Review of Pharmacology - 9E (2015)

Review of Pharmacology
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Major toxicity is gastrointestinal (nausea, vomiting, diarrhea, abdominal pain). It can also cause hypertension
and reversible neutropenia.
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Unlike cyclosporine and tacrolimus, it does not cause nephrotoxicity.
7. Ans. (d) Tacrolimus (Ref: Katzung 11/e p972; KDT 6/e p204, 728, 840-841)
• Tacrolimus and cyclosporine toxicity include nephrotoxicity, neurotoxicity, hyperglycemia, hypertension, hyperkalemia
and GI complaints. Cyclosporine also cause hirsutism, which is not seen with tacrolimus use.
8. Ans. (b) Rheumatoid arthritis with hepatitis B (Ref: Katzung 11/e p634)
• Anti-TNF α drugs should be avoided in
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Pulmonary tuberculosis
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Multiple sclerosis
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Hepatitis B
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Congestive heart failure
• Anti –TNF-α drugs like infliximab, etanercept and adalimumab are used in rheumatoid arthritis and increase
the risk of bacterial infections. These can lead to reactivation of latent tuberculosis. Infliximab rarely, result in
leucopenia, activation of hepatitis B and vasculitis.
Immunomodulators
9. Ans. (a) Intravenous immunoglobulin (Ref: CMDT-2010/1288)
• All patients of Kawasaki’s disease should be treated with intravenous immunoglobulin (IVIG).
• Aspirin should be used for fever and inflammation. It should be continued if coronary aneurysm develops.
• Methyl prednisolone should follow if disease symptoms persist after two injections of IVIG.
• Drugs for refractory cases include infliximab, cyclophosphamide and methotrexate.
10. Ans. (c) Rifampicin (Ref: KDT 6/e p840)
• Rifampicin is a potent enzyme inducer. The drug has the chance of inducing the metabolism. This might reduce the
efficacy of tacrolimus and graft rejection may occur.
• Gentamicin, cisplatin and vancomycin have additive nephrotoxic effect with tacrolimus, but dose reduction may
protect from these adverse effects.
11. Ans. (c) Ototoxic (Ref: Principles of Pharmacology by Dr. KK Sharma & Dr. HL Sharma 1/e p914; KDT 6/e p840)
• Ototoxicity is not a side effect of tacrolimus.
• Tacrolimus can cause nephrotoxicity, neurotoxicity, hepatotoxicity and diabetes mellitus.
• Unlike cyclosporine, it do not cause hirsutism.
12. Ans. (c) Cephalosporin (Ref: Principles of Pharmacology, 1/e p912; KDT 6/e p837)
Cephalosporins are β-lactam antibiotics whereas other drugs are immunosuppressants.
13. Ans. (b) Hiv Associated Peripheral Neuropathy (Ref: P 876, Indian Journal of Pharmacology 2003; 35: 204-212)
Peripheral neuropathy is an adverse effect of thalidomide, therefore it is not indicated for HIV induced peripheral
neuropathy.
Clinical uses of thalidomide
• AIDS related aphthous ulcers
• AIDS related wasting syndrome
• Multiple myeloma and other solid tumors like AIDS-related Kaposi’s sarcoma
• Prevention of graft versus host disease (GVHD) after transplantation
• Rheumatoid arthritis
• Ankylosing spondylitis
• Crohn’s disease and Behcet’s syndrome
Adverse reactions to thalidomide
• Teratogenicity
• Peripheral neuropathy
• Drowsiness
• Skin rashes
• Constipation
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