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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5579_Библиотеки_им_академика_М_И_Перельмана.pdf
A. Dihydropteridine pyrophosphokinase
B. Hypoxanthine–guanine
phosphoribosyltransferase
C. Lanosterol demethylase
D. Purine nucleoside phosphotransferase
57. Which of the following antimalarial drugs causes
a dose–dependent toxic state that includes ushed
and sweaty skin, dizziness, nausea, diarrhea,
tinnitus, blurred vision, and impaired hearing?
A. Amodiaquine B. Primaquine
C. Pyrimethamine D. Quinine
58. An example of a cytokine is:
A. Interleukin B. Insulin
C. Gonadotropin D. Thyroxine
59. The following helminthic disease can be treated
by albendazole but not by space mebendazole:
A. Hookworm infestation
B. Threadworm infestation
C. Trichuriasis
D. Neurocysticercosis
60. This drug is the antimalarial agent most commonly
associated with causing an acute hemolytic
reaction in patients with glucose-6-phosphate
dehydrogenase deciency.
A. Chloroquine B. Clindamycin
C. Mefloquine D. Primaquine
61. Which type of cell does not contain double
standard deoxyribonucleic acid (DNA)?
A. Human cells B. Bacteria cells
C. (HIV) cells D. All of the above
62. This drug can clear trypanosomes from the blood
and lymph nodes and is active in the late CNS
stages of African sleeping sickness.
A. Emetine B. Melarsoprol
C. Nifurtimox D. Pentamidine
63. Chemical interactions between this drug and cell
membrane components can result in the formation
of pores lined by hydrophilic groups present in
the drug molecule.
A. Dactinomycin B. Griseofulvin
C. Fluconazole D. Nystatin
64. Which one of the following statements about the
mechanisms of action of antiviral drugs is least
accurate?
A. The initial step in activation of famciclovir in
HSV-infected cells is its phosphorylation by
viral thymidine kinase
B. The reverse transcriptase of HIV is 30–50 times
more sensitive to inhibition by indinavir than
host cell DNA polymerases
C. Ganciclovir inhibits viral DNA polymerase but
does not cause chain termination
D. Increased activity of host cell phosphodiesterases
that degrade tRNA is one of the antiviral actions
of interferons
65. Which one of the following is least likely to
be a mechanism of cancer cell resistance to
antineoplastic drugs?
A.
An increase in drug–metabolizing cytochrome
P450
B. Change in properties of a target enzyme
C. Decreased activity of activating enzymes
D. Increase in DNA repair
66. Which one of the following agents acts at the step
of antigen recognition?
A.
Cyclosporine
B. Cyclophosphamide
C. Methotrexate
D. Rho(D)immune globulin
67. Which of the following drug does not cross blood–
brain barrier?
Sulfonamide B. Thiopentone
A.
C. Penicillin D. None
68. The failure of oral contraceptives is seen with:
A. Ethambutol B. INH
C. Rifampicin D. Pyrazinamide
69. Passive immunization involves:
A. Live immunogens
B. Polysaccharide vaccines
C. Use of antigens
D. Use of preformed antibodies
70. In an acute UTI with alkaline urine and unidentied
organism, the treatment should begin with
A. Co-trimoxazole B. Sulphonamide
C. Nitrofurantoin D. Mendallic acid
71. Nitrofurantoin is useful only in urinary tract
infections because:
A. It is rapidly excreted and concentrated in the urine
B. It is rapidly metabolized in the liver which
prevents effective plasma concentration
C. It is effective against common organisms of UTI
e.g. proteins, and E. coli
D. All above reasons
72. The activity of dihydrofolate reductase is inhibited
by:
A.
Sulfasaxazole B. Trimethoprim
C. Sulphadimidine D. Sulfasalazine
73. In a patient with diplopia, dysarthria and trouble
swallowing, the best recommended medicine for
resolving myasthenic crisis is:
A. Neostigmine B. Pilocarpine
C. Pralidoxime D. Succinylcholine
74. An enzyme that cleaves deoxyribonucleic acid
(DNA) at a specic site is called:
Restrictive endonuclease
A.
B. Restrictive ribonuclease
C. Trypsin
D. None of the above
Section 1 Pharmacology
99
75. Which one of the following peptides is not a
vasodilator?
A.
Atrial natriuretic factor (ANF)
B. Calcitonin gene-related peptide
C. Endothelin
D. Substance P
76. A young female patient using an oral contraceptive
is to be treated for pulmonary tuberculosis.
She is advised to use an additional method of
contraception since the efcacy of the oral agents is
commonly decreased if her drug regimen includes:
A.
Amikacin B. Ethambutol
C. Pyrazinamide D. Rifampin
77. Which enzyme is used by the human
immunodeciency virus (HIV) to form
deoxyribonucleic acid (DNA) in the host cell?
A.
Restrictive endonuclease
B. DNA-directed polymerase
C. Reverse transcriptase
D. None of the above
78. Gamma immunoglobulin is considered:
A.
Deoxyribonucleic acid (DNA)
B. Ribonucleic acid (RNA)
C. Protein
D. None of the above
79. Which of the following is incorrect?
A. Mesna is given in acrolein toxicity
B. Folic acid is used to treat Mtx toxicity
C. Cyclophosphamide also used
immunosuppressant
D. None of the above
80. Which one of the following drugs is most likely to
be effective in the treatment of gonorrhea in this
patient and safe to use?
A.
Amoxicillin - clavulanate
B. Clarithromycin
C. Ofloxacin
D. Tetracycline
81. Select the antimicrobial drug which is used
orally only for urinary tract infection for bacterial
diarrhea’s
A.
Pefloxacin B. Azithromycin
C. Bacampicillin D. Nalidixic acid
82. Which of the following statement is incorrect?
A. Ketoconazole has androgenic adverse effect
B. Clotrimazole is effective in ring worm infection
C. Terbinafine is a competitive inhibitor of
squalene epoxiadase
D. Voriconazole-QTc prolongation
83. Which one of the following anticancer drugs
acts in the M-phase of the cell cycle to prevent
disassembly of the mitotic spindle?
A.
Section 1 Pharmacology
84. Colchicine has been used to treatment acute
100
Dactinomycin B. Etoposide
C. Paclitaxel D. Procarbazine
gout, however it is known to produce severe
gustrointestinal problem. As a result authorities
believe that the best treatment of acute gout is:
A.
Acetaminophen B. Aspirin
C. Indomethacin D. Methotrexate
85. All of the following chemotherapy agents can be
administered intrathecally except:
A.
Vincristine B. Methotrexate
C. Cytrabine D. Hydrocortisone
86. Which of the following patients complaining
of vaginal yeast infection symptoms should be
referred to a physician?
A.
If there is a history of recurrent vaginal yeast
infection
B. If she is pregnant
C. If she is less than age 12
D. All of the above
87. Hematological testing of a patient with acquired
immune deciency syndrome(AIDS) is most likely
to show which of the following abnormalities?
A.
Basophilia B. Eosinophilia
C. Lymphopenia D. Reticulocytosis
88. Which of the following compounds is a
good substrate for hypoxanthine–guanine
phosphoribosyltransferase in trypanosomes (but
not mammals) and is eventually converted into
metabolites that are incorporated into RNA?
A.
Allopurinol
B. Alpha-difluoromethylornithine
C. Glycerol
D. Mebendazole
89. Which of the following chemotherapeutic agents
is classied as an alkylating agent?
A.
Cyclophosphamide
B. Etoposide
C. Paclitaxel
D. Cyclophosphamide and mechlorethamine
90. Which one of the following agents is able to
suppress both B and T lymphocytes via its
inhibition of de novo synthesis of purines?
A.
Cyclophosphamide
B. Methotrexate
C. Mycophenolate mofetil
D. Prednisone
91. Which of the following chemotherapy agents acts
by intercalation?
A.
Vincristine
B. Paclitaxel
C. Doxorubicin
D. Vincristine and paclitaxel
92. An important therapeutic or toxic effect of loop
diuretics is:
A.
Decreased blood volume
B. Decreased heart rate
C. Increased serum sodium
D. Increased total body potassium
93. Metronidazole is the drug of choice in the
treatment of:
A.
Giardiasis
B. Trichomoniasis in female
C. Infection with Bacteroides fragilis
D. All of the above
94. Procarbazine (Matulane) is used primarily to treat:
A.
Ovarian carcinoma B. Psoriasis
C. Breast carcinoma D. Hodgkin’s disease
95. Which of the following drugs is most likely to cause
additive anemia and neutropenia if administered
to an AIDS patient taking zidovudine?
A.
Acyclovir B. Amantadine
C. Ganciclovir D. Pentamidine
96. The following drugs interfere with the synthesis
of cell wall except:
A.
Bacitracin B. Vancomycin
C. Colistin D. Cycloserine
97. Which one is correct for phase specic
chemotherapeutic agents?
A.
Are most effective in one phase of the cell cycle
B. Effective in all phases of the cell cycle
C. Effective in G1 phase
D. Include the antitumor antibiotics
98. One of the following drugs is useful in the
treatment of pulmonary tuberculosis:
A.
Carbenicillin B. Cephalosporin
C. Rifampicin D. Pyrazinamide
99. Which of the following is contraindicated in the
presence of active tuberculosis?
A.
Hydrocortisone B. Streptomycin
C. INH D. PAS
100. A drug that is very effective in the treatment of
tinea versicolor is:
A.
Undecylenic acid B. Clotrimazole
C. Acrisorcin D. Penicillin G
101. Which of the following herbs is known to cause
cancer?
A.
Chaparral B. Comfrey
C. Mahuang D. Licorice
102. Which of the following diarrhoeas is consistently
beneted by antimicrobial therapy:
A.
Irritable bowel syndrome
B. Cholera
C. Salmonella diarrhoea
D. Traveller’s diarrhea
103. Which one of the following drugs is recommended
as a single agent for oral treatment of uncomplicated
malaria due to chloroquine-resistant P. falciparum
strains?
A.
Doxycycline B. Primaquine
C. Proguanil D. Quinine
104. The therapeutic effect of sulfasalazine in ulcerative
colitis is exerted by:
A.
Inhibitory action of the unabsorbed drug on the
abnormal colonic flora
B. Breakdown of the drug in colon to release
5-aminosalicylic acid which suppresses
inflammation locally
C. Release of sulfapyridine having antibacterial
property
D. Systemic immunomodulatory action of the drug
105. Choose the correct statement about topotecan:
A. It is a DNA topoisomerase I inhibitor which
causes single strand DNA breaks
B. It is a cell cycle specific anticancer drug
C. It is a COMT-inhibitor used in advanced
parkinsonism
D. Both 'A' and 'B' are correct
106. Which of the following drugs is an antimetabolite
that inhibits a trypanosomal enzyme involved in
putrescine synthesis?
Alpha-difluoromethylornithine
A.
B. Alpha-fluorodeoxyuridine
C. Metronidazole
D. Thiopurinol riboside
107. The characteristic toxicity of doxorubicin is:
A. Kidney damage B. Liver damage
C. Cardiomyopathy D. Pulmonary fibrosis
108. Rifampicin has gained signicance in
antitubercular therapy because:
It is the cheapest and effective drug It is least
A.
toxic, so suitable for chronic use
B. It potentiates the antitubercular effect of other
drugs
C. It has reduced the duration of antitubercular
therapy
109. Nalidixic acid is primarily active against:
Cocci
A.
B. Bacilli
C. Gram-positive bacteria
D. Gram-negative bacteria
110. Which of the following agents used in drug
combination regimens to treat testicular
carcinoma is most likely to cause nephrotoxicity?
Bleomycin B. Cisplatin
A.
C. Etoposide D. Leuprolide
111. The most important reason for using a combination
of chemotherapeutic agents in the treatment of
tuberculosis is:
To obtain bactericidal effect
A.
B. To prevent development of resistance to the
drugs
C. To broaden the spectrum of activity
D. To reduce adverse effects of the drugs
112. The most important dose dependent toxicity of
dapsone is:
Methemoglobinemia
A.
B. Haemolysis
C. Hepatitis
D. Dermatitis
Section 1 Pharmacology
101
113. Multidrug therapy with dapsone, rifampin and
clofazimine is the treatment of choice of
A.
Multibacillary leprosy
B. Paucibacillary leprosy
C. Dapsone resistant leprosy
D. All forms of leprosy
114. Fluconazole differs from ketoconazole in that
A. It is not active by the oral route
B. It is a more potent inhibitor of drug metabolism
C. It is not effective in cryptococcal meningitis
D. It is unlikely to produce anti-androgenic side
effects
115. The antiviral action of amantadine is exerted
through
A.
Interaction with a virus directed thymidine
kinase
B. Interaction with a viral M2 protein
C. Inhibition of a viral protease enzyme
D. Inhibition of viral RNA mediated DNA
synthesis
116. Indicate the drug which attains therapeutic
antibacterial concentration in the urinary tract but
not in other tissues
A.
Sulfasomidine B. Piperacillin
C. Nitrofurantoin D. Both (b) and (c)
117. Select the sulfonamide drug which is active against
pseudomonas and is used by a topical application
for prophylaxis of infection in burn cases
A.
Sulfadiazine B. Silver sulfadiazine
C. Sulfadoxine D. Sulfamethoxazole
118. Chloroquine acts as
A. Preerythrocyticschizontocide for both P.
falciparum and P. vivax
B. Erythrocytic schizontocide for both P. falciparum
and P. vivax
C. Exoerythrocytic schizontocide for P. vivax
D. Gametocidal for P. falciparum
119. Cyclosporine is effective in organ transplantation.
The immunosuppressant action of the drug
appears to be due to:
A.
Activation of natural killer (NK) cells
B. Blockade of tissue responses to inflammatory
mediators
C. Increased catabolism of IgG antibodies
D. Inhibition of the gene transcription of
interleukins
120. Azathioprone:
A.
Binds avidly to a cytoplasmic immunophilin
B. Blocks formation of tetrahydrofolic acid
C. Is a precursor of cytarabine
D. Is markedly hematotoxic and has caused
neoplasms
121. Intravenous injection of quinine produces:
A.
Section 1 Pharmacology
102
Hypoglycaemia
B. Rise in blood pressure
C. Neuromuscular block
D. Hyperglycaemia
122. Yellow pigmentation of the skin is most common
with:
Chloroquine B. Pamaquin
A.
C. Quinacrine D. Atabrine
123. Clavulanic acid is:
Potent inhibitor of cell wall transpeptidase
A.
B. Inactivates bacterial 13-lactamases
C. Specific for Gram-negative organisms
D. None
124. The following is true of quinine
A. It is not to be used for prophylaxis of malaria
B. It has a longer elimination half-life than
chloroquine
C. It is not active against P. vivax
D. It should not be used along with
sulfapyrimethamine
125. Which of the following drugs is suitable for
treatment of malaria during pregnancy?
Quinine B. Chloroquine
A.
C. Pyrimethamine D. Primaquine
126. Tinidazole differs from metronidazole in that
A. It is not active against anaerobic bacteria
B. It has a broader spectrum of activity
C. It has a longer elimination half life
D. It has better oral absorption
127. The drug of choice for kala azar is:
Pentamidine
A.
B. Amphotericin B
C. Sodium stibogluconate
D. Ketoconazole
128. Albendazole is less effective than mebendazole
in the following helminthic infestation:
Hydatid disease B. Trichuriasis
A.
C. Strongyloidosis D. Ascariasis
129. Metronidazole is used for:
Roundworm infestation
A.
B. Hookworm infestation
C. Kala-azar
D. Giardiasis
130. Which of the following is a rst-line drug to treat
tuberculosis?
PAS B. Rifampin
A.
C. Ethionamide D. Cycloserine
131. The most important target of action of chlorambucil
is:
Myeloid tissue B. Lymphoid tissue
A.
C. Neural tissue D. Skin
132. What is true of docetaxel?
A. It is used as a reserve drug for refractory breast
and ovarian cancer
B. It is a selective estrogen receptor modulator
used for breast cancer
C. It is effective only in estrogen receptor positive
breast cancer
D. Both 'B' and 'C' are correct
133. The anti-fungal agent amphotericin B is also active
against:
A.
Anaerobic bacteria B. Giardia lambila
C. Leishmania D. Rickettsiae
134. Which of the following antimalarial drugs is more
active against pre and exoerythrocytic stages of
the malarial parasite than against the erythrocytic
stage?
A.
Chloroguanide B. Primaquine
C. Pyrimethamine D. Quinine
135. Multi-drug resistant (MDR) tuberculosis is
dened as resistance to:
A.
Any two or more antitubercular drugs
B. Isoniazid + any other antitubercular drug
C. Isoniazid + rifampin ± any one or more
antitubercular drugs
D.
All five first line antitubercular drugs
136. The bactericidal drugs act most effectively on:
A.
The toxin liberated by organisms
B. Preventing liberation of toxins from organisms
C. Slowly dividing organisms
D. Rapidly dividing organisms
137. The drug of choice for streptococcal infection is:
A.
Penicillin B. Tetracyclin
C. Erythromycin D. Sulphadiazine
138. Sulphamethizole is principally used for:
A.
Topical application B. Systemic infection
C. Occular infection D. Urinary infection
139. Optic neuritis is a chief adverse effect of:
A.
INH B. Pyrazinamide
C. Rifampicin D. Ethambutol
140. In co-trimoxazole, sulphamethoxazole and
trimethoprim are in ratio of:
A.
2 : 1 B. 1 : 5
C. 5 : 1 D. 1 : 1
141. The less common causative organism in urinary
tract infection is:
A.
Coli B. Pseudomonas
C. Tubercular bacilli D. Proteus
142. Antimicrobial agents primarily administered
topically include:
A.
Bacitracin B. Polymyxin
C. Neomycin D. All of the above
143. The following antineoplastic drug is a mitotic
inhibitor and causes metaphase arrest:
A.
Busulfan B. Vincristine
C. Cytarabine D. Procarbazine
144. Streptomycin inhibits bacterial protein synthesis
by binding to:
A.
DNA
B. mRNA
C. 50s ribosomal subunit of cell ribosomes
D. 30s ribosomal subunit of cell ribosomes
145. Melphalan is the drug of choice in:
Leukemia B. Multiple myeloma
A.
C. Hodgkin’s disease D. Osteosarcoma
146. Bactericidal inhibitor of protein synthesis is:
Erythromycin B. Gentamicin
A.
C. Tetracyclin D. Penicillin-G
147. Which of the following neoplastic diseases is
almost curable by chemotherapy:
Choriocarcinoma
A.
B. Bronchogenic carcinoma
C. Malignant melanoma
D. Colorectal carcinoma
148. Praziquantel is effective against the following
helminth(s):
Taenia saginata
A.
B. Diphyllobothrium latum
C. Schistosomes
D. All of the above
149. Which of the following chemotherapy agents are
correctly paired according to their mechanism of action?
Vincristine and paclitaxel
A.
B. Etoposide and paclitaxel
C. Docetaxel and paclitaxel
D. Docetaxel and etoposide
150. N-acetylcysteine is classied as a (an):
Analgesic B. Antitussive
A.
C. Mucolytic agent D. Antitubercular agent
151. The following anticancer drug has high emetogenic
potential:
Vincristine B. Chlorambucil
A.
6-Mercaptopurine D. Cisplatin
A.
152. The following is true of cancer chemotherapy:
A. Anticancer drugs increase the risk of developing
leukemia’s and lymphomas several years later
B. All anticancer drugs are highly emetogenic
C. Growth fraction of cancers is higher than any
normal tissue of the body
D. All of the above are correct
153. Alkylating agents exert cytotoxic action by
inducing:
Breakage of DNA strand
A.
B. Cross-linking of DNA strands
C. Abnormal pairing of purine and pyrimidine
bases
D. All of the above
154. Methotrexate has the following attributes except:
A. It is cell cycle specific and kills cells in the S
phase
B. Its toxicity primarily affects bone marrow and
epithelial structures
C. Folic acid reverses its toxic effects
D. It is the drug of choice for choriocarcinoma
155. Mechanism of action of cephalosporins involves:
Inhibition of transpeptidase enzymes
A.
B. Inhibition of beta-lactamases
C. Inhibition of peptide synthesis
Section 1 Pharmacology
103
156. Vincristine differs from vinblastine in the
following respect(s):
A. Its prominent adverse effect is neuropathy
B. It frequently produces alopecia
C. It does not significantly depress bone marrow
D. All of the above
157. All of the following statements concerning
sulfonamides are correct except:
A. They are bacteriostatic
B. Inhibit dihydrofolate reductase
C. Crystalluria may occur
D. They are antimetabolites of PABA
158. Anticancer drugs weaken host defense by:
A. Damaging respiratory and gut epithelia
B. Inducing granulocytopenia
C. Altering resident microbial flora
D. Both 'A' and 'B' are correct
159. All of the statements about aminoglycosides are
correct except:
A. Inhibition the bacterial protein synthesis
B. Resistance is usually plasmid-mediated
C. Used for gram-negative infection
D. Antibacterial action occurs through inhibition
of dihydrofolate reductase
160. Sulphonamide-trimethoprim combination
becomes bactericidal because:
A. Sulphonamide inhibits the conversion of folic
acid to folinic acid, and trimethoprim from
PABA to folic acid
B. Sulphonamide prevents conversion of PABA to
folic acid and trimethoprim from folic acid to
folinic acid
C. Trimethoprim increases the free drug
concentration of sulphonamide
D. Sulphonamide increases the free drug
concentration of trimethoprim
161. RBCs are hemolysed by ______ in G6PD deciency.
A. Dapsone B. Clofazimine
C. Streptomycin D. All of the above
162. Vinca alkaloids exert antitumor activity by:
A. Activating topoisomerase II to cause breaks in
DNA strands
B. Crosslinking DNA strands
C. Inhibiting DNA mediated RNA synthesis
D. Inhibiting polymerization of tubulin to form
intracellular microtubules
163. Thioguanine differs from mercaptopurine in that:
A. It is not metabolized by xanthine oxidase
B. It does not cause hyperuricemia
D. Its dose need not be reduced when allopurinol
is given concurrently
D. Both ‘A’ and ‘C’ are correct
164. The following does not apply to cancer chemo-
Section 1 Pharmacology
104
therapy:
A. Each treatment with a cytotoxic drug kills a
constant number of malignant cells
B. Drugs are generally used at maximum tolerated
doses
C. The same regimen which is palliative for a
large solid tumor may be curative after surgical
removal of the tumor
D. Combination regimens using several drugs
in succession are superior to single drug used
continuously
165. Mesna is administered with cyclophosphamide
and ifosphamide to:
A. Potentiate their cytotoxic action
B. Retard their renal excretion
C. Block their emetic action
D. Ameliorate cystitis caused by them
166. Which of the following drug is synergistic with
sulfadoxine against malarial parasites?
A. Chloroquine B. Primaquine
C. Pyrimethamine D. Pentamidine
167. Ethambutol is not used in children below 6 years
of age because
A. Young children are intolerant to ethambutol
B. Ethambutol causes growth retardation in young
children
C. It is difficult to detect ethambutol induced
visual impairment in young children
D. In young children visual toxicity of ethambutol
is irreversible
168. Biological response modiers like GM-CSF are
used in conjunction with anticancer drugs for the
following purpose(s):
A. To enhance antitumour activity of the drug
B. To prevent hypersensitivity reactions to the drug
C. To hasten recovery from drug induced
myelosuppression
D. Both ‘A’ and ‘C’ are correct
169. Methotrexate is an antagonist of:
A. Cobalamine B. Folic acid
C. Riboflavin D. All of the above
170. What is true of thalidomide:
A. It exerts antitumour activity in some solid
malignant tumours
B. It ameliorates cancer associated cachexia
C. It exerts antileprotic action
D. All of the above
171. Select the drug which is used exclusively in organ
transplantation and autoimmune diseases, but not
in cancers:
A. Cyclophosphamide B. Cyclosporine
C. Methotrexate D. 6-Mercaptopurine
172. The betalactam antibiotics are:
A. Penicillin B. Cephalosporin
C. Imipenem D. All of the above
173. In patient with hepatic coma, the choice of
antibiotics is:
A. Chloramphenicol B. Penicillin G
C. Neomycin D. Erythromycin
174. Select the cell cycle nonspecic antineoplastic drug:
A. Vincristine B. Bleomycin
C. Methotrexate D. 5-Fluorouracil
175. Primaquine sensitivity is due to deciency of:
A. Glucose-6-phosphatase
B. Glucose-6-phosphate dehydrogenase
C. Pseudocholinesterases
D. None of the above
176. Which of the following drug inhibits the entry of
virus in the cell?
A. Zioduvadine B. Lopinavir
C. Ritonavir D. Enfuvirtide
177. Which of the following antitubercular drugs is an
inhibitor of protein synthesis with potential for
nephrotoxicity effects?
A. Ethambutol B. Dapsone
C. Streptomycin D. INH
178. Disruption of the purine and pyrimidine bases of
DNA pairing occurs with:
A. 5-fluorouracil B. Methotrexate
C. Cyclophosphamide D. All of the above
179. According to the currect WHO guidelines new
(untreated) sputum smear positive cases of
pulmonary tuberculosis are to be treated with the
following regimen:
A. Isoniazid + rifampin + pyrazinamide for
6 months
B. Isoniazid + thiacetazone + rifampin for
2 months followed by isoniazid + Thiacetazone
for 6 months
C. Isoniazid + rifampin for 6 months with
additional pyrazinamide + ethambutol/
streptomycin during the initial 2 months
D. Isoniazid + rifampin for 6 months with
additional pyrazinamide during the initial
2 months
180. Chloroquine should not be given along with
phenylbutazone because it:
A. Produces blindness
B. Produces hypotension
C. Produces dermatitis
D. All of the above
181. Streptomycin is more effective at:
Acidic pH B. Alkaline pH
A.
C. Neutral pH D. None
182. The side effect of pyrazinamide is:
A. Peripheral neuritis B. Aplastic anaemia
C. Liver dysfunction D. All of the above
183. Which antifungal drug affects DNA?
A. AMB B. Terbinafin
C. Griseofulvin D. Ketoconazol
184. Hormonal agents that are useful in the treatment
of cancer include:
A. Tamoxifen B. Prednisone
C. Flutamide D. All of the above
185. _______________ can be given in renal toxicity.
A. Demeclocycline B. Minocycline
C. Doxycycline D. Tetracycline
186. Ganciclovir is the drug of choice for which of the
following?
A.
Influenza virus B. Cytomegalovirus
C. Poxvirus D. Adenovirus
187. Griseofulvin is indicated in.
A. All types of tinea infection
B. Onychomycosis
C. Pityriasis versicolor
D. Both (B) and (C)
188. Choose the azole antifungal drug which is used
only topically:
A.
Ketoconazole B. Fluconazole
C. Itraconazole D. Econazole
189. Traveller’s diarrhea is treated with:
A.
Sulphadiazine B. Cotrimoxazole
C. Dapsone D. Pyrimethamine
190. The most important target of action of chlorambucil
is:
A Myeloid tissue B Lymphoid tissue
C Neural tissue D Skin
191. Does sulphonamide blocks the synthesis of which
of the following?
A.
PABA B. DFA
C. DHFA D. TFA
192. Patients treated with the following anticancer drug
are likely to develop a disulram like reaction on
taking alcohol:
A.
Dacarbazine B. Procarbazine
C. Melphalan D. Hydroxyurea
193. The following is true about use of prednisolone
in malignant diseases except:
A.
It is effective in acute childhood leukaemia
B. It is used in Hodgkin’s disease
C. It regulates hypercalcaemia in patients with
bony metastasis
D. It provides symptomatic relief in most cancer
patients
194. Which sulfonamide is used topically?
A. Sulphadoxine
B. Sulphamethoxazole
C. Silver sulfamide
D. Dapsone
195. Which of the following is non-steroidal anti-
androgens and useful as an anticancer agent?
A.
Tamoxifen B. Flutamide
C. Etoposide D. Aminoglutethimide
196. Which of the following is a free radical alkylating
drug?
A.
Carmustine B. Thiotepa
C. Procarbazine D. Altretamine
Section 1 Pharmacology
105
ANSWER KEY
1. B 2. C 3. A 4. B 5. D 6. C 7. B 8. A 9. C 10. D 11. B 12. C 13. C 14. A
15. C 16. B 17. D 18. B 19. A 20. B 21. C 22. D 23. B 24. C 25. A 26. B 27. C 28. B
29. D 30. A 31. A 32. D 33. A 34. D 35. C 36. A 37. D 38. C 39. B 40. C 41. B 42. C
43. C 44. A 45. B 46. D 47. D 48. C 49. B 50. A 51. C 52. D 53. C 54. A 55. C 56. B
57. D 58. A 59. D 60. D 61. C 62. B 63. D 64. B 65. A 66. D 67. C 68. C 69. D 70. A
71. D 72. B 73. A 74. A 75. C 76. D 77. C 78. C 79. D 80. C 81. D 82. C 83. C 84. C
85. A 86. D 87. C 88. A 89. D 90. C 91. C 92. A 93. D 94. D 95. C 96. C 97. A 98. D
99. A 100. C 101. B 102. C 103. D 104. B 105. D 106. A 107. C 108. C 109. D 110. B 111. B 112. B
113. D 114. D 115. B 116. C 117. B 118. B 119. D 120. D 121. A 122. D 123. B 124. A 125. B 126. C
127. C 128. B 129. D 130. B 131. B 132. A 133. C 134. B 135. C 136. D 137. A 138. D 139. D 140. C
141. C 142. D 143. B 144. D 145. B 146. B 147. A 148. D 149. C 150. C 151. D 152. A 153. D 154. C
155. A 156. D 157. B 158. D 159. D 160. B 161. A 162. D 163. D 164. A 165. D 166. C 167. C 168. C
169. B 170. B 171. B 172. D 173. C 174. D 175. B 176. D 177. C 178. C 179. C 180. C 181. B 182. C
183. C 184. D 185. C 186. B 187. B 188. D 189. B 190. B 191. C 192. B 193. A 194. C 195. D 196. B
8. Autacoids and Their Antagonists
Substances which are—
i. Secreted by specialized cells
ii. Acts locally
iii. Protects the body from some adverse situations
iv. Degraded quickly are termed autacoids. From Greek,
autos (self ) coid (remedy), i.e. full meaning is 'selfremedy'. Autocoids or local hormone: divided into
3 groups
1. Amine: Histamine, 5hydroxytryptamine (Serotonin)
2. Peptide-Plasma kinin, angiotensin.
3. Lipid derivative: Prostaglandin, Leukotrienes,
Platelet activating factor.
Classifications (Fig. 8.1)
Larger arteries and veins are constructed.
Increased capillary permeability-exudation of Plasma.
Injected intradermally (elicit a triple response)
Red spot: Due to capillary dilation.
Wheel: Due to accumulation of fluid.
Flair: Redness due to arterioles dilation mediated by
axon reflex.
2) Heart
No effect.
3) Smooth muscle
Bronchoconstriction, abdominal cramps and colic.
No effect on the uterus.
1) Glands: Increase in secretion (gastric)- H2.
2) Sensory nerve ending: Itching.
3) Autonomic ganglia: Stimulated adrenal release
increase in blood pressure.
Uses
No therapeutic, only diagnostic
1. Test of acids secreting capacity of stomach.
2. To test bronchial hyperreactivity in asthmatic.
Note: Competitively antagonise actions of histamine at the
H1 receptor.
Receptor–H1, H2, H3.
Pharmacological action
Section 1 Pharmacology
1) Blood vessels
106
Dilation of smaller blood vessels including (capillaries,
arterioles, venules)
Fig. 8.1: Histamine
Antihistaminic
H1 classification
They cross BBB and excretion effects on CNS, particularly
sedation.
First Generation
1. Highly sedative: Diphenhydramine, promethazine.
2. Moderately Sedation: Pheniramine.
3. Mild sedative: Chlorpheniramine, cyclizine.
Second Generation
Non-sedative—antiallergic, cetrizene, loratadine,
astemizole, azelastine.
Antivertigo—cinnarizine.
Uses
1. Motion sickness—cinnarizine.
2. Vertigo
3. Common cold
4. Cough
5. Acute muscle dystonia (cause by antiemetic drug)
6. Allergy
7. Parkinsonism
8. Pruritis
9. Preanesthetic, hypnotic, anxiolytic.
5. Variant angina—released from platelet cause coronary
spasm and variant angina.
6. Reynaud's phenomenon—it triggers acute vasospastic
episodes of large arteries.
7. Hypertension—responsible for pre-eclampsia rise in
blood pressure.
5-HT antagonist
Ergot derivative: Ergotamine, LSD, methylsergid.
a -blocker: Cinnarizine, cyproheptadine.
Migraine
Migraine is a mysterious disorder characterized by
pulsating headache, usually restricted to one side,
lasting for 4–48 hours, associated with nausea, vomiting,
sensitivity to light and sound, vertigo, loose motion.
H2 antagonist
Used in peptic ulcers.
Cimetidine, ramitidine.
5HT/SEROTONIN
Receptors
1) 5-HT1
z
Inhibit neural activity in the brain.
z
Inhibit the release of inflammation neuropeptide in
them. Sumatriptan act through this.
2) 5-HT2
z
Vascular and visceral smooth muscle contraction,
platelet aggregation, neuronal activity in the brain.
z
Ketanserin act through this.
3) 5HT3
z
Cause emesis, gut paralysis, bradycardia, apnoea, pain,
z
Ondansetron act through this.
4) 5-HT4
z
Mediate intestinal secretion
z
Augmentation of peristalsis.
Actions
1) CVS
z
Larger arteries and veins are constricted while
arteriole and venules are elevated.
z
Not involved in the regulation of blood pressure.
2) Smooth muscle
z
Peristalsis
z
Constrict bronchi.
3) Gland
z
Inhibit gastric secretion
z
Increase mucus production (ulcer protective)
4) Respiration—stimulation but larger dose cause apnoea.
5) Platelet—aggregation cause haemostasis.
6) CNS—poorly crosses BBB.
Pathological Role
1. Neurotransmitter—involved in sleep, temperature
regulation, thought, behaviour, vomiting.
2. Neuroendocrine—control release of anterior pituitary
hormone.
3. Nausea and vomiting—especially cause by cytotoxic
drugs.
4. Migraine—initiate vasoconstrictor phase of migraine.
Two types
1. Migraine with aura (classical)
z
Headache is produced by other symptoms.
2. Migraine without aura (common migraine)
z
Pulsatile of large cranial vessel is the cause of pain
construction
Treatment
Mild—simple analgesic/NSAID (antiemetic)
combination.
Moderate—NSAIDS/ergotamine derivative
Severe—ergotamine/sumitriptan +antiemetic+
Prophylaxis
Propranolol/other β-blocker
Amitriptyline/other antidepressant.
Methylsergide
NSAIDS
Analgesics divided into two types
1. Opioids/narcotics/morphine like analogue
2. Non-opioids/non-narcotic/anti-pyretic/aspirin like
analgesics
Classification
A) Analgesic and Anti-Inflammatory
Indole derivative: Indomethacin.
Salicylates: Aspirin.
Sulphonamide: Nimesulide.
Oxicam: Piroxicam.
Anthranilic acid: Mefenamic Acid.
Aryl acetic acid: Diclofenac
Alkanones: Nabumetone.
Pryazolone: Phenyl butazone.
Propionic Acid: Ibuprofen
Pyrrolopyrol: Ketorolac.
B) Analgesic but Poor Anti-inflammatory
Paraaminophenol: Paracetamol
Pyrazolon derivative: Metamizol
Aspirin
Mechanism of action
NSAIDs inhibit: Cox enzyme thus preventing the
synthesis of prostaglandin. PG are mediator of
inflammatory process and bring about an effect like
pain and fever.
Section 1 Pharmacology
107
Pharmacological action
1) Analgesic/antipyretic/anti-inflammatory
z
Weaker analgesic than morphine.
z
It is in effective in severe visceral and ischaemic pain.
z
It acts on hypothalamus and decrease fever by
promoting heat loss (sweating vasodilation) but does
not decrease heat production.
2) Metabolic effects: Increase heat production
3) Respiration: Hyperventilation
4) Acid base and electrolyte balance
5) Urate excretion: Decrease thromboxane A2- responsible
for platelet aggregation.
z
Anti-inflammatory action exerted at high dose 3 to
6 gram per day.
z
Sign of inflammation suppressed pain, tenderness,
swelling.
Adverse effects
1) At analgesic dose (.3–1.5 g/day)
z
Cause nausea vomiting most important adverse effect
is peptic ulcer and gastric mucosal damage.
2) Anti-inflammatory dose (3–6 gram per day)
z
Produce a syndrome called salicylism.
z
Salicylism cause dizziness, tinnitus, vertigo.
z
Reversible impairment of hearing and vision
excitement mental confusion hyperventilation
electrolyte imbalance
z
An association between salicylate therapy and Reye
syndrome (a rare form of hepatic encephalopathy seen
in children having viral infection).
3) Hypersensitivity and idiosyncrasy
z
In frequent but serious.
z
Rashes, urticaria, angioedema, asthma anaphylactic
reaction.
4) Acute salicylate poisoning
z
Common in children.
z
Occurs at more than 50 mg/day.
Treatment
Gastric lavage.
External cooling.
IV fluid electrolyte balance.
Contraindication
Peptic ulcer
Bleeding tenderness
Avoided in diabetes
Hypersensitive patient
Hepatic neurosis
After tooth extraction
Breastfeeding mother
In pregnancy cause prolonged labour, increased
Postpartum blood loss, premature closer of cluster
arteriosus.
Avoided in G-6-PD deficient individual.
Stopped 1 week before effect surgery.
Uses
Analgesic
Antipyretic
Rheumatoid arthritis
Osteoarthritis
Postmyocardial infarction and post-stroke patient.
Other—to delay labour, for closure of Dusty's arteriosus.
Paracetamol/ Acetaminophen
Acute paracetamol—increase poisoning occur in small
children, having low hepatic glucuronide conjugating
ability, decrease 10 grams in adult.
Clinical features
Nausea, vomiting, abdominal pain, liver tenderness, no
impairment of consciousness.
After 12 to 18 hours hepatic necrosis then renal tubular
necrosis, hypoglycaemia, jaundice occurs after 2 days,
hepatic failure and death.
Mechanism of toxicity
N-acetylbezoquinone—immune is a toxic metabolite of
paracetamol which is detoxified by conjugation with
glutathione
If a very large dose taken—glucorination capacity is
saturated.
Treatment
If the patient brought early vomiting should be induced,
gastric lavage should be done, activated charcoal is given
to prevent further absorption.
Antidotes: N-acetyl cysteine—it replenishes the glutathione.
Systemic edema: Increased fluid retention in the interstitial
spaces and cells of the body; can be seen as swelling over
large areas of the body, particularly the lower extremities
systemic venous capacitance:
MULTIPLE CHOICE QUESTIONS
1 Autacoids differ from hormones in that:
A. Autacoids are involved only in the causation of
pathological states
B. Autacoids do not have a specific cell/tissue of
origin
Section 1 Pharmacology
108
C. Autacoids generally act locally at the site of
generation and release
D. Both ‘B’ and ‘C’ are correct
2. Common side effect of rst-generation H1
antagonists:
A. Tachycardia
B. Pulmonary hypertension
C. Cholecystitis
D. Sedation
3. Which of the following opioid analgesics is similar
to codeine in pharmacological prole but is less
constipating?