Clinical Pharmacology and Drug Toxicity Practice Questions

Q: Pink's disease is due to

Toxicity of Mercury. ***Toxicity of Mercury*** - **Pink's disease**, also known as **acrodynia** or **Sweating Sickness**, is caused by chronic exposure to **mercury toxicity**, often from environmental sources or certain medications in children. - Key symptoms include **pinkish discoloration of the hands and feet**, **profuse sweating**, irritability, photophobia, and hypertension. *Toxicity of Tetracycline* - **Tetracycline toxicity** is primarily associated with issues such as **tooth discoloration** (yellow-brown staining) in developing teeth and photosensitivity. - It does not cause the characteristic rash or autonomic symptoms seen in Pink's disease. *Toxicity of Lead* - **Lead toxicity** (plumbism) manifests with symptoms like **abdominal pain**, anemia, neurological deficits (e.g., foot drop), and developmental delays in children. - While serious, these symptoms are distinct from the acrodynia presentation. *Toxicity of silver* - **Silver toxicity**, particularly from chronic exposure, leads to **argyria**, a condition characterized by **blue-gray discoloration of the skin, eyes, and mucous membranes**. - This is a cosmetic rather than systemic metabolic issue like acrodynia, and its symptoms differ significantly.

Q: Which of the following drugs can produce dramatic improvement in patients with type 2 lepra reaction?

Thalidomide. **Thalidomide** - **Thalidomide** is highly effective in managing **type 2 lepra reactions (erythema nodosum leprosum)**, leading to rapid resolution of symptoms. - Its anti-inflammatory and immunomodulatory properties directly address the inflammatory cascade characteristic of this reaction. *Steroids* - While **steroids** are effective in treating **type 1 lepra reactions** and severe type 2 reactions, they do not produce the same dramatic, rapid improvement seen with thalidomide in typical type 2 reactions. - Long-term steroid use carries significant side effects, making them less ideal for primary management of type 2 reactions when thalidomide is available. *Dapsone* - **Dapsone** is a crucial component of **multi-drug therapy (MDT)** for leprosy itself, but it does not treat reactions. - It has no significant anti-inflammatory effect on the acute immune-mediated processes of lepra reactions. *Clofazimine* - **Clofazimine** is an anti-inflammatory drug used in lepromatous leprosy treatment and sometimes as an alternative for steroid-resistant type 2 reactions. - However, its effect is generally slower and less dramatic compared to thalidomide in the acute management of typical type 2 lepra reactions.

Q: Nephrotoxic agent is:

Methoxyflurane. ***Methoxyflurane*** - Methoxyflurane undergoes significant **metabolism** in the liver, releasing **fluoride ions** and dichloroacetic acid. - The fluoride ions can cause **dose-dependent high-output renal failure** by interfering with the kidney's concentrating ability, leading to nephrotoxicity. *N2O (Nitrous Oxide)* - While widely used, N2O is known for its ability to **oxidize vitamin B12**, which can impair methionine synthase activity. - It does not directly cause nephrotoxicity but is associated with **bone marrow suppression** with prolonged or repeated exposure. *Halothane* - Halothane is a potent **hepatotoxin**, primarily linked to **halothane-induced hepatitis**, ranging from mild liver enzyme elevation to fulminant hepatic failure. - It is not primarily associated with nephrotoxicity; its main organ toxicity concern is the **liver**. *Isoflurane* - Isoflurane is largely **excreted unchanged** by the lungs, with minimal metabolism. - Due to its low metabolism and minimal production of inorganic fluoride, it has a **low risk of nephrotoxicity**.

Q: All of the following are adverse effects of thalidomide except:

Myocarditis. ***Myocarditis*** - **Myocarditis** is not an established adverse effect of thalidomide in standard pharmacology references. - While thalidomide can cause cardiovascular effects such as **bradycardia** and **thromboembolic events**, direct myocardial inflammation is not a recognized complication. - This is the correct answer as it is NOT an adverse effect of thalidomide. *Constipation* - **Constipation** is a very common gastrointestinal side effect of thalidomide due to its **anticholinergic-like effects**. - Patients often require proactive management with laxatives to mitigate this side effect. *Peripheral neuropathy* - **Peripheral neuropathy** is the most significant and dose-limiting adverse effect of thalidomide, often presenting as **sensory deficits** in a stocking-glove distribution. - It can be **irreversible** and may necessitate discontinuation of the drug. - This is a major concern requiring regular monitoring during treatment. *Sedation* - **Sedation** and **drowsiness** are common adverse effects of thalidomide due to its **central nervous system depressant properties**. - This effect often leads to administration before bedtime to minimize impact on daily activities.

Q: Adverse reactions following whole-cell pertussis immunization include:

All of the options. ***All of the options*** are well-documented adverse reactions following whole-cell pertussis immunization. *Fever* - **Fever** is a common systemic adverse reaction following whole-cell pertussis immunization, occurring in **10-50%** of recipients - It usually presents within the first **24-48 hours** after vaccination due to the immunostimulatory components of the vaccine - Generally mild and self-limiting, resolving within 1-2 days *Anaphylaxis* - **Anaphylaxis** is a rare but severe allergic reaction that can occur after whole-cell pertussis vaccination (approximately **1 in 1,000,000** doses) - It is an **IgE-mediated type I hypersensitivity reaction** requiring immediate medical intervention with intramuscular epinephrine - Usually occurs within **minutes to hours** after vaccination *Local swelling* - **Local swelling** at the injection site is a very common adverse reaction, occurring in **>50%** of recipients - This reaction is typically mild, localized to the injection site, and represents a normal inflammatory response - Usually resolves spontaneously within **2-3 days** without specific treatment

Q: Drug Induced Lupus is caused by all except

Procaine. ***Procaine*** - While **procainamide**, a derivative of procaine, is a known cause of **drug-induced lupus (DIL)**, **procaine** itself is not typically implicated. - Procaine is a **local anesthetic** and its mechanism of action does not commonly lead to the immunological reactions seen in DIL. *Hydralazine* - **Hydralazine** is a well-established cause of **drug-induced lupus (DIL)**, particularly with higher doses and prolonged use. - It frequently results in the development of **anti-histone antibodies**, a hallmark of DIL. *Sulphonamides* - Various **sulphonamide antibiotics** (e.g., sulfasalazine, sulfamethoxazole) are known to induce **lupus-like syndromes**. - These drugs can trigger immune responses leading to symptoms characteristic of **systemic lupus erythematosus (SLE)**. *Isoniazid* - **Isoniazid**, an anti-tuberculosis medication, is a recognized cause of **drug-induced lupus (DIL)**. - It often leads to the formation of **anti-histone antibodies** and clinical manifestations resembling spontaneous lupus.

Q: All of the following drugs cause amorphous whorl like corneal deposits except:

Indomethacin. ***Indomethacin*** - While indomethacin can cause various ocular side effects, **corneal deposits** are not typically described as the **amorphous whorl-like type** seen with the other listed drugs. - Ocular side effects of indomethacin more commonly include **corneal opacities** and **retinal changes** but not the specific **"cornea verticillata"** pattern. *Chlorpromazine* - **Chlorpromazine** can cause **corneal and lenticular deposits**, but these are typically described as **fine granular or stellate deposits** rather than the classic whorl pattern. - While these deposits can accumulate in the corneal epithelium, they do not characteristically present with the **"cornea verticillata"** (whorl keratopathy) pattern seen with amiodarone and chloroquine. - The deposits are generally benign but can lead to visual disturbances. *Amiodarone* - **Amiodarone** is a classic cause of **cornea verticillata**, or **whorl keratopathy**, with amorphous, whorl-like deposits in the corneal epithelium. - These deposits occur in **>90% of patients** on long-term therapy and are typically benign and rarely affect vision. - The whorl pattern is highly characteristic and reversible upon drug discontinuation. *Chloroquine* - **Chloroquine** (and hydroxychloroquine) commonly causes **corneal deposits** known as **cornea verticillata**, which appear as gray-brown, whorl-like opacities in the corneal epithelium. - While these deposits are usually asymptomatic, high doses or prolonged use can lead to visual blurring or halos. - The whorl pattern is a characteristic finding with this class of drugs.

Q: Thalidomide is useful in:

Treatment of type II lepra reaction. ***Treatment of type II lepra reaction*** - **Thalidomide** is highly effective in managing the severe inflammatory response seen in **Type II lepra reaction** (erythema nodosum leprosum, ENL). - Its efficacy in ENL is primarily due to its **anti-inflammatory** and **immunomodulatory** properties, inhibiting TNF-α. *Treatment of leprosy* - **Thalidomide** is not a primary antibacterial drug and thus does not directly treat the underlying **Mycobacterium leprae infection**. - Its role is limited to modulating the immune response during a reaction, not eradicating the bacteria. *Treatment of type I lepra reaction* - **Type I lepra reaction** (reversal reaction) is typically managed with **corticosteroids**, not thalidomide. - Type I reactions involve a delayed-type hypersensitivity response, distinct from the immune complex-mediated Type II reaction. *Treatment of neuritic leprosy* - **Neuritic leprosy** refers to nerve damage caused by the infection itself, or during both types of reactions, and its treatment focuses on preventing further damage with **multidrug therapy** and corticosteroids. - While thalidomide can reduce inflammation in Type II reactions that might contribute to nerve damage, it's not a direct treatment for the established nerve damage itself.

Q: Not true about thalidomide:

Has no antiangiogenesis action against tumour. ***Has no antiangiogenesis action against tumour*** - Thalidomide is known to possess **anti-angiogenic properties**, meaning it inhibits the formation of new blood vessels, which is crucial for tumour growth. This makes the statement "has no antiangiogenesis action against tumour" incorrect. - Its anti-angiogenic effects are one of the mechanisms proposed for its use in certain cancers, such as **multiple myeloma**. *Causes phocomelia* - **Phocomelia**, a severe birth defect characterized by malformed or absent limbs, is the most infamous **teratogenic effect** of thalidomide. - This adverse effect led to its withdrawal from the market in the early 1960s. *Still has restricted clinical use* - Despite its teratogenic risks, thalidomide has been reintroduced with strict regulations due to its unique immunomodulatory and anti-inflammatory properties. - It is currently used in the treatment of conditions like **multiple myeloma**, **erythema nodosum leprosum**, and certain autoimmune diseases. *Not tested in pregnant animals before introduction* - A significant reason for the thalidomide tragedy was the **lack of robust teratogenicity testing** in pregnant animals before its widespread introduction to the market. - If such testing had been adequately conducted, its severe teratogenic effects might have been identified earlier, preventing widespread harm.

Question 1

Pink's disease is due to

Accepted Answer

Toxicity of Mercury

Answer

Toxicity of Tetracycline

Answer

Toxicity of Lead

Answer

Toxicity of Silver

Question 2

Which of the following drugs can produce dramatic improvement in patients with type 2 lepra reaction?

Accepted Answer

Thalidomide

Answer

Steroids

Answer

Dapsone

Answer

Clofazimine

Question 3

Nephrotoxic agent is:

Accepted Answer

Methoxyflurane

Answer

N2O

Answer

Halothane

Answer

Isoflurane

Question 4

All of the following are adverse effects of thalidomide except:

Accepted Answer

Myocarditis

Answer

Constipation

Answer

Peripheral neuropathy

Answer

Sedation

Question 5

Adverse reactions following whole-cell pertussis immunization include:

Accepted Answer

All of the options

Answer

Fever

Answer

Anaphylaxis

Answer

Local swelling

Question 6

The Drug of choice for a pregnant woman in 2nd trimester with pustular psoriasis is:

Accepted Answer

Prednisolone

Answer

Acitretin

Answer

Methotrexate

Answer

Dapsone

Question 7

Drug Induced Lupus is caused by all except

Accepted Answer

Procaine

Answer

Hydralazine

Answer

Sulphonamides

Answer

Isoniazid

Question 8

All of the following drugs cause amorphous whorl like corneal deposits except:

Accepted Answer

Indomethacin

Answer

Chlorpromazine

Answer

Amiodarone

Answer

Chloroquine

Question 9

Thalidomide is useful in:

Accepted Answer

Treatment of type II lepra reaction

Answer

Treatment of leprosy

Answer

Treatment of type I lepra reaction

Answer

Treatment of neuritic leprosy

Question 10

Not true about thalidomide:

Accepted Answer

Has no antiangiogenesis action against tumour

Answer

Causes phocomelia

Answer

Still has restricted clinical use

Answer

Not tested in pregnant animals before introduction

Clinical Pharmacology and Drug Toxicity — MCQs

Clinical Pharmacology and Drug Toxicity — MCQs

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