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f937db62-9446-4155-a085-e42c55c64c6f | A male with insulin-dependent diabetes and having macular edema develops glaucoma. Which drug should be used as the least resort to treat? | Alpha agonist | Prostaglandin analogue | pilagan | Beta blocker | 1b
| single | Ans. B. Prostaglandin analoguesAlthough prostaglandin analogues are the first-line treatment for open angle glaucoma, these should not be given in case a patient with macular edema develops glaucoma. The reason for the same is maculopathy caused by prostaglandin analogues (can cause blurring of vision).Extra Edge: Other drugs causing maculopathy* Niacin* Griseofulvin* Thiazolidinediones* Tamoxifen* Clofazimine, chloroquine (Bulls' eye maculopathy)* PG analoguesDrugs used for treatment of macular degeneration* Monoclonal antibodies: Bevacizumab, Ranibizumab* Photodynamic therapy: Verteporfin* Steroids (Dexamethasone, Prednisolone)* I/V Methotrexate* Pegaptanib: PEGylated oligonucleotide that binds VEGF | Pharmacology | A.N.S. | [
"pilocarpine"
] | 57,533 |
924da240-007f-4b56-bfea-6fbe2c5f4752 | Drug of choice for Trigeminal neuralgia is: | tegretol | Phenobabitone | dilantin | Valproic acid | 0a
| single | Trigeminal and related neuralgias: Carbamazepine is the drug of choice. These neuralgia;. characterized by attacks of high intensity electric shock-like or stabbing pain set off by evening. REF: KD TRIPATHI 8TH ED. | Pharmacology | Central Nervous system | [
"carbamazepine",
"phenytoin"
] | 57,540 |
5dc8c675-2f3f-4065-88ee-b7b5cf17395a | Carbapenem with maximum seizure risk is | doribax | Imipenem | Eapenem | Meropenem | 1b
| single | * Imipenem is a Carbapenem group of Beta-Lactam antibiotic with highest propensity to induce seizures compared to the other Carbapenem congeners. * Seizure is noted in 1.5% patients receiving Imipenen. Seizure risk is increased in patients receiving high doses in the presence of renal insufficiency and CNS lesions. Ref:- Goodman & Gilman Pharmacological Basis of Therapeutics 13th Ed; Pg num:- 1035 | Pharmacology | Chemotherapy | [
"doripenem"
] | 57,544 |
5a3fb07e-9607-44b4-98d6-e9e2046b8ce4 | Which statin is not metabolized by CYP3A4? | mevacor | zocor | lipitor | pravachol | 3d
| single | Pravastatin causes minimum drug interactions, minimum food interactions and minimum risk of myopathy. They also decreases amount of fibrinogen and it is not metabolised by CYP3A4. | Pharmacology | JIPMER 2019 | [
"atorvastatin",
"lovastatin",
"simvastatin",
"pravastatin"
] | 57,558 |
9b2c029d-7c7c-44da-bed0-1e101398a359 | Drug of choice in pain relief in diabetic neuropathy is - | neurontin | Lamotrigene | Pregabalin | Mexiletene | 2c
| single | Arts, is 'c'.i.e., Pregabalin Modalities used to treat painful diabetic neuropathyTreatment of diabetic neuropathyo A management algorithm outlined by a statement published in 2005 from the American Diabetes Association (ADA I recommended treatment in sequential steps ordered as follows:-o Exclude nondiabetic etiologieso Stabilize glycemic control (insulin not always required in type 2 diabetes)o Tricyclic drugs (eg, amitriptyline 25 to 150 mg before bed)o Anticonvulsants (eg, gabapentin, typical dose 1.8 gfday)o Opioid or opioid-like drugs (eg, tramadol or controlled release oxy>codone)o Consider pain clinic referralo The ADA statement noted that nonpharmacologic, topical, or physical therapies might be useful at any stage. These measures include acupuncture, capsaicin, glyceryl trinitrate spray or patches, and other therapies.o The American Academy of Neurology (AAN) performed a systematic review and published guidelines in 2011 for the treatment of painful diabetic neuropathy,o The following observations were made:o Preeabalin was regarded as effective.o A number of treatments were regarded as probably effective.GabapentinSodium valproateAmitriptylineDuloxetineVenlafaxineDextromethorphanMorphine sulphate, titrated Oxycodone, meanTramadolCapsaicinIsosorbide dinitrate sprayPercutaneous electrical nerve stimulation for three to four weeksLidocaine patch was regarded as possibly effective.o Treatments regarded as probably not effective by the AA Y were : -OxcarbazepineLamotrigineLacosamideClonidinePentoxifyllineMexiletine | Medicine | Diabites & Inappropriate Antidiuretic Hormone | [
"gabapentin"
] | 57,561 |
01f15712-2397-4af9-bf30-05be94a0c17a | Drug which decreases efficacy of testosterone | nydrazid | extina | Rifampicin | None | 1b
| multi | Ans. is 'b' i.e., Ketoconazole | Pharmacology | null | [
"isoniazid",
"ketoconazole"
] | 57,580 |
43506087-b929-4d04-b5b7-a1f2a561dc6d | diflucan differs from extina in that: | It is not active by the oral route | It is a more potent inhibitor of drug metabolism | It is not effective in cryptococcal meningitis | It is unlikely to produce anti-androgenic side effects | 3d
| single | Fluconazole does not have anti-androgenic side effects. Ketoconazole is rarely used now a days because of several limitations like: Poor oral bioavailability Limited CNS penetration Powerful inhibition of microsomal enzymes Used in treatment of Cushing Syndrome Anti-androgenic adverse effects like gynaecomastia Fluconazole is preferred agent because it has: Very good oral absorption Maximum CNS penetration (therefore effective in cryptococcal meningitis). No inhibitory action on microsomal enzymes No anti-androgenic propey. | Pharmacology | Anti-Fungal Drugs | [
"fluconazole",
"ketoconazole"
] | 57,582 |
fefc49bd-9767-498a-bf5e-9296493e13ac | Myasthenics are resistant to following muscle relaxant – | quelicin | Pancurium | Atracuronium | norcuron | 0a
| single | Mysthenic patient
Resistant to depolarizing blocker (Sch)
Hypersensitive to non deplarizing blocker. | Anaesthesia | null | [
"suxamethonium",
"vecuronium"
] | 57,597 |
8f6db1bb-5b83-47da-8e88-b0d5e1d5c316 | Which of the following statements is true of toradol ? | Has potent anti-inflammatory activity | Its analgesic efficacy is equal to oramorph in postoperative pain | Is used as preanaesthetic analgesic | It interacts with opioid receptor | 1b
| multi | Ketorolac is an NSAID promoted for systemic use mainly as an analgesic, not as an anti-inflammatory drug (though it has typical NSAID properties).
The drug does appear to have significant analgesic efficacy and has been used successfully to replace morphine in some situations involving mild to moderate postsurgical pain. | Pharmacology | null | [
"morphine",
"ketorolac"
] | 57,605 |
3cb002bb-6132-49cd-b688-2bb3242999f1 | Longest acting local anaesthetic drug is? | novocaine | Prilocaine | Lignocaine | exparel | 3d
| single | Ans. (d) BupivacaineRef: Morgan's Anaesthesiology 4/e, p 269 | Anaesthesia | Miscellaneous (Local and Regional Anesthesia) | [
"procaine",
"bupivacaine"
] | 57,615 |
c01986f1-435f-4d9d-9d4e-d2bac392d483 | Toxicity of nitrogen mustards can be decreased by | caplenal | Folinic acid | GM-CSF | All | 2c
| multi | Ans. is `c GM-CSF o Nitrogen mustards and other alkylating agents can cause myelosuppression --> Leukopenia can be reversed by sargramostim (recombinant GM-CSF). o Haemorrhagic cystitis is more common with some (not all) nitrogen mustards, especially cyclophosphamide and ifosphamide, which is blocked by the use of MESNA or acetylcysteine. So, best option amongst the given options is 'c' (GM-CSF) as myelosuppression can be caused by all nitrogen mustard, whereas hemorrhagic cystitis is more common with cyclophosphamide and Ifosphamide. | Pharmacology | null | [
"allopurinol"
] | 57,624 |
1d994b39-9047-41f2-88e0-5ae30b46966b | The dose of lanoxin should be reduced when given along with - | quinora | Rifampicin | indocin | Antacids | 0a
| single | Ans. is 'a' i.e., Quinidine Quinidine reduces binding of digoxin to tissue proteins as well as its renal/biliary clearance. Its plasma concentration is then doubled and toxicity may occur if dose is not reduced. | Pharmacology | null | [
"digoxin",
"indomethacin",
"quinidine"
] | 57,627 |
95bc4e9a-edfc-4ece-880f-335f3485de72 | Hepatitis with cholestatic jaundice occurs most frequently as an adverse reaction to the following preparation of staticin: | staticin base | staticin stearate | staticin estolate | staticin ethyl succinate | 2c
| single | Erythromycin estolate is responsible for cholestatic jaundice. It stas after 2-3 weeks of staing treatment. Symptoms include nausea, vomiting and cramping pain in abdomen. Risk of this adverse effect increases significantly in pregnancy. Therefore, erythromycin estolate is contra-indicated in pregnancy. | Pharmacology | Protein Synthesis Inhibitors | [
"erythromycin"
] | 57,647 |
d1c43178-f3fe-40d9-a1f3-f9b0ccf506b0 | A 55-year-old male, with uncontrolled diabetes mellitus and hypeension, developed severe air-borne contact dermatitis. The most appropriate drug for his treatment would be: | Systemic coicosteroids | ['thalomid'] | imuran | restasis | 2c
| single | C i.e. Azathioprine In contact dermatitis, the allergic reaction is mediated by delayed hypersensitivity (cell mediated immunity). It is treated by: - Antihistamincis - Steroids (topical/systemic) - Agents depressing cell mediated immunity as cyclosporine, tacrolimus, azathioprine | Skin | null | [
"azathioprine",
"cyclosporine",
"thalidomide"
] | 57,663 |
8fbedba2-2b27-4d89-875d-10c0d99df045 | False about actos aEUR' | It PPARy agonist | >It metabolized in liver | >Not given in case of diastolic dysfunction | It acts on insulin gene and even in absence of insulin helps in metabolism of carbohydrate | 3d
| multi | It acts on insulin gene and even in absence of insulin helps in metabolism of carbohydrate km * Pioglitazone belongs to Thiazolidinediones -Other drugs of this group are Troglitazone, Rosiglitazone It is an oral antihyperglycemic agent that acts primarily by decreasing insulin resistance. - Pioglitazone deceases insulin resistance in the muscles, adipose tissues and in the liver resulting in increased L insulin dependent glucose disposal and decreased hepatic glucose output. Mechanism of action Pioglitazone is a potent and higly selective agonist for peroxisome proliferator activated receptor gamma (PPAR - PPAR receptors are, found in tissues impoant. for insulin action such as adipose tissue, skeletal muscle and liver. - PPAR is .found in highest level in adipose tissue. - Activation of PPAR7 nuclear receptors modulates the transcription of a number of insulin responsive genes involved in the control of glucose and lipid metabolism. -Pioglitazone appears to reduce insulin resistance by enhancing fatty acids storage and possibly by increasing adinopectin levels. - In animal models of diabetes pioglitazone reduces the hyperglycemia, hyperinsulinemia and hyperiglyceridemia which are characteristic of insulin resistant states. Pioglitazone depends on the presence of insulin for its mechanism of action. - Since piogletazone acts by enhancing the effect of circulating insulin it does not lower blood glucose in persons that lack endogenous insulin, - Circulating insulin level decrease with the use of pioglitazone indicating decrease in insulin resistance. Thiazolidinediones are considered euglycemics. -The overall response is similar to sulfonylureas and biguanide monotherapy. - Because their mechanism of action involves gene regulation, the thiazolidinediones have a slow onset and offset of activity over weeks or even months. - Combination therapy with sulfonylurea or insulin may lead to hypoglycemia. Metabolism of Pioglitazone Pioglitazone is extensively metabolized in liver by hydroxylation and oxidation. aiims pgmee answers & explanations - May 2011 Multiple CYP isoforms are involved in the metabolism of pioglitazone. - The cytochromes p450 isoforms primarily invove are : -CYP2 C8 - CYP 3A4 (to a lesser degree) Liver function should be monitored in patients receiving thiazolidinediones even though pioglitazone and rosiglitazone rarely have been associated with hepatotoxicity. Originally three member of thiazolidinedione family were introduced - Pioglitazone - Rosiglitazone - Troglitazone (This was withdrawn from the market due to an increase incidence of drug induced hepatitis). The withdraw! of troglitazone has also led to concerns of other thiazolidinediones also increasing the incidence of hepatitis and potential liver failure. Because of this FDA, recommends two to three months checks of liver enzyme for the first year of thiazolidinedione therapy, to check for this rare but potentially catastrophic complication. - Till date newer thiazolidinediones have been free of this problem. Thiazolidinediones should not be used in patients with NewYork Hea association class III or IV failure. The main side effect of all thiazolidinediones is water retention leading to edema.Sometimes there is significant water retention leading to decompensation of potentially previously unrecognized hea failure. herefore thiazolidinediones should be prescribed with both caution and patient warnings about the potential ,for water retention/weight gain especially in patients with decreased ventricular function. | Pharmacology | null | [
"pioglitazone"
] | 57,687 |
c2a719af-b21f-484e-932a-40df78598200 | Drug-induced colitis is most frequently associated with: | Neomycin | Vancomyc in | cleocin | chloromycetin | 2c
| single | Ans. c. Clindamycin | Pharmacology | null | [
"chloramphenicol",
"clindamycin"
] | 57,692 |
6916c480-680a-46bd-9352-b14c8828431d | WHICH OF THE FOLLOWING DRUGS ACTS BY INHIBITING TRANSCRIPTION OF DNS TO RNA? | RIFAMPICIN | macrobid | proquin | OLAXACIN | 0a
| single | RIFAMPICIN INHIBITS DNA DEPENDENT RNA POLYMERASE REF : KD TRIPATHI 8TH ED | Pharmacology | All India exam | [
"ciprofloxacin",
"nitrofurantoin"
] | 57,702 |
525b5e51-7207-4c3e-82a9-995c111668f3 | prograf level is increased by all except | staticin | sporanox | Danazole | Rifampicin | 3d
| multi | Ans. (D) Rifampicinwww.medscape.com/druginfo(Ref: KDT 8/e p940, )Erythromycin, itraconazol and danazol inhibit the metabolism of tacrolimus and thus increase the plasma concentration whereas rifampicin is an enzyme inducer and decrease its plasma level. | Pharmacology | Immunomodulatory: DMARDS, Monoclonal Antibodies | [
"erythromycin",
"itraconazole",
"tacrolimus"
] | 57,711 |
59e2315f-7439-4f37-8342-3ee6d87b05c6 | Probencide interacts with | Streptomycin | penbritin | firvanq | staticin | 1b
| single | Interaction of probeecid Competitively blocks active transpo of organic acids at all sites especially renal tubules. it inhibits excretion of penicillin or ampicellin and increases its blood level It also inhibits urinary excretion of cephalosporins, sulfonamides, methotrexates and indomethacin. It enables tubular secretion of nitrofurantoin Salicylates, pyrazinamide and ethambutol inhibit uricosuric action of probeecid It inhibits biliary excretion of rifampicin Refer kDT 6/e p209 | Pharmacology | Autacoids | [
"vancomycin",
"erythromycin",
"ampicillin"
] | 57,716 |
3deb0bef-09d3-470d-a65c-9d472f3d3109 | Monoclonal antibody used for Rheumatoid arthritis: | kineret | Leflunomide | Adalimumab | azulfidine | 0a
| single | Ans. A. AnakinraAnakinra is IL-1 antagonist, leflunomide inhibit the growth of B cells. Adalimumab is monoclonal antibody which inhibit the TNF alpha. Sulfasalazine is DMARD. | Pharmacology | Immunomodulator | [
"anakinra",
"sulfasalazine"
] | 57,720 |
eac029ad-0829-4883-b5db-e76a305c9912 | All the following drugs are mono amino oxidase inhibitors except | Moclobemide | Tranylcypromine | Selegeline | cymbalta | 3d
| multi | Duloxetine is antidepressant -SNRI-Serotonin norepinephrine reuptake inhibitorRef: Katzung 13thed.Pg 528 | Pharmacology | All India exam | [
"duloxetine"
] | 57,725 |
210c4122-74d6-4276-8c08-23626f38a844 | Which of the following is a mineralocorticoid antagonist - | carospir | Inamrinone | Nicorandil | toradol | 0a
| multi | Ans. is 'a' i.e., Spironolactone Potassium sparing diureticsAldosterone antagonistsRenal epithelial Ma+ channel inhibitorso Spironolactoneo Eplerononeo Canrenoneo Potassium canrenoneo Prorenoneo MexrenoneoAmilorideo Triamterene | Pharmacology | Diuretic | [
"spironolactone",
"ketorolac"
] | 57,734 |
e02944a9-4a90-4a70-be86-2503719d9e4b | All of the following statements about amiloride are true EXCEPT : | It antagonises the action of aldosterone | It is the drug of choice for the treatment of lithium induced diabetes insipidus | It decreases calcium loss in the urine | It is more potent than dyrenium | 0a
| multi | Amiloride acts by blocking epithelial Na+ channels. It has no effect on aldosterone receptors.
It is more potent than triamterene.
It decreases Ca2+ loss in the urine
It is the drug of choice for lithium-induced DI. | Pharmacology | null | [
"triamterene"
] | 57,747 |
85d272a3-e06c-4c56-a716-3e9329df8677 | Canrenone is a metabolite of : | penbritin | carospir | lasix | diamox | 1b
| multi | null | Pharmacology | null | [
"furosemide",
"spironolactone",
"acetazolamide",
"ampicillin"
] | 57,764 |
31044fdd-b76a-422c-bd46-1ad646a5e6c6 | FDA approved drug for the treatment of superficial basal cell carcinoma is ? | Imiquinod | Acyclovir | Clobesterol | lamisil | 0a
| single | Ans. is 'a' i.e., i.e., Imiquimod Imiquimod Immunomodulator and enhances both innate and acquired immunity. It is used in the treatment of actinic keratosis, bowen's disease, keloids, basal cell carcinoma and anogenital was. It is applied for 8 - 12 hrs, 3 days/ week for 16 weeks. Superficial basal cell carcinoma Superficial BCC is characterized microscopically by buds of malignant cells extending into the dermis from the basal layer of the epidermis. The peripheral layer shows palisading cells. There may be epidermal atrophy, and dermal invasion is usually minimal. There may be a chronic inflammatory infiltrate in the upper dermis. This histologic sub- type is encountered most often on the trunk and extremities, but may also appear on the head and neck. Imiquimod (5% cream) has been used in the treatment of skin cancers.Approved in 2004 by the FDA for the topical treatment of biopsy- confirmed, small (less than 2 cm), primary superficial BCC. | Skin | null | [
"terbinafine"
] | 57,771 |
2ff87d5d-12b1-461e-b326-72ca92d34af8 | Which of the following causes significant Alopecia (epilation agent): | adriamycin | taxotere | rituxan | paraplatin | 0a
| single | Ans. A. Doxorubicina. Epilation - cancer drugs causing significant alopeciab. Anthracyclines - Doxorubicin, Daunorubicinc. Cyclophosphamide, Ifosfamided. Paclitaxele. Etoposide | Pharmacology | Anti-Cancer | [
"docetaxel",
"carboplatin",
"doxorubicin",
"rituximab"
] | 57,785 |
bcc58b04-ff90-4ae9-9779-a83b009f8f8f | A 35 year old female patient presents with proximal weakness of muscles, ptosis and easily fatiguability. September 2011 | Muscle biopsy | CPK levels | EMG | tensilon test | 3d
| single | Ans. D: Edrophonium test The intravenous injection of the sho acting anticholinesterase, edrophonium bromide, is a valuable diagnostic aid (the tensilon test) for myasthenia gravis Myasthenia gravis/ MG: A disease characterized by episodic muscle weakness, chiefly in muscle innervated by cranial nerves and characteristically improved by anti-cholinesterase inhibiting drug There is decreased myoneural junction transmission due to auto-immune attack on the acetylcholine receptor of the post-synaptic neuromuscular junction, which results in loss of dysfunction of Ach receptors and jeopardizing normal neuromuscular transmission Dysahria, dysphagia and proximal limb weakness is common Sensory modalities and deep tendon reflexes are normal Pyridostigmine/ Neostigmine are the MC used cholinergic drugs Thymectomy is indicated in all patients with generalized MG Plasmapheresis may be useful for preparing refractory cases fro thymectomy and during respiratory crisis | Medicine | null | [
"edrophonium"
] | 57,800 |
b33993d1-bea0-4a58-aa0b-2c48eea4a344 | Second generation antihistaminics used in allergic rhinitis are : | Azelastine | allegra | Desloratadine | All of these | 3d
| multi | Chlorpheniramine and promethazine are first generation antihistaminics. | Pharmacology | null | [
"fexofenadine"
] | 57,855 |
58aacbff-4913-4091-95dc-ec7624f60405 | Which of the following anesthetic drugs produces powerful stimulation of the cerebral cortex | Cocaine | novocaine | xylocaine | Tetracaine | 0a
| single | null | Pharmacology | null | [
"procaine",
"lidocaine"
] | 57,860 |
98a26025-fbee-4f92-91d6-08b6667c0e45 | All of the following agents are used in obesity EXCEPT : | xenical | Sibutramine | Olestra | Neuropeptide Y analogues | 3d
| multi | Drugs used for the treatment of obesity are:
Fenfluramine
Sibutramine (serotonin and NA reuptake inhibitor)
Sucrose polyester (olestra)
β3 agonists
Dexfenfluramine
Orlistat (a Pancreatic lipase inhibitor)
Neuropeptide Y antagonists | Pharmacology | null | [
"orlistat"
] | 57,875 |
6735d722-fd49-45ad-a557-c248bb7409c5 | Which of the following is an irreversible inhibitor of COX enzyme | Aspirin | Phenylbutazone | indocin | feldene | 0a
| single | null | Pharmacology | null | [
"piroxicam",
"indomethacin"
] | 57,892 |
72a4d628-3a19-4bc9-b8b3-caf63d25211c | Which of the following drug increases the duration of orthodontic treatment? | dilantin | Aspirin | tylenol | Vitamin D | 1b
| single | null | Dental | null | [
"paracetamol",
"phenytoin"
] | 57,916 |
ff2f26ab-b306-4cba-b62e-b5a24902debf | How to differentiate between psychological and organic erectile dysfunction | Nocturnal penile tumescence | PIPE therapy | viagra induced erection | Squeeze technique | 0a
| single | Psychological impotence usually occurs acutely. The early morning erections and erections during REM sleep (nocturnal penile tumescence; NPT) are usually preserved. If a man repos of spontaneous erections at times when he does not plan to have an intercourse, having morning erections, or having good erections with masturbation or with paners other then his usual one, the organic causes can be considered negligible. Nocturnal penile tumescence is a normal physiological phenomenon seen in males during early morning hours. Squeeze technique is used in pre mature ejacualtion Ref: A Sho Textbook of Psychiatry, Niraj Ahuja, 7th Edition, pg. no. 128, 130 Synopsis of Psychiatry, 11e, pg 577. | Psychiatry | Sleep disorders and eating disorders | [
"sildenafil"
] | 57,917 |
6d8e5608-5edc-4569-b073-dfee6b60a6b7 | Which of the following drugs does not possess even slightest agonist action ? | Buprenorphine | stadol | Nalbuphine | Nalmefene | 3d
| single | null | Pharmacology | null | [
"butorphanol"
] | 57,927 |
fc302976-7c53-4f8e-b170-a9a7a7411dfd | Drugs used in lepra reaction is: | ['thalomid'] | lamprene | resochin | All of the above | 3d
| multi | All of the above | Skin | null | [
"clofazimine",
"thalidomide",
"chloroquine"
] | 57,929 |
6dcbcaa9-656d-400f-af61-cc343aead66a | Drug used for the management of ectopic pregnancy: | trexall | mifeprex | matulane | Cytosine arabinoside | 0a
| single | Ans: a (Methotrexate) Ref: Shaw, 13th ed. p. 258Drugs used - Methotrexate. KC1, hyperosmolar glucose, Ru - 486, PGF,oc and Actinomycin D.Indication for Methotrexate in ectopic pregnancy:(1) Patient haemodynamically stable(2) Tubal diameter < 4 cm without cardiac activities(3) Beta-HCG level < 10,000SurgeryLinear salpingostomyLineal- salpingotomySalpingectomyMilking of tubeMedical management and drugs used in gynaecologial conditions is an often asked question. Go through the list given below.Endometriosis:To decrease vascularity of fibroid:OCPsMifepristoneProgesteroneProgesteroneDanazolDanazolGnRH analoguesGnRH analoguesLetrazole PCOD:DUB:Clomiphene citrateCyproterone acetateOCPsGnRH analoguesDexamethasone and prednisoloneMetforminOCPsProgesteroneMDPADanazolIUCDs - Mirena, progestasertEthamsylateAntifibrinolytics - EACAGnRH analoguesNSAIDsEmergency contraception:DrugsDoseShould be usedFailure rateEstrogen1 mg x 5daysWith in 72 hrs1.5 %Levonorgestrel2 tabs 12 hrs apartWith in 120 hrs(5 days)1.1%Mifepristone600 mg single doseWith in 72 hrs0.9%Centchroman2 tabs twice in 24 hrsWith in 24 hrs1%IUCD-With in 5 days0.1%Danazol400 mg b.d x 5 days 2.5% | Gynaecology & Obstetrics | Miscellaneous (Gynae) | [
"methotrexate",
"procarbazine",
"mifepristone"
] | 57,932 |
7b0946a7-5111-463f-9fc3-ac5e5275a4f6 | In treatment of Parkinsonism, L–Dopa is combined with lodosyn mainly : | To decrease dose requirement of L–Dopa | To decrease side effects of L–Dopa | To decrease effectiveness of L–Dopa | To increase crossing of L–Dopa through BBB | 3d
| single | null | Pharmacology | null | [
"carbidopa"
] | 57,961 |
bee66401-a54b-47e8-9920-030f94973b3b | Which of the following is a uterine relaxant? | detrol | Ritodrine | spiriva | serevent | 1b
| single | Ans. B. Ritodrine. (Ref. KDT, Pharmacology, 6th ed., p 125; 323)SELECTIVE b2 STIMULANTSThese include, salbutamole, terbutaline, salmeterol, formoterol and ritodrine. They cause bronchodilatation, vasodilatation and uterine relaxation, without producing significant cardiac stimulation. b2 selectivity is only relative. Salbutamol has b2:bj action ratio of about 10. They are primarily used in bronchial asthma. Other uses are:# As uterine relaxant to delay premature labour. Ritodrine is the preferred drug;# In hyperkalemic familial periodic paralysis - benefit by enhancing K+ uptake into muscles a lowering plasma K+ levels.The most important side effect is muscle tremor; tachycardia and arrhythmias are less likely.THERAPEUTIC CLASSIFICATION OF ADRENERGIC DRUGSI.Pressor agentsNoradrenalineMethoxaminePhenylephrineDopamineeEphedrineMephentermineII.Cardiac stimulantsAdrenalineeDobutamineeIsoprenalineeIII.BronchodilatorsAdrenalineSalmeterolTerbutalineSalbutamoleIsoprenalineFormoterolIV.Nasal decongestantsPhenylephrineePseudoephedrineNaphazolineOxymetazolineXylometazolinePhenylpropanolamineV.CNS stimulantsAmphetamineMethamphetamineDexamphetamineVI.AnorecticsFenfluramineSibutramineDexfenfluramineVII.Uterine relaxant and vasodilatorsRitodrineSalbutamol IsoxsuprineeTerbutalineeTocolytic drugsSr. no.Tocolytic AgentsComments1Isosuprine (DUVADILAN)It is an orally effective long acting selective b receptor stimulant, which has direct smooth muscle relaxant property as well. It has been used as uterine relaxant for threatened abortion and dysmenorrhoea, but efficacy is poor.Side effects: nausea, tachycardia, flushing, dizziness, and tremor. Isoxsuprine has been used in threatened abortion and dysmenorrhoea, but efficacy is doubtful.2Ritodrine (Selective b2 stimulants)infused i.v. have been successfully used to postpone labour but maternal morbidity and mortality may be increased due to their cardiac and metabolic actions and incidents of pulmonary edema.3Atosiban & nifedipineAlthough atosiban and nifedipine seem equally effective in delaying preterm labour, there is increasing concern in twin pregnancies about the adverse CVS effects of nifedipine. Nifedipine should not be used in multiple pregnancies due to fear of pul edema. However, atosiban, which is principally an AVP receptor antagonists is oxytocin receptor antagonist, used for the treatment of preterm labour.4Magnesium sulphateAlso acts as a tocolytic agent. With the withdrawal of sympathomimetic drugs and the failure of atosiban, an oxytocinantagonist, to obtain FDA approval, magnesium sulphate is therefore in commonly used tocolytic drug.Educational points:# Tolterodine is being developed as a vasicoselective antimuscarinic.# Tiotropiumbromide Congener of ipratropium bromide, which binds very tightly to bronchial M1/M3 muscarinic receptors producing long lasting bronchodilatation. Binding to M2 receptors is less tight confering relative M1/M3 selectivity. Like ipratropium, it is not absorbed from respiratory and g. i. mucosa and has exhibited high bronchial selectivity of action. | Gynaecology & Obstetrics | Miscellaneous (Gynae) | [
"tiotropium",
"salmeterol",
"tolterodine"
] | 57,992 |
978ef597-1e96-464b-86ee-28e6e6067cd4 | refolin is used for side effect reduction in which anticancer drug? | trexall | 5-FU | Adriamycin | platinol | 0a
| single | ANSWER: (A) MethotrexateREF: KDT 6th Edn Page: 387, 590, 591See APPENDIX-37 below for "CLASSIFICATION OF CANCER CHEMOTHERAPY AGENTS"See APPENDIX-42 below for "ANTIDOTES TOXICOLOGY"Repeat Pharmacology 2001Note: Leucovorin is also known as Folinic add APPENDIX - 37Classification of Cancer Chemotherapy Agents:GroupSubgroups & AgentsAcute ToxicityDelayed ToxicityUsesAlkylatingAgentsNitrogen Mustard Alkylation of DNA at N7 &06 position of Guanine -DNA crosslinking I; b/n 2 strands - prevents duplication(1) Mechiorethamine(First anticancer drug)CINV-chemo induced nausea vomiting (4hr- 48hrs)MyelosuppressionMyelosuppression (delayed type-onset = 7d, Nadir = 10-14d, reco%rerv = 21-28d)AlopeciaMOPP-HodgkinslymphomaAA are commonly used in chronic leukemia(2) Cyclophosphamide1CP - 4hydroxyCP -aldophosphamide- Acrolein (toxic) & phosphamide mustard (active)]CINVMyelosuppression(CP>Ifo)Myelosuppression (CP>Ifo) Alopecia, SIADHHemorrhagic cystitis (Ifo>CP)Sec cancer-transitional cell cancer of bladderWagner'sgranulomatosis DOC CMF-Breast, small cell lung ca Broad spectrumAA are nonphase specific(3) Ifosfamide 4hydroxy ifosfamide (active)CINVMyelosuppression(CP>Ifo)Myelosuppression(CP>Ifo)AlopeciaHemorrhagic cystitis (Ifo>CP)Broad spectrum Lung, breast, ovary, sarcoma, testis, germ cell tumorAA causes secondary leukemia in 4-5 years(4) Melphanamino acid derivative ofmechloretamineCINVMyelosuppressionMyelosuppression No alopeciaMultiple myeloma DOCCan replace C in CMF (5) ChlorambucilMyelosuppression CINV is rareMyelosuppression No alopeciaCLL, Hodgkin's Nitrosoureas(lipophilic-crosses BBB) Nitrosoureas causes delayedMyelosuppression (onset-15d, Nadir-4wks, recovery-6wks) (1) Carmustine (BCNU- bis chloro nitroso urea)CINV (severe-2hrs)Myelosuppression, male infertility,Pulmonary fibrosisBrain tumors DOC(Glioblastomamultiforme.Astrocytoma,Medulloblastoma) (2) Lomustine (CCNU)CINV (severe-2hrs)Myelosuppression Interstitial lung diseasedo (3) Semustine (methyl CCNU)CINV (severe-2hrs)Myelosuppressiondo (4) Streptozocin (methylation of protein & nucleic acid)CINV (severe-2 hrs)No MyelosuppressionPancreatic islet cell tumorCarcinoid tumor Alkyl Sulfonates(Intra strand cross linking of DNA by 2 N7 Guanine) BUSULFAN {Dealkylating agent)Hyperuricemia(MC)Sterility, gynecomastia, seizures, Skin pigmentation, Adrenal insufficiency Pulmonary fibrosis (specific)CM L-DOC until imatinibConditioning of BM transplant Ethyl Enimines Thiotepa(Organophosphorous)CINVMyelosuppressionSeldom used nowNon ClassicalAlkylatingAgentsTriazenes Acts on RNA &Protein synthesis not/ mild DNADacarbazine (Active- methyl carbonium ion)CINV-severePermanent sterility Myelos uppre ssion (early/classical)MAID-sarcoma, ABVD-Hodgkins Malignant melanoma (most active agent) Procarbazine (autoxidize spontaneously, Active- Azoprocarbazine, crosses BBB)CINV, MAO inhibitor Disulfiram like reactionMyelosuppression,DermatitisLeukenogenic,teratogenicMOPP-Hodgkin'sPCV-Glioblastoma AltretamineCINV-severe HypotensionNeuro toxic NephrotoxicRefractory ovarian cancerAlkylating Like AgentsPlatinum Compounds 1st gen platinum Inactivated by aluminumCisplatinCINV (most emitogenic)Hypo Mg, K, Ca sec to hypo Mg)Myelosuppression N ephrotoxicity, Ototoxicity Secondary leukemiaCMF-Solidmalignancies2nc generation platinum, Cross resistance- cisplatinCarboplatinCINV (cis>carbo)Myelosuppression(carbo>ds)No nephrotoxicityLess potent than cisplatin (1:4) GemCarco-Iung cancer3rd generation platinum No cross resistanceOxaliplatinPSN pathy (reversible hand & foot, temp loss)Neurotoxicity (dose limiting)No nephrotoxicity PSN pathyflrreversible, hand, foot, leg, arm, temp loss, propio loss)FOLFOX- colon cancerCis/carboplatin resistance AntimetabolitesFolate Antagonists S phase specificMethotrexate HepatotoxicityMyelosuppressionMucositisChoriocarcinoma DOC, ALL, Osteosarcoma. RA, ectopic Myasthenia, psoriasis, meningeal leukemia (intrathecal route)Inhibits DMA syn thesisPemetrexed : Mesothelioma, nonsmall cell lungNo acute toxicidesPurine Analogue Commonly used in acute leukemias6 THIO Guanine MyelosuppressionHepatotoxicityAdult acute leukemia 6 Mercapto Purine Myelosupp ression, hepatotoxicityChildhood acute leukemia Fludrabine Myelosuppression, Flu like symptom (fever, myalgia, arthralgia) Cladribine Myelosuppression, Nephrotoxic, ClXVHairy cell leukemia Pentostatin NephrotoxicHairy cell leukemia Pyrimidine Analogue 5 Fluorouracil (5-FU) GI upset-diarrhea (MC) Hand foot syndrome, CINVMyelosuppression, neurotoxicity Cerebellar ataxia Cytrabine Stomatitis, CINV, Cerebellar ataxia MyelosuppressionAML Capecitabine CINV, Diarrhea, Hand foot syndrome Myelosupp ression (<5FU)Metastatic breast cancer, Metastatic colorectal cancer Gamecitabine CINV, Myelosuppression (dose limiting)Pancreatic cancer DOC Bladder & Nonsmall cell lung CaAntibioticsAnthracyclinsTopoisomerase 2 inhibitor (me)Quinone Free radical injury & intercalation b/n DNA strandsMembrane binding (responsible for cardiotoxicity) Doxorubicin (Adriamycin)CINV, AlopeciaMyelosuppression (dose limiting, neutropenia >th rombocytopenia) Cardiotoxicity(cardiomy opathy, CHF)Radiation recall Hand foot syndromeBroad spectrum Solid tumors & sarcomas (rhabdo/ leiomyosarcoma, Kaposi sarcoma) DaunorubcinCl MV, AlopeciaMyelosuppression, cardiotoxicity, radiation recallNarrow spectrum AML Idarubcin (synthetic Daunorubicin analogue)CINV, Alopecia, Red urine (not hematuria)Myelosuppression, cardiotoxicity, radiation recallAML (more efficacious than daunorubicin) MitoxantroneCINV, Bluish discoloration of nailsMyelosuppression (dose limiting)Lower cardiotoxicity? Other Antibiotics Bleomycin(Glyco peptide Antibiotic) Free radical injury - ds- ss DMA breaks, have both DNA & Fe binding domainAllergic reaction HypotensionPulmonary fibrosis (dose limiting)Mucocutaneous toxicity? Marrow sparingHL, NHL, SCC Malignant pleural effusionAscitis (sclerosing agent) Mitomycin- CActs as alkylating agentCINVHemolytic uremic syndrome. Pulmonary- fibrosis, 8th nerve damageRadiosensitizer- DOC, SCC Dactinomycin Inhibits all forms of DMA dependent RMA synthesis, r-RNA most sensitiveCINVMyelosupp ression Alopecia Radiation recallPediatric tumors (Ewing's, witm's, Rhabdomyosarcoma) Radiosensitizer ActinomycinCINVDesquamationMyelosuppressionAlopeciaPediatric tumors (Ewing's, wilm's, Rhab domyosarcoma) Radiosensitizer PlicamycinCINV EnzymeL-ASPARGINASE (inhibits protein synthesis of tumor cell by depletion of L-Aspargine)Anaphylaxis/ hyper sensitivity- fever, chills, rash, urticaria (brochospasm, hypotension if severe)Hypercoagulable state Pancreatitis, Hepatotoxicity Marrow sparing, no alopeciaALLIneffective in solid tumors(normal cells spared)Plant DerivedVinca AlkaloidsM phase specificInhibits tubulin polymerizationMitotic inhibitors VincristineAlopeciaPSNpathySIADH, Marrow sparingLymphosarcoma, wilm's, Ewing's Remission of childhood acute leukemia. VinblastineAlopecia (Vc >Vb)PSNpathy (Vc >Vb) MyelosuppressionHodgkin s, testicular carcinoma EpipodophylotoxinsTopoisomerase 2 inhibitor Etopside (VP-16)CINV, HypotensionMyelosuppression, early onset secondary leukemia (1-3 years) alopecia Teniposide (VP-26) TaxansM phase specificEnhance tubulin polymerizationSpindle poison PaclitaxelHypersensitivityPSNpathy (stocking glove type) Myelosuppression,Cisplatin resistance Relapse &resistant breast/ovary ca Docetaxel (more potent)HypersensitivityMyelosuppression, PSNpathy (is less frequent)Cisplatin resistance, Relapse-resistant br/ovary ca CamptothecinTopoisomerase 1 inhibitorss DNA breaks TopothecanCINVMyelosuppression (dose limiting) Irinothecan (active = SN-38)CINV, Cholinergic syndrome (SLUDGE) including early diarrhea-24hrsMyelosuppression, cholinergic syndrome (SLUDGE) including late diarrhea 3-10d (dose limiting)Advanced colorectal ca- DOCMiscellaneousArsenic Trioxide (degradation of PM LI & RARa protein)Headache, lightheadednessCINVCardiotoxicity (QT prolongation, arrhythmias), Myelosuppression Syndrome-fever, fluid retention, wt gain, rashAPL-induction in tretinoin relapse and refractoryHydroxyurea has 100% oral bioavailabilityHydroxyurea (inhibits ribonucleotide reductase - inhibits DMA synthesis)CINVMyelosuppression (dose limiting)HyperpigmentationCMLAML-blast crisis Imatinib (Bcr-Abl Tyrosine kinase inhibitor)CINVFluid retention, Ankle & perioral edemaCML-chronic phase GIST with Ckit tyrosine kinase Dasatinib & Nilotinib (novel agents- TK inhibitors) CML- imatinibresistance/intoleranceAnticancer Drug Toxicities:MYELOSUPPRESSIONAll except Asparginase, Vincristine, BleomycinCARDIOTONICAnthracyclins, arsenic trioxideNEPHROTOXICPlatinum compounds (cisplatin>carboplatin>oxaliplatin)PULMONARY FIBROSISBleomycin. Busulfan, CarmustinePERIPHERAL NEUROPATHYGxaliplatin, vincristine Taxans (stoking & glove type)HAEMORRHAGIC CYSTITISCyclophosphamide, IfosfamideHAND FOOT SYNDROME5FU, Capecitabine, DoxorubicinCEREBELLAR ATAXIAPyrimidine analogs like Cytrabine & 5FUSIADHCyclophosphamide, VincristineSECONDARY LEUKEMIAAll alkylating agents & alkylating like agents (in 4-5 years) E topside (in 1-3 years)STERLITYAlkylating agentsDISULFIRAM LIKE REACTIONProcarbazineCHOLINERGIC SYNDROMEIrinitecanRADIATION RECALL SYNDROMEAnthracydinsAnticancer Drugs Toxic Amelioration:ToxicityMeasuresMethotrexateFolinic acidAlkalization of urine (Mtz is weak acid & reabsorbed in acidic urine)Hemorrhagic cystitis (cyclophosphamide, ifosfamide)ME SNA (2 mercapto ethyl sulfonyl sodium) systemic ACETYLCYSTEINE irrigation of bladderHigh fluid intakeFrequent voidingCINV (Cytotoxic drug induced nausea Stvomiting )Ondansetron (5HT3 Antagonist)Cytotoxic drug induced MucositisPabfermin (human recombinant keratinocyte growth factor)TUMOR LYSIS SYNDROME (hyperkalemia, hypophosphatemia, hyperuricemia, hypemricosuria, hypocalcaemia, acute renal failure)prophylactic ALLOPURINOL (xanthine oxidase inhibitor)alternatively RASBURICASE (urkase)Aggressive hydrationHigh urine outputAlkalization of urine not recommended/controversialDiuresis is reserved for well hydrated patientsHEMODIALYSIS (if above fails) MYE LOS OPPRESSIONFor AnemiaERYTHROPOIETIN (recombinant)For NeutropeniaFILGRASTIM- Granulocyte colony-stimulating factor (G-CSF) analogSARGRAMOSTTM - Recombinant granulocyte macrophage colony stimulating factor (GM-CSF)For ThrombocytopeniaOPRELVEKIN (IL-11)BONE MARROW TRANSPLANT (for extreme suppression)CANCER CACHEXIATHALIDOMIDECYTOPROTECTION of normal tissueAMIFOSTINE= WTR-2721=prodrug(active = free thiol=WR-1065. activation normal tissue)USES=cispIatin based chemotherapy & radiation therapyAnthracyclins induced CARDIOTOXICITYDEXRAZOXAXE (ICRF-187) Iron chelating agent Cardio protective agent, derivative of EDTA APPENDIX - 42AntidotesAntidotePoison/drug/toxinN-AcetylcysteineAcetaminophenCarbon tetrachlorideOther hepatotoxinsAmyl nitrite, sodium nitrite and sodium thiosulfate (Cyanide antidote kit)NitrilesBromatesChloratesCyanide (e.g., HCN, KCX and NaCN)Mustard agentsNitroprussideSmoke inhalation (combustion of synthetic materials)Antivenin, Crotalidae Polyvalent (Equine Origin)Pit viper envenomation (e.g. rattlesnakes, cottonmouths, timber rattlers and copperheads)Antivenin, Crotalidae Polyvalent Immune Fab - Ovine (CroFab)Pit viper envenomation (e.g.. rattlesnakes, cottonmouths, timber rattlers and copperheads)Atropine sulfateAlpba2 agonists (e.g., clonidine)Alzheimer drugs (e.g., donepezil, galantamine, rivastigmine, tacrine)Antimyesthenk agents (e.g., pyridostigmine)Bradyarrhythmia-producing agents (e.g., beta blockers, calcium channel blockers and digitalis glycosides)Cholinergic agonists (e.g., bethanechol) .Muscarine-containing mushrooms Nerve agents (sarin, soman, tabun and VX)Organophosphate and carbamate insecticidesDigoxin immune FabCardiac glycoside-containing plants (foxglove and oleander)Digitoxin, DigoxinEthanolEthylene glycolMethanolFlumazenilBenzodiazepinesZaleplonZolpidemFolic acid and Folinic acid (Leucovorin)Formaldehyde/Formie AcidMethanolMethotrexate, trimetrexatePyrimethamineTrimethoprimFomepizoleEthylene glycolMethanolGlucagonBeta blockersCalcium channel blockersHypoglycemiaHypoglycemic agentsHydroxocobalaminNitrilesBromatesChloratesCyanide (e.g., HCN, KCN and NaCN)Mustard agents NitroprussideSmoke inhalation (combustion of synthetic materials)Hyperbaric oxygen (HBO)Carbon monoxideCarbon tetrachlorideCyanideHydrogen sulfideMethemoglobinemiaMethylene blueMethemoglobin-inducing agents including;Aniline dyesDapsoneLocal anesthetics (e.g., benzocaine)MetoclopramideNaphthaleneNitrates and nitritesNitrobenzenePhenazopyridineNalmefene and NaloxoneACE inhibitorsAlpha2 agonists (e.g., clonidine)Imidazoline decongestants (e.g., oxymetazoline and tetrahydrozoline) LoperamideOpioids (e.g., codeine, fentanyl, heroin, meperidine, morphine)Physostigmine salicylateAntihistaminesAtropine and other anticholinergic agentsDhatura poisoningIntrathecal baclofenPhytonadione (Vitamin Kl)Long-acting anticoagulant rodenticides (e.g., brodifacoum and bromadiolone) WarfarinPralidoxime chloride (2-PAM)Antimyesthenic agents (e.g., pyridostigmine)Nerve agents (sarin, soman, tabun and VX)Organophosphate insecticidesTacrineProtamine sulfateEnoxaparinHeparinPyridoxine hydrochloride (Vitamin B6)Acrylamide Ethylene glycol Hydrazine Isoniazid (INH)Sodium bicarbonateChlorine gasHyperkalemiaSerum Alkalinization:Agents producing a quinidine-like effect as noted by widened QRS complex on EKG (e.g., amantadine, carbamazepine, chloroquine,cocaine, diphenhydramine, flecainide,tricyclic antidepressants, quinidine)Urine Alkalinization:Weakly acidic agents (chlorpropamide, methotrexate, phenobarbital and salicylates)Deferoxamine and DeferasiroxAcute iron poisoningDimercaprol (BAL in oil)Hydrofluoric acid (HF)Hyperkalemia (not digoxin-induced)HypermagnesemiaCalcium disodium EDTA (Versenate)Acute arsenic poisoning,Acute mercury poisoning,Lead poisoning (in addition to EDTA)Dicobalt EDTACyanide poisoningSucdmer/ Dimercaptosuccinic acid (DMSA)Lead poisoning,Arsenic poisoning,Mercury poisoningDimercapto-propane sulfonate (DMPS)Severe acute arsenic poisoning,Severe acute mercury poisoningD-Penicillamine (Cuprimine)Mainly in: copper toxicityOccasionally adjunctive therapy in: Gold toxicity, Arsenic poisoning, Lead poisoning, Rheumatoid arthritisBotulinum antitoxin * Bivalent (types AB)<< Trivalent (types ABE)Food-borne botulismWound botulismBotulism as a biological weaponNote: Not currently recommended for infant botulismL-CarnitineValproic acidCyproheptadine HCLMedications causing serotonin symdromeDantrolene sodiumMedications causing neuroleptic malignant symdrome (NMS)Medications causing malignant hyperthermiaInsulin and dextroseBeta blockersCalcium channel blockers (diltiazem, nifedipine, verapamil)Octreotide acetateSulfonylurea hypoglycemic agents (e.g., glipizide, glyburide)Sodium thiosulfateBromatesChloratesMustard agentsNitroprussideThiamineEthanolEthylene glycolPrussian blue, ferric hexacyan ofer rateRadioactive cesium (Cs-137), radioactive thallium (Tl-201), and nonradioactive thallium | Pharmacology | Anti-Neoplastic Agents | [
"methotrexate",
"adriamycin",
"cisplatin",
"leucovorin"
] | 58,010 |
fd954304-0b00-4aba-9e90-70a57268a6a4 | Which of the following statements regarding toxicity of local anesthetics is false? | The first signs of toxicity are dizziness, tinnitus, and nystagmus | Systematic convulsions are rare and usually self- limited | Most allergic reactions are to aminoamide compounds | For patients allergic to local anesthetics, benadryl hydrochloride 1% can be injected into the wound. | 2c
| multi | Most allergic reactions are to aminoamide compounds * Slow injections limit the chance for local anesthetic toxicity. When history of allergy is unceain, an antihistamine such as diphenhydrarnine injected directly into the wound can be used as an alternative and achieves anesthesia in approximately 30 mm. * True allergic reactions to local anesthetics are rare, especially to aminoamide compounds such as lidocaine and bupivicaine. The ester derivatives of paraaminobenzoic acid, such as procaine, are responsible for most local anesthetic allergic reactions. * Toxicity should be suspected in patients who complain of dizziness, tinnitus, and periorbital tingling. Rarely, systemic convulsions follow. * These are usually self-limited because of rapid redistribution of the drug, with resultant lower serum levels. | Surgery | null | [
"diphenhydramine"
] | 58,011 |
7b57516a-b15f-4f70-bcdc-29fb55a12ffd | The first step in management of head injury is: | Secure airway | I.V. osmitrol | I.V. decadron | Blood transfusion | 0a
| multi | null | Surgery | null | [
"mannitol",
"dexamethasone"
] | 58,018 |
d3ffc5f6-7b23-4148-8aec-252059e2b80a | The drug of choice for chemoprophylaxis in contacts of a patient of pneumonic plague is : | Penicillin. | Rifampicin | staticin. | panmycin. | 3d
| single | Ans. is 'd' i.e. Tetracycline Park writes- "The drug of choice for chemoprophylaxis is Tetracycline. For adults the dose in 500 mg 6 hourly for 5 days. A cheaper alternative is sulfonamideRemember that -DOC for treatment of Plague is streptomycin*. Tetracycline is an alternative drug.Also Remember-The DOC for chemoprophylaxis and treatment of the following diseases- :DiseaseDOC for ChemoprophylaxisDOC for TreatmentPlagueTetracycline*Streptomycin*InfluenzaAmantadine or RimantadineAmantadine* or RimantadineDiptheriaErythromycin*Penicillin* or ErythromycinMeningococcal meningitisRifampicin* is the DOC (unless the organism is known to be sensitive tosulfadiazine)Penicillin*CholeraTetracycline*DOC for adults (except pregnant females is -Doxycycline*)DOC for Children -Trimethoprim sulfamethoxazole* DOC for Pregnancy -Furazolidone*Bacterial ConjunctivitisErythromycin ointment | Social & Preventive Medicine | Infectious Disease Epidemiology | [
"erythromycin",
"tetracycline"
] | 58,025 |
2af4ac43-57ff-4592-8728-9420c2af5491 | Drug of choice for paracoccidioidomycosis is | nilstat | diflucan | extina | Amphotericin B | 3d
| single | Amphotericin B is the drug of choice for most of the systemic fungal infections It acts by forming pores in the cell membrane leading to escape of various major electrolytes from fungus Ref: Baveja 5th ed pg: 554 | Microbiology | mycology | [
"fluconazole",
"nystatin",
"ketoconazole"
] | 58,026 |
62350f50-3c8a-48d8-ba84-f27225692181 | Which is/ are not desirable for a patient with pacemaker? | Thiopentone sodium | ECG monitoring | quelicin | Unipolar diathermy | 3d
| single | unipolar diathermy is not desirable it is preferable to use Bipolar diathermy. | Anaesthesia | Inhalational Anesthetic Agents | [
"suxamethonium"
] | 58,049 |
16b06559-faa7-4cf3-a5f8-7980bc025c71 | Savlon contains: | Cetrimide and cetavlon | Cetrimide and Chlorhexidiine | Cetrimide, chloraprep and butyl alcohol | Cetrimide and butyl alcohol | 1b
| single | Cetrimide along with chlorhexidine is most popularly used antiseptic and disinfectant for surgical instruments, utensils, baths, etc- savlon ESSENTIALS of medical PHARMACOLOGY SEVENTH EDITION -KD TRIPATHI Page:900 | Pharmacology | Other topics and Adverse effects | [
"chlorhexidine"
] | 58,064 |
7c06cf4e-7810-4136-b91a-cc5a96341996 | Streptococcus toxin which is responsible for connective tissue breakdown ? | hylenex | Streptolysin 0 | Streptolysin S | Streptococcus pyogenic exotoxin | 0a
| single | Ans. is 'a' i.e., Hyaluronidase Hyaluronidase splits hyaluronic acid, an impoant component of the ground substance of connective tissue. Thus, hyaluronidase aids in spreading infecting microorganisms (spreading factor).Hyaluronidases are antigenic and specific for each bacterial or tissue source. Following infection with hyaluronidase-producing organisms, specific antibodies are found in the serum. | Microbiology | null | [
"hyaluronidase"
] | 58,068 |
84d967ce-51d6-4392-b821-4c31d534413c | Drug of choice in rhinoscleromatosis is: | panmycin | Fluoroquinolone | Aminoglycosides | None of the above | 0a
| multi | In rhinoscleromatosis, organism may be difficult to eradicate, despite aggressive therapy. A combination of conservative surgical debridement and long-term antibiotic coverage is the mainstay of therapy for rhinoscleroma. Tetracycline has been shown to be effective and inexpensive for patients unless contraindicated. Fluoroquinolones may be used as an alternative, given their excellent gram-negative activity and convenient dosing regimen | ENT | null | [
"tetracycline"
] | 58,080 |
16accff7-46f8-4fa3-aaa6-fd189adafd7d | Hyperprolactinemia is a side effect of: | Bromocriiptine | dopar | symmetrel | reglan | 3d
| single | Metoclopramide | Pharmacology | null | [
"amantadine",
"metoclopramide",
"levodopa"
] | 58,082 |
9a20c13d-0231-4e54-b412-26f555619a47 | A 40 weeks pregnant developed postpaum hemorrhage due to uterine atony. Which of the following drug can be given to this patient to stop the bleeding? | oxoject | Methergine | Progesterone | Prostaglandins | 1b
| single | Ergot alkaloids markedly increase the motor activity of the uterus. Although their capacity to induce sustained uterine tetany precludes their use in the induction or facilitation of labor, they are used to prevent or treat postpaum hemorrhage in normotensive women. In this setting, the preferred ergot alkaloids are ergonovine or its methyl analog methylergonovine (methergine). They are administered intramuscularly or intravenously, exhibit rapid onsets of action, and their effects persist for 45 minutes to 3 hours depending on the route of administration. Adverse effects include nausea and vomiting, elevated blood pressure, and decreased pain threshold requiring analgesia. Ref: Schimmer B.P., Parker K.L. (2011). Chapter 66. Contraception and Pharmacotherapy of Obstetrical and Gynecological Disorders. In L.L. Brunton, B.A. Chabner, B.C. Knollmann (Eds), Goodman & Gilman's The Pharmacological Basis of Therapeutics, 12e. | Gynaecology & Obstetrics | null | [
"oxytocin"
] | 58,098 |
f26f37a3-4638-4a3a-9591-f93e01aa7dad | Anaesthetic agent which is explosive in the presence of cautery – | Nitrous oxide | Ether | Trilene | fluothane | 1b
| single | null | Anaesthesia | null | [
"halothane"
] | 58,126 |
b34269d9-22cc-4f3f-9e54-e4e6ae353df1 | 30 yrs female presented with unilateral breast cancer associated with axilary lymph node enlargement. Modified radical mastectomy was done, further treatment plan will be | Observation and follow-up | Adriamycin based chemotherapy followed by nolvadex depending on estrogen/progesterone receptor status | Adriamycin based chemotherapy only | nolvadex only | 1b
| single | Ans. is 'b' i.e. Adriamycin based chemotherapy followed by tamoxifen depending on.... Stage I & II breast cancers (Early invasive breast cancers) are managed byPrimary therapy for local management &Adjuvant therapyPrimary therapy consists of:Mastectomy with assessment of axillary lymph node status (or modified radical mastectomy) orBreast conservation (lumpectomy, wide local excision or quadrantectomy) with assessment of axillary lymph node status + radiotherapy.Various trials have found both these methods to be equally effective. Breast conservation is the preferred form of treatment because of cosmetic advantages However there are certain contraindications for conservative surgery (described in subsequent question)Management of axillary lymph nodesEarlier dissection of axillary lymph nodes (level I and II) was performed to assess the lymph node status (i.e. presence or absence of occult metastasis)Now Sentinel lymph node biopsy is considered the standard for evaluation of the axillary lymph nodes for metastasis in women who have clinically negative lymph nodes, (the sentinel lymph node is the first regional lymph node to receive tumor cells that metastasize along the lymphatic pathway from the primary breast cancer)Axillary Lymph node dissection is performed for clinically palpable axillary lymph nodes or metastatic disease detected in sentinel lymph node biopsy.Adjuvant chemotherapy is given to all node-positive cancersnode negative cancers if > 1 cm in size * node negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion high nuclear grade high histological grade HER 2/neu overexpression negative hormone receptor statusAdjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive tumors.HER-2/neu expression is determined for all patients with newly diagnosed breast cancer and may be used to provide prognostic information in patients with node-negative breast cancer and predict the relative efficacy of various chemotherapy regimens. Trastuzumab is the HER-2/neu-targeted agent that is added to the adjuvant therapy is the tumor shows overexpression of HER-2/neu receptors.Advanced Local-Regional Breast Cancer (Stage III)(Neoadjuvant chemotherapy + MRM + adjuvant radiation therapy + chemotherapy + antiestrogen therapy)Here the disease is advanced on the chest wall or in regional lymph nodes (or both), with no evidence of metastasis to distant sites. Such patients are recognized to be at significant risk for the development of subsequent metastases, and treatment addresses the risk for both local and systemic relapse.In an effort to provide optimal local-regional disease-free survival as well as distant disease-free survival for these women, surgery is integrated with radiation therapy and chemotherapy.Neoadjuvant chemotherapy (administration of therapeutic agents prior to the main treatment) should be considered in the initial management of all patients with locally advanced stage III breast cancer.Surgical therapy for women with stage III disease is usually a modified radical mastectomy, followed by adjuvant radiation therapy and chemotherapy. Antiestrogen therapy (tamoxifen) is added for hormone receptor positive tumors.Chemotherapy is used to maximize distant disease-free survival, whereas radiation therapy is used to maximize local-regional disease-free survival.In selected patients with stage IIIA cancer, neoadjuvant (preoperative) chemotherapy can reduce the size of the primary cancer and permit breast-conserving surgery.Distant Metastases (Stage IV)(mainly palliative treatment)Treatment for stage IV breast cancer is not curative but may prolong survival and enhance a woman's quality of life.Hormonal therapies that are associated with minimal toxicity are preferred to cytotoxic chemotherapy. Appropriate candidates for initial hormonal therapy include women with hormone receptor-positive cancers; women with bone or soft tissue metastases only; and women with limited and asymptomatic visceral metastases.Systemic chemotherapy is indicated for women with hormone receptor-negative cancers, symptomatic visceral metastases, and hormone-refractory metastases.Bisphosphonates, which may be given in addition to chemotherapy or hormone therapy, should be considered in women with bone metastases.About Adjuvant TherapyAdjuvant therapy is the use of systemic therapy (chemotherapy or/and hormone therapy) in patients who have received local therapy but are at risk of relapse.The objective is to eliminate the occult metastasis responsible for late recurrences while they are microscopic and theoretically most vulnerable to anticancer agents.Adjuvant chemotherapy is given to all node-positive cancersnode negative cancers if > 1 cm in size node negative cancer > .5 cm in size with adverse prognostic factors such as blood vessel or lymph vessel invasion high nuclear grade high histological grade HER 2/neu overexpression negative hormone receptor statusAdjuvant hormone therapy (tamoxifen) is added to all those with estrogen receptor positive.* The use of chemotherapy in post-menopausal women is controversial.In post menopausal women, chemotherapy is frequently used upto age 70 yrs, if she can tolerate it.In older women, chemotherapy is performed less frequently.In estrogen positive tumors, in postmenopausal women, antiestrogen (tamoxifen/ aromatase inhibitors) therapy is the preferred form of adjuvant systemic treatment.Neoadjuvant chemotherapy it involves the administration of adjuvant therapy before primary therapy (surgery & radiation therapy) it has shown to down-stage the tumor.Previously CMF (cyclophosphamide, methotrexate & 5-fluorouracil) was the chemotherapeutic regimen of choice. "CMF is no longer considered adequate adjuvant chemotherapy and modem regimens include an anthracycline (doxorubicin or epirubicin) and the newer agents such as the taxanes (paclitaxel and docetaxel)"- Bailey and Love 25/e p844Anti-HER-2/neu antibody therapy (Trastuzumab)HER-2/neu expression for all newly diagnosed patients with breast cancer is now recommended.Trastuzumab is added to the chemotherapy for tumors overexpressing HER-2/neu receptors. (Trastuzumab is added along with taxanes) | Surgery | Breast Cancer - Treatments | [
"adriamycin",
"tamoxifen"
] | 58,131 |
4f95ef67-f81a-41b4-8e4b-af6a6e943d73 | Which of the following hormone decreases intestinal motility? | glucagen | CCK | Serotonin | Gastrin | 0a
| single | Glucagon is produced by the A cells of the pancreatic islets and the upper gastrointestinal tract. It is glycogenolytic, gluconeogenic, lipolytic, and ketogenic. Large doses of glucagon produce profound relaxation of the intestine. It has a potent inotropic and chronotropic effect on the hea, mediated by the cAMP mechanism. It also stimulates the secretion of growth hormone, insulin, and pancreatic somatostatin. CCK (Cholecystokinin), gastrin, and serotonin increases intestinal motility. Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 24. Endocrine Functions of the Pancreas & Regulation of Carbohydrate Metabolism. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds), Ganong's Review of Medical Physiology, 24e. | Physiology | null | [
"glucagon"
] | 58,145 |
aea8ba8c-385b-45f2-b9cc-36a196e5520e | Drug highly distributed to body fat ? | lanoxin | Heparin | osmitrol | Thiopentone | 3d
| single | Ans. is 'd' i.e., Thiopentone Redistribution of drugs Highly lipid soluble drugs get initially distributed to organs with high blood flow i. e. brain, hea, kidney etc. Later, less vascular but more bulky tissues take up the drug- plasma concentration falls and the drug is withdrawn from the highly perfused sites. If the site of action was in the highly perfused tissues, redistribution results in termination of the action of drug. Greater the lipid solubility of the drug faster is its redistribution. The drugs with high lipid solubility and faster redistribution are - thiopentone and diazepam. | Pharmacology | null | [
"digoxin",
"mannitol"
] | 58,152 |
0a352295-31c3-44f6-851c-9993eea0c9bc | Which of the following causes minimum bone marrow suppression ? | Bleomyc | 5FU | cytosar | ['hycamtin'] | 0a
| single | Ans. is `a' i.e., Bleomycin Marrow sparing anticancer drugs- Vicristine, bleomycine and L-asparaginase. | Pharmacology | null | [
"cytarabine",
"topotecan"
] | 58,154 |
41fd6139-d73a-4d41-925d-1a8b324b982d | Drug causing megaloblastic anemia is : | INH | chloromycetin | Pyrimethamine | aldomet | 2c
| single | null | Pharmacology | null | [
"methyldopa",
"chloramphenicol"
] | 58,172 |
a29ce887-4c57-445a-8bd3-203c1b65bda5 | Complication of restasis therapy is: | Hypeension | Pulmonary fibrosis | corneal deposits | Nephrotoxicity | 0a
| single | Cyclosporine selectively suppresses cell-mediated immunity, prevents graft rejection and vet leaves the recipient with enough immune ctivity to combat bacterial infection. Unlike cytotoxic immunosuppressants, it is free of toxic effects on bone marrow and RE system. Humoral immunity remains intact. However, it is a nephrotoxic-the major limitation and impairs liver function. Other adverse effects are sustained the rise in BP, precipitation of diabetes, anorexia, lethargy, hyperkalemia, oppounistic infections, hirsutism, gum hyperplasia, tremor and seizures. Cyclosporine is the most effective drug for the prevention and treatment of graft rejection reaction. It is routinely used in the renal, hepatic, cardiac, bone marrow and other transplantations. For induction, it is staed orally 12 hours before the transplant and continued for as-long-as needed. ESSENTIALS of MEDICAL PHARMACOLOGY SIXTH EDITION -KD TRIPATHI Page:854 | Pharmacology | Immunomodulators | [
"cyclosporine"
] | 58,176 |
05084280-941a-44d6-84f0-3ca65dc21a53 | Latest (most recent) oral direct thrombin inhibitor is - | Ximelagatran | Indraparinux | Dabigatran | arixtra | 2c
| single | Ans is 'c' i.e. Dabigatran o Ximelagatran was the first oral direct thrombin inhibitor approved; however, it was subsequently withdrawn from the market because of repos of liver failure. o Recently a new oral direct inhibitor, dabigatran, was approved for use in Europe for prevention of various thromboembolism in patients who have undergone hip or knee replacement surgery. | Pharmacology | null | [
"fondaparinux"
] | 58,177 |
87db442a-c2df-445e-b60e-1da74d0f48b4 | All of the following are used for secondary prevention of MI except? | Aspirin | Statins | Beta-blockers | jantoven | 3d
| multi | Aspirin and clopidogrel have been shown to reduce moality due to MI. Statins regress atherosclerosis and b blockers which have an oxygen conserving action will prevent future episode of MI. Warfarin is not routinely used in post-MI patients. | Medicine | Acute coronary syndrome | [
"warfarin"
] | 58,203 |
a349a3b9-f511-4876-ad9c-232139b7309f | Drug of choice in postpaum hemorrhage resistant to oxoject and Ergomterine: | hemabate | cervidil | Dinoprost | cytotec | 0a
| single | Treatment for PPH - IV oxytocin ( 10 - 20 units drip ) ( DOC ) .when oxytocin given in bolus it can cause profound hypotension. thus, oxytocin should be given as a dilute solution by continuous intravenous infusion IV methyl ergometrine 0.2 mg ( peak act at 90 sec ) - IM also can be given Tab misoprostol ( PGE1 ) - 1000 mg / rectum Injection carboprost ( PGF2 a) * IM only * IV - sudden HTW | Gynaecology & Obstetrics | JIPMER 2018 | [
"carboprost",
"oxytocin",
"misoprostol",
"dinoprostone"
] | 58,211 |
76c5cb90-d172-48df-a76c-8e6ed1280bc4 | A patient presented with Hypovolemeia and Na is 154, The initial treatment includes | Normal saline | 1/2 N saline with 5% dextrose | macrodex 40 | Ringer's lactate | 0a
| single | (A) Normal saline | Surgery | Miscellaneous | [
"dextran"
] | 58,227 |
9d7e0a18-df18-4326-884f-95d456778070 | Most cardiotoxic local anaesthetic is? | exparel | novocaine | Prilocaine | rectacaine | 0a
| single | Ans. is 'a' i.e., Bupivacaine Bupivacaine (Sensoricaine, Marcaine) Bupivacaine is 2nd most commonly used local anaesthetic (after lidocaine). Bupivacaine has the highest local tissue irritancy amongst local anaesthetics. It is the most cardiotoxic local anaesthetic. Levobupivacaine (The S(-) enantiomer of bupivacaine) is less cardiotoxic and less prone to cause seizure. o Concentrations used for bupivacaine are : - Nerve block : 0.5%, Epidural : 0.25 - 0.5 %, and spinal : 0.5%. o Maximum safe dose is 2 mg/kg without adrenaline and 3mg/kg with epinephrine. | Anaesthesia | null | [
"procaine",
"bupivacaine",
"dibucaine"
] | 58,236 |
942042a7-c08a-4450-88d4-c7b95ff64f55 | oxoject challenge test for assessing fetal well-being is contraindicated in all except : | Placenta pre | Previous 2 LSCS | Breech | Premature labour | 2c
| multi | Contraindications compromised fetus previous history of CS Complications likely to produce premature labour APH multiple pregnancy D.C.DUTTA'S TEXTBOOK OF GYNECOLOGY,pg no:501,7th edition | Gynaecology & Obstetrics | Diagnosis in obstetrics | [
"oxytocin"
] | 58,256 |
fba9a718-4b25-403d-97d1-4a1b318b90e6 | Substrate controlled hormone is: | glucagen | FSH | LH | TRH | 0a
| single | Blood glucose and amino acids are the substrates for glucagon. The levels of these substrates control the glucagon secretion. Glucagon secretion is stimulated by: Hypoglycemia, increase amino acids, stress, exercise, sympathetic stimulation Glucagon secretion is inhibited by: Insulin, increase blood glucose, somatostatin. Hypoglycemia is the most impoant stimulus. Protein rich meal and serum amino acids stimulate glucagon and insulin secretion. Arginine stimulates both glucagon and insulin secretion; alanine stimulates only glucagon secretion directly. | Physiology | Endocrine System | [
"glucagon"
] | 58,265 |
aebac434-fee8-4c15-a158-956d02511d1f | Plasma concentrations (g/mL) after administration of 5. 1 mg/kg of garamycin intravenously to a hypothetical patient has shown in the Graph. The red color depicted in the graph is dose given at | 24 hours | 12 hours | 8 hours | Threshold | 0a
| single | Ans: A | Pharmacology | Miscellaneous (Pharmacology) | [
"gentamicin"
] | 58,276 |
a894d0aa-4698-4e9b-a9fa-3f227f929f03 | The chemotherapeutic agents "endoxana" is associated with which side effects (SELECT 1 SIDE EFFECT) | Hemorrhagic cystitis | Renal failure | Tympanic membrane fibrosis | Necrotizing enterocolitis | 0a
| single | Cyclophosphamide is an alkylating agent that cross-links DNA and also inhibits DNA synthesis. Hemorrhagic cystitis and alopecia are common side effects. Cisplatin causes renal damage and neural toxicity. Patients must be well hydrated. Its mode of action does not fit a specific category. Taxol can produce allergic reactions and bone marrow depression. Bleomycin and doxorubicin are antibiotics whose side effects are pulmonary fibrosis and cardiac toxicity, respectively Vincristine arrests cells in metaphase by binding microtubular proteins and preventing the formation of mitotic spindles. Peripheral neuropathy is a common side effect. | Gynaecology & Obstetrics | Fetal Skull and Maternal Pelvis | [
"cyclophosphamide"
] | 58,289 |
4303ca51-83ff-48b1-b426-97246f310a5e | Lactic acidosis is a side effect of | diuril | glucophage | restasis | nebupent | 1b
| single | (B) Metformin # LACTIC ACIDOSIS: occurs when the rate of production of lactic acid from pyruvate in muscle, skin, brain & erythrocytes exceeds the rate of removal by liver & kidney.# Causes of Lactic Acidosis:# Group A (Due to poor tissue perfusion)> Shock from any cause, Respiratory failure, Severe anaemia, Mitochondrial enzyme inhibitor (Cyanide or CO)# Group B (Due to aerobic disorder)> Diabetes mellitus; Hepatic failure; Renal failure; Severe infection (cholera, malaria)> Malignancies; Seizures> Drugs (biguanides such as metformin, salicylates, isoniazid, sorbitol, AZT analogues, fructose)> Toxins (ethanol, methanol), Congenital enzyme defect | Pharmacology | Miscellaneous (Pharmacology) | [
"pentamidine",
"cyclosporine",
"metformin",
"chlorothiazide"
] | 58,291 |
02bec161-a6e1-4209-8ce0-c76d7bcd392a | Which is NOT an alkylating agent? | 5-FU | leukeran | Melphalan | endoxana | 0a
| single | Ans. is 'a' i.e., 5 Fluorouracil Alkylating agentsAlkylating agents are antineoplastic agents having alkyl groups in their structure. They exert their cytotoxic effect via transfer of their alkyl group to the various cellular constituents.Alkylation of D.N.A. is the major interaction that leads to cell death.Before transferring their alkyl group, the drugs undergo intramolecular cyclization to form an ethylene immonium ion that may directly or through formation of carbonium ion transfer an alkyl group.The major site of alkylation within the DNA is the N7 position of Guanine with D.N.A.Major types of Alkylating agents used in the chemotherapy of neoplastic diseases B15 (chloro ethylamines), Nitrogen mustardsCyclophosphamideMechlorethamineChlorambucilMelphalanIfosfamide NitrosoureasCarmustineLomustineSemustineStreptozocin AziridinesThiotepaAltretamine Alkyl sulfonateBusulfanIn addition for pedagogical reasons, the methyl hydrazine and platinum complexes are included under alkylating agents even though the latter do not formally alkylate DNA and exhibit a different means to form covalent adducts.Platinum compoundsCisplatinOxaliplatinCarboplatinNedaplatinTriazene, methyl hydrazineProcarbazineAltretamine (hexamethyl melamine)Dacarbazine | Pharmacology | Anti-Neoplastic Agents | [
"cyclophosphamide",
"chlorambucil"
] | 58,294 |
0a2cc35a-a16d-4882-838a-4e8c57511a29 | All are true regarding oral hypoglycemic agent, EXCEPT : | Effective only after total pancreatectomy | glucophage causes lactic acidosis | Causes release of insulin from beta-cells | Useful in obese maturity onset diabetics | 0a
| multi | Ans. is 'a' Effective only after total pancreatectomy Mechanism of action of sulfonylureasPresence of at least 30% functional pancreas is necessary for the action of oral hypoglycemics (Sulfonyl ureas).They act on sulfonylurea receptors present on beta cells of pancreas. This increase insulin secretion.Oral hypoglycemics are used only in uncomplicated type 11 diabetes (N1DDM).Both phenformin and metformin cause lactic acidosis (Phenformin > metformin). | Pharmacology | Anti Diabetes | [
"metformin"
] | 58,296 |
79bb99af-ec35-4d8c-882c-8254e7db2444 | A 60-year-old diabetic woman develops angina and will need a coronary angiogram for evaluation of coronary artery disease. She has a creatinine of 2.2. Which of the following is the most effective in reducing the risk of contrast-induced nephropathy? | Administer osmitrol immediately after the contrast is given. | Perform prophylactic hemodialysis after the procedure. | Give IV hydration with normal saline or sodium bicarbonate prior to and following the procedure. | indocin 25 mg the morning of the procedure. | 2c
| single | Contrast agents harm the kidney by causing the production of oxygen radicals and by causing vasoconstriction, both of which can lead to acute kidney injury. Patients with underlying kidney disease at baseline, those with diabetes, congestive heart failure, multiple myeloma, and dehydration are at greatest risk of this complication. Pre-hydration with IV normal saline or bicarbonate has been proven to decrease the risk of contrast nephropathy. V-acetylcysteine is also used by some clinicians for prevention, though studies have not been as convincing as those using saline or bicarbonate. Mannitol, dopamine, and prophylactic hemodialysis have been studied and found ineffective in preventing contrast nephropathy. Indomethacin would cause further vasoconstriction and is contraindicated in patients with renal insufficiency. | Medicine | Kidney | [
"indomethacin",
"mannitol"
] | 58,298 |
b4544941-7c0b-4eaf-959e-7b7c11c457a2 | Stage 2 block (Phase II block) is seen with: | quelicin | isoflo | ultane | ethrane | 0a
| single | Ref: Miller Textbook of Anaesthesia. 6th edition.Explanation:Succinyl Choline - Mechanism of action1. Phase 1 block (depolarizing)Succinylcholine is the only clinically useful depolarizing blocking drug.Its neuromuscular effects are like those of acetylcholine except that succinylcholine produces a longer effect at the myoneural junction.Succinylcholine reacts with the nicotinic receptor to open the channel and cause depolarization of the motor end plate, and this in turn spreads to the adjacent membranes, causing contractions of muscle motor units.Because succinylcholine is not metabolized effectively at the synapse, the depolarized membranes remain depolarized and unresponsive to subsequent impulses (ie, in a state of depolarizing block).Furthermore, because excitation-contraction coupling requires end plate repolarization ("reprintmg") and repetitive firing to maintain muscle tension, a flaccid paralysis results.This so-called phase 1 (depolarizing) block is thus augmented, not reversed, by cholinesterase inhibitors.2. Phase II block (desensitizing)With continued exposure to succinylcholine, the initial end plate depolarization decreases and the membrane becomes repolarized.Despite this re polarization, the membrane cannot easily be depolarized again because it is desensitized.The mechanism for this desensitizing phase is unclear, but some evidence indicates that channel block may become more important than agonist action at the receptor in phase II of succinylcholine' s neuromuscular blocking action.Later in phase II. the characteristics of the blockade are nearly identical to those of a nondepolarizing block (ie, a nonsustained twitch response to a tetanic stimulus), with reversal by acetylcholinesterase inhibitors. | Anaesthesia | Depolarising Neuromuscular Blocking Agents | [
"suxamethonium",
"sevoflurane",
"enflurane",
"isoflurane"
] | 58,306 |
cb1196da-6548-4137-bb38-bbb7d352b666 | Which of the following is not a 4 — Aminoquinolone? | resochin | Amodiaquine | Primaquine | lariam | 2c
| single | null | Pharmacology | null | [
"mefloquine",
"chloroquine"
] | 58,316 |
235219b1-3469-49b9-a775-594164789556 | The volatility of an anesthetic agent is directly propoional to lowering the flow in the poal vein. Poal flow is maximally reduced by: | Ether | fluothane | isoflo | ethrane | 1b
| multi | Halothane reduces splanchnic and hepatic blood flow as a consequence of reduced perfusion pressure. This reduced blood flow has not been shown to produce detrimental effects on hepatic or GI function. The metabolism and clearance of some drugs (eg, fentanyl, phenytoin, verapamil) appear to be impaired by halothane. Ref: Morgan, Jr. G.E., Mikhail M.S., Murray M.J. (2006). Chapter 7. Inhalation Anesthetics. In G.E. Morgan, Jr., M.S. Mikhail, M.J. Murray (Eds), Clinical Anesthesiology, 4e. | Anaesthesia | null | [
"enflurane",
"isoflurane",
"halothane"
] | 58,339 |
5342bb8b-89a6-4daa-a86a-9af94b53f397 | All of the following drugs can be used in hypeensive crisis except:- | trandate | visken | nitropress | adalat | 1b
| multi | Pindolol is non-selective b blocker and not used in hypeensive emergencies. Labetalol is DOC for gestational hypeension as well as hypeensive emergencies in pregnancy. Nitroprusside is DOC for hypeensive emergencies in patients with aoic dissection. Nifedipine can be used rarely for the rapid control of blood pressure but the route of administration is sub-lingual. Nicardipine and Clevidipine are also DOC for hypeensive emergencies. DRUGS USED FOR HYPEENSIVE EMERGENCIES Group Drugs Vasodilators Sodium NitroprussideNitroglycerineHydralazine Calcium channel blockers NicardipineClevidipineNifedipine Alpha blockers PhentolamineTolazolineUrapidil Beta blockers LabetalolEsmolol ACE inhibitor Enalaprilat D1 agonist Fenoldopam Diuretic Furosemide | Pharmacology | Hypeension, Arrhythmias, Dyslipidemia | [
"nitroprusside",
"nifedipine",
"pindolol",
"labetalol"
] | 58,345 |
79349bb7-3941-4806-87af-ae7e15ebb261 | Which one of the following cofactors must be utilized during the conversion of acetyl CoA to malonyl CoA? | Thiamine pyrophosphate | Acyl carrier protein | FAD | appearex | 3d
| single | The key enzymatic step of fatty acid synthesis is the carboxylation of acetyl CoA to form malonyl CoA. The carboxyl of biotin is covalently attached to an e-amino acid group of a lysine residue of acetyl CoA carboxylase. The reaction occurs in two stages. In the first step, a carboxybiotin is formed: HCO3- + biotin-enzyme + ATP - CO2-biotin-enzyme + ADP + Pi In the second step, the CO2 is transferred to acetyl CoA to produce malonyl CoA: CO2-biotin-enzyme + acetyl CoA -- malonyl CoA + biotin-enzyme None of the other cofactors listed are involved in this reaction. Ref:Bender D.A. (2011). Chapter 44. Micronutrients: Vitamins & Minerals. In D.A. Bender, K.M. Botham, P.A. Weil, P.J. Kennelly, R.K. Murray, V.W. Rodwell (Eds),Harper's Illustrated Biochemistry, 29e. | Biochemistry | null | [
"biotin"
] | 58,358 |
eb3fba89-962f-4dd2-ab02-b3c9f996f00a | Which of the following hormones regulates blood levels of 1,25-OH-cholecalciferol positively: | synthroid | Parathormone | Insulin | Calcitonin | 1b
| single | PTH - PTH acts in a positive feed forward manner in regulating vitamin D in response to | S. Ca At Ca2+ concentration below 9-10 mg /100 ml PTH promotes conversion of 25 -OH-cholecalciferol to 1,25 di OH cholecalciferol in the kidneys CALCITONIN - Peptide hormone secreted by thyroid gland - parafollicular cells / C. cells - Tends to decrease serum Ca level that is effect opposite to PTH INSULIN - Causes intracellular movement of plasma glucose | S. glucose | Physiology | FMGE 2018 | [
"thyroxine"
] | 58,362 |
d27fcb75-fb47-4d0f-b223-7476f4665b34 | Which of the following best explains why Lignocaine has a higher fetal-to-maternal plasma ratio when compared with exparel? | exparel has low molecular weight | Lignocaine has higher protein-binding | exparel has a lower dissociation constant (pKa) | Lignocaine is less protein bound | 3d
| single | Lignocaine is less protein bound than bupivacaine. Unbound form of drug thus easily gets transferred across placenta. | Anaesthesia | null | [
"bupivacaine"
] | 58,372 |
ed48098f-352b-4e46-8ab1-2fa967b70df2 | stimate is a synthetic analog of ADH. It is preferred over arginine pitressin in the treatment of diabetes insipidus for all of the following reasons EXCEPT: | It is a more potent antidiuretic | It is a selective pitressin V1 receptor agonist | It has a little vasoconstrictor activity | It is longer acting | 1b
| multi | Vasopressin can act on V1 and V2 receptors whereas desmopressin is a selective V2 receptor agonist. Desmopressin: It is a more potent antidiuretic It is longer acting It has a little vasoconstrictor activity | Pharmacology | Kidney | [
"desmopressin",
"vasopressin"
] | 58,397 |
cd1ee472-eb50-4424-ad4d-1ae4ed1ee8d9 | pilagan is a - | Muscarinic cholinergic drug | Nicotinic cholinergic drug | Alpha-adrenergic drug | Beta-adrenergic drug | 0a
| single | Ans. is 'a' i.e., Muscarinic cholinergic drug Cholinomimetic drug|||With muscarinic actionWith Nicotinic Actiono Acetylcholineo Methacholineo Carbacholo Bethanecholo Pilocarpineo Muscarineo Arecholineo Acetylcholineo Carbacholo Arecholine | Pharmacology | A.N.S. | [
"pilocarpine"
] | 58,413 |
78627b6b-c15d-4122-a3e0-eaac64093afb | In unconjugated hyperbilirubinemia, the risk of kernicterus increases with the use of – | rocephin | Phenobarbitone | penbritin | Sulphonamide | 3d
| single | The administration of sidfonamides to newborn infants, especially if premature, may lead to the displacement of Bilirubin from plasma albumin. In newborn infants, free Bilirubin can become deposited in the basal
subthalamic nuclei of the brain 'causing an encephalopathy called kernicterus. Sulfonamides should not be given to pregnant women near term because these drugs pass through the placenta and are secreted in milk.
Kernicterus is due to unconjugated hyperbilirubinemia. | Pediatrics | null | [
"ampicillin",
"ceftriaxone"
] | 58,414 |
eab27d56-06e8-4999-8c49-19418415e456 | Which of the following drug can be given in a case of combined gonococcal and nongonococcal cervicitis? | rocephin | zithromax | proquin | Cefixime | 1b
| single | Currently ceftriaxone is the mainstay of therapy for uncomplicated gonococcal infection of the urethra, cervix, rectum or pharynx. Alternative regimens for uncomplicated gonococcal infection are: Gemifloxacin plus Azithromycin Gentamycin plus Azithromycin Because of co- infection with C. Trachomatis initial treatment regimen must incorporate azithromycin (extended release microsphere formulation) or doxycycline. Rising MIC of cefixime has resulted in CDC to discontinue its recommendation. | Medicine | Bacterial infection | [
"azithromycin",
"ciprofloxacin",
"ceftriaxone"
] | 58,422 |
85caedbb-2cb5-4f54-9e81-76c2c407301e | A 15-year-old type I diabetic faints after injecting himself with insulin. He is administered glucagen and rapidly recovers consciousness. glucagen induces activity of: | Glycogen synthase | Glycogen phosphorylase | Glucokinase | Hexokinase | 1b
| single | Glucagon (catabolic hormone) activates the Rate limiting enzyme of glycogenolysis (catabolic pathway) i.e. Glycogen phosphorylase. ADDITIONAL EDGE: Fig.: In fasting state, Glucagon hormone is released. Regulation of glycogen metabolism at the level of glycogen phosphorylase: cAMP activates phosphorylase kinase (by a cAMP-dependent protein kinase), which in turn activates glycogen phosphorylase. Calcium activates the calmodulin component of phosphorylase kinase directly, which in turn activates glycogen phosphorylase. 5' AMP acts allosterically to activate glycogen phosphorylase. Protein phosphatase-1 inactivates glycogen phosphorylase. | Biochemistry | Diabetes | [
"glucagon"
] | 58,429 |
2e65a736-a4fd-4d39-8b7c-a375e1779a2a | SLE like syndrome may be produced by all except:- | Sulfonamide | Psoralen | apresoline | pronestyl | 1b
| multi | Drugs causing DLE ( Drug induced Lupus Erythematosus ) can also be asked as drugs undergoing metabolism by liver acetylation. Such drugs are: C- SHIP C-Chlorpromazine S - Sulfonamides H - Hydralazine I - Isoniazid P - Procainamide | Medicine | Systemic Lupus Erythematous | [
"hydralazine",
"procainamide"
] | 58,441 |
f40fab15-efbd-49ae-96e0-9ffb5ec6e3cd | All of the following drugs can be given to a mother with lupus after 35th week of gestation, except: | resochin | trexall | Sulphadiazine /Sulphasalazine | orapred | 1b
| multi | Methotrexate is a folic acid antagonist and it is contraindicated in pregnancy. It is highly teratogenic. The metabolites are active in the cells and tissues even after several weeks to months following discontinuation. So it is usually recommended to stop 3-6 months prior to the planned conception. Ref: Prescribing in Pregnancy edited by Peter C. Rubin, Margaret Ramsey, Pages 105, 103; Oxford textbook of medicine, Volume 1 By D. A. Warrell, Timothy M. Cox, John D. Fih, Page 752; Drugs During Pregnancy and Lactation By Christof Schaefer, Pages 166; Harrison textbook of medicine 17th edition, Pages 1291, 1272, 2082. | Gynaecology & Obstetrics | null | [
"methotrexate",
"prednisolone",
"chloroquine"
] | 58,461 |
ee998901-aeb1-4859-a627-b2475c045118 | Commonest cause of hypothyroidism is | Defective synthesis of synthroid | Defect of iodide transport | Defect of the thyroglobulin synthesis | Thyroid dysgenesis | 3d
| single | (Thyroid dysgenesis) (1872-73-Nelson 17th) (481-Ghai 7th)HYPOTHYROIDISM results from deficient production of thyroid hormone or a defect in thyroid hormone or a defect in thyroid hormonal receptor activity* Someform of thyroid dysgenesis (aplasia, hypoplasia or an ectopic gland) is the most common cause of congenital hypothyroidism, accounting for 85% of cases, 10% are caused by an in bom error of thyroxine synthjesis and 5% are the result of transplacental maternal thyrotropin receptor blocking antibody.* Pendred syndrome - congenital hypothyroidism with sensorineural deafness and goiter, also have a positive perchlorate discharge.* ** Sodium L-thyroxine given orally is the treatment of choices (side effects are - craniosynostosis and temperature problems pseudotumour cerebri)* Acquired hypothyroidism - is most commonly caused by auto immune destruction of thyroid as a part of Chronic lymphocytic thyroidits (Hashimoto's thyroiditis | Pediatrics | Endocrinology | [
"thyroxine"
] | 58,467 |
b3029346-c375-4e3d-9ac3-6a3a03a57da9 | Which of the following anti-HIV drug should never be given as rechallenge once history of producing allergic reaction with drug is known? | epivir | Abacavir | retrovir | viracept | 1b
| multi | Abacavir (ABC) This guanosine analogue is a potent ARV drug that acts after intracellular conversion to carbovir triphosphate. Resistance to ABC develops slowly, and it exhibits little cross resistance with other Nis. Its oral bioavailability is 80% and it is mainly eliminated by metabolism. The plasma half life is 1-1.5 hour, but intracellular half life of active metabolite is > 12 hours. Hypersensitivity reactions such as rashes, fever, flu-like symptoms are the major problems. Some fatalities have occurred when patients developing the reaction were given fuher doses of ABC. Avoidance of alcohol is advised. ESSENTIALS OF MEDICAL PHARMACOLOGY K.D.TRIPATHI SIXTH EDITION PAGE NO:772 | Pharmacology | Chemotherapy | [
"lamivudine",
"nelfinavir",
"zidovudine"
] | 58,476 |
9cca7487-042e-4905-a03d-5404749d0f7a | Sympathomimietic causing increase in mean blood pressure, hea rate and cardiac output on intravenous infusion is? | Adrenaline | Isoprenaline | Norepinephrine | vazculep | 0a
| single | Ans. is 'a' i.e., Adrenaline | Pharmacology | null | [
"phenylephrine"
] | 58,491 |
a2c1b8d2-6d39-4eba-a0da-6ef94e34a6b1 | The production of cervical mucus is stimulated by | Progesterone | Pregnenolone | incurin | Estradiol | 3d
| single | Cervical mucus is a glycoprotein gel that expand and contract in response to cyclic changes in the steroid hormone environment across the menstrual cycle to facilitate or inhibit the passage of sperm
Estrogen stimulates cervical mucus production, and as levels rise during the follicular phase, mucus becomes more abundant and watery, less cellular, and more easily penetrated by sperm
Progesterone inhibits cervical mucus production and renders it opaque, viscid, and impenetrable | Gynaecology & Obstetrics | null | [
"estriol"
] | 58,507 |
4dc98531-af49-4923-9269-fd1fde318ecb | Androgen receptor blocking drug is- | nolvadex | cyprostat acetate | mifeprex | Nalondrone | 1b
| single | Ans. is 'b' i.e., Cyproterone acetate | Pharmacology | null | [
"mifepristone",
"tamoxifen",
"cyproterone"
] | 58,529 |
9a586a37-fb87-4f57-91ae-0ac9a0c6354d | A 26-year old lady has just recovered from acute manic episode. She has a diagnosis of bipolar affective disorder. Which one of the following is not used for the prophylaxis of the condition? | tegretol | Lithium | Semisodium depakene | largactil | 3d
| single | Lithium, Semi Sodium Valproate (Depakote) and Carbamazepine are used in prophylaxis of Bipolar disorder. Lithium is the drug of choice but it will require frequent blood level montoring due to it's narrow therapeutic index. Sodium valproate cannot be used in women of child bearing age due to possible teratogenicity to the foetus. All mood stabilisers work by preventing manic episodes. They have very little effcet on the depression. However, if mania is controlled the episodes of depression are likely to be insignificant. Chlorpromazine is an old generation anti-psychotic. | Psychiatry | null | [
"valproate",
"chlorpromazine",
"carbamazepine"
] | 58,537 |
a9f0c5d5-ec3b-4d52-82bb-4b25b0769a48 | Which of the following binds to viral envelope glycoprotein preventing the conformational changes required for the fusion of viral and cellular membranes? | Abacavir | crixivan | Enfuviide | tamiflu | 2c
| single | Enfuviide is a fusion inhibitor useful in the treatment of HIV infections. It acts by binding to HIV-I envelope transmembrane glycoprotein (gp41) which is involved in fusion of viral and cellular membranes. Abacavir is a NI Indinavir is a protease inhibitor Oseltamivir is a neuramindase inhibitor. | Pharmacology | Anti-HIV Drugs | [
"oseltamivir",
"indinavir"
] | 58,542 |
b64d13a0-9735-4203-985d-fe69364e03f1 | A child presents with infective skin lesion of the leg. A culture was done which showed gram+ve cocci in chains which were hemolytic colonies. The test to confirm the organism is | Bile solubility | Optochin sensitivity | baci-im sensitivity | Catalase positive | 2c
| single | The culture is suggestive of infection with Streptococcus pyogenes which is gram-positive, occurring in chains and beta-hemolytic. A convenient method for the identification of Streptococcus pyogenes is based on Maxted's observation that they are more sensitive to bacitracin than other streptococci. Bacitracin sensitivity test: A filter paper disc of 0.04U is applied on the surface of an inoculated blood agar. After incubation, a wide zone of inhibition is seen with Streptococcus pyogenes and not with other streptococci. Reference: Textbook of Microbiology; Anathanarayan and paniker's; 10th edition; Page no: 217 | Microbiology | Bacteriology | [
"bacitracin"
] | 58,548 |
a66cbc7e-838c-487a-9582-2ed7084124c0 | A 54-year-old man comes to the emergency room complaining of severe pain in his right toe. The pain is interfering with his ability to walk and he reports no prior trauma to the toe. He has had multiple less severe episodes in the past, which he always treats with pain medications.On physical examination, the toe is red, inflamed, and exquisitely sensitive to movement. An x-ray of the toe is normal and needle aspiration of the joint confirms uric acid crystals. He is treated with oral indocin (NSAID) for 7 days, and 1 month later he remains symptom free. caplenal is recommended for prevention of this condition. Which of the following is the most likely mechanism of action of caplenal? | inhibition of xanthine oxidase | solubilization of uric acid | reactivity with hypoxanthine | anti-inflammatory effect on joint tissue | 0a
| multi | Allopurinol inhibits the enzyme xanthine oxidase, resulting in decreased uric acid production. Allopurinol is particularly useful in the treatment of uric acid nephrolithiasis in gouty individuals. Even if the gouty individual has calcium oxalate stones, allopurinol may be helpful. | Medicine | Endocrinology | [
"indomethacin",
"allopurinol"
] | 58,566 |
53531f0c-becb-4175-b637-b2a626815848 | Which of the following inhalational agents has the minimum blood gas solubility coefficient? | isoflo | ultane | suprane | Nitrous oxide | 2c
| single | C i.e. Desflurane Pungent volatile anesthetic agents are desflurane, isoflurane, enflurane and etherQ. (Mn-"DIE') Volatile Anesthetic Agent Physical propey Blood/ Gas paition coefficient Xenon Colourless, odourless, nonirritating (i.e. non pungent) 0.115 Low B/G Coeffiecient = Low solubitity in blood i.e. fast induction & rapid recoveryQ Desflurane Pungent (irritating / unpleasant to inhale) 0.42 Nitrous oxide (N20) Colourless, sweet smelling, non irritant (i.e. non pungent) 0.47 Sevoflurane Colourless, non pungent 0.69 Isoflurane Pungent ethereal odor (i e. moderately irritating) 1.4 Mn-"Xena- Dislikes No Save" "IE HEAT" Enflurane Pungent 1.9 Halothane Colourless, non irritating (non pungent/pleasant) odor 2.5 High B/G coefficient = High solubility in blood i.e. Slow induction & slow recoveryQ Ether Extremely irritating (pungent) 12 * Because of lack of chlorine / bromine ions; sevoflurane & desflurane have no effect on ozone layer. Pungent = Unpleasant= Causing Cough = Irritant | Anaesthesia | null | [
"sevoflurane",
"isoflurane",
"desflurane"
] | 58,575 |
b677bcc3-888d-4d44-b7fb-7f9f402b0b51 | gleevec mesylate used in the treatment of GIST is a inhibitor of | IL-12 | TNF-x | Tyrosine kinase | VEGE | 2c
| single | Imatinib mesylate used in the treatment of GIST ( GastroIntestinal Stromal Tumours) is a c-kit(transmembrane receptor tyrosine kinase) tyrosine kinase inhibitor. GIST is rare but most common nonepithelial small bowel tumours. More than 95% show c-kit mutation. Reference : page 877 SRB's manual of surgery 5th edition | Surgery | Urology | [
"imatinib"
] | 58,580 |
8fcbac56-dedf-41c2-baa9-7763fef26fff | Which of the following drugs is not used in prostate carcinoma | Finasteride | apstil | Testosterone | eulexin | 2c
| single | Ref-KDT 6/e p291 Prostatic carcinoma results due to excessive testosterone. Testosterone is cnveed to dihydrotestosterone (DfT) by 5-alpha reductase. DfI is responsible for prostatic growth Flutamide is an androgen rereptor antagonist whereas finasteride is reductase inhibitor. Both of these drugs can be used in pros tatic cancer. Diethylstilbesterol is an estrogen. It will cause feedback inhibition of pituitary and hypothalamus. Decreased secretion of GnRH (LH and PSH) results in the decrease in testosterone. It was also used previously for orostatic carcinoma. | Anatomy | Other topics and Adverse effects | [
"diethylstilbestrol",
"flutamide"
] | 58,587 |
df8b9891-888c-4851-96e0-43fc4496715a | Active form of Vitamin D is:March 2011, March 2013 (a, e, g) | Cholecalciferol | 24, 25 hydroxy Vitamin D | 1, 25 hydroxy Vitamin D (calcijex) | 25, hydroxyl Vitamin D | 2c
| single | Ans. C: 1, 25 hydroxy Vitamin D (Calcitriol)Calcitriol (1, 25-DHCC) is the biologically active form of vitamin DCalcitriol/ 1, 25-dihydroxycholecalciferol/ 1,25-dihydroxyvitamin D3It is the hormonally active form of vitamin D with three hydroxyl groups (abbreted 1,25-(OH)2D3 or simply 1, 25 (OH)2D).It increases the level of calcium (Ca2+) in the blood by (1) increasing the uptake of calcium from the gut into the blood, (2) decreasing the transfer of calcium from blood to the urine by the kidney, and (3) increasing the release of calcium into the blood from boneCalcitriol increases blood calcium levels () by promoting absorption of dietary calcium from the gastrointestinal tract and increasing renal tubular reabsorption of calcium thus reducing the loss of calcium in the urine.Calcitriol also stimulates release of calcium from bone by its action on the osteoblasts, causing them to release RANKL, which in turn activates osteoclasts.Calcitriol acts in conce with parathyroid hormone (PTH) in all three of these roles.For instance, PTH also stimulates osteoclasts.However, the main effect of PTH is to increase the rate at which the kidneys excrete inorganic phosphate (Pi), the counterion of Ca2+.The resulting decrease in serum phosphate causes Ca5 (PO4)30H to dissolve out of bone thus increasing serum calcium.PTH also stimulates the production of calcitriol.Many of the effects of calcitriol are mediated by its interaction with the calcitriol receptor, also called the vitamin D receptor or VDR.The maintenance of electroneutrality requires that the transpo of Ca2+ ions catalyzed by the intestinal epithelial cells be accompanied by counterions, primarily inorganic phosphate.Thus calcitriol also stimulates the intestinal absorption of phosphate.Calcitriol also inhibits the release of calcitonin, a hormone which reduces blood calcium primarily by inhibiting calcium release from bone.Calcitriol is produced in the cells of the proximal tubule of the nephron in the kidneys by the action of 25-hydroxyvitamin D3 1-alpha-hydroxylase, a mitochondrial oxygenase and an enzyme which catalyzes the hydroxylation of 25-hydroxycholecalciferol (calcifediol).The activity of the enzyme is stimulated by PTH.The reaction is an impoant control point in Ca2+ homeostasis.The production of calcitriol is also increased by prolactin, a hormone which stimulates lactogenesis, a process which requires large amounts of calcium. | Anatomy | null | [
"calcitriol"
] | 58,595 |
5b956614-2df7-4084-91a4-37f71b18ce00 | antabuse is a type of | Aversion therapy | Anticraving therapy | Detoxification | Opioid management therapy | 0a
| single | Disulfiram inhibits Aldehyde dehyrogenase enzyme and leads to accumulation of Acetaldehyde resulting in aversive symptoms. | Psychiatry | null | [
"disulfiram"
] | 58,600 |
22893d48-957c-4ff3-9830-07924a7021d3 | vasotec increases the levels of which of the following ? | Bradykynin | Interferon | PAF | TNF | 0a
| single | null | Pharmacology | null | [
"enalapril"
] | 58,606 |
e61320ca-ce9d-4acd-93d7-2823eb5a67dd | All of the following are anticoagulant ,except | Phytonadione | jantoven | LMW heparin | Lepirudin | 0a
| multi | Phytonadione is Vit K. All others are anti coagulants. From essential of medical pharmacology K D Tripati 7th edition Page no 613 | Pharmacology | Hematology | [
"warfarin"
] | 58,617 |
11b8bde2-6539-4460-825f-a99356dd2ff4 | The following is the indication of integrilin | Angina | HIV | CCF | Hypeension | 0a
| single | Eptifibatide, terofiban are the newer antiplatelet drugs(Glycoprotein IIB/IIIA inhibitors) used in unstable anginaRef: Goodman Gillman 12thed. Pg: 871 | Pharmacology | All India exam | [
"eptifibatide"
] | 58,653 |
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