Review of Pharmacology - 9E (2015)

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Review of Pharmacology Chemotherapy A: General Considerations and Non-specific... 518 Penicillinase resistant penicillins Cloxacillin Oxacillin Nafcillin Dicloxacillin Methicillin C O N D O M Methicillin resistance occurs due to altered PBPs, thus no penicillin, (infact no β-lactam antibiotic) is useful against methicillin-resistant Staphylococcus aureus (MRSA) infections. Anti-pseudomonal penicillins C – Carbenicillin T – Ticarcillin M – Mezlocillin A – Azlocillin P – Piperacillin Mnemonic: A CT MAP • All of these are effective against gram negative bacteria like E.coli, salmonella, shigella (except amoxycilin) etc. • Last five penicillins (CT MAP) are effective against pseudomonas. • Last three (MAP) are effective against klebsiella also. 4. Problem of resistance can be tackled by: (a) Adding β-lactamase inhibitors to penicilins. These inhibit the bacterial enzyme and penicillins escape degradation. (b) By administering penicillinase resistant penicillins like cloxacillin, oxacillin, nafcillin, dicloxacillin or methicillin. 5. Hypersensitivity reactions can occur with any penicillin. Infact, penicillins are the most common drugs responsible for anaphylactic shock. If a person is severely allergic to any penicillin, no β - lactam (except monobactams) should be administered to that person. Intra-dermal skin testing can be used to prevent severe allergic reactions. Pharmacokinetics • One gram of penicillin is equivalent to 1.6 million units. • Gastric acid breaks down penicillins and results in decreased oral bioavailability. Penicillin G can be used orally only for infections in which clinical experience has proven efficacy. • Ampicillin and nafcillin are excreted partly in the bile. • Benzyl penicillin (Penicillin G) is given by i.m. injection. It has small t 1/2 so given 6-12 hourly whereas procaine penicillin (12-24 hourly) and benzathine penicillin (longest acting) are long acting due to slow release. Procaine helps to prolong the duration of action. Clinical Uses • Penicillin G: It is the drug of choice for syphilis. Benzathine penicillin G is used for primary, secondary and early latent syphilis (2.4 million units i.m.) as single dose and late latent and tertiary syphilis for 3 weeks (once weekly). Aqueous penicillin G is DOC for neurosyphilis (benzathine penicillin has little entry in brain). It can also be used for gram positive bacteria like streptococci and meningococci. Penicillin G is also the drug of choice for meningococcus, actinomycosis, tetanus (now metronidazole is preferred), gas gangrene, rat bite fever, yaws, leptospirosis, group A and B streptococcal infections and viridan streptococcal endocarditis. Most staphylococci and gonococci are now resistant. It is effective against anaerobic bacteria except bacteroides. • Methicillin, nafcillin, oxacillin and cloxacillin: Main use of these drugs is for the treatment of Staphylococcus aureus infections although organisms resistant to these drugs also have been isolated. Methicillin resistance is developed due to the formation of alternative penicillin binding proteins that have less affinity for the drugs. Organisms resistant to methicillin (MRSA) are resistant to all other beta lactam drugs. These resistant organisms are treated by vancomycin or teicoplanin. Vancomycin resistant staphylococcus (VRSA) can be treated by linezolid or streptogramins. • Ampicillin, amoxicillin: These are wide spectrum penicillinase sensitive antibiotics. In addition to gram positive organisms, these are also effective against enterococci, listeria and haemophilus organisms. The activity of these drugs is enhanced when used with beta lactamase inhibitors like sulbactam or clavulanic acid. Ampicillin is drug of choice for listeria meningitis (cephalosporins are not effective) and UTI caused by E. faecalis. • Piperacillin, ticarcillin, carbenicillin, azlocillin and mezlocillin: These possess activity against gram negative rods including pseudomonas. These are used with beta lactamase inhibitors and with aminoglycosides. Ureidopenicillins (piperacillin, azlocillin and mezlocillin) are also highly effective against klebsiella species. • MRSA is not susceptible to β-lactam antibiotics. https://kat.cr/user/Blink99/
Chemotherapy A: General Consideration and Non-specific Antimicrobial Agents Toxicity • Main toxicity is hypersensitivity including serum sickness. Anaphylaxis is most commonly associated with these drugs; therefore intra-dermal sensitivity testing is must before administration of penicillins. If a patient develops severe hypersensitivity reaction to a penicillin, all other beta lactam antibiotic are contra-indicated except aztreonam (cross sensitivity is not present). • Ampicillin is involved in causing maculopapular skin rash in the patients with viral diseases like infectious mononucleosis. • Methicillin is the most common antibiotic implicated in causing interstitial nephritis. • Nausea and diarrhea may be caused by oral drugs like amoxicillin and ampicillin. Ampicillin causes diarrhea more frequently, because it is incompletely absorbed and causes more suppression of normal microbial flora. It can also cause pseudomembranous colitis. • Procaine penicillin in high doses can result in seizures and CNS abnormalities (due to procaine). • Oxacillin can cause hepatitis and nafcillin is involved in causing neutropenia. • Carbenicillin in high dose can result in bleeding. Cephalosporins These are β-lactam antibiotics having 7-aminocephalosporanic acid nucleus. These are classified into four generations. First Generation Second Generation Third Generatin Fourth Generation Fifth Generation Oral Parenteral Oral Parenteral Oral Parenteral Parenteral Parenteral Cephalexin Cefadroxil Cepharadine Pharmacokinetics Cefazolin Cefaclor Cefuroxime axetil Loracarbef Cefprozil Cefuroxime Cefotetan Cefoxitin Cefmetazole Cefixime Cefpodoxime Ceftibuten Cefditoren Cefdinir • Most cephalosporins are excreted via kidney through tubular secretion. • Ceftriaxone and cefoperazone are secreted in the bile. • Nephrotoxicity of these drugs is increased with loop diuretics. Antibacterial Spctrum Useful spectrum of cephalosporins Generation Organism Remarks First Second Gram +ve Cocci • Streptococci • Staphylococci Gram –ve bacilli • E. coli • Klebsiella • Proteus • H. influenza • M. catarrhalis • Bacteroides Cefotaxime Ceftizoxime Ceftriaxone Ceftazidime Cefoperazone Moxalactam Not active against penicillin resistant strains Only cefoxitin, cefmetazole and cefotetan are effective against Bacteroides Contd... Nafcillin can cause neutropenia Ampicillin should be avoided in patients with viral illness particularly EBV because it can cause rash in these patients. Cefepime Cefpirome Ceftaroline Ceftobiprole 1. All cephalosporins having A after cef are 1st generation (except cefaclor) 2. Cephalosporins containing PI are 4th gen. (cefePIme, cefPIrome) 3. Cephalosporins ending with ME are 3rd gen. except. cefuroxiME. Chemotherapy A: General Considerations Pharmacology and Non-specific... 519 https://kat.cr/user/Blink99/
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Review of Pharmacology Ninth Editio
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Dedicated to My parents, wife Prave
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Preface to the Ninth Edition We wan
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Acknowledgments When emotions are p
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References • Harrison’s Princip
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Contents 1. History of Pharmacology
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CHAPTER 1 History of pharmacology S
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CHAPTER 2 General Pharmacology Phar
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General Pharmacology Note: It is si
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General Pharmacology Drug metaboliz
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General Pharmacology Order of kinet
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General Pharmacology Therapeutic Dr
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General Pharmacology Fig. 2.4: G-pr
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General Pharmacology sigmoid shaped
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General Pharmacology Phase 1: Here,
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General Pharmacology 5. Essential m
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General Pharmacology (b) Bioavailab
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General Pharmacology (c) Are highly
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General Pharmacology (c) Strong aci
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General Pharmacology (a) 50 mg/hour
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General Pharmacology 140. Phamacoge
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General Pharmacology (c) Piroxicam
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206. Which of the following drugs s
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General Pharmacology 29. In which t
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General Pharmacology Explanations 1
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General Pharmacology • Other fact
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General Pharmacology -- Suppose, 10
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General Pharmacology 77. Ans. (a) W
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= 40 L × 4 mg/L = 160 mg Clearance
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General Pharmacology 126. Ans. (c)
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General Pharmacology 154. Ans. (d)
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General Pharmacology Intolerance is
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General Pharmacology 6. Ans. (b) b
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CHAPTER 3 Autonomic Nervous System
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Autonomic Nervous System Functions
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Autonomic Nervous System • Carbac
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Autonomic Nervous System used for g
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Autonomic Nervous System -- Central
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Autonomic Nervous System • Theref
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Autonomic Nervous System • Eye: S
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Autonomic Nervous System • Dopami
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Autonomic Nervous System • Phenox
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Autonomic Nervous System Lipid Inso
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Autonomic Nervous System Drug of Ch
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Multiple Choice Questions Autonomic
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Autonomic Nervous System (c) Organo
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(c) Physostigmime (d) Hyoscine hydr
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Autonomic Nervous System (c) Tropic
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132. A drug that blocks the uptake
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165. Clonidine is used for: (Kolkat
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as an effective substitute which do
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Autonomic Nervous System 13. Which
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Autonomic Nervous System (c) Increa
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Autonomic Nervous System 9. Ans. (a
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Autonomic Nervous System 39. Ans. (
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Autonomic Nervous System - Temazepa
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Autonomic Nervous System 103. Ans.
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Autonomic Nervous System have no ef
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Autonomic Nervous System 23. Ans. (
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CHAPTER 4 Autacoids These are the s
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Autacoids All second generation ant
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Autacoids v v v v v Calcium channel
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Autacoids nary bypass. It can also
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Autacoids to presence of sulfur con
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Autacoids Rheumatoid Arthritis Rheu
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Autacoids It is a monoclonal antibo
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Autacoids Drug of choice Condition
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15. Anti-vertigo drug which modulat
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49. Sumatriptan is: (DPG 1999, TN 2
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81. All of the following effects ar
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114. Which prostaglandin helps in c
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Autacoids 148. Which of the followi
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Autacoids 30. A 15 year old boy was
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Autacoids 16. Ans. (b) Dangerous ve
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Autacoids 56. Ans. (c) Cyclooxygena
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Autacoids 85. Ans. (b) Aspirin supp
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Autacoids 125. Ans. (b) Indomethaci
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Autacoids 13. Ans. (a) Naproxen (Re
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CHAPTER 5 Cardiovascular System CON
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Cardiovascular System In atrial fib
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Cardiovascular System Treatment of
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Cardiovascular System should be use
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Cardiovascular System tive α 1 blo
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Cardiovascular System nifedipine an
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Cardiovascular System Treatment of
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Cardiovascular System ANGINA PECTOR
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Cardiovascular System BETA BLOCKERS
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Cardiovascular System The action po
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Cardiovascular System depolarized c
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Cardiovascular System • Digoxin i
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Cardiovascular System Contd... •
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Cardiovascular System DRUG OF CHOIC
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15. Digoxin toxicity is aggravated
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(c) Treat digoxin toxicity (d) Rapi
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(c) Decreases sodium and increases
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Cardiovascular System 113. All of t
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146. Which of the following drugs i
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Cardiovascular System 180. Characte
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213. In a patient with hypertriglyc
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247. ACE inhibitors cause: (PGI Dec
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Cardiovascular System 16. Dialysis
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Cardiovascular System 53. Which of
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• Nesiritide is a recombinant BNP
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Cardiovascular System 43. Ans. (d)
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Cardiovascular System 81. Ans. (a)
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Cardiovascular System -- Hypertensi
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Cardiovascular System Cyanide has v
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Cardiovascular System 13. Ans (b) P
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CHAPTER 6 Kidney Diuretics Diuretic
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Kidney Uses Main use of loop diuret
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Kidney • Amiloride is more potent
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Kidney Amiloride It is the agent of
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Kidney Multiple Choice Questions di
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30. Which of the following statemen
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66. Advantage of desmopressin over
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Kidney Explanations 1. Ans. (b) Hyp
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16. Ans. (b) Bumetanide (Ref: KDT 6
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Kidney 55. Ans (d) V 4 : Central Ne
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CHAPTER 7 Endocrinology Hormones ar
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Endocrinology Prolactin It causes g
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Endocrinology • In the liver and
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Endocrinology I 131 can be used for
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Endocrinology Drug interactions •
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Endocrinology Lactic acidosis (more
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Endocrinology 3. amylin analogs Pra
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Endocrinology Important Points Maxi
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Endocrinology • Steroids with sel
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Endocrinology • Vitamin D 2 is er
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Endocrinology Denosumab Osteoclasts
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Endocrinology • SERMs are targete
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Endocrinology Contd... • Uliprist
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Endocrinology only pills. Chances o
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Endocrinology Pharmacokinetics Test
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Endocrinology Ergot Derivatives Erg
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Endocrinology Contd... • Hyperpro
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completion of therapy, the patient
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(c) Glucose (d) Starch 47. True abo
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(c) Na + exit/K + entry (d) K + ent
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Endocrinology 113. Which of the fol
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147. Bisphosphonates act by: (AI 20
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180. Women receiving estrogen thera
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(c) Clomiphene (d) Mifepristone (RU
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246. Mechanism of Calcitriol is: (R
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Endocrinology 32. Drug used to cont
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(b) Glimepiride (c) Repaglinide (d)
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Endocrinology Explanations 1. Ans.
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Endocrinology 24. Ans. (c) Propylth
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Endocrinology • When this drug is
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Endocrinology Hypoglycemia is cause
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Endocrinology Drugs causing Addison
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Endocrinology Raloxifene is a selec
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Endocrinology • Enzyme inducers l
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Endocrinology 197. Ans. (b) Blocks
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Endocrinology A spider angioma (als
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Endocrinology 4. Ans (c) Glaucoma (
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Endocrinology 70. Ans. (c) Mifepris
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NOTES _____________________________
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CHAPTER 8 Central Nervous System Se
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Central Nervous System It is admini
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Central Nervous System • Abnormal
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Central Nervous System useful in AD
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Central Nervous System Wilson’s D
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Central Nervous System Important Dr
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Central Nervous System • Lamotrig
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Central Nervous System play a role
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Central Nervous System According to
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Central Nervous System bulimia, pre
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Central Nervous System Anti Manic D
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Central Nervous System dependence,
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Central Nervous System increase hea
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Central Nervous System Actions •
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Central Nervous System Contd... •
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(c) Alkalization of the urine will
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Central Nervous System (c) Ketamine
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79. Drug of choice for myoclonic ep
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(c) Phenytoin (d) Valproic acid 112
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146. Which of the following antipsy
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(c) Regular measurements of blood c
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210. A patient Rajnish having depre
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242. Drug useful in malignant hyper
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279. Preferred drug for alcohol wit
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314. Morphine can administered by a
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(c) Analgesia (d) Mydriasis 348. Di
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17. Antiparkinson drug known to cau
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53. Which drug is the most useful i
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Central Nervous System 15. Ans. (c)
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Central Nervous System 39. Ans. (b)
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67. Ans. (a) Phenytoin (Ref: Katzun
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97. Ans. (a) Hepatitis (Ref: KDT 6/
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Central Nervous System 145. Ans (c)
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Central Nervous System 159. Ans. (d
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Central Nervous System 187. Ans. (b
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Central Nervous System 212. Ans. (a
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Central Nervous System 258. Ans. (a
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Central Nervous System 303. Ans. (c
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Central Nervous System 326. Ans. (c
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Central Nervous System 60. Ans. (a)
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CHAPTER 9 Anaesthesia Local Anaesth
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Anaesthesia trigeminal nerve, cervi
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Anaesthesia Centrally Acting Muscle
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Anaesthesia • These drugs release
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Anaesthesia Anaesthetic MAC (% atm)
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Anaesthesia Methemoglobinemia and l
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Anaesthesia Chloroform • It is a
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Anaesthesia Contd... • It does no
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Anaesthesia Anaesthetic agents of c
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Anaesthesia Multiple Choice Questio
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33. Post dural (Spinal) puncture he
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(b) Dantrolene (c) Succinylcholine
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103. Which of the following drugs a
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Anaesthesia 138. Thiopental sodium
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Anaesthesia Explanations 1. Ans (c)
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Anaesthesia 20. Ans. (d) Seizures a
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Anaesthesia 49. Ans. (b) Meprobamat
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Anaesthesia • The patient underwe
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Anaesthesia 91. Ans. (b) Sevofluran
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Anaesthesia • In pheochromocytoma
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CHAPTER 10 Hematology HAEMATINICS T
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Hematology • Deficiency of folic
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Hematology • Main drugs acting as
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Hematology 1. Oral Anticoagulants
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Hematology • Bioavailability of u
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Hematology • Rodenticides contain
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Hematology Condition • Anemia Dru
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(c) Erythropoietin (d) Filgrastim (
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Hematology 46. Tirofiban is a: (RJ
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80. The anticoagulant of choice in
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6. Mechanism of action of clopidogr
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Hematology Explanations 1. Ans. (c)
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Hematology 17. Ans. (d) Oprelvekin
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Hematology 51. Ans. (a) Dabigatran:
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Hematology 71. Ans. (c) Warfarin (R
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Page 487 and 488: Respiratory System Condition • Br
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Page 493 and 494: Respiratory System Explanations 1.
Page 495 and 496: Respiratory System • Inhalational
Page 497 and 498: CHAPTER 12 Gastrointestinal Tract P
Page 499 and 500: Gastrointestinal Tract Contd... --
Page 501 and 502: Gastrointestinal Tract Anti Emetic
Page 503 and 504: Gastrointestinal Tract Domperidone
Page 505 and 506: Gastrointestinal Tract Oral Rehydra
Page 507 and 508: Gastrointestinal Tract Condition
Page 509 and 510: (c) Misoprostol (d) Omeprazole 15.
Page 511 and 512: 49. The most effective antiemetic f
Page 513 and 514: Gastrointestinal Tract recent Quest
Page 515 and 516: Gastrointestinal Tract Explanations
Page 517 and 518: Gastrointestinal Tract 30. Ans. (b)
Page 519 and 520: Gastrointestinal Tract 1. EarlyPhas
Page 521 and 522: Gastrointestinal Tract 17. Ans. (c)
Page 523 and 524: CHAPTER 13 Chemotherapy A: General
Page 525 and 526: Chemotherapy A: General Considerati
Page 527 and 528: contd... Drugs Binds to Mechanism o
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Page 533 and 534: Contd... Chemotherapy A: General Co
Page 537 and 538: Clinical Uses Chemotherapy A: Gener
Page 545 and 546: Important Points About Antimicrobia
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Chemotherapy A: General Considerati
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CHAPTER 14 Chemotherapy B: Antimicr
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Chemotherapy B: Antimicrobials for
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Clofazimine It is a dye with lepros
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Foscarnet It is not an antimetaboli
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Human Immunodeficiency Virus (HIV)
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16. Bactericidal drugs in ATT are:
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50. Ethambutol should be used very
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120. Regarding ritonavir use in AID
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ACTs). All of the following combina
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ecent Questions asked by National B
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Explanations Chemotherapy B: Antimi
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25. Ans. (b) Ethionamide (Ref: KDT
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CHAPTER 15 Chemotherapy C: Antineop
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Chemotherapy C: Antineoplastic Drug
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4-5 years). Another distinguishing
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GnRH Antagonists Cetrorelix, ganire
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This drug was used in 1960s as a se
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Multiple Choice Questions Chemother
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37. Which of the following statemen
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CHAPTER 16 Immunomodulators IMMUNOS
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Immunomodulators 9. Antibodies Poly
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Immunomodulators Examples of each t
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Immunomodulators Clinical Diagnosis
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(b) Podophylline (c) Interferon (d)
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(c) Cytarabine (d) Cycloserine 51.
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Immunomodulators Explanations 1. An
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Immunomodulators 14. Ans. (a) Syste
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Immunomodulators 33. Ans. (a) Gluco
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CHAPTER 17 Other Topics and Adverse
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Other Topics and Adverse Effects Co
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17. A 2 years old child without fev
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54. Isotretinoin is: (PGI June, 200
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Other Topics and Adverse Effects (c
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Other Topics and Adverse Effects
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Other Topics and Adverse Effects
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Other Topics and Adverse Effects 39
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Other Topics and Adverse Effects 55
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Other Topics and Adverse Effects Dr
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CHAPTER 18 Drugs of Choice Drug of
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Drugs of Choice Contd... Hypertensi
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Contd... VRSA LINEZOLID/STREPTOGRAM
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CHAPTER 19 New Drugs 1. Abatacept:
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New Drugs 52. Canakinumab: A human
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New Drugs 100. Ecallantide: A plasm
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New Drugs 153. Laronidase: Recombin
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New Drugs 204. Peginesatide: A pept
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New Drugs been approved for the tre
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New Drugs and B lymphocytes after e
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New Drugs prevents nausea and vomit
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CHAPTER 20 Recent Topics TRICYCLIC
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Recent Topics 2. Drugs 5-HT 2 recep
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Recent Topics Arginine NOS NO + Cit
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Recent Topics Contd... Drug Tetracy
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Recent Topics -- If the patient has
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CHAPTER 21 Latest Papers AIIMS Nove
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Latest Papers explanations 1. Ans.
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• Clindamycin and erythromycin ar
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Latest Papers AIIMS May 2014 1. Whi
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Latest Papers explanations 1. Ans.
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13. Ans. a. Hypokalemia (Ref: Harri
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NOTES _____________________________
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Image Based Questions https://kat.c
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Image Based Questions 1. The result
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5. A new antiarrhythmic drug is fou
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10. Amarnath, a 58 year old busines
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14. A 72-year-old male, Hemraj was
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Review of Pharmacology - 9E (2015)

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