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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5337_Библиотеки_им_академика_М_И_Перельмана.pdf
A. Dextropropoxyphene B. Methadone
C. Buprenorphine D. Butorphanol
4. Fall in blood pressure caused by larger doses of
histamine is blocked by:
A. H1 anti-histaminics alone
B. H2 antagonists alone
C. Combination of H1 and H2 antagonists
D. None of the above
5. Choose an antihistaminic which blocks cardiac K+
channels when given in high doses or along with
drugs that inhibit CYP3A4 isoenzyme:
A. Chlorpheniramine B. Promethazine
C. Astemizole D. Loratadine
6. Gold in rheumatoid arthritis
A. Can cause regression of degenerative lesions of
this disease
B. Can reduce the concentrations of rheumatoid
factor
C. The progression of the disease is not slowed
D. Is used as a first line treatment
7. The following statement about histamine is not
correct:
A. It is the sole mediator of immediate hyper-
sensitivity reaction
B. It plays no role in delayed hypersensitivity
reaction
C. It serves as a neurotransmitter in the brain
D. None
8. A responsible drug which cause direct release
of histamine from mast cells without any
involvement of antigen-antibody reaction is:
A. Aspirin B. Procaine
C. Morphine D. Sulfadiazine
9. The glucocorticoid described as highly potent
anti-inammatory agent is:
A. Methyl prednisolone B. Cortisone
C. Triamcinolone D. Dexamethasone
10. The conventional H1 anti-histaminics possess the
following additional properties except:
A. Local anaesthetic
B. Vasopressor
C. Antiarrhythmic
D. Catecholamine potentiating
11. The capacity of an antihistaminic to produce
sedation depends on the following except:
A. Relative affinity for central versus peripheral
H1 receptors
B. Ability to penetrate the blood–brain barrier
C. Individual susceptibility
D. Ratio of H1:H2 blockade produced by the drug
12. Example of a selective H1 receptor agonist:
A. 4-methyl histamine
B. Impromidine
C. 2-Thiazolyl ethylamine
D. Chlorpheniramine
13. The following is not a feature of second generation
anti-histaminics:
A. No impairment of psychomotor performance
B. High antimotion sickness activity
C. Absence of anticholinergic/anti 5-HT actions
D. Additional mechanisms of antiallergic action
14. While prescribing a rst generation H1 antihistaminic
the patient should be advised to avoid:
A. Driving motor vehicles
B. Consuming processed cheese
C. Strenuous physical exertion
D. All of the above
15. The following second generation anti-histaminic
is not likely to produce ventricular arrhythmias
when administered along with ketoconazole:
A. Mizolastine B. Ebastine
C. Terfenadine D. Astemizole
16. The earliest sign of aspirin toxicity is:
A. Tinnitus B. Metabolic acidosis
C. Reye syndrome D. Respiratory depression
17. Select the antihistaminic which modulates
calcium channels and has prominent labyrinthine
suppressant property:
A. Cyproheptadine B. Cinnarizine
C. Clemastine D. Cetirizine
18. Pentazocine differs from morphine in that:
A. It is inactive by the oral route
B. It does not produce physical dependence
C. It has a lower ceiling of analgesic effect
D. Its action is not blocked by naloxone
19. H1 anti-histaminics are benecial in:
A. All types of allergic disorders
B. Certain type I allergic reactions only
C. Certain type IV allergic reactions only
D. Bronchial asthma
20. The corticosteroid with a longer duration of action is:
A. Cortisone B. Prednisone
C. Betamethasone D. Fludrocortisone
21. Actions of 5-HT2 receptor activation are primarily
mediated by:
A. Increased membrane permeability to Na+ ions
B. Increased formation of cAMP
C. Activation of guanylyl cyclase
D. Generation of inositol trisphosphate and diacyl
glycerols
22. The following serotonergic receptor functions
primarily as an autoreceptor on neurons:
A. 5-HT1A B. 5-HT2A
C. 5-HT3 D. 5-HT4
23. Tachyphylaxis to many actions on repeated
injection is a feature of the following autacoid:
A. Histamine B. 5-Hydroxytryptamine
C. Bradykinin D. Prostaglandin
24. Fexofenadine differs from terfenadine in that:
A. It undergoes high first pass metabolism in liver
B. It is a prodrug
C. It does not block cardiac delayed rectifier K
+
channels
D. It has a high affinity for central H1 receptors
Section 1 Pharmacology
109
25. The smooth muscle stimulating action of 5-HT is
most marked in the:
A. Bronchi B. Intestines
C. Ureter D. Biliary tract
26. Which of the following is an agonist-antagonist
type of opioid analgesic?
A. Pethidine B. Pentazocine
C. Fentanyl D. Buprenorphine
27. Histamine is involved as a mediator in the
following pathological condition:
A. Delayed hypersensitivity reaction
B. Inflammation
C. Carcinoid syndrome
D. Variant angina
28. The ‘amine’ ergot alkaloid differs from ‘amino
acid’ ergot alkaloid in that it has:
A. High oral bioavailability
B. Better CNS penetrability
C. Weaker oxytocic action
D. Strong anti-5-HT action
29. Following 5-HT receptors is a ligand gated ion
channel:
A. 5-HT1A B. 5-HT2A
C. 5-HT3 D. 5-HT4
30. The characteristic feature of the isoenzyme
cyclooxygenase-2 is:
A. Its inhibition is not done by indomethacin
B. It is inducible in nature
C. It produces prostaglandins in gastric mucosa
D. All of the above
31. Choose the ergot alkaloid that is well absorbed
orally, has weak vascular but prominent uterine
stimulant action:
A. Ergometrine B. Ergotamine
C. Dihydroergotamine D. Dihydro-ergotoxine
32. The following H1 antihistaminic has additional
anti 5-HT, anticholinergic, sedative and appetite
stimulating properties:
A. Promethazine B. Terfenadine
C. Cyproheptadine D. Hydroxyzine
33. Select the ergot compound which is primarily used
for dementia:
A. Bromocriptine B. Ergotamine
C. Codergocrine D. Methylsergid
34. Which of the following statements concerning
bradykinin is not true?
A. It is generated by the action of the enzyme
kininase.
B. The substrate for its generation is kininogen, a
plasma globulin.
C. It is inactivated by the loss of its C-terminal
arginine.
D. It is a potent vasodilator.
35. Which of the following eicosanoids is released
from platelets and promotes their aggregation?
Section 1 Pharmacology
36. The non-steroidal anti-inammatory drug which is
110
A. PGI B. TXA2
C. LTB4 D. LTC4
contraindicated in drivers and machine operators is:
A. Phenylbutazone B. Indomethacin
C. Naproxen D. Diclofenac sodium
37. The following is a selective 5-HT1D receptor
agonist:
A. Buspirone B. Ondansetron
C. Sumatriptan D. aMethyl 5-HT
38. Which following glands is not stimulated by
products of the anterior pituitary?
A. The adrenal cortex. B. The pancreas.
C. The thyroid gland. D. All of the above
39. The action of histamine that is not mediated
through H1 receptors is:
A. Release of EDRF from vascular endothelium
resulting in vasodilatation
B. Direct action on vascular smooth muscle
causing vasodilatation
C. Bronchoconstriction
D. Release of catecholamines from adrenal medulla
40. Choose incorrect statements from the following
about glucocorticoids.
A. Cortisol is secreted from the adrenal cortex in
humans.
B. Cushing's syndrome may occur by the excessive
levels of glucocorticoids.
C. Cortisol release is stimulated by ACTH from
the anterior pituitary
D. Drugs such as prednisolone increase the
secretion of ACTH.
41. The second generation H1 anti-histaminics have
the following advantages except:
A. Lack of anticholinergic side effects
B. Lack of alcohol potentiating potential
C. Recipient can drive motor vehicles
D. Good antipruritic action
42. Reverses serious ergot alkaloid-mediated
vasospastic reactions:
A. Nitroglycerin
B. Nitroprusside sodium
C. Both A and B
D. Neither
43. Receptor type mediating urinary retention
associated with rst-generation H1 antagonists:
A. Adrenergic B. Cholinergic
C. Serotonergic D. GABAergic
44. Which action of morphine is incompletely
reversed by naloxone?
A. Analgesia
B. Respiratory depression
C. Sedation
D. Miosis
45. Aspirin is contraindicated in pregnant women
near term because:
A. Labor may be delayed and prolonged
B. Blood loss during delivery may be more
C. Foetus may suffer premature closure of ductus
arteriosus
D. All of the above risks
46. Histamine induced edema results from the action
on _____ receptors.
A. H3 B. H2
C. H1 D. All of the above
47. High anticholinergic property is present in the
following antihistaminic:
A. Diphenhydramine B. Astemizole
C. Cetirizine D. Terfenadine
48. Select the H1 antihistaminic which is used
topically in the nose for allergic rhinitis:
A. Loratadine B. Cetirizine
C. Fexofenadine D. Azelastine
49. The following nonsteroidal anti-inammatory
drug is a relatively selective cycloodygenase-2
inhibitor:
A. Tenoxicam B. Meloxicam
C. Diclofenac sod D. Ketoprofen
50. For a patient of peptic ulcer, the safest non-opioid
analgesic is:
A. Ketorolac B. Diclofenac sodium
C. Paracetamol D. Ibuprofen
51. Which of the following statements is correct about
gold therapy of rheumatoid arthritis?
A. It is indicated only in rapidly progressing
disease, not controlled by nonsteroidal antiinflammatory drugs
B. It is indicated only in severe cases after both
nonsteroidal anti-inflammatory drugs and
corticosteroids have failed
C. When gold therapy is started, non-steroidal anti-
inflammatory drugs should be discontinued
D. Intramuscular gold is the most rapidly acting
drug in severe rheumatoid arthritis
52. Sulfasalazine is used in the following disease(s):
A. Bacillary dysentery B. Ulcerative colitis
C. Rheumatoid arthritis D. Both B and C
53. Benet afforded by certain H1 anti-histaminics
in the following condition is not based on
antagonism of histamine:
A. Dermographism B. Insect bite
C. Common cold D. Seasonal hay fever
54. In a person suffering from hepatic disease, the
dose of pethidine should be:
A. Reduced because it demonstrate idiosyncratic
reaction
B. Reduced due to reduction in clearance
C. Increased because the clearance is increased
D. Increased because patient becomes resistant to
pethidine
55. Kinins play a role in which of the following:
A. Pain B. Asthma
C. Vasodilatation D. All of the above
56. Choose anti-inammatory analgesics has been
cleared for pediatric use:
A. Indomethacin B. Ibuprofen
C. Ketorolac D. Piroxicam
57. Probenecid increases the excretion of:
A. Digoxin B. Furosemide
C. Enalapril D. Amrinone
58. Which of the following is a side effect of NSAID?
A. GI ulceration
B. Blockade of platelet aggregation
C. Renal vasoconstriction
D. All of the above
59. Erythromycin should not be given to a patient
being treated with terfenadine because:
A. Erythromycin induces the metabolism of
terfenadine
B. Dangerous ventricular arrhythmias can occur
C. Terfenadine inhibits metabolism of erythromycin
D. Terfenadine antagonizes the antimicrobial
action of erythromycin
60. Which of the following has minimal antiinammatory action?
A. Piroxicam B. Oxaprozin
C. Enalapril D. Amrinone
61. Which of the following statements about serotonin
is correct?
A. 5-HT1 receptors are found on nerve endings
and are stimulatory.
B. 5-HT2 receptors are found on smooth muscle
and are stimulatory.
C. 5-HT3 receptors are found on smooth muscle
and are inhibitory.
D. Cyproheptadine is a highly selective antagonist
of 5-HT2 receptors.
62. Which of the following is involved in pathobiology
of inammatory process?
A. Cytokines
B. Cell adhesion molecules
C. Phospholipase A2
D. All of the above
63. Histamine exerts the following actions except:
A. Dilatation of large blood vessels
B. Dilatation of small blood vessels
C. Stimulation of isolated guinea pig heart
D. Itching
64. Following is the effect of histamine on small
vessels
A. Outward passage of plasma protein and fluid
into the extracellular spaces
B. Increase in the flow of lymph and its protein
content
C. Formation of edema
D. All of the above
ANSWER KEY
1. D 2. D 3. A 4. C 5. C 6. B 7. A 8. C 9. D 10. B 11. D 12. C 13. B 14. A
15. A 16. A 17. B 18. C 19. B 20. C 21. D 22. A 23. B 24. C 25. B 26. B 27. B 28. A
29. C 30. B 31. A 32. C 33. C 34. A 35. B 36. B 37. C 38. B 39. B 40. D 41. D 42. C
43. B 44. C 45. D 46. C 47. A 48. D 49. B 50. C 51. A 52. C 53. C 54. B 55. D 56. D
57. C 58. D 59. B 60. C 61. B 62. D 63. A 64. D
Section 1 Pharmacology
111
9. Pharmacology of Drug Acting on the Gastrointestinal Tract
Vomiting is a forceful expulsion of gastric content to the
exterior, via oral cavity while nausea is an urge to vomit.
(Flowchart 9.1)
NTS: Nucleus tractus solitarius
CTZ: Chemoreceptor trigger zone
Definition of Antiemetics
These are drugs, used to prevent or suppress vomiting.
(Flowchart 9.2)
a. Diarrhea: It is the passage of stool more than 3 times
a day or when the stool is liquid or semiformed
irrespective of frequency.
b. Dysentery: It is the passage of stool mixed with blood
and mucus
1. Antimicrobials are of no value in diarrhea due to
noninfective causes such as—
a. Irritable bowel syndrome
b. Celiac disease
c. Pancreatic enzyme deficiency
d. Tropical spuro (except with secondary infection)
e. Thyrotoxicosis.
2. Antimicrobials do not benefit when the disease is mild
but are useful in severe disease—
a. Traveler's diarrhea — cotrimoxazole, doxycycline and
erythromycin shorten the duration and total fluid
needed in severe cases.
b. EPEC is less common but causes shigella like invasive
illness —cotrimoxazole, neomycin, colistin, nelidixic
acid, norfloxacin may be used in acute cases and in
infants.
c. Shigella enteritis — nelidixic acid can be used.
3. Antimicrobials are regularly useful in
a. Cholera—P. tetracyclines reduce the stool volume to
nearly half, cotrimoxazole and chloramphenicol are
alternatives.
b. Campylobacter jejuni—P. norfloxacin and other
fluoroquinolones eradicate the organism from the stool
erythromycin and firazolidone are fairly effective.
c. Clostridium difcile— it produces antibiotic associated
pseudomembranous enterocolitis—vancomycin/
metronidazole is an alternative. Offending antibiotic
must be stopped.
d. Diarrhea— It is associated with bacterial growth in blind
loops.
Diverticulitis may be treated with—tetracycline or
metronidazole (Flowchart 9.3).
Constipation
It is difficult to define, because different persons have
different bowel habits, if the bowel frequency is 3 times a
week then, it is considered as constipation.
Flowchart 9.1: Mechanism of vomiting
Flowchart 9.2: Drugs used to prevent vomiting
Section 1 Pharmacology
112
Flowchart 9.3: Treatment of diarrhea
PEPTIC ULCER AND ITS MANAGEMENT
An ulcer is a local defect or excavation of the surface of
an organ or tissue which is produced by the sloughing of
inflammatory necrotic tissue. Ulcers which arise at any
site of the GIT exposed to acid pepsin digestion are called
peptic ulcers.
Peptic ulcer occurs in that part of the gastrointestinal
tract (G.I.T.) which is exposed to gastric acid and pepsin,
i.e. the stomach and duodenum. The etiology of peptic
ulcer is not c lea rly known. It results probably due to an
imbalance between the aggressive (acid, pepsin, bile and
H. pylori) and the defensive (gastric mucus and bicarbonate
secretion, prostaglandins, nitric oxide, high mucosa I blood
flow, innate resistance of the mucosa ( cells) factors.
Drugs Used for the Rx of Peptic Ulcers
Drugs Used
These are drugs that promote evacuation of bowels.
A distinction is sometimes made according to the intensity
of action.
a. Laxative: Milder action, eliminations of soft but formed
stools
b. Purgative: Stronger action resulting in more fluid
evacuation
Many drugs in low doses act as laxative and in larger doses
as purgatives (Flowcharts 9.4 and 9.5).
1. Bulk forming: Dietary fiber—bran, ispaghula,
methylcellulose
2. Stool softener: Decussates (DOSS)
3. Lubricant: Liquid paraffin.
4. Stimulant (contact) purgatives: Phenolphthalein,
bisacodyl, castor oil.
5. Osmotic purgatives: Magnesium salts, lactulose
Flowchart 9.4: Types of laxatives
1. Drugs opposing the development of gastric acidity
a. Antacids — neutralize acid that is already secreted.
b. Antisecretory agents.
1. H2 blockers, i.e. cimetidine, ranitidine, famotidine,
nizatidine
2. Proton pump inhibitors, i.e. omeprazole and
lansoprazole
3. Anticholinergics, i.e. pirenzepine
4. Somatostatin, i.e. octreotide.
2. Drugs enhancing defense mechanism
1. Prostaglandins, i.e. misoprostol
2. Mucus secretion stimulants, i.e. carbenoxolone
3. Anti H. pylori agents, i.e. amoxicillin 500 mg 3 times in
a day with metronidazole 400 mg 3 times in a day for 2
weeks + colloidal bismuth subcitrate 120 mg 4 times in
a day for 2 weeks.
4. Coating agents, i.e. sucralfate (Flowchart 9.6)
Section 1 Pharmacology
113
Flowchart 9.5: Types of purgatives
Antacids
Properties: An ideal antacid should be:
1. Nonabsorbable from GIT
2. Should contain low amount of sodium
3. Should be palatable
4. Should be chief.
Systemic Antacids
Sodium bicarbonate: It is water soluble, acts instantaneously,
but the duration of action is short. It is a potent neutralizer
( 1 g • 12 mEq HCI), pH may rise above 7. However, it has
several demerits:
a. Absorbed systemically: Large doses will induce
alkalosis.
b. Produces CO2 in stomach, distention, discomfort,
belching, risk of ulcer perforation.
c. Acid rebound occurs, but is usually short lasting.
d Increases Na load: May worsen edema and CHF.
Use of sodium bicarbonate is restricted to casual treatment
of heartburn. It provides quick symptomatic relief. Other
uses are to alkalinize urine and to treat acidosis.
Sodium citrate properties similar to sodium bicarbonate;
1 g neutralizes 10 mEq HCI; CO
is not evolved.
2
Nonsystemic Antacids
These are insoluble and poorly absorbed basic compounds;
react in stomach to form the corresponding chloride
salt. The chloride salt again reacts with the intestinal
bicarbonate so that HCO
is not spared for absorption—
3
no acid–base disturbance occurs. However,. small
amounts that arc absorbed have the same alkalinizing
Section 1 Pharmacology
effect as NaHCO
solubility: its aqueous suspension (milk of magnesia) has
114
low concentration of OH ions and thus; low alkalinity.
. Magnesium hydroxide has low water
3
However, it reacts with HCI promptly and is an efficacious
antacid (1 g • 30 mEq HCI).
Mechanism of action: Antacids are weak bases, react
with HCl of stomach to produce salt and water, thus
removing HCl and raising the pH of gastric content and
causing loss of peptic activity. Finally, there is blunting of
aggressive factor.
Al (OH)
+HCl—AlCl3 + H2O
3
Examples: Major antacids are:
1. Aluminum compounds Al(OH)3 ALPO
4
2. Magnesium compound Mg (OH)2, MgCO3, Mg –
trisilicate
3. Calcium compounds Ca (OH)2, CaCO3, Ca3 (PO4)
2
4. Sodium bicarbonate (NaHCO3), Na+-citrate, Na+–
acetate.
Antisecretory Agents
H2 receptors blockers
Cimetidine, ranitidine, famotidine and nizatidine
Mechanism of action: H2 receptors are found in the
parietal cells, uterine muscles and atrial muscles of heart.
Combination of histamine with the H2 receptors in the
stomach leads to secretion of HCl.
Uses
1. They are used against duodenal and gastric ulcer
2. They are also used in reflux esophagitis
3. They may be used to prevent gastroduodenal bleeding
in some stressful condition like burns trauma or renal
failure
4. Prophylactically, they may be used in subjects receiving
NSAIDs
5. They are also used in preanesthetic medication to
prevent GER aspiration into the lungs.
Proton pump inhibitors
1. Omeprazole
2. Lansoprazole.
Mechanism of action: H+ produced from HOH is pumped
into the canaliculus within the parietal cells by H+– K+
ATPase which is also called the proton pump. Inhibition
of H+ – K+ ATPase, therefore, would result in no pumping
of H+ into the canaliculus no HCl will be formed. Thus a
complete inhibition of proton pump must inhibit all HCl
formation.
Uses: Clinically omeprazole can be used in:
1. Peptic ulcer, where H2 blockers have failed
2. GER
3. Zollinger-Ellison syndrome
4. MED (multiple endocrine diseases).
Flowchart 9.6: Drugs used to treat peptic ulcer
EMETICS
These arc drugs used 10 evoke vomiting.
1. ACT on CTZ Apomorphine
2. Act reflexly and on CTZ ipecacuanha
Vomiting needs to be induced only when an undesirable
substance (poison) has been ingested. Powdered mustard
suspension or strong sails solution may be used in
emergency. They act reflexly by irritating the stomach.
Apomorphine is a semisynthetic derivative of morphine;
act; as a dopaminergic agonist on the CTZ injected I.M./S.C.
in a dose of 6 mg. It promptly (within 5 min) induces
vomiting. It should not be used if respiration is depressed,
because it has inherent respiratory and CNS depressant act
ions. Apomorphine has a therapeutic effect in parkinsonism,
but is not used due to side effects (Flowchart 9.7).
Flowchart 9.7 Type of antiemetics
Section 1 Pharmacology
115
QUICK REVISION
PHARMACOLOGY OF DRUG ACTING ON THE
GASTROINTESTINAL TRACT
Drugs for peptic ulcer–it results due to imbalance between
the aggressive (acid pepsin and H. pylori) and defensive
factor (gastric mucus and HCO
1. Reduction of gastric acid secretion
a. H2 antihistamine: Cimetidine, ranitidine, famotidine.
b. Proton pump inhibitor: Omeprazole, pantoprazole,
rabeprazole.
c. Anticholinergic: Pirenzepine, propretheline.
d. PG analogues: Misoprostol, emprostile, rioprostile.
2. Neutralization of gastric acid (antacids): Sodium
bicarbonate, sodium citrate, magnesium hydroxide
magnesium trisilicate
3. Ulcer protective: Colloidal bismuth sulphate sucralfate
4. Ulcer healing drugs: Carbenoxolone sodium
5. Anti H. pylori drugs: Amoxicillin, metronidazole,
tinidazole, tetracycline
Use:
1. Duodenal ulcer—limited in 400 mg BD at bedtime
suppressive of a nocturnal secretion at high bedtime
doors in efficacious continuation lead to a chloride Ria
CHK is considered undesirable promotes colonisation
of stomach overgrowth of nitroso bacteria main
predispose.
2. Gastric ulcer—healing rate is somewhat lower
3. GERD
4. Stress ulcer and gastritis—stressful condition, comma
hepatic, severe burn and croma prolonged surgery, renal
failure, asphyxia
5. Zollinger-Ellison syndrome—it is a gastric secretory
state due to rear tumor secreting
6. Profile axis of aspiration pneumonia given free operative
Li decrease the risk of aspiration of acid gastric control
during anaesthesia and surgery
Combination of two or more antacids infrequently
1. Fast magnesium hydroxide and slow aluminium
hydroxide gives better result.
2. Magnesium salt are laxatives and aluminium salt are
constipation
3. Aluminium salt tend to delay gastric emptying and
magnesium salt increase gastric emptying
4. Dose of individual component decreases so systemic
effect decrease
Emetic: By irritating gastric acid:
1. Act on CTZ: Apomorphine
2. Act reflex: Ipecacuanha.
It is needed in poison ingestion.
Powder mustard or strong salt solution may be used in
emergency
Contraindications of emetics
Alkali or acid poisoning—risk of perforation
CNS stimulant drug poisoning
Section 1 Pharmacology
Kerosene poisoning— chances of aspiration of the liquid
116
due to low viscosity and chemical pneumonia are high
Unconscious patient
secretion) classification
3
Antiemetics
Classification:
1. Anticholinergic—Hyoscine dicyclomine
2. H1 antihistaminics—Promethazine, diphenhydramine
3. Prokinetics: Metoclopramide, Domperidone, Cisapride
4. 5HT3 antagonist: (It controls postoperative nausea and
vomiting), ondansetron
5. 5- adjuvant antiemetic: Dexamethasone benzodiazepine
Use:
1. Antiemetic: Used as a postoperative drug specially
migraine less effective in motion
2. Gastrokinetic: To accelerate gastric emptying
z
When emergency GA has to be given and patient has
been taken food in less than 4 hours before
z
To facilitate duodenal intubation
3. Dyspepsia: Pantoprazole, domperidone is given
4. Gastro-oesophageal reflux disease
Treatment
Antacid
Sodium alginate forms frothy layer non-gastric content
and prevents contact
Metoclopramide increases lower oesophageal sphincter
tone and facilitates emptying and improve oesophageal
clearing
H2 blocker decreases the acid formation
Omeprazole, lansoprazole decrease acid formation
Carminatives: It promote compulsions of gases for example
sodium bicarbonate, oil of peppermint and oil of Dill and
charcoal (absorb gases)
Digestant
These are substances intended to the promote digestion
of food.
1. Pepsin
2. Papain
3. Pancreatin
Gallstone dissolving drugs
Chenodiol—it inhibits cholesterol synthesis in liver.
Ursodiol—it inhibits intestinal cholesterol absorption
Laxatives
Aperients—purgatives cathartics
Laxatives—Milder action, elimination of soft but formed
stools purgative or cathartic: Stronger action resulting in
more fluid evacuation.
Classification
1. Bulk forming—ispaghula. Methycellulose (use in
simple constipation and when straining at stool has to
be avoided
2. Stool softener—docusates (doss)
(useful in increasing absorption of non-absorbable
drugs)
3. Lubricant—liquid paraffin (it is a viscous liquid. a
mixture of Petroleum HC.)
4. Stimulant purgative—bisacodyl (also used as a
suppository).
5. Osmotic purgative—lactulose, glycerol, mannitol
(used to prepare bowel before surgery, food
poisoning)
Use:
1. Functional constipation: Of inadequate diet lake of
exercise and atonic intestine.
2. Bedridden patient: MI, stroke, fracture.
3. To avoid straining at stool.
4. Preparation of bowel for surgery
5. Food or drug poisoning.
The disadvantage of liquid paraffin:
Very unpleasant
To swallow.
MULTIPLE CHOICE QUESTIONS
Small amount passes into intestine mucosa, it is carried
into lymph produce foreign body granuloma in intestine
submucosa lymph node and liver
While swallowing it may tickle into lungs and cause
lipoid pneumonia
Chronic use of it cause deficiency of fat-soluble vitamin
as it gets eliminate into the stool
Many interfere with healing in the anogenital region.
During aspiration liquid paraffin cause liquid pneumonia
During chronic use deficiency of fat-soluble vitamin
1. Cause of chronic gastritis and peptic ulcer is:
A. Campylobacter jejuni
B.
Escherichia coli
C. Helicobacter pylori
D. Giardia lamblia
2. Alcoholic patients should not be given:
A. Metronidazole B. Emetine
C. Niridazole D. All of these
3. In Helicobacter pylori infection following drug
combination is preferred:
A.
Only proton pump inhibitor
B. Proton pump inhibitor and sucralfate
C. Proton pump inhibitor, amoxicillin and
metronidazole
D.
All of the above
4. In peptic ulcer treatment how prostaglandins E
acts:
A.
Inhibit proton pump
B. H2 receptor antagonist
C. Antacid
D. Inhibition of acid secretion and stimulation of
mucus and bicarbonate secretion
5. Peptic ulcer occurs because of:
A. Gastric mucosa with Helicobacter pylori infection
B.
Imbalance between the mucosal-damaging and
mucosal-protecting agents
C.
Both A and B
D. None
6. Lansoprazole used in peptic ulcer which act as
…………………………
A.
Histamine H2 receptor antagonist
B. Proton pump inhibitor
C. Antacid
D. Inhibit gastrin secretion
7. Simethicone is used:
A. As antacid
B. To increase the viscosity and adherence to
mucous to the oesophageal mucosa
C.
Both A and B
D. None
8. Famotidine acts as:
A. H2-histamine antagonist
B. H1-histamine antagonist
C. Proton pump inhibitor
D. H1 agonist
9. Mechanism of action of ondansetron is:
A. Muscarinic receptor antagonist
B. Histamine H2 receptor antagonist
Histamine H1 receptor antagonist
C.
5HT3 receptor antagonist
D.
10. One of the following is not H1 receptor antagonist
which is used as an anti-emetic agent
Meclizine B. Promethazine
A.
C. Prochlorperazine D. Cinnarazine
11. Lactulose is a:
2
A. Purgative agent
B. Anti-diarrhea agent
C. Antispasmodic agent
D. Antacid
12. Following are the agents that decrease motility of
the stomach except:
Loperamide B. Diphenoxylate
A.
C. Atropine D. Cisapride
13. An example of stimulant purgative is:
A. Ispaghula husk B. Cisapride
C. Senna D. Lactulose
14. Lactulose is a:
A. Osmotic laxative
B. Bulk laxative
C. Faecal softener
D. Stimulant purgative
15. Magnesium aluminium silicate is used as:
A. Oral rehydration salt
B. Absorbent
C. Antimotility agent
D. Anti-emetic agent
16. Which laxative should not be used to treat acute
constipation because of its slow onset of action?
Glycerin B. Bisacodyl suppository
A.
C. Psyllium D. Milk of magnesia
Section 1 Pharmacology
117
17. A peptide that causes increased capillary
permeability and edema is:
Angiotensin II B. Bradykinin
A.
C. Captopril D. Histamine
18. Losartan A vasodilator that can be inactivated by
proteolytic enzymes is:
Angiotensin I
A.
B. Isoproterenol
C. Neuropeptide Y
D. Vasoactive intestinal peptide
19. Which of the following is the most potent
vasodilator discovered to date and is found in high
concentration in the thyroid?
Angiotensin I
A.
B. Angiotensin II
C. Atrial natriuretic peptide
D. Calcitonin gene-related peptide
20. Cardiac arrhythmias have occurred when this drug
was used by patients taking the gastrointestinal
promotility agent Cisapride:
Amphotericin B B. Clotrimazole
A.
C. Griseofulvin D. Ketoconazole
21. Metronidazole is least likely to be effective in the
treatment of:
Amebiasis
A.
B. Giardiasis
C. Pneumocystosis
D. Pseudomembranous
22. Which of the following statements about non-drug
therapies for acute diarrhea is not correct?
Breast feeding should be continued as normal
A.
B. Even if the patient is not vomiting, food should
be withheld for 6–12 hours
C. Fluids can be given to patients who experience
vomiting, but small amounts of fluid should be
used.
D. Replacement fluids mainly consist of water,
sugar, potassium, sodium and bicarbonates
23. A 2-year-old child was brought to the emergency
room 1 hour after ingestion of tablets he had managed
to obtain from a bottle on top of the refrigerator.
His symptoms included marked gastrointestinal
distress, vomiting (with hematemesis), and
epigastric pain. Metabolic acidosis and leukocytosis
were also present. This patient is most likely to have
ingested tablets containing
Iron B. Acetaminophen
A.
C. Aspirin D. Diphenhydramine
24 . A patient who must take verapamil for hypertension
and angina has become severely constipated.
Which of the following drugs would be most
suitable as a cathartic?
Aluminium hydroxide
Section 1 Pharmacology
118
A.
B. Diphenoxylate
C. Magnesium hydroxide
D. Mineral oil
25. A drug associated with the long QT syndrome and
cardiac arrhythmias is:
Aluminium hydroxide
A.
B. Cisapride
C. Loperamide
D. Metronidazole
26. Alginate is used:
A. As antacid
B. To increase the viscosity and adherence to
mucous to the oseophageal mucosa
C. To relieve bloating and flatulence
D. Both B and C
27. Cyclizine used as an antiemetic agent act through
A. Histamine H1 receptor antagonist
Histamine H2 receptor antagonist
B.
C. Muscarinic receptor antagonist
D. Dopamine D2 receptor antagonist
28. One of the following acts as an antiemetic agent
to antagonize the D2 receptor:
Metoclopramide B. Ondansetron
A.
C. Nabilone D. Cyclizine
29. On your way to an examination you experience
that vulnerable feeling that an attack of diarrhea is
imminent. If you stopped at a drugstore, you could
buy this antidiarrheal drug without a prescription
even though it is related chemically to the strong
opioid – analgesic meperidine:
Aluminium hydroxide
A.
B. Loperamide
C. Magnesium hydroxide
D. Metoclopramide
30. This antibiotic is not appropriate for use as an oral
agent in the treatment of recurrent peptic ulcer
associated with Helicobacter pylori:
Clarithromycin B. Metronidazole
A.
C. Tetracycline D. Vancomycin
31. Which one of the following drugs has resulted
in severe hematotoxicity when administered to a
patient being treated with azathioprine?
Allopurinol B. Cholestyramine
A.
C. Digoxin D. Lithium
32. Which one of the following antibodies has the
longest half-life?
Black widow spider antivenin
A.
B. Botulinum antitoxin
C. Diphtheria antitoxin
D. Hepatitis B immune globulin
33. Dietary supplementation with DHEA is best
documented to have therapeutic value in the
treatment of:
Acne
A.
B. Diabetes insipidus
C. Postmenopausal osteoporosis
D. Systemic lupus erythematosus