1

Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

Anesthesia
Propofol is a 1% milky white powder (Emulsion) that is preservative free. Therefore, it
must be used within 6 hours.
-Ketamine is the intravenous anesthetic agent of choice for induction in children.
-Ketamine is dissociative anesthesia,
-Isoflurane is maintained Cardiac output. Hence it is the inhalational agent of choice for
cardiac surgery.
-Isoflurane produces least increase in intra-cranial tension, therefore is the agent of choice
for neurosurgery.
-Halothane is the inhalational agent of choice in bronchial asthma due to its bronchodilator
action.
Two types of bottle are use for inhalation anesthesia
1. Supplying bottle 2. Vaporizing bottle
Both have same color code
DESFLURANE - D B- BLUE
ENFLURANE- E O- ORANGE
SEVOFLURANE- S Y- YELLOW
ISOFLURANE- I P- PURPLE
HALOTHANE- H R- RED
DESI – H – BOY – PR

-Adrenaline (1:100000 &1:200000) is added to Lignocaine to make them long acting.

- 1:200000 Adrenaline is combined with lignocaine for dental surgical procedure
-Lignocaine (lidocaine) is the most commonly used LA and is the drug of choice for
ventricular tachycardia.
-Lignocaine used for Spinal Anaesthesia – 5%Lignocaine in 7.5% dextrose.

-Dose of lignocaine is limited to 7 mg/kg with adrenaline or 4 mg/kg without adrenaline.

 2
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

CNS
-Benzodiazepines (preferably lorazepam) are drug of choice for status epilepticus.
Adverse effect of phenytoin:
H –Hypertrophy of gums (Most common)
Hirsutism
O – Osteomalacia
T – Teratogenicity
M – Megaloblastic anemia
A – Ataxia and nystagmus
L – Lymphadenopathy
I – Inhibits insulin release(hyperglycemia)
K – Vitamin K deficiency
A – Arrhythmias
-Therapeutic Range of Phenytoin – 10–20 μg/ml

> 20 μg/ml - Nystagmus (Earliest sign of Toxicity)

> 30 μg/ml - Slurred speech, Ataxia

- Carbamazepine is drug of choice for partial seizures and trigeminal neuralgia.

Therapeutic plasma concentration of Carbamazepine is 5–10 μg/ml and toxic plasma
concentration of Carbamazepine is > 12 μg/ml
-extrapyramidal symptoms (maximum with haloperidol) whereas it is least common with
thioridazine.
Acute muscular dystonia is the earliest appearing symptom whereas akathisia is the most
common extrapyramidal symptom.
-Malignant neuroleptic syndrome- (due to typical antipsychotic drugs) It presents as
hyperthermia, extreme generalized rigidity, autonomic instability and altered mental status. It
can be treated by i.v. dantrolene (DOC) or bromocriptine.
-Haloperidol and fluphenazine are most potent typical antipsychotic drugs whereas
risperidone is most potent atypical antipsychotic agent. Risk of extrapyramidal adverse
effects is negligible with clozapine, quetiapine and aripiprazole.
 3
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

-Lithium takes 1-2 weeks to exert its maximum effect. It is the drug of choice for the
prophylaxis of bipolar disorder. Its t1/2 is 24 hours.
-Plasma concentration of lithium should be 0.5-0.8 mEq/L for maintenance therapy of
bipolar disorder and 0.8-1.2 mEq/L for acute mania. Toxic symptoms are seen if plasma
concentration exceeds 1.5mEq/L.
-There is no specific antidote for lithium. Dialysis is most effective means of removing Li
from body. It is indicated at serum Li levels of > 4m Eq/L in acute overdose or > 1.5
mEq/L in chronic overdose.
-Morphine is absolutely contraindicated in head injury because it increases intracranial
tension by causing retention of CO2 (due to respiratory depression). It also interferes with the
assessment of neurological function by masking the important pupillary signs (causes
miosis).
-Magnesium sulphate is DOC for treating the convulsions during labour (eclampsia). Its
toxicity is monitored by patellar reflex (knee jerk).
-Serum Concentration (mg/dL) Magnesium sulphate

Serum Manifestation
Concentration
(mg/dL)

Normal concentration
1.5–3
4–6 Therapeutic levels
5–10 Electrocardiogram changes
8–12 Loss of patellar reflex
9–12 Feeling of warmth, flushing
10–12 Somnolence; slurred speech
15–17 Muscle paralysis; respiratory difficulty
30 Cardiac arrest
 4
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

Respiratory
-The only drugs effective for the treatment of acute attack of bronchial asthma are
bronchodilators.
-Theophylline is a potent vasodilator and can cause hypotension which leads to reflex
tachycardia
GIT
-Major role of antacids in peptic ulcer is to provide prompt relief from ulcer pain.
-PPIs are drugs of choice for -Peptic ulcer disease (PUD) due to any etiology (even NSAID
induced).
• Gastroesophageal reflux disease (GERD)
• Zollinger Ellison Syndrome (ZES).
-Hyoscine is used as i.m. injection or transdermal patch (applied behind pinna) for
prophylaxis of motion sickness. It has no role in treatment, once the vomiting starts.
-Combination of doxylamine (antihistaminic) with pyridoxine (Vit B6) in high dose is safest
antiemetic drug in pregnancy
-5 HT3 blockers like ondansetron, granisetron, dolasetron, palonosetron and ramosetron are
DOC for chemotherapy induced vomiting.
-Drugs for Post Operative Vomiting 5 HT3 antagonists are preferred over other drugs.
-indication of Metoclopramide is to enhance gastric emptying for emergency general
anaesthesia (if the patient has taken food within 4 hrs.)

Endocrine
Complications of insulin therapy
-Most common complication is hypoglycemia that can be treated by glucose (oral or i.v.) or
glucagon (i.v.).
-Lipodystrophy at the injection site can occur with conventional preparations and the
chances are less with highly purified and recombinant forms of insulin.
-Allergic reactions like lipoatrophy can occur with conventional preparations.
-Sodium and water retention leading to edema has been rarely reported
 5
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

-Use of non-selective beta blockers in patient on insulin therapy delays the recovery from
hypoglycemia (less chances with cardioselective beta blockers). These drugs may also mask
the warning signs of hypoglycemia i.e. palpitations, tremors and anxiety. All the warning
signs may be masked except sweating.
-Metformin is drug of choice for type 2 diabetes mellitus.
-Dexamethasone suppression test is used to test the intactness of HPA axis function and
diagnosis of Cushing’s syndrome.
-Given during pregnancy, steroids can cause fetal abnormalities and given to young children
for prolonged periods, these may result in growth retardation.
-Steroids are contraindicated in psychosis (due to CNS stimulatory action) and epilepsy (due
to lowering of seizure threshold).

Chemotherapy
-Ototoxicity, Nephrotoxicity, Neuro muscular blocking effect are three major adverse effect
of aminoglycoside antibiotic.
-Prolonged use of high doses of chloroquine can result in blindness due to retinal damage
(Bull’s eye maculopathy
-Qunine or qunindine produce, cinchonism ,hypoglycaemia and hypotension cinchonism
include deafness and visual disturbances, tinnitus , headache , nausea & vomiting.
-Pyridoxine 10 mg/day is routinely given with INH to reduce the risk of peripheral neuritis.
-Rifampicin stain various body fluid such as urine, tear, saliva ,sweat , sputum etc
orange red which is harmless.
-Optic neuritis is the main adverse effect seen with ethambutol
penicillin is DOC for treatment of meningococcal meningitis, it is not indicated for
prophylaxis where rifampicin (or ceftriaxone) is DOC because only rifampicin and 3rd
generation cephalosporins can eliminate nasal carriers.
-Rifampicin is the least toxic antitubercular drug and is also the safest drug in pregnancy
-Rifaximin is a rifampicin derivative indicated for Traveller’s diarrhea (E.coli) and hepatic
encephalopathy
-Clarithromycin or azithromycin is recommended for prophylaxis of Mycobacterium avium
complex (MAC) in patients with CD4 count less than 50μl. Treatment of MAC requires
REC regimen (rifabutin + ethambutol + clarithromycin/azithromycin).
 6
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

-DOC for radical cure of P. vivax malaria is primaquine

-Prolonged use of high doses of chloroquine can result in blindness due to retinal damage
(Bull’s eye maculopathy
-Ivermectin has recently been approved for topical treatment of scabies

Specific toxicity of anticancer drugs

1. Haemorrhagic cystitis with cyclophosphamide. Ameliorated by administering mesna

systemically and acetylcysteine locally.

2. Megaloblastic anaemia with methotrexate: - It is reduce by administration of folinic acid /

leucovorin/citrovorum factor.

3. Nephrotoxicity with cisplatin.Saline infusion and mannitol reduces the incidence of

nephrotoxicity.

4. Neurophothy with vincristine & paclitaxel

5. Pulmonary fibrosis and pigmentation of skin with busulphan and bleomycin.

6. Cardio toxicity with doxorubicin & daunorubicin

-Methotrexate is the drug of choice for the treatment of choriocarcinoma.

Drugs for ANS

-Neostigmine is DOC in -1. Mysthenia gravis 2. Cobra bites 3. Reversal of muscle relaxants
(Nicotinic actions)
-Neostigmine is DOC in- 1.Post operative paralytic ileus 2.Post operative urinary retention
(Muscarinic actions).
-Ameliorative test (Edrophonium test/ Tensilon test): Initially edrophonium 2 mg is
injected i.v. as a test dose.
-Atropine is the specific antidote for OP poisoning.
-Atropine is the drug of choice for early mushroom poisoning.
-Atropine used in pupil dilation in children because it is long acting.
 7
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

-Tropicamide given in adults to dilate pupils because it is short acting.

-Atropine Decrease risk of bradycardia during surgery and, at times, vagal slowing of
the heart due to parasympathetic response to surgical manipulation.
-Adrenaline is the drug of choice for anaphylactic shock. It is given as 0.5 ml of 1:1000
solution (i.e. 0.5 mg) i.m./s.c. injection. Intramuscular route (on Lateral thigh) is
preferred because of variability in absorption from s.c. sites. Intravenous route is avoided
but can be used rarely in much lower concentration (1:10,000).
-Label indication for adrenaline -Do not use this product if it's color is pinkish or
darker than slightly yellow or if it contains a precipitate.

-Dopamine is the drug of choice for cardiogenic shock with oliguric renal failure. It acts on
D1 (at a dose of 1-2 μg/kg/min.), β1 (at 2-10 μg/kg/min.) and α1 (at > 10 μg/kg/min.)
receptors. It causes renal vasodilation by acting on D1 receptors and maintains renal
perfusion and GFR.
NSAIDs
-Alprostadil is used to keep ductus arteriosus patent before surgery whereas NSAIDs like
aspirin and indomethacin are used for treatment of. Patent ductus arteriosus.
-At low doses (40-325 mg), Aspirin acts as an antiplatelet drug and is useful in the
prophylaxis of myocardial infarction and stroke.
- Aspirin is used to inhibit niacin induced flushing (it is PG mediated).
- Salicylates (aspirin) can cause dose dependent effects on acid base balance. Respiratory
alkalosis occurs first characterized by headache, vertigo, tinnitus, vomiting and
hyperventilation (salicylism). Excessive metabolic compensation can result in metabolic
acidosis.
CVS
-Treatment of Acute Heart Failure- It is aimed at decreasing the congestive symptoms with
diuretics (Furosemide) and increasing the contractility with positive ionotropic agents
(dopamine).
- Digoxin is the only inotropic drug available that can be given orally, yellow color tablet
produce yellow vision.
-Digoxin increases the force of contraction (+ inotropic effect) and decreases the heart rate (-
chronotropic). It also decreases the AV conduction.
 8
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

-Therapeutic concentration of digoxin is 0.5–1.4 ng/ml, Toxic concentration of digoxin is .

> 2 ng/ml
- Earliest appearing adverse effect of digitalis is nausea and vomiting.
-For ventricular arrhythmias (digoxin induce), lignocaine is the drug of choice (phenytoin
is an alternative)
- Hypokalemia, hypomagnesemia and hypercalcemia increases the risk of digitalis toxicity.

- Most frequent adverse effect associated with ACE inhibitors is dry cough hence stop the
drug and prefer ARB(losartan).

- labetalol as DOC for hypertension in pregnancy as well as hypertensive emergencies in

pregnancy.

-Nitroglycerine and isosorbide dinitrate sublingually can be used for aborting the acute
attack of angina. Hypotension and headache are most common adverse effect with NTG.

- Amiodarone is longest acting whereas adenosine is shortest acting anti-arrhythmic drug.

- Verapamil is drug of choice for the treatment of supraventricular tachycardia (SVT) and for
the prophylaxis of PSVT.

-Bleeding is the most common adverse effect of all anticoagulants. If a patient develops
bleeding due to overdose of warfarin, fresh frozen plasma (to supply clotting factors) is the
treatment of choice but specific antidote is vitamin K1.

- The major adverse effect of Heparin also is bleeding which is treated with fresh frozen
plasma. Specific antidote of heparin is protamine (highly basic drug that can cause release of
histamine).

-Epsilon amino caproic acid (EACA) and tranexaemic acid are specific antidotes for
overdose of fibrinolytic agents.

- Main indication of Fibrinolytic drugs (streptokinase, alteplase) is treatment of acute

myocardial infarction (Stemi), for which these should be administered i.v. within 12 hours
preferably within first 3-6 hours.
 9
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

Drug of choice for ANS

Condition/Disease/Disorder DOC
Mushroom poisoning Early Atropine
Open angle Glaucoma Latanoprost
Angle closure Glaucoma Acetazolamide
Myasthenia gravis(Diagnosis) Edrophonium
Myasthenia gravis(treatment) Neostigmine/pyridostigmine
Atropine/Belladona/ Dhatura poisoning Physostigmine
Alzhiemer’s dementia Donepezil/Rivastigmine
Organophosphate/Carbamate Atropine
poisoning(Anticholinesterase poisoning)
Refraction testing of eye In adults Tropicamide
Refraction testing of eye In children Atropine
Bradycardia atropine
Atrioventricular block atropine atropine
Drug induced Parkinsonism (EPS) Benzhexol(THP)/benztropine/promethazine
Anaphylactic Shock Adrenaline 1:1000 IM
Attention deficit hyperkinetic disorder Methylphenidate
(ADHD)
Narcolepsy Modafinil/amphetamines
Pheochromocytoma Phenoxybenzamine
Cheese reaction(Tyramine induce) PhentolamineIV
Beta blocker poisoning Glucagon
Benign prostate hyperplasia(BPH) Tamsulosin
Performance anxiety Propanolol
 10
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

Drug of choice for CNS

Condition/Disease/Disorder DOC
Alcohol Withdrawl symptoms (including Benzodiazepines(chlordiazepoxide or
seizures) diazepam)
Methanol poisoning Fomepizole
Insomnia (Mainly in night shift worker) Zolpidem
Benzodiazepine poisoning Flumazenil
Epilepsy/seizure disorders Valproate
Grand mal (GTCS), Petit mal (Absence)
Febrile seizures (children) Diazepam per rectal
Status epilepticus Lorazepam
Eclamptic seizures Magnesium sulphate
Epilepsy in pregnancy Lamotrigine/Topiramate/levetiracetam
Trigeminal neuralgia Carbamazepine
Parkinsonism Pramipexole/Ropinirole
Levo-dopa induced Vomiting Domperidone
Schizophrenia Olanzapine
Acute mania Benzodiazepines/Antipsychotics + lithium
Prophylaxis of mania Lithium
Bipolar disorder Lithium
Depression– Mild to moderate SSRI (Fluoxetine)
Severe Depression SNRI (Venlafaxine
Obsessive compulsive disorderand Post- SSRI (Fluoxetine)
traumatic stress disorder
Attention deficit hyperkinetic disorder Methylphenidate
Severe (cancer) pain Opioids (morpine)
 11
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

Neurolept analgesia Droperidol + fentanyl

Acute Opioid poisoning Naloxone
Opioid poisoning (Maintenance) Naltrexone
Opioid de-addiction substitution therapy Methadone/Buprinorphine

Neurolept malignant syndrome Dantrolene

Drug of choice for GIT and Respiratory

Condition/Disease/Disorder DOC
Peptic ulcer (All types), Zollinger Ellison PPI
syndrome and GERD
Chemotherapy induced vomiting Ondansetron
Post-operative vomiting Ondansetron
Prophylaxis of motion sickness Hyoscine

Pregnancy (Morning sickness) Doxylamine + Pyridoxine

Hepatic encephalopathy Lactulose
Bronchial Asthma( Acute attack) and Salbutamol
Exercise-induced asthma

Drug of choice for CVS

Condition/Disease/Disorder DOC
Angina pectoris( Acute attack) Sublingual nitroglycerine
Myocardial infarction– Pain relief nitroglycerine and Morphine
Sublingual

MI Prophylaxis Aspirin

Thrombolytic for STEMI Reteplase (Streptokinsae)

Hypertension Thiazides
Hypertension In pregnancy Labetalol
 12
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

Hypertensive emergencies Nicardipine + Esmolol

Acute severe digitalis toxicity Digibind
Ventricular tachycardia (Digoxin induce) Lignocaine
Supraventricular tachycardia Beta bloker

Drug of choice for Chemotherapy

Condition/Disease/Disorder DOC
Cholera Tetracycline
Rheumatic fever: Benzathine penicillin
Meningococcal meningitis Rifampicin/Ciprofloxacin/Ceftriaxone
Surgical prophylaxis Cefazolin
Malaria Chloroquine
Otitis media Amoxicillin
Plague Tetracycline
Methicillin resistant (MRSA) Vancomycin
Salmonella typhoid Ceftriaxone
Treponem pallidum (syphilis) Penicillin G
Rickettsia fever Doxycycline
Endocarditis Vancomycin + gentamicin
Pelvic inflammatory Disease (PID) Fluoroquinolone + Metronidazole
Leishmania donovani , Kala-azar Liposomal amphotericin B
Trichomonas vaginalis and Giardia Metronidazole
lamblia
Candida albicans Fluconazole
Mucormycosis (black fungus) AMB
Avian influenza (including bird flu) Oseltamivir
Human immunodeficiency virus (HIV) Zidovudine + Lamivudine + Nevirapine
 13
Pharmacology important revision point for NORCET 2024 by Ajay Kumar Sharma
(8058096490)

-- Treatment
Dracunculus (Guinea worm) Metronidazole
Ovarian cancer Paclitaxel + Carboplatin
Breast cancer Tamoxifen
Choriocarcinoma Methotrexate

DOC for miscellaneous category

Acetaminophen poisoning ACETYLCYSTEINE

Acute gout NSAIDS(indomethacin)
Cyanide toxicity AMYL NITRITE
Diabetes mellitus Insulin
– Type 1
Diabetes mellitus Metformin
Type 2
Pulmonary edema Furosemide
Cerebral edema Mannitol
Nocturnal enuresis Desmopressin
Hypothyroidism and Myxedema coma Levo-thyroxine

Hyperthyroidism Carbimazole or methimazole

Induction of labour Oxytocin
Post partum hemorrhage
Myocardial Infarction- Acute STEMI Thrombolytics (Reteplase)