UPSC-CMS 2022 — Pharmacology

Q: Which of the following drugs should be avoided in labouring women with bronchial asthma?

Prostaglandin F2α. ***Prostaglandin F2α*** - **Prostaglandin F2α** (e.g., **carboprost**) is a potent **bronchoconstrictor** and can exacerbate asthma, leading to severe respiratory distress in susceptible individuals. - Its use for **uterine atony** in labouring women with a history of asthma is generally contraindicated due to the risk of inducing an **asthma attack**. *Ergometrine* - **Ergometrine** is an **ergot alkaloid** used to prevent or treat **postpartum hemorrhage** by causing sustained uterine contractions. - While it can cause some adverse effects like nausea or hypertension, it is **not generally contraindicated** in asthma and does not directly cause bronchoconstriction. *Prostaglandin E1* - **Prostaglandin E1** (e.g., **misoprostol**) is used for cervical ripening and induction of labour, or for preventing postpartum hemorrhage. - It generally has **bronchodilating** properties and is therefore considered safe for use in patients with asthma. *Opioid analgesics* - **Opioid analgesics** (e.g., **pethidine**, **morphine**) are commonly used for pain relief during labour. - While they can cause respiratory depression at high doses, they do **not directly induce bronchoconstriction** and are generally safe for use in asthmatic patients when carefully monitored. [Practice more Pharmacology PYQs on OnCourse]

Q: All of the following are correct regarding drospirenone EXCEPT:

It is safe in renal failure patients.. ***4. It is safe in renal failure patients*** - **Drospirenone** has **antimineralocorticoid activity**, which can lead to **hyperkalemia**, especially in patients with **renal impairment**. - Therefore, it is **contraindicated** and not safe in patients with **renal failure** due to the increased risk of potentially life-threatening **hyperkalemia**. *3. It has antimineralocorticoid action* - Drospirenone is a unique progestin derived from **spironolactone**, giving it a distinct **antimineralocorticoid effect**. - This effect helps to reduce symptoms like **bloating** and **fluid retention**, which are often associated with other hormonal contraceptives. *2. It has antiandrogenic property* - Drospirenone possesses significant **antiandrogenic properties**, which are beneficial in treating conditions like **acne** and **hirsutism**. - This action helps to counteract the androgenic side effects some other progestins might exhibit, making it a favorable choice for women who experience these issues. *1. It is a fourth generation progestin* - Drospirenone is classified as a **fourth-generation progestin**, developed to offer an improved side effect profile compared to older progestins. - These newer progestins often have more selective receptor binding and distinct pharmacological properties like **antiandrogenic** and **antimineralocorticoid** effects. [Practice more Pharmacology PYQs on OnCourse]

Q: For the treatment of kala-azar, the daily dose of miltefosine in a 3-year-old child who weighs 15 kg is

40 mg. ***40 mg*** - Miltefosine dosage for children weighing 12 to 29 kg (including a 15 kg child) is typically **2.5 mg/kg body weight per day orally**. - For a 15 kg child, this translates to 2.5 mg/kg * 15 kg = **37.5 mg**, which is rounded to **40 mg** for practical dosing since miltefosine capsules come in 10 mg or 50 mg sizes. *20 mg* - This dose is lower than the recommended **2.5 mg/kg/day** for a 15 kg child, which would be 37.5 mg. - An underdose of miltefosine could lead to **treatment failure** and the development of drug resistance. *10 mg* - This dose is significantly lower than the recommended therapeutic dose for a 15 kg child, which requires approximately **37.5 mg daily**. - Such a low dose would be **ineffective** in treating kala-azar, risking worsening disease. *30 mg* - While closer than 10 mg or 20 mg, 30 mg is still below the calculated **37.5 mg/day** for a 15 kg child. - An insufficient dose may compromise the efficacy of treatment and lead to **suboptimal parasitic clearance**. [Practice more Pharmacology PYQs on OnCourse]

Q: What is the shelf life of Dukoral (wc-rBS) oral vaccine used for cholera prevention, when stored at a temperature of 2 °C to 8 °C?

2 years. ***2 years***- Dukoral (wc-rBS) oral vaccine, when stored correctly at **2 °C to 8 °C**, maintains its efficacy and stability for **2 years**. - This is the manufacturer-specified shelf life that ensures the vaccine remains potent and safe for use. - The vaccine contains inactivated whole-cell V. cholerae and recombinant cholera toxin B subunit, with a validated 2-year stability period. *3 years*- A 3-year shelf life is an **overestimation** for Dukoral under standard refrigerated storage conditions. - Beyond the validated 2-year period, the vaccine's potency cannot be guaranteed. - This could lead to administration of potentially ineffective vaccine. *6 months*- A 6-month shelf life is significantly **underestimated** for Dukoral, indicating a lack of understanding of vaccine stability. - Such a short duration would lead to premature discarding of usable vaccine and increased waste. - Most modern refrigerated vaccines have longer shelf lives than this. *5 years*- A 5-year shelf life is a significant **overestimation** for Dukoral (wc-rBS). - This duration exceeds the manufacturer's validated stability data for this oral vaccine. - Using vaccine beyond its validated shelf life poses risks of reduced immunogenicity. [Practice more Pharmacology PYQs on OnCourse]

Q: Which of the following is a rare vaccine reaction known to occur with BCG vaccine in immunocompetent individuals?

Osteitis. ***Osteitis*** - **Osteitis** (inflammation of bone) is a **rare complication** of the BCG vaccine, occurring in **immunocompetent individuals**, particularly infants. - Incidence: approximately **1-30 cases per million doses**. - It results from the **dissemination of live attenuated *Mycobacterium bovis*** (the strain used in BCG) to bone tissue. - Typically presents months after vaccination with localized bone pain and swelling. *Guillain-Barré syndrome* - **Guillain-Barré syndrome** is a rare neurological disorder characterized by rapid-onset muscle weakness. - While it can be triggered by various infections and, rarely, by some vaccines (e.g., influenza vaccine), it is **not specifically associated with the BCG vaccine**. *Suppurative lymphadenitis* - **Suppurative lymphadenitis** (inflammation and pus formation in lymph nodes) is a **relatively common adverse reaction** to the BCG vaccine, not a rare one. - Incidence: **0.01-4.3%** of vaccinees. - It typically occurs in regional lymph nodes draining the injection site and usually resolves with conservative management or needle aspiration. *Disseminated infection* - **Disseminated BCG infection** is an **extremely rare** complication (0.06-1.56 per million doses). - It occurs **primarily in immunocompromised individuals** (e.g., severe combined immunodeficiency, HIV). - This is a contraindication-related complication rather than a typical vaccine reaction in the general population. - The question specifies immunocompetent individuals, making **osteitis** the most appropriate answer as it represents the classic rare complication in normal hosts. [Practice more Pharmacology PYQs on OnCourse]

6 Previous Year Questions with Answers & Explanations

Questions

All Subjects Anatomy (2)Biochemistry (3)Community Medicine (27)Dermatology (2)ENT (1)Internal Medicine (21)Obstetrics and Gynecology (32)Pathology (6)Pediatrics (3)Pharmacology (6)Physiology (2)Radiology (1)Surgery (14)

Which of the following drugs should be avoided in labouring women with bronchial asthma?

All of the following are correct regarding drospirenone EXCEPT:

For the treatment of kala-azar, the daily dose of miltefosine in a 3-year-old child who weighs 15 kg is

What is the shelf life of Dukoral (wc-rBS) oral vaccine used for cholera prevention, when stored at a temperature of 2 °C to 8 °C?

Which of the following is a rare vaccine reaction known to occur with BCG vaccine in immunocompetent individuals?

Which one of the following vaccines is known to interfere with the Yellow Fever vaccine if administered within 3 weeks of each other?

UPSC-CMS 2022 - Pharmacology UPSC-CMS Practice Questions and MCQs

Question 1: Which of the following drugs should be avoided in labouring women with bronchial asthma?

A. Ergometrine
B. Prostaglandin E1
C. Opioid analgesics
D. Prostaglandin F2α (Correct Answer)

Explanation: ***Prostaglandin F2α*** - **Prostaglandin F2α** (e.g., **carboprost**) is a potent **bronchoconstrictor** and can exacerbate asthma, leading to severe respiratory distress in susceptible individuals. - Its use for **uterine atony** in labouring women with a history of asthma is generally contraindicated due to the risk of inducing an **asthma attack**. *Ergometrine* - **Ergometrine** is an **ergot alkaloid** used to prevent or treat **postpartum hemorrhage** by causing sustained uterine contractions. - While it can cause some adverse effects like nausea or hypertension, it is **not generally contraindicated** in asthma and does not directly cause bronchoconstriction. *Prostaglandin E1* - **Prostaglandin E1** (e.g., **misoprostol**) is used for cervical ripening and induction of labour, or for preventing postpartum hemorrhage. - It generally has **bronchodilating** properties and is therefore considered safe for use in patients with asthma. *Opioid analgesics* - **Opioid analgesics** (e.g., **pethidine**, **morphine**) are commonly used for pain relief during labour. - While they can cause respiratory depression at high doses, they do **not directly induce bronchoconstriction** and are generally safe for use in asthmatic patients when carefully monitored.

Question 2: All of the following are correct regarding drospirenone EXCEPT:

A. It is safe in renal failure patients. (Correct Answer)
B. It has antimineralocorticoid action.
C. It is a fourth generation progestin.
D. It has antiandrogenic property.

Explanation: ***4. It is safe in renal failure patients*** - **Drospirenone** has **antimineralocorticoid activity**, which can lead to **hyperkalemia**, especially in patients with **renal impairment**. - Therefore, it is **contraindicated** and not safe in patients with **renal failure** due to the increased risk of potentially life-threatening **hyperkalemia**. *3. It has antimineralocorticoid action* - Drospirenone is a unique progestin derived from **spironolactone**, giving it a distinct **antimineralocorticoid effect**. - This effect helps to reduce symptoms like **bloating** and **fluid retention**, which are often associated with other hormonal contraceptives. *2. It has antiandrogenic property* - Drospirenone possesses significant **antiandrogenic properties**, which are beneficial in treating conditions like **acne** and **hirsutism**. - This action helps to counteract the androgenic side effects some other progestins might exhibit, making it a favorable choice for women who experience these issues. *1. It is a fourth generation progestin* - Drospirenone is classified as a **fourth-generation progestin**, developed to offer an improved side effect profile compared to older progestins. - These newer progestins often have more selective receptor binding and distinct pharmacological properties like **antiandrogenic** and **antimineralocorticoid** effects.

Question 3: For the treatment of kala-azar, the daily dose of miltefosine in a 3-year-old child who weighs 15 kg is

A. 20 mg
B. 40 mg (Correct Answer)
C. 10 mg
D. 30 mg

Explanation: ***40 mg*** - Miltefosine dosage for children weighing 12 to 29 kg (including a 15 kg child) is typically **2.5 mg/kg body weight per day orally**. - For a 15 kg child, this translates to 2.5 mg/kg * 15 kg = **37.5 mg**, which is rounded to **40 mg** for practical dosing since miltefosine capsules come in 10 mg or 50 mg sizes. *20 mg* - This dose is lower than the recommended **2.5 mg/kg/day** for a 15 kg child, which would be 37.5 mg. - An underdose of miltefosine could lead to **treatment failure** and the development of drug resistance. *10 mg* - This dose is significantly lower than the recommended therapeutic dose for a 15 kg child, which requires approximately **37.5 mg daily**. - Such a low dose would be **ineffective** in treating kala-azar, risking worsening disease. *30 mg* - While closer than 10 mg or 20 mg, 30 mg is still below the calculated **37.5 mg/day** for a 15 kg child. - An insufficient dose may compromise the efficacy of treatment and lead to **suboptimal parasitic clearance**.

Question 4: What is the shelf life of Dukoral (wc-rBS) oral vaccine used for cholera prevention, when stored at a temperature of 2 °C to 8 °C?

A. 2 years (Correct Answer)
B. 3 years
C. 6 months
D. 5 years

Explanation: ***2 years***- Dukoral (wc-rBS) oral vaccine, when stored correctly at **2 °C to 8 °C**, maintains its efficacy and stability for **2 years**. - This is the manufacturer-specified shelf life that ensures the vaccine remains potent and safe for use. - The vaccine contains inactivated whole-cell V. cholerae and recombinant cholera toxin B subunit, with a validated 2-year stability period. *3 years*- A 3-year shelf life is an **overestimation** for Dukoral under standard refrigerated storage conditions. - Beyond the validated 2-year period, the vaccine's potency cannot be guaranteed. - This could lead to administration of potentially ineffective vaccine. *6 months*- A 6-month shelf life is significantly **underestimated** for Dukoral, indicating a lack of understanding of vaccine stability. - Such a short duration would lead to premature discarding of usable vaccine and increased waste. - Most modern refrigerated vaccines have longer shelf lives than this. *5 years*- A 5-year shelf life is a significant **overestimation** for Dukoral (wc-rBS). - This duration exceeds the manufacturer's validated stability data for this oral vaccine. - Using vaccine beyond its validated shelf life poses risks of reduced immunogenicity.

Question 5: Which of the following is a rare vaccine reaction known to occur with BCG vaccine in immunocompetent individuals?

A. Guillain-Barre syndrome
B. Osteitis (Correct Answer)
C. Suppurative lymphadenitis
D. Disseminated infection

Explanation: ***Osteitis*** - **Osteitis** (inflammation of bone) is a **rare complication** of the BCG vaccine, occurring in **immunocompetent individuals**, particularly infants. - Incidence: approximately **1-30 cases per million doses**. - It results from the **dissemination of live attenuated *Mycobacterium bovis*** (the strain used in BCG) to bone tissue. - Typically presents months after vaccination with localized bone pain and swelling. *Guillain-Barré syndrome* - **Guillain-Barré syndrome** is a rare neurological disorder characterized by rapid-onset muscle weakness. - While it can be triggered by various infections and, rarely, by some vaccines (e.g., influenza vaccine), it is **not specifically associated with the BCG vaccine**. *Suppurative lymphadenitis* - **Suppurative lymphadenitis** (inflammation and pus formation in lymph nodes) is a **relatively common adverse reaction** to the BCG vaccine, not a rare one. - Incidence: **0.01-4.3%** of vaccinees. - It typically occurs in regional lymph nodes draining the injection site and usually resolves with conservative management or needle aspiration. *Disseminated infection* - **Disseminated BCG infection** is an **extremely rare** complication (0.06-1.56 per million doses). - It occurs **primarily in immunocompromised individuals** (e.g., severe combined immunodeficiency, HIV). - This is a contraindication-related complication rather than a typical vaccine reaction in the general population. - The question specifies immunocompetent individuals, making **osteitis** the most appropriate answer as it represents the classic rare complication in normal hosts.

Question 6: Which one of the following vaccines is known to interfere with the Yellow Fever vaccine if administered within 3 weeks of each other?

A. Tetanus toxoid
B. Cholera vaccine
C. Typhoid vaccine
D. Measles vaccine (Correct Answer)

Explanation: ***Correct: Measles vaccine*** - **Measles vaccine (MMR)** is a **live attenuated viral vaccine** that can interfere with yellow fever vaccine immune response - Both are live viral vaccines and CDC/WHO guidelines recommend they be administered **simultaneously OR separated by ≥4 weeks** - When live viral vaccines are given too close together (but not simultaneously), immune interference can reduce antibody response to the second vaccine - This is due to **interferon production** from the first vaccine suppressing replication of the second vaccine virus *Incorrect: Typhoid vaccine* - While **oral typhoid vaccine (Ty21a)** is live attenuated, it is a **bacterial vaccine** and does not have the same viral interference pattern - Can generally be co-administered with yellow fever vaccine without significant spacing requirements - Main concern with oral typhoid is interference from **antibiotics and antimalarials**, not other vaccines *Incorrect: Tetanus toxoid* - **Inactivated vaccine** that does not interfere with live vaccines - Can be given simultaneously or at any interval with yellow fever vaccine - No immune competition with live viral vaccines *Incorrect: Cholera vaccine* - Currently available **oral cholera vaccines** (CVD 103-HgR or killed whole-cell vaccines) do not have documented interference with yellow fever - No specific spacing requirements with yellow fever vaccine - Can be co-administered or given at any interval **Note:** This question is from UPSC-CMS 2022. The original exam key may have listed typhoid, but current CDC and WHO immunization guidelines identify measles (MMR) as the primary vaccine requiring spacing with yellow fever due to live viral vaccine interference.