1) Drug formulation
a. What are the advantages of scored/divisible tablet?
Scored tablet enables us to divide the tablet into2 or 4 equal parts whenever the smaller dose is required.
b. What are the advantages of dispersible tablet?
In dispersible tablet, the drug is uniformly dispersed in water and hence there will be a rapid absorption of the drug.
2) Capsule
a. Mention 2 drugs, which are dispensed as capsules?
Antibiotics: Amoxycillin, tetracycline, ampicillin, Rifampicin.
b. What are the advantages of a capsule over a tablet?
It masks the unwanted taste, odour or colour. It is easy to swallow, coating protects drug from environmental oxidation. Liquid & oil preparation can be dispensed as capsules. Capsules are more attractive.
c. What are the advantages of soft capsule?
Liquid, semisolid or oily substances can be dispensed as soft capsules. Water insoluble but soluble in oil can be dispensed as capsules.
3) Drug formulation
a. Mention one advantage of the following type of coated tablet.
· Enteric coated: Prevents the inactivation of the drugs by acids in stomach. It prevents gastric irritation caused by the drug.
· Film coated: It masks the taste, protects the drug from environmental oxidation, and helps in handling.
· Sugar coated: It masks the taste, biter drugs can be given, better patient compliance.
4) Controlled release oral preparations
a. Mention 2 significant features of controlled release oral preparations?
Sustained and prolonged action: slow release of the drug over a long period; Frequency of the doses can be reduced, lesser fluctuation of plasma level of the drug; Patient compliance is better.
5) Transdermal preparation
a. Mention 2 advantages of this formulation?
Sustained and prolonged action; Fist class metabolism is bypassed therefore less individual variation; Less GIT adverse effects; Better patient compliance
b. Name 3 drugs given transdermally
Estrogen preparation; Scopalamine (Hyoscine): Anti cholinergic;
Nitroglycerine: Angina; Clonidine: anti hypertensive
6) Parenteral formulations
a. Name the difference betn an ampule and a vial
An ampule contains a single dose or the drug where as a vial contains more than one dose.
7) Parenteral formulations
a. What are the adv. of the following routes?
· Subcutaneous: Faster action compared to oral route, self-administrable. Eg: Insulin, heparin
· Intra muscular: Oily, depot preparations can be given by this route for prolonged effect. Eg: benzathine, penicillin, procaine penicillin.
· Intra venous bolus injection: for quick effect. Eg: Aminophylline bolus
· Intra venous infusion: for prolonged action, dose of the drug can be adjusted. Eg: Aminophylline infusion.
8) Suppository
a. Give 2 reasons for dispensing drug in suppository form. Give 2 Eg.
Suppositories can be given for local or systemic effect.
Eg: Glycerin for edema; Miconozole PV for candidiasis; Bisacodyl for constipation.
9) Oral liquid formulations
a. Mention 1 advantages of the following
· Suspension: The ingredients are insoluble but uniformly distributed in the vehicle.
· Syrup: Sugary solution used as vehicle for easy palatability.
· Linctus Thick conc. Sugar soln gives soothing effect on pharyngeal mucosa bcoz of viscosity.
10) Sublingual formulation
a. Mention the advantages of sublingual ROA; give 2 uses.
Avoids first class metabolism in GIT & liver, effect could be terminated by spitting the drug out, fast action.
Eg: Nitroglycerin: Acute angina
Buprinorphine: To relieve cancer pain.
11) Dose calculation for body surface area
a. What is the dose for a 20 kg person?
From the chart 44 pound gives a value of 47% of adult dose. 47% of 500mg is 235 mg 6 Hrly
12) Clinical pharmacokinetics:
a)
Name 2 drugs where the duration of action does not
correlate with plasma t1/2 ?
Omeprazole, glibenclamide.
b) Name 2 drugs following zero-order kinetics?
Alcohol, phenytoin, theophylline
c) Name
a b
blocker having the shortest t1/2?
Esmolol
d) Name 2 factors which effect t1/2 of a drug?
Hepatic function and renal function.
13) Time for steady state level
a. Dobutamine has a t1/2 of 2 min. How long does it take to achieve steady state level?
4 half lives = 8 mins.
14) Determination of dosage from surface area
a. Find the dose of Amoxycillin to be given for a child weighing 10 kgs
28% = 140 mg 8 Hrly.
15) Post marketing surveillance.
a. What are the objectives of the programme?
To study the efficacy and safety in large population & interaction with other drugs or food.
b. On what grounds are drugs withdrawn?
Drugs are withdrawn when the incidence is unexpectedly high, when it shows less efficacy compared to the existing drug or standard drug.
16) Double-blind trial
a. Define double-blind trial.
Both the patients as well as the investigator in the study are unaware whether a drug is a placebo or an active drug.
b. What is the percentage of placebo reactors?
20-40%
c. What is the importance of wash out period in cross-over study?
17) Lactation & Drug administration
a. What preparation should the nursing mother take when she has to take drugs?
Should avoid drugs as far as possible during lactation; Drugs should be taken 30-60 min after the feed and atleast 3-4 Hrs before the next feed. This will avoid the peak effect of the drug in milk.
b. Diazepam: what is the adverse effect seen in breast fed infants of mothers taking diazepam?
Baby will be lethargic; sedated; poor suckling; voluntary muscles will be flabby; may lead to respiratory depression.
c. Chloramphenicol: Why it is not recommended in lactation?
Bcoz it causes bone marrow suppression, leading to aplastic anemia, agranulocytoses, thrombocytopenia.
18) Commonly used drugs requiring therapeutic drug monitoring
|
Drug |
Conc. Below which therapeutic efficacy is unlikely |
Conc. Above which toxic effect is more likely |
|
1. Digoxin |
1.0 n mol/ Ltr |
3.8 n mol/ Ltr |
|
2. Lithium |
0.4 n mol /Ltr |
1 n mol/ Ltr |
|
3. Phenytoin |
40 m mol/ Ltr |
80 m mol/ Ltr |
|
4. Theophylline |
35 m mol/ Ltr |
100 m mol/ Ltr |
a. Why is the therapeutic drug monitoring necessary for the above mentioned drugs?
Due to its narrow safety margin
b. Name 2 commonly used group of drugs where plasma conc. Monitoring may not be worth?
Oral anticoagulants, oral hypoglycemics, diuretics
1) Pilocarpine
What are the after effects of long term usage of pilocarpine in glaucoma?
- Cataract, proache, congestion of eye, spasm of accommodation.
2) Physostigmine
Why is it not useful in Myasthenia Gravis?
It crosses blood brain barrier and causes unwanted central side-effects
Short acting agent; - It has no direct action on skeletal muscles
3) Myasthenia Gravis
What is myasthenia crisis? How would you treat it?
It is seen in myasthenia gravis patients due to under or no treatment. Neostigmine is used, Physostigmine can also be used.
4) Atropine
Name the atropine like drug used in Bronchial Asthma? Mention its route of administration.
Epitropium bromide & Diatropium. ROA: inhalation
5) Adrenaline
Mention 2 life saving uses for adrenaline with dose and route of administration. What is dipivefrine?
· Anaphylactic shock: 0.5-1 mg i.m.
· Cardiac arrest: 0.5-1 mg intra cardiac
Dipivefrine in a prodrug of adrenaline used in glaucoma.
6) Xylometazoline
Name one clinical condition where it is used. Give one A/E.
Allergic rhinitis, common cold
Mucosal damage, anosmia, rebound congestion when drug is withdrawn.
7) Dopamine
Mention 2 advantages over nor-adrenaline
It is used in cardiogenic shock
· It has dose dependent effect on CVS
· Less arrythmogenic
· Increases urine outflow
1) Digoxin
Mention one clinical use with rationale other than CCF.
Supraventricular arrhythmia. It ¯ AV conduction, decreases ventricular rate
2) Lignocaine
Why is it not useful in Supraventricular arrhythmia?
It has no significant action on AV node. Bcoz it is not a pure Na+ channel blocker Þ no action on AV nodeÞ does not help to decrease ventricular rate.
3) Low dose aspirin tablet
a) Mention one clinical condition for its use
· Prevention of coronary thrombosis (both primary and secondary)
· Prevention of microthrombi induced placental insufficiency leading to growth retardation
· Prevention of cerebral thrombosis
b) Why does low dose aspirin act only on platelet and not on endothelial cell?
Platelets do not have nucleus & hence action of aspirin (inhibition of enzyme thrombaxane synthase) lasts forever in every platelet affected (Irreversible action)
4) Isosorbide mono nitrate
What is its adv. over nitrogycerine?
Isosorbide has longer action, hence can be used for prophylaxis.
5) Ventricular tachycardia
a) Name 2 drugs causing this?
Digitalis, Adrenaline, Isoprenaline
b) Name 2 drugs effective in this?
Lignocaine, procainamide, phenytoin
6) Ventricular Fibrillation
Is there any drug for this condition?
· No
7) Propranolol
Why is it administered with nitrates in the management of angina pectoris?
· Reflex tachycardia produced by nitrates is blocked by propranolol.
· Ventricular dilatation caused by propranolol is blocked by nitrates.
8) Atenolol
a. Write 2 adv. over propranolol
Selective b1-blocker: Lipid profile not altered, No bronchospasm. Does not produce CNS effect by passing Blood brain barrier.
b. Why should not be atenolol discontinued abruptly?
Withdrawal symptom: Rebound hypertension
9) Clonidine
Name 2 common & disturbing A/E
Abrupt withdrawal: Rebound hypertension, impotence, sedation, mental depression, constipation.
10) Captopril
Why is it used in CCF?
It reduces both preload & after load due to arterial & venous dilatation, relieving symptoms, disease progression (Hypertrophy) is reversed.
11) Enalapril
a. Name one common A/E
Dry cough. Bradykinin & Substance P metabolism is decreased.
b. What is the active form of this drug?
Enalaprilat.
12) Nifidipine: Short acting CCB.
a. Which emergency is it used?
Hypertensive crisis
1) Frusemide
Mention the rationale & route of administration in acute pulmonary edema
On i.v. administration Þ Increases venous capacitance by rapid venous dilatation due to PG synthesis.
2) Hydrochlorothiazide
a. Why is it used used with triamterene?
To prevent hypokalemia
b. Name one thiazide with longer duration of action
Chlorthalidone.
1) Salbutamol
Mention one adv and one limitation of this device.
Adv: Local action, no systemic A/E
Limitation: faulty technique- loss of therapeutic efficacy, expensive
2) Budosanide
Write an indication. Why is it preferred over Beclomethazone?
Useful in prophylaxis of bronchial asthma. It has a high topical: systemic ratio.
3) Aminophylline
a. Name one emergency condition where it is used?
Status asthmaticus
b. Mention the basis for slow i.v. administration
They are CNS,CVS and GIT irritants. Tachycardia and cardiac arrhythmia may occur on i.v. administration.
4) Chromolyn sodium
Mention one use, write the duration required to establish efficacy
Prophylaxis of Broncial Asthma; 2-4 weeks.
1) Fetal Hydantoin Syndrome
a. List out 2 characteristic features of this syndrome
Dense hair growth on scalp, widened gap betn upper lip and nose, narrow papabral fissure, under developed distal phalanges.
b. Is Sodium Valproate an alternate drug to phenytoin in pregnancy?
Sodium Valproate is more teratogenic than phenytoin. Alt drugs: Carbamazapine, Phenobarbitone.
2) Fetal Hirsutism
a. Mention one drug that causes this
Phenytoin sodium, anabolic steroids (testosterone), minoxidil
b. Give one indication for the drug mentioned
Phenytoin sodium: Grand mal epilepsy
Minoxidil: Hypertension
3) Alcohol: Delirium tremens
a. What is delirium tremens?
It is a withdrawal syndrome in chronic alcoholic patients. Characterized by restlessness, tremor, anxiety, convulsion.
b. Mention 2 drugs with route of administration in the treatment of this condition.
Diazepam: Chlordiazepoxide, haloperidol
Route: Oral (mild cases); i.v. (severe convulsing cases)
4) Alopecia
a. Mention 2 drugs causing this
Anticancer drugs: Methotrexate, cyclophosphamide, Vincalkaloides.
b. Name a drug causing hypertrichosis
Minoxidil, phenytoin sodium
5) Fetal alcohol syndrome
a. Identify this condition: Fetal alcohol syndrome
b. Mention the characteristics: Reduced scalp hair, microencephalopathy, fenestral gap increased, narrow palpabral fissure, norrow upper lip, mental retardation, low IQ.
6) Diazepam
a. Mention one life saving use for diazepam?
Status epilepticus.
b. Write the drug interaction betn diazepam and L-dopa?
Diazepam reduces efficacy of L-dopa.
7) Linctus Codeine
a. Why is it not useful in productive cough?
Supression of productive cough decreases the expectoration of secretions, infection, atelectasis.
b. Mention one common side-effect
Constipation.
8) Pethidine
a. Why is it preferred to morphine in obstetric analgesia?
Less likely to produce asphyxia of the newborn
b. Mention a pethidine congener which is more potent than morphine?
Fentanyl, ol-fentanyl, su-fentanyl, remi-fentanyl
9) Morphine
a. Name the long acting morphine antagonist
Naltrexone: orally
b. Name one morphine substitute which is used sublingually?
Buprenorphine
10) Buprenorphine
Name the drug used in the treatment of overdose?
Naloxone + Doxapram a respiratory stimulant
11) Cholpromazine
Why is it not used in motion sicknes?
Motion sickness id due to dysfunction in tubular component of inner ear. A stimulus goes to vomiting center. These vestibular component contains H1 & muscarinic receptors but chlorpromazine acts via D2 receptors. Drugs effective are: Hyoscine & promethacine
12) Haloperidol
What is the adv over chlorpromazine?
More potent, less anti cholinergic property (dry mouth), less sedation
13) Imipramine
Mention 2 uses
Antidepressant, nocturnal diuresis (anti cholinergic property).
14) Floxitine
Mention 2 adv over imipramine
Selective SSRI, less anticholinergic action, less sedation, does not cause postural hypotension, can be used in pregnancy, used in compulsive disorders.
15) Lithium carbonate
a. Write an indication
Acute maniac episode, prophylaxis of maniac depressive illness and bipolar MDI
b. What is the interaction with diuretics?
Lithium toxicity: loop diuretics like frusemide cause sodium oss. So to compensate theis loss, monovalent cation Na+ & Li+ are absorbed in PCT. This causes toxicity. (Range: 0.8-1.2 m eq/Ltr, >1.5 m eq/Ltr: Toxicity).
16) Buspirone
a. Mention one therapeutic use
Anxiolytic
b. Mention one diff over diazepam
Does not produce significant sedation, does not produce tolerance or physical dependence, has no muscle relaxation or anti-convulsant activity.
17) Levodopa & carbidopa
a. Write 2 adv. of this combination
t1/2 of levodopa is prolonged: frequency can be reduced; Systemic A/E are less
b. Name 2 drugs causing parkinsonism
Haloperidol, Metaclopramide
18) Gingival hyperplasia/ Hyperplasia of gums
a. Name 2 drugs of different group causing this
Phenytoin, Ca2+ channel blocker: Verapamil
b. Can therapeutic drug monitoring avoid this? NO
c. Would you advice withdrawal of the drug from treatment?
No. good oral hygiene can minimize the condition.
19) Scarletiniform rash
a. A drug used for febrile convulsion caused this. Which drug?
Phenobarbitone,
b. Name the alternative drug.
Alt drugs: Sodium Valproate, Diazepam
1) Aspirin
Why aspirin is not prescribed for a child suffering from influenza?
There is risk of Reye’s syndrome. (Acute encephalopathy and fatty degeneration of the liver).
2) Paracetamol
a. What is the antidote for acute paracetamol poisoning?
N-acetyl cysteine , methionine – these replenish the depleted stores of glutathione. Glutathione is necessary for detoxification of NABQI
b. Why the duration of paracetamol (Full dose therapy equal to 3gm/day) should not exeed 10 consecutive days?
Bcoz of hepatotoxicity due to accumulation of metabolite N-acetyl benzo quinone imine which binds covalently to the proteins in the liver cells and renal cells leading to necrosis.
3) Ibuprofin
Mention 2 diff betn ibuprofin and aspirin
Less hepatotoxic, better tolerated, less gastric irritation, can be used for longer duration, can be given in children, in pregnancy& in lactating women. No effect on coagulation.
4) Rheumatoid arthritis
Name 2 disease modifying drugs
· Piroxicam- first line
· DMARD- Penicillamine, sulfasalazine, anti-malarials
5) Piroxicam
Mention 2 advantages over aspirin
Longer acting, more potent, well absorbed from GIT& after topical administration. Can be used in children below 6 yrs.
6) Pheniramine
Mention a drug interaction with alcohol
Alcohol synergises the CNS effects: Sedation, decreased alertness, decreased conc., motor incoordination, fatigue, tendency to fall asleep, psychomotor impairment.
7) Terfenadine
Mention one adv. & one therapeutic use
Highly selective H1 antagonist with rapid onset& moderate duration of action. Short term and intermediate use. Use: Symptomatic cure of allergic rhinitis.
8) Migraine
a. Which drug used in migraine gives rise to this condition
Ergotamine
b. Name one contraindication for this drug
Peripheral vascular diseases, hypertension, IHD, pregnancy.
9) Promethazine
Mention 2 indications & 2 A/E
Indication: Motion sickness, allergic reactions, drug induced parkinsonism.
A/E: Sedation, dry mouth, constipation, blurring of vision, urinary retention.
1) Antacid combination
Why Mg2+ and Al3+ salts are combined?
Mg2+: fast acting, causes diarrhea
Al3+: slow acting, causes constipation
Þ Prolonged action, less side effects.
2) Ranitidine
Mention 2 adv over cimitidine
· Anti-androgenic effect is less
· Hepatic microsomal enzyme induction is less
· More potent, better patient compliance
3) Meraclopramide
a. What are the precautions ro be taken before taking it?
It should not be given in case of bowel obstruction, GI hemorrhage, epilepsy, parkinsonism, elderly patients & children
b. Why is it not used in motion sickness
Vestibular pathway does not involve dopaminergic limb. So it is not useful. It also has a cholinomemetic action.
c. Write 2 uses and 2 A/E
Use: Drug induced vomiting, radiation sickness, during chemotherapy, emergency anesthesia .
A/E: Parkinsonism, galactorrhoea, sedation, diarrhoea.
1) Oxytocin
a. Give 2 indications
Induction of labour, uterine atony, breast engorgement, abortion, oxytocin challenge test
b. What precaution should be taken during infusion?
5 IU in 500 ml of saline as slow i.v. Keep on increasing gradually noting uterine contraction. (Oxytocin antagonist- Atociban)
2) Ergometrin
a. Give 2 indication
PPH, when involution does not take place, after caesarian section for atony of uterus.
b. Why is it not used to induce labour?
· Contracts both upper and lower segments
· Continuous contraction, constricts blood vessels
· Long t1/2, cant be regulated.
3) O. C. Pills
a. What may happen to foetus in the event pills are continued in pregnancy?
Increased incidence of adenocarcinoma in vagina and cervix among female offsprings of mothers. Teratogenic in 1st trimester.
b. Name one clinical usage other than contraception for this pill.
Dysfunctional uterine bleeding, for abdominal pre menopausal active bleeding. In patient with submucous myomas (if there is heavy bleeding), endometrial ablation is done.
c. What advice should you give in case,
· Administration of the pill missed for 12 Hrs: Next day take 2 opills
· Administration of pill missed for > 2 weeks: Do pregnancy tests. If –ve, start new regimen from next cycle, till then practise other method of contraception.
d. What is the regimen of administrating the pill?
Combination of oral contraception, administered once daily at bedtime. Started at first day of menstrual cycle and continued as long as contraception is desired.
e. Name 2 indication for the use of post coital pill?
Unprotected sex or emergency contraception in victims of rape.
f. Name 2 contra indication for the use of the pill
Pregnancy, any cervical or genital carcinoma, thromboembolic diseases.
4) Discoloration of teeth
Which drug causes this? How to avoid this?
Tetracyclins. Don’t give to pregnant woman & children. Maintain good oral hygine if given, brush with saline.
5) Human insulin
a. Name 3 preparations
Lispro insulin, humulin- U, Humulin N.
b. Mention 2 adv: Less antigenic, lower dose required, lipid dystrophy absent, Can be used in IDDM.
c. How is human insulin manufactured?
Comercially by rDNA technology. By removing amino acid by hydrolysis of porcine insulin.
6) Insulin
a. Why should serum K+ should be monitored with insulin therapy in diabetic ketoacidosis?
Hypokalemia is precipitated due to insulin therapy. Therefore K+ should be supplemented.
b. Name the preparation & route of administration in diabetic ketoacidosis?
Regular insulin I.V. bolus followed by infusion.
c. How is insulin resistance overcome?
Ø Switching over from conventional insulin to human insulin purified
Ø Immunosuppressants for short period.
d. When is a diabetic pt. regarded as insulin resistant?
When the pt. Requires >100 IU of insulin per day for 3 consecutive days in absence of stress, trauma or infection, he is said to have developed insulin resistance.
7) Anabolic steroids
a. Name 2 anabolic steroids:
Oxandrolone, Stanozolol
b. Name 1 indication and 1 A/E
Indication: CRF, Chronically bed ridden patient, refractory anemia, after chemotherapy for cancer.
A/E: Can produce hepatic tumours.
Males: Impotence, gynecomastia; Females: hair growth.
8) Testosterone
a. Give 2 indications for this preparation (depot)?
Cryptorchidism, 1° or 2° testosterone deficiency.
b. Name 2 contra indication:
Prostatic cancer, not to be given in liver disease.
9) Prednisolone
a. What is the objective of tapering the dose before withdrawal?
It causes H-P axis suppression.
b. Which disease is aggravated by long-term use?
Osteoporosis, gastric acidosis, diabetes, Tb. Absolute C/I: Herpes simplex keratitis.
10) Cushing syndrome
a. Which drug produces this syndrome?
Prednisolone
11) Pemphigus Vulgaris
a. Name DOC and Route of administration
Prednisolone; oral or parenteral; high dose.
12) Metformin
a. Is it euglycemic or hypoglecemic?
Euglycemic
b. What is the reason for using with other anti-diabetic agents?
Since it’s MOA is not shared by other drugs. It sensitizes peripheral tissues for insulin.
13) Tetany
a. How do you treat this condition?
Ca gluconate I.V. infusion 10% 10-20 ml at 2 ml/min
b. Which drug is used in this condition?
Propyl thiouracyl
14) Cretinism
Mention the drug used in this condition & duration of treatment?
T4, l- thyroxine. Life long treatment.
15) Second generation sulfonylurea
a. Mention 2 adv. over tolbutamide
More potent, ¯ frequency OD or BD, t1/2 longer [ hit and run] drugs, better patient compliance
b. Give 1 contra indication: Glibenclamide is not given to gidiatric patients and patients with renal failure.
16) Oral anti diabetic drugs
a. What is secondary failure with these drugs?
Down regulation of insulin receptors. Type2 ® Type 1 due to ¯ secretion of insulin.
b. What in the treatment?
Metformin, thioglitasone, rosiglitasone
1) Iron total dose infusion formula
Calculate the Parenteral iron requirement in a patient 60 kg weight, presenting with Hb of 6gm/dl?
Taking normal= 13gm/dl
Elemental iron = 4.4 x iron deficit x weight in Kgs
4.4 x 7 x 60 = 1848 mg
2) Iron salts
What precautions are to be taken while giving parenteral iron i.m. and i.v.?
i.m.: Deep i.m. in gluteal region using Z track technique to avoid staining of the skin. 50 mg/ml;
2ml/day
i.v.: Test dose of 0.5ml should br given before to screen for hypersensitivity reaction; slow i.v. over 6-10 min.
3) Iron tablets
a. Mention 2 oral iron preparations
Ferrous sulphate, ferrous citrate, ferrous gluconate, ferrous succinate
b. Mention 2 common A/E of oral iron
Nausea, vomiting, epigastric pain, constipation, diarrhoea.
c. Give one interaction for oral iron
Vit C enhances absorption of iron.
Phytate, oxalate, antacids, tetracycline decrease absorption of iron.
4) Iron dextran injection
a. Give 2 indication for parenteral iron therapy
Malabsorption, intolerance to oral iron
b. Give the anti-dote and ROA for acute iron poisoning
Desferrioxamine: Route is i.m. but oral(gastric tube) and i.v. possible
c. Give the formula for total dose parenteral iron therapy.
Iron in mg/dl = 4.4 x body wt in kg x haemoglobin deficit.
5) Iron deficiency anaemia
a. Why oral iron therapy is continued after correcting the Hb deficit?
To replenish stores
b. Which is the specific anti-dote for acute iron poisoning?
Desferrioxamine
6) Megaloblastic anaemia
a. Which drugs induce megaloblastic anaemia?
Methotrexate, phenytoin, trimethoprim, pyrimethamine.
b. Name 2 drugs used in this
Vit B12 & folic acid.
7) Folic acid tablets
a. Give 2 sources & daily requirement of folic acid
Green leaf vegetable, liver, eggs, milk
Daily requirement: 0.1-0.2 mg; 0.4 mg in pregnancy
b. Mention 2 conditions caused by its deficiency
Megaloblastic anaemia, Glossitis, sterility, diarrhoea, enteritis
c. Mention 2 metabolic actions of folate
Purine synthesis, Generation of deoxy thymidilate
d. Mention 2 drugs causing folate deficiency
Methotrexate, trimethoprim, pyrimethamine, phenytoin.
8) Vitamin B12
a. Give 2 sources & the daily requirement
Legumes, sea fish, liver, cheese; Requirement: 1-3 m gm, pregnancy & lactation: 3-5 mgm
b. Mention the drug, ROA, frequency& duration of therapy of pernicious anaemia?
Hydroxy cobalamine, i.m., 100 mg weekly for 1 month, then 100 mg monthly lifelong.
9) Oral anticoagulant tablet
a. What is the test done to monitor oral anticoagulant therapy?
PT & INR (International Normalised Ratio = Ratio of PT of patient to PT of control)
b. Write one clinically significant drug interaction.
· High dose of aspirin displaces warfarin from protein binding site Þ antiplatelet action Þ bleeding and ulcers.
· Barbiturate, Rifampicin, Griseofulvin (Enz inducers) decrease efficacy of warfarin.
c. Mention the treatment for overdosage
Withhold anticoagulants, fresh blood, Vit K1 (i.m.)
d. Give 2 contra indications for oral anticoagulant therapy
Severe hypertension, pregnancy, lumbar puncture
10) Oral anticoagulant tablet
a. Name 2 oral anticoagulant preparations
Warfarin, dicumarol
b. Indicate their mechanism of action
It inhibits the synthesis of Vit K dependent clotting factors II, VII, IX, X
c. Give 2 imp A/E of this preparation
Bleeding, warfarin: rashes, dermatitis
d. Mention 2 condition for their use
Prophylactically maintenance therapy of DVT, Pulmonary Embolism, RHD, Atrial fibrillation.
11) Heparin
a. Mention 2 condition where heparin in used
Post MI, DVT
b. Mention the A/E of heparin
Bleeding, hypersensitivity, osteoporosis, transient alopecia
c. Why heparin should not be given i.m.?
Hematoma formation
12) Heparin
a. Name 2 LMW heparin
Enoxheparin, daltaparin, Reviparin
b. Mention 2 adv of LMW heparis
Longer duration of action, longer
t1/2,
daily dose, 70% absorption
c. Name the heparin antagonist. Give the amount of antagonist required to neutralize 1000 units of heparin
Protamine sulphate. 10 mg is required i.v.
1) Cotrimoxazole
Write 2 indications
Chancroids (double strength BD 7 days), Pneumocystis Carinii, Pneumocystis jeroveci in HIV pt.
2) Primary Chancre
Write the DOC & alternative Drug
DOC: Benzathine penicillin: 2-4 million unit i.m. at gluteal region.
Other: Doxacyclin 100 mg BD 2 weeks
Erythromycin
3) Giardiasis
Write the DOC, dose and duration of treatment
DOC: Metronidazole 200 mg TDS 7days (400 mg TDSx7 in amoebiasis)
Alternate: Tinidazole
4) Metronidazole
a. Name a clinical condition for its i.v. use.
Severe anaerobic infection, prophylaxis of GI surgery.
b. What is the rationale for its use in peptic ulcer?
H.pylori infection is associated with peptic ulcer. So Metronodazole is given as combination therapy.
5) Erythromycin
a. Mention one clinical condition where it is the DOC?
Atypical pneumonia, whooping cough, legionella pneumonia
b. Mention 1 contra indication with reason
Hepatic disease, since it can cause cholestatic jaundice.
6) Gentamicin
a. Write the D/I that occurs outside the body
Penicillin & aminoglycosides should never be mixed in the same syringe, penicillin inactivates aminoglycoside effect to a significant extent.
b. Mention 2 clinical indication for 2 diff formulation
i.m. & i.v.: Gram negative UTI
Eye and ear drop: Conjunctivits, otitis media
Ointment and cream: dressing of burn infection
7) Bacampicillin (Prodrug of ampicillin)
a. Write 2 adv. over ampicillin.
Better tissue penetration & absorption. Bio-availability in more.
b. Write 2 A/E
Diarrhoea, rashes (common in HIV, EBV infections)
8) Fluroquinolone
a. Write an imp. C/I & reason for it.
Not to be used in children: causes cartilage damage in weight bearing joints.
9) Pyrazinamide
a. Is it a first anti-tubercular drug? Give reason.
Yes. It is bactericidal, acts best on intracellular bacilli and those at inflamed site. It has sterilizing action.
b. Mention 2 A/E
Hyperuricemia: Gout, Hepatotoxicity
10) Ethambutol
a. Why is it not used in children?
It causes retrobulbar neuritis, a dose & duration dependent toxicity. Children are unable to report early visual impairment. Hence not to be used <6 months
b. What is the characteristic A/E?
Optic neuritis, hyperuricemia, hypersensitivity reactions: rashes
11) Leprosy
Mention the drugs used in multi drug therapy
Rifampicin, clofamizine, dapsone
12) Rifampicin
Mention 2 uses other than TB.
Leprosy, meningococcal meningitis, MRSA infection, Prophylaxis of contacts of meningococcal & H. influenza infection.
13) Malaria
Mention two gametocidal antimalarial drugs. What are its advantages?
Primaquin, chloroquine. It prevents transmission.
14) Pyrimethamine & Sulfadoxime
Give rationale for the combination. Give C/I
To have synergistic effect, sequential blockade.
C/I: Hepatitis, 1st trimester of pregnancy, h/o allergy
15) Chloroquine
a. Write 2 uses other than malaria
Rheumatoid arthritis; along with Metronidazole & diloxanide (luminal amoebicidal) for amoebic liver abscess; SLE; Lepra reaction.
b. Give the A/E on first dose and measure to prevent it.
A/E: Nausea, vomiting.
Domperidone is given before chloroquine.
16) Cyclophosphamide
a. Why MESNA is indicated along with this therapy?
MESNA is excreted in urine, binds to toxic metabolite of cyclophophamide (acrolene) & inactivates them, thus preventing haemorrhagic cystitis.
b. What is the rationale for using this in nephrotic syndrome?
Cyclophosphamide acts as an immunosupressant & ¯ deposition of immune complexes.
17) Methotrexate
a. What is leucoverin rescue?
Leucoverin rescue is needed in case of over dosage of methotrexate treatment. This is done because, due to inhibition of DHFA reductase, folic acid synthesis is ¯. To overcome this folinic acid is given.
b.
Mention
a curative neoplastic indicarion.
Choriocarcinoma.
18) Vincristine
a. Write 2 common indications
Hodgkin’s lymphoma, Wilm’s tumour
b. Is it used as a curative or inducing remission?
Inducing remission
19) Tinea Versicolor
a. Name 2 topical preparation effective in this condition
Selenium sulphide 2-5% lotion, applied neck to waist, left for 5 min®wash, daily for 7 days, afterwards weekly for 1 month
Ketocaonazole shampoo weekly for maintanance.
20) Herpes Zoster
a. Name the drug used in this condition
Acyclovir, femcyclovir
21) Tinea pedis
Name 2 topical preparation effective in this condition
Meconozole, ketoconazole
22) Oral candidiasis
a. Mention a drug causing this: Corticosteroid inhalation, Beclomathasone
b. Mention a drug used : Cotrimoxazole
23) Cotrimoxazole
a. Mention 1 formulation & its indication
Cream: used in tinea pedis
24) Ketoconazole
Mention one indication other than fungal infection
Cushing disease, Kalaazar, polycystic ovarian disease, prostatic Ca.
25) Strongyloides
Name the DOC, dose & duration.
· Ivermectin, single dose 200 mg/ Kg
· Thibendazole 25 mg/ Kg, given after meals, BD for 3 days
Ivermectin is preferred due to less toxicity, high efficacy
26) Tape worm
a. Name 2 drugs used in tape worm infestation
Praziquentol, niclosamide
b. Which drug is preferred in neurocysticercosis?
Albendazole 15 mg /Kg in 2 divided dose, 8-28 days
27) Diethyl carbamazine (DEC)
a. Write 1 indication other than filariasis
Tropical eosinophilia.
b. Why chlorpheniramine in combine eith this drug?
Antihistaminics reduce allergic manifestation during treatment.
28) Hydatid cyst
Name the DOC. Write dose & duration.
Albendazole 800 mg daily in 2 divided doses with meals for 3 months and continue upto 6 months.
29) Filariasis
Mention the dose & duration of therapy
2 mg/kg, TID, after meals for 3 weeks. Require multiple course.
30) Scabies
Name 2 scabicidal drugs
· Permethrine 5% cream (Les CNS toxicity)
· g- benzene hexachloride: Lindane
· Benzyl benzoate 20-35%
31) Hook worm
Name DOC. Write dose & duration
· Albendazole 400 mg OD once
· Mebendazole 100 mg BD for 3 days
· Parenteral pamoate 10 mg base/ Kg once (Not useful in Trichura)
32) Round worm
Mention 2 drugs used in this infestation, dose & duration.
· Albendazole 400 mg OD once
· Mebendazole 100 mg BD for 3 days
· Parenteral Pamoate 10 mg base/ Kg once
33) Maculopapular rashes
Which b lactam causes this? Mention the other common A/E with this drug?
Ampicillin, bacampicillin, Amoxycillin
A/E: Diarrhoea, secondary infection, pseudomonas colitis
34) Fixed drug eruption
Name two drugs causing this
Sulfonamides, barbiturates
35) Spina bifida
Which drug causes this? How will you reduce the incidence?
Sod. Valproate, antifolate drugs, corticosteroids
Ø Give Folic acid supplements: 4.5 mg daily 1st
Ø Give Vit K to newborns to prevent bleeding due to deficiency of Vit K dependent clotting factors.