Review of Pharmacology - 9E (2015)

Review of Pharmacology
• Adrenal insufficiency has been noted in many cases of septic shock that can be treated by steroids.
• Activated protein C available as drotrecogin alpha is also approved for septic shock.
• Rituximab has no role in treatment of septic shock.
93. Ans. (a) Thrombolytic agent (Ref: KDT 6/e p606, 607)
• Anticoagulants are the mainstay for the treatment of pulmonary embolism.
• Thrombolytic therapy is indicated in massive pulmonary embolism with hemodynamic instability and in hemodynamically
stable patients but with compromised right ventricular function.
94. Ans. (a) Interference with blood group matching (Ref: KDT 6/e p622)
Dextran is a polysaccharide obtained form sugar beat. It is a plasma expander and have all properties of an ideal plasma
expander except :
• May interfere with blood grouping and cross matching.
• Some polysaccharide reacting antibodies if present in patients may cross-react with dextran and trigger an
anaphylactoid reaction.
• They coat the platelets and coagulation factors and may interfere with coagulation and platelet function,
thus prolong bleeding time. It is not used when hypofibrinogenemia, thrombocytopenia or bleeding is present.
• Dextran prevent roleaux formation of RBCs and have anti-sludging effects, thereby increases microcirculation.
[Satoskar 18/e p453].
Hematology
95. Ans. (d) Hemorrhagic stroke (Ref: KDT 6/e p607, 608)
Bleeding is the most common adverse effect of anticoagulants, antiplatelets and fibrinolytic agents. This bleeding can
manifest as hemorrhagic stroke.
96. Ans. (c) Warfarin (Ref: KDT 6/e p604)
Patients of chronic atrial fibrillation are at high risk of developing thromboembolism. Oral anticoagulants are most
frequently advised drugs in these patients to decrease the risk of this adverse effect.
97. Ans. (c) Epsilon amino caproic acid (Ref: KDT 6/e p608)
Tranexamic acid and EACA are antidotes for the management of fibrinolytic drug poisoning.
98. Ans. (c) Argatroban (Ref: Katzung 11/e p592)
It is a case of heparin induced thrombocytopenia (HIT). Four ‘T’ are used to suspect the diagnosis of HIT:
• hrombocytopenia
• Timing of heparin administration (5-14 days) before developing thrombocytopenia
• Thrombosis
• OTher causes of thrombocytopenia not evident.
DOC for HIT is direct thrombin inhibitors like argartroban.
99. Ans. (d) Activates plasminogen bound to fibrin (Ref: KDT 6/e p606)
Fibrinolytics are the drugs which activate plasminogen to form plasmin and thus help in lysis of thrombus. These drugs
can cause bleeding as the major adverse effect due to lysis of physiological thrombi as well as due to excessive amount of
plasmin generated in the circulation.
100. Ans. (b) Dextran 40 (Ref: KDT 6/e p622)
Dextran 40 and 70 interferes with coagulation and platelet function and thus prolong bleeding time and so is not used in
hypofibrinogenemia, thrombocytopenia or in presence of bleeding.
101. Ans. (b) Severe trauma (Ref: KDT 6/e p623)
102. Ans. (a) Supraventricular tachycardia (Ref: KDT 6/e p607-608)
103. Ans. (d) Sepsis (Ref: CMDT/2010, 437)
104. Ans. (b) History of hemorrhagic stroke in past one year (Ref: KDT 6/e p607)
466
105. Ans. (c) Reteplase (Ref: KDT 6/e p606)
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