Pharmacology High Yield

Pharmacology
High-yield
Index
Sl.No. Chapter Pg.No.
1. Autonomic Nervous System 09
2. General Pharmacology 28
3. Neuropharmacology 43
4. CVS Pharmacology 70
5. Nephrology 83
6. Haematology 93
7. Anti Cancer Drugs 100
8. Hormonal Therapies, DMARDS & Biologicals 107
9. Antibiotics 117
10. Endocrinology 145
Autonomic Nervous System
Basic Idea
Sympathetic Parasympathetic
Mediation - Norepinephrine Mediation - Acetyl Choline

Thoracolumbar Outflow. Craniosacral Outlow
T3 - l3 segment Some cranial nerves having
parasympathetic supply
- III, VII, IX, X
Parasympathetic system
MCQ Bulletins Synthesis
1) Source of Choline Choline Choline MCQ Bulletins
is Serine. +
Na+ Acetyl
•
Rate Limiting Step
2) Defect in this channel CoA
causes
Ach
LAMBERT EATON SYNDROME Ca 2+
Rx : 3,4 - diaminopyridine
by increasing Ach release. Vesicle
MOA
i) Ca2+ channel activation. -
ii) K+ channel blockade.

3) Normally sympathetic post Ach
ganglionic fibres release NE.
Exception - Post ganglionic
→→
sympathetic fibres releasing

ACh at sweat glands
M M
4) Tetrodoxin Na A) Muscarinic B) Nicotinic
-
Channel
M1, M3, M5 - Gq Nm, Nn
(Blocker) -
Puffer fish M2, M4 - Gi
- Ligand Gated
Toxin Skeletal
Receptor
Muscle “G” Protein Coupled
Paralysis Receptor
Previous Year Questions AIIMS 2018
Which of the following is an example of a GPCR?

A) Muscarinic
✓
B) Nicotinic
C) GABA-A
D) Insulin
What is the mechanism by which acetylcholine causes a

decrease in the heart rate?
A) Delayed diastolic depolarization
✓
B) Increase in plateau
C) Decrease in preload
D) Increase in afterload
Which of the following GPCRs does not act via the K+

channel?
A) Angiotensin 1 receptor
✓
B) Muscarinic M2 receptor
C) Dopamine D2 receptor
D) Serotonin 5 HT1 receptor
Which of the following causes an increase in ACh release

from the presynaptic neuron?
A) Potassium channel blocker
✓
B) Sodium channel blocker
C) Calcium channel blocker
D) Chlorine channel blocker
Muscarinic Receptors
M1 M2
a
Location - Stomach Location - In Myocardium, maximally located at AV Node
v.
a
Releases HCL Action - Decreases Myocardial contractility
v.
a
Selective M1 Agonist
- Oxetremorine Bradycardia
a
C/I - Gastritis v.
Selective M2 Agonist - Methacoline

Selective M1 Antagonist Selective M2 Antagonist - Methoctramine
:
Tripitramine
- Pirenzepine
- Telenzepine
Previous Year Questions NEET PG 2018
Which of the following conditions can be treated with

pirenzepine?
A) Asthma
B) Peptic ulcer disease
C) Glaucoma
D) Hypertension
Previous Year Questions AIIMS & INICET 2020
The response on stimulation of muscarinic receptor is:

A) Erection
:
B) Ejaculation
C) Bronchodilation
D) Increased myocardial contractility
M3 Receptors location
Smooth Muscle
Visceral Muscle
: Eye
M3
Location - a) Smooth Muscle
b) Visceral Muscle
c) Eye
Smooth Muscle Clinical Aspect

M3 Antagonist
Vascular Bronchial
Endothelium Smooth Muscle Used in COPD/Bronchial Asthma
Vasodilation Spasm i) Ipratropium Bromide

ii) Triotropium Bromide
Hypotension
Visceral Muscle
- Intestine and Bladder
Selective M3 M3 Agonist M3 Antagonist

Antagonist acting Bethanechol
0
Darifenacin
only on Bladder
Uses : Solifenacin
Oxybutynin
: Flavoxate i) Constipation Uses
Tolteridone ii) Post Op paralytic Ileus i) D - IBS
: Fesoteridone iii) Urinary Retention ii) Overactive bladder
Previous Year Questions INICET 2021
Paradoxical bronchoconstriction seen with ipratropium

bromide is due to all except
A) Hypertonic saline
✓
B) EDTA
C) Benzalkonium chloride
D) Prejunctional M2 receptor blockade
M3 Receptors in Eye
M3 agonists on eye
Pilocarpine
: Ecothiophate
Sphincter
M3
Pupillae
Muscle In Organophosphate poisoning
Constriction
They are irreversible
Miosis cholineseterase inhibitors
Increase in Ach
Miosis
(Very Imp - NEET & INICET)

Anti glaucoma drugs
i) Reduces Aqueous Humor Formation Drugs S/E
Sympathomimetics Anticholineesterase agents Cataract
: Beta blockers (Ecothiophate)
Carbonic anhydride inhibitors Cholinergic agents Corneal Oedema
:
ii) Increases uveosclreal outflow
Prostaglandin Analogues
(Pilocarpine)
Sympathomimetics Conjunctival hyperemia
Sympathomimetics Alpha 2 agonists CNS depression in infants
:
iii) Increases Trabecular Outflow
Miotics
(Brimonidine, Apraclonidine)
Beta Blockers Corneal hypoesthesia
a
Rhokinase inhibitors (Netarsudil) (Timolol) Systemic S/E
Carbonic anhydrase Systemic S/E
Inhibitors Corneal Oedema
Prostaglandin Eyelash Hypertrichosis
Analogues Macular Oedema
(Latanoprost) Iris pigmentation
Periorbital fat
A patient with diabetic macular edema developed glaucoma. Which of the

following drugs would you consider giving last?
A) Beta blocker
B) Alpha blockers
C) Pilocarpine
D) Prostaglandin analogues
:
Which of the following cannot be used to decrease

intraocular pressure in glaucoma?
A) Dexamethasone
B) Acetazolamide
C) Apraclonidine
D) Mannitol
Which of the following antiglaucoma medications is

unsafe in infants?
A) Timolol
B) Brimonidine
C) Latanoprost
D) Dorzolamide
Which of the following can be prescribed in case of an

open angle glaucoma with bronchial asthma?
A) Timolol
B) Gemeprost
C) Latanoprost
D) Mannitol infusion
Scopolamine (Hyoscine)
✓
Anticholinergic.
Used in the treatment for motion sickness
: Scopolamine patch is the preferred mode of administration and is most effective.
Patch should be applied the night before the journey.
: Not given to children less than 10 years of age.
Place patch behind the ears at least 4 hours before travel and lasts for 3 days.
: S/E : Dry mouth, Sedation.
Other anticholinergic used in motion sickness - Dicyclomine.
: Other drugs used in Motion Sickness -
: Promethazine
Cinnarizine
Diphenhydramine
:
Cyclizine
Meclizine
: Dimenhydrinate
You and your friend plan for a mountain trip for the day after. What medication
would you advise him to help with his motion sickness?
A) Ranitidine tablet before start of trip
B) Dimenhydrinate before start of trip
C) Scopolamine patch the night before trip
✓
D) Omeprazole the night before and before start of trip
Which of the following drugs is used for the treatment of

motion sickness?
A) Cetrizine
B) Promethazine
✓
C) Misolastin
D) Loratidine
Nicotine receptors
ACh SCh
Na+ Succinylcholine
Structure mimics Ach structure
Nm Nn
Membrane depolarised
Skeletal
Muscle
Persistent
Na+ Muscle Mechanism of Action

Contraction Flaccid Paralysis Depolarising skeletal muscle
Eg : Relaxation
d - tubocurarine
Goes by competitive antagonism with ACh
Mechanism of action
Non depolarising skeletal d - tubocurarine ACh
muscle relaxation x
Nm Nn
Skeletal
Muscle
Anticholineesterases
Reversible
1) Physostigmine (Natural Origin)
Highly lipid soluble. So can cross Blood Brain Barrier.
DOC - Atropine (Belladona) Poisoning
2) Pyridostigmine
Orally given drug, longer acting in myasthenic patients.
3) Neostigmine
Has direct action on Nm, for myasthenic patients in injection form.
4) Edrophonium
Water soluble. So can’t cross Blood Brain Barrier.
Edrophonium Challenge Test - Short Acting, If after injecting, symptoms improve, then
it’s positive test.
Other drugs are : Rivastigmine Used in Alzheimer’s disease
Donepezil Pathology - Deficiency of ACh
Galantamine
Which of the following drugs exacerbates myasthenia and is

usually avoided in a patient with myasthenia gravis?
1. Lidocaine
2. Digene
3. Meropenem
4. Phenytoin
A) 1 and 2
:
B) 2 and 3
C) 1 and 3
D) 1 only
What is the drug used to differentiate myasthenia gravis

from cholinergic crisis?
A) Obidoxime
B) Edrophonium
C) Donepezil
D) Atropine
Irreversible
Mnemonics
Organophosphorous Compounds (OPCs) Drugs that can’t cross BBB
1) Dyflos Goa on SuNDay
2) Parathion
3) Malathion G - Glycopyrrolate
4) Diazinon S - Streptomycin
OPCs inhibit cholinesterase enzyme by binding N - Neostigmine
with esteric site of cholineseterase enzyme. D - Dopamine
ACh accumulation
•
Carbamate
1) Carbaryl
2) Propoxur
Drugs used in Organophosphorous poisoning
i) Atropine
First line drug of choice.
Max dose 200 mg.
Signs and symptoms of Atropinisation
- Until the HR > 100/min
- Pupil size : dilated
- Pulmonary secretions and other secretions decreases
ii) Oximes
Bind to anionic site - reactivation of cholineseterase enzyme.
Eg : Pralidoxime
Obdoxime
Diacetyl monooxime (more potent)
MCQ Boost MCQ Boost

Atropine reverses all the symptoms of OP poisoning In Carbamate poisoning,
except : Oximes are not used as it occupies both the
A) Miosis sites - no site remaining.
B) Diarrhoea
C) Secretions
D) Muscle Twitching
- as Atropine doesn’t reverse signs of Nm receptor.
A patient presents to the emergency department with diarrhea, sweating, excessive

lacrimation, and salivation. His pulse rate is 55/min and his plasma cholinesterase level was
50U/mL. Which of the following can be used to treat this patient?
A) Neostigmine
B) Atropine
✓
C) Epinephrine
D) Benztropine
Sympathetic System
Tyrosine Tyr
Tyrosine Hydroxylase
Dopa
DOPA Decarboxylase
Dopamine
Dop
NE
The 2 enzymes that cause metabolism
:
of NE : i) MonoAmine Oxidase (MAO)
ii) Catechol - O - Methyl transferase
NE
(COMT)
Alpha Beta
Alpha 1 - Gq Beta 1
Gs
Alpha 2 - Gi Beta 2
Beta 3
Alpha 2
NE Inhibits release of NE
Alpha 2
Controls release
A patient was treated for septicemia with norepinephrine infusion. Which of the following
best explains the benefit of this drug?
A) Bradycardia
B) Tachycardia
C) Increases urine output
D) Increases mean arterial blood pressure
Examples of Alpha 2 Agonists and Uses
1) Clonidine
Uses of Clonidine
- As autoreceptor : inhibited release of NE
i) Hypertension
- As heteroreceptor : inhibits release of ACh
ii) Opiod Withdrawal symptoms
S/E : a) Mental depression
iii) Useful in controlling smoking habits
b) Sedation
iv) Analgesic action
c) Impotence
v) Prophylaxis of chronic migraine
d) Dry mouth, nose, eye.
ACh vi) For controlling loose motion d/t Diabetes.
e) Constipation
Sudden Withdrawal : Rebound Hypertension
2) Moxonidine
Used as anti HTNs but has much lesser incidence for rebound HTN.
3) Rilmonidine
4) Apraclonidine Aqueous humor Uveoscleral Treatment of
5) Brimonidine formation Outflow Glaucoma
in
6) Tizanidine - Centrally acting SMR
7) Dexmedetomidine - Sedation in ICU patients.
Important selective Alpha 2 Antagonists

i) Yohimbine NE
Alpha 2 Antagonism
ii) Idazoxan
Creative BP
Mood So used in
Sexual hypertension
Stimulation
Alpha 1 - Sites and Action
1) Vascular Smooth muscle - Vasoconstriction
Useful for the treatment of
Hypotension Nasal Congestion

i) Methoxamine i) Naphazoline
ii) Mephenteramine ii) Oxymetazoline
iii) Midodrine iii) Xylometazoline
2) Radial Muscle fibres of Iris - Mydriasis
3) Alpha 1 present in Internal Urethral sphincter.
Alpha blockers are used to relieve symptoms of BPH.

Alpha 1 blocker
Alpha 1A @ bladder Alpha 1B @ blood vessel
Examples of Alpha 1 Blockers

i) Prazosin - Alpha 1 blocker ii) Terazosin Also have apoptotic
iii) Dorazosin effect on prostate.
Blood Vessel (Alpha 1B) iv) Silodosin Relieves symptoms
v) Alfulosin of BPH.
Vasodilation vi) Tamsulosin
Use in i) Scorpion bite
ii) HTN
iii) Peripheral Vascular Disease
iv) CCF
A/E - Postural Hypotension
The drug that decreases the size of prostate is:

A) Tamsulosin
B) Sildenafil
C) Finasteride
:
D) Flutamide
A patient with diabetes and COPD developed post-operative urinary retention. Which of
the following drugs can be used for short-term treatment of the condition?
A) Tamsulosin
B) Bethanechol
C) Terazosin
D) Methacoline
Non - Selective Alpha Blocker
Irreversible Reversible
Phenoxybenzamine Tolazoline, Phentolamine
T/t : HTN due to Pheochromocytoma

(Tumour in adrenal)
Beta 1
β1 Heart Increase HR
Increased force of contraction.
Increased Cardiac Output.
Kidney Renin release increases.
Synthetic Catecholamines
Isoprenaline - β1, β2, β3
: Dopexamine - D1, β2
Dobutamine - β1 : Stress Echo & ECG
: Fenoldopam - D1 : Given as IV infusion in HT emergency with renal impairment.
Beta 2
Beta 2 Vascular - Vasodilatation
Visceral Uterus
(Relaxation)
Tocolytic Agents
Bronchus Ritodrine
: Isoxsurpine
n
Bronchodilatation
Selective B2 agonists - T/t for Bronchial Asthma
- Salbutamol, Terbutaline : SABA (< 4 hours ; Short Acting)

for acute attack of asthma
- Salmeterol, Formeterol, Indaceterol : LABA (> 12 hours)
- Olodaterol, Vilanterol : Use in COPD (VLABA > 24 hours)
Adverse Reaction : Tremor, Palpitation, Hypokalemia, Hyperglycaemia
Beta 3
Beta 3 Adipose Tissue - Adipolysis.
Eg : Sibutramine. (C/I - Cardiotoxic)
Bladder - Relaxes Detrussor

Causing urinary retention
Eg : Mirabegron - used for overactive bladder
(B3 agonist)
The following table gives BP values before and after administration of drug 'X'.
What would be the probable mechanism of action of drug 'X'?
A) a1 agonist and ß1 agonist Drug X
B) M2 agonist and M3 agonist SBP 120 150
C) a1 antagonist and ß2 agonist DBP 80 68
D) B1 agonist and ß2 agonist
:
HR 72 86
Which of the following is not a side effect of salbutamol?

A) Hypoglycemia
B) Hypokalemia
C) Tremors
D) Tachycardia
Which of the following is not an adverse effect of salbutamol?

A) Tachycardia
B) Tolerance
C) Hypokalemia
D) Hypoglycemia
What dose of epinephrine is used in anaphylactic shock?

A) 1:10000 I.V. - 10 ml
B) 1:1000 I.M. - 0.5 ml
:
C) 1:1000 1.M. - 1 ml
D) 1:1000 I.V. - 0.5 ml
The drug of choice in Anaphylactic Shock is?

A) Adrenaline 0.5 mg 1/1000 IM
B) Adrenaline 1 mg 1/10000 IV
C) Atropine 3 mg
D) Adenosine 6 mg followed by 12 mg IV
Match the following dilution of adrenaline and its use:

A. 1:1000
B. 1:10000
C. 1:100000
1. Cardiac arrest
2. Anaphylaxis
3. Local anesthesia
A) A-1 B-2 C-3
B) A-2 B-1 C-3
C) A-3 B-2 C-1
D) A-1 B-3 C-2
Other Catecholamines
1) Dopamine (D1, B1, Alpha 1)
T/t - Cardiogenic Shock, especially in cases with oliguria.
2) Adrenaline
T/t - a) Anaphylactic Shock
b) On BP - Cardiac Output (B1) - SBP increases
- Peripheral Resistance (Alpha 1) - DBP increases
3) Isoprenaline (B1, B2, B3)
B1 B2
Increases CO DBP decreases
Increases SBP To reverse the decrease in DBP
Reflux Symp. Stimulation
Reflux Tachycardia
4) Noradrenaline (Alpha 1, Alpha 2, Beta 1 - No Beta 2 action)

Alpha 1 CO increases
Vasoconstriction SBP increases
DBP increases
5) Adrenaline (Alpha 1, Alpha 2, Beta 1, Beta 2)
In very high concentration, Adrenaline acts on Alpha 1.
: In very low concentration, Adrenaline acts on Beta 2.
Beta Blockers
a) Non selective Beta blockers - First generation
b) Cardioselective Beta blockers - Second generation
(Predominantly blocks Beta 1)
c) Beta blockers with additional properties - Third Generation (Blocks Beta + Alpha)
Cardioselective Beta blockers
i) Nebivolol - Most cardioselective Releases NO
Causes Vasodilatation
So used along with third generation B blockers

ii) Bisprolol - Used in CCF
iii) Betaxolol - Treatment of Glaucoma (safe in asthmatics)
- CCB
iv) Acebutolol - Partial Beta agonist
- Membrane stabilisation
v) Celiprolol - Cardioselective Beta blocker
- NO release
- Weak B2 agonist
3rd generation Beta Blockers

i) Labetalol - Beta and Alpha blocker
- Norepinephrine reuptake inhibitor
Use - Hypertensive emergencies in pregnancy.
Adverse Reaction - Postural Hypotension
- Hepatotoxic
ii) Carvedilol - Beta and Alpha blocker
Use - Antioxidant
Anitiinflammatory
CCB
CCF in HTNsive
Opening of K+ channel - Tilisolol

K+ channel blocker - Sotalol
Calcium Channel Blocker - Carvedilol, Betaxolol
Other Beta blockers having Release of NO by Beta Blockers

Beta + Alpha blocking property Nebivolol
Bucindolol : Nipradilol
:Bevantolol
Nipradilol
Celiprolol
: Bopindolol
@
Cartelol
Previous Year Questions AIIMS AND INICET 2020
If a patient who is on metoprolol is started on verapamil,

which of the following side effects would be seen?
A) Bradycardia with AV block
:
B) Torsades de pointes
C) Tachycardia
D) Ventricular fibrillation
Which of the following antihypertensives are not used in

pregnancy?
A) Alpha methyldopa
B) Hydralazine
C) Propranolol
D) Labetalol
Cisatracurium is preferred over atracurium because?

A) It has rapid onset of action
B) It has less depressant action on heart
C) It has short duration of action
D) It causes less release of histamine
General Pharmacology
Important formulas for INICET, NEET PG
Clearance = Blood flow to an organ X Extraction Ratio
: Half Life = 0.693 X Volume of distribution /Clearance
Loading dose = Target Plasma concentration X Volume of distribution
Maintenance dose = Target plasma concentration X Clearance X Dosing interval
: Therapeutic Index = LD50/ ED50

Steady State Concentration = Rate of infusion / Clearance
Volume of distribution = Amount of drug in the body
Initial plasma concentration

What instruction do you give to a mother who is lactating for drug use?
A) No advice as most of drug are not present in breast milk
B) Give longer half-life drugs
C) Tell the mother to feed when it is least efficacious
D) To feed just before the next dose, when the plasma concentration of the drug
✓
would be the least
A drug was given IV at a rate of 1.6mg/min. The clearance of the drug is 640ml/min. The half
life of the drug is 1.8 hour. Calculate the plasma concentration of the drug.
A) 2.88mg/ml
B) 0.004mg/ml
C) 3.55mg/ml
D) 0.002mg/ml
✓
The loading dose of a drug is governed primarily by:

A) Clearance
B) Volume of distribution
✓
C) Plasma half life
D) Bioavailability
I -
Basic Idea of Drug Absorption
Drug absorption is favourable when there is lipid solubility & non ionisation
So, if any drug toxicity occurs, we need to think about the pH of the drug
In basic drug poisoning In acidic drug poisoning
We need to inject acidic agent (Eg : NH4Cl or We need to inject basic agent (Eg : NaHCO3) to
Ascorbic Acid) to make the drug ionised, hence make the drug ionised, hence decreasing
decreasing absorption. absorption.
“P” Glycoprotein
Reduces the bioavailability of digoxin
Mnemonics
Mnemonics
“P” Glycoprotein Inhibitors “P” Glycoprotein Inducers
Eat - Erythromycin St. John’s - St. John’s wart
All - Amiodarone Baby - Barbiturate
V - Verapamil needs
I - Itraconazole C - Carbamazepine
Q - Quinidine P - Phenytoin
R - Rifampicin

Which of the following is not true about P-glycoprotein?
A) Pp stands for permeability glycoprotein
B) Also known as CD243
C) Also known as ABCB1
D) Also known as MDR2
:
A patient on digoxin, potassium chloride, clarithromycin, atenolol, and triamterene

developed atrial fibrillation with controlled ventricular rate. Serum digoxin levels
were raised. Which of the following is responsible for the same?
A) Potassium chloride
B) Clarithromycin
C) Atenolol
D) Triamterene
Therapeutic index is used for assessing which of the

following factors?
A) Safety
:
B) Efficacy
C) Potency
D) Toxicity
Which of the following parameters is used to assess the extent of

drug absorption in a plasma concentration vs time graph?
A) Tmax
B) Cmax
C) T1/2
D) Area under the curve
When the pH = pKa of a drug, which of the following statements is true?

A) Concentration of the drug is 50% ionic and 50 % non-ionic
B) Concentration of the drug is 90% ionic and 10% non-ionic
C) Concentration of the drug is 75% ionic and 25 % non-ionic
D) Concentration of the drug is 25% ionic and 75 % non-ionic
Previous Year Questions

NEET PG 2019
Apparent volume of distribution of a drug is very high (6L/kg). Which of the
following is true regarding the distribution of that drug?
A) Highly bound to plasma proteins
B) Confined to vascular compartment
C) Sequestered in body tissues
D) Both A and B
Calculate the therapeutic index of a drug whose dose-

response curves are plotted as shown below:
A) 1
B) 2
C) 4
:
D) 8
Which of the following statements is true regarding the

dose-response curve shown in the image below?
A) C is competitive antagonist
B) C is more potent than A
C) B is more potent than A
D) B is competitive antagonist
Apparent volume of distribution of a drug is very high (6L/kg). Which of the
following is true regarding the distribution of
that drug?
A) Highly bound to plasma proteins
B) Confined to vascular compartment
C) Sequestered in body tissues
:
D) Both A and B
The graph below shows the relationship between the log (dose) and the response
of three drugs, A, B, and C. Which of these drugs has the highest potency?
A) A
B) B
C) Both A and B
D) C
What formula is the dosing rate of a drug based on?

A) Clearance / plasma concentration
B) Clearance × plasma concentration
C) Clearance × loading dose
D) Clearance / loading dose
Bioavailability
Cmax
Area under the curve - Bioavailability
Concentration
Tmax
Time
Drug Distribution
If any drug gets distributed only in plasma - Low volume of distribution.
Lipid insoluble
Ionised
In this kind of drug poisoning,
Highly protein bound
Large Size
We need hemodialysis
Lipid Soluble
Non ionised Large volume of distribution Mnemonics
Free form AVOID
So it gets distributed in A - Amphetamine
cellular component also. V - Verapamil
O - Opioids
There is no role of dialysis I - Imipramine
in such poisoning D - Digoxin
Examples of such drugs:

Amphetamine
: Verapamil
Opioids
: Imipramine
Digoxin
Which of the following routes of administration will not

bypass hepatic first-pass metabolism?
A) Sublingual
B) Oral
:
C) Intravenous
D) Transdermal
What is the bioavailability of a

drug administered intravenously?
A) 10%
B) 100%
C) 50%
D) Variable
Diamox is given to a patient with glaucoma. It is a non-competitive

inhibitor of the carbonic anhydrase enzyme. Which of
the following would be the effect of this drug?
A) Decrease in Vmax
B) Decrease in Km
C) Decrease in both Km and Vmax
D) No change in Vmax
Low apparent volume of distribution of drug indicates

A) Low t 1/2
B) Low bioavailability
C) Low efficacy
D) Not extensively distributed to tissues
Plasma protein binding of drugs
Acidic Drugs bind with Albumin

: Basic drugs bind with Alpha - 1 - Glycoprotein
Clinical relevance
In Nephrotic Syndrome Hypoalbunemia
Liver failure
So in these situations,
free level of acidic drugs are high
High chance of toxicity
Biotransformation
Phase I Reaction Phase II Reaction

(Non - Synthetic) (Synthetic or Conjugate Reaction)
A) Oxidation (Most Common) A) Glucoronidation (Most Common)
B) Reduction B) Sulfate Conjugation
C) Hydrolysis C) Glycine Conjugation
D) Cyclisation D) Glutathione
E) Decyclisation E) Acetylation
F) Methylation
Important one liners of this chapter to solve MCQs effectively
Drugs undergoing Acetylation

S - Sulphonamide
H - Hydralazine
I - Isoniazide
P - Procainamide
D - Dapsone
C - Clonazepam
P - PAS
Drugs causing Gynaecomastism
D - Digoxin
I - Isoniazid
Which of the following atypical antipsychotics
S - Spironolactone
has the highest risk of galactorrhea?
C - Cimetidine
A) lloperidone
K - Ketoconazole
B) Risperidone
✓
O - Oestrogen/ Antiandrogen
C) Clozapine
R - Risperidone
D) Aripiprazole
A - Alpha - methyldopa
P - Phenytoin
Drug Regulatory Schedules

Schedule Drugs
Schedule C Biological and special products.
Schedule D Drugs spared from the provision of import.
Schedule F Blood and blood products.
Schedule G Marked with a label of “caution”. Used only under medical supervision.
Schedule H Sold only under prescription from a registered medical practitioner.
Schedule J Drugs which does not claim to prevent or cure a disease.
Schedule M Good Manufacturing Practices
Schedule P Expiry periods and storage of drugs.
Schedule W Drugs sold under generic names.
Schedule X Drugs abused and those which cause dependence. (Psychotropic drugs)
Schedule Y Manufacture/Import/ Clinical trials of drugs.
Previous Year Questions AIIMS 2018 Previous Year Questions AIIMS 2019
Which of the following is a

Which of the following drugs should be sold
schedule X drug?
only on prescription from a registered
A) Halothane
medical practitioner?
B) Thalidomide
A) Schedule M drugs
✓
C) Ketamine
✓
B) Schedule H drugs
D) Colistin
C) Schedule J drugs
D) Schedule X drugs
Drugs causing Glucoronidation Drugs causing Megaloblastic Anaemia
C - Chloramphenicol Prime - Phenytoin, Primidone
L - Lorazepam B - B12 Vitamin, Folic Acid depletions
A - Aspirin T - Triamterene, Trimethoprim
M - Morphine S - Sulphasalazine
P - Pethidine M - Metformin
A - Antifolate
Disulfuram like reaction N - N2O
C - Chlorpropamide, Cefoperazone
M - Metronidazole Anti craving drugs
Praises - Procarbazine Ba - Baclofen (GABA B agonist)
G - Griseofulvin T - Topiramate
T - Tinidazole A - Acamprosate
Naidu - Nitrofurantoin N - Naltrexone
Drugs following
Zero Order Kinetics Microsomal Enzyme Inducers
Zero G - Griseofulvin
W - Warfarin P - Phenytoin
A - Alcohol R - Rifampicin
A - Aspirin S - Smoking
T - Tolbutamide Cell - Carbamazepine
T - Theophylline Phone - Phenytoin
Power - Phenytoin Chronic Alcoholism
Microsomal Enzyme Inhibitor

Vit- Valproate
K - Ketoconazole What should not be consumed by patients with
Can - Ciprofloxacin bacterial vaginosis and trichomoniasis on
Cause - Cimetidine metronidazole?
Enzyme - Erythromycin MAOI-Monoamine oxidase inhibitor
Inhibition - Isoniazid SSRI- Selective serotonin reuptake inhibitor
Acute Alcoholism A) Grapefruit juice
B) Alcohol
✓
C) Benzodiazepine
D) MAOI/SSRI
Which of the following drugs does not increase the risk of

bleeding in patients undergoing warfarin therapy?
A) Cimetidine
B) Carbamazepine
:
C) Isoniazid
D) Amiodarone
Which of the following should not be prescribed with

theophylline?
A) Erythromycin
B) Cefotaxime
C) Cotrimoxazole
D) Amoxicillin
A female patient on oral contraceptive pills (OCP) was diagnosed to have tuberculosis
and started on antitubercular therapy (ATT). She was advised to use an additional barrier
method of contraception. What is the reason for this advice?
A) Teratogenic
B) Failure of ATT
C) Rifampicin decreases OP metabolism
D) Rifampicin induces CP metabolism and cause failure
Zero Order Kinetics
11
100
Constant 75
amount T1/2 - 2 hours
is eliminated. 50
No fixed T1/2 T1/2 - 1 hour
25
0
First Order Kinetics
100
1st T1/2 50% drug eliminated
Constant 50 +
fraction 2nd T1/2 25% drug eliminated
is eliminated 25 = 75% drug eliminated
with constant 3rd T 1/2 12.5 %
interval. 12.5
So fixed T1/2. 4th T1/2
6.25%
6.25

How much drug will remain at the end
What would happen to the half-life and
of 6 hours when a patient is given 200
plasma concentration of a drug which
mg drug, 75 mg excreted in 90 min and
follows first-order kinetics, if the dose
if the drug follows first-order kinetics?
is doubled?
A) 50 mg
A) Half-life doubles and plasma
B) 30.5 mg
✓
concentration remains the same
C) 12.5 mg
B) Half-life remains the same and plasma
✓
D) 6.25 mg
concentration doubles
C) Half-life and plasma concentration
remains the same
D) Half life and plasma concentration
doubles
A patient requires Ceftriaxone 180 mg. You have a 2 ml syringe with 10 divisions per ml. The
vial contains 500 mg/5ml of ceftriaxone. How many divisions in the 2 ml syringe will you fill
to give 180 mg ceftriaxone?
A) 18
✓
B) 1.8
C) 20
D) 2
For which of the following drugs, is absorption increased after a fatty meal?
A) Griseofulvin
÷
B) Amphotericin B
C) Ampicillin
D) Aspirin
Which one of the following is a placebo?

A) Herbal medication with no effect known
B) Physiotherapy
C) Sham surgery
D) Cognitive behavioural therapy
The package description of a drug states that 500mg of paracetamol is present in each unit of
the tablet formulation, but in reality, each unit contains only 200mg. What is the terminology
used to refer to these kinds of drugs?
A) Counterfeit drug
B) Adulterated drugs
C) Spurious drugs
D) Mislabelled drugs
A drug solution containing 500 mg/5 ml of the drug is given to you. You are provided with a
2 ml syringe (having 10 divisions for each mi). How many divisions of the 2 ml syringe need
to be administered to deliver 180 mg of the drug to a patient?
A) 1.8
B) 10
C) 14
D) 18
A drug label suggests storage in a 'cool' place. What is the

temperature at which this drug is to be stored?
A) - 2 degree Celsius
B) O degree Celsius
C) 2-6 degree Celsius
D) 8-15 degree Celsius
;
All of the following are the uses of enteric-coated drugs except:

A) Protect the acid labile drug from gastric acidity
B) Protect the gastric mucosa from irritant effects of certain drugs
C) Prolongs the half life of the drug
D) Deliver drugs distal to stomach
Which of the following is not a prodrug?

A) Proguanil
B) Sulindac
C) Primidone
D) 5 Fluro-uracil
The normality of 2M HCI is

A) Half
B) Twice
C) Same
D) 4 times
as 1M H2S04.
Which of the following phases of a clinical trial is also

referred to as efficacy trial?
A) Phase 1
B) Phase 2
:
C) Phase 3
D) Phase 4
Which of the following is false about the selection of essential drugs?

A) Adequate safety profile needs to be established
B) Cost to benefit has to be considered
C) Fixed drug combination is preferred over single drugs
D) Disease prevalence is considered
As a medical practitioner in India, how will you prescribe

alprazolam to a patient?
A) 0.5 mg OD before bedtime for 7 days
B) 1/2 mg HS for 7 days
C) 500 mcg OD before bedtime for 7 days
D) 0.5 mg daily before bedtime for 7 days
Neuropharmacology
Basis of action of Benzodiazepines and Barbiturates
Benzodiazepine attached with

GABA A BZD BZD receptor site
Cl-
Receptor - αγ Subunit of GABA A receptor.
αβ αγ
BZD
Causing
Hyperpolerisation
GABA facilitatory action
Increase in frequency of Cl- opening
Causing hyperpolarisation
Benzodiazepines Actions
Sedation Anti Convulsant Anti anxiety SMR
Whereas Barbiturates attach to
Barbiturates GABA A
Cl- Receptor
αβ αγ
In low dose, act as GABA facilitatory.

In high dose, act as GABA mimetic.
Increase duration of Cl- chain opening.
Benzodiazepines
Examples for Benzodiazepines

1) Diazepam
•
DOC for Acute Febrile Seizures
Status Epilepticus [DOC - Lorazepam]
: Delirium Tremens (Alcohol Withdrawal)
2) Midazolam (Short Acting) Anaesthesia

3) Remimazolam (Ultrashort Acting) Daycare Anaesthesia
Majority of Benzadiazepenes undergo Hepatic metabolism.

So they are Contraindicated in Hepatic failure.
MCQ Boost
Three important Benzodiazepenes that can be used in Hepatic failure also :
i) Temazepam
ii) Oxazepam
i
iii) Lorazepam
Z Compounds (INI CET special topics)

Acts on Benzodiazepine receptors but not a BZD
i) Zolpidem
ii) Zopiclone
iii) Zaleplon
Use - Sleep onset insomnia
Melatonin Analogues (INI CET special topics) -
i) Remelteon - Agonist on MT1, MT2

ii) Tasimelteon - Sleep wake d/s in blinds
iii) Agomelatine - Agonist on MT1, MT2, Antagonist on 5HT2C, having
antidepressant action
iv) Suvorexant - Non selective orexin receptor antagonist.
Use of Melatonin Analogues - Sleep onset insomnia. No risk of
The drug of choice for insomnia in blind people is

A) Latanoprostene
B) Zerviate
C) Tasimelteon
✓
D) Ramelteon
Benzodiazepine Antagonism INICET SPECIAL TOPICS
Flumazenil : Competitive Antagonist of BZD (Specific Antidote)
: Not given orally due to excessive absorption in GIT. So given IV.

Bicuculline
Competitive antagonist of GABA
Non competitive antagonist of BZD.
Picrotoxin : Cl- channel blocker
: Betacarboline : Inverse agonist of BZD, when it acts, BZD acts oppositely.
Barbiturates
•
General properties
•
They itself causes pain. So general anaesthesia using these cause pain.
• Narrow therapeutic index.
• Used only for two purposes - Epilepsy, Anaesthesia.
Examples of Barbiturates
Ultrashort acting Barbiturates Short Acting Barbiturates
i) Thiopentone Sodium i) Secobarbitone
t1/2 is slow because of redistribution. ii) Pentobarbitone
Highly lipid soluble, so can cause BBB.
Uses : a) i.v induction for GA.
b) Narcoanalysis
c) Status Epilepticus
ii) Methohexitone
Causes : Convulsion
Use : Electroconvulsive therapy
Long Acting
i) Phenobarbitone
ii) Primidone (Active Metabolite)
Use : Anticonvulsive agent in pregnancy and paediatric use.
Adv effects : Hyperkinesia in children.
Clinical symptoms of barbiturate poisoning MCQ BOOSTEr
1) Flabiness of muscle. It is a Microsomal Enzyme Inducer,
2) Comatose, shallow and falling respiration. so it reduces the level other drugs
3) Bullous eruption - Hallmark skin lesion for poisoning. given along with it.
Barbiturate poisoning has no specific antidote. So if given with OCP, contraceptive
failure can occur.
GABA analogues
Valproate
Glutamate
Glutamate +
Decarboxylase Induces
GABA
Inhibits
Tigabine Reuptake
- GABA
Inhibits
Valproate
Digestion by
GABA transaminase
Vigabatrin Used in
Inhibits Infantile spasm
In Tuberous Sclerosis
Gabapentin Treatment of i) DM neuropathies
Pregabalin MCQ BOOSTER
ii) Post Hepatic neuralgia ACTH is the DOC
for Simple Infantile
Spasm.
Promotes synthesis and release of GABA
GABA B receptor
•
G protein coupled receptor.
•
Agonist : Baclofen
•
Uses : i) Centrally Acting SMR
ii) Rx of hiccup
iii) Central craving of alcohol
•
Antagonist : Saclofen
A patient who was on antiepileptics for the management of seizure disorder

started having visual disturbance. Evaluation reveals the contraction of the
visual field. The drug responsible is likely to be?
A) Phenobarbitone
B) Vigabatrin
✓
C) Ethosuximide
D) Levetiracetam
Glutamate
Has action on CNS Excitatory Neurotransmitter
Acts on AMPA NMDA

Antagonists - AMPA blocker, NMDA blocker
AMPA blocker
i) Topiramate Previous Year Questions INICET 2021
- Prophylaxis of Chronic migraine.
Topiramate is used for
- Controlling alcohol and smoking habit.
A) Treatment of migrane
- S/E : Weight loss, Renal Stone.
B) Treatment of Lennox Gastaut syndrome
✓
- Used in T/t of Lennox Gastaut Syndrome.
C) Prophylaxis of ADHD
ii) Lamotrigene (safest in pregnancy)
D) Treatment of dementia
- Treatment of epilepsy
- Depression stage of bipolar disorder
- Steven Johnson Syndrome
- Toxic Epidermal Necrolysis
iii) Remacemide
iv) Perampenel
v) Telampenel
*
NMDA Blocker MCQ Boosters
i) Felbamate
Antiepileptics useful for
- Treatment of Lennox Gastaut Syndrome the Prophylaxis of migraine
(Multiple pattern of epilepsy) • Valproate
- ADR : Severe epilepsy, Anaemia, Severe • Topiramate
Hepatic failure • Gabapentin
ii) Valproate Anti epileptics causing
Treatment of multiple spectrum weight gain
a) Epilepsy - Myoclonic, Atonic, Tonic Clonic, Valproate
Absence, Lennox Gastaut Syndrome.
: Gabapentin
b) Migraine Prophylaxis
Antiepileptics causing
c) Treatment of Rapid Cycle d/o, weight loss
Manic bipolar d/o (> 4 cycles) - DOC •
Topiramate
d) Tardive dyskinesia. •
Zonisamide
Adverse Effects Of Valproate

V - Vomitting / GI toxic Previous Year Questions NEET PG 2018
AL - Alopecia
Which is the drug used for
P - Pancreatitis, Increase in NH3
refractory intractable
R - Rashes
rheumatic chorea?
O - Ovary (PCOS)
A) Probenecid
A - Allergy
B) Diazepam
T - Teratogenicity
C) Haloperidol
(Spina Bifida, CVS problems, Orofacial
D) Sodium valproate
✓
cleft lip)
E - Elevation of Liver enzyme, Hepatotoxicity
Which of the following drugs are used for absence seizures?

A. Carbamazepine
B. Valproate
C. Ethosuximide
D. Gabapentin
A) A, B and C
B) B and C only
✓
C) B only
D) A, B and D
Other miscellaneous Glutamate Antagosist
Acting on NMDA blocker
• Ketamines, Xenons, N2O
Memantine T/t of Alzheimer’s disease

: Acamprosate GABA agonist action also - “Anti Craving Agent”
Riluzole - Treatment of Amyotropic Lateral Sclerosis
: Inhibits Superdioxide Dysmutase

Amantadine - Parkinsonism
Sodium Channel Blockers useful for the treatment of epilepsy

Phenytoin
:
S/E - Acute toxicity
High i.v dose - Cardiac arrest
Chronic Adverse Effects
Fetal Hydantoin Syndrome Hyperplasia of gums
Hirsuitism
Hypotension and
H
Hypersensitivity Reaction -
on iv cause arrhythmias Rashes, Lymphadenopathy
Hyperglycaemia, Hypocalcemia
Cerebella Ataxia and
vestibular nystagmus Hallucination, Behavioural
Abnormality
Hepatotoxicity
Non epileptic use
i) Trigeminal Neuralgia
ii) Digoxin induced VT.
Carbamazepine
¥
,
DOC for Parial Seizure (Simple and complex).

¥
,
Treatment of temporal lobe epilepsy.

¥
,
Adverse reactions i) SJS (Most Common)

ii) Rash
iii) Aplastic anaemia and agranulocytosis
Which of the following is not an idiosyncratic reaction of

carbamazepine?
A) Blurred vision
÷
B) Agranulocytosis
C) Rash
D) Steven Johnson Syndrome
If carbamazepine is added to ongoing valproate therapy,

what adverse effect is risked?
A) Pancreatitis
B) Thrombocytopenia
C) Hepatotoxicity
D) Hyperammonemia
A patient who was diagnosed with epilepsy was put on retigabine TDS. Now phenytoin is
being added. Which of the following changes should be made to retigabine?
A) Increase the dose
B) Decrease the dose
C) Stop the drug
D) Stop retigabine and start on carbamazepine
MCQ Boost
Absence seizure
Pathology - Abnormal T Type Calcium Channels
T/t of absence seizures - i) Ethosuccimide
ii) Sodium Valproate
iii) Trimethadione
Antiepileptics having Carbonic Anhydrase activity
i) Topiramate
ii) Zonisamide
First line goals in different types of seizures
l
Types of Seizures First Line Drugs
Generalised Onset Tonic Clonic Lamotrigene
Valproate
Focal Lamotrigene
Oxcarbazepine
Carbamazepine
Phenytoin
Levetiracetam
Typical Absence Valproic Acid
Ethosuccimide
Lamotrigene
Atypical, Absence, Valproic Acid
Myoclonic, Atonic, Lamotrigene
Topiramate
Important Adverse Effects of Antiepileptic drugs

Anti epileptic drugs Adverse Effects
Carbamazepine SJS, Diplopia, Ataxia
Phenobarbitone Sedation, Depression
Ataxia, Automatism
Vigabatrin Loss of peripheral vision
Felbamate Fulminant Hepatic failure
Lamotrigene Hypersensitivity Reactions, SJS
Topiramate Parasthesia, Renal calculi,
Weight loss, Acute Glaucoma
Ezogabine Urinary Retention
Zonisamide Renal Calculi
Perampenel Homicidal Ideation
Dopamine
Acts on
- Nigrostriatal Pathway : Initiation of movement
- Mesolimbic fibre : Controls behaviour
- Tuberoinfundibular fibre : Inhibits pituitary for prolactin secretion
A known epileptic patient on levetiracetam has been seizure-free for 2 years. But he develops
agitation and anger issues
interfering with his day-to-day activities as a result of the drug intake. Which of the following
measures is to be taken next?
A) Slowly taper the drug over next 6 months
✓
B) Continue levetriacetam since a 5 year seizure free interval is needed
C) Stop levetiracetam and start on a different anti-epileptic
D) Discontinue the drug as he is seizure free
Antipsychotics
Antipsychotics
Typical Antipsychotics Atypical Antipsychotics

Most potent D2 blocker 5HT2 antagonism
: No action on D2, that’s why EPS is not seen
•
•
Extrapyramidal signs more prominent
Extra Edge
Extra Pyramidal Side effects - Common side
Effect of Typical Antipsychotics
Types Treatment
i) Drug induced Parkinsonism Promethazine
ii) Acute Muscular dystopia Benzhexol
Benztropin
iii) Tardive dyskinesia Valbenazine
Deuterabenazine
iv) Akathesia (Restless urge Propranolol
to move)
(Most Common EPS)
v) Neuroleptic Malignant Dantrolene Sodium
Syndrome
A patient presented to the casualty with signs of dehydration due to severe vomiting. The intern
gave the patient a parenteral medication, following which the patient developed grimacing and
abnormal posturing. What could have been the inciting drug for this reaction?
A) Atropine
B) Ranitidine
C) Metoclopramide
:
D) Domperidone
Z track technique is used for?

A) Administration of nicotine patches
B) Monitoring of carbamazepine therapy
C) Administration of long acting depot antipsychotics
D) Monitoring of lithium therapy
A patient presented with history of multiple episodes of vomiting.

He was given an intravenous drug and later he developed abnormal
movements. Which of the following can be used to treat him?
A) Hyoscine
B) Cyproheptadine
C) Levodopa
D) Benzhexol
Non Extrapyramidal Side effects of Antipsychotics
Drug Side Effects
Typical Chlorpromazine Corneal lenticular deposits,
Antipsychotics Vortex Keratopathy,
Obstructive Jaundice
Thioridazine Irreversible Retinal Pigmentation
QT Prolongation
Atypical Clozapine Agranulocytosis, Metabolic Syndrome,
Antipsychotics Diabetes, Wt gain,
Wet pillow syndrome (excessive drooling at night)
Olanzapine Metabolic Syndrome, Diabetes, Weight Gain
Quetiapine Cataract
Ziprasidone QT prolongation
Amisulpride Hyperprolactinemia
Aripiprazole Hypoprolactinemia
Anti Parkinsonian Drugs
Main Pathology - Decrease in Dopamine
Levodopa
In peripheral circulation,
Dopa
Levodopa Dopamine
Decarboxylase
Alpha 1 - Vasoconstriction
Beta 1 - HR increases, Increase in Cardiac contraction
CTZ - Nausea and Vomitting, Altered taste sensorium
Toxicity causes Cardiac Arrythmia & Increased Angina
That is why we have to add peripheral Dopa Decarboxylase inhibitor - Carbidopa
Reduces toxicity,increases bioavailability

Adverse reactions of Levodopa
i) Abnormal Choreoathetoid psychosis
ii) Precursor of melanin - So C/I for melanoma patient.
iii) On (dyskinesia) and Off phenomena
T/t T/t
MAO(B) Inhibitors Rescue therapy by Apomorphine
Irreversible - Selegiline
Rasagiline
Reversible - Safinamides
COMT Inhibitor - Tolcapone
Amantadine
It’s an antiviral drug used for influenza A.
: Mechanism of Action : i) Anticholinergic
ii) Dopaminergic Agonist
iii) NMDA Antagonism
Adverse Reactions : i) Ankle Edema
:
ii) Levido Reticularis (Net like skin rashes on extremities)
(Imp NEET MCQ visual)
Ergot D2 Agonist
They all have vasoconstrictor property.
So Side effects of erythromyalgia and increased anginal pain.
: Eg : i) Bromocriptine
ii) Pergolide
iii) Cabergoline
Non Ergot D2 agonists

Eg : i) Pramiprexole - Additional antioxidant property
: ii) Ropinirole - Also used for Restless Leg Syndrome

iii) Rotigotine - Only Antiparkinson drug available on transdermal patch also
Adverse Reaction
i) Compulsive shopping and gambling.
ii) Kleptomania
iii) Increased sexual desire.
MAO (B) Inhibitors COMPT Inhibitors
•
Irreversible •
Tolcapone • Entacapone
- Selegiline (Also used for So dangerous S/E profile Do not cross BBB
depression as Transdermal Patch) S/E So only peripheral use
- Rasagiline - Rabdomyolysis
•
Reversible - Diarrhoea
- Safinamide - Hepatotoxicity
•
S/E : Metabolite is amphetamine.
- Yellowish orange urine d/t
So can cause anxiety insomnia
- Myoglobinuria
Huntington’s Chorea and
Tourette Syndrome
T/t DOC (Dopamine Depletor)
D2 blockers - Tetrabenazine
- Chlorpropamide - Deuterabenazine
- Haloperidol
Serotonin
Source - Tryptophan MCQ Booster
Tryptophan Carcinoid Tumour
Increased Serotonin/ 5 HT production
5 - hydroxy Tryptophan
Urinary Estimation of
5 - hydroxy Tryptamine 5 - hydroxy Indole Acetic Acid
(Serotonin)
Action of serotonin
G Protein Ligand
Coupled Gated
Receptors Receptors
5HT, 5HT2, 5HT4 5HT3
5HT1 -
- 5HT1A : Suppresses Serotonin activity

- 5HT1B/D : Presynaptically present - Vasoconstriction
Triptans are 5HT 1B/D agonists. So acts in headache.
5 HT2
- Controls behaviour, If overstimulation.
- In Abnormal behaviour in Schizophrenia, 5HT 2 blocker acts as antipsychotic.
Eg : Clozapine
5 HT3
- Nausea, Vomitting.
So 5 HT3 blocker has use as antiemetic.
Eg : Ondansetron, Granisetron
Migraine
Acute - One sided.
: - Can be associated with nausea.

Pathology - Vasodilatation.
So Treatment is vasoconstriction.
Ergot Alkaloids
- Ergotamine
Overdosing of Ergotamine can
cause Ergotism aka St. Anthony’s fire.
To be used with caution in patients of HTN, IHD.
5 HT 1B/D Agonists - Triptans

Sumatriptan - Decrease in nausea
: Can be given orally, S/C, Nasal
Rizatriptan - Fastest onset
Highest Efficacy
Almotriptan - Highest oral Bioavailability
: Frovatriptan - Longest half life
Drugs for prophylaxis of Migraine

Beta Blockers Previous Year Questions AIIMS 2019
- Most Common
- Propranolol Propranolol is drug of choice for:
- Can be used in - Performance anxiety A) Ulcerated infantile hemangioma
✓
Infantile Hemangioma B) Lymphangioma circumscriptum
C) Capillary malformation
D) Pyogenic granuloma
Calcium Channel Blocker
- Flunarizine
Also having Na+ channel blocking
property.
- Anti oxidant
Verapamil
An elderly woman on treatment for migraine presents with chest pain. She has a
previous history of angina/MI. Which of the following mechanism of the prescribed
drug for migraine might have caused this presentation?
A) 5-HT antagonist
B) 5-HT agonist
:
C) Calcium Channel Blocker action
D) Nitric oxide mediated vasodilation
Most effective antiemetic for chemotherapy-induced vomiting is

A) Domperidone
B) Tegaserod
C) Granisetron
D) Doxylamine
5 HT2 blockers Anticonvulsants

Pizotifen - Valproate
Ciproheptadine - Gabapentin
Acts on H1, 5HT2, M - Topiramate
Treatment of :
TCA
Appetiser - Amitriptylline
Serotonin Syndrome
Carcinoid Syndrome
Delayed Orgasm
Methysergide
Banned from market because can cause fibrosis.
Newer Drugs for the prophylaxis of Migraine (INICET IMP TOPIC)
• Basic Principle
Calcitonin Gene Related Peptide (CGRP) - Causes Vasodilatation - Hence Migraine occurs
CGRP Antagonist
:
- Olcegepant (i.v)
- Telcegepant (oral)
Monoclonal Antibodies
- Erenumab
- Fremanezumab
Anxiety Disorder
- Overaction of Serotonin
- Poor action of GABA
- Performance Anxiety
DOC - Propranolol
- Anxiety with Panic Attack
SSRI + Benzodiazepine
- 5 HT1A Agonist - causes auto regulation
i) Buspirone
ii) Ipsapirone
iii) Gepirone
Advantage
- Non sedative
- Non habit forming
Disadvantage
- Delay in onset of action.
Antidepressants
A) Serotonin Reuptake Inhibitor (SSRI)

B) Selective NE Reuptake Inhibitor (SNRI)
C) Tricyclic Antidepressant (TCA)
D) Norepinephrine Dopamine Reuptake Inhibitor (NDRI)
Atypical Antidepressants
i) Mianserin - Presynaptic Alpha 2 blocker - Causes increase in NE.
ii) Mirtazapine - Decreased sexual side effects
- Blocks 5HT1A + Alpha 2
SSRI
Main treatment of depression.
i
i) Fluoxetine
(Longest acting SSRI, Least chances of having “discontinuation”)
ii) Fluoxamine
iii) Paroxetine
- Causing weight gain
- Teratogenicity
- T/t of Premenstrual tension
iv) Citalopram - QT Prolongation
v) Escitalopram - Highly Selective SSRI
vi) Sertraline - Safe in cardiac patients
- Less drug interaction
Uses of SSRI
1) Depression - Juvenile Depression
2) OCD
3) PTSD
4) Bullimia
5) Premature Ejaculation
6) Premenstrual Tension
S/E Drug Interactions
:
5 HT2 - i) Insomnia Combination of SSRI with MAO Inhibitor
ii) Anxiety
iii) Delayed Ejaculation
5 HT3 - Nausea, Vomitting Serotonin Level increases
Severe anxiety, Diarrhoea, Vomitting

(Serotonin Syndrome)
T/t - Cyproheptadine
TCA
Blocks - Histaminic, Muscarinic and Alpha 1 receptors
: Examples :
- Clomipramine - Used for OCD
- Doxepine - Strongest Antihistamine
- Imipramine - Strong anticholinergic
- Amitryptiline - Antidepressant, Prophylaxis of Migraine, DM Neuropathy
- Maprotiline
- Amoxapine - Additional D2 blockage + Antipsychotic
- Nortriptylline - S/E : EPS, Galactorrhea.
Antihistamine Side Effects
:
- Sedation
- Increase in appetite
- Weight Gain
Anti Muscarinic side effects
- Dryness of mouth
- Constipation
- Tachycardia
- Retention of urine.
Blockage of Alpha 1 receptors
:
Vasodilatation
Postural Hypotension
TCA Poisoning
i) Cardiac Arrhythmia
ii) Convulsion
iii) Coma
iv) Metabolic Acidosis
A patient was treated with TCA for a major depressive episode in the hospital for 4
weeks. What is the main concern while considering his discharge from the hospital?
A) Need for drug monitoring
B) ECG monitoring for arrhythmias
C) Suicidal risk
✓
D) Sedation being the side effect
Which of the following antidepressants causes the least

sexual dysfunction?
A) Fluoxetine
B) Venlafaxine
C) Mirtazapine
✓
D) Imipramine
Snri
i) Venlafexine - Can cause HTN in severe form due to increased NE.
ii) Duloxetine - T/t of i) Neuropathic Pain
ii) Fibromyalgia
iii) Stress Incontinence
iii) Milnacipran
iv) Vilazodone
v) Vortioxetine
NDRI
Bupropion
T/t of i) ADHD
ii) Obesity
iii) Smoking Control
S/E : More Anxiogenic
Seizure
Bipolar Disorder
Mania
+
Depression
BPD Type 1 BPD Type 2
T/t of acute mania T/t of depressive phase - Lamotrigene
- Valproate
- Lithium
- Carbamazepine
- Olanzapine
- Risperidone
- Aripiprazole
- Diazepam
Which of the following is not an off-label use of risperidone?

A) OCD
B) Dementia
C) PTSD
D) Bipolar disorder
✓
Lithium
Narrow Therapeutic Index - Unsafe
: T 1/2 - 24 hours
Hyponatremia, Diuretics, NSAIDs - Aggravates Lithium Toxicity (NEET 2020)
: Lithium Plasma Concentration
- Maintenance margin safety for BPD : 0.5 - 0.8 meq/L
- Maintenance margin safety For Acute Mania : 0.8 - 1.2 meq/L
- Toxic symptoms arise : > 1.5 meq/L
- Hemodialysis needed : 4 meq/L
Drug Interactions with Lithium :
:
Aggregation of Action of Succinylcholine : SCh Apnoea
Aggregation of Action of Pancuronium : Tachycardia
Adverse Reaction
Li - Leukocytes increase in number.
T - Tremor (Most Common of 8 - 10 Hz)
H - Hypothyroidism - Inhibit release of T3/T4 from follicle.
IU - Increased Urination - T/t : Amiloride
M - Pregnant Mother - Ebstein’s Anomaly : Box Shaped Heart
Which is a mood stabiliser with an anti-suicidal role?

A) Carbamazepine
B) Lamotrigine
C) Lithium
÷
D) Valproate
Lithium usage in pregnancy can lead to which of the

following teratogenic effects?
A) Cardiac defects
B) Facial defects
C) CNS defects
D) Urogenital defects
A patient is started on lithium therapy. Which of the following side effects should the
patient be asked to watch out for to monitor for toxicity?
A) Malaise and sore throat
B) Vertigo and Diarrhoea
C) Fever
D) Breathlessness
A psychiatric patient was started on lithium for the management of bipolar disorder. To
monitor the blood lithium levels, at what time interval should the blood sample be collected
after the administration of lithium tablets?
A) After 24 hours
B) After 12 hours
C) After 6 hours
D) Immediately after taking tablets
A patient on lithium therapy developed hypertension. He was started on thiazides for

hypertension. After few days, he developed coarse tremors and other symptoms suggestive of
lithium toxicity. Explain the likely mechanism of this interaction.
A) Thiazide inhibits the metabolism of lithium
B) Thiazides act as an add on drug to lithium
C) Thiazides increase the tubular resorption of lithium
:
D) Thiazides cause water loss therby increase lithium levels
A female patient was on lithium therapy for bipolar disorder for 6 months. She
kept a fast for few days due to religious reasons and presented with seizures,
coarse tremors, confusion and weakness of limbs. Which of the following
investigations should be done to help diagnose her condition?
A) Serum electrolytes
B) Serum lithium level
C) ECG
D) MRI
Opiod Receptors
Endogenous Opiod Receptors and peptides
Endorphin Enkephalin Dynorphin
µ Receptor Delta δ Kappa K

Actions of Opioids due to μ and δ Actions due to K receptor
-
P - Physical dependence, D - Dysphoria
-
Prolactin release
M - Miosis
:M - Miosis
A - Analgesia
-
C - Constipation -
R - Resp. Depression
Convulsion -
D - Diuresis
-
A - Analgesia -
S - Sedation
-
R - Resp. Depression
-
E - Euphoria
-
S - Sedation
MCQ Booster
All the actions of Morphine will produce tolerance on chronic therapy except
3 Cs
i) Constipation
ii) Convulsion
iii) Miosis
Pure Agonist
•
Natural Opiod
- Morphine : Controls pain
- CodEine : Antitussive
•
Semisynthetic
- Diacetylmorphine (Heroin)
- Pholcodine
•
Synthetic
- Pethidine (Meperdine)
- Analgesic : Used in post op pain
- Antimuscarinic : C/I in MI pain
- Metabolite is Norpethidine - Causes seizures
- Methadone
- Longer acting Opiod
- MOA : NMDA blocking action, Inhibits Reuptake of NE, Serotonin.
- Use : Neuropathic pain and Cancer pain
- DOC in Opiod deaddiction.
Pure Antagonist
Nalmefene
: Naloxone (i.v) - Specific antidote of Opiod poisoning
Naltrexone - Oral, long acting
: Peripheral Opiod Antagonist - Useful for treating Opiod induced constipation.
Eg : Methyl Naltrexone, Alvimopan, Naloxegol
T/t of Diarrhoea Predominant (IBS)

µ receptor agonist - Asimadoline, Eluxadoline
: K receptor agonist - Tedotozine
MCQ Boost
Morphine and Pethidine excreted through kidney.
So, unsafe in kidney failure.
Which of the following statements are true?

A. Morphine used in pulmonary oedema
B. Pethidine used in biliary colic
C. Indomethacin is used in headache
D. Aspirin used in peptic ulcer disease
A) A and C
B) A, B and C
✓
C) A and D
D) B, C and D
A patient presented with biliary colic. The intern has administered an analgesic, following
which the pain got aggravated. Which of the following could be responsible for the
aggravation of the patient's symptoms?
A) Morphine
✓
B) Diclofenac
C) Nefopam
D) Etoricoxib
Classification of few opioids on their action on Opiod
Receptors (INICET 2020)
Receptors : µ δ K
Drugs
Buprenorphine +/- - -
Butorphanol +/- +++
Nalbuphine - ++
Pentazocine +/- +
+++ : Strong Agonist
+/- : Partial/ Weak agonist
- : Antagonist
Which of the following opioids is a partial agonist at mu and a full agonist at kappa receptors?
A) Pentazocine
✓
B) Buprenorphine
C) Tramadol
D) Fentanyl
Antitussive Opiods of Anti Diarrhoeal

Codeine Opiods
•
Codeine ④
Diphenoxylate
•
Folcodeine ④
Loperamide
Dextrometnorphan
Diphenoxylate
:
Crosses BBB
Risk of addiction
So cautiously used
Morphine absolutely C/I for

Head Injury Pain - as respiratory depression can occur.
Biliary Colic - Due to increase in contraction of sphincter of Oddi.
b-
Severe Asthma.
If codiene is coming to the market in combination with

dextromethorphan as an anti-tussive, this combination
A) Should not be used due to risk of addiction
B) Can be used as both have different mechanism of action
C) Should not be used as it is irrational
:
D) Can be used to treat cough effectively
A patient presented with pelvic fracture and head trauma after a road traffic accident. He
was given IV morphine for pain relief following which he developed respiratory difficulty.
What could be the most likely cause?
A) Pelvic Fracture
B) CO2 retention due to opioid use
C) Cerebral Edema
D) Pulmonary embolism
Apart from mu-opioid receptors, on which other receptor

does tramadol act?
A) Anticholinergic
B) 5HT1a inhibition
C) Serotonergic and norepinephrine reuptake inhibition
D) Antihistaminic
A patient was prescribed an antipsychotic drug following which he developed

parkinsonism. Which of the following drugs can be given?
A) Trihexiphenidyl
B) Entacapone
C) Rasagiline
D) Pramipexole
CVS Pharmacology
Anti Anginal Drugs
Stable Angina - Angina during exacerbation
: Unstable Angina - Pain during normal condition also
Anti anginal drugs
Vasodilators Cardiac Depressants Fatty Acid Oxidation Inhibitors

i) Nitrates i) Calcium Channel blockers
ii) K+ channel opener ii) Beta Blockers
iii) Calcium Channel
blockers
Nitrates
MOA : Cysteine Receptor Short Acting
:
Glyceryl Trinitrate
NO Amyl Nitrate
Guanyl Cyclase Intermediate Acting

Isosorbide Dinitrate ( 2 - 5 hours)
CGMP
Long Acting
:
Accumulation Isosorbide Mononitrate (6 - 10 hours)
Skeletal Muscle Longest Acting

Relaxation Pentaerythritol tetranitrate (8 - 32 hours)
Vasodilatation Chronic uses of nitrates
Receptor Downregulation
Tolerance
Nitrate Action
It is a Smooth Muscle Relaxant.
Nitrates are useful in cyanide poisoning as they can form Methaemoglobin.
Action on Visceral Muscle
Relaxation of biliary muscle Relaxes Oesophagus Relaxes Bronchus

Useful for biliary colic Useful for the treatment Safe in asthmatics
Of Achalasia Cardia
Action on
Vascular Smooth muscle
Dilates both artery and vein

but predominantly venodilation.
Peripheral Pooling of blood
Decrease in Preload
So by reducing Oxygen
demand,
Angina is relieved.
Important drug interaction with Nitrate
Nitrates shouldn’t be taken with Sildenafil
Excessive accumulation of cGMP
Severe Hypotensive Shock

h
A patient with prinzmetal angina is administered isosorbide mononitrate and is noticed to
have symptomatic relief. What is the mechanism of action of nitrate in this case?
A) Endothelium independent coronary vasodilation
✓
B) Reduced cardiac contractility
C) Increased left ventricular end diastolic volume
D) Decreased diastolic perfusion pressure
A patient who is on treatment for angina, presents to you

with erectile dysfunction. You decide against prescribing
sildenafil because the patient is being treated with
A) Calcium channel blockers
B) Beta blockers
C) Nitrates
✓
D) ACE inhibitors
Potassium Channel Openers

Additional NO releasing property
: Hydralazine : Hypertensive Emergency in pregnancy
Minoxidil : Also used for treatment of Alopecia (S/E - Hirsuitism)
: Diazoxide : S/E - Hyperuricemia
Hyperglycemia - due to decreased insulin release.
- So used in the treatment of insulinoma
Nicorandil - Additional NO release. S/E - Hypotension
:
Headache
Aphthous Ulcer
Isosorbide dinitrate is indicated for congestive heart failure in combination with

which of the following vasodilators?
A) Minoxidil
B) Hydralazine
C) Nimodipine
D) Nitrendipine
Which of the following drugs causes activation of K+-ATP channels?

A) Nicorandil
✓
B) Molsidomine
C) sosorbide dinitrate
D) Nitroglycerin
Role of Betablockers
•
in Angina
Inhibits Beta 1 receptor
Reduction of Heart Rate

Reduction of work load
- Betablockers should not be stopped abruptly. MCQ Booster
- Abrupt withdrawal can precipitate angina.
Non - selective Beta blockers
- Combined with NTG to prevent palpitation.
are C/I variant angina
(Reflex Tachycardia)
•
in Acute MI
- To control fear by reducing Catecholamines.
- Reducing the size of infarct by controlling HR.
- Additional Antiarrythmic Property (Class V)
Reduces Mortality
Sodium Nitroprusside
Only iv infusion
: Short Acting ( <10 min)
•
Treatment of i) Hypertensive Emergency
ii) Dissection of Aorta
It is a cyanide containing drug, so contraindicated in pregnancy.
: Thiocyanate - Inhibits uptake of Iodine by thyroid gland causing hypothyroidism.
What is the mechanism of action of sodium

nitroprusside?
A) Increased cAMP
B) Stimulation of guanylyl cyclase
✓
C) Calcium channel blockage
D) K+ channel opener
Which of the following is not used in heart failure?

A) Trimetazidine
✓
B) Sacubitril
C) Metoprolol
D) Nesiritide
Fatty Acid Oxidation Inhibitors

Pure - Trimetazidine
: With Added property of Na+ channel blocking - Ranolazine
S/E : i) GI upset
ii) Thrombocytopenia
iii) Liver dysfunction
iv) Increased risk of movement disorder.
v) QT prolongation
Excretion through Renal Route - So C/I in renal failure.
:
Types of Calcium Channels
L Type - All cardiac CCBs
N Type
: T Type - Ethosuximide
- Treatment of Absence Seizures
Calcium Channel Blockers
Type of Calcium channels :
- L Type - All cardiac CCBs
- N Type
- T Type - Ethosuximide - Treatment of Absence Seizures
CCBs are of two types
Dihydropyridines (DHP) Non - DHPs
•
These CCBs maximally dilate Artery •
Verapamil
- Controls HR.
Peripheral Vasodilatation - Acts predominantly on AV Node.
- Additional antiarrythmic property.
Reduction in BP - Used mainly in i) SVT
ii) AT
Useful in the treatment of : - SE
:
i) HTN i) Bradycardia
ii) Peripheral vascular disease ii) AV block
Approved for Hypertensive emergency. iii) Ankle Edema
i.v use : Clevidipine iv) Constipation
Nicardipine - Contraindicated in the
Adverse Reactions : i) Hypotension treatment of Arrythmia due to
ii) Reflex tachycardia Wolf Parkinson White Syndrome
iii) Ankle Edema (Aberrant Conducting fibre).
•
Diltiazem
MCQ Booster
- Acts on both SA and AV Node and
First line drugs for Angina
peripheral blood vessel.
- Beta blockers
- Treatment of angina
- CCB (Diltiazem)
by reducing Oxygen demand
- Nitrates
and increased Oxygen supply due to
Second line drugs for Angina vasodilatation.
•
pFOX inhibitors - Trimetazidine •
Ivabradine
- Ramolazine
Causes bradycardia.
•
If Na + channel blocker
- “I funny current” (Na+ channel
- Ivabradine
blocker) in SA Node.
- Uses - Angina, Heart failure.
- Adverse Reaction - Bradycardia.
Antiarrythmic Drugs
Rapid closure
ST Segment
of Na channels
Phase I
Ca2+ influx
Phase II
T wave
Phase 0 Phase III

Closure of Ca2+ channels
K+ efflux
APD
If K + blocker is
R (Duration of Action Potential) added
T
P Increase in
Action Potential
duration
QT prolongation
Q
S
Classification of Antiarrythmic drugs
•
Class I - Na+ channel blockers + K+ channel blocker (Class IA)
OR
K+ channel opener (Class IB)
Class II - Beta Blockers
: Class III - K Channel Blocker
Class IV - Ca channel blocker - (Verapamil, Diltiazem)
: Miscellaneous and unclassified agents - Adenosine, Atropine, Digoxin, MgSO4, KCl
Which of the following drugs acts by inhibiting the late

sodium current in the heart?
A) Ivabradine
B) Ranolazine
✓
C) Trimetazidine
D) Fasudil
Class I Antiarrythmic Drugs
Class IA Class IB Class IC

Class IA
Block Na channel and K channel.
: QT Prolongation
Examples :
:
i) Quinidine
ii) Procainamide - Acetylation : S/E - SLE, Rheumatic Arthritis
iii) Disopyramide - Has highest anticholinergic activity.
Dryness of mouth
Constipation
Retention of urine (Not suitable for elderly patients with BPH).
Class I B
Na channel blockers & K channel openers.
QT interval reduces & Action Potential duration decreases.
: Acts upon Purkinje fibres at ventricles.
Used for Ventricular Tachycardia.
: Examples for Class Ib Antiarrythmics
Lignocaine Phenytoin
For treatment of digoxin induced VT (first line drug). Only in digoxin induced VT .
Mexilitine Tocainide
Derivative of lignocaine. This drug causes agranulocytosis.
Can be given orally. Not in use
Useful for i) Ventricular Arrythmia
ii) Diabetic Neuropathy
iii) Phantom Limb
Side Effects i) Bradycardia
ii) Tremor
iii) Nausea
Class Ic
0
Na+ blocking with negligible effect on K+ channel.
No change in ECG.
: Maximum proarrythmic property.
Examples :
:
i) Flecainide
ii) Encainide Useful for controlling arrhythmia due to
iii) Propafenone aberrant pathway in
iv) Moricizine Wolf Parkinson White syndrome
Definitive Treatment of Choice - Radiofrequency Ablation
Class II
Beta Blocker.
a
Useful for Atrial and Ventricular Arrythmia.
Adverse Reaction : Bradycardia
-
Heart block
Hypotension
Class III
K+ channel blocker.
Thus prolongs Action potential duration.
QT Prolongation
Examples of Class III
Antiarrythmic drugs
i) Amiodarone Previous Year Questions AIIMS 2017
ii) Dronederone
Dofetilide belongs to which
iii) Bretylium
class of anti-arrhythmic drugs?
iv) Sotalol
A) Class I
v) Ibutilide
B) Class II
vi) Vernakalant
C) Class Ill
= vii) Dofetilide
D) Class IV
Examples of Class III Antiarrythmic drugs
Amiodarone
:
- Broad Spectrum antiarrythmic.
- It has multiple mechanisms of action :
Na+ blocking
Beta blocker
Calcium channel blocker
K+ blocking
- Long T1/2 - 53 days
- Iodine containing drugs
- S/E
PLZ - Photosensitivity - Pigment of skin
Check - Whorl like pattern in Cornea : Cornea Verticillata
Pft - Pulmonary fibrosis, Peripheral Neuropathy
Lft - Liver damage : Hepatitis
TFT - Thyroid : Hypothyroidism (Inhibits peripheral conversion of T4 - T3)
: Hyperthyroidism (As, it is an Iodine containing drug)
Dronederone - No Iodine
Bretylium - Chemical defibrillator.
: Sotalol - Beta blocking property & K+ channel blocker.
Normal
Ibutilide Converts
: Vernakalant AF
Sinus
Rhythm
Which of the following antiarrhythmic drugs is

contraindicated in a patient with interstitial lung disease?
A) Amiodarone
✓
B) Sotalol
C) Quinidine
D) Lignocaine
Class IV
CCB having Antiarrhythmic activity.
Verapamil
: Diltiazem
Miscellaneous Antiarrythmics
Atropine
•
Anticholinergic agent
•
Useful for treatment of : Symptomatic bradycardia
1° Heart block
Digoxin induced AV block
Adenosine
•
DOC for supraventricular tachycardia.
•
IV (Rapid i.v bolus) - 12 mg
•
Shortest Acting - < 10 seconds
•
Actions
a) Adenosine in brain - Antiepileptic Action
b) Adenosine in bronchus - Bronchoconstrictor
c) Adenosine in kidney - Na+ absorption from PCT.
•
Adenosine Antagonist
- Theophylline S/E - Seizures
- Aminophylline - Diuresis
- Bronchodilator
•
Adenosine Agonist - Dipyridamol
Coronary Steal Phenomenon (Recent NEET MCQ)

Steals the blood away from ischaemic myocardium
which are already maximally dilated.
Theophylline causes diuresis by:

A) Adenosine antagonism
✓
B) PDE 4 inhibition
C) Beta 2 agonism
D) PDE 3 inhibition
MgSO4
Management
Congenital long Propranolol
QT Syndrome
Long QT
Syndrome
Acquired long MgSO4
QT syndrome
Other Action of MgSO4
Respiratory System GIT Ortho OBG
Bronchial Asthma Laxative in Anti inflammatory In Ecclampsia

constipation role in synovitis Tocolytic action
Safety level : 4 meq/L - 7 meq/L Adverse Reactions
Patellar Reflex gone : > 7meq/L - Decreased deep tendon reflex
Respiratory Failure : if > 14 meq/L - Rarely respiratory failure
Antidote for Toxicity - Calcium Gluconate - Kidney problem : So monitor urine output
A 53 year old man is found to have stage 2 hypertension

without any co morbidities. Which drug will you start?
A) Furosemide
B) Chlorthalidone
:
C) Spironolactone
D) Triamterene
Inhaled Nitric oxide is approved for treatment of

A) Labile hypertension
B) Pulmonary hypertension
C) Treatment of resistant migraine
D) Resistant Parkinson's disease
Digoxin
Vagomimetic action on AV Node - Decreases heart rate
So, used in Atrial Fibrillation and Atrial Flutter
Mechanism Of Action : Inhibition of Na+ - K+ ATPase pump Rate controller

by blocking AV Conduction
Increase in Calcium concentration
Ionotropic effect
Increase in Cardiac Output

S/ E :
I) Nausea, Vomitting
2) CNS depression
3) Yellow vision defect (Xanthosis)
4) Gynaecomastia
5) Cardiac proarrythmia
Ventricular Bigeminy
- Most Common arrythmia by digoxin - Rx : Propranolol
AV Block - Rx : Atropine
Ventricular tachycardia - Rx : Lignocaine
Nephrology
geom
•*Bgmrh••gAaaa•m; •••*qa•g•*
•µpkeg_Bs•µ.q¥•••ÉB! BB.mbgmo.ae iBook
HCO3-
qzE'Y amazon.eaah-z-g.bg
•••Ñ
DCT
(Na+_Cl- Symporter)
!kB•m!Ba•
PCT
Collecting
B. duct and late
a.q.ae#ttNhnoamaRBgBaoa.z
Loop part of DCT
Of Henle
(Na+_K+_Cl- Symporter) qamar
.
Carbonic anhydrase Inhibitor

•
Mechanism of Action :
i) Inhibition of reabsorption of NaHCO3 @ PCT
Metabolic Acidosis
ii) Inhibit secretion/retention of H+ in collecting duct.
These excess H+ along with NH3 forms NH4+
The non ionised form crosses BBB
Convulsions
iii) Hypokalemia
Eg : i) Acetazolamide
:
ii) Dorzolamide
iii) Brinzolamide
Adverse Reaction
Sulpha derivative - Hypersensitivity, Bone marrow suppression
Contraindicated in Liver Disease, Severe COPD, Metabolic acidosis
: Other Uses : i) Treatment of Glaucome
ii) Mountain Sickness
iii) Catamenial Seizure
iv) Periodic Paralysis
Which of the following is used in acute mountain sickness?

A) Dexamathasone
B) Digoxin
C) Diltiazem
D) Acetazolamide
:
Loop Diuretics
H
Inhibits Na+ - K+ - Cl- Symporter
Furosemide
Uses
1) Renal failure
2) Left ventricle failure ( To promote urination with oligura/Anuria)
Additional vasodilatory property
Increased Renal
Helps in shifting pulmonary fluid to systemic circulation
Blood Supply
Diuresis Relieves pulmonary edema
Avoid using NSAIDs in patients of Furosmide
NSAIDs inhibits Prostaglandin synthesis
Bumetamide
Torsemide - Longest t1/2
O Ethacrynic acid - S/E : Ototoxicity
S/E of loop diuretics
Water Loss - Reduction in ECF Volume
i. Electrolyte Abnormality .
Metabolism
- Hyponatremia - Hypouricemia
- Hypokalemia - Hyperglycemia
- Hypocalcemia - Hyperlipidemia
- Increased H+ : Metabolic Acidosis
Thiazide Diuretics
Inhibits Na - Cl symporter @ DCT
: Loss of Na+, K+, H+, Cl-
Calcium reabsorption, so safe in renal failure patients.
: Preferred drug of HTN in post menopausal women.
Examples of Thiazide Diuretics
: - Indapamide
- Chorthalidone
Uses : Mild edema
HTN
Antidiuretic property - Use in nephrogenic diabetes insipidus
: S/E of Thiazide Diuretics :
Water loss
Electrolyte Abnormalities
- Hyponatremia
- Hypokalemia
- Hypochlorinemia
- Decreased H+
- Hypercalcemia
A patient with gout develops hypertension. The uric acid level was found to be
elevated. Which of the following is not administered?
A) Hydrochlorothiazide
✓
B) Atenolol
C) Enalapril
D) Prazosin
A 34-year-old hypertensive man is diagnosed with stage 4 CKD, with eGFR<30. His doctor
wants to prescribe a thiazide diuretic. Which of the following can be given?
A) Chlorothiazide
B) Chlorthalidone
C) Metolazone
D) Hydrochlorothiazide
✓
A patient with renal insufficiency presented with very low urine output, pedal
edema, headache and BP 160/90. Which anti-hypertensive can be administered?
A) Aliskiren
B) Chlorthalidone
:
C) Amlodipine
D) Prazosin
Potassium Sparing diuretics
Potassium Sparing diuretics
Aldosterone Antagonists Epithelial Na+

Channel blockers
Spironolactone
d
Eplerenone
d
Amiloride
d
Drosperinone d
Triamterene
Therapeutic Effects of Potassium Sparing Diuretics

1) Potassium sparing diuretics are given usually along with loop diuretics/ Thiazide
diuretics to compensate hypokalemia caused by them.
2) Specific uses of spironolactones
For treatment of Primary Hyperaldosteronism (Conn’s Disease).
: The drug of choice for treatment of liver failure induced edema aka Cirrhotic Ascites.
Treatment of heart failure - Disease modifying drug for Heart Failure.
3) Treatment with Amiloride in
Liddle’s Syndrome - Co overaction of ENAC.
: Treatment of Lithium induced Diabetes Insipidus.
S/E - Hyperkalemia
Metabolic acidosis
Antiandrogenic action
Aldosterone Antagonists
Act on collecting duct.
Active metabolite
Canrenone (MCQ NEET)
Gynaecomastia
(Eplerenon doesn’t cause)
They are the only group of diuretics that work from the interstitium.
Aldosterone - Na+ So Na+ and H2O gets excreted

K+
&
Retention of H+ Diuresis
Hyperkalemia Metabolic Acidosis
Epithelial Na+ Channel blockers

Pentamidine and Trimethoprim can also act as ENAC blockers
: MOA : These drugs act from the luminal side.
3 Na+ ENAC
Na+
Antidiuretic
Mannitol
a
Site of action
- Loop of Henle Previous Year Questions NEET PG 2019
- PCT
Intravenous mannitol is used in
a
Used in the treatment of
A) Pulmonary edema
- Glaucoma
B) Congestive cardiac failure
- Cerebral Edema
C) Acute kidney injury with anuria
- Cisplatin toxicity
a
C/I D) Glaucoma
✓
- Pulmonary Oedema
- Cerebral Haemorrhage
Vasopressin Receptors
V1 V2
V2
Site : 1) Medullary Collecting Ducts
:
2) Vascular Endothelium
Medullary Collecting Ducts Vascular Endothelium
Water Retention Release of VWF and Factor VIII

(Insertion of Aquaporin 2
channels into apical membrane)
Desmopressin
Selective V2 analogue.
DOC for
- Cranial diabetes insipidus
- Nocturnal enuresis
- T/t of bleeding due to deficiency of VWF in haemophilia.
SIADH
co
Increase in ADH. Previous Year Questions NEET PG 2019
Increase in water retention.
: Treatment by V2 Antagonist The best approach in the treatment of chronic SIADH is
- Lixivaptan A) Tolvaptan
✓
- Mozavaptan B) Reducing fluid intake to <500 ml per day
- Tolvaptan C) Demeclocycline
- Satavaptan D) Fludrocortisone
V1
Sites And Action :
:
Vascular Smooth Muscle Platelet Hepatocytes Myometrium
Vasoconstriction and Platelet Glycogenolysis Myocardial

Uterine contraction aggregation Hypertrophy
Selective V1 Analogues
- Telipressin
- Felypressin Treatment of oesophageal varices
- Lypressin
Selective V1 Antagonist for HTN (i.v use)
:
- Relcovaptan
- Nelivaptan
- Conivaptan
RaAS System Drugs
ACE
Direct -
Renin Inhibitor ACEI (Angiotensin
- Converting Enzyme)
Renin Angiotensin Angiotensin I Angiotensin II
- By acting on
ARB Angiotensin
Receptor
Direct Renin Inhibitor
MCQ Bulletins
Aliskiren
Enalkiren Any drug blocking RAAS Vasoconstriction
: Remikiren pathway will cause hyperkalemia.
A patient who was diagnosed with ADPKD was prescribed tolvaptan. After a few weeks, he
presented with dry mouth. and increased thirst. What is the likely cause?
A) Increased free water clearance
✓
B) V2 receptor agonism
C) Increased renal cAMP levels
D) Increase in urine osmolality
ACE Inhibitor
e
Captopril
e
Lisinopril
e
Ramipril
e
Fosinopril
e
Trandolapril
e
Enalapril
e
All ACEIs are prodrugs except Captopril and Lisinopril.
e
Use in e
S/E & C/I
i) HTN C - Cough and Angioedema
ii) CCF A - Anaemia
iii) MI P - Potassium (Hyperkalemia)
iv) DM T - Taste Change
v) Proteinuria O - Orthostatic Hypotension
vi) Scleroderma P - Pregnancy (C/I)
Enalapril - Best drug for HTN, DM R - Renal Artery Stenosis (C/I)
I - Increased Creatinine
L - LAAL (Red) Skin Rashes
A 35-year-old chronic hypertensive woman visits the outpatient department for pre-
conceptional counseling. Which of the following anti-hypertensives should she discontinue?
A) Labetalol
B) Calcium channel blockers
C) Angiotensin-converting enzyme inhibitors
✓
D) Alpha methyldopa
Angiotensin Receptor Blocker PDE3 Inhibitors

a
Losartan - ARBs having antiplatelet action. 0
Amrinone
Valsartan - Uricosuric Action
0
Milrinone
: - TXA2 Antagonism
T/t in HTN and gout
Telmisartan - PPAR Gamma agonist - Insulin Sensitisation

Asolasartan
: C/I in pregnancy
Levosimendon - Ca2+ sensitiser

A patient started on antihypertensive presented with the following picture.

Which of the following drugs is the most likely cause?
A) Lisinopril
✓
B) Nifedipine
C) Atenolol
D) Clonidine
Vasopeptide
Example ANP BNP Urodilatin
Natriuresis Natriuresis
Function
Diuresis Diuresis
Vasodilatation Vasodilatation
Analogue Carpreotide Nesiritide Ularitide
Nesiritide
Can’t be taken orally.
: Only as iv infusion.
T/t of CHF.
: Metabolised by Vasopeptidase/ Neprilysin ( Neutral Endopeptidase).
Selective Neprilysin Inhibitors - Ecadotril, Sacubitril
: Neprilysin Inhibitors with additional ACE Inhibition - Omapatrilat, Sampatrilat
The replacement dose of hydrocortisone for adrenal

insufficiency is (in mg/m2/day):
A) 20
B) 15
C) 10
:
D) 5
Sacubitril is a new drug approved for chronic heart failure.

The mechanism of action of sacubitril is:
A) Angiotensin Il inhibitor
B) ACE inhibitor
C) Renin inhibitor
D) Neutral endopeptidase inhibitor
A patient with chronic kidney disease underwent a

nephrectomy. Which of the following can be
administered as a
postoperative analgesic in this patient?
A) Naproxen
B) Indomethacin
C) Diclofenac
D) Acetaminophen
Haematology
Thrombolytics
MOA : Plasminogen Activator
: Plasminogen
Examples :
Plasmin Breaks Cut
1) Streptokinase
2) Urokinase
3) Alteplase
4) Reteplase
5) Tenecteplase
Indication :
: - Acute MI
- Pulmonary Embolism
S/E :
- Bleeding (Most Common)
- Severe Intracerebral Haemorrhage (Rare)
Antithrombolytic Therapy
Increases clotting action
i) Epsilon Aminocaproic Acid
ii) Tranexamic Acid
iii) Aprotinin

Which of the following drugs can be used as an antidote
for fibrinolytic therapy?
A) Protamine
B) Streptokinase
C) Heparin
D) ε-Aminocaproic acid
✓
The antidote for fibrinolytic therapy is?

A) Tranexemic acid
B) Dalteparin
C) EACA
✓
D) Alteptase
Anticoagulant Drugs
Indirect Oral Direct Vitamin K epoxide

Direct Thrombin Oral Direct
Thrombin IIa Inhibitors reductase inhibitors
Inhibitors (II a) Xa Inhibitors
Inhibitors aka WARFARIN
Direct Thrombin Inhibitors (II a)

Oral - Dabigatran
: Parenteral
Monovalent - Argatroban
Bivalent - Bivalirudin, Lepirudin
Coagulation profile monitoring is needed in therapy with

which of the following drugs?
A) Fondaparinux
B) Enoxaparin
C) Dabigatran
D) Lepirudin
✓
Indirect Thrombin Inhibitors
Anticoagulants acting via Antithrombin III
: Heparin
-
Factor IIIa and Xa
-
LMWH Factor Xa
: LMWH
- Enoxaparin
- Dalteparin
- Nadroparin
Other Injectable Anticoagulants acting via Antithrombin III, Factor Xa inhibition
:
- Fondaparinux
- Idraparinux
- Idrabiotaparinux
Which is the anticoagulant of choice for the management of cancer-associated thromboembolism?

A) Unfractionated Heparin
B) Warfarin
C) Low molecular weight heparin
D) Dabigatran
For the action of heparin as an anticoagulant, availability of which of

the following chemical substances is mandatory?
A) Thrombin
B) Plasmin
C) Antithrombin-Ill
✓
D) Thrombomodulin
LMWH is given by which route?

A) Intravenous
B) Subcutaneous
✓
C) Intramuscuar
D) Intradermal
Which of the following is incorrectly matched?

A) Andexanet alfa: Edoxaban
B) Andexanet alfa: Rivaroxaban
C) Idarucizumab : Dabigatran
D) Ciraparantag: Fondaparinux
✓
Oral Direct Xa Inhibitors Oral Direct IIa Inhibitors

(INICET IMP TOPIC) •
Ximelagabran (Severe liver damage)
Apixaban
Dabigatran (Unsafe in renal failure)
•
Rivaroxaban
: Edoxaban
Betrixaban
Apixaban belongs to which of the following class of drugs?

A) Antifirbrinolytic
B) Factor Xa inhibitor
✓
C) Oral direct thrombin inhibitor
D) Parenteral direct thrombin inhibitor
Which of the following is an oral factor Xa inhibitor?

A) Bivalirudin
B) Dabigatran
C) Rivaroxaban
✓
D) Enoxaparin
Vitamin K epoxide reductase
inhibitor / WARFARIN
Warfarin
x
Vit K Epoxide Reductase
Oxidised Reduced
Vit K Vit K
Gamma carboxylation
Precursor Functioning
Clotting Clotting Factors
Factors II, VII, IX, X
Elimination half lives of Vit K

dependent coagulants
Protein Half Life Maximum
Factor II 72 hours
Factor VII 4 - 6 hours Warfarin comes into
Factor IX 24 hours action after 72 hours
Factor X 44 hours
Protein C 8 hours So, not in Acute use
Protein S 30 hours
Protein C, Protein S
Due to deactivation
Hypercoagulation
S/E of Warfarin Therapy
Purple Toe Syndrome
: Dermal Necrosis
Narrow Therapeutic Index
: Warfarin safety assessed by INR
Anticoagulant Specific Antidote INICET 2021

DABIGATRAN Idarucizumab
Oral Xa Inhibitors Andexanet Alfa
Heparin Protamine Sulfate
Warfarin Vit K
Heparin Adverse Reaction Warfarin
Alopecia - A- Alopecia
Bleeding - B- Bleeding
Osteoporosis - O- Oral/GI intolerance
Urticaria - U- Ulcer (Dermatitis)
Thrombocytopenia - T- Teratogenesis
Antiplatelet drugs
Cyclogenase 1 Inhibitor
:
Low dose aspirin.
Inhibition of TXA2 production.
Thromboxane synthase enzyme inhibitor - DAZOXIBEN
Thromboxane Receptor blockers : LOSARTAN
DALTROBAN
IFETROBAN
SULTROBAN
Irreversible P2Y12 inhibitors : TICLODIPINE
CLOPIDOGREL
ADP Receptor PRASUGREL
ADP mediated
action of GPIIb/IIIa
Reversible P2Y12 Inhibitors : TICAGRELOR
: CANGRELOR
GP IIb/IIIa Inhibitors : ABCIXIMAB
EBTIFIBATIDE
TIROFIBAN
Thrombin (PAR - 1) Receptor Antagonist : VORAPAXAR
: ATOPAXAR
Phosphodiesterase Inhibitors : DIPYRIDAMOLE
Arterial clots are mainly Venous clots are mainly

formed with platelets. formed by clotting factors.
Management : Management : Heparin

Antiplatelet drugs
Which of the following statements is true about prasugrel?

A) It acts as an P2 Y12 agonist
B) It is 10 times less potent than clopidogrel
C) It is a pro drug
:
D) Omeprazole interferes in its activation to an active metabolite

A patient with history of ischemic stroke was started on clopidogrel. However, she had
another attack of stroke after 6 months. Which of the following is likely to be responsible for
the failure of clopidogrel in this patient?
A) Downregulation of CYP2C19
B) Downregulation of CYP2D6
C) Upregulation of CYP1A1
D) Downregulation of CYP2E1
A patient on aspirin presented with occult blood in the stool. This is due to
inhibition of __________ by aspirin.
A) Phospholipase A2
B) Thromboxane
C) Phospholipase C
D) Phospholipase D
Anticancer Drugs
Cell cycle specific Anticancer Agents
G2
Cell G1
Cycle
Drugs Acting on G2
• Acts on Topoisomerase I
Bleomycin - Only anticancer antibiotic which is cell cycle specific.
: Campothecins : Irinotecan
Topotecan
S/E : Diarrhoea
M Phase
Vinka Alkaloids (Polymerisation Inhibitors)
: Vinblastin - Maximum myelosuppression
Vincristin - Maximum neurotoxicity
: Taxames
- Stabilise microtubules.
- Paclitaxel
- Docitaxel
- Cobazitaxel
- Can be used as stent eluting.
AIIMS & INICET 2020
A boy presents with pallor and lymphadenopathy, the X-ray of his skull is given below. Which
of the following drug is not used for the management of the suspected diagnosis?
A) Cyclosporine
B) Methotrexate
C) Vinblastine
D) Vincristine
✓
G1 Phase
L - Asparagine
:
Use - ALL
S/E - Hypercoagulation, Haemorrhagic Pancreatitis
Palbociclib
CDK 4 - 6 Inhibitor
Amebaciclib
Used in the treatment of Breast CA
:
Ribociclib
Steroids : Apoptosis of t and B Cell.
Used in Lymphoma.
S Phase
Topoisomerase II Inhibitors
- Etoposide
- Tenoposide
Antimetabolites acting on S phase
Antifolate Purine Antimetabolite Primidine Antimetabolite

Antifolates
Methotrexate
:Uses
C - Choriocarcinoma
A - Abortion
-
N - Non Hodgkin’s Lymphoma MCQ Booster

C - Crohn’s Disease Drugs causing Hand Foot Syndrome
E - Ectopic Pregnancy 5 - Fluorouracil
R - Rheumatic Arthritis : Doxorubicin
S/E IL 2
Myelosuppression : Premetrexed
GI Toxicity
Alopecia
Liver Damage
Pneumonitis (Rare)
Premetrexed T/t of Mesothelioma
Trimetrexate
Pralatrexate : T/t of T cell Lymphoma
What is the mechanism of action of methotrexate in osteosarcoma?

UMP- Uridine monophosphate
DHFR- Dihydrofolate reductase
A) Analog of UMP
B) Competitive inhibitor of DHFR
✓
C) Blocks purine synthesis
D) Blocks pyrimidine synthesis
Pyramidine Antimetabolite
Cytarabine
: 5 - Fluorouracil : Given along with Levamisole in the treatment of Colorectal Ca.
Floxuridine
: Gemcitabine - T/t for pancreatic cancer.
Capecitabine - T/t of AML and Paediatric ALL.
: Adverse Reaction - Hand Foot Syndrome
Purine Antimetabolite
6 - Thioguanine
: 6 - Mercaptopurine
6 - Mercaptopurine 6 Mercaptothiouric Acid (Inactive)
:
Xanthine
Oxidase
Caution to be taken while in T/t with Allopurinol as it inhibits Xanthine Oxidase.

Mycophenolic acid
-
IMP
Dehydrogenase
IMP AMP
Fludarabine
: Cladribin Hairy Cell Leukaemia
Pentostatin
:
Fludarabine and Pentostatin also used in CLL.
Which of the following is an inhibitor of DNA synthesis?

A) 6-mercaptopurine
B) Mitomycin
C) Actinomycin
D) Asparaginase
Cell cycle Non - Specific Agents
Tyrosine Kinase Inhibitor (TKIs)
EGFR Blockers VGFR Blockers PDGFR Blocker

EGFR Blockers
6
Gefitinib
6
Erlotinib - Useful for pancreatic Ca ; S/E : Dysmorphic Eyelashes.
6
Afatinib
6
Osmertinib
6
EGFR blockers are useful for Metastatic non small cell lung Ca.
VGFR Blockers PDGFR Blocker

Sorafenib - RCC, HCC
~ ~
Imatinib - DOC for CML & GIST (CKZ is the target)
Sunitinib - RCC, GIST
~
Nilotinib
For Imatinib resistant cases.
~
Levatinib - Thyroid Ca
~
Dasatinib
:
EGFR Blockers VGFR Blockers PDGFR Blockers
Vandetanib Axitinib
T/t of T/t
Medullary Ca Thyroid Renal Cell Carcinoma
Multitarget TKIs
Alkylating Agents
General properties Nitrosureas
N7 guanine residue as target. Temozolomide
Cell cycle non - specific. : Cyclophosphamide
Can be used for T/t of Ca. Ifosfamide - T/t of Beast Ca, Lymphoma
o
Adverse effects of Alkylating Agents : : Procarbazine
L - Leukaemia (Secondary) Dacarbazine
-
G - GI Toxicity
S - Sterility
T - Teratogenic
A - Alopecia
M - Myelosuppression
P - Pulmonary Toxicity
Anticancer Antibiotics
Actinomycin D (Dactinomycin)
: Daurorubicin
Doxorubicin
: Mitoxantrone
S/E of Doxorubicin : Cardiomyopathy Heart Failure
:
Doxorubicin in the presence of Iron forms free radicals.
Free Radical Cardiotoxicity

T/t of Doxorubicin Toxicity : Dexrazoxane (Iron Chelator)
+
Alpha Tocopherol (Antioxidant)
Daurorubicin
Doxorubicin Inhibits Topoisomerase II (S Phase - Has Anthracyclines)
Mitoxantrone
Mitomycin - Use : Urinary Bladder Ca
: Bleomycin - Only cell cycle specific anticancer antibiotic.
S/E - Flagellate Hyperpigmentation. (AIIMS 2020 JULY)
Pulmonary fibrosis - as Bleomycin hydrolyse is not present in lungs.
Which of the following drugs causes flagellate

pigmentation?
A) Bleomycin
✓
B) Doxorubicin
C) Vincristine
D) Minocycline
NitrosOureas Temozolomide
a
Lomustine Highly lipid soluble
a
a
Semustine Crosses BBB
a
Carmustine So used in Brain tumour like

a
: S/E Glioblastoma Multiforme.

- Pulmonary fibrosis
- Adrenal insufficiency
- Delayed and prolonged myelosuppression.
Cyclophosphamide
Activation
Cyclophosphamide Aldophosphamide
Phosphoramide Acrolein
Haemorrhagic Cystitis
T/t - MESNA + N - Acetyl cysteine

Treatment of :
Breast Ca
: Lymphoma
Testes Ca
: Breast Ca
Head neck Ca
:
Drugs for Multiple Myeloma
Melphalan
Drugs for Malignant Melanoma
Vemurafenib
i
•
BRAF -
•
Thalidomide &
Dabrafenib
&
Lenolidomide Trametinib
&
&
Bortezomib (DOC) Cobimetinib
&
Nivolumab is used as a checkpoint inhibitor in

A) Retinoblastoma
B) Medulloblastoma
C) Pleuropulmonary blastoma
D) Hodgkin's lymphoma
✓
Hormonal Therapies,
DMARDS & Biologicals
Role of Hormone Therapy in Cancer
Three types of drugs
SERM SPRM Aromatase

(Selective Oestrogen (Selective Progesterone Inhibitors
Receptor Modulator) Receptor Modulator)
SERM
Antagonistic Action on some oestrogen receptors.
: Agonistic action on some other oestrogen receptors.
Tamoxifen
:
- Has only antagonistic action on Estrogen Receptor of breast.
- So used in the treatment of Breast Ca.
- Agonistic action on Estrogen receptors :
- Vasodilatory action on blood vessels - Hot Flush
- Endometrial Proliferation - Ca Uterus
- Hypercoagulation (Increased clotting factor syntheis) - DVT
Toremifene
Doloxifen Breast Ca
: Raloxifen
Ospemifene - Dyspareunia
: Clomiphene - Ovulation Induction
Ormeloxifene - Contraception, Dysfunctional Uterine Bleeding.
:
(Centchroman)
SPRM
Ulipristal (Emergency Contraceptive) : Can be taken 5 days after unsafe coitus.
Asoprisnil
: Telapristone Use in Uterine Fibroid/Endometriosis
Aromatase Inhibitors
Peripheral Androgen Oestrogen Post Menopausal Bleed
Aromatase
Enzyme
Exemestane
:
Irreversible Aromatase Inhibitor
Formestane
Vorozole
:
Fadrozole To reduce Androgen induced Prostate Ca
Letrozole
Anastrozole
:
Drugs for Inhibiting Testosterone
GnRH Analogues
Agonists (“relin”) Antagonists (“relix”)

Leuprolide Ganirelix
Goserelin Cetrorelix
Buserelin Abarelix
Nafarelin Degarelix
Deslorelin
Histrelin
Triptorelin
Agonistic Action - Initial Flare up

Histamine release
These drugs on Pulsatile Therapy acts as agonist.
On continuous administration they acts as antagonist.
Antagonistic Action - No Initial Flare up
: No Histamine release
S/E of GnRH analogues - Hot flush
Loss of libido
Impotence
Sarcopenia (Decreased muscle mass)
Osteoporosis
In which of the following conditions is non-pulsatile

dosing of GnRH agonist not used?
A) Male infertility
i
B) Endometriosis
C) Precocious puberty
D) Prostate cancer
DHT Receptor Blocker

Eg : Testes
1) Flutamide
2) Nilutamide Testosterone
3) Bicalutamide
4) Enzalutamide DHT (Dihydro Testosterone)
5) Abiraterone
DHT Receptor
Thalidomide
MOA : Anti Ca + Immune Modulation
In Multiple Myeloma
R Isomer - Therapeutic use and teratogenicity.
S Isomer - Sedation.
Previously used as antiemetic sedative.
Most common S/E :
i) Constipation
ii) Aphthous Ulcer
iii) Peripheral sensory neuropathy
iv) Never use in pregnancy (Phocomelia - Baby with no limbs)
Highly teratogenic - Category X Drug
MCQ Boosters
Anticancer drugs Antidote
Methotrexate Foilinic acid, Glucarpidase
Doxorubicin Dexrazoxane (Iron Chelator)
Cyclophosphamide Mensa in Haemorrhagic cystitis
Cisplatin Amifostine
Which of the following disease-modifying anti

rheumatoid drug increases extracellular adenosine?
A) Methotrexate
✓
B) Lefunamide
C) Sulphasalazine
D) Hydroxychloroquine
Drugs useful for T/t of neutropenia (Colony Stimulating Factors)

rG - CSF GM - CSF
(Recombinant Granulocyte CSF) (Granulocyte Monocyte CSF)
a
Filgrastim o
Sargramostim
o
Pegfilgrastim a
Moligramostim
(Progylacted - To elongation of Action)
: Lenograstim
Which of the following is true about pegylated-filgrastim?

A) Duration of action is shorter than normal filgrastim
B) Added advantage is that it can be taken orally
C) It should not be administered in sickle cell patients
✓
D) It is not effective in the treatment of severe neutropenia
Drugs for Thrombocytopenia

Oprelvekin - IL 11 Analogue
: Thrombopoietin
Romiplostim - Given S/C
}
.
Given in ITP
Eltrombopag - Oral
: Caplacizumab - Anti VWF, used in Acquired Thrombotic Thrombocytopenic Purpura.
Drugs for Anemia
Epoietin
:)
Darbopoietin
Recombinant Erythropoietin
Peginesatide - Erythropoietin Receptor Stimulator
:
Drugs for Anti Ca/ Radiation induced Vomitting
5 HT3 Antagonists
Ondansetron
: Granisetron
Tropisetron
: Palonosetron - Most selective 5HT3 blocker; Also used in late phase Vomitting.
Dolasetron - S/E : QT Prolongation and
:Supportive Antiemetics for Emesis Management due to Ca Chemotherapy
D2 blocker
: Benzodiazepine
Steroids - Dexamethasone, Methyl prednisolone
:Drugs for late phase Vomiting (Vomiting after 48 hours following chemotherapy)
Aprepitant - Oral Neurokinin 1 Antagonist
:
Fosaprepitant - i.v
Immunological drugs for Rheumatoid
Pro inflammatory cytokines Anti inflammatory Cytokines
TNF α, IL - 1, IL - 6 IL - 4, 6, 10, 13, TGF - β
Cancer Cachexia
IL - 1 Antagonist : Anakinra
IL - 6 blocker : Tocilizumab, Sarilumab
Fusion Protein (Target - CD 80/86) : Abatacept, Belatacept
Which of the following interleukin (IL) is inhibited by

tocilizumab?
A) IL-6
✓
B) IL-2
C) IL-4
D) IL-5
TNF α blockers
Drugs Route Use Test
Infliximab i/v Rheumatic Arthritis Before starting TNF α blocker
Etanercept s/c
Adalimubab s/c Crohn’s Disease Rule out TB by PPD/Mantoux test
Golimubab s/c
Certolizumab s/c Ankylosing Spondylitis
Adverse Reaction
Secondary Infections.
: All TNF α blocker may cause liver damage - C/I in Hep B patients.
All TNF α blocker cause cardiotoxicity - C/I in Heart failure patients.
:
Rarely cause 2° cancer.
MCQ Booster
Uses of Rituximab - Target : CD - 20
C - CLL
A - Autoimmune Haemolytic Anemia
N - NHL
T - TTP
M - Marginal Zone Lymphoma, Mantle Cell Lymphoma
I - ITP
Ss - SLE
RITU - Rheumatic Arthritis
Drugs useful for treating gout

Treatment of Acute Gout
NSAIDs
: Commonly used NSAIDs for acute gout are Naproxen, Indomethacin, Sulindac.
Aspirin shouldn’t be used due to its Uric Acid retention property.
Colchicine
MOA : Disruption of microtubule of Neutrophil.
A
Steroids
Treatment of Chronic Gout
Drugs reducing Immunosuppressants

uric acid
What is the mechanism of action of colchicine?

A) Inhibits synthesis of uric acid
B) Promotes excretion of uric acid
C) Inhibits xanthine oxidase enzyme
D) Binds to tubulin and inhibits granulocyte migration
✓
Which one of the following drugs inhibits neutrophil recruitment?

A) Montelukast
B) Sodium cromolyn
C) Colchicine
✓
D) Febuxostat
Drugs reducing uric acid

Drugs reducing the synthesis of uric acid
: Xanthane Oxidase Inhibitor : Allopurinol, Fevuxostat

Drugs increasing the excretion of uric acid in urine
Probenecid
: Sulfinpyrazone
Benzbromanone
: Lesinurad
Uric Acid metabolism enhancer
: Rasburicase
For aggressive therapy
Pegloticase
: Previous Year Questions
What is pegloticase used for?

A) Chronic gout
B) Rheumatoid arthritis
AIIMS 2019
C) Psoriatric arthritis
D) Paralytic ileus
Pegloticase is used in management of:

A) Chronic gout
✓
B) Rheumatoid arthritis
C) Psoriatric arthritis
D) Calcium pyrophosphate dihydrate crystal deposition (CPPD)
Immunosuppressants
e
Calcineurin Inhibitors
Inhibits synthesis of IL - 2
: Examples : Cyclosporine, Tacrolimus Unique S/E of Cyclosporine
Indication : Autoimmune patients, Organ transplant patients. n
Hypertrophy of gums
: S/E : Dose limiting S/E - Nephrotoxicity Hirsutism
Neurotoxicity
Diabetes/Diarrhoea
: Hypertension
Hyperkalemia
Alopecia
Hepatotoxicity
IL - 2 receptor inhibitors
:
Sirolimus
Everolimus
Which of the following is correct about the drugs used in Gout?

A. Aspirin is not used as it decreases the uric acid secretion
B. Diclofenac is used as it concentrates in the joint
C. Indomethacin is used as it acts by multiple pathways
D. Aspirin is used as it is most powerful NSAID
A) A, B& C
B) A, B, C & D
C) A&B
D) C&D
Disease Modifying Drugs
Glatiramer acetate
: Natalizumab - Interferes with α4β1 Integrin.
Mitoxantrone - Anticancer Antibiotic ; S/E - Cardiotoxicity
: Fingolimod (Oral) - Bradycardia
Dalfampridine - Improve walking capacity
: Cladribine - Purine Antimetabolite
Dimethyl fumerase
: Teriflunomide - Derivative of Leflunomide : Inhibits Dihydroorotate dehydrogenase
Altizumab - Anti CD 20
: Alemtuzumab - Anti CD 52
Monoclonal Antibodies
Name Analysis
U - Full Human
ZU - Humanised (90% Human, 10% Animal) MAB
Xi - Chimerical (50% Human, 50% Animal)
Receptor Blockade Target Example
IL - 2 Li - Lowering Immunity BasiLiximab
GP IIB - IIIA Ci - Circulation AbCiximab
Respiratory Syncitial Virus Vi - Virus PaliVizumab
RANK - L Ligand OS - Osleo DenOsumab
PCSK - 9 OC - Over Cholesterol AlirOcumab, EvolOcumab
Trastuzumab Target : HER - 2

: Pertuzumab Uses : HER - 2 positive Breast Ca
S/E : Infusion reaction, Cardiomyopathy
Rituximab
: Brentuximab - Target : CD 30 on B Cell
Uses : Hodgkin’s Lymphoma
a
Bevacizumab - Target : VGFR
Uses - Metastatic Colorectal CA
Renal Cell Ca
DM Retinopathy (Intravitreal Injection)
What is basiliximab?
A) IL-1 receptor antagonist
B) Anti-CD3 antibody
C) IL-2 receptor antagonist
:
D) TNF inhibitor
Other MABs
Ramucizumab - Target : VGFR
Uses : Gastric Ca
Omalizumab - Target : IgE ; Uses - Bronchial Asthma
: Reslizumab
Target : IL - 5
Mepolizumab Uses : Bronchial Asthma, Churg Strauss Syndrome
: Duplilumab -Target : IL - 4; Uses - Moderate and severe atopic dermatitis.
Ibalizumab - Entry Inhibitor; Used in HIV patients
: Cetuximab - Target : EGFR; Used in Menetrier’s disease.
Panitumumab - Target : EGFR; Used in Colorectal Ca.
: Eculizumab - Target : Complement component C5;
Used in Paroxysmal Nocturnal Haemoglobinuria
Antibiotics
Inhibition of cell wall synthesis Mnemonics
Drug Mechanism of Action
Cycloserine Inhibition of Alanine Ligase/Racemase BBCVan
S/E - Psychosis
Fosfomycin Inhibition of Enol Pyruvate/Transferase B - Beta Lactam
S/E - Diarrhoea B - Bacitracin
Bacitracin Inhibition of dephosphorylation of Bactoprenol C - Cycloserine
Vancomycin Inhibition of Transglycolase
Van - Vancomycin
Beta Lactam Transpeptidase
Penicillin
Penicillin G
Oldest One
: Limitations : i) Not effective orally (As it is acid sensitive, destroyed by HCl).
ii) Narrow spectrum only - UNSAFE.
iii) Resistance develops easily.
Newer Penicillins
Acid Resistant Penicillins/Orally Used
:
V - Penicillin V
O - Oxacillin
D - Dicloxacillin
C - Cloxacillin
A - Ampi/ Amoxycillin
Extra Edge
Probenecid added with Penicillin - Prolongs duration of action.
Most of the penicillins are excreted by renal route.
: Ampicillin and Nafcillin are excreted by bile.
Duration of Action of Procaine Penicillin : 12 - 24 hours.
: Duration of Action of Benzathine Penicillin : 4 weeks.
What is the mechanism of action of vancomycin?

A) Cell wall synthesis inhibition
✓
B) Cell membrane inhibition
C) Peptide synthesis inhibition
D) 50s ribosome inhibition
Which of the following steps does Vancomycin act on?

A) 1
B) 2
C) 3
D) 4
✓
Penicillin Resistance
Mechanism 1 - Enzymatic degradation by Penicillinase or β - Lactamase.
: Mechanism 2 - Alteration of Penicillin Binding Protein (Seen in MRSA, VRSA)

NEET PG 2020
What is the mechanism of resistance by lactamases to ß-lactam antibiotics?

A) Alteration of penicillin binding protein
B) Degradation of antibiotics
✓
C) Drug efflux
D) Alteration in 50s ribosome structure
Penicillinase
Resistant Penicillins β - Lactamase Inhibitors
5
C - Cloxacillin 5
Combined with Penicillin to prevent resistance.
5
O - Oxacillin 5
Clavulonic Acid
5
N - Nafcillin 5
Sulbactam
Do - Dicloxacillin 5
Tazobactam
: M - Methicillin
Extended Spectrum Penicillins
Aminopenicillins Carboxypenicillins Ureidopenicillins

(Most Extended Spectrum)
Aminopenicillins
Ampicillin
: Amoxycillin (Prodrug - Becampicillin)
C/I : Infectious Mononucleosis (Causes Skin Rash)
Thioacetazone : C/I for treating TB in HIV patients due to risk of Steven Johnson’s Syndrome.
:
Which of the following anti-tubercular drug is not bactericidal?

A) Isoniazid
B) Rifapentin
C) Thioacetazone
D) Kanamycin
A known asthmatic patient with fever and sore throat was prescribed an antibiotic. Two
days later he presents with a maculopapular rash. Which of the following drugs might
have caused this?
A) Prednisolone
B) Salbutamol
C) Fexofenadine
D) Amoxicillin
✓
Carboxypenicillins Ureidopenicillins
e
Carbenicillin Azlocillin
e
e
Ticarcillin Piperacillin
e
e
Effective against Pseudomonas. Mezlocillin
e
Effective against Pseudomonas And Klebsiella.

e
Use of Penicillins (First Line of Choice)

n
Leptospirosis
n
Anthrax
n
Actinomyosis
n
Rat Bite Fever
n
Tetanus
Syphilis
i
Which of the following antimicrobials is effective against

an organism producing extended-spectrum beta-
lactamases?
A) Amoxicillin - clavulanic acid
B) Penicillin
C) Piperacillin - tazobactam
D) Ceftriaxone
Atypical Beta Lactam Antibiotics
Carbopenems Monobactam
Carbopenems
Imipenem
÷
Meropenem
Broad spectrum of antibiotics are short acting, as they are rapidly degraded by
Dehydropeptidase I.
So it is administered along with Cisplatin to get longer duration of action.
Monobactam
Aztreonam
:Doesn’t show cross reaction with other β - Lactam drugs.
Use : Aerobic gram negative.
Cilastatin is administered to prolong the action of which of

the following drugs?
A) Meropenem
B) Imipenem
✓
C) Cefazolin
D) Piperacillin
Which of the following carbapenems has increased risk of

causing seizures?
A) Meropenem
B) Imipenem
✓
C) Etrapenem
D) Doripenem
Cephalosporins
How to memorise the names.
1st Generation : Cefazolin, Cefalexin, Cefaloridine
: (If ‘a’ is present after ‘Cef’ - Exception is Cefaclor which is 2nd generation.
3rd Generation
Contains ‘me’ - Ceftizoxime, Ceftazidime ( Exception : Cefuroxime - 2nd Gen)
Contains ‘one’ - Cefoperazone, Ceftriaxone
Contains ‘ten’ - Ceftibuten
4th Generation - Name contains ‘pi’ : Cefepime, Cefpirone
: 5th Generation - Name contains ‘rol’ in it : Ceftobiprole, Ceftaroline.
All the other Cephalosporins are 2nd Generation.
Glycopeptide Antibiotics
Vancomycin
Uses - Taken orally in Pseudomembranous colitis caused by Clostridium.
: Taken i.v - DOC for MRSA
S/E - Red Man Syndrome due to histamine release.
- Neurotoxicity
- Ototoxicity
Other Gylcopeptide Antibiotics
Teicoplanin - Least chances of histamine release.
Oritavancin - No need of modifying dose in CRF.
Telavancin
Dalbavancin - Longest Acting (6 - 10 days)
Drugs useful for Management of MRSA and VRSA
Linezolid
-
Acting by Inhibiting Protein Synthesis.

-
Uses - MRSA, VRSA, MDTRB

-
S/E - Thrombocytopenia, Optic and peripheral neuropathy,

MAO inhibition
NE Increases
Cheese Reaction
Streptogranin
9
Quinupristin + Daltopristin
9
Given as i.v.
9
S/E - Infusion Reaction, Joint Pain (Arthralgia)
Daptomycin Tigecycline
T
Lipopeptide Antibody n
i.v Tetracycline
T
Acting on cell membrane. n
Excretion by bile - Safe in renal failure.
n
Resistance to efflux, pump.
MCQ Booster
Pseudomonas Colitis
Most commonly caused by 3rd Gen Cephalosporins, Clindamycin.
e
Causative organism - Clostridium difficile.

: Agents for treatment - Metronidazole, Vancomycin, Rifampicin, Fidaxomicin
Rifampicin Uses
IBS
: Traveller’s Diarrhoea
Hepatic Encephalopathy
: Pseudomonas Colitis
Clostridium difficile associated diarrhea occurs maximally

due to:
A) Aminopenicillins
✓
B) Tetracyclines
C) Carbapenems
D) Macrolide
Match the following bacteria with the drug of choice used for each.
A. Bacteroides
B. MRSA
C. Hemophilus
D. Klebsiella
1. Vancomycin
2. Metronidazole
3. Meropenem
4. Penicillin
A) A-1, B-3, C-4, D-2
B) A-2, B-1, C-4, D-3
✓
C) A-3, B-4, C-1, D-2
D) A-4, B-1, C-2, D-3
Sulfonamides
Mechanism of action - Inhibits Fatty acid synthesis.
: Sulfazaline : 5 - Aminosalicylic acid + Sulfapyridine
Used in the treatment of bowel pathology of ulcerative colitis.
S/E - Oligospermia and infertility.
Topical Sulfonamides : Sulfactamide - Eyedrop
: Silver Sulfadiazine - Burns, Fungal keratomycosis

Sulfadoxine - with Pyremethamine useful for the treatment of Malaria.
Sulfadiazine - with Pyremethamine and Folinic acid in the treatment of Toxoplasmosis.
: (DOC for Toxoplasmosis : Spiramycin)
Sulfamethoxazole - In combination with Trimethoprim = Cotrimoxazole.
DOC for Pneumocystis Carini Pneumonia in HIV patients.
An infant had a serum bilirubin level of 33 mg/dL. The mother might have taken which of the
following drugs during the third trimester for this to occur?
A) Ampicillin
B) Co-trimoxazole
:
C) Azithromycin
D) Chloramphenicol
Inhibition of Protein Synthesis
Acts on 50S / 30S subunits of Ribosome.
Mnemonic : 50 “CELLS” into 30 “TeAm”

Working on 50s subunits of Ribosome Resistance by
C - Chloramphenicol alteration at 50s
E - Erythromycin ribosomal subunit
L - Lincosamide by Methylation.
L - Linezolid
S - Streptogranin
Working on 30s subunits Previous Year Questions NEET PG 2019

Te - Tetracyclines
Am - Aminoglycosides What is the drug of choice for diphtheria carrier state?
A) Amoxicillin
S/E B) Erythromycin
i) Allergy C) Rifampicin
ii) In newborn - Kernicterus D) Tetracycline
iii) Haemolytic Anaemia
iv) Kidney - Crystaluria
Antimicrobial combinations are used in all except

A) Gonorrhea
B) Tuberculosis
C) Intra abdominal infections
D) Malaria
Tetracyclines
• Tigecycline : Given as i.v.
Useful for MRSA + VRSA
Resistant by Efflux Pump.
Excretion by bile - Safe in Renal failure.
•
Doxycycline : Excretion by bile - Safe in Renal failure.
•
Demeclocycline : Can cause severe Phototoxicity, Diabetes Insipidus.
•
Minocycline : Used for Leprosy in older days
90% excreted through bile and 10% excreted through urine.
S/E : i) Vestibular toxicity
ii) Pseudotumour Cerebri
iii) Outdated Tetracycline cause : Kidney damage.
•
Tetracyclines are first drug of choice for : Rickettsial Infection
Lymphogranuloma Venereum
Chlamydial Infection
•
Treatment Used as prophylaxis in : Cholera
Brucellosis
Plague (T/t - Streptomycin)
•
Tetracyclines are C/I in pregnancy
.
In Mother - Hepatic Failure
•
In Baby - Bone and Teeth problem.
Which of the following drugs does not require dose

reduction in patients with renal failure?
A) Gentamicin
B) Vancomycin
C) Amphotericin B
D) Doxycycline
✓
Which of the following is the drug of choice for scrub

typhus?
A) Doxycycline
✓
B) Azithromycin
C) Chloramphenicol
D) Ciprofloxacin
Chloramphenicol - Develop resistance due to enzymatic degradation by Acetyl transferase.

Macrolides
7
Azithromycin
MAC Infection
✓
MCQ Booster
Gonorrhoea/Syphilis/Chancroid Eravacycline is used in the t/t
: Chlamydia
of Severe Combined
Legionella Intraabdominal Infection.
: Campylobacter jejuni
Spiramycin : Toxoplasma in pregnancy
:
S/E : GI Toxicity
Hearing Problem
Hepatitis
Cholestatic Jaundice
Erythromycin is most potent Microsomal
enzyme inhibitor.
What is the drug of choice for scrub typhus during

pregnancy and otherwise respectively?
A) Chloramphenicol, doxycycline
B) Doxycycline, doxycycline
C) Doxycycline, azithromycin
D) Azithromycin, doxycycline
Aminoglycoside
Not given orally - Given patenterally - IV/IM/Eyedrop/Eardrop

: Totally excreted through kidney - So unsafe in kidney failure.
s
Uses :
TB - Streptomycin (First Line)
:
- Kanamycin
- Capreomycin Second Line
- Amikacin
In Pseudomonas Infection
T - Tobramycin
A - Amikacin
G - Gentamicin
Other uses of Streptomycin
ATT - Category 1
÷
DOC for Plague, Pneumonia.

÷
Prophylaxis of Plague.
÷
T/t of Tularemia.
÷
Other Aminoglycosides
Paromomycin
:
Oral - In Amoebiasis
IV - In Kala Azar ( For Indian Population - DOC is Liposomal Amphotericin B)
Neomycin
Oral - Gut sterilisation (In Hepatic Encephalopathy)
S/E of Aminoglycosides
Ototoxicity : First affects base of hair cells.
:
First high frequency are affected followed by low frequency.
K - Kanamycin
A - Amikacin
N - Neomycin
Vestibular Toxicity : Streptomycin, Gentamicin, Tobramycin
Nephrotoxicity
: Neuromuscular block
Which of the following statements is correct for a patient on high dose of

penicillin and gentamicin?
A) TDM is done with penicillin because of narrow therapeutic index
B) TDM is done with gentamicin because of narrow therapeutic index
✓
C) TDM is done with both because of dangerous side effects
D) Both drugs do not need monitoring
MCQ Bullets
Aminoglycoside follows “concentration dependent killing pattern.”
: So, don’t split the dose.
G Also have post antibiotic effect, whereas β - Lactam shows time dependent killing pattern.
Name of Bacteriostatic Drugs

L - Linezolid Calcutta - Clindamycin
E - Ethambutol Electric - Erythromycin
T - Tetracyclines Supply - Sulphonamides
Corporation - Chloramphenicol
An example of a bacteriostatic drug is

A) Aminoglycoside
B) Vancomycin
C) Metronidazole
D) Linezolid
✓
Quinolones
Mechanism of Action - Inhibits DNA Gyrase in Gram negative Bacteria.
Inhibits Topoisomerase in Gram positive Bacteria.
Excretion - Through Renal Route.
Pefloxacin, Moxifloxacin, Trovafloxacin excreted through bile.
Ciprofloxacin : First line drug for Typhoid fever.
S/E : Chance for Tendinitis, Tendon rupture.
Microsomal Enzyme Inhibitor - Increases drug level of concurrently
administered drug.
Which of the following fluoroquinolone is not given in liver disease?

A) Ofloxacin
B) Levofloxacin
C) Pefloxacin
✓
D) Lomefloxacin
Withdrawn Fluoroquinilones and the

associated adverse effects
Drugs Adverse Effects
Lomefloxacin, Gatifloxacin Phototoxicity, QT Prolongation
Trovafloxacin Hepatotoxicity
Gatifloxacin Hypoglycemia
Grepafloxacin Cardiotoxicity
Temafloxacin Immune Hemolytic Anaemia
Clinafloxacin Phototoxicity
Available Quinolones causing

dangerous Side Effects
Phototoxicity - Sparfloxacin, Lomefloxacin
: QT Prolongation - Lomefloxacin, Sparfloxacin, Moxifloxacin, Gemifloxacin.
Uses of Quinolones
Treatment of MDR - TB : Levofloxacin, Moxifloxacin.
: Treatment of Leprosy Infection : Ofloxacin, Ciprofloxacin.

NEET PG 2019
Which of the following fluoroquinolones has maximum bioavailability?

A) Ciprofloxacin
B) Levofloxacin
✓
C) Gatifloxacin
D) Norfloxacin
Antibiotics Associated Defects/ Adverse Effect
Chloramphenicol Grey Baby
Sulphonamide Yellow Baby
Cyclosporine A Fibroadenoma
Amiodarone Blue Man Syndrome
Nitrofurantoin Coffe Coloured Urine
Ethambutol Loss of red/green perception
Vancomycin Red Man Syndrome
Clofazimine Reddish Black Pigmentation of Skin
Isoniazid Shoulder Hand Syndrome
Rifampicin Flu like Symptoms
Phenytoin Pseudolymphoma
Drugs causing QT Prolongation, Widened QRS Complex

(Torsades De Pointes Rhythm)
Antimicrobials Antidepressants Antiarrythmics Antipsychotics Others
Moxifloxacin Amitriptylline Sotalol Haloperidol Cisapride
Ciprofloxacin Desmipramine Amiodarone Droperidol Sumatriptan
Gatifloxacin Imipramine Quinidine Quetiapine Dolasetron
Levofloxacin Doxepine Dofetilide Ziprasidone Arsenic
Clarithromycin Sertraline Ibutilide Thioridazine
Erythromycin Fluoxetine Procainamide
Ketoconazole Ventafexine
Itraconazole
Rilpivirine
A male patient who is suffering from a psychotic disorder is on antipsychotic, antidepressant

and antihypertensive treatment. He suddenly developed tachycardia and chest tightness. On
evaluation he had metabolic acidosis. ECG showed widened QRS complex and prolonged QT
interval. Which of the following drugs is responsible for this?
A) Amitriptyline
✓
B) Amlodipine
C) Chlorthalidone
D) Enalapril
Which of the following drugs is associated with QT

prolongation?
A) Lignocaine
B) Quinidine
✓
C) Magnesium sulfate
D) All of the above
Anti Tubercular drugs
First Line Anti TB Drugs

Isoniazid
÷ Rifampicin
Pyrazinamide
Ethambutol
Which of the following is true about tedizolid?

A) Active against gram positive organisms
✓
B) Poor oral bioavailability
C) Active against anaerobes
D) Causes peripheral neuropathy
Rosuvastatin should not be combined with which of the

following drugs?
A) Oxycodon
B) Clarithromycin
✓
C) Adalimumab
D) Rivoraxaban
Isoniazid
MOA : Inhibition of Mycolic Acid Synthesis
: Action : Bactericidal (Intracellular + Extracellular Action)
Excretion through liver.
: Mechanism of Resistance : Kat G gene mutation
Inh a gene overespression - Cross resistance with Ethionamide
Unique side effects : Shoulder Hand Syndrome
:
CNS side effects
Rifampicin
MOA : Inhibition of DNA dependent RNA polymerase.
Action : Bactericidal (Intracellular + Extracellular Action)
: Excretion through liver.
Mechanism of Resistance : Mutation of HPO B gene - β subunit of RNA polymerase.
: Unique side effects :Microsomal Enzyme Inducer - Other drug failure
Orange yellow urine.
Flu like symptoms with intermittent dosing.
Which of the following is an inhibitor of RNA synthesis?

A) 5-Fluorouracil
B) Rifampicin
:
C) Nitrofurantoin
D) Novobiocin
Pyrazinamide
MOA : Inhibition of Fatty Acid Synthase I - Inhibition of Cell membrane synthesis.
Action : Bactericidal (Intracellular)
: Excretion through liver.
Mechanism of Resistance : Mutation of Pn Ca gene.
: Unique side effects : Hepatotoxicity (Max)
Hyperuricemia
Ethambutol
MOA : Inhibition of Arabians transferase - Inhibition of cell wall synthesis.
: Action : Bactericidal (Extracellular)
Excretion through kidney.
: Mechanism of Resistance : Mutation of emb B gene.
~
Unique side effects : Optic neuritis, Hyperuricemia.
Second Line Anti TB Drugs
Thiacetazone - C/I in HIV : Can cause Steven Johnson’s Syndrome.
Paramino salicylic acid - Bacteriostatic
Ethionamide : S/E - Hepatitis, Hypothyroidism, Cross resistance to INH.
Cycloserine - Neuropsychosis
Aminoglycoside - Used in MDR cases. (Kanamycin, Amikacin, Capreomycin)
Fluoroquinolone - Ciprofloxacin, Moxifloxacin, Levofloxacin, Ofloxacin.
Which of the following is a second line anti-tubercular drug?

A) Streptomycin
B) Ethionamide
:
C) Acyclovir
D) Vancomycin
Newer Drugs for MDR - TB

Bedaquiline
Inhibits Mycobacterial ATP synthase.
: Food increases absorption.
Shows cross resistance with Clofazimine.
: Use in B Pa L regimen - Bedaquiline, Pretomanid, Linezolid
S/E - QT Prolongation, Liver damage.
:Delamanid , Pretomanid : Inhibits Mycolic Acid formation.
Anti TB drugs and Side Effects
Hyperthyroidism - Ethionamide
:
Psychosis - INH, Cycloserine
Uveitis - Rifabutin
Anti Leprosy drugs
Clofazamine
Bacteriostatic drug of Leprosy.
Anti Inflammatory action - So used for Lepra reaction also.
: Adverse Reaction : Dermatological - Reddish black discolouration.
Dapsone
Sulphonamide drug (S containing)
:S/E : Can cause allergy.
Also used as DOC for Dermatitis Herpetiformis.
New Form : Injection Acadapsone (IM) - 3 months dosage.
:
What is the mechanism of action of dapsone, considering

that it is used in the treatment of leprosy, fungal infections
and, also for immunomodulatory actions?
A) Cell wall synthesis inhibitor
B) Folic acid synthesis inhibitor
C) Protein synthesis inhibitor
D) Cell membrane inhibitor
Anti TB Drugs used in Leprosy

Rifampicin
: Ethionamide
Clofazimine
: Dapsone
Tetracyclines
: For Rifampicin resistant therapy : Clofazamine
+
Any 2 Antibiotcs (Minocycline, Ofloxacin, Clarithromycin)
Which of the following anti-tubercular drugs is associated

with ophthalmic toxicity?
A) Ethambutol
✓
B) Isoniazid
C) Kanamycin
D) Rifampin
What is the most bactericidal anti leprotic
drug amongst the given drugs?
A) Amoxicillin
B) Ciprofloxacin
C) Ofloxacin
✓
D) Erythromycin
Lepra Reaction
Type II Reaction
Type I Reaction (Erythema Nodosum Leprosum)
±
Mainly seen in Borderline spectrum. ±
Mainly seen in LL (50%) > BL.
(BT,BB,BL)
*
Type 4 Hypersensitivity - Inflammation *
Type 3 Hypersensitivity - New erythematous
of existing skin lesion. and tender lesions.
±
T/t : *
T/t :
Supportive therapy for Mild Reaction. Oral corticosteroid (1st line drug).
Severe Reaction - Oral Corticosteroids. Clofazimine (Steroid dependent ENL).
Thalidomide (Most effective but not used first).
Antifungal Drugs
Mechanism of Action
Fungal Cell
Griseofulvin
DNA & RNA
- synthesis
-
Microtubule
Flucytosine
Assembly
Squalene
Squalene
Cell Membrane Cell Wall
Epoxidase
-
Squalene Epoxide Terbinafine
Squalene
Amphotericin B
Epoxidase Nystatin
Lanosterol Ergosterol
- 14 α Demthylase
Azoles
Cyt P450 1,3, β-D - Glucan
Synthase
-
Echinocandin
Identify the wrongly matched pair of antifungals with its mechanism of action:
A) Ketoconazole : Lanosterol-14-demethylase inhibition
B) Flucytosine : Inhibits microtubule synthesis and thus hinders mitosis
✓
C) Terbinafine : Squalene epoxidase inhibition
D) Amphotericin B : Sequesters ergosterol
What is the site of action of amphotericin B in fungi?

A) Nucleic acid
B) Ribosome
C) Cell membrane
✓
D) Cytoplasm
What is the mechanism of triazoles?

A) Interferes with DNA and RNA synthesis
B) Inhibition of ergosterol synthesis
✓
C) Forms pores in fungal membranes
D) Inhibits epoxidation of squalene in fungi
Polyene Antibiotic
Eg : Amphotericin B
: MOA - Binds with Ergosterol to form multiple pores in fungal cell membrane.
Not absorbed through GIT - So given as IV infusion (Chance of Infusion reaction).
Poor distribution into CNS.
: Adverse Reaction
- Dose limited toxicity - Nephrotoxicity : Manifests as
hypokalemia, hypomagnesemia.
- Anaemia (Rare)
- CNS Toxicity (Rare) - Seizure, Neurological Change.
To reduce Nephrotoxicity
Maintain hydration.
÷ Targeted drug delivery
- Colloid Dispersion (Remember as ‘ABCD’)
- Lipid Complex (Remember as ‘ABLC’)
Azoles
e)
Ketoconazole
Acid medium required for absorption.
: Can also be used for Cushing’s syndrome.
Microsomal Enzyme Inhibitor - Increases effect of other concurrent drugs.
:
S/E - Hepatotoxic, Gynaecomastia, Adrenal Insufficiency.
Fluconazole : Treatment of Candidiasis, Cryptococcal Meningitis.
: Voriconazole : S/E - Hepatotoxic, Visual Problems, QT Prolongation.
Posaconazole : Alternate drug in the treatment of Mucormycosis in renal failure patients.
: Terbinafine : Squalene epoxidase inhibitor.
Use - Superficial + Systemic Fungal Infection.
Griseofulvin: Inhibit microtubule assembly of fungus.
:
Use - Only for superficial fungal infection.
Given orally.
Microsomal Enzyme Inducer - Reduces effect of concurrently administered drug.
Shows Disulfiram Reaction.
Voriconazole is not effective against which of the

following?
A) Candida albicans
B) Mucormycosis
C) Candida tropicalis
D) Aspergillosis
AIImS Booster - Newer Antifungal Agents

-
Echinocandins
Acts on cell wall by inhibiting 1,3 - β - D Glucan Synthase.
-
-
Used in Systemic Candidiasis + Aspergillosis.
-
Eg : Caspofungin, Micafungin, Anidulafungin.

-
Nikkomycin
-
Acts on cell wall by inhibiting Chitin synthesis.
-
Used in Candidiasis + Aspergillosis.

Antimalarial Drugs
Chloroquine For Chloroquine resistant malarial cases

n
Uses : Mefloquine
R - Rheumatoid Arthritis Uses : Treatment and prophylaxis of malaria.
E - Extraintestinal Amoebiasis
D - Discoid Lupus Erythematosis
L - Lepra Reaction
÷Long T 1/2.
S/E : Neuropsychosis, QT Prolongation.
Drug Interaction : Halofantrine, Quinine.
I - Infectious Mononucleosis
Quinine
P - Photogenic Reaction
S/E : Cinchonism
My - Malaria Hypoglycemia
God - Giardiasis Black Water Fever
S/E QT Prolongation
÷
G/I Side effects Vision Loss
Eye - Bull’s Eye Maculopathy
Not used nowadays due to its S/E profiles.
CVS - Bradycardia, Hypotension
Liver damage
Safest antimalarial drug in pregnancy.
:
Halofantrine
Uses : To treat Falciparum Malaria in a combination with Artemisinin.
Lumefantrine : Absorption increases with food.
Halofantrine is the more cardiotoxic.
Primaquine
Vivax curative drug.
Kills dormant Hypnozoite phase also to prevent recurrence.
: C/I in pregnancy and G - 6 - PD deficiency (Haemolytic Anaemia).
Which of the following is gametocidal to all the species

causing malaria?
A) Primaquine
✓
B) Chloroquine
C) Quinine
D) None
MCQ Booster
Antimalarials Unsafe in pregnancy
Halofantrine
: Tetracycline/Demeclocycline
Primaquine
i Previous Year Questions AIIMS 2019
Tafenoquine is used in which of the following conditions?

A) Radical cure of plasmodium vivax
B) Prophylaxis of malaria in pregnancy
C) Treatment of severe falciparum malaria
D) Treatment of malaria in children <2 years
Which of the following topical antifungal has both anti-

inflammatory effects and anti-pruritic action?
A) Ketoconazole
B) Sertaconazole
✓
C) Luliconazole
D) Terbinafine
Which of the following drugs gets deposited in cornea?

A) Leflunamide
B) Chloroquine
✓
C) Methotrexate
D) Sulfasalazine
Artemisinin
Extend duration of treatment in case of Monotherapy.
: Or it is combined with Mefloquine.
Indications for use : Severe Multidrug resistant Malaria
: Cerebral/Falciparum Malaria
Not used in chemoprophylaxis.
Adverse Reaction : GI - Nausea, Vomitting, Diarrhoea
CVS - QT Prolongation, 1st degree heart block
Haematology - Reversible Leucopenia
Artemisinin, Artemether, Arteether - All are fast acting drugs.
: Artemisinin Combination Therapies
Artemether + Lumefantrine
: Artesunate + Amodiaquine
Artesunate + Sulphadoxine - Pyrimethamine
: Artesunate + Medloquine
Anti Retroviral drugs
Before Entry
①
Target
HIV CD 4 Cells
CCR -5
GP -120
So we categorise the drugs along with their action.

Target CD 4 Cells : Fusion Inhibitors
: Eg : Enfuvirtide (S/C)
Adverse effects : Infection Site Reaction, Pneumonia (Rare)
GP - 120 Blocking Receptor : Fostemsavir
CCR - 5 Inhibitor : Maraviroc
: Aplaviroc
Vicriviroc
Entry Blocking MAB - Ibalizumab
After Entry Reverse Transcriptase Inhibitors
-
Reverse Transcriptase Inhibitor Nucleoside Reverse Transcriptase Inhibitors
-
✗
Integrase Inhibitor Non - Nucleoside Reverese Transcriptase Inhibitors
✗
Protease Inhibitor
: Maturation Inhibitor
Reverse Tanscriptase Inhibitors
Zidovudine - S/E : Myelosuppression - Macrocytic Anaemia
: Lipoatrophy
Nail Hyperpigmentation
Didanosine - S/E : Pancreatitis, Severe Diarrhea
Stavudine - S/E : Severe Neuropathy
: Severe Lactic Acidosis

Severe Lipodystrophy
So Withdrawn from market
Abacavir - S/E : Can cause Steven Johnson Syndrome in patients with HLA B 5701
allele.
Genetic screening test should be done before administering.
Severe hyper cholesterolemia : Can cause MI
Lamivudine : Best tolerated drug.
:
Do not cause any severe adverse reaction.
Can be used in HIV as well as HBV.
Prophylactic use in pre exposure prophylaxis.
Emtricitabine : Can be used in HIV as well as HBV.
Tenofovir : Can be used in HIV as well as HBV.
:
First line drug for HBV.
S/E - GI Toxicity, Fanconi Syndrome
The antiviral drug having dual antiviral activity against

HIV and HBV is:
A) Enfuviritide
B) Abacavir
C) Emtricitabine
D) Ritonavir
Non nucleoside Reverse Transcriptase Inhibitors
-
First Generation
E - Efavirenz ; S/E - Neuropsychosis Shows
: N - Nevirapine ; S/E - Hepatitis. It is the safest drug in pregnancy. Cross
n
D - Delavirdine Resistance
-
Second Generation
Etravirine
: Rilpivirine
Doravirine
: Adverse Reaction : Rashes ( Usually mild form)
Rarely SJS and TEN.
Integrase Inhibitor
Raltegravir
: Elvitegravir
n
Dolutegravir
Protease Inhibitor ±
.
Saquinavir - Best tolerated Protease Inhibitor
Indinavir - S/E : Nephrolithiasis (Radioluscent Stones)
: Nelfinavir
Ritonavir - Most powerful Microsomal enzyme Inhibitor
: Amprenavir
Acts as a booster for other drugs
S/E : Circumoral Parasthesia
Fosamprenavir
: Atazanavir - Least chance of Lipodystrophy.
Lopinavir
: Common S/E of Protease Inhibitor : Hyperglycemia
Fat redistribution - T/t : Tesamorelin
(Synthetic form of GHRF)
Lipid abnormality
Maturation Inhibitor - bevirimat

A patient with AIDS was treated with zidovudine, lamivudine, indinavir, ketoconazole and
cotrimoxazole. He developed nephrolithiasis, central obesity, hyperlipidemia and insulin
resistance. Which of the drugs could have been the cause?
A) Ketoconazole
B) Indinavir
:
C) Lamivudine
D) Zidovudine
An HIV-positive woman on ART was prescribed ergotamine for a migraine attack 4

days back. She presented with complaints that she is unable to feel her legs from
the mid-thigh to her toes, for the past two days. The angiography image is given
below. What is the likely diagnosis?
A) Atherosclerosis
B) Ergotism
C) Polyradicular neuropathy
D) Herniated disc
Endocrinology Pharma
Hypothalamo - Pituitary Axis
Hypothalamus
GHRF GHIF (Somatostatin)
Anterior Pituitary
Growth Hormone
Liver
Somatomedin
(Insulin Like Growth Factor)
Tissue
Octreotide
Forty times more potent than Somatostatin.
÷
It is longer acting - 12 hours.
Given as S/C or IV (in emergencies).
Not used orally.
Uses
Acromegaly
Carcinoid Diarrhoea
i. AIDS
Variceal Bleeding
S/E
Vit B12 deficiency
: Gallstone
Diabetes Mellitus
Treatment of Acromegaly
- Increase in GH
r
Drugs inhibiting release of Growth Hormone
(Somatostatin Analogue)
r
Octreotide
r
Lanreotide
S/C
r
Vapreotide
r
Seglitide
r
Ergot D2 analogues
r
Bromocriptine
Orally
Cabergoline
r
r
Growth Hormone Receptor Blocker
r
Pegvisomant - S/C
27-year-old female came for treatment of infertility to OPD. Bromocriptine was prescribed.
What could be the possible reason?
A) Hyperprolactinemia
v
B) PCOD
C) Hypogonadotrophic hypogonadism
D) PID
Treatment of Dwarfism - Decrease in GH

r
GH releasing factor analogue

r
Sermorelin
r
Hexarelin
r
Tesamorelin
r
GH analogues
Somatrem
: Somatropin
Uses - Dwarfism
: AIDS related wasting

Turner syndrome
S/E - Type II DM
Increase in Intracranial Tension
r
IGF1 + IGF Binding Proteins
-
Mecasermin (S/C) - Insulin Like Action
S/E - Hypoglycemia
Drugs in OBG
N
Oxytocin
A post pituitary hormone.
: Acts on fundus and body of uterus
Does not act on lower segment.
: Useful for labour induction.
Useful for PPH.
: In breast, it causes contraction of myoepithelial cell - Milk ejection.
Overacting of oxytocin : Uterine rupture in post CS patient.
: High dose causing SIADH action.

Methyl Ergometrine (Methergine)
Acting on Fundus, Body and lower segment.
: Used in control of PPH.
Carboprost
: Prostaglandin analogue (PGF2 α) to control PPH.
Tocolytics
: Oxytocin Antagonist - Atosiban
Beta selective Tocolytics - Isoxuprine, Ritodrine
: Tocolytics can be used even in cardiac patients - MgSO4.
Which of the following is a synthetic PGF2 alpha

derivative used as an abortifacient?
A) Dinoprost
B) Dinoprostone
C) Misoprostol
D) Carboprost
✓
A dermatologist wants to prescribe acitretin to a patient with psoriasis. Which of

the following statements is false regarding the drug?
A) Contraindicated in persons with hyperlipidemia
B) It can cause increased sensitivity to sunlight
C) Female patients should avoid getting pregnant for 6 months after therapy
✓
D) Acitretin has a half life of about 50 hours
A pregnant woman was prescribed indomethacin. Which

of the following effects does the drug have on the fetus?
A) Premature closure of ductus arteriosus
✓
B) Keeps ductus arteriosus patent
C) Closure of fossa ovalis
D) Premature closure of ductus venosus
Corticosteroid indicated for the stimulation of fetal lung

maturation in preterm labor is?
A) Hydrocortisone
B) Triamcinolone
C) Methylprednisolone
D) Betamethasone
✓
Thyroid Gland Pharmacology

Antithyroid drugs
They inhibit formation of T3 from T4 in thyroid gland.
: Those drugs based in this MOA shows action only after 3 - 4 weeks because they
get stored in gland for 3 - 4 weeks. So Propylthiouracil is the DOC for Thyroid Storm/ Crisis.
Propylthiouracil - Additional action : Stops peripheral conversion of T4 - T3 at periphery.
: Methimazole Most Common S/E : Skin Rash (Maculopapular Rash)
Carbimazole Other S/E : Foetal Aplastia Cutis, Choanal Atresia
: Propylthiouracil strongly binds with plasma protein
Less chance of crossing BBB
Less teratogenicity
Lugol’s Iodine
Inhinits release of T3, T4 from follicle.
: Fastest symptom relieving drug.
Use : For pre operative preparation before Thyroid surgery
:
Reduces vascularity
Less operative bleeding
Potassium Perchlorate Thiocyanate

Used in Iodine dependent Hyperthyroidism
Inhibits entry of I2 into cells.
Used in Amiodarone induced hyperthyroidism
:
5’ Deiodinase Enzyme Inhibitors
Beta blockers
Amiodarone
: Propylthiouracil (Also Inhibits peripheral conversion of T4 to T3 - Dual MOA)
Dexamethasone
: Ipodate
Radioiodine Therapy
I 131
: T1/2 - 8 days
Emits 2 Rays - β Ray for Therapeutic Index.
: γ Ray for diagnostic purpose.
Damage the gland from inside to outside.
Total destruction - Permanent hyperthyroidism
:
(Not useful for Medullary Ca as it doesn’t accumulate in parafollicular cells)
Lenvatinib
Inhibits VGFR
A Tyrosine Kinase Inhibitor useful for well differentiated Thyroid Ca.
:
Vandetanib
Inhibits EGFR, VGFR
Useful for Medullary Ca thyroid.
Levothyroxine/liothyronine acts by binding to thyroid receptors.

Thyroid hormone receptors belong to which of the
following class of receptors?
A) Transmembrane receptor linked to tyrosine kinase
B) Nuclear receptor
=
C) Ion channel receptor
D) G protein coupled receptor
Insulin Preparations Classification (Important NEET PG QUESTION)
Insulin Preparations
Shortest Short Immediate Long Longest

Acting Acting Acting Acting Acting
Fast Onset and Shortest Acting Intermediate Acting

5
Onset : 10 - 20 minutes I
Onset : 1 - 3 hours
Duration : 3 - 4 hours
g- I
Duration : 16 - 20 hours
5
Aspart I
NPH Insulin
5
Lispro I
Lente Insulin
5
Glulisine
I
Used in controlling Post Prandial Glucose. Long Acting
5
Glargine (pH - 4)
I
Detemir
Short Acting
All are neutral insulins except Glargine.
Onset : 30 mins
5
I
So can’t be mixed with any other insulin.
5
Duration 5 - 8 hours
I
Regular Insulin
Longest Acting - Degludec
Composition of Lente insulin is:
A) 70% amorphous 30% crystalline
B) 70% crystalline 30% amorphous
✓
C) Only 70% amorphous
D) Other name of NPH insulin
New update in Insulin preparation (AIIMS Update)
Inhalational Insulin
: Exubera
Afrezza - Ultrarapid acting : Action within 15 minutes.
: S/E : Hypoglycemia, Weight Gain
Newer Antidiabetics
GLP - 1 Analogue
-
Promotes insulin release.
Glucagon like peptide.
: Exenatide - Origin : Salivary gland of Gil’s monster in sea.
-
Liraglutide : FDA approved treatment of obesity.

Taspoglutide
÷ Albiglutide
Dulaglutide
Adverse Reaction : GIT - Nausea, Vomitting, Diarrhoea
- Necrotising Pancreatitis
Which of the following can be given for long term

management of obesity?
A) Liraglutide
✓
B) Metformin
C) Sibutramine
D) Fenfluramine
DPP - 4 Inhibitors
Metabolism of GLP - 1 is by DPP - 4.
: Accumulation of GLP - 1 therefore increases.
Oral drug.
: Sitagliptine
Saxagliptin
Linagliptin
Vidagliptin
: Alogliptin
Excretion is by renal route.
Linagliptin is excreted through bile, so it is safe in renal failure.
: Adverse Reactions - Nasopharyngitis (URTI), Liver Damage, Pancreatitis.
In a middle-aged diabetic patient with chronic kidney disease stage 5, which of the following
drugs can be given safely without altering the dose?
A) Vildagliptin
B) Linagliptin
✓
C) Saxagliptin
D) Sitagliptin
In a middle-aged diabetic patient with chronic kidney disease stage 5, which of the following
drugs can be given safely without altering the dose?
A) Vildagliptin
B) Linagliptin
✓
C) Saxagliptin
D) Sitagliptin
Which of the following drugs do not need dose

adjustment in renal failure?
A) Sitagliptin
B) Saxagliptin
C) Vildagliptin
D) Linagliptin
✓
SGLT - 2 Blockers
Inhibition of Sodium Glucose Cotransporter at PCT of neuron (Responsible for 90% of
: Glucose Absorption).
Can cause Glycosuria (So caution in patients with Renal Failure).
: Canagliflozin
Sergliflozin
: Dapagliflozin
Empagliflozin
: Adverse Reaction - Urinary Tract Infection
- Risk of Bladder Ca and Breast Ca
True statement about teduglutide is :

A) It is a GLP-2 analogue
✓
B) It's half life is 6 - 8 hours
C) It is administered orally
D) It is recommended for patients with colorectal cancer
Aldosterone Reductase Inhibitors

Useful for Microvascular complications of Type II DM.
: Epalrestat
Fidarestat
: Ranirestat
Oral Antidiabetic Drugs
Sulphonamide Ureas (Secretagogues)

n
First Generation
n
Tolbutamide
n
Chlorpropamide (Longest Acting)
- Dilutional Hyponatremia (SIADH)
- Cholestatic Jaundice
- Disulfuram like reaction.
n
Second Generation
n
Glibenclamide
n
Glipizide
n
Gliclazide - Has additional antiplatelet and antioxidant property
n
Glimepiride
n
Mechanism of Action : Acts on Pancreatic β cells - Insulin Release.
n
S/E : Hypoglycemia, Weight Gain
Meglitinide Analogues
'
MOA : Acts on pancreas to increase Insulin release.
To control post prandial glucose
: Eg : Repaglinide, Nateglinide
Biguanides
Mechanism of Action - AMP activated protein kinase activation : Insulin sensitisation.
: Drug is not acting on Pancreas, so no increase in Insulin release and no chances of hypoglycemia.
Reduces both micro and macro vascular complications.
: Eg : Metformin
Excretion through renal route.
: So C/I in renal failure patients.
Adverse Reaction
: GI Toxicity - Diarrhoea, Indigestion.
Inhibits Intestinal Absorption of Glucose, Hexose, Vit B12
: Deficiency of Vitamin B12 - Megaloblastic Anaemia
Increases chances of Lactic Acidosis.
:
Alpha Glucosidase Inhibitors
Inhibits polysaccharide to monosaccharide conversion by inhibiting Alpha Glucosidase enzyme.
Helps to reduce post prandial glucose.
: S/E
Flatulence, Abdominal distension, Diarrhoea,
: Unsafe in renal failure due to excretion by renal route.
Examples
: Acarbose
Voglibose
:
Miglitol
Thiazolidinedones MCQ Booster (INICET)

Insulin Sensitiser α and γ agonist
Acts on PPAR - γ Receptors.
•
Useful in Diabetic
•
Eg : Pioglitazone Dyslipidemia.
Eg : Saroglitazar
Adverse Effects
:
- Weight Gain
- Macular Oedema
- Osteoporosis
- Bladder Ca
Drugs for treating Obesity
PPAR - α Activated Receptor

Increase in action of lipoprotein Lipase - Reduction in TG and VLDL.
S/E : Muscle weakness, Gall Stone formation.
: Eg : Clofibrate, Fenofibrate, Benzafibrate.
Statin
MOA - Inhibition of cholesterol synthesis by inhibiting HMG CoA Reductase.
: - LDL upregulation : Reduction in total cholesterol.
S/E : Myopathy, Hepatotoxicity, Teratogenic.
PCSK 9 Inhibitors
MOA : Increase in LDL Receptors.
: Eg : Alirocumab, Evolocumab.
Nicotinic Acid (Vitamin B3)
MOA - Decrease in LDL and Increase in Lipoprotein and HDL.
: S/E
Cutaneous Flushing (Most Common) - Due to increase in Prostaglandins.
: Hyperuricemia
Diabetes due to Insulin resistance.
: Hepatotoxicity.
Ezetimibe
Inhibit cholesterol absorption from Intestine.
Bile Acid Sequestrants Mipomersen
I
Cholestyramine z
Given S/C.
s
Colestipol 2
Given Once in a week.
•
Colesevelam ,
MOA : Inhibits VLDL secretion from liver.
Newer Drugs
Cholesterol Ester Transport Protein Inhibitor (“cetrapib in suffix”)
÷
Dalcetrapib
Evacetrapib
Anacetrapib
Microsomal Triglyceride Transport Protein Inhibitor
Eg : Lomitapide
Avasimibe
Inhibits conversion of Cholesterol to Cholesterol Ester by
blocking LCAT - 1 (Lecithin Cholesterol Acyl Transferase)
Drugs in Orthopaedics
Drugs Inhibiting Osteoclast Drugs promoting Osteoblast

n
Bisphosphonate
-
Calcitriol
n
Oestrogen and SERM
-
Calcium Teriparatide
n
Cinacalcet
-
Calcium Abaloparatide
-
Romosozumab
n
Calcitonin
Thiazide Diuretics
: Denosumab : Blocks RANK - 1 Ligand
Previous Year Questions AIIMS AND
INICET 2020
Which of the following drugs
promotes bone formation?
A) Calcitonin
Strontium Renelate B) Raloxifene
Drug which both inhibits Osteoclast C) Bisphosphonates
and promotes Osteoblast. D) Teriparatide
✓
Which of the following acts by

causing both decreased bone
resorption and increased bone
formation?
A) Strontium ranelate
✓
B) Ibandronate
C) Teriparatide
D) Calcitonin
Bisphosphonates
DOC for osteoporosis
: - In post menopausal women, Hypercalcemia, Paget’s disease.
Zolindronate
IV infusion once in a year.
S/E : Infusion reaction, Nephrotoxicity, Osteonecrosis of Jaw (Rare)
Ibandronate
: Given once in a month.
Risedronate
Given once in a week.
Which of the following is used in the first-line

management of postmenopausal osteoporosis?
A) Estrogen
B) Bisphosphonates
✓
C) Raloxifene
D) Combined oral contraceptives
Drugs for Bronchial Asthma
Bronchodilators
t
β2 Agonist
M3 Blocker
: Methyl Xanthines
Theophylline Non selective - Increases Cyclic AMP
Aminophylline PDE Inhibitors
Other actions of Methyl Xanthines
Increase strength of contraction of diaphragm.
: CNS Stimulation (Insomnia, Seizure)
Cardiac stimulation
: Diuresis
S/E
Nausea, Vomitting
: Headache, Gastritis PDE4 Blocking
Diuresis - A1 Receptor Antagonism
: Epileptic Seizures
PDE3 Inhibition/A1 Receptor Antagonism
Cardiac Arrythmias
:
Mast Cell Stabilisers
Sodium Chromoglycate
Ketotifen
: Nedocromil
A 60-year-old postmenopausal female patient with a previous history of Colle's fracture

came with complaints of lower
backache. On evaluation, her T score was -2.5. Which of the following statements are false
about the management of her
condition?
A) Teriparatide should be started before supplementing with bisphosphonates
B) Bisphosphonates are not given for more than a year
✓
C) Calcium requirement is 1200 mg per day
D) Oral vitamin D3 is given along with oral calcium
Leuokotriene Antagonists
Leukotriene Receptor Blockers
Arachidonic Acid
- Monteleukast
Zileuton 5 - lipoxygenase
Zafirleukast
LTA4 Used for prophylaxis.
LTB4 LTC4 MABs used for Asthma

Omalizumab : IgE
BLT Receptor
LTD4
LTE4
÷Mepolizumab : IL - 5
Reslizumab
Dupilumab : IL - 4 (Also used in Atopic Dermatitis)
Inhalational Steroids
Beclomethasone
: Budesonide Antiinflammatory by inhibiting Phospholipase A2
i
Fluticasone Increase the responsiveness of β receptors.
Mometasone
: S/E
i
Hoarseness
Dysphonia
: Oral Thrush
i
For severe asthma DOC : Inhalational steroids + Long Acting Beta Agonist (LABA)
The most common drawback of the given device is :

A) Bacterial contamination
B) Doesn't provide multiple doses
C) Drug deposited in the oropharynx
✓
D) Not portable

In a case of acute exacerbation of asthma, salbutamol was given, however, no improvement was
noticed. Intravenous corticosteroids and aminophylline were given and the condition improved.
What is the probable mechanism by which the corticosteroids would have improved the condition?
A) Corticosteroids increase bronchial responsiveness to salbutamol
✓
B) Corticosteroids cause direct bronchodilatation when used with xanthines
C) Corticosteroids indirectly increase the effect of xanthines on adenosine receptor
D) Corticosteroids increase mucociliary clearance
H. Pylori Eradication Regime
First Line Second Line Third Line Sequential Regime

“OCA/OCAM” “TOMB” for “LOA” for “OA” (5 days)
for 14 days 14 days Clarithromycin resistance +
“OCT” (5 days)
Omeprazole Tetracycline Levofloxacin Omeprazole
Clarithromycin Omeprazole Omeprazole Clarithromycin
Amoxicillin Metronidazole Amoxicillin Amoxicillin
Metronidazole Bismuth Tinidazole
Oseltamivir
^
Neuraminidase inhibitor.
^
Given for the treatment of Influenza A and B.
^
Competitively and reversibly interact with the enzyme sites to inhibit the activity of viral
neuraminidase.
^
This interferes with the release of the progeny from infected host cells, stopping the spread
of infection.
^
Therefore, early administration is needed.
^
Can be given for treatment and prophylaxis.
^
Other neuraminidase inhibitor - Zanamivir
Mechanism of action of Oseltamivir as an antiviral agent is:

A) Inhibition of M2 receptor
B) Neuraminidase inhibition
✓
C) Inhibition of RNA dependent DNA polymerase
D) Apoptosis of infected cells
What is the mechanism of action of oseltamivir and zanamivir?

A) DNA polymerase inhibition
B) Protein synthesis inhibition
C) Nucleotide analogue
D) Neuraminidase inhibition
:
Drugs reducing acid formation and ulcer formation
H2 Antihistaminics
Cimetidine : Antiandrogenic action (So can cause Gynaecomastia)
Microsomal Enzyme Inhibitor
Famotidine - Most potent H2 blocker.
: Ranitidine
Roxatidine
: Nizatidine
Loratadine
: All given at bedtime to reduce nocturnal acid output and basal acid output.
Excretion through renal route, so contraindicated in renal failure patients.
: Lafutidine : Reduces acid secretion and promotes ulcer healing by NO release and
mucous production. (Ulcer healing property)
M1 blockers
MCQ BOOSTER
Pirenzepine
Sodium Bicarbonate/Calcium Bicarbonate + Milk : Telenzepine
Milk Alkali Syndrome

Proton Pump Inhibitors
-
Omeprazole
-
Esomeprazole Even drugs with short T1/2
Short Half life inhibits proton pump irreversibly.
-
Pantoprzole
-
Lansoprazole
-
Tenatoprazole - Long Half life. So action remains even after it
exists from circulation.
Hit and run drug

Ulcer Protective drugs
Sucralfate (Sucrose + Sulfate Aluminium Hydroxide) : Acts only in acid medium.
: Bismuth : S/E - Black stool, Black Tongue.
C/I in renal failure.
Ulcer Healing Drug
^
Carbenoloxone
^
MOA : Displaces Aldosterone from protein binding.
Which of the following is not a prokinetic?

A) 5HT4 agonist
B) Dopamine antagonist
C) Motilin
D) Diphenylmethane
✓
Drugs in IBS
Pain Relief Medications For Diarroea dominant cases
TCAs d
Opiods
: Imipramine Loperamide, Diphenoxylate
Desmipramine d
Kappa Agonists
: Nortriptylline Fedotozine
Citalopram
C d
µ Agonist and δ Antagonist
c
Anticholinergics Eluxadoline
Dicyclomine d
Reserpine Analogue
: Hyoscine
Mebeverine
d
5HT3 Antagonists
Alosetron
For Constipation Dominant Cases
~
5 HT4 Agonists
Tegaserod
: Prucalopride Prucalopride is a
CCK 1 Antagonist A) 5HT2a agonist
: Loxiglumide
Chloride Channel Stimulant
B) 5HT2b agonist
C) 5HT4 antagonist
Lubiprostone D) 5HT4 agonist
✓
Guanylyl Cyclase Agonist
: Linaclotide
SSRI
Paroxetine
Miscellaneous Drugs
PDE inhibitors
PDE inhibitors Drugs Clinical Application
Non - Selective Methylated Xanthines Asthma

PDE Inhibitors Caffeine COPD
Theophylline
Pentoxyphylline Peripheral Artery Disease
PDE2 Inhibitors Anagrelide Essential Thrombocytosis
PDE3 Inhibitors Cilostazol Peripheral Artery Disease

Milrinone, Amrinone Cardiac Failure
PDE4 Inhibitors Roflumilast COPD

Drotaverine Antispasmodic Drug
PDE5 Inhibitors Sildenafil Erectile Dysfunction

Vardenafil (Also Pulmonary Hypertension
inhibits PDE6)
Preferential COX - 2 Inhibitors Side effects of corticosteroids
N - Nimesulide C - Cushing’s Syndrome
: O - Osteoporosis
-
-
A - Aceclofenac
M - Meloxicam R - Retardation of Growth
: E - Etodolac
-
D - Diclofenac ÷ T - Thin Skin and easy bruisability
I - Infection and Immunosuppression
C - Cataract
Drugs Precipiating gout O - Oedema
7
C - Cyclosporine/Anti Ca Drugs
A - Aspirin
: S - Suppression of HPA Axis
T - Thinning and ulceration of Gastric Mucosa
: N - Niacin -
E - Emotional Disturbance
7
T - Thiazide R - Rise in BP
.
L - Lasix (Frusemide)
: O - Other fatal Abnormality like Hypokalemia
I - Increase in Hair Growth
7
E - Ethambutol -
D - Diabetes Mellitus precipitation
7
A - Alcohol -
S - Striae
7
P - Pyrizinamide
Drugs Precipitating Porphyria
B - Barbiturate
Drugs Causing Pulmonary Fibrosis : O - OCPs
n
A - Amiodarone n
O - Orphenadrine
n
A - Azathioprine n
S - Sulphonamide
n
B - Bleomycin ^
T - Tetracycline
n
B - Busulfan
C - Carmustine C - Chloramphenicol, Carbamazepine
÷
C - Chloramphenicol H - Haloperidol, Hydralazine
C - Cyclophosphamide A - Alcohol
D - Doxorubicin P - Phenytoin
M - Methysergide
: M - Methotrexate Drugs which need
Therapeutic Drug Monitoring
D - Digoxin
: A - Antiarrhythmic
A - Antiepileptic
Which of the following inhibits the
T - Theophylline
synthesis of glucocorticoid?
A) Mifepristone : A - Aminoglycoside
L - Lithium
B) Flutamide
C) Finasteride
T - TCAs
D) Metyrapone
✓
: M - Methotrexate
C - Calcineurin Inhibitors
Teratogenic Drugs and Birth Defects
Drugs Adverse Effects
Pencillamine Cutis Laxa Syndrome
Lithium Epstein Anomaly

Facial Ear Anomalies, Heart Diseases
CNS Anomalies
Progesterone Masculinisation of female foetus
Quinine Abortion, Thrombocytopenia, Deafness
Topiramate Cleft Lip
Valproate Spina Bifida, Limb Defect, Autism Spectrum Disorder

Facial and Cardiac Anomalies, Pulmonary Atresias, VSD
Warfarin Hypoplastic Nasal Structures, Foetal Bleeding
Statins VACTERL Defects

Vertebral, Anal, Cardiac,Tracheoesophageal Fistula,
Renal, Arterial, Limb Defects
Alcohol ASD, VSD, Microcephaly
Which is not given in Wilson's disease?

A) Zinc
B) Penicillamine
C) Calcium citrate
✓
D) Trientene
Prostaglandin Analogues Drugs Uses
PGE1 Analogues Misoprostol MTP in First Trimester
Alprostadil Erectile Dysfunction

Peripheral Limb Disease
PGE2 Analogues Dinoprostone Cervix Ripening

MTP in Second Trimester
PGF2 α Analogues Carboprost PPH
Latanoprost Open Angle Glaucoma

Bimatoprost Open Angle Glaucoma
Travoprost Open Angle Glaucoma
PGI2 Analogues Iloprost Pulmonary Hypertension

Epoprostenol
Treprostinil
Which of the following helps in maintaining the patency

of ductus arteriosus?
A) PGF2a
B) PGE1
:
C) PGH2
D) PGI2
Which of the following statements is true about disulfiram?

A) When used with alcohol, the patients feels drowsy, with chest
discomfort and respiratory depression
B) It is an anticraving drug
C) It can be initiated even in minimally motivated person
D) Its action persists up to 2-3 days after stopping the drug
A colonoscopy of an elderly patient revealed brownish pigmented lesions as shown below.

He admitted to chronic laxative abuse. Which of the following laxatives is most likely to
cause this condition?
A) Bran
B) Psyllium
C) Senna
:
D) Methylcellulose
Which of the following is least likely to be useful in a

patient with severe COVID-19?
A) Low molecular weight heparin
B) Oxygen
C) Favipiravir
D) Steroids
Which of the following drug reduces mortality in COVID-19 patients?

A. Dexamethasone
B. Remdesivir
C. Favipravir
A) Band C
B) A and B
C) Only A
D) A, B, C

Pharmacology High Yield

Uploaded by

Copyright:

Available Formats

Pharmacology High Yield

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Pharmacology High Yield

Uploaded by

Copyright:

Available Formats

What are the main components of the autonomic nervous system?

What are the main components of the autonomic nervous system?

What are the main muscarinic receptor subtypes and their locations/functions?

What are the main muscarinic receptor subtypes and their locations/functions?

Pharmacology

Mediation - Norepinephrine Mediation - Acetyl Choline

ii) K+ channel blockade.

sympathetic fibres releasing

Which of the following is an example of a GPCR?

Previous Year Questions AIIMS 2018

What is the mechanism by which acetylcholine causes a

Previous Year Questions AIIMS 2019

Which of the following GPCRs does not act via the K+

Previous Year Questions AIIMS 2019

Which of the following causes an increase in ACh release

Selective M2 Agonist - Methacoline

Previous Year Questions NEET PG 2018

Which of the following conditions can be treated with

Previous Year Questions AIIMS & INICET 2020

The response on stimulation of muscarinic receptor is:

Smooth Muscle Clinical Aspect

Vasodilation Spasm i) Ipratropium Bromide

Selective M3 M3 Agonist M3 Antagonist

Previous Year Questions INICET 2021

Paradoxical bronchoconstriction seen with ipratropium

(Very Imp - NEET & INICET)

A patient with diabetic macular edema developed glaucoma. Which of the

Which of the following cannot be used to decrease

Previous Year Questions NEET PG 2019

Which of the following antiglaucoma medications is

Previous Year Questions NEET PG 2021

Which of the following can be prescribed in case of an

Previous Year Questions AIIMS 2017

Previous Year Questions NEET PG 2020

Which of the following drugs is used for the treatment of

Na+ Muscle Mechanism of Action

Which of the following drugs exacerbates myasthenia and is

Previous Year Questions NEET PG 2019

What is the drug used to differentiate myasthenia gravis

MCQ Boost MCQ Boost

Previous Year Questions AIIMS 2019

A patient presents to the emergency department with diarrhea, sweating, excessive

Previous Year Questions AIIMS 2017

Important selective Alpha 2 Antagonists

Useful for the treatment of

Hypotension Nasal Congestion

Alpha blockers are used to relieve symptoms of BPH.

Alpha 1A @ bladder Alpha 1B @ blood vessel

Examples of Alpha 1 Blockers

Previous Year Questions AIIMS 2017

The drug that decreases the size of prostate is:

Previous Year Questions NEET PG 2020

Phenoxybenzamine Tolazoline, Phentolamine

T/t : HTN due to Pheochromocytoma

Kidney Renin release increases.

Selective B2 agonists - T/t for Bronchial Asthma

- Salbutamol, Terbutaline : SABA (< 4 hours ; Short Acting)

Bladder - Relaxes Detrussor

Previous Year Questions AIIMS 2017