-
 Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes
abnormal, causing seizures or periods of unusual behavior, sensations and sometimes loss of
awareness.
 The seizures in epilepsy may be related to a brain injury or a family tendency, but often the cause
is completely unknown.
 It is characterized by brief episodes of involuntary movement (seizures) that may involve a part of
the body (partial) or the entire body (generalized) and is sometimes accompanied by loss of
consciousness and control of bowel or bladder function.
PARKINSON'S DISEASE
 Parkinson's disease is a nervous system disease that affects ability to control body movement.
 The disease usually starts out slowly and worsens over time.
 Common symptoms include tremor slowness of movement, stiff muscles, unsteady walk, balance
and coordination problems.
 As the disease worsens, patient may have trouble while talking, sleeping, have mental and
memory problems, experience behavioral changes, and have other symptoms.
ALZHEIMER'S DISEASE-
 Alzheimer's disease (AD) is a slowly progressive neurodegenerative disease in the elderly that is
characterized by impairment of memory and eventually by disturbances in reasoning, planning,
language, and perception.
 AD is first described By German physician Alois Alzheimer in 1906. Alzheimer’s disease is the
most common cause of dementia which cause continuous decline in king, behavioral and social
skills that affects a person's ability to function independently.
 The dementia describes a syndrome characterized by memory impairment, intellectual
deterioration, changes in personality and behavioral abnormalities.
STROKE
 Stroke is the second most common cause of mortality worldwide and the third most common
cause of disability. Stroke is a cerebrovascular disease.
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 A stroke occurs when the blood supply to part of brain is interrupted or reduced. It affects the
blood vessels that feed the brain oxygen.
 If brain does not receive enough oxygen and nutrients, damage may start to occur and brain cells
beg to lie in minutes. Stroke is a medical emergency.
MIGRAINE
 Migraine is a severe and disabling brain condition listed as the sixth most disabling disorder
globally by the World Health Organization and the most disabling of all neurological disorders
 A migraine is a headache that can cause severe throbbing pain or impulsing sensation, usually on
one side of the head. It is often accompanied by nausea, vomiting and extreme sensitivity to light
and sound. Migraine attacks can last for hours to days and the pain can be so severe that it
interferes with daily activities.
Ques.7 Prepare notes on stroke.

Ans- STROKE
 Stroke is the second most common cause of mortality worldwide and the third most common
cause of disability. Stroke is a cerebrovascular disease.
 A stroke occurs when the blood supply to part of brain is interrupted or reduced. It affects the
blood vessels that feed the brain oxygen.
 If brain does not receive enough oxygen and nutrients, damage may start to occur and brain cells
beg to lie in minutes. Stroke is a medical emergency.
Epidemiology
 Stroke in the second leading cause of death worldwide and was responsible for an estimated 63
million deaths and 113 million DALY's in 2016. More than 2/3 of these deaths occurred
developing countries. By 2050, more than 80% of the predicted global burden of new strokes of
15 million will occur in low and middle-income countries. In India, studies estimate that incidence
of stroke population varies from 116 to 163 per 100,000 population. Recently, ICMR has come
out with report entitled "India Health of the Nation's States, according to which stroke was 4"
leading cause of death and 5th Leading cause of Disability Adjusted Life Years (DALY) in 2016.
Etiology-
 Stroke a neurological disorder characterized by blockage of blood vessels. Clots form in the brain
and interrupt blood flow of arteries.
 There are two main causes of stroke: a blocked artery fame strike or leaking or bursting of a blood
vessel (hemorrhagic stroke). Stroke can also lead to depression and dementia.
Types of Strokes-
 There are three primary types of strokes:
 Transient ischemic attack (TIA) involves a blood clot that typically reverses on its own
 Ischemic stroke involves a blockage caused by either a clot or plaque in the artery. The Symptoms
and complications of ischemic stroke can last longer than those of a TIA, or may become
permanent.
Hemorrhagic strokes caused by either a burst or leaking blood vessel that seeps into the brain.
 The reduction in blood flow that occurs during a stroke is due primarily to either ischemia or
hemorrhage. The two major types of strokes (ischemic and hemorrhagic), the ischemic form is
more common, accounting for 85% to 87% of stroke cases.
Risk factors
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Many factors can increase your stroke risk. Potentially treatable stroke risk factors include:
 Lifestyle risk factors
 Obesity Physical inactivity
 Heavy alcohol consumption
 Use of illegal drugs such as cocaine and methamphetamine.
Medical risk factors
 Cigarette smoking
 High cholesterol High blood pressure
 Diabetes
 Obstructive sleep apnea
 Cardiovascular disease, including heart failure, heart defects
 Personal or family history of stroke, heart attack or transient ischemic attack
 COVID-19 infection.
Sign and Symptoms
 Nausea and vomiting
 Paralysis
 Numbness or weakness in the arm, face and leg, especially on one side of the body.
 Slurred speech or trouble in speaking or understanding others.
 Confusion, disorientation, or lack of responsiveness.
 Sudden behavioral changes, especially increased agitation.
 Vision problems, blurred or blackened or double vision in one or both eyes.
 Dizziness, loss of balance and coordination trouble in walking.
 Severe, sudden headache with an unknown cause seizure.
Pathophysiology-
 Stroke is caused by impaired perfusion through the blood vessels to the brain.
 The blood flow is supplied by two pairs of large arteries internal carotids which carries blood
anteriorly and two vertebral arteries which carries blood to the posterior part.
 Ischemic stroke is caused by deficient blood and oxygen supply to the brain hemorrhagic stroke
caused by bleeding or leaky blood vessels.
Pharmacological treatment
 Preventive medications
 Anti-platelet drugs
 Anticoagulants
 THROMBOLYTIC AGENTS Tissue Plasminogen Activator (tPA)
 Tissue plasminogen activator (IPA)
 Heparin
 Statins
 Thrombectomy
 ICU Management
Non-Pharmacological treatment
 Knowing patient stroke risk factors and following doctor's recommendations for adopting a
healthy lifestyle are the best steps to prevent a stroke.
 Many stroke prevention strategies are the same as strategies to prevent heart disease. Lifestyle
changes cannot prevent all strokes. But, many of these changes can lowering the risk of stroke. In
general, healthy lifestyle recommendations include:
 Quitting tobacco use: Smoking raises the risk of stroke for smokers. Quitting tobacco use
reduces risk of stroke.
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 Lowering the amount of cholesterol and saturated fat in diet: Eating less cholesterol and fat,
especially saturated fat, and trans fats, may reduce the buildup of plaque in arteries.
Ques.8 What is hyperlipidaemia. Give its types and treatment.

Ans- HYPERLIPIDEMIA
 Hyperlipidemia is a medical condition characterized by abnormally high levels of fats (lipids)
triglycerides, cholesterol, cholesterol esters phospholipids and or plasma lipoproteins including
very low-density lipoprotein and low-density lipoprotein in the blood, which include cholesterol
and triglycerides.
 This elevation of plasma lipids is among the leading risk factors associated with cardiovascular
diseases. For every 1% increase in blood cholesterol levels, there is a 1% to 2% increase in the
risk of CHD.
Epidemiology
 Hyperlipidemia is considered one of the major risk factors causing cardiovascular diseases
(CVDs). CVDs accounts for one third of total deaths around the world, it is believed that CVDs
will turn out to be the main cause of death and disability worldwide by the year 2020.
Etiology
 Hyperlipidemia subdivides into two broad classifications: primary (familial) or secondary
(acquired) hyperlipidemia.
 Primary: It is Genetic in nature.
 Secondary: It is caused by lifestyle and other factors.
Classification of Lipoproteins
 Chylomicrons: large particles that carry dietary fat (mainly TG) from the intestine to the liver.
 Very low-density lipoprotein (VLDL): carries endogenous TG synthesized in the liver to the
tissues
 Low density lipoprotein (LDL): is formed from intermediate density lipoprotein (IDL) hepatic
lipase. Is termed as bed cholesterol. It carries cholesterol from liver to tissues.
 High density lipoprotein (HDL): carries cholesterol from tissues to liver
Hyperlipidemia Treatments
Non-pharmacological Therapy
 Healthy lifestyle changes that can lower cholesterol. It is advised to
 1. Eat a low-salt diet that emphasizes fruits, vegetables and whole grains.
 2. Limit the amount of animal fats and use moderate amount of good fats
 3. Lose extra pounds and maintain a healthy weight.
 4. Quit smoking.
 5. Exercise on most days of the week for at least 30 minutes.
 6 Drink alcohol in moderation, if at all.
Pharmacological Treatment:
 Statins: atorvastatin, simvastatin, Fluvastatin, etc.
 Non-statins- Several non-statin therapies are available as adjunctive treatment for patients who do
not respond adequately to statins or for those who are intolerant of statins.
 Fibrates: Clofibrate, gemfibrozil, etc.
 Bile Acid Sequestrants: cholestyramine, colestipol, and colesevelam.
 Niacin
 Ezetimibe, etc.
Ques.9 Give the etiology of the following diseases

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b) Epilepsy
d) Asthma
e) Hyperlipidaemia
f) Diabetes
g) COPD
Ans-
Etiology- The leading causes of heart failure are coronary artery disease and hypertension. Heart
failure can result from any disorder that reduces ventricular filling (diastolic dysfunction) and/or
myocardial contractility (systolic dysfunction).
b) Epilepsy
Etiology- Epilepsy is not contagious. Although many underlying disease mechanisms can lead to
epilepsy. The cause of the disease is still unknown in about 50% of cases globally. The causes of
epilepsy are divided into the following categories: structural, genetic, infectious, metabolic,
immune, and unknown.
Etiology- Environmental and others factors-A number of environmental factors have been
associated with an increased risk of AD, including stroke, alcohol abuse, small head
circumference, repeated or severe head trauma, Down syndrome, and lower levels of education.
d) Asthma
Etiology-Asthma can develop in many different ways and for many different reasons, but the
triggers are often the same. They can include several broad categories, such as
a) Allergens, including dander and pollen
b) Irritants, such as smoke and chemicals
c) Exercise
d) Other health conditions
e) Weather
f) Certain medications
g) Strong emotional
e) Hyperlipidaemia
Etiology-Hyperlipidemia subdivides into two broad classifications: primary (familial) or
secondary (acquired) hyperlipidemia.
Primary: It is Genetic in nature.
Secondary: It is caused by lifestyle and other factors.
f) Diabetes
Etiology- There are mainly two types of cells insulin-producing beta cells and glucagon secreting
alpha cell present in the Langerhans of pancreas. The secretions of insulin and glucagon depend
on the blood sugar level cells. The hyperglycemia which is the main features of DM occurs due to
the relatively or absolute deficiency of insulin.
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g) COPD
Etiology- Cigarette smoking is the primary modifiable risk factor for the development of COPD
The leading cause of chronic bronchitis is cigarette smoking and inhaled irritants which lead to
chronic inflammation by increasing the size and number of mucous glands and goblet cells of the
airway epithelium The thickened and excessive mucus produced narrows the airway and impairs
ciliary function. Thus, inhaled pathogens become embedded in airway secretions and multiply
rapidly.
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Short Answers
Ques.1 Define Evidence Based Medicine. Mention the Evidence
Based Medicines (EBM) Process.
Ans- EVIDENCE BASED MEDICINE-
 EBM is an approach to medical practice that uses the results of patient care research and other
available objective evidence as a component of clinical decision making.
 The concept of EBM has its origins in 18th Century France when clinicians Pierre Louis rejected
the pronouncements of the authorities and sought the truth in the systematic observation of patient.
 Medical, pharmacy and paramedical students are the future health care providers.
EBM PROCESS-
 EBM always begins and ends with the patient. The following steps involved in applying the EBM
process to a pharmacotherapeutic decision are described:
 1. Ask the question: Recognize information needs and convert them into answerable questions.
 2. Acquire the evidence: Conduct efficient searches for the best evidence with which to answer
these questions.
 3. Appraise the evidence: Critically evaluate the evidence for its validity and usefulness.
 4. Apply the results to patient situations to best assist clinical decision making.
 5. Self-evaluation: Evaluate your decision with the result.
Ques.2 What are the advantages and disadvantages of Standard

Treatment Guidelines (STGs).
Ans- Advantages-
The use of STGs can benefit health care providers, health care officials, supply management personnel,
and patients in the following ways-
A. Health Care Providers
1. Provides standardized guidance to practitioners.
2. Encourages high quality care by directing practitioners to the most appropriate medicines for specific
conditions.
B. Health Care Officials
1. Provides a basis for evaluating quality of care provided by the health care professionals.
2. Provides the most effective therapy in terms of quality.
C. Supply Management
1. Utilizes only formulary or essential medicines, therefore the health care system needs to provide only
medicines in the STGs.
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2. Provides information for forecasting and ordering (because medicines and quantities for common
diseases will be known)
D. Patients
1. Patients receive optimal pharmaceutical therapy
2. Enables consistent and predictable treatment from all levels of providers and at all locations within the
health care system.
Ques.3 Write a short note on Congestive Heart Failure.

Ans- HEART FAILURE
Heart failure is a clinical syndrome that can result from any disorder that impairs the ability of the
ventricle to fill with or eject blood, thus rendering the heart unable to pump sufficient blood to meet the
metabolic demands of the body. This inadequacy results in congestion of pulmonary and systematic bed
or both.
Diastolic Dysfunction (Restriction in Ventricular Filling) is due to:
 Increased ventricular stiffness
 Ventricular hypertrophy (e.g., hypertrophic cardiomyopathy)
 Myocardial ischemia and infarction.
 Mitral or tricuspid valve stenosis,
 Pericardial disease (e.g., pericarditis).
Sign and symptoms
 Fatigue, Exercise intolerance, Dyspnea, Tachycardia, Edema - (lung, liver, abdomen, legs)
 Nocturia. Behavioral changes, Chest pain, Skin changes, Tachypnea, Abdominal pain.
 Anorexia, Nausea, Bloating, Pulmonary rales, and Pleural effusion.
Diagnostic Tests
 Electrocardiogram
 Serum creatinine
 Complete blood count
 Chest X-ray
 Echocardiogram
Ques.4 What is COPD. Give its signs & symptoms.

Ans- COPD-
 Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease of the airways.
Characterized by the gradual progressive loss of lung function. Emphysema and chronic bronchitis
are the two most common conditions that contribute to COPD.
 These two conditions usually occur together and can vary in severity among individuals with
COPD Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to
and from the air sacs (alveoli of the lungs).
 It is characterized by daily cough and mucus (sputum) production.
Signs and Symptoms
 1. Shortness of breath, especially during physical activities.
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 2. Wheezing
 3. Chest tightness
 4 A chronic cough that may produce mucus (sputum) that may be clear, white, yellow greenish
 5 Frequent respiratory infections
 6. Lack of energy
 7. Unintended weight loss (in later stages)
 8. Swelling in ankles, feet, or legs.
Ques.5 Define Asthma. Mention the diagnostic tests for asthma.

Ans- ASTHMA-
 Asthma is a very common chronic disease of inflammatory respiratory system which makes
breathing difficult and can make some physical activities challenging or even impossible. Asthma
induces inflammation which narrows airways.
 It is characterized by dyspnea, wheezing tightness in chest and cough. The coughing often occurs
at night or early in the morning.
 In asthma, there is increased sensitivity of airways to a variety of triggers.
 The episode of asthma is triggered by exposure to allergen, smoke, perfume, moist air, exercise or
emotional stress.
Diagnostic Tests-
 Spirometry: It is the most effective and common method for diagnosing lung function It is also:
known as a pulmonary function test or PFT The total volume of air exhaled from lungs is called
the forced vital capacity (FVC). The percentage of the FVC forced out in the first second is called
the FEVI FEV stands for forced expiratory volume
 Normal individuals can inhale at least 75% of their total capacity in 1 second.
 Any reduction indicates deterioration in lung performance. For confirming the diagnosis of asthma
response to bronchodilator should be checked.
 The Peak expiratory flow rate is measured before and after the use of bronchodilator.
 If there is more than 15% improvement the diagnosis is confirmed as asthma
Ques.6 What is diabetes mellitus. Mention the non-

pharmacological treatment of diabetes mellitus.
Ans- DIABETES MELLITUS-
 Diabetes mellitus (DM) is derived from the Greek word diabetes which means to pass and the
Latin word mellitus which means sweet.
 DM is a metabolic disorder of carbohydrate, fat and protein that is characterized by hyperglycemia
and glucose intolerance. It occurs as a result of absolute or relative deficiency of insulin that
results in metabolic and vascular abnormalities.
Non-pharmacologic Therapy-
 Nutrition therapy is also recommended for all patients. For type
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 1. DM, the focus is on physiologically regulating insulin administration with a balanced diet to
achieve and maintain healthy body weight.
 2. Healthy balanced meal plan should be followed which should be moderate in carbohydrates and
low in saturated fat.
 3. Overweight patient should be advised to control weigh as it is one of the main risk factors for
DM.
 4. Insulin sensitivity and glycemic control can be improved by physical activity and aerobic
exercise which may also reduce cardiovascular risk factors.
 5. Cessation of smoking is also advised to control DM.
Ques.7 Give the clinical manifestations of hyperlipidaemia.

Ans- Clinical manifestation
The most useful clinical signs are myotomies (slow-relaxing) tendon reflexes, bradycardia, hair loss and
cool, dry skin.
Cardiovascular System:
 Hyperlipidemia, Atherosclerosis, Angina, CHF, Pericardial effusion
 Gastrointestinal system symptoms: Anorexia, Constipation, Weight gain, Delayed Glucose wake,
Decreased Glucose absorption.
 Genitourinary System: Infertility, Menstrual irregularity.
 Integumentary System: Myxedema. Thickened skin, dry skin, Yellowing of skin, Coarse and
inning hair, thin brittle nails, Poor wound healing.
 Central Nervous System: Headache, Ataxia, Depression, Slurred Speech. Hoarse Voice and
Fatigue.
Ques.8 Mention the types of seizures.

Ans- TYPES OF SEIZURES-
A. Generalized seizures Generalized seizures are so called because they are caused by diffuse electrical
activity that involves whole of the brain. They produce symptoms symmetrically in both sides of the
body, indicating involvement of both cerebral hemispheres.
1.Generalized tonic- (Grand Mal) seizures are the most common generalized seizures. They begin with a
sudden loss of consciousness. Sometimes there may be premonitory symptoms (Aura) before loss of
consciousness.
2. Tonic seizures: Tonic seizures cause stiff muscles and may affect consciousness. These seizures
usually affect muscles in your back, arms and legs and patient may fall to the ground. However, there is
no lamb jerking (clonic phase).
3. Clonic seizures: There is no tonic phase. These are characterized only by limb repeated or Rhythmic,
jerking muscle movements. These seizures usually affect the neck, face, and arm.
4. Myoclonic Seizures are usually characterized by brief, shock-like contractions jerks of twitches of
muscles and usually affect the trunk, limbs arms and legs.
5. Atonic /Akinetic seizures: Atonic seizures is also known as drop seizures because it causes a loss of
muscle control/tome. Symptoms of these seizures therefore include head drop dropping of ham and
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slumping of the patient to ground. The seizure passes in a period after which the patient gets up
immediately.
6. Absence seizures: Absence seizures, previously known as petit mal seizures, which typically occur in
children.
Ques.9 Define Parkinson’s Disease. Give its pharmacological

treatment.
Ans- PARKINSON'S DISEASE
 Parkinson's disease is a nervous system disease that affects ability to control body movement.
 The disease usually starts out slowly and worsens over time.
 Common symptoms include tremor slowness of movement, stiff muscles, unsteady walk, balance
and coordination problems.
 As the disease worsens, patient may have trouble while talking, sleeping, have mental and
memory problems, experience behavioral changes, and have other symptoms.
Pharmacological Treatment
Medications are the main treatment method for patients with Parkinson's disease Medications combat
Parkinson's disease by:
 Helping brain neurons to synthesized and release dopamine.
 Mimicking the effects of dopamine in the brain
 Inhibiting an enzyme which cause degradation of dopamine in the brain.
 Reducing some specific symptoms of Parkinson's disease
 Levodopa
 Dopamine agonists
 Catechol O-methyltransferase (COMT) inhibitors
 MAO B inhibitors
 Anticholinergics
 Amantadine
 Istradefylline
Ques.10 What is Alzheimer’s Disease. Give its pathophysiology.

Ans- ALZHEIMER'S DISEASE-
 Alzheimer's disease (AD) is a slowly progressive neurodegenerative disease in the elderly that is
characterized by impairment of memory and eventually by disturbances in reasoning, planning,
language, and perception.
 AD is first described By German physician Alois Alzheimer in 1906. Alzheimer’s disease is the
most common cause of dementia which cause continuous decline in king, behavioral and social
skills that affects a person's ability to function independently.
 The dementia describes a syndrome characterized by memory impairment, intellectual
deterioration, changes in personality and behavioral abnormalities.
Pathophysiology-
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 Alzheimer's disease (AD) is a highly complex and progressive neurodegenerative disease. A
number of factors such as the cholinergic dysfunction, amyloid toxicity and oxidate
stress/mitochondrial dysfunctions are responsible for the development of Alzheimer's disease.
 AD destroys neurons in the cortex and limbic structures of the brain (i.e., basal forebrain,
amygdala, hippocampus, and cerebral cortex) which are responsible for higher learning, memory,
reasoning behavior and emotional control.
 Production and accumulation of neurotic plaques and neurofibrillary tangles (NFTs) are the
pathologic hallmarks of AD.
Ques.11 What is migraine? What are the symptoms of migraine.

Ans- MIGRAINE
 Migraine is a severe and disabling brain condition listed as the sixth most disabling disorder
globally by the World Health Organization and the most disabling of all neurological disorders
 A migraine is a headache that can cause severe throbbing pain or impulsing sensation, usually on
one side of the head. It is often accompanied by nausea, vomiting and extreme sensitivity to light
and sound. Migraine attacks can last for hours to days and the pain can be so severe that it
interferes with daily activities.
Symptoms of Migraine-
Nausea or vomiting
Disabling & recurring headaches
Sinus symptoms (stuffy nose or watery nose)
Intense throbbing sensations often on one side of the head
Frequent neck pain
Pain worsens when around light, noise, or smells.
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Very Short Answers
1.Define the term pharmacotherapy
Ans- The treatment of disease and especially mental illness with drugs
2. Write the scope of pharmacotherapeutics.
Ans-
 Provides knowledge and skills required for the quality use of medicine.
 Covers pathophysiology and therapeutic of disease.
 Selection of the most appropriate drug, dose, dosage form and duration of action and route of
administration.
 Pharmacokinetic and pharmacodynamic of drugs alter with the disease state and patient condition
and concurrently administered drugs.
3. What do you understand by rational use of medicines?
Ans- Rational use of medicines requires that "patients receive medications appropriate to their clinical
needs, in doses that meet their own individual requirements, for an adequate period of time, and at the
lowest cost to them and their community.
4. What do you understand by essential medicines.
Ans- Essential medicines are those that satisfy the priority health care needs of a population. They
are selected with due regard to disease prevalence and public health relevance, evidence of efficacy and
safety and comparative cost-effectiveness.
5. Write the aims of EBM.
Ans-
 EBM aims to enhance the quality and accountability for the medical practice.
 It creates common concepts and unify the language for implementation of research into practice.
 Promote a lifelong learning process by continuous searching for best evidence.
6. What is the need of EBM?
Ans-
 Its real purpose is that by the use of the best possible evidence doctor chooses for his patient the
best possible solution.
 Wanting to provide to him the optimum health care in every aspect.
 It is also used to avoid major mistakes in the course of treatment, and by this raises the quality of
provided health care to the patient.
7. Define RDU.
Ans- Rational Drug Use (RDU) is the process of appropriate prescribing, dispensing, and patient use of
drugs for diagnosis, prevention, and treatment of diseases.
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8. Define CHF.
Ans- A chronic condition in which the heart doesn't pump blood as well as it should.
Heart failure can occur if the heart cannot pump (systolic) or fill (diastolic) adequately. Symptoms
include shortness of breath, fatigue, swollen legs and rapid heartbeat.
9. Write the name of layers covering the heart.

Ans- The outer layer of the heart wall is the epicardium, the middle layer is the myocardium, and the
inner layer is the endocardium.
10. Explain the double circulation of heart.
Ans- A mechanism in which blood circulates twice through the heart in one complete cycle is known
as double circulation. Systemic circulation and pulmonary circulation are two pathways in which the
blood flows in double circulation.
11. What is blood pressure?
Ans- Blood pressure is the pressure of circulating blood against the walls of blood vessels. Most of this
pressure results from the heart pumping blood through the circulatory system. When used without
qualification, the term "blood pressure" refers to the pressure in the large arteries.
12. Write the role of renin in the pathology of hypertension.
Ans- Renin is an enzyme that helps control your blood pressure and maintain healthy levels of
sodium and potassium in your body. Made by special cells in your kidneys, renin is released into your
bloodstream when your blood pressure drops too low.
13. What is atherosclerosis?
Ans- The build-up of fats, cholesterol, and other substances in and on the artery walls.
A build-up of cholesterol plaque in the walls of arteries, causing obstruction of blood flow. Plaques may
rupture, causing acute occlusion of the artery by clot.
Atherosclerosis often has no symptoms until a plaque ruptures or the build-up is severe enough to block
blood flow.
14. State true or false Angina is a symptom and not disease and explain the reason for the
statement.
Ans- Angina is chest pain or discomfort that happens when your heart is not receiving enough oxygen-
rich blood. As a result, your heart may beat faster and harder to gain more blood, causing you noticeable
pain. Angina is not a disease. It is a symptom and a warning sign of heart disease.
15. Differentiate-Angina pectoris and myocardial infarction.
Ans- A myocardial infarction is a serious condition where there is complete blockage of blood supply to
the heart. In contrast, stable angina is chest pain or discomfort that usually occurs with activity or stress
resulting from poor blood flow through the blood vessels in the heart.
16. Define essential hypertension.
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Ans- Essential, primary, or idiopathic hypertension is defined as high BP in which secondary causes such
as renovascular disease, renal failure, pheochromocytoma, aldosteronism, or other causes of secondary
hypertension or mendelian forms (monogenic) are not present.
17. Adrenergic receptor is present in heart and its stimulation causes________.
Ans- β-1adrenergic receptor is present in heart and its stimulation causes increases heart rate
(chronotropy) and force of contraction (inotropy).
18. Asthma is defined as chronic inflammation disease of
Ans- Respiratory system
19.is an enlargement of alveoli with destruction of alveolar septa
Ans- Emphysema
20. Gaseous exchange takes place from the plasma membrane of
Ans- Alveoli
21. The lower respiratory system includes
Ans- Larynx trachea, bronchi & lungs
22. Define and classify the asthma
Ans- Asthma is a very common chronic disease of inflammatory respiratory system which makes
breathing difficult and can make some physical activities challenging or even impossible. Asthma induces
inflammation which narrows airways.
Classification includes
(1) intermittent asthma,
(2) mild persistent asthma,
(3) moderate persistent asthma,
(4) and severe persistent asthma.
23. What is Extrinsic asthma and Intrinsic asthma
Ans- Extrinsic asthma is simply asthma caused by an allergic reaction, especially a chronic one. If
your asthma is allergic, you will have higher levels of IgE (Immunoglobulin E) present in your blood test.
Intrinsic asthma is also known as non-allergic asthma. This means an allergic reaction doesn't trigger an
asthma attack. Instead, it may be a variety of things, including: Hormonal changes, such as menstruation.
24. What is the sign and symptoms of asthma
Ans- Symptoms
The most common symptom of asthma is wheezing. This is a squealing or whistling sound that occurs
during breathing.
Other asthma symptoms may include
 coughing, especially at night, when laughing, or during exercise, tightness in the chest,
 dyspnea shortness of breath,
 difficulty talking, fatigue,
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 chest pain, rapid breathing, respiratory acidosis,
 frequent infections, & trouble sleeping
25. Spirometry is used to check function.

Ans- Spirometry is a simple test used to help diagnose and monitor certain lung conditions by
measuring how much air you can breathe out in one forced breath. It's carried out using a device
called a spirometer, which is a small machine attached by a cable to a mouthpiece.
26. Define COPD List down its symptoms
Ans- Signs and Symptoms
1. Shortness of breath, especially during physical activities.
2. Wheezing
3. Chest tightness
4 A chronic cough that may produce mucus (sputum) that may be clear, white, yellow greenish
5 Frequent respiratory infections
6. Lack of energy
7. Unintended weight loss (in later stages)
8. Swelling in ankles, feet, or legs.
27. List the treatment goals of COPD

Ans- Treatment
Drugs currently recommended for the treatment of COPD are
1. Bronchodilators (selective B, -agonists, anticholinergic methylxanthines);
2. glucocorticoids,
3. other types of medication (vaccines, antibiotics, beta_ {1} -antitrypsin augmentation therapy.
mucolytic agents, antioxidants, immunoregulators, antitussives and vasodilators).
28. Mention the role of corticosteroids in COPD
Ans- Inhaled corticosteroids (ICS) decrease the rate of exacerbation and may improve the response
to bronchodilators and decrease dyspnoea in stable COPD. No study shows that ICS reduce the loss
of lung function; however, recent data suggest a possible survival benefit when combined with long-
acting β agonists.
29. Differentiate between Asthma and COPD.
Ans- With asthma, the swelling is often triggered by something you're allergic to, like pollen or mold, or
by physical activity. COPD is the name given to a group of lung diseases that include emphysema and
chronic bronchitis. Emphysema happens when the tiny sacs in your lungs (called alveoli) are damaged.
30. Glands is also known as master gland.
Ans- Pituitary gland
31. Blood glucose level is regulated by 1 Type 2 Diabetes is also known as
Ans- Insulin & Glucagon
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32. Synthesis and release thyroid hormones are regulated by the secretion from the anterior
pituitary.
Ans- Non-Insulin Dependent Diabetes
33. Glucose tolerance test.
Ans- The glucose tolerance test, also known as the oral glucose tolerance test, measures your body's
response to sugar (glucose). The glucose tolerance test can be used to screen for type 2 diabetes.
34. The secretions of insulin and glucagon depend on blood level.
Ans- Sugar
35. Is also known as "good" cholesterol
Ans- High Density Cholesterol
36. Define primary hypothyroidism
Ans- Primary hypothyroidism is defined as low levels of blood thyroid hormone due to destruction of
the thyroid gland. This destruction is usually caused by autoimmunity, or an intervention such as
surgery, radioiodine, or radiation.
37. Define Myxedema coma
Ans- Myxedema coma is defined as severe hypothyroidism leading to decreased mental status,
hypothermia, and other symptoms related to slowing of function in multiple organs. It is a medical
emergency with a high mortality rate.
38. Define thyrotoxicosis
Ans- Thyrotoxicosis is a clinical state of inappropriately high levels of circulating thyroid hormones
(T3 and/or T4) in the body from any cause. It is often incorrectly used interchangeably with
hyperthyroidism, which is a form of thyrotoxicosis caused by excessive endogenous thyroid hormone
production.
39. Define grave's disease.
Ans- Graves' disease is an immune system disorder that results in the overproduction of thyroid
hormones (hyperthyroidism). Although a number of disorders may result in hyperthyroidism, Graves'
disease is a common cause. Thyroid hormones affect many body systems, so signs and symptoms of
Graves' disease can be wide ranging.
40. In patients with primary hypothyroidism, the thyroid-stimulating hormone (TSH) level is
elevated (True/False)
Ans- True
41. What is the role of Beta-Blockers in the management of Hyperthyroidism?
Ans- Beta blockers ameliorate the symptoms of hyperthyroidism that are caused by increased beta-
adrenergic tone. These include palpitations, tachycardia, tremulousness, anxiety, and heat intolerance.
42. What is the tonic phase of epilepsy.

Ans- A tonic seizure causes a sudden stiffness or tension in the muscles of the arms, legs or trunk.
The stiffness lasts about 20 seconds and is most likely to happen during sleep. Tonic seizures that occur
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while the person is standing may cause them to fall. After the seizure, the person may feel tired or
confused.
43. Write the name of excitatory neurotransmitter which may be involved in the pathogenesis of
epilepsy.
Ans- Glutamate and gamma-aminobutyric acid (GABA) are the main neurotransmitters playing a
critical role in the pathophysiology of this balance, and irreversible neuronal damage may occur as a
result of abnormal changes in these molecules.
44. Define Bradykinesia.
Ans- Bradykinesia means slowness of movement and is one of the cardinal manifestations of Parkinson's
disease. Weakness, tremor, and rigidity may contribute to but do not fully explain bradykinesia.
45. y-aminobutyric acid (GABA) is the neurotransmitter in CNS.
Ans- Inhibitory
46. Write the role of levodopa in Parkinson's disease.
Ans- In patients with Parkinson's disease, there is not enough dopamine in some parts of the brain.
Levodopa enters the brain and helps replace the missing dopamine, which allows people to function
better.
47. Why carbidopa should be given with levodopa?
Ans- Carbidopa is in a class of medications called decarboxylase inhibitors. It works by preventing
levodopa from being broken down before it reaches the brain. This allows for a lower dose of
levodopa, which causes less nausea and vomiting.
48. Write the role Catechol O-methyltransferase (COMT) inhibitors in the treatment of
parkinsonism.
Ans- Catechol-O-methyltransferase (COMT) inhibitors are a new therapeutic option in the treatment of
patients with Parkinson's disease. COMT inhibitors act by extending the duration of action of
levodopa, thus improving the amount of time a patient can experience benefit from levodopa.
49. Write the full form of MRI and CT scan.
Ans- CT (computed tomography) and MRI (magnetic resonance imaging) are both used to diagnose and
stage cancer.
50. Write the role of Cholinesterase Inhibitors in Alzheimer's Disease,
Ans- Cholinesterase inhibitors result in higher concentrations of acetylcholine, leading to increased
communication between nerve cells, which in turn, may temporarily improve or stabilise the
symptoms of dementia.
51. Role of fibrinolytics in Ischemic Stroke.
Ans- Thrombolytic treatment, also known as fibrinolytic therapy, dissolves dangerous intravascular
clots to prevent ischemic damage by improving blood flow. Thrombosis is a significant physiological
response that limits haemorrhage caused by large or tiny vascular injury.
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PHARMACOTHERAPEUTICS

Ques.2 Discuss in detail about Rational Use of Medicines.

Reason for Irrational Use of Drugs-

Ques.3 Discuss in detail about Cardiovascular System.

Lungs Volumes and Capacities

Ques.5 Discuss in detailed about Endocrine System.

Ques.6 Discuss in detailed about Central Nervous System.

Ques.7 Prepare notes on stroke.

Ques.8 What is hyperlipidaemia. Give its types and treatment.

Ques.9 Give the etiology of the following diseases

Ques.2 What are the advantages and disadvantages of Standard

Ques.3 Write a short note on Congestive Heart Failure.

Ques.4 What is COPD. Give its signs & symptoms.

Ques.5 Define Asthma. Mention the diagnostic tests for asthma.

Ques.6 What is diabetes mellitus. Mention the non-

Ques.7 Give the clinical manifestations of hyperlipidaemia.

Ques.8 Mention the types of seizures.

Ques.9 Define Parkinson’s Disease. Give its pharmacological

Ques.10 What is Alzheimer’s Disease. Give its pathophysiology.

Ques.11 What is migraine? What are the symptoms of migraine.

9. Write the name of layers covering the heart.

25. Spirometry is used to check function.

27. List the treatment goals of COPD

42. What is the tonic phase of epilepsy.

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