Questions summary:

1. All of the following are non selective beta blockers with additional actions except?
2. All of the following may be associated with beta 2 agonist treatment except?
3. True statement about clonidine are all except,
4. Finasteride is a:
5. Which of the following is not an alkylating agent?
6. Which of the following is a prodrug
7. All of the following are Gp IIb/Illa antagonist except?
8. Orange coloured urine is due to:
9. The drug having maximum propensity to cause peripheral neuropathy?
10. Nesiritide is a:

1. Online test series 18 – Paediatrics
2. Pharmacology – MCQ 10 – Nesiritide is a?
3. Online test series 14 – Forensic Medicine

• General considerations
  • Statistics
  • Important things to remember
• Aspirin
  • Indications
  • Clinical presentation in aspirin overdose
  • Complications
  • Management of salicylism
• Paracetamol
  • Clinical presentation
  • Use of IV N-acetylcysteine
• Carbon monoxide
  • Mechanism of hypoxia
  • Use of hyperbaric oxygen in management
• Cocaine poisoning
• Opiates
• 3,4-methylenedioxy-methamphetamine - MDMA (Ecstasy)

Author : Kevin O’Shaughnessy
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1. Pharmacology of acute poisoning – Powerpoint presentation (ppt)
2. Anticoagulants, Antiplatelet drugs and Thrombolytic agents – Powerpoint presentation (ppt)
3. Diabetes insipidus – Powerpoint presentation

• Major classes of drugs
• Platelet Activation
• Aspirin
• Newer antiplatelets – Thienopyridines
• CAPRIE trial
• CURE trial
• MATCH trial
• Glycoprotein IIb/IIIa antagonists
• Fibrinogenesis
• Heparin – Mechanism of action
• Features of Low Molecular Weight Heparin
• LMWH vs Unfractionated heparin
• Warfarin
• Pharmacokinetics of warfarin
• Drugs interactions of Warfarin
• Warfarin toxicity treatment
• Fibrinolysis
• Tissue plasminogen activator vs streptokinase
• Beyond LMWH
• Ximelagatran

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1. Diabetes insipidus – Powerpoint presentation
2. Common poisonings and their management – Powerpoint presentation (ppt)
3. Amyloidosis – Powerpoint presentation

• General considerations
• History
• Investigations
• Management
  • Decreasing poison absorption
  • Increasing poison elimination
• Paracetamol – overdose and management
• Aspirin – overdose and management
• Tri cyclic antidepressants - overdose and management
• Benzodiazepine - overdose and management
• Poisoning by other drugs

Author : Dr Ian Wilkinson

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1. Common poisonings and their management – Powerpoint presentation (ppt)
2. Acute Leukemia – Powerpoint presentation
3. Diabetes insipidus – Powerpoint presentation

Reference:
Osteoporosis: a guide for clinicians By Pauline M. Camacho, Paul Miller

1. Microbiology – MCQ 27 – Mechanism of action of Cholera toxin
2. Physiology – MCQ 76 – Primary action of Inhibin
3. Microbiology – MCQ 41 – Mechanism of action of cholera toxin

• Peripheral neuropathy
• Deep vein thrombosis
• Constipation
• Rash
• Fatigue
• Hypothyroidism

Reference:
Basic and Clinical Pharmacology, Katzung, 10th edition, p919

1. Drug interactions of lithium
2. Pharmacology – MCQ 57 – Adverse effects of ACE inhibitors
3. Pharmacology – MCQ 123 – Side effects of amiodarone

Reference:
Basic and Clinical Pharmacology, Katzung, 10th edition, p471

1. Adverse effects of thalidomide
2. Pharmacology – MCQ 96 – Drug interactions of digoxin
3. Pharmacology – MCQ 89 – Treatment of lithium toxicity

SERCA stands for:

• Smooth Endoplasmic Reticulum Calcium Aptase (involved in sequestration of calcium for later release)

1. Biochemistry – MCQ 82 – Factors influencing release of Ca2+ from endoplasmic reticulum
2. Physiology – MCQ 3
3. Physiology – MCQ 54 – Organs involved in calcium homeostasis

1. Biguanides: e.g. Metformin
2. Glinides: e.g. Repaglinide, Nateglinide
3. Sulfonylureas: e.g. Glibenclamide, Glimiperide
4. Alpha-glucosidase inhibitors: Acarbose, Voglibose
5. Thiazolidinediones: e.g. Rosiglitazone, Pioglitazone
6. Incretin mimetics (glucagon-like peptide-1 mimetics): Exenatide
7. Dipeptidyl peptidase-IV inhibitors (DPP-IV): Sitagliptin
8. Amylin analogs: e.g. Pramlintide
9. Bile acid sequestrants: e.g. Colesevelam
10. Insulin

1. Classification of oral hypoglycemic agents
2. Incretin pathway and diabetes mellitus
3. AIIMS May 2011 – MCQ 63

1. NEET PG / USMLE – MCQ 39
2. Surgery – MCQ 95 – Finasteride
3. Pharmacology – MCQ 89 – Treatment of lithium toxicity

e.g.: choline, lipocaic, inositol

1. Fatty change
2. Biochemistry – MCQ 82 – Factors influencing release of Ca2+ from endoplasmic reticulum
3. Anaesthesia – MCQ 2

-used as pharyngeal demulcent

-also used in confectionaries

1. Clinical signs in allergic rhinitis – nasal, ocular, otologic, pharyngeal, laryngeal
2. Forensic medicine – MCQ 34 – Gustafson’s method of identification
3. RGUHS Karnataka PGET 2011 – MCQ 95

Definition

1. SPM – MCQ 10 – Which is true of BCG vaccination ?
2. Swajaldhara
3. Diabetic ketoacidosis

1. Dimercaprol – British anti lewisite (BAL)
2. Forensic medicine – MCQ 14 – Preservation of brain
3. DOTS – Acronym

Inability to concentrate, tremors, seizures

Head ache, dizziness, rashes, photophobia

Swelling of lips, tendonitis, tendon rupture

Seizures are more likely if ciprofloxacin is combined with theophylline because theophylline increases the blood levels of ciprofloxacin.

1. Adverse effects of corticosteroids
2. Adverse effects of thalidomide
3. Pharmacology – MCQ 57 – Adverse effects of ACE inhibitors

1. Obstetrics & Gynaecology – MCQ 23 – Anti tuberculosis drug not given in pregnancy
2. Pharmacology – MCQ 100 – Drug induced parkinsonism
3. Pharmacology – MCQ 53 – Anti Tuberculosis drug causing transient memory loss

1. Physiology – MCQ 86 – Anti diuretic hormone (ADH) circulation in plasma
2. Forensic medicine – MCQ 14 – Preservation of brain
3. Forensic medicine – MCQ 22 – Toxin induced priapism

1. Ethinyl estradiol and norgestrel
2. Radiology – MCQ 4 – Hormone deficiency after intracranial radiation therapy
3. Surgery – MCQ 91 – Cancer screening

Mechanism of action

Ethinyl estradiol and norgestrel cause feed back inhibition of GNRH (Gonadotropin releasing hormone), FSH (follicle stimulating hormone) and LH (leutinizing hormone). Thus the mid cycle LH surge is prevented and ovulation does not occur. Progesterone makes the cervical mucus thick and impenetrable to sperms. The tubal and uterine motility is affected in such a way as to prevent fertilisation. Even if ovulation and fertilization occurs, the endometrium will be out of phase with the fertilization and implantation does not occur. The addition of progesterone ensures that the bleeding will occur after the cycle so that continuous endometrial proliferation and potential for endometrial carcinoma by estrogenic stimulation is prevented.

1. Physiology – MCQ 57 – Induction of ovulation
2. Leuprolide and flutamide
3. Obstetrics & Gynaecology – MCQ 56 – Mechanisms of action of oral contraceptive pill

Spectrum of action

MRSA (Methicillin resistant Staphylococcus areus), some VRSA (Vancomycin resistant Staphylococcus areus), VRE (Vancomycin resistant enterococci), Streptococcus pyogenes, S. viridans, S. pneumoniae, Clostridia, Mycobacterium tuberculosis, Listeria.

Mechanism of action

It binds to the 23S fraction of the 50S subunit of the bacterial ribosome. It prevents the formation of N-formyl methionine tRNA – 70S ribosome complex, thus preventing protein synthesis. Since the drug has a different site of action, it does not have cross resistance with other antimicrobial agents.

Pharmacokinetics

It is well absorbed orally.

Uses

Linezolid should not be used for simple infections to prevent development of resistance. It is used for severe hospital acquired pneumonias, wound infections by MRSA, VRSA, and in febrile neutropenia.

It is not useful for treatment of enterococcal bacterial endocarditis as it is only bacteriostatic.

Dosage

600 mg twice daily, oral or intravenous.

1. RGUHS Karnataka PGET 2011 – MCQ 144
2. Pharmacology – MCQ 22 – The following drug is not useful for MRSA?
3. Pharmacology – MCQ 84 – Antibiotic for MRSA

1. Paediatrics – MCQ 61 – UTI in childhood
2. Surgery – MCQ 54 – Primary grade IV-V vesicoureteric reflux in children
3. Physiology – MCQ 68 – Urinary concentrating ability of kidney

Pyridoxine 10 mg per day can be used to prevent peripheral neuropathy. In established isoniazid induced peripheral neuropathy, pyridoxine 100 mg per day is given.

1. Drugs causing peripheral neuropathy as side effect
2. Biochemistry – MCQ 17 – Regarding synthesis of triacyl glycerol in adipose tissue, all of the following are true except?
3. PGIMER November 2011 – MCQ 20

1. Pharmacology – MCQ 85 – Mycophenolate mofetil
2. Pharmacology – MCQ 124 – Drug interaction – ranitidine and sucralfate
3. Pharmacology – MCQ 19 – All of the following antiepileptic agents act via Na+ channel except?

1. Ten classes of antidiabetic drugs
2. Incretin pathway and diabetes mellitus
3. AIIMS May 2011 – MCQ 63

Mechanism of action

It acts by increasing the release of insulin from the pancreatic beta cells. Glibenclamide acts by binding to sulphonyl urea receptor of the ATP sensitive potassium channel in the pancreatic beta cells. This reduces conductivity of the channel, which causes depolarisation of the pancreatic beta cells, resulting in the opening of voltage sensitive calcium channels. Opening of the channels cause calcium influx which leads to release of insulin.

1. AIIMS November 2011 – MCQ 153
2. Alpha-2 adrenergic receptor – Location, Actions, Agonist, Antagonists
3. Classification of oral hypoglycemic agents

Adverse effects

Mostly GI symptoms, alopecia

Uses

Single dose 400 mg albenazole is given for hook worm, ascarias, enterobius. 400 mg daily for 3 days is given for strongyloides and tape worm. 400 mg twice daily for two weeks is given for neurocysticercosis. Should not be given in ocular cysticercosis as the reaction can cause blindness.

In hydatid disease, it is given as 400 mg twice daily for four weeks. Can be given before and after surgery and also in inoperable cases. Albenazole is also given in cutaneous larva migrans in a dose of 400 mg daily. Albendazole is used in filariasis along with diethyl carbamazine.

1. RGUHS Karnataka PGET 2011 – MCQ 106
2. Obstetrics & Gynaecology – MCQ 66 – Chorion villous biopsy for prenatal diagnosis
3. Pharmacology – MCQ 92 – Adrenal suppression due to steroid therapy

Spectrum

Protozoans - Entamoeba histolytic, Giardia lamblia, Trichomonas vaginalis

Bacteria – Camphylobacter jejuni, Helicobacter pylori, Fusobacterium, Bacteriodes fragilis, Spirochaetes, Clostridium perfringens, Clostridium difficile

Mechanism of action

Metronidazole has a nitro group which is converted into nitro radicle by the redox proteins of anaerobes. This acts as an electron acceptor and the availability of electrons to the electron transport chain is reduced. Certain organizms develop resistance to metronidazole by preventing the generation of nitro radicle.

Pharmacokinetics

Metronidazole is completely absorbed from the intestine and very little reaches the colon.

Adverse effects

CNS side effects, peripheral neuropathy, anorexia, nausea, metallic taste in mouth, head ache, neutropenia, rashes, thrombophlebitis when injected.

Contra indications

Chronic alcoholism because of disulfiram like reaction (Antabuse like reaction), neurological disorders, blood dyscrasias.

Drug interactions

Rifampicin and barbiturates induce hepatic metabolism. Cimetidine reduces the metabolism. Both these are by the action on CYP450.

Uses of metronidazole

Amoebiasis – 800 mg thrice daily for 7 to 10 days is given for amoebic liver abscess. In severe infections, intravenous therapy is initially given and followed by oral therapy. 400 mg thrice daily for mild intestinal amoebiasis.

It is also indicated in Giardiasis and Trichomoniasis.

Metronidazole is used in the triple drug regimen for Helicobacter pylori infection in peptic ulcer.

It can also be given in pseudomembranous colitis due to Clostridium difficile.

Metronidazole can be given for anaerobic infection after pelvic or colorectal surgery. Gentamicin is added as it is usually a mixed infection.

Trench mouth (ulcerative gingivitis) caused by fusobacterium is also treated with metronidazole.

1. Organisms producing gas gangrene
2. Clostridium welchii
3. Pharmacology – MCQ 56 – Treatment of H. Pylori infection

It is used after the delivery of the shoulder of the infant to reduce post partum hemorrhage. But it is indicated only in cases which have a higher risk of post partum hemorrhage.

1. Fourth stage of labour
2. Obstetrics & Gynaecology – MCQ 33 – Asherman syndrome secondary to Dilatation and Curettage
3. Obstetrics & Gynaecology – MCQ 75 – Uses of Misoprostol

1. Pharmacology – MCQ 57 – Adverse effects of ACE inhibitors
2. Adverse effects of ciprofloxacin
3. Adverse effects of thalidomide

Hence it is used in the treatment of constipation. 10 gm twice daily is the dosage. It softens stools in one to three days.

Use in hepatic precoma

The products of lactulose degradation decreases the pH of the intestine. This converts the ammonia produced by the intestinal flora into NH4+ ions, thus decreasing the absorption. Hence it is used in the treatment of hepatic coma (porto-systemic encephalopathy). For this a higher dose of 20 gm three times daily or more may be needed.

1. Hepatic encepahalopathy
2. Advantages of doxycycline over other tetracyclines
3. Microbiology – MCQ 78 – Hepatic failure in pregnancy