PHARMACOLOGY- 1

REMEMBER ALL QUESTIONS ARE VERY IMPORTANT

RED FOR MOST IMP QUE

BLUE FOR SAME QUE BUT DIFFERENTLY ASKED

+ FOR HOW MANY TIMES IT ASK

GENERAL PHARMACOLOGY

(1) Describe First order and zero order kinetics.[3M] ++

(1.1) Explain first order kinetics of elimination with appropriate examples[3M]

(2) Explain importance of Alkaline diuresis in therapeutics by giving pharmacological basis.[3M]

(3) Explain ways to prolong the action of drug with use pharmacokinetic principles.[3m]

(4) What is Bioavailability? Describe factors affecting bioavailability with giving suitable examples. [5M]
+++

(4.1) Define Bioavailability. Describe in detail various factors affecting bioavailability with appropriate
examples. (1+4)

(4.2) Enumerate factors that affect the bioavailability of a drug. Explain, how pH affects the drug
absorption? [3M]

(5) What is the Log Dose response curve? Describe its advantages. Compare and contrast Competitive vs
Non-competitive antagonism along with diagram. [5M]

(6) Enumerate parenteral routes of drug administration. Enlist the advantages of intravenous route.[3M]
++

(6.1) Enumerate various routes of drug administration, mention its advantages and disadvantages [3M]

(7) Describe various factors modifying drug action with examples of each.[5M]

(8) Explain the concept of placebo with suitable examples.[3M]

(9) What is microsomal enzyme inhibition? Describe consequences of microsomal enzyme inhibition
with examples.[5M]
(10) Explain Various types of drug antagonism based on their mechanism with suitable examples.[5M]
+++++

(10.1) Describe various types of drug antagonism giving appropriate examples. Describe the difference
between Reversible and Irreversible antagonism using a dose response curve diagram. (2+3M)

(10.2) Define drug antagonism and mention various drug-drug interactions occur in various steps of
pharmacokinetics [5M]

(10.3) Discuss drug antagonism. Compare and contrast competitive and non-competitive antagonism.
[5M]

(10.4) List the various types of the following phenomena. Explain how each of them can serve a
beneficial purpose with an example.

i). Pharmacokinetic drug interaction

ii). Drug antagonism [5M]

(11) Describe briefly any three clinical significances of Plasma Protein Binding of drugs.[3M] +++

(12) Give one advantage and one disadvantage of the following routes of administration

i) Rectal ii) Nasal iii) Sublingual. [3M]

(13) Define the following and give clinical relevance of each.

i) Plasma half life ii) Placebo iii) Zero order kinetic [3M]

(13) What is hepatobiliary circulation and what is its clinical significance?[3M]

(14) What is pharmacovigilance? Give classification and one example of each class of Adverse
effects.[5M] ++

(14.1) Pharmacovigilance [3M]

(15) Describe various phases of clinical trials [3M] +++

(16) Pharmacogenomics and its clinical importance [3M]

(17) Explain rationale of FDCs. (1) Adrenaline with lidocaine (ii) levodopa with carbidopa [3M]

(18) Define pharmacodynamics. Explain about GPCR (G-Protein Coupled Receptors) with appropriate
examples [5M]

(19) What is therapeutic index? Explain with the help of example.[3M] ++

(19.2) Define Therapeutic Index and write its clinical significance with help of suitable examples.[3M]
(20) A set of related terms are given below. Differentiate each of them with examples.

i). Zero order and first order kinetics of elimination

ii). Phase I and Phase IV clinical trial [5M]

(21) Explain various categories of drug nomenclature with help of suitable examples.[3M]

(22) Write a short note on acute paracetamol poisoning.[3M]

Autonomic Nervous System

(1) Describe pharmacotherapy of organophosphate poisoning.[3M] +++

(2) Describe dose dependant action of Dopamine. Compare and contrast dopamine vs dobutamine. [3M]
+++

(2.1) Describe mentioning the receptors involved; the three different effects of dopamine at three
different doses.(3M)

(3) Pharmacological basis of Tamsulosin in Benign prostatic hypertrophy. [3M]

(4) Classify sympathomimetic agents. Describe pharmacological actions, adverse effects and therapeutic
uses of Adrenalin. [5M]

(5) Classify anti cholinergic agents. Describe pharmacological actions and adverse effects of Atropine.
Describe therapeutic uses of Atropine substitute. [5M] ++

(6) CASE : MYASTHENIA GRAVIS [10 MARKS] ++++

A 60 year old male patient having complains of muscle weakness, drooping eyelids, difficulty in chewing
food. The symptoms fluctuate in intensity over time. The patient was diagnosed with Myasthenia gravis.

(a) What is Cholinergic crisis? (1 mark). How can you differentiate it from myasthenic crisis? (2 marks)

b) Describe pharmacotherapy of Myasthenia Gravis with pharmacological basis (4 marks)

c) Compare and contrast Neostigmine vs Physostigmine? (2 Marks) Why is neostigmine prefered over
physostigmine in this patient? (1 marks) ++
(6.1) Describe myasthenia gravis with pharmacological basis.[3M]

(7) Name drugs used in glaucoma and explain the pharmacological basis for the use of prostaglandin
analogues in glaucoma.[3M] +++

(7.1) Enumerate various drugs used for the treatment of glaucoma. Discuss pharmacotherapy for angle
closure glaucoma. (1+4)

(7.2) Classify the drugs used in Glaucoma. Explain their mechanism of action and basis of use in
Glaucoma.[5M]

(8) Classify neuromuscular blocking agents. Describe mechanism of action and uses of depolarizing
blockers.[5M] ++++++

(8.1) Classify Neuromuscular blockers. Describe the mechanism of action of non-depolarising agents.
(1+2)

(8.2) Differentiate between non-depolarizing and depolarizing skeletal muscle relaxants.[5M]

(8.3) Explain mechanism of action of peripherally acting skeletal muscle relaxants [3M]

(8.4) Classify neuromuscular blocking agents. Write compare and contrast of depolarizing and non-
depolarizing agents. [3M]

(8.5) Enumerate differences between centrally and peripherally acting muscle relaxants.[3M]

(9) Name beta blockers, describe its uses with pharmacological basis.[5M] ++++

(9.1) Classify B-blockers drugs. Discuss their therapeutic uses with preferred agent. (2+3)

(9.2) Classify ẞ-adrenergic blocker drugs. Describe therapeutic uses and adverse effects of
propranolol.[5M]

(10) CASE: BPH [10 MARK]

A 70-year-male presented with the complaints of weak stream of urine, sense of incomplete bladder
voiding, increased urinary frequency and nocturia. After physical examination and ultrasound, he was
diagnosed to have developed benign hypertrophy of prostate and he was prescribed: Tab. Terazosin 5
mg, one tab daily. He took the medicine as adivised but he felt giddy and faint whenever he stood up.

(a) Classify drug use for Benign prostatic hypertrophy(2mark).

(b) Describe the pharmacological bases of prescribing terazosin to this patient? (3marks)

(c) What is the likely explanation for the fainting attack?(2marks)

(d) What precautions could have avoided the fainting episode?(1 mark)
(e) Which drug should be avoided in this situation?(2marks)

(11) Enumerate adrenergic agents used as nasal decongestant and mention their adverse effects. [5M]
++

(11.1) Nasal Decongestant. [3M]

(12) Give one clinical use of each of the following drugs with pharmacological basis for the use.

(i) Ephedrine (ii) Amphetamine (iii) Oxymetazoline [3M]

(13) What is the role of oxime in OP poisoning? [3M]

(14) Describe the process of synthesis, storage, release and uptake of catecholamine.[5M]

(15) CASE: [10M]

A lady aged 55 years was brought at night to the hospital emergency with severe breathlessness and
wheezing. Chest auscultation revealed marked bronchoconstriction. She was managed with 100% O,
inhalation and nebulized salbutamol + ipratropium bromide. The asthmatic attack was controlled in
about 6 hours. Next day, history taking revealed that she was having mild episodic asthma off and on,
but never had such a severe attack. Day before she had visited an ophthalmologist for visual difficulty
and frontal headache. The intraocular pressure was measured to be 24 and 25 mmHg in right and left
eye respectively. She was prescribed: Timolol 0.5% eye drops in each eye twice a day.

(a) What is the most likely cause for the precipitation of severe attack of asthma?(2)

(b) How could such a complication be avoided?(1)

(c) What are the advantages of topical beta-blockers over miotic?(2)

(d) Pharmacotherapy for angle closure glaucoma.(3)

(e) Name 2 prostaglandin analogue. What is the role of prostaglandin analogue in glaucoma (2)

(16) Classify cholinergic drugs. Mention therapeutic uses of neostigmine in detail.[5M]

(17) Food adulterants [3M]

(18) CASE: OP POSIONING [10M] ++

A 35 years old male farmer presented to emergency department in semiconscious state with laboured
breathing and pinpoint pupil. He also had profuse sweating, lacrimation and salivation. His pulse was
48/min and blood pressure was 90/60 mmHg.

a) Which might be the culprit agent? Name the agents which cause actions seen-as-in above case.(2M)

b) Explain how the agent will cause the above sign and symptoms in the patient. (3M)
c) Write the drug therapy of this patient.(2M)

d) Explain the pharmacological basis for use of the medicines used in therapy.(3M)

(18.2) CASE: OP POISIONING [10M]

A 22-year-old woman is brought to the emergency room after deliberately ingesting a bottle of
organophosphate insecticide. Patient complains of irritation of eye, lacrimation, salivation, sweating,
miosis, blurring of vision, fall in blood pressure, breathlessness, and colic. Patient is diagnosed as a case
of organophosphate poisoning.

a. Mention antidote used in this case with its dosing schedule. (2M)

b. Describe in detail management of organophosphate poisoning.(4M)

c. Why Cholinesterase reactivators are not used in carbamate poisoning?(2M)

d. Mention importance of ageing for phosphorylated enzyme-Acetyl Cholinesterase.(2M)

(19) Explain the rationale for the following.

i). Tropicamide is the preferred mydriatic for fundoscopic examination in adult whereas it is atropine for
children.

ii). Mention drugs for open angle glaucoma, write a brief note on prostaglandin analogues.iii)
Dobutamine is the drug of choice for cardiogenic shock. [5M]

(20) Enumerate various indications of α(alpha) blocker drugs. [3M]

Respiratory System
(1) Classify drugs for asthma and explain pharmacotherapy of status asthmaticus.[5M] ++++

(1.1)Describe pharmacotherapy of status asthmatics with pharmacological basis. [3M]

(2) Compare and contrast Bromhexine vs Dextromethorphan. [3M]

(3) Write a note on antitussive drug or cough suppressant. [3M] ++

(4) Write note on inhaled corticosteroids.[3M]

(5) Enumerate one antitussive, one mucolytic and one expectorant with clinical relevance of each.[3M]
(5.1) Classify drugs for cough.[3M]

(6) Classify Antiasthmatic drugs. Discuss the treatment for an acute attack of Bronchial Asthma. (2+3M)

(7) Name two mucolytic agents. Explain briefly role of mucolytic in treatment of cough.[3M]

(8) CASE: ASTHMA [10M]

A 30-year-old man presents with complaints of episodic breathlessness, often following exertion. One to
three episodes occur daily and are accompanied by wheezing. Every 2-3 days, he wakes up at night with
breathlessness. The episodes subside on taking 2 puffs of the inhaler prescribed by his family doctor
(salbutamol 100 µg/puff), Lately, the episodes have become more frequent and are limiting his activities
to some extent. Spirometry revealed FEV1 to be 70% of predicted value at baseline, and 88% after 2
puffs of salbutamol (100 µg/puff) inhalation. He is diagnosed to be a case of moderate bronchial asthma.

(a) Enumerate various drug groups useful in bronchial asthma (3M)

(b) Write down various adverse effects of bronchodilators. (3M)

(c) Is this patient receiving adequate treatment for his condition, or some other drug/drugs need to be
used? What should be the first line treatment for this patient? (4M)

(9)(a) Name the drug which has bronchodilator as well as anti-inflammatory effect on the bronchus.
What is the role of this drug in the management of bronchial asthma?

(b) What are the concerns in using long-acting beta agonists in bronchial asthma? Are there any
concerns in using short acting beta agonists for bronchial asthma? Explain. [5M]

Autacoids
(1) Classify the drugs used for the Migraine. Discuss the rationale of using triptans in migraine. [5M]
+++++

(1.1) Write a note on prophylaxis of migraine. [3M]

(1.2)Classify the drugs used in treatment of migraine. Discuss the preventive therapy of migraine. [3M]

(1.3) Write pharmacotherapy of migraine.[5M]

(2) Classify the drugs used for gout. Describe mechanism of action, adverse effects and current status of
allopurinol in gout. [5M] +++

(2.1) Pharmacological basis of Allopurinol in Gout. [3M]

(3) Classify NSAIDs. Describe pharmacological actions, adverse effects and therapeutic uses of
Aspirin.[5M] +++

(3.1) Describe pharmacological actions and therapeutic uses of aspirin at different doses.[3M]

(4) Enumerate various drugs acting through H, receptors. Describe the therapeutic uses of the H1
antagonist drugs.[3M]

(5) Enumerate various prostaglandin analogues. Describe briefly four uses with preferred agent for each
use you mention. (1+2)

(6) numerate various Hi - Antihistamins. Write advantages and disadvantages of second generation
antihistamines over first generation. (1+2) +++

(6.1) Compare and contrast: 1st and 2nd generation antihistaminic agents. [3M]

(7) Describe various 5-HT agonists and antagonists with their uses.[5M]

(8) CASE: GOUT [10M] ++

A 34 years old male patient presented with chief complain of sudden onset of severe pain in the right
big toe. His physical examination and laboratory investigation were suggestive of acute gout. He was
prescribed tablet Allopurinol (100 mg) once a day for 1 month and tab. Naproxen (500 mg) twice a day
for 3 days. He returns after 10 days with recurrence of symptoms as severe as the initial episodes. On
further investigation, he mentioned that the pain had a completely subsided initially but had recurred
just the previous night. Answer the following questions

a) Was the approach towards the initial episodes appropriate? Explain.(2)

b) How will you manage this case? (2)

c) Classify the drugs used for treatment of gout. (2)

d) Describe briefly the Pharmacotherapy of Chronic Gout. (4).

(8.1) Describe various drug groups useful in chronic gout.[5M]

(9) Write a note on selective cox-2 inhibitors.[3M] +++

(10) DMARDS [3M]

(11) Write a short note on management of vertigo. [3M]

Central Nervous System
(1) What is diffusional hypoxia and second gas effect? [3M]

(2) Why anti-depressant effect of Selective Serotonin Reuptake Inhibitor (SSRI) is delayed in patients?
[3M] ++++

(2.1) Write a short note on: selective serotonin reuptake inhibitors (SSRI). [3M]

(2.2) Classify antidepressant drugs. Mention therapeutic uses of SSRIs. [5M]

(3) Classify anti-epileptic agents. Describe mechanism of actions, adverse effects of various class of anti-
epileptics. Write pharmacotherapy of status epilepticus.[5M]

(4) Describe pharmacological actions of alcohol and management of alcohol addiction. Write
pharmacotherapy of methanol poisoning with giving pharmacological basis.[5M] ++

(5) Describe pharmacological actions, contraindications and therapeutic uses of Morphine with
pharmacological basis.[5M] +++

(5.1) Explain giving reasons three conditions where Morphine is contraindicated. [3M]

(6) CASE: PARKINSON DISEASE [10 MARK] +++++

A 55 year old Male patient presented with mask like face, tremors, rigidity. Patient's blood pressure is
120/80 mm and heart rate is 70/min. Patient was diagnosed as Parkinson's disease.

a) What are advantages of Levodopa-Carbidopa combination? (2 Marks) What is On-off phenomenon?

(1 mark)

b) Classify anti-parkinsonian drugs. (1 Mark) Describe mechanism of actions and adverse effects of
various class of drugs. (3 marks)

c) Which drugs can produce Parkinsonism as side effect? ( 1 Mark) How will you manage drug induced
Parkinsonism? (2 marks)

(6.1) Describe pharmacological basis of l-dopa +Carbidopa combination for Parkinson's disease. And
short term and long-term adverse drug effects of levodopa. [5M] ++

(6.2) CASE: PARKINSON [10M]

A 50 yr old male patient presented to the medicine outpatient department with tremors at rest in one
hand, difficulty in initiating movements, mask like face, defective posture and gait along with dementia.
After a clinical and central nervous system examination, he was diagnosed with Parkinsons disease. The
clinician prescribes combination of Levodopa (100mg) and Carbidopa (10 mg) orally once daily for 1
month. The patient was asked to visit for follow up after a month. Answer the following questions
related to this case.

a) Explain the rationale for prescribing a fixed dose combination of Levodopa + Carbidoņa Discuss the
consequences of initial as well as prolonged levodopa therapy. (2+2)

b) Classify the drugs prescribed for parkinsonism. (2)

c) What is drug induced parkinsonism? How will you treat it? (2)

d) Mention recent developments in treatment of Parkinsonism. (2)

(6.3) COMT inhibitors and MAO inhibitors in treatment of Parkinson's.[3M]

(7) Describe pre-anesthetic medication with their bases of use.[3M] +++

(9) CASE: EPILEPSY [10MARK] ++++++

A young lady aged 25 years comes for consultation along with her husband for having suffered two
episodes of fits lasting 2-3 min each over the past one week. Just before each seizure, she experienced
flickering in her right arm. Patients were diagnosed with generalized tonic-clonic seizures. There is no
family history of epilepsy.

a) Classify anti-epileptic drugs. [2mark]

b) Write mechanism of action of any one drug which can be used in tonic-clonic seizure.(3mark)

c) Mention drug of choice for above condition. Give justification.(3mark)

d) What adverse drug reactions can occur due to use of chosen drug in above condition (2mark)

(9.1) Enumerate the drugs used for the treatment of epilepsy. Describe mechanism of action and
adverse effect of phenytoin (3+2M)

(9.2) CASE: EPILEPSY

Answer the following questions on the given case scenario.

young lady aged 25 years comes for consultation along with her husband for having suffered two
episodes of fits lasting 2-3 min each over the past one week. Just before each fit, she experienced
flickering in her right arm. Description of the fit given by the husband corresponds to tonic-clonic
seizures. She gave the history of having met a car accident about one year back in which she received
head injury. There is no family history of epilepsy. General physical and neurological examination
revealed no abnormality. Investigations, including EEG and MRI scan of the brain, were ordered.

a) should anti epileptic drugs be started right away or therapy be deayed till finding of the investgation
become availabe or till more fits occur? (1)

b) Which antiepileptic drugs are drug of choice for tonic -clonic seizures?(2)

(c) Mechanism of action of valproic acid.(3)

(d) What is status epilepticus? How it can be treated?(1+3)

(9.3) CASE: EPILEPSY

A young lady aged 25 years comes for consultation along with her husband for having suffered two
episodes of fits lasting 2-3 min each over the past one week. Just before each fit, she experienced
flickering in her right arm. Description of the fit given by the husband corresponds to tonie-clonic
seizures. She gave the history of having met a car accident about one year back in which she received
head injury. There is no family history of epilepsy. General physical and neurological examination
revealed no abnormality. Investigations, including EEG and MRI scan of the brain, were ordered.

(a) Classify antiepileptic according to their mechanism of action. (3M)

(b) Mention various adverse effects of antiepileptic drugs (4M)

(c) In case antiseizure therapy has to be started right away, should a single drug or a combination of
drugs be given? Which drug(s) would be the most appropriate for this patient (3M)

(9.4) CASE: EPILSEY

The parents of a 8 years old male child come to OPD with complains that child stops all sort of activity
and keeps starring some object and also fails to respond to any commands many times in a day. History
and clinical examination suggestive of absence seizure.

a) Classify anti-epileptic agents.(2)

b) Among them which drug you will choose for therapy? Why?(2)

c) Write the mechanisms of action, adverse effects, and interactions of phenytoin and valproic acid.(3+3)

(9.5) CASE: EPILEPSY [10M]

Read the case history and answer the following questions. A female patient, aged 38 is a known epileptic
was on treatment with Tab. Phenytoin for the past 3 yrs. She was taking oral contraceptive pills for the
last 6 months. She did not get her menstrual cycle for the past 2 months. On investigation, her
pregnancy was confirmed.

1. Explain pregnancy despite taking oral contraceptive pills?(2M)

2. Classify antiepileptic drugs. Describe in detail mechanism of action, side effects, drug interactions and
uses of sodium valproate.(5M)

3. Describe drug treatment of status epilepticus.(3M)

(10) Classify antipsychotic drugs. Mention advantages of atypical over typical antipsychotics. [5M]
+++++

(10.1) Typical versus atypical antipsychotic agents.[3M]

(10.2) Discuss in detail: Adverse effects of typical and atypical antipsychotic agents.[3M]

(10.3) Enumerate antipsychotic agents. Describe its adverse effects profile briefly.[3M]

(10.4) Enumerate differences between typical and atypical antipsychotics.[3M]

(11) Compare and contrast barbiturates versus benzodiazepines [3M]

(12) Classify local anesthetics and mention its therapeutic uses [3M] ++

(12.1) Classify local anaesthetic agents. Explain the Pharmacological basis of combining local anaesthetic
agent with adrenaline? [5M]

(14) Mention therapeutic uses of benzodiazepines. [3M]+++

(14.1) Mention the therapeutic uses of Benzodiazepines and management of its over dose? [5M]

(15) Classify opioid agonist and antagonist agents. Discuss use and contraindications of morphine. +++

(15.1) Opioid antagonists [3M]

(15.2) Write a short note on pure opioid antagonist.[3M]

(16) Write a short note on: spinal anaesthesia. [3M]

(17).Explain, why benzodiazepines are more preferred as hypnotic than the barbiturates? Enumerate
the uses of benzodiazepines.[3M]

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