AIIMS MAY 2017: PHARMACOLOGY

Dr. Ranjan Kumar Patel

www.cpr.org.in

1. Empirical drug of choice for treatment of meningococcal meningitis is

a. Ceftriaxone

b. Cefotetan

c. Gentamicin

d. Cefoxitin

Ans is a, Ceftriaxone (Ref: Harrison 19th E/P767)

• Ceftriaxone is the empirical drug of choice for treatment of meningitis. It is frequently

combined with vancomycin.

2. Initial feature of storage of drug in tissues is

A. Large apparent volume of distribution

B. Less excretion in urine

C. Small apparent volume of distribution

D. High excretion of drug in urine

Ans is b, Large apparent volume of distribution

 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
• Large volume of distribution indicates storage of drug in tissues.

• Small volume of distribution indicates presence of drug in plasma.

3. Mechanism of action of oseltamivir is

a. Neuraminidase inhibitor

b. RNA dependent RNA Polymerase inhibition

c. Viral M2 ion channel protein inhibition

d. Fusion inhibitor

Ans is a, Neuraminidase inhibitor

Neuraminidase inhibitors:

• Oseltamivir

• Zanamivir

• Peramivir

• Laninamivir

4. A 12 year old child presents with four lesions of leprosy on back and four lesions on
left arm. What should be the treatment of this child?

A. Rifampicin 600mg once a month + dapsone 100mg daily + clofazimine 300 mg once
a month & 50 mg daily

B. Rifampicin 600 mg once a month + dapsone 100 mg daily

C. Rifampicin 450 mg once a month + dapsone 50 mg daily + clofazimine 150 mg once

a month + 50 mg alternate days

D. Rifampicin 450 mg once a month + dapsone 50 mg daily + clofazimine 150 mg once

a month + 50 mg daily
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
Ans is C, Rifampicin 450 mg once a month + dapsone 50 mg daily + clofazimine 150
mg once a month + 50 mg alternate days

Ref: NLEP

5. A girl with APML was treated and during treatment she developed tachypnea, fever,
pulmonary infiltrate. what is the treatment of choice?

a. Dexamethosone

b. Cytarabine

c. Doxorubicin
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
d. Methotrexate

Ans is a, Dexamethasone (Ref: Harrison 19th E/1686-87)

• Patient of APML when treated with retinoic acid can develop pulmonary syndrome
charcetrized by fever, dyspnea, pulmonary infiltrates, chest pain, fluid retention and
hypoxemia.

• The treatment of choice for same is dexamethasone.

6. A patient was administered 200 mg of a drug. 75 mg of the drug is eliminated in 90

minutes. If the drug follows first order kinetics how much drug will remain after 6 hours?

A. 6.25 mg

B. 12.5 mg
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
C. 25 mg

D. 50 mg

Ans is D, 50 mg

First of all calculate the half life of drug:

Rate of drug elimination = 0.693 • Dose/T1/2

Here rate of drug elimination is 75/90 mg/min

Hence 75/90 = 0.693 • 200/T/1/2

Or T1/2 = 0.693•200• 90/75 = 166.32 minutes = approximately 3 hours.

So drug becomes 50% in 3 hours i.e. 100 mg.

So in another 3 hours drug ll become 50% of 100 mg = 50 mg

7. A drug x was given continuous IV 1.6mg/min and elimination rate of x was 640ml/min.
With t1/2 of 1.8h, What would be the concentration of drug after achieving study state?

A. 2.88 mg/ml

B. 0.004 mg/ml

C. 0.002 mg/ml

D. 3.25 mg/ml

Ans is C, 0.003 mg/ml

The formula for infusion rate is similar to rate of drug elimination.

RDE = Infusion rate = PC at steady state • Cl

Or 1.6 = PC at steady state • 640

Or PC at steady state = 1.6/640 = 0.0025 mg/ml = 0.002 mg/ml

 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
8. In an animal model how will u show vasomotor reversal of dale

a. Beta 2 stimulation by low epinephrine and thereafter beta 1 stimulation

b. Stimulation of beta 1 followed by block of beta 2

c. Stimulation of beta 1 receptor followed by block of beta 2 receptor

d. Beta 2 stimulation by norepinephrine followed by beta 1 stimulation

Ans is a, Beta 2 stimulation by low epinephrine and thereafter beta 1 stimulation

Dale's Phenomenon:

When epinephrine is administered to a living system there is an initial rise in BP due to

stimulation of alpha1 followed fall in blood pressure due to stimulation of beta 2.

Vasomotor reversal of Dale:

When epinephrine is administered to a living system with an alpha blocker, there is only
fall in blood pressure mediated by beta 2 stimulation.

Hence among the given option a is the best answer.

9. A patient of CAD with history of MI 2 months back, diabetes mellitus with LDL 126,
HDL 32 and triglycerides 236. what should be given

a. Atorvastatin 80 mg

b. Rosuvastatin 10 mg

c. Fenofibrate

d. Fenofibrate and Rosuvastatin

Ans is b, Atorvastatin 80 mg (Ref: CMDT 2017/P1263-64)

• There is history of MI and hence in this case there is clinical atherosclerotic disease
and hence high intensity statin therapy is indicated.

• Among given options atorvastatin 80 mg is high intensity statin therapy.

 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
• Note: Moderate intensity statin can be used if patient is above 75 years of age.

• Hypertriglyceridemia above 150 association with CAD is not defined. Triglycerides

above 500 is treated to prevent pancreatitis.

10. Drug of choice for strawberry vagina is

a. Metronidazole
b. Doxycycline
c. Fluconazole
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
d. Amoxycillin
Ans is a, Metronidazole
• Strawberry vagina is seen with trichomoniasis for which the drug of choice is
meteonidazole 2 grams single oral dose. In case of intolerance to single dose 500 mg
BD is given for 7 days.
• In resistant cases tinidazole is used at 2 grams as single oral dose.
Strawberry Vagina seen in trichomoniasis:

11. Antidote of fibrinolytic drug is

a. Heparin
b. Epsilon amino capreoic acid
c. Protamine
d. Alteplase
Ans is b, Epsilon amino capreoic acid
Antidotes for fibrinolysis:
• Epsilon amino capreoic acid
• Tranexamic acid
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in

12. Mechanism of action of protease inhibitors is

A . Inhibits proviral RNA synthesis
B. Inhibits assembly of viral proteins
C. Inhibits conversion if RNA to DNA
D. Cell death (apoptosis )of the infected cell
Ans is B, Inhibits assembly of viral proteins
• During the final stages of viral assembly protease cuts Gag pol precursor protein in to
smaller proteins and enzymes required by the virus. This step is required for maturation
of the virus as well.
• Hence protease inhibitors block both assembly and maturation of virus.
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
13. A 40 year old man presents with NYHA 3 class, dyspnea, creatinine of 2.5mg%,
potassium level of 4.5 meq/L. Drug contraindicated is
A.Carvedilol
B.Spironolactone
C.Enalapril
D.Digoxin
Ans is A. Carvedilol (Ref: CMDT 2017/P407)
• Patient with class III NYHA CHF, and is dyspneic, which confirms volume overload
causing pulonary edema.
• Beta blockers can be used in all stages of heart failure if there are no signs of volume
overload.
AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
14. Drug of choice for prophylaxis of pneumucystis jirovecii in an
immunocomprompromised patient is
a. Cotrimoxazole
b. Amoxycillin
c. Dexamethasone
d. Cephalosporin
Ans is a, Cotrimoxazole
• DOC for prophylaxis and treatment of pneumocystis infection in both
immunocompetent as well as immunocompromised is cotrimoxazole.
• Other drugs used are
1. Dapsone + Pyrimethamine
2. Clindamycin + Primaquine
3. Pentamidine
4. Atovaquone
5. Prednisolone is given only in immunocompromised along with antimicrobials in case
they present with PaO2 less than 70 mmHg or oxygen saturation less than 90%.

15. 30 year old epileptic was on levetrecetam 1gm BD was experiencing anger and
aggression as a adverse effect and it was affecting his quality of life and has come to
you. He had a two year seizure free period. What is to be done?
A. Taper levetrecetam and stop it after 6 months
B. Stop immediately
C. Wait till the 5 year clearance period of seizure
D. Change the anti epileptic
Ans is a. Taper levetiracetam and stop it after 6 months
The patient had been antiepileptic for 2 years and there is a possibility if he is tapered
off he might not develop seizure.
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
16. Idiosyncratic reactions associated with carbamazepine are all except
a. Steven Jhonson syndrome
b. Rash
c. Agranulocytosis
d. Blurred vision
Ans is d, Blurred vision
• There is genetic predisposition to carbamazepine induced hypersesitivity related to
HLA-B 1502 gene and hence its screening can be done.
• Hypersensitivity associated with carbamazepine presents as SJS, TEN, rash,
lymphadenopathy, eosinophilia and splenomegaly.
• Other idiosyncratic reactions associated are agranulocytosis, hepatic failure, serum
sickness and pancreatitis.
• Blurred vision though can be seen is not a idiosyncratic reaction.

17. Which of the following mood stabilizer has antisuicidal effect?

a. Lithium
b. Valproate
c. Carbamezapine
d. Lamotrigine
Ans is a, Lithium (Ref: Amercian Psychiatric textbook of Mood disorder/P492)
• Apart from its effect on mania and BPD, lithium is also associated with decreased
suicidal events in patients with BPD and resistant depression.
• Antiepileptics are yet to be proved that they have antisuicidal effects.
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in

18. Components of lente insulin are

a. 30%amorphous + 70% crystalline
b. 30% crystalline + 70% amorphous
c. Same as NPH insulin
d. Only 70% amorphous
Ans is a, 30% amorphous + 70% crystalline
Ref: CROP 2nd E/P387
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in

19. A 70 year old patient has diabetes mellitus and hypertension. He presents with CKD
stage 5 and does not want to take insulin. Which antidiabetic drug will you prefer in this
patient that does not require dose modification in renal disease?
a. Linagliptin
b. Vildagliptin
c. Repaglinide
d. Glimepride
Ans is a, Linagliptin (Ref: CMDT 2017/P1227)
• Repaglinide can be given by oral route but only for post prandial hyperglycemia and as
its excreted by kidney its doseis reduced.
• Sulfonylureas like glomepride are contraindicated in both hepatic and renal failure.
• DPP-4 inhibitors can be given by oral route and the only drug in this class excreted by
liver and can be given in renal failure in linagliptin.
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in

20. What is the treatment of choice for Burkholderia Cepacia?

a. Carbepenams and 3rd generation cephalosporins
b. Aminoglycosides and colistin
c. Cefepime and Tigecycline
d. Cotrimoxazole
Ans is a. Carbepenams and 3rd generation cephalosporins (Ref: Harrison 19th
E/P1048)
First line drugs for B. Capecia
1. Cotrimoxazole
2. Meropenam
3. Doxycycline
Second line drugs
1. 3rd generation cephalosporins
2. Fluoroquinolones
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in

21. Which of the following is a P glycoprotein inducer

Rifampicin
Erythromycin
Voriconazole
Ketoconazole
Ans is a, Rifampicin
Pgp inducers are similar to CYP3A4 enzyme inducers like
• Phenytoin
• Phenobarbital
• Rifampicin
• St. Johns wort
• Carbamazepine etc
22. Which of the following anti rheumatic drug acts by increasing extracellular
adenosine?
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
a. Hydroxychloroquine
a. Leflunomide
c. Methotrexate
d. Azathioprine
Ans is c, Methotrexate
Antiinflammatory effect of methotrexate is produced by:
* Inhibition of purine synthesis which causes selective toxicity to lymphocytes.
* Inhibition of effect produced by inflammatory modulators like TNF alpha, IL1, IL 6 at
the site of inflammation.
* Increase in adenosine release which leads to 1. Decrease in complement C2
production
2. Inhibition of neutrophil adhesion
3. Inhibition of free radical production
All these factors downregulation decreases tissue destruction in joints.
* Adenosine also induces fusion of macrophages in tissues, which leads to
granulomata. Adenosine is also believed to cause hepatic fibrosis seen with
methotrexate.
Note: Methotrexate also causes keratinocyte apoptosis and hence is beneficial in
resistant psoriasis.

23. Which of the following is a bacteriocidal antileprotic drug?

a. Amoxicillin
b. Ciprofloxacin
c. Erythromycin
d. Ofloxacin
Ans is d, Ofloxacin
 AIIMS MAY 2017: PHARMACOLOGY
Dr. Ranjan Kumar Patel

www.cpr.org.in
* Among the drugs used in standard regimens for pauci and multibacillary leprosy,
Rifampicin is cidal.
* In another regimen for paucibalillary i.e. ROM therapy, Rifampicin and Ofloxacin are
cidal.