NEET-PG 2024 - Pharmacology Practice Questions

Q: A 45-year-old patient with a history of depression was initially being treated with sertraline, but his symptoms were not adequately controlled. His medication regimen was changed to include an MAO inhibitor and amitriptyline. Shortly after the change in medication, the patient developed agitation, seizures, hyperreflexia, and tremor. Which of the following is the most appropriate treatment for this patient?

Cyproheptadine. ***Cyproheptadine*** - This patient exhibits symptoms of **serotonin syndrome** (agitation, seizures, hyperreflexia, tremor) due to the combination of an **MAO inhibitor** and **amitriptyline**. - **Cyproheptadine** is a **serotonin antagonist** and is the most appropriate treatment for reversing the effects of serotonin syndrome. - Treatment also includes discontinuing offending agents and supportive care. *Lorazepam* - **Lorazepam** is a **benzodiazepine** that can help manage agitation and seizures, but it does not address the underlying serotonin overstimulation. - It would be used as an adjunct for symptom control, not as the primary treatment for serotonin syndrome. *Dantrolene* - **Dantrolene** is a **muscle relaxant** used for **neuroleptic malignant syndrome (NMS)** and **malignant hyperthermia**. - While NMS and serotonin syndrome can have overlapping features (hyperthermia, rigidity), dantrolene is not indicated for serotonin syndrome. - Cyproheptadine is the specific serotonin antagonist needed for this condition. *L-carnitine* - **L-carnitine** is a supplement often used for conditions like **carnitine deficiency** or certain **metabolic disorders**. - It has no role in the treatment of serotonin syndrome. *Leucovorin* - **Leucovorin** (folinic acid) is used to **rescue bone marrow** from the toxic effects of **methotrexate** or to enhance the effects of **fluorouracil**. - It is not indicated for the treatment of serotonin syndrome.

Q: A 25 -year-old male presented to the emergency department with head trauma due to a road traffic accident. In the hospital, the patient developed seizures, and an emergency CT scan revealed widespread cerebral edema. Which of the following is the diuretic of choice for cerebral edema in this patient?

A. Mannitol. ***Mannitol*** - **Mannitol** is an osmotic diuretic that creates an osmotic gradient, drawing water from the brain parenchyma into the intravascular space, thereby reducing **cerebral edema**. - Its rapid onset of action and ability to cross an intact blood-brain barrier sparingly makes it the drug of choice for acute management of elevated intracranial pressure due to **cerebral edema**. *Spironolactone* - **Spironolactone** is a potassium-sparing diuretic that primarily acts on the distal tubules to inhibit aldosterone, leading to sodium and water excretion. - It is unsuitable for acute cerebral edema as its diuretic effect is too slow and it does not create the necessary osmotic gradient. *Furosemide* - **Furosemide** is a loop diuretic that inhibits sodium-potassium-chloride co-transporter in the loop of Henle, leading to significant diuresis. - While it can remove fluid, it does not create the same osmotic gradient as mannitol and is less effective at rapidly reducing **intracranial pressure** directly related to cerebral edema. *Hydrochlorothiazide* - **Hydrochlorothiazide** is a thiazide diuretic that primarily acts on the distal convoluted tubule to inhibit sodium reabsorption. - Its diuretic action is too slow and relatively mild for the acute management of severe conditions like **cerebral edema**. *Acetazolamide* - **Acetazolamide** is a carbonic anhydrase inhibitor that reduces CSF production and has a role in chronic management of idiopathic intracranial hypertension. - However, it is not suitable for acute cerebral edema following trauma as its onset is too slow and its diuretic effect is relatively weak compared to osmotic diuretics.

Q: Which of the following chelating agents is indicated in iron overdose?

Desferrioxamine. ***Desferrioxamine*** - **Desferrioxamine** is a **chelate** formed by the bacterium *Streptomyces pilosus* that has a high affinity for **iron**. - It is currently the most commonly used chelating agent for **acute iron overdose** and **chronic iron overload** conditions like hemochromatosis or transfusional hemosiderosis. *BAL* - **BAL (dimercaprol)** is a chelating agent primarily used for poisoning with **arsenic**, **mercury**, and **gold**. - It works by forming stable cyclic compounds with these metals, facilitating their excretion. *Calcium Edetate* - **Calcium edetate (Calcium-EDTA)** is primarily used for **lead poisoning**. - It works by forming a stable, water-soluble complex with lead, which is then excreted by the kidneys. *DTPA* - **Diethylenetriamine pentaacetate (DTPA)** is a chelating agent primarily used for poisoning with **plutonium** and other **radioactive metals**. - It is not indicated for iron overdose. *Penicillamine* - **Penicillamine** is a chelating agent primarily used for **copper** overload (Wilson's disease) and can also be used for **lead** and **mercury** poisoning. - It is not effective for iron chelation in overdose situations.

Q: Which of the following drugs is used in opioid maintenance therapy?

Buprenorphine. ***Buprenorphine*** - **Buprenorphine** is a **partial opioid agonist** used in opioid maintenance therapy to reduce cravings and withdrawal symptoms without producing the full euphoric effects of other opioids. - It is often combined with **naloxone** (as Suboxone) to prevent misuse by injection, as naloxone is only active if injected. - Buprenorphine has a **ceiling effect** for respiratory depression, making it safer than full agonists like methadone. *Naltrexone* - **Naltrexone** is an **opioid antagonist** that blocks opioid receptors, preventing the euphoric effects of opioids and reducing cravings. - While used in opioid use disorder treatment, it is primarily for relapse prevention and not typically for the active maintenance phase where agonist effects are desired. *Clonidine* - **Clonidine** is an **alpha-2 adrenergic agonist** primarily used to manage the **autonomic symptoms of opioid withdrawal**, such as anxiety, sweating, and rapid heart rate. - It does not directly act on opioid receptors and is not a primary agent for long-term opioid maintenance therapy. *Disulfiram* - **Disulfiram** is a drug used in the treatment of **alcohol use disorder**, not opioid use disorder. - It works by inhibiting acetaldehyde dehydrogenase, leading to an unpleasant reaction when alcohol is consumed. *Naloxone* - **Naloxone** is an **opioid antagonist** used for **emergency reversal of opioid overdose**, not for maintenance therapy. - It rapidly displaces opioids from receptors and reverses respiratory depression. - While combined with buprenorphine in Suboxone to prevent misuse, naloxone itself is not used for maintenance therapy.

Q: A patient on SSRI sertraline was also prescribed amitriptyline and subsequently developed serotonin toxicity. What is the likely treatment for serotonin toxicity?

Cyproheptadine. ***Cyproheptadine*** - **Cyproheptadine** is a serotonin antagonist that can help reverse the effects of excessive serotonin in the central nervous system. - It works by blocking **serotonin 5-HT2A receptors**, which are implicated in the pathophysiology of serotonin toxicity. *Flumazenil* - **Flumazenil** is a benzodiazepine receptor antagonist used to reverse the effects of benzodiazepine overdose. - It has no role in the treatment of **serotonin toxicity**, as it does not affect serotonin pathways. *L-Carnitine* - **L-Carnitine** is a mitochondrial co-factor used in fatty acid metabolism, sometimes supplemented for certain metabolic disorders or muscle pain. - It does not have any direct action on **serotonin receptors** or the serotonin system, making it ineffective for serotonin toxicity. *Leucovorin* - **Leucovorin** (folinic acid) is used to counteract the effects of methotrexate toxicity or to enhance the effects of fluorouracil in chemotherapy. - It is not involved in modulating **neurotransmitter levels** or reversing the symptoms of serotonin toxicity. *Naloxone* - **Naloxone** is an opioid receptor antagonist used to reverse opioid overdose. - It has no effect on **serotonin receptors** or serotonergic pathways, making it ineffective for treating serotonin toxicity.

Q: A mother reports that her daughter ingested a substance in an unknown dose. The girl presents with hypertension, tachycardia, mydriasis, and hyperthermia. What is the most likely substance?

Cocaine. ***Cocaine*** - The presented symptoms of **hypertension, tachycardia, mydriasis, and hyperthermia** are characteristic of a **sympathomimetic toxidrome**, frequently caused by cocaine overdose. - Cocaine acts as a **norepinephrine-dopamine-serotonin reuptake inhibitor**, leading to excessive stimulation of the central and peripheral nervous systems. *Heroin* - Heroin is an **opioid**, and overdose generally presents with **respiratory depression, bradycardia, miosis (pinpoint pupils)**, and hypotension, which are contrary to the patient's symptoms. - Patients typically exhibit central nervous system **depression**, rather than the hyperactive state seen here. *Morphine* - Similar to heroin, morphine is an **opioid** and causes symptoms like **respiratory depression, bradycardia, miosis**, and hypotension. - These effects are the opposite of the **sympathomimetic** signs observed in the patient. *Chlorpheniramine* - Chlorpheniramine is an **antihistamine** with significant **anticholinergic effects**. An overdose might cause **mydriasis and tachycardia**, but not typically severe hypertension or hyperthermia as the primary features. - Other anticholinergic signs such as **dry mucous membranes, urinary retention, and altered mental status (delirium)** would also be expected. *Organophosphate* - Organophosphate poisoning causes a **cholinergic toxidrome** due to **acetylcholinesterase inhibition**, resulting in excessive cholinergic stimulation. - Classic presentation includes **SLUDGE syndrome** (Salivation, Lacrimation, Urination, Defecation, GI upset, Emesis) along with **miosis (pinpoint pupils), bradycardia, bronchospasm**, and muscle fasciculations. - These findings are the **opposite** of the sympathomimetic signs seen in this patient.

Question 1

A 45-year-old patient with a history of depression was initially being treated with sertraline, but his symptoms were not adequately controlled. His medication regimen was changed to include an MAO inhibitor and amitriptyline. Shortly after the change in medication, the patient developed agitation, seizures, hyperreflexia, and tremor. Which of the following is the most appropriate treatment for this patient?

Accepted Answer

Cyproheptadine

Answer

Lorazepam

Answer

L-carnitine

Answer

Leucovorin

Answer

Dantrolene

Question 2

A 30-year-old drug addict presents to the emergency department with signs of unknown drug poisoning. The patient exhibits dilated pupils, diaphoresis, tachycardia, and tremors. On examination, the blood pressure is 180/110 mmHg, and the heart rate is 120 beats per minute. What is the most likely diagnosis?

Accepted Answer

Cocaine intoxication

Answer

Dhatura poisoning

Answer

Cannabis poisoning

Answer

Alcohol intoxication

Answer

Amphetamine intoxication

Question 3

A 25 -year-old male presented to the emergency department with head trauma due to a road traffic accident. In the hospital, the patient developed seizures, and an emergency CT scan revealed widespread cerebral edema. Which of the following is the diuretic of choice for cerebral edema in this patient?

Accepted Answer

A. Mannitol

Answer

B. Spironolactone

Answer

C. Furosemide

Answer

D. Hydrochlorothiazide

Answer

E. Acetazolamide

Question 4

Which of the following chelating agents is indicated in iron overdose?

Accepted Answer

Desferrioxamine

Answer

BAL

Answer

Calcium Edetate

Answer

DTPA

Answer

Penicillamine

Question 5

Which of the following drugs is used in opioid maintenance therapy?

Accepted Answer

Buprenorphine

Answer

Naltrexone

Answer

Clonidine

Answer

Disulfiram

Answer

Naloxone

Question 6

A patient on SSRI sertraline was also prescribed amitriptyline and subsequently developed serotonin toxicity. What is the likely treatment for serotonin toxicity?

Accepted Answer

Cyproheptadine

Answer

Flumazenil

Answer

L-Carnitine

Answer

Leucovorin

Answer

Naloxone

Question 7

A mother reports that her daughter ingested a substance in an unknown dose. The girl presents with hypertension, tachycardia, mydriasis, and hyperthermia. What is the most likely substance?

Accepted Answer

Cocaine

Answer

Heroin

Answer

Morphine

Answer

Chlorpheniramine

Answer

Organophosphate

NEET-PG 2024 — Pharmacology