Clinical Pharmacology and Drug Toxicity Practice Questions

Q: Prescription of which of the following drugs can lead to periorbital edema of non-pitting variety?

Aliskiren. ***Aliskiren***- **Aliskiren**, a **direct renin inhibitor**, can lead to **angioedema**, which often manifests as **non-pitting periorbital edema**. This occurs due to its effect on the **renin-angiotensin-aldosterone system (RAAS)** and bradykinin metabolism.- The angioedema caused by aliskiren is similar to that caused by **ACE inhibitors**, involving an increase in **bradykinin** levels, leading to increased vascular permeability and fluid leakage into tissues [1, 2].*COX-1 inhibitor*- **COX-1 inhibitors**, such as NSAIDs, can cause **fluid retention** and **edema** through various mechanisms, including effects on kidney function and prostaglandin synthesis.- However, the edema typically caused by COX-1 inhibitors is usually **pitting edema** and is not primarily characterized as isolated non-pitting periorbital swelling, which is more typical of angioedema.*Recombinant C1 INH*- **Recombinant C1 esterase inhibitor (C1 INH)** is used to **treat** angioedema, particularly in cases of hereditary angioedema, by replacing deficient or dysfunctional C1 INH.- Therefore, prescribing this drug would act to **resolve** or prevent angioedema, not cause it.*Icatibant*- **Icatibant** is a **bradykinin B2 receptor antagonist** used to treat acute attacks of **hereditary angioedema**.- Its mechanism of action involves **blocking the effects of bradykinin**, which is responsible for the increased vascular permeability and edema in angioedema; thus, it would **alleviate** rather than cause this type of edema.

Q: The following malformation in a baby due to drug intake by mother is classified as \qquad ADR?

Type D. ***Type D*** - **Type D** ADRs are **delayed effects** that include **teratogenicity** and **carcinogenicity**, occurring after prolonged exposure or during critical developmental periods. - The image shows **phocomelia** (severe limb malformation), a classic example of drug-induced teratogenicity (e.g., **thalidomide**), which is classified as a Type D ADR. *Type A* - **Type A** ADRs are **augmented** reactions that are predictable, dose-dependent pharmacological effects of drugs. - Examples include **bleeding** with anticoagulants or **hypotension** with antihypertensives, not congenital malformations. *Type E* - **Type E** ADRs are **end-of-use** effects or **withdrawal symptoms** that occur when a drug is discontinued. - These reactions (like **opioid withdrawal**) are unrelated to developmental malformations from in-utero drug exposure. *Type F* - **Type F** is not a recognized category in standard ADR classification systems, which typically include only Types A through E. - The established classification covers predictable, unpredictable, chronic, delayed, and end-of-use effects without requiring a Type F category.

Q: Which is correct about the marked area in the blister strip of Paracetamol (PCM)? (Recent NEET Pattern 2016-17)

Expiry date of last day of Feb 2014. **Understanding Pharmaceutical Expiry Dates:** When a drug expiry date lists only the month and year (without a specific day), pharmaceutical regulations specify that the product remains valid through the last day of that stated month. ***Expiry date of last day of Feb 2014*** - When an expiration date specifies only the month and year (e.g., **FEB.14**), it signifies that the product is considered stable and potent up to and including the **last day of that month** (February 28/29, 2014). - This ensures that the medication remains effective and safe throughout the entire month indicated, allowing for proper use until its conclusion. - This follows **WHO guidelines** and **pharmaceutical regulatory standards** worldwide. *Expiry date of first day of Feb 2014* - This interpretation would incorrectly limit the product's usability to the very beginning of the month, which is not the standard practice for drug expiration dates. - The standard is to consider the product viable for the **entire duration of the stated month**, not just the first day. *Expiry date extending 3 months from last day of Feb 2014* - There is no information or standard convention that would extend the expiration date by an additional three months beyond the stated month. - This option incorrectly adds a time period that is not indicated on the packaging and could lead to the use of an expired product. *Expiry date extending 3 months from the first day of Feb 2014* - Similar to the previous incorrect option, this adds an unfounded three-month extension to the expiration date. - Expiration dates are precisely determined by manufacturers based on stability testing and should be followed as printed, without arbitrary extensions.

Q: A 65-year-old patient of dilated cardiomyopathy was prescribed 1 mg warfarin tablet for sustained atrial fibrillation. The chemist however gave him 2 mg tablets by mistake which resulted in him developing hemorrhagic complications (bleeding). CT scan is performed. This is which kind of ADR? (Recent NEET Pattern 2016-17) Warfarin Sodium Tablets, USP Crystalline 2 mg Protect from light

Type A. ***Type A*** - This is an **exaggerated pharmacological effect** of warfarin due to a higher than intended dose, leading to excessive anticoagulation and subsequent **hemorrhagic stroke** (bleeding in the brain). - Type A ADRs are **predictable** based on the known pharmacology of the drug and are dose-dependent. *Type B* - Type B ADRs are **unpredictable**, idiosyncratic reactions that are not directly related to the pharmacological action of the drug (e.g., allergic reactions). - They are typically **dose-independent** and often occur in a small subset of the population. *Type C* - Type C ADRs are associated with **long-term exposure** to a drug, leading to chronic effects or tolerance. - Examples include drug dependence or adrenal suppression from prolonged corticosteroid use. *Type D* - Type D ADRs are also related to **delayed effects** of drug exposure, such as carcinogenesis or teratogenesis. - These effects may not manifest until months or years after the drug was taken.

Q: Which of the following instructions is not given if a second puff is required from this device?

Wash mouth between two puffs. ***Wash mouth between two puffs*** - Washing the mouth is typically recommended *after* the final dose of certain inhaled medications (especially **corticosteroids**) to prevent oral candidiasis (thrush), not *between* puffs of the same medication. - Doing so between puffs would be inconvenient and unnecessary for optimal drug delivery, especially for bronchodilators where quick repeated dosing is often required. *Wait for one minute before taking the second puff* - This is a standard instruction for metered-dose inhalers (MDIs) to allow the first dose to take effect and to ensure proper delivery of the second dose by allowing the propellant to reset and the airways to potentially open further. - It ensures that the medication from the first puff has time to reach the lungs before the second puff is administered. *Shake again* - Shaking the inhaler before each puff is crucial to ensure that the medication is **evenly mixed** with the propellant. - This guarantees that a consistent and accurate dose of medication is delivered with every actuation, even for subsequent puffs. *Keep mouth piece dry* - Keeping the mouthpiece dry is important for **hygiene** and to prevent blockages or malfunction. - Moisture could potentially affect the aerosolization process or lead to bacterial growth.

Q: A patient with rheumatic heart disease is in atrial fibrillation. The ECG shows irregularly irregular heart rhythm with absent P waves and down-sloping ST segment depression pronounced in V2-V3 and in the rhythm strip. The patient is experiencing general unwell being. Given the ECG findings and history, which medication is most likely causing the patient's symptoms?

Digoxin. ***Digoxin*** - The ECG findings of **irregularly irregular rhythm with absent P waves** (atrial fibrillation), combined with **down-sloping ST segment depression** (often described as "digoxin effect" or "digitalis effect"), are classic signs of **digoxin toxicity**. - **General unwell being** is a common non-specific symptom of digoxin toxicity, which can manifest as fatigue, malaise, or gastrointestinal upset. *Flecainide* - Flecainide is a Class Ic antiarrhythmic and can cause various ECG changes, including **PR interval prolongation** and **QRS widening**, but not typically the characteristic down-sloping ST segment changes associated with digoxin. - While it can be proarrhythmic, leading to symptoms of general unwell being, the specific ECG pattern described points away from flecainide and more towards digoxin. *Amiodarone* - Amiodarone is a Class III antiarrhythmic that primarily **prolongs the QT interval** on an ECG. - It does not typically cause the down-sloping ST segment depression seen in this patient, although it can cause bradyarrhythmias or other proarrhythmic effects. *Quinidine* - Quinidine is a Class Ia antiarrhythmic that typically causes **QRS widening** and **QT prolongation**, and can also lead to U waves. - While it can be associated with "quinidine syncope" due to arrhythmias like Torsades de pointes, it does not produce the specific down-sloping ST segment changes seen here that are characteristic of digoxin.

Q: A primigravida at 38 weeks pregnancy was put on oxytocin drip in view of slow labour at the rate of 30 mIU/min by the newly appointed registrar. She complains of confusion and starts throwing fits. What electrolyte imbalance is expected to have happened in this case?

Hyponatremia. ***Hyponatremia*** - **Oxytocin** has an antidiuretic hormone (ADH)-like effect, leading to **water retention** and dilutional hyponatremia, especially when administered in large doses or with hypotonic solutions [1]. - Symptoms like **confusion** and **seizures (fits)** are classic signs of neurological impairment due to severe hyponatremia. *Hypokalemia* - While electrolyte imbalances can occur with oxytocin, **hypokalemia** is not typically associated with oxytocin's ADH-like actions or its direct effects on renal tubules. - Symptoms related to hypokalemia usually involve **muscle weakness** and cardiac arrhythmias, which are not the primary features here. *Hypocalcemia* - **Hypocalcemia** is more commonly associated with conditions like parathyroid dysfunction or vitamin D deficiency, not directly with oxytocin administration. - Symptoms would typically include **tetany**, muscle cramps, and paresthesias, not primarily confusion and seizures in this context. *Hypernatremia* - **Hypernatremia** would involve excess sodium or severe dehydration, which is contrary to the fluid retention effect of oxytocin and unlikely to cause seizures in this context. - Elevated sodium levels would typically present with symptoms of extreme thirst, lethargy, and dry mucous membranes.

Q: The best drug for maintenance therapy of Systemic Lupus Erythematosus (SLE) during pregnancy is :

Hydroxychloroquine. ***Hydroxychloroquine*** - **Hydroxychloroquine** is the cornerstone of SLE treatment, including during pregnancy, due to its efficacy in preventing flares and its established safety profile for both mother and fetus. - Continuation of **hydroxychloroquine** throughout pregnancy is recommended to reduce the risk of disease activity, which can lead to adverse maternal and fetal outcomes. *Tacrolimus* - **Tacrolimus** is an immunosuppressant typically reserved for patients with severe organ-threatening lupus, such as lupus nephritis, especially when other treatments fail or are contraindicated. - While it can be used in pregnancy under close monitoring, it is not considered the first-line or best drug for routine maintenance therapy due to potential risks and the availability of generally safer options. *Progestins* - **Progestins** are hormones primarily used in contraception or hormone replacement therapy and have no direct role in the treatment or maintenance of systemic lupus erythematosus. - They do not possess immunomodulatory properties essential for managing SLE disease activity. *Sulfasalazine* - **Sulfasalazine** is an anti-inflammatory and immunomodulatory drug primarily used for inflammatory bowel disease and rheumatoid arthritis, and sometimes for psoriatic arthritis. - It is not a standard treatment for **Systemic Lupus Erythematosus (SLE)** and is less effective for systemic manifestations of lupus.

Q: Detection of magnesium toxicity in a patient receiving magnesium sulphate is noticed by which of the following? I. Loss of tendon reflexes II. Increased respiratory rate III. Heart block, prolonged PR interval IV. Cardiac arrest Select the correct answer using the code given below :

I, III and IV. ***I, III and IV*** - **Loss of tendon reflexes** is an early sign of magnesium toxicity, typically occurring at serum magnesium levels between **4-6 mEq/L**. - **Heart block** and a **prolonged PR interval** are cardiac manifestations of magnesium toxicity, indicating impaired electrical conduction in the heart. **Cardiac arrest** represents the most severe cardiac complication, usually occurring with very high magnesium levels (**>15 mEq/L**). *III and IV only* - This option correctly identifies **heart block** (prolonged PR interval) and **cardiac arrest** as signs of magnesium toxicity. - However, it **omits the loss of tendon reflexes**, which is a crucial and often earlier indicator of toxicity. *I and III only* - This option correctly includes **loss of tendon reflexes** and **heart block** (prolonged PR interval) as signs of magnesium toxicity. - It **fails to include cardiac arrest**, which is a severe and critical consequence of profound magnesium toxicity. *II and IV only* - **Increased respiratory rate** is generally **not a sign of magnesium toxicity**; rather, magnesium toxicity can lead to **respiratory depression** or arrest. - While **cardiac arrest** is a correct sign, the inclusion of increased respiratory rate makes this option inaccurate.

Q: Consider the following statements with regard to the treatment of vitamin A deficiency : I. Repeated high doses of retinol can cause liver damage and teratogenicity II. Acute overdose of vitamin A may lead to increased intracranial pressure and skin desquamation III. Regular vitamin A supplementation is also recommended for pregnant women even in countries where vitamin A deficiency is not endemic IV. Excessive intake of carotene may cause harmless orange pigmentation of the skin Which of the statements given above are correct?

I, II and IV. **I, II and IV** - Statement I is correct: Repeated high doses of **retinol** (preformed vitamin A) can accumulate in the liver, leading to **hepatotoxicity** and potential **teratogenic effects** on a developing fetus. - Statement II is correct: **Acute vitamin A overdose** can manifest as symptoms such as **increased intracranial pressure** (pseudotumor cerebri) and **skin desquamation** (peeling skin). - Statement IV is correct: Excessive intake of **carotene** (a vitamin A precursor from plants) can cause **carotenemia**, characterized by a harmless **orange pigmentation** of the skin, but it does not lead to vitamin A toxicity due to regulated conversion. *II, III and IV* - This option incorrectly includes statement III, which is false because regular vitamin A supplementation is generally **not recommended for pregnant women in non-endemic areas** due to the risk of teratogenicity. - The other statements (II and IV) are correct, as acute overdose of vitamin A can cause increased intracranial pressure and skin desquamation, and excessive carotene intake can lead to harmless orange skin pigmentation. *I, II and III* - This option incorrectly includes statement III, which is false as routine vitamin A supplementation is **contraindicated for pregnant women in non-endemic areas** due to the risk of birth defects. - Statements I and II are correct, as high retinol doses can cause liver damage and teratogenicity, and acute vitamin A overdose can lead to increased intracranial pressure and skin desquamation. *I, III and IV* - This option incorrectly includes statement III, which is false because **pregnant women in non-endemic areas should avoid regular vitamin A supplementation** to prevent toxicity and teratogenic effects. - Statements I and IV are correct; high retinol doses can cause liver damage and teratogenicity, and excessive carotene intake can result in harmless orange skin pigmentation.

Question 1

Prescription of which of the following drugs can lead to periorbital edema of non-pitting variety?

Accepted Answer

Aliskiren

Answer

COX-1 inhibitor

Answer

Recombinant C1 INH

Answer

Icatibant

Question 2

The following malformation in a baby due to drug intake by mother is classified as \qquad ADR?

Accepted Answer

Type D

Answer

Type A

Answer

Type E

Answer

Type F

Question 3

Which is correct about the marked area in the blister strip of Paracetamol (PCM)? (Recent NEET Pattern 2016-17)

Accepted Answer

Expiry date of last day of Feb 2014

Answer

Expiry date of first day of Feb 2014

Answer

Expiry date extending 3 months from last day of Feb 2014

Answer

Expiry date extending 3 months from the first day of Feb 2014

Question 4

A 65-year-old patient of dilated cardiomyopathy was prescribed 1 mg warfarin tablet for sustained atrial fibrillation. The chemist however gave him 2 mg tablets by mistake which resulted in him developing hemorrhagic complications (bleeding). CT scan is performed. This is which kind of ADR? (Recent NEET Pattern 2016-17) Warfarin Sodium Tablets, USP Crystalline 2 mg Protect from light

Accepted Answer

Type A

Answer

Type B

Answer

Type C

Answer

Type D

Question 5

Which of the following instructions is not given if a second puff is required from this device?

Accepted Answer

Wash mouth between two puffs

Answer

Wait for one minute before taking the second puff

Answer

Shake again

Answer

Keep mouth piece dry

Question 6

A patient with rheumatic heart disease is in atrial fibrillation. The ECG shows irregularly irregular heart rhythm with absent P waves and down-sloping ST segment depression pronounced in V2-V3 and in the rhythm strip. The patient is experiencing general unwell being. Given the ECG findings and history, which medication is most likely causing the patient's symptoms?

Accepted Answer

Digoxin

Answer

Flecainide

Answer

Amiodarone

Answer

Quinidine

Question 7

A primigravida at 38 weeks pregnancy was put on oxytocin drip in view of slow labour at the rate of 30 mIU/min by the newly appointed registrar. She complains of confusion and starts throwing fits. What electrolyte imbalance is expected to have happened in this case?

Accepted Answer

Hyponatremia

Answer

Hypokalemia

Answer

Hypocalcemia

Answer

Hypernatremia

Question 8

The best drug for maintenance therapy of Systemic Lupus Erythematosus (SLE) during pregnancy is :

Accepted Answer

Hydroxychloroquine

Answer

Tacrolimus

Answer

Progestins

Answer

Sulfasalazine

Question 9

Detection of magnesium toxicity in a patient receiving magnesium sulphate is noticed by which of the following?
I. Loss of tendon reflexes
II. Increased respiratory rate
III. Heart block, prolonged PR interval
IV. Cardiac arrest

Select the correct answer using the code given below :

Accepted Answer

I, III and IV

Answer

III and IV only

Answer

I and III only

Answer

II and IV only

Question 10

Consider the following statements with regard to the treatment of vitamin A deficiency :
I. Repeated high doses of retinol can cause liver damage and teratogenicity
II. Acute overdose of vitamin A may lead to increased intracranial pressure and skin desquamation
III. Regular vitamin A supplementation is also recommended for pregnant women even in countries where vitamin A deficiency is not endemic
IV. Excessive intake of carotene may cause harmless orange pigmentation of the skin

Which of the statements given above are correct?

Accepted Answer

I, II and IV

Answer

II, III and IV

Answer

I, II and III

Answer

I, III and IV

Clinical Pharmacology and Drug Toxicity — MCQs

Clinical Pharmacology and Drug Toxicity — MCQs

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