30 - PGI december 2003 pharmacology mcqs

note : questions can have multiple answers .

1q: side effects of timolol maleate ?

1. asthma
2. depression
3. tachycardia
4. hypotension
5. hypertension

answer: a , b , d .

2q: methotrexate acts by ?

1. inhibition of dihydrofolate reductase
2. aldose dehydrogenase
3. glutathione reductase
4. inhibition of sterol synthesis

answer: a .

3q: true about carvedilol ?

1. alpha 1 blocker
2. beta 1 blocker
3. beta 2 blocker
4. antioxidant
5. used in hypertension

answer: a , b , c , d , e .

4q: prophylaxis of migraine ?

1. flunarizine
2. cinarizine
3. beta blockers
4. sodium valproate
5. carbamazepine

answer: a , c , d .

5q: which of the following are prodrugs ?

1. mercaptopurine
2. dipivefrine
3. enalapril
4. phenytoin
5. linezolid

answer: a , b , c .

6q: first pass metabolism is seen in ?

1. lignocaine
2. propranolol
3. salbutamol
4. dypyridamol
5. erythromycin

answer: a , b , c .

7q: true about quinidine

1. it increases the effective refractory period
2. used in hypertension
3. causes paradoxical tachycardia
4. it decreases absolute refractory period
5. cinchonism is seen

answer: a , c , e .

8q: regarding ritonavir in AIDS patient which of the following are true ?

1. interacts with terfenadine
2. gastrointestinal symptoms are seen
3. contraindicated in renal failure
4. it is NNRTI
5. should not be used in AIDS patient with bleeding disorder

answer: a , b .

9q: anti hypertensive drug beneficial or neutral role in lipid metabolism ?

1. prazocin
2. propranolol
3. furosemide
4. losartan
5. chlorthiazide

answer: a , d . prazocin and losartan .

10q: neurochemical mechanism of analgesia

1. VR-1
2. Nicotinic cholinergic
3. Nocistatin pattern
4. Nociceptin pattern
5. Anandomide

Answer: a, b , d , e .

11q: side effects of phenytoin are ?

1. gum hypertrophy
2. alopecia
3. subungual exostosis
4. onycholysis
5. acne rosacea

answer: a .

12q: ototoxicity of aminoglycosides is increased with concurrent use of which of the following drugs ?

1. cisplatin
2. furosemide
3. vancomycin
4. vincristin
5. erythromycin

answer: a , b , c , e .

13q: treatment of pencillinase producing neisseria gonorrhea is/are ?

1. amoxicillin
2. ciprofloxacin
3. cefotaxime
4. azithromycin
5. doxycycline

answer: b , c .

14q: true about lispro-insulin ?

1. action is faster and short in duration than regular insulin
2. it is given 15 minutes prior to meal
3. source is lamb
4. action is faster and long in duration than regular insulin

answer: a , b .

15q: true about pseudocholine esterase ?

1. present in neuromuscular junction
2. level is increased in pregnancy
3. succinyl choline is metabolized
4. organophosphorous inhibits it

answer: c .

16q: alkylating agents are ?

1. vincristin
2. actinomycin-D
3. chlorambucil
4. 5-FU
5. Cyclophosphamide

Answer: c , e .

29 - ezetimibe

Ezetimibe is an anti-hyperlipidemic medication which is used to lower cholesterol levels. It acts by decreasing cholesterol absorption in the intestine. It may be used alone when other cholesterol-lowering medications are not tolerated, or together with statins (e.g. ezetimibe/simvastatin, marketed as Vytorin and Inegy) when cholesterol levels are unable to be controlled on statins alone. It is marketed by Schering-Plough and Merck under the trade names Ezetrol, Zetia and Ezemibe. Ezetimibe was originally discovered by a team of four Schering-Plough research chemists: Drs. Stuart B. Rosenblum, Duane A. Burnett, John W. Clader and Brian A. McKittrick.

Ezetimibe localises at the brush border of the small intestine, where it inhibits the absorption of cholesterol from the diet. Specifically, it appears to bind to a critical mediator of cholesterol absorption, the Niemann-Pick C1-Like 1 (NPC1L1) protein on the gastrointestinal tract epithelial cells as well as in hepatocytes. In addition to this direct effect, decreased cholesterol absorption leads to an increase in LDL-cholesterol uptake into cells, thus decreasing levels in the blood plasma.

Ezetimibe is indicated as an adjunct to dietary measures in the management of:

• Hypercholesterolaemia
• Homozygous sitosterolemia (phytosterolemia)

On 9 June 2006, U.S. regulators approved the use of ezetimibe in combination with fenofibrate to treat mixed hyperlipidaemia.

Common adverse drug reactions (greater than or equal to 1% of patients) associated with ezetimibe therapy include: headache and/or diarrhea. Infrequent adverse effects (0.1–1% of patients) include: myalgia and/or raised liver function test (ALT/AST) results. Rarely (less than 0.1% of patients), hypersensitivity reactions (rash, angioedema) or myopathy may occur.

Ezetimibe is available as 10 mg tablets in most markets. A combination preparation ezetimibe/simvastatin, which combines ezetimibe with a statin, is also available.

On January 14, 2008, it was reported in the New York Times that a clinical trial (ENHANCE trial) of Zetia that was designed to show that the drug could reduce the growth of fatty plaques in arteries instead resulted in growth of plaques. However, the growth noted was less than it would have been had the patients been on placebo alone. Merck and Schering-Plough completed the clinical trial in April 2006 and had initially planned to release the findings no later than March 2007. The companies missed several self-imposed deadlines, and in December 2007, finally agreed to publish the results "soon" after the delays were publicized in news reports.

It should be recognized that the ENHANCE trial was not a clinical-outcome trial, but merely an imaging study. Formally, the American College of Cardiology (ACC) maintains that Zetia may be a reasonable option for patients who cannot tolerate a statin or cannot be controlled on a high dose statin. Results from the trial have provoked three large clinical-outcome trials. The results from these trials will be presented in the next three to four years. However, a March 30th, 2008 meeting of the ACC resulted in negative press for drugs like Zetia as Yale University Cardiologist Harlan Krumholz and concurring colleagues called into question the efficacy of such drugs. Krumholz' statements maintained that such pharmaceuticals should not be the first or even second option for prescribing doctors. Definitive conclusions of the efficacy and safety of Zetia can be made such a time when the results of more substantial and comprehensive trials are released, such as the upcoming IMPROVE-IT Trial which has an enrollment of 18000 patients and will report results in 2012.

28 - cephalosporins - 1st,2nd,3rd and 4th generations

1^st generation parenteral cephalosporins :

1. cephalothin
2. cefazoline

1^st generation oral cephalosporins

1. cephalexin
2. cephradine
3. cefadroxil

2^nd generation parenteral cephalosporins

1. cefuroxime
2. cefoxitin

2^nd generation oral cephalosporins

1. cefaclor
2. cefuroximeaxetil

3^rd generation parenteral cephalosporins

1. cefotaxime
2. cetizoxime
3. cefoperazone
4. ceftriaxone
5. ceftazidime

3^rd generation oral cephalosporins

1. cefixime
2. cefpodoximeproxetil
3. cefdinir
4. ceftibuten

4^th generation parenteral cephalosporins

1. cefepime
2. cefpirome

27 - Dopamine agonists, antagonists and depleters

Dopamine agonists :

1. dopamine
2. bromocriptine
3. apomorphine

dopamine is an inhibitor of prolactin release , so these drugs cause a decrease in the plasma level of prolactin and hence are used in the treatment of galactorrhea .

Dopamine antagonists :

1. metoclopramide
2. chlorpromazine
3. haloperidol

these drugs cause an increase in the plasma level of prolactin .

Dopamine depleters

1. reserpine
2. methyldopa

26 - pseudotumor cerebri causing drugs

1. hypervitaminosis A

2. oral contraceptive pills

3. tetracyclines

4. glucocorticoids ( withdrawal )

5. amiodarone

6. mineralocorticoids ( withdrawal )

try this stupid mnemonic : HOT Glucose And Minerals – treat pseudotumor cerebri.

25 - gynaecomastia causing drugs with mechanism of action

Various drugs are implicated in gynecomastia and can be classified into the following categories:

• Estrogens or drugs with estrogen like activity such as diethylstilbestrol, digitalis, phytoestrogens, and estrogen-contaminated food and estrogen-containing cosmetics

• Drugs that enhance estrogen synthesis such as gonadotropins, clomiphene, phenytoin, and exogenous testosterone

• Drugs that inhibit testosterone synthesis or action such as ketoconazole, metronidazole, alkylating agents, cisplatin, spironolactone, cimetidine, flutamide, finasteride, and etomidate

• Drugs that act by unknown mechanisms such as isonicotinic acid hydrazide, methyldopa, busulfan, tricyclic antidepressants, diazepam, penicillamine, omeprazole, phenothiazines, calcium channel blockers, ACE inhibitors, alcohol, marijuana, and heroin

• Drugs in the same class do not all cause gynecomastia to the same extent

24 - Hemolysis causing drugs in G6PD deficiency

1. Dapsone

2. Cotrimoxazole

3. Sulfonamides

4. Aspirin

5. Anti-malarials eg: primaquine

6. Nitrofurantoin

7. phenacetin

8. probenecid

9. chloramphenicol

try this stupid mnemonic : Deepa Caught Selling Aspirin At Primetime Night. Phone Probe Closed .

please visit this page for a very detailed list of drugs which carry a definite risk , possible risk and doubtful risk of hemolysis in glucose 6 phosphate dehydrogenase deficient patients .

23 - prodrugs and active forms

MCQ: all of the following are prodrugs except ?

a. lisinopril

b. enalapril

c. levodopa

d. sulindac

answer: a . lisinopril .

PRODRUGS AND ACTIVE FORMS

1. LEVODOPA ------------------- dopamine

2. ENALAPRIL ------------------- enalaprilat

3. SULINDAC --------------------- sulfide metabolite

4. BECAMPICILLIN –---------- ampicillin

5. SULFASALAZINE –---------- 5 – aminosalicyclic acid

6. PREDNISONE ----------------- prednisolone

7. ZIDOVUDINE ----------------- zidovudine triphosphate

8. CYCLOPHOSPHAMIDE --- aldophosphamide

22 - theophylline - drug interactions

THEOPHYLLINE -- DRUG INTERACTIONS

1. drugs which inhibit theophylline metabolism and increase its plasma level :

1. allopurinol
2. cimetidine
3. ciprofloxacin
4. erythromycin
5. OCP

2. drugs which induce theophylline metabolism and decrease its plasma level are :

1. phenytoin
2. phenobarbitone
3. charcoal broiled meat meal
4. rifampicin
5. smoking

3. theophylline enhances the effect of the following drugs:

1. hypoglycemics
2. furosemide
3. digitalis
4. oral anticoagulants
5. sympathomimetics

4. theophylline decreases the effect of :

1. lithium
2. phenytoin

21 - antacids - drug interactions

Examples of antacids (brand names may vary in different countries).

• Aluminium hydroxide (Amphojel, AlternaGEL)
• Magnesium hydroxide (Phillips’ Milk of Magnesia)
• Aluminum hydroxide with magnesium hydroxide (Maalox, Mylanta)
• Aluminum carbonate gel (Basaljel)
• Calcium carbonate (Alcalak, TUMS, Quick-Eze, Rennie, Titralac, Rolaids)
• Sodium bicarbonate (Bicarbonate of soda, Alka-Seltzer)
• Hydrotalcite (Mg₆Al₂(CO₃)(OH)₁₆ · 4(H₂O); Talcid)
• Bismuth subsalicylate (Pepto-Bismol)
• Magaldrate with Simethicone (Pepsil)

1.Sparfloxacin is a broad-spectrum oral fluoroquinolone antimicrobial agent with a long elimination half-life. Concurrent treatment with antacids has demonstrated a reduction in the oral absorption of many quinolones.

2.Antacids may reduce zinc and iron absorption due to the inhibition of gastric acid secretion.

3.Possible effects of antacids and acid-lowering drugs on the pH of the proximal small intestine. Both cimetidine and an antacid containing aluminum and magnesium hydroxide reduced folate absorption from a liquid formula meal. Although the effects of these drugs on reducing folic acid absorption were relatively small, such reductions could become clinically significant in chronic antacid or H2 receptor antagonist use or intensive antacid or H2 receptor antagonist use by individuals eating diets that are marginal in folate content.

4.The effect of small doses of four commercially available aluminum-containing antacids on calcium and phosphorus metabolism was investigated in adult males in 20 studies. During the use of these doses of antacids, urinary and fecal calcium increased significantly during a low calcium intake averaging 252 mg/day, and the calcium balances became distinctly more negative. There was a reversal of the normal pattern of phosphorus excretions, namely, the fecal phosphorus was high and the urinary phosphorus was low. During a normal calcium intake of 800 mg/day, these doses of antacids did not result in significant changes of the calcium excretions or balance. In three patients who received large therapeutic doses of antacids, 240 to 450 ml/day, the changes of calcium and phosphorus metabolism were intensified.

5.Following all doses of antacid, a significant increase in 24 h urinary excretion of aluminium was seen. The estimated absorption of aluminium was 8 and 50 times higher when antacids were taken with orange juice or with citric acid, respectively, than when taken with water. Thus, measurable quantities of aluminium are absorbed from single oral doses of antacids. The absorption is substantially enhanced by concomitant ingestion of citric acid.

6.Two infants presented with growth failure and were found to have generalized osteomalacia (rickets) due to phosphate depletion from prolonged administration of an aluminum-containing antacid given for the symptoms of colic. One of the infants developed bilateral proptosis due to craniosynostosis related to the underlying metabolic bone disease. The chronic use of aluminum-containing antacids in infants has potential risk for the growing skeleton and is not innocuous. Therefore, antacid therapy should be used in low doses and very cautiously, with routine monitoring of serum calcium and phosphorus in children taking medications which reduce gastrointestinal phosphate absorption.

7.antacids reduce the absorption of tetracyclines from the gut .

20 - gynaecomastia causing drugs

MCQ: gynecomastia is caused by

1. rifampicin
2. spironolactone
3. thiazide
4. propranolol

answer: b . spironolactone .

DRUGS CAUSING GYNAECOMASTIA

1. spironolactone
2. ketoconazole
3. estrogens
4. testosterone
5. digitalis
6. clomiphene
7. phenytoin
8. griseofulvin
9. calcium channel antagonists
10. reserpine
11. isoniazid
12. methyldopa
13. ethionamide

for last seven drugs try this mnemonic : PG CRIME . for the first six drugs try TC DESK .

19 - drugs causing interstitial nephritis

1. MCQ: drug induced interstitial nephritis is caused by ?

2. methicillin
3. cloxacillin
4. azlocillin
5. piperacillin

answer: a . methicillin .

drugs causing interstitial nephritis :

1. pencillins especially methicillin

2. cephalosporins

3. ciprofloxacins

4. NSAIDS

5. sulfonamides

6. thiazides

7. furosemide

8. rifampicin

9. phenindone

18 - hypolipidemic drugs - mechanism of action

There are mainly four type of hypolipidemic drugs , they are

1. statins : they act by inhibiting the enzyme HMG CoA reductase which is the rate limiting step of cholesterol synthesis .

examples of statins are : lovastatin, mevastatin, simvastatin , rosuvastatin .

2. fibric acid derivatives : these drugs act by activating the lipoprotein lipase .

examples are : gemfibrozil , clofibrate .

3. bile acid resins : these drugs act by interrupting the enterohepatic recycling of bile acids .

examples of bile acid resins are : cholestyramine and cholestipol .

4. nicotinic acid : this drug acts by unclear mechanisms but it is believed that it acts by inhibition of lipolysis .