INI-CET 2023 — Pharmacology
17 Previous Year Questions with Answers & Explanations
Which of the following is true about lithium?
A kid went to a temple with his grandmother and was constantly crying. On examination he had excruciating pain, hypertension, increased heart rate, sweating profusely, priapism and cold clammy skin. What should be the treatment given to the patient?
A female was given morphine sulphate during labour for pain but she developed respiratory distress. Which of the following will be the correct antidote?
A child went to temple along with his grandmother. He developed altered sensorium, BP of $150 / 90 \mathrm{~mm} \mathrm{Hg}$, sweating, palpitations, priapism, and mouth secretion all at once. What drug can be given to this patient?
A patient presented with dizziness, cool clammy skin, pinpoint pupil with blue lips and fingernails suffering from respiratory depression. The patient was producing a pink frothy sputum on coughing. The drug used to reverse the effects is?
A patient of schizophrenia is being treated with clozapine. For which rare but serious side effects should he be monitored?
What is the MOA of thalidomide?
Which of the following is a new drug approved for Rett syndrome?
A 52-year-old female patient presents with HER-2 positive breast cancer that has become resistant to trastuzumab treatment. The oncologist is considering the next line of treatment for the patient. Which of the following options would be the most appropriate choice?
A female patient presented with vulvovaginal pruritus. On detailed history taking, it was found that she was on some antidiabetic drugs. Which antidiabetic drug can cause the above-mentioned side effect?
INI-CET 2023 - Pharmacology INI-CET Practice Questions and MCQs
Question 1: Which of the following is true about lithium?
- A. It is also used for treatment of absence seizures
- B. It is not teratogenic
- C. It can cause fine postural tremors at therapeutic dosage (Correct Answer)
- D. It is not absorbed from the gut
Explanation: ***It can cause fine postural tremors at therapeutic dosage*** - **Fine postural tremors** are a common and well-known side effect of lithium, even within its therapeutic range. - This side effect can be dose-dependent and may worsen with higher lithium concentrations. *It is also used for treatment of absence seizures* - Lithium is primarily used as a **mood stabilizer** for bipolar disorder and is not indicated for the treatment of **absence seizures**. - **Absence seizures** are typically treated with drugs like ethosuximide or valproate. *It is not teratogenic* - Lithium is known to be **teratogenic**, especially during the first trimester of pregnancy. - It is associated with an increased risk of **Ebstein's anomaly**, a congenital heart defect. *It is not absorbed from the gut* - Lithium is **rapidly and completely absorbed** from the gastrointestinal tract after oral administration. - Its absorption is not significantly affected by food, and peak plasma concentrations are usually reached within 1-3 hours.
Question 2: A kid went to a temple with his grandmother and was constantly crying. On examination he had excruciating pain, hypertension, increased heart rate, sweating profusely, priapism and cold clammy skin. What should be the treatment given to the patient?
- A. Atropine
- B. Phentolamine (Correct Answer)
- C. Pralidoxime
- D. Naloxone
Explanation: ***Phentolamine*** - The symptoms described (hypertension, tachycardia, sweating, priapism, cold clammy skin) are indicative of an **alpha-adrenergic crisis** or **pheochromocytoma crisis**, which results from excessive release of catecholamines (e.g., norepinephrine) [1]. - **Phentolamine** is a **non-selective alpha-adrenergic antagonist** that effectively blocks the effects of excessive catecholamines, thereby reducing blood pressure and heart rate and relieving other alpha-mediated symptoms like priapism [1]. *Atropine* - **Atropine** is an **anticholinergic drug** used to treat **bradycardia** or **organophosphate poisoning**. - It would worsen the patient's condition by potentially increasing heart rate further and would not address the underlying alpha-adrenergic overstimulation. *Pralidoxime* - **Pralidoxime** is an **acetylcholinesterase reactivator** used specifically for **organophosphate poisoning**. - It works by restoring the function of acetylcholinesterase, which is inhibited by organophosphates, and is not indicated for an adrenergic crisis. *Naloxone* - **Naloxone** is an **opioid receptor antagonist** used to reverse the effects of **opioid overdose**. - This patient's symptoms are not consistent with opioid toxicity, and naloxone would have no therapeutic benefit.
Question 3: A female was given morphine sulphate during labour for pain but she developed respiratory distress. Which of the following will be the correct antidote?
- A. Naloxone (Correct Answer)
- B. Epinephrine
- C. Pralidoxime
- D. Atropine
Explanation: ***Naloxone*** - **Naloxone** is a pure opioid antagonist that rapidly reverses the effects of **opioid overdose** [1, 3], including **respiratory depression** [2], by competitively binding to opioid receptors [1]. - Its short half-life may necessitate repeated doses, especially with longer-acting opioids like morphine, to prevent recurrence of respiratory depression [1]. *Epinephrine* - **Epinephrine** is an adrenergic agonist used to treat **anaphylaxis** and severe allergic reactions, as it causes **vasoconstriction** and **bronchodilation**. - It is not an antidote for opioid-induced respiratory depression, which primarily results from central nervous system effects rather than allergic reactions. *Pralidoxime* - **Pralidoxime** is a **cholinesterase reactivator** used to treat poisoning by **organophosphates**, which inhibit acetylcholinesterase, leading to cholinergic crisis. - It works by restoring the function of the enzyme, thereby breaking down excess acetylcholine, and is not indicated for opioid overdose. *Atropine* - **Atropine** is an **anticholinergic agent** that blocks muscarinic acetylcholine receptors, used to treat **bradycardia** and **organophosphate poisoning**. - It would not reverse opioid-induced respiratory depression, as it primarily affects the parasympathetic nervous system and does not antagonize opioid receptor effects.
Question 4: A child went to temple along with his grandmother. He developed altered sensorium, BP of $150 / 90 \mathrm{~mm} \mathrm{Hg}$, sweating, palpitations, priapism, and mouth secretion all at once. What drug can be given to this patient?
- A. Steroid
- B. Adrenaline
- C. Prazosin (Correct Answer)
- D. ASV
Explanation: ***Prazosin*** * This patient's symptoms (altered sensorium, **hypertension**, sweating, palpitations, **priapism**, and increased mouth secretions) are highly suggestive of **scorpion venom poisoning**, specifically from the Indian red scorpion (*Mesobuthus tamulus*). * **Prazosin**, an **alpha-1 adrenergic receptor blocker**, is the drug of choice for treating systemic manifestations of scorpion envenomation. It helps to counteract the excessive catecholamine release and the resulting sympathetic overdrive, thereby reducing hypertension and cardiac dysfunction. *Steroid* * Steroids are **anti-inflammatory agents** and immunosuppressants, primarily used in conditions like allergic reactions, asthma, or autoimmune diseases. * They are **not indicated** for the acute management of venom-induced symptoms such as those seen in scorpion envenomation. *Adrenaline* * **Adrenaline (epinephrine)** is a potent **vasoconstrictor** and **bronchodilator**, primarily used in anaphylaxis, cardiac arrest, or severe asthma. * It would be **contraindicated** in this patient as it would further exacerbate the existing hypertension and sympathetic stimulation caused by the scorpion venom. *ASV* * **ASV (Anti-Snake Venom)** is an antiserum used to neutralize the toxins found in snake venom. * It is **ineffective** against scorpion venom and is therefore not an appropriate treatment in this scenario.
Question 5: A patient presented with dizziness, cool clammy skin, pinpoint pupil with blue lips and fingernails suffering from respiratory depression. The patient was producing a pink frothy sputum on coughing. The drug used to reverse the effects is?
- A. Atropine
- B. Naloxone (Correct Answer)
- C. Physostigmine
- D. Phentolamine
Explanation: ***Naloxone*** - This patient's presentation with **pinpoint pupils**, **respiratory depression**, and **pink frothy sputum** is highly suggestive of **opioid overdose**. - **Naloxone** is a competitive opioid receptor antagonist used specifically to reverse the effects of opioid-induced respiratory depression and central nervous system depression. *Atropine* - **Atropine** is an anticholinergic drug used to treat **bradycardia** and **organophosphate poisoning**. - It would worsen opioid-induced respiratory depression and is not indicated for this presentation. *Physostigmine* - **Physostigmine** is a cholinesterase inhibitor used to reverse the effects of anticholinergic toxicity, such as from **tricyclic antidepressants** or **atropine overdose**. - It would not treat opioid toxicity and could exacerbate some symptoms. *Phentolamine* - **Phentolamine** is an **alpha-adrenergic blocker** primarily used to treat hypertensive crises, particularly those due to **pheochromocytoma** or in extravasation of vasopressors. - It has no role in the management of opioid overdose.
Question 6: A patient of schizophrenia is being treated with clozapine. For which rare but serious side effects should he be monitored?
- A. Seizures
- B. Agranulocytosis (Correct Answer)
- C. Hepatomegaly
- D. Renal bleed
Explanation: ***Agranulocytosis*** - **Agranulocytosis** is a severe and potentially fatal reduction in white blood cells (specifically neutrophils) that can occur with clozapine use [2, 3]. - This is the **rare but serious side effect** that requires mandatory monitoring, occurring in **0.8-2%** of patients. - Patients on clozapine require routine **complete blood count (CBC)** monitoring: **weekly for the first 6 months**, then biweekly for months 6-12, then monthly thereafter . - This is the primary reason clozapine has restricted use despite being the most effective antipsychotic for treatment-resistant schizophrenia. *Seizures* - While clozapine can lower the **seizure threshold** (especially at higher doses), seizures occur in **1-2%** of patients and are **dose-dependent** . - Seizures are a known side effect that warrants dosage adjustment, but they are **not as rare** as agranulocytosis and do not require the same intensive blood monitoring protocol. - Management involves dose reduction or adding anticonvulsants. *Hepatomegaly* - **Hepatic dysfunction** can occur with clozapine, but **hepatomegaly** (enlarged liver) itself is not one of its rare, life-threatening side effects requiring specific monitoring above other, more severe issues. - Liver enzyme elevation may be monitored, but this is not the primary "rare but serious" concern. *Renal bleed* - **Renal complications** or **renal bleeding** are not recognized as significant or specifically monitored rare side effects of clozapine. - Clozapine's major concerns primarily involve hematologic (agranulocytosis), cardiovascular (myocarditis), and metabolic systems.
Question 7: What is the MOA of thalidomide?
- A. Inhibits factor Xa
- B. Prevents folic acid synthesis in bacteria
- C. Inhibits leukotrienes
- D. Angiogenesis inhibitor (Correct Answer)
Explanation: ***Angiogenesis inhibitor*** - Thalidomide is known to **inhibit angiogenesis** [1] by blocking the formation of new blood vessels, a key mechanism in its anti-cancer effects. - It also has **immunomodulatory** [1], [2], [3] and **anti-inflammatory** properties, affecting cytokine production and immune cell function [1], [3]. *Inhibits factor Xa* - This is the mechanism of action for **direct oral anticoagulants (DOACs)** like rivaroxaban and apixaban, used to prevent blood clot formation. - Thalidomide does not primarily act on the **coagulation cascade** at this step. *Prevents folic acid synthesis in bacteria* - This is the classic mechanism of action for **sulfonamide antibiotics**, which target bacterial enzymes involved in folate metabolism. - Thalidomide is an **immunomodulatory drug** [2], [3], not an antibiotic that interferes with bacterial folic acid synthesis. *Inhibits leukotrienes* - **Leukotriene inhibitors**, such as montelukast and zafirlukast, are used to treat asthma and allergies by blocking inflammatory pathways. - Thalidomide's primary mechanism is not the direct inhibition of **leukotriene synthesis or receptor binding**.
Question 8: Which of the following is a new drug approved for Rett syndrome?
- A. Sodium oxybate
- B. Trofinetide (Correct Answer)
- C. Memantine
- D. Lunesta
Explanation: ***Trofinetide*** - **Trofinetide**, marketed as Daybue, was approved by the FDA in **March 2023** specifically for the treatment of **Rett syndrome**. - It is a synthetic analog of **glycine-proline-glutamate (GPE)**, which is a cleavage product of **insulin-like growth factor-1 (IGF-1)**, and is thought to reduce neuroinflammation and improve synaptic function. - This is the **first and only FDA-approved drug** specifically indicated for Rett syndrome. *Sodium oxybate* - **Sodium oxybate (Xyrem)** is a CNS depressant (gamma-hydroxybutyrate or GHB) primarily used for the treatment of **narcolepsy with cataplexy**. - It is a GABA-B receptor agonist and has sedative properties, but it is **not approved for Rett syndrome**. - It does not address the underlying pathophysiology or core symptoms of Rett syndrome. *Memantine* - **Memantine** is an NMDA receptor antagonist used primarily for moderate to severe **Alzheimer's disease**. - While it has been studied in some neurodevelopmental disorders, it is **not approved for Rett syndrome**. - It may help with certain symptoms but is not a disease-specific treatment. *Lunesta* - **Lunesta (eszopiclone)** is a nonbenzodiazepine sedative-hypnotic medication used for the treatment of **insomnia**. - It is not indicated for **Rett syndrome** and would only address sleep disturbances symptomatically, not the core neurological deficits.
Question 9: A 52-year-old female patient presents with HER-2 positive breast cancer that has become resistant to trastuzumab treatment. The oncologist is considering the next line of treatment for the patient. Which of the following options would be the most appropriate choice?
- A. Vemurafenib
- B. Erlotinib
- C. Lapatinib (Correct Answer)
- D. Sorafenib
Explanation: ***Lapatinib*** - Lapatinib is an oral **dual tyrosine kinase inhibitor** that targets both **HER2** and **EGFR** receptors, specifically approved for **trastuzumab-resistant HER2-positive breast cancer**. - Unlike trastuzumab (a monoclonal antibody that binds the extracellular domain), lapatinib inhibits the **intracellular tyrosine kinase domain** of HER2, providing an **alternative mechanism** to overcome resistance. - Often used in combination with capecitabine for patients who have progressed on trastuzumab-containing regimens. - **Clinical evidence**: The EGF100151 trial demonstrated efficacy in trastuzumab-refractory disease. *Vemurafenib* - Vemurafenib is a **BRAF V600E/K inhibitor** used primarily for **metastatic melanoma** with BRAF mutations. - It has **no activity against HER2** and is not indicated for breast cancer. - Would not provide benefit in this clinical scenario. *Erlotinib* - Erlotinib is a selective **EGFR tyrosine kinase inhibitor** used for **EGFR-mutant non-small cell lung cancer** and **pancreatic cancer** (with gemcitabine). - While it inhibits EGFR (which lapatinib also targets), erlotinib has **insufficient HER2 inhibition** to be effective in HER2-driven breast cancer. - Not approved or effective for trastuzumab-resistant HER2-positive breast cancer. *Sorafenib* - Sorafenib is a **multi-kinase inhibitor** targeting **RAF kinases, VEGFR-2/3, and PDGFR-β**, approved for **hepatocellular carcinoma, renal cell carcinoma, and thyroid cancer**. - It does **not specifically target HER2** signaling and has no established role in HER2-positive breast cancer. - Would not address the mechanism of disease in this patient.
Question 10: A female patient presented with vulvovaginal pruritus. On detailed history taking, it was found that she was on some antidiabetic drugs. Which antidiabetic drug can cause the above-mentioned side effect?
- A. Metformin
- B. Canagliflozin (Correct Answer)
- C. Linagliptin
- D. Liraglutide
Explanation: ***Canagliflozin*** - Canagliflozin is a **sodium-glucose co-transporter 2 (SGLT2) inhibitor**. These drugs work by increasing **urinary glucose excretion**. - The increased glucose in the urine (glycosuria) creates a favorable environment for fungal and bacterial growth, leading to common side effects such as **vulvovaginal candidiasis** (yeast infections) and urinary tract infections, which manifest as pruritus. *Metformin* - Metformin is a **biguanide** that primarily reduces hepatic glucose production and increases insulin sensitivity. - Its common side effects are gastrointestinal, such as **diarrhea, nausea, and abdominal discomfort**, but it does not typically cause genitourinary infections or pruritus. *Linagliptin* - Linagliptin is a **dipeptidyl peptidase-4 (DPP-4) inhibitor** that increases endogenous GLP-1 and GIP levels, enhancing glucose-dependent insulin secretion. - Common side effects include **nasopharyngitis** and **headache**, but it is not associated with vulvovaginal pruritus. *Liraglutide* - Liraglutide is a **glucagon-like peptide-1 (GLP-1) receptor agonist** that increases glucose-dependent insulin secretion, suppresses glucagon secretion, and slows gastric emptying. - Its most common side effects are **gastrointestinal (nausea, vomiting), decreased appetite, and pancreatitis (rare)**, but it generally does not cause vulvovaginal pruritus.