UPSC-CMS 2018 — Pharmacology

Q: A pregnant woman in 2nd trimester of pregnancy from North Eastern State has been diagnosed with uncomplicated P. falciparum. She should be treated with:

Artemether and Lumefantrine. ***Artemether and Lumefantrine*** - This combination is a **fixed-dose artemisinin-based combination therapy (ACT)** specifically recommended by WHO for treating uncomplicated *P. falciparum* malaria in the **second and third trimesters of pregnancy**. - ACTs are highly effective against *P. falciparum* and have a favorable safety profile compared to other antimalarials during this period of pregnancy. *Chloroquine and Primaquine* - **Chloroquine** is primarily used for treatment of *P. vivax* and *P. ovale* malaria, as *P. falciparum* has widespread resistance. - **Primaquine** is contraindicated in pregnancy due to the risk of **hemolysis** in the fetus if there is G6PD deficiency and is used for radical cure of *P. vivax* and *P. ovale*. *Artesunate and Sulphadoxine* - While **artesunate** is an artemisinin derivative, **sulphadoxine** is often combined with pyrimethamine (as SP, sulphadoxine-pyrimethamine) for intermittent preventive treatment in pregnancy (IPTp) but is not the first-line for *uncomplicated P. falciparum* treatment in the second trimester, especially with increasing resistance. - This combination lacks the **lumefantrine** component, which provides a longer duration of action and higher efficacy when combined with artemether. *Artesunate, Sulphadoxine and Pyrimethamine* - The combination of **sulphadoxine-pyrimethamine (SP)** alone or with artesunate can be used for intermittent preventive treatment in pregnancy (IPTp), but it is generally *not* the first-line treatment for **uncomplicated P. falciparum malaria** in the 2nd trimester due to resistance concerns and the superior efficacy of Artemether-Lumefantrine. - **Pyrimethamine** is a folate antagonist and generally avoided in significant doses during pregnancy if alternatives are available, although it is part of SP for IPTp. [Practice more Pharmacology PYQs on OnCourse]

Q: What is the correct daily dose of Iron and Folic acid to be prescribed to a child aged 12 years?

60 mg elemental Iron and 300 mcg folic acid. ***60 mg elemental Iron and 300 mcg folic acid*** - This is the **standard daily prophylactic dose** recommended for children aged 10-19 years (adolescents) in India as per **WIFS (Weekly Iron and Folic Acid Supplementation) program** when given daily. - Aligns with **ICMR and National Iron+ Initiative** guidelines for daily supplementation in adolescents. - This dose provides adequate iron for growth requirements and prevention of **nutritional anemia** in this age group. *20 mg elemental Iron and 100 mcg folic acid* - This dose is **too low** for a 12-year-old child and does not meet the iron requirements for adolescents. - This might be appropriate for younger children (6-59 months) but is **inadequate for adolescent growth and development**. - Would not effectively prevent iron deficiency anemia in this age group. *100 mg elemental Iron and 500 mcg folic acid* - This is the dose recommended for **weekly prophylactic supplementation** under the WIFS program, not for daily use. - When used daily, this dose may be used for **treatment of established iron deficiency anemia** rather than routine prophylaxis. - Daily use at this dose may cause **gastrointestinal side effects** like nausea and constipation. *30 mg elemental Iron and 250 mcg folic acid* - This dose is **intermediate but not standard** as per Indian guidelines for this age group. - Does not align with recommended protocols for adolescent supplementation. - Provides suboptimal iron for the growth spurt and increased requirements in 12-year-olds. [Practice more Pharmacology PYQs on OnCourse]

Q: The amount of Ethinyl Estradiol in third generation combined oral contraceptive pills is:

30–35 mcg. ***30–35 mcg*** - **Third-generation combined oral contraceptive pills (COCs)** typically contain **30-35 mcg of Ethinyl Estradiol**. - Third generation is defined by the type of **progestin used** (desogestrel, gestodene, or norgestimate), not the estrogen dose. - This dosage provides effective contraception while minimizing estrogen-related side effects compared to first-generation pills. - Common formulations include **30 mcg or 35 mcg** of ethinyl estradiol. *20–30 mcg* - While some third-generation formulations may contain doses at the lower end (20 mcg), this range overlaps with **ultra-low dose formulations**. - The typical and most common dosage for third-generation COCs is **30-35 mcg**, not this lower range. *10–20 mcg* - This represents **ultra-low dose COCs**, which aim to further reduce estrogen exposure. - These formulations may be associated with **breakthrough bleeding** and reduced cycle control. - Not the standard dose for third-generation COCs. *35–50 mcg* - These higher doses are characteristic of **first-generation COCs** from the 1960s-1970s. - Associated with higher rates of **thromboembolic events** and estrogen-related side effects. - Modern COCs use lower doses for improved safety profiles. [Practice more Pharmacology PYQs on OnCourse]

Q: Herceptin (Trastuzumab) is an immunotherapeutic agent used in the treatment of:

Carcinoma breast. ***Carcinoma breast*** - **Herceptin (Trastuzumab)** is a monoclonal antibody that targets the **HER2 receptor**, which is overexpressed in a significant subset of breast cancers. - Its use is specifically indicated for **HER2-positive breast cancer**, where it helps to inhibit cancer cell growth and proliferation. *Carcinoma rectum* - Treatment for **colorectal cancer** (including rectal carcinoma) typically involves surgery, chemotherapy (e.g., 5-fluorouracil), and radiation, with targeted therapies like cetuximab or bevacizumab for specific mutations. - **HER2 overexpression** is rare in colorectal cancer and Trastuzumab is not a standard treatment. *Ovarian malignancy* - Treatment for **ovarian cancer** usually involves surgery and platinum-based chemotherapy (e.g., carboplatin, paclitaxel), and sometimes bevacizumab. - While HER2 can be expressed in some ovarian cancers, it is not a primary therapeutic target, and **Trastuzumab is not routinely used** for this malignancy. *Carcinoma prostate* - **Prostate cancer** treatment primarily involves hormone therapy, radiation, chemotherapy (e.g., docetaxel), and targeted agents for specific mutations (e.g., PARP inhibitors). - HER2 is not a significant driver of prostate cancer growth, and **Trastuzumab is not indicated** for its treatment. [Practice more Pharmacology PYQs on OnCourse]

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A pregnant woman in 2nd trimester of pregnancy from North Eastern State has been diagnosed with uncomplicated P. falciparum. She should be treated with:

What is the correct daily dose of Iron and Folic acid to be prescribed to a child aged 12 years?

The amount of Ethinyl Estradiol in third generation combined oral contraceptive pills is:

Herceptin (Trastuzumab) is an immunotherapeutic agent used in the treatment of:

UPSC-CMS 2018 - Pharmacology UPSC-CMS Practice Questions and MCQs

Question 1: A pregnant woman in 2nd trimester of pregnancy from North Eastern State has been diagnosed with uncomplicated P. falciparum. She should be treated with:

A. Chloroquine and Primaquine
B. Artesunate and Sulphadoxine
C. Artemether and Lumefantrine (Correct Answer)
D. Artesunate, Sulphadoxine and Pyrimethamine

Explanation: ***Artemether and Lumefantrine*** - This combination is a **fixed-dose artemisinin-based combination therapy (ACT)** specifically recommended by WHO for treating uncomplicated *P. falciparum* malaria in the **second and third trimesters of pregnancy**. - ACTs are highly effective against *P. falciparum* and have a favorable safety profile compared to other antimalarials during this period of pregnancy. *Chloroquine and Primaquine* - **Chloroquine** is primarily used for treatment of *P. vivax* and *P. ovale* malaria, as *P. falciparum* has widespread resistance. - **Primaquine** is contraindicated in pregnancy due to the risk of **hemolysis** in the fetus if there is G6PD deficiency and is used for radical cure of *P. vivax* and *P. ovale*. *Artesunate and Sulphadoxine* - While **artesunate** is an artemisinin derivative, **sulphadoxine** is often combined with pyrimethamine (as SP, sulphadoxine-pyrimethamine) for intermittent preventive treatment in pregnancy (IPTp) but is not the first-line for *uncomplicated P. falciparum* treatment in the second trimester, especially with increasing resistance. - This combination lacks the **lumefantrine** component, which provides a longer duration of action and higher efficacy when combined with artemether. *Artesunate, Sulphadoxine and Pyrimethamine* - The combination of **sulphadoxine-pyrimethamine (SP)** alone or with artesunate can be used for intermittent preventive treatment in pregnancy (IPTp), but it is generally *not* the first-line treatment for **uncomplicated P. falciparum malaria** in the 2nd trimester due to resistance concerns and the superior efficacy of Artemether-Lumefantrine. - **Pyrimethamine** is a folate antagonist and generally avoided in significant doses during pregnancy if alternatives are available, although it is part of SP for IPTp.

Question 2: What is the correct daily dose of Iron and Folic acid to be prescribed to a child aged 12 years?

A. 30 mg elemental Iron and 250 mcg folic acid
B. 20 mg elemental Iron and 100 mcg folic acid
C. 100 mg elemental Iron and 500 mcg folic acid
D. 60 mg elemental Iron and 300 mcg folic acid (Correct Answer)

Explanation: ***60 mg elemental Iron and 300 mcg folic acid*** - This is the **standard daily prophylactic dose** recommended for children aged 10-19 years (adolescents) in India as per **WIFS (Weekly Iron and Folic Acid Supplementation) program** when given daily. - Aligns with **ICMR and National Iron+ Initiative** guidelines for daily supplementation in adolescents. - This dose provides adequate iron for growth requirements and prevention of **nutritional anemia** in this age group. *20 mg elemental Iron and 100 mcg folic acid* - This dose is **too low** for a 12-year-old child and does not meet the iron requirements for adolescents. - This might be appropriate for younger children (6-59 months) but is **inadequate for adolescent growth and development**. - Would not effectively prevent iron deficiency anemia in this age group. *100 mg elemental Iron and 500 mcg folic acid* - This is the dose recommended for **weekly prophylactic supplementation** under the WIFS program, not for daily use. - When used daily, this dose may be used for **treatment of established iron deficiency anemia** rather than routine prophylaxis. - Daily use at this dose may cause **gastrointestinal side effects** like nausea and constipation. *30 mg elemental Iron and 250 mcg folic acid* - This dose is **intermediate but not standard** as per Indian guidelines for this age group. - Does not align with recommended protocols for adolescent supplementation. - Provides suboptimal iron for the growth spurt and increased requirements in 12-year-olds.

Question 3: The amount of Ethinyl Estradiol in third generation combined oral contraceptive pills is:

A. 35–50 mcg
B. 10–20 mcg
C. 20–30 mcg
D. 30–35 mcg (Correct Answer)

Explanation: ***30–35 mcg*** - **Third-generation combined oral contraceptive pills (COCs)** typically contain **30-35 mcg of Ethinyl Estradiol**. - Third generation is defined by the type of **progestin used** (desogestrel, gestodene, or norgestimate), not the estrogen dose. - This dosage provides effective contraception while minimizing estrogen-related side effects compared to first-generation pills. - Common formulations include **30 mcg or 35 mcg** of ethinyl estradiol. *20–30 mcg* - While some third-generation formulations may contain doses at the lower end (20 mcg), this range overlaps with **ultra-low dose formulations**. - The typical and most common dosage for third-generation COCs is **30-35 mcg**, not this lower range. *10–20 mcg* - This represents **ultra-low dose COCs**, which aim to further reduce estrogen exposure. - These formulations may be associated with **breakthrough bleeding** and reduced cycle control. - Not the standard dose for third-generation COCs. *35–50 mcg* - These higher doses are characteristic of **first-generation COCs** from the 1960s-1970s. - Associated with higher rates of **thromboembolic events** and estrogen-related side effects. - Modern COCs use lower doses for improved safety profiles.

Question 4: Herceptin (Trastuzumab) is an immunotherapeutic agent used in the treatment of:

A. Carcinoma rectum
B. Ovarian malignancy
C. Carcinoma breast (Correct Answer)
D. Carcinoma prostate

Explanation: ***Carcinoma breast*** - **Herceptin (Trastuzumab)** is a monoclonal antibody that targets the **HER2 receptor**, which is overexpressed in a significant subset of breast cancers. - Its use is specifically indicated for **HER2-positive breast cancer**, where it helps to inhibit cancer cell growth and proliferation. *Carcinoma rectum* - Treatment for **colorectal cancer** (including rectal carcinoma) typically involves surgery, chemotherapy (e.g., 5-fluorouracil), and radiation, with targeted therapies like cetuximab or bevacizumab for specific mutations. - **HER2 overexpression** is rare in colorectal cancer and Trastuzumab is not a standard treatment. *Ovarian malignancy* - Treatment for **ovarian cancer** usually involves surgery and platinum-based chemotherapy (e.g., carboplatin, paclitaxel), and sometimes bevacizumab. - While HER2 can be expressed in some ovarian cancers, it is not a primary therapeutic target, and **Trastuzumab is not routinely used** for this malignancy. *Carcinoma prostate* - **Prostate cancer** treatment primarily involves hormone therapy, radiation, chemotherapy (e.g., docetaxel), and targeted agents for specific mutations (e.g., PARP inhibitors). - HER2 is not a significant driver of prostate cancer growth, and **Trastuzumab is not indicated** for its treatment.