Review of Pharmacology - 9E (2015)

Review of Pharmacology
198. Ans. (a) Amiodarone (Ref: KDT 6/e p511)
199. Ans. (a) Adenosine (Ref: KDT 6/e p519)
200. Ans. (a) Verapamil (Ref: KDT 6/e p519)
201. Ans. (c) Xylocaine (Ref: KDT 6/e p519, CMDT 2014/362)
• DOC for ventricular arrhythmias after MI is lignocaine (lidocaine; xylocaine).
• DOC for supraventricular arrhythmias after MI is beta blockers if cardiac function is adequate.
202. Ans. (a) Diphenylhydantoin (Ref: KDT 6/e p498)
Phenytoin is an alternative to lignocaine for digitalis induced ventricular arrhythmia.
203. Ans. (c) Amiodarone (Ref: Katzung 11/e p241)
204. Ans. (b) Na + channel blockade (Ref: Katzung. 11/e p237)
205. Ans. (b) Decreased absorption of cholesterol (Ref: Katzung 10/e p571; KDT 6/e p618-619)
Ezetimibe is an intestinal cholesterol absorption inhibitor and is combined with statins.
206. Ans. (c) Absorbed good on empty stomach and absorption is delayed by fatty meals (Ref: KDT 6/e p616-617; Katzung 11/e
p615)
Cardiovascular System
• Absorption of fibrates improve when they are taken with food.
• Fibric acid derivatives acts by stimulating LPL by activating a nuclear receptor PPARa (peroxisome proliferators
activated receptor alpha). Major effect of fibrates is to reduce TG (contained in VLDL) and to increase
HDL.
• Fibrates are the drugs of choice in hypertriglyceridemia (type III and IV) and can be used with other drugs in
type IIb Zfenofibrate, as it has maximum LDL reducing action).
• GI distress and elevation of aminotransferases are important adverse effect of fibric acid derivatives. Risk of
myopathy is increased if these are used with statins except bezafibrate.
207. Ans. (d) Fibrinogen levels are increased by pravastatin (Ref: Goodman & Gilman 11/e p950, 951, 952)
Pravastatin has the least chances of drug interactions because it is metabolized by non-microsomal enzymes. It also has
minimum chances of myopathy among statins. Bioavailability of pravastatin is least affected with food intake. It has little
CNS penetration. Most studies indicate that pravastatin decreases serum fibrinogen levels.
208. Ans. (c) Indirect increase of LDL receptor synthesis (Ref: KDT 6/e p614, 615)
For explanation, see text
209. Ans. (c) Niacin (Ref: KDT 6/e p618)
210. Ans. (c) Statins (Ref: KDT 6/e p614)
211. Ans. (d) Nicotinic acid (Ref: Katzung 11/e p613)
212. Ans. (d) Activating lipoprotein lipase, resulting in VLDL degradation (Ref: KDT 6/e p616, 617)
Fibrates activate PPAR-a that results in the increased transcription of genes for lipoprotein lipase.
213. Ans. (b) Nicotinic acid (Ref: KDT 6/e p618)
214. Ans. (b) Niacin (Ref: KDT 6/e p618)
215. Ans. (d) Statins (Ref: KDT 6/e p614, 615)
216. Ans (a) Rofecoxib (Ref: KDT 6/e p534, 197)
• Angiotensin receptor blockers (like losartan) and beta blockers (like metoprolol) are cardioprotective in congestive
heart failure. These decrease the mortality.
• Nicorandil is a potassium channel opener used in angina. It is cardioprotective by causing ischemic preconditioning.
• Rofecoxib is a selective COX-2 inhibitor that was withdrawn due to increased risk of myocardial infarction.
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