What is the drug of choice for most forms of interstitial lung disease?
What is the drug of choice for managing generalized tonic-clonic seizures (GTCS) during pregnancy?
Which of the following antiglaucoma medications can cause drowsiness?
Drug of choice for open angle glaucoma:
Which of the following medications is not typically used for the treatment of erectile dysfunction?
All are symptoms of morphine withdrawal except?
Which local anaesthetic is known to cause methemoglobinemia?
In pseudocholinesterase deficiency, which drug should be used cautiously?
In ophthalmology, if a patient is allergic to aminoesters, which local anesthetic can be safely used?
Which drug is most commonly associated with causing exanthema?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 121: What is the drug of choice for most forms of interstitial lung disease?
- A. Antibiotics
- B. Bronchodilators
- C. Aspirin
- D. Corticosteroids (Correct Answer)
Explanation: ***Corticosteroids*** - **Corticosteroids** are the **drug of choice** for many forms of **interstitial lung disease (ILD)** due to their potent **anti-inflammatory** and **immunosuppressive properties**, which help reduce lung inflammation and prevent fibrosis. - They are particularly effective in inflammatory ILDs such as **sarcoidosis**, **hypersensitivity pneumonitis**, and some **connective tissue disease-associated ILDs**. *Antibiotics* - **Antibiotics** are primarily used to treat bacterial and other microbial infections and are **not effective** against the **inflammatory and fibrotic processes** characteristic of most ILDs. - They might be used if there's a **secondary bacterial infection** complicating ILD, but not as primary treatment for the ILD itself. *Bronchodilators* - **Bronchodilators** work by relaxing the muscles around the airways, making them wider and easier to breathe through, which is beneficial in conditions like **asthma** or **COPD**. - They are **not primarily used** in ILD as the main problem is **inflammation and scarring of the lung tissue**, not reversible airway constriction. *Aspirin* - **Aspirin** is an **NSAID** with **anti-inflammatory**, **anti-platelet**, and **analgesic properties**, commonly used for pain relief, fever reduction, and cardiovascular protection. - It has **no established role** in the primary treatment of **interstitial lung disease**, as its anti-inflammatory effects are typically insufficient for the severe inflammation seen in ILD.
Question 122: What is the drug of choice for managing generalized tonic-clonic seizures (GTCS) during pregnancy?
- A. Lamotrigine (Correct Answer)
- B. CBZ
- C. Levetiracetam
- D. Valproate
Explanation: ***Lamotrigine*** - **Lamotrigine** is considered **one of the preferred drugs** for managing epilepsy during pregnancy due to its relatively **low teratogenic risk** compared to older antiepileptic drugs. - Its established safety profile in pregnancy makes it a preferred option to balance seizure control and **fetal well-being**. - **Important Note:** For **GTCS specifically**, lamotrigine and levetiracetam are both considered appropriate first-line choices, with selection depending on individual patient factors and seizure control history. - Lamotrigine levels **decrease during pregnancy** and require monitoring and dose adjustments. *CBZ* - **Carbamazepine (CBZ)** is associated with an increased risk of **neural tube defects** and other congenital malformations when used during pregnancy, making it less favorable. - While effective for GTCS, its teratogenicity often leads to avoidance or careful consideration of alternatives in pregnant women. *Levetiracetam* - **Levetiracetam** is increasingly recognized as an **excellent choice for GTCS in pregnancy** with a favorable safety profile and growing evidence base. - Many recent guidelines and clinical practices favor levetiracetam as **first-line for GTCS** due to its low risk of major congenital malformations and good efficacy. - It is a **medically appropriate alternative** to lamotrigine, and in some contexts may be preferred, particularly for primary generalized epilepsy. *Valproate* - **Valproate** has the highest risk of **teratogenicity** among common antiepileptic drugs, including a significant risk of **neural tube defects**, developmental delay, autism spectrum disorder, and other anomalies. - Due to these significant risks, valproate is generally **contraindicated** in women of childbearing potential, especially during pregnancy, unless no other effective and safer alternative exists.
Question 123: Which of the following antiglaucoma medications can cause drowsiness?
- A. Brimonidine (Correct Answer)
- B. Latanoprost
- C. Dorzolamide
- D. Timolol
Explanation: ***Brimonidine*** - **Brimonidine** is an **alpha-2 adrenergic agonist** [1] that can cause central nervous system depression, leading to side effects such as **drowsiness** and fatigue. - This systemic side effect is more common with the topical ophthalmic formulation due to systemic absorption. *Latanoprost* - **Latanoprost** is a **prostaglandin analog** that primarily works by increasing uveoscleral outflow, and its side effects are mainly localized to the eye (e.g., iris color change, eyelash growth). - It does not typically cause systemic side effects like drowsiness because its systemic absorption is minimal. *Dorzolamide* - **Dorzolamide** is a **topical carbonic anhydrase inhibitor** [1] that reduces aqueous humor production, and its most common side effects include local ocular irritation and a bitter taste. - While systemic carbonic anhydrase inhibitors can cause fatigue and drowsiness, the topical formulation has very limited systemic absorption, making drowsiness uncommon. *Timolol* - **Timolol** is a **non-selective beta-blocker** [1] that reduces aqueous humor production and can cause systemic side effects such as bradycardia, bronchospasm, and hypotension. - While some beta-blockers can cause fatigue, **drowsiness** as a prominent side effect is less common compared to alpha-2 agonists.
Question 124: Drug of choice for open angle glaucoma:
- A. Acetazolamide
- B. Latanoprost (Correct Answer)
- C. Brimonidine
- D. Timolol
Explanation: ***Latanoprost*** - **Prostaglandin F2α analogs** like latanoprost are generally considered **first-line therapy** for open-angle glaucoma due to their efficacy and once-daily dosing. - They work by **increasing uveoscleral outflow** of aqueous humor, thereby lowering intraocular pressure (IOP). *Acetazolamide* - **Acetazolamide** is a **carbonic anhydrase inhibitor** that reduces aqueous humor production. - It is typically used for **acute angle-closure glaucoma** or when initial treatments fail, often due to systemic side effects with long-term use. *Timolol* - **Timolol** is a **non-selective beta-blocker** that reduces aqueous humor production. - While effective, it is often a second-line agent or used in combination due to potential systemic side effects like **bronchospasm** and **bradycardia**. *Brimonidine* - **Brimonidine** is an **alpha-2 adrenergic agonist** that reduces aqueous humor production and increases uveoscleral outflow. - It is typically used as a second-line agent or in combination therapy due to potential side effects like **ocular pruritus** and **allergic conjunctivitis**.
Question 125: Which of the following medications is not typically used for the treatment of erectile dysfunction?
- A. Beta blockers (Correct Answer)
- B. Papaverine
- C. Sildenafil
- D. PG-E
Explanation: ***Beta blockers*** - **Beta blockers** are primarily used to treat conditions like **hypertension** and **heart disease**. - While they can cause ED as a side effect, they are **not used for its treatment**. *Sildenafil* - **Sildenafil** is a **PDE5 inhibitor** that works by increasing **blood flow to the penis**, facilitating an erection. - It is a **first-line oral medication** widely prescribed for erectile dysfunction. *PG-E* - **PG-E** refers to **Prostaglandin E1** (alprostadil), which can be administered via **intracavernosal injection** or **urethral suppository**. - It directly causes **vasodilation** in the penis, leading to an erection, and is used when oral medications are ineffective or contraindicated. *Papaverine* - **Papaverine** is a **non-specific vasodilator** that can be used as an **intracavernosal injection** for ED. - It works by relaxing **smooth muscle** in the penile arteries, increasing blood flow and inducing an erection, often used in combination with phentolamine.
Question 126: All are symptoms of morphine withdrawal except?
- A. Yawning
- B. Lacrimation
- C. Mydriasis
- D. Fall in BP (Correct Answer)
Explanation: ***Fall in BP*** - **Hypotension (fall in BP)** is **not** typically a symptom of opioid withdrawal; rather, **hypertension** can occur due to sympathetic overdrive. - Opioid withdrawal symptoms are primarily characterized by **hyperactivity** and increased sympathetic nervous system activity. *Mydriasis* - **Mydriasis (dilated pupils)** is a classic symptom of opioid withdrawal, resulting from reduced parasympathetic tone and increased sympathetic activity. - In contrast, opioid intoxication causes **miosis (pinpoint pupils)**. *Yawning* - **Yawning** is a very common and early symptom of opioid withdrawal, often accompanied by feelings of fatigue and restlessness. - It reflects generalized **autonomic dysregulation** during withdrawal. *Lacrimation* - **Lacrimation (tearing)** is another prominent autonomic symptom of opioid withdrawal. - This, along with rhinorrhea, contributes to the **"flu-like" symptoms** experienced during withdrawal.
Question 127: Which local anaesthetic is known to cause methemoglobinemia?
- A. Procaine
- B. Prilocaine (Correct Answer)
- C. Ropivacaine
- D. Etidocaine
Explanation: ***Prilocaine*** - **Prilocaine** is metabolized into **ortho-toluidine**, which can oxidize hemoglobin to **methemoglobin**, especially at higher doses or in susceptible individuals. - **Methemoglobinemia** symptoms include **cyanosis**, **dyspnea**, and in severe cases, central nervous system depression, due to reduced oxygen-carrying capacity of blood. *Procaine* - **Procaine** is an ester-type local anesthetic. It is metabolized to **para-aminobenzoic acid (PABA)**, which can cause allergic reactions, but it is not associated with methemoglobinemia. - It has a relatively **short duration of action** and is less commonly used now compared to amide-type local anesthetics. *Etidocaine* - **Etidocaine** is an amide-type local anesthetic that is known for its **long duration of action** and high potency. - While it can cause systemic toxicity with high doses due to its cardiac and neurological effects, **methemoglobinemia** is not a characteristic side effect. *Ropivacaine* - **Ropivacaine** is an amide-type local anesthetic similar to bupivacaine, known for its **motor-sparing effect** and use in regional anesthesia. - It is associated with a lower risk of **cardiotoxicity** compared to bupivacaine but does not cause methemoglobinemia.
Question 128: In pseudocholinesterase deficiency, which drug should be used cautiously?
- A. Succinylcholine (Correct Answer)
- B. Barbiturates
- C. Gallamine
- D. Halothane
Explanation: ***Succinylcholine*** - **Succinylcholine** is primarily metabolized by **pseudocholinesterase** (also known as butyrylcholinesterase). - In individuals with **pseudocholinesterase deficiency**, the metabolism of succinylcholine is significantly delayed, leading to **prolonged neuromuscular blockade** and extended paralysis. *Barbiturates* - **Barbiturates** are mainly metabolized by the **hepatic cytochrome P450 system** and do not depend on pseudocholinesterase for their breakdown. - Their metabolism would not be significantly affected by pseudocholinesterase deficiency. *Halothane (an inhalational anesthetic)* - **Halothane** is primarily metabolized by the **hepatic cytochrome P450 system** and excreted via the lungs. - Its metabolism is unrelated to **pseudocholinesterase activity**. *Gallamine (a neuromuscular blocker)* - **Gallamine** is a **nondepolarizing neuromuscular blocker** that is primarily eliminated by **renal excretion** as an unchanged drug. - Its metabolism and elimination are independent of **pseudocholinesterase**.
Question 129: In ophthalmology, if a patient is allergic to aminoesters, which local anesthetic can be safely used?
- A. Procaine
- B. Cocaine
- C. Prilocaine (Correct Answer)
- D. Tetracaine
Explanation: **Local anesthetics are classified into two chemical groups: esters (aminoesters) and amides. Allergies to esters typically do not cross-react with amides.** ***Prilocaine*** - **Prilocaine** is an **amide-type local anesthetic**, and allergies to **aminoesters** typically do not cross-react with **amides**. - It is a safe alternative in patients with a known allergy to **ester-type local anesthetics**. *Cocaine* - **Cocaine** is an **ester-type local anesthetic**, sharing a similar chemical structure with **aminoesters**. - Patients allergic to **aminoesters** are likely to experience a **cross-reaction** with **cocaine**. *Procaine* - **Procaine** is a classic **ester-type local anesthetic** (an aminoester). - An allergy to aminoesters directly implies an allergy to **procaine** due to its chemical classification. *Tetracaine* - **Tetracaine** is also an **ester-type local anesthetic** (an aminoester). - It is contraindicated in patients with an allergy to **aminoesters** due to the high risk of **allergic reaction**.
Question 130: Which drug is most commonly associated with causing exanthema?
- A. Atropine
- B. Phenytoin
- C. Sulfonamide (Correct Answer)
- D. All of the options
Explanation: ***Sulfonamide*** - **Sulfonamides** are among the **most common causes** of drug-induced exanthema (maculopapular/morbilliform rash). - They account for a significant proportion of cutaneous adverse drug reactions, with exanthema being the most frequent presentation. - The mechanism typically involves a **delayed hypersensitivity reaction** (Type IV) to the drug or its metabolites. - **Classic presentation:** Symmetrical, erythematous, maculopapular rash appearing 7-14 days after drug initiation. *Phenytoin* - **Phenytoin** can cause exanthematous eruptions, but it is more notably associated with **severe cutaneous adverse reactions** such as: - **DRESS syndrome** (Drug Reaction with Eosinophilia and Systemic Symptoms) - **Stevens-Johnson syndrome (SJS)** and **Toxic Epidermal Necrolysis (TEN)** - While exanthema can occur, **sulfonamides** are more frequently implicated in simple morbilliform rashes. *Atropine* - **Atropine** is an anticholinergic agent primarily causing **predictable pharmacological effects**: - Dry mouth, mydriasis, tachycardia, urinary retention - **Allergic skin reactions** with atropine are rare and not a characteristic adverse effect. - Atropine is **not recognized** as a common cause of exanthema. *All of the options* - This is incorrect because **atropine** is not commonly associated with exanthema. - While both sulfonamides and phenytoin can cause exanthema, only **sulfonamides** are considered among the **most common** causes.