INI-CET 2025 - Pharmacology Practice Questions

Q: Which of the following anti-epileptics is not given during pregnancy?

Valproate. ***Correct: Valproate*** - Valproate (Valproic Acid) is the anti-epileptic drug (AED) with the **highest teratogenic risk**, particularly causing **Neural Tube Defects (NTDs)** like spina bifida (1-2% risk), in a dose-dependent manner - It is **strictly contraindicated** during pregnancy (FDA Category X) due to increased risks of **major congenital malformations (10-20%)** and long-term neurodevelopmental consequences, including lower IQ and increased risk of **Autism Spectrum Disorder** in the child - This is the AED that should **NOT be given during pregnancy** *Incorrect: Lamotrigine* - Lamotrigine is generally considered one of the **safer AEDs** used in pregnancy, often a preferred alternative when monotherapy is necessary - While initial data suggested a small risk of oral clefts, current extensive evidence shows it has a **low overall risk** of major congenital malformations - Can be safely used during pregnancy when needed *Incorrect: Levetiracetam* - Levetiracetam (Keppra) is highly favored during pregnancy because it has one of the **lowest risks** of causing major congenital malformations among all AEDs - It is often recommended as the **drug of choice** for women who require AED continuation during gestation due to its favorable safety profile for both physical and neurodevelopmental outcomes *Incorrect: Carbamazepine* - Carbamazepine increases the risk of teratogenicity, classically associated with a risk of **NTDs** (~1%, lower than Valproate) and minor craniofacial defects like cleft lip/palate - Although generally reserved for situations where safer alternatives are ineffective, it **can still be used** when benefits outweigh risks - not absolutely contraindicated like valproate

Q: Which of the following is the classical drug for clinical cure in malaria?

Chloroquine. ***Chloroquine*** - **Clinical cure** in malaria refers to the eradication of the **asexual erythrocytic forms** of the parasite, which are responsible for the clinical symptoms. - **Chloroquine** is the classical 4-aminoquinoline drug historically used as the prototype for clinical cure, acting specifically against asexual blood stages in chloroquine-sensitive *Plasmodium* species. - It remains the drug of choice for *P. vivax*, *P. malariae*, and *P. ovale* in areas without resistance. *Primaquine* - Primarily used for **radical cure** (preventing relapse) by eliminating **hypnozoites** (dormant liver stages) in *P. vivax* and *P. ovale*. - Also kills **gametocytes** (sexual stages) to reduce transmission, but does NOT provide clinical cure as it has minimal activity against asexual blood stages. *Artesunate* - A fast-acting artemisinin derivative that rapidly clears **asexual blood stages** and is used in Artemisinin-based Combination Therapy (ACT) as first-line treatment for *P. falciparum*. - While artesunate does achieve clinical cure in modern practice, chloroquine is the **classical prototype drug** traditionally associated with this concept in pharmacology teaching. *Sulfadoxine-pyrimethamine* - A **folate antagonist** combination used as alternative treatment or for Intermittent Preventive Treatment in Pregnancy (IPTp). - Widespread resistance limits its use for clinical cure, and it's not the classical drug associated with this concept.

Q: Which of the following is not true regarding bempedoic acid?

It non-competitively inhibits ATP citrate lyase. ***It non-competitively inhibits ATP citrate lyase*** - This statement is **incorrect** because Bempedoic acid's active metabolite, **ETC-1002-CoA**, inhibits **Adenosine Triphosphate Citrate Lyase (ACL)**, but it does so in a **competitive** manner, not a non-competitive one. - This inhibition leads to reduced acetyl-CoA production in the liver, subsequently lowering **cholesterol synthesis**. ***It is a dicarboxylic acid*** - This statement is **true**. Bempedoic acid (ETC-1002) is structurally a **dicarboxylic acid derivative**, requiring activation in the liver by short-chain acyl-CoA synthetase 1 (ACSVL1). - The presence of the dicarboxylic acid structure is key to its mechanism and selective liver activation. ***It is used when statins and diet cannot control dyslipidemia*** - This statement is **true**. Bempedoic acid is approved primarily for patients with **heterozygous familial hypercholesterolemia** or established **atherosclerotic cardiovascular disease (ASCVD)** who require additional lowering of LDL-C despite maximally tolerated statin therapy. - It is often used as an adjunct to diet and other lipid-lowering therapies, particularly in statin-intolerant patients. ***It inhibits de-novo synthesis of liver cholesterol*** - This statement is **true**. By competitively inhibiting **ATP Citrate Lyase (ACL)**, Bempedoic acid reduces the availability of **acetyl-CoA** in the cytosol, which is the necessary precursor for *de novo* cholesterol synthesis in the liver. - This mechanism is upstream of the HMG-CoA reductase step targeted by statins, offering a complementary path to reducing cholesterol.

Q: Which of the following is the treatment for complicated gonorrhoea due to penicillin-resistant Neisseria gonorrhoeae?

Ceftriaxone. ***Correct: Ceftriaxone*** - **Ceftriaxone** (a third-generation cephalosporin) is the current cornerstone of treatment for both uncomplicated and complicated gonorrhoea, especially given the high prevalence of **penicillin resistance** in *N. gonorrhoeae*. - For complicated infections (e.g., disseminated gonococcal infection, epididymo-orchitis, pelvic inflammatory disease), it is often given as a higher dose (e.g., 1g IV daily) and sometimes combined with **azithromycin** where co-infection with *Chlamydia* is possible. *Incorrect: Amoxicillin* - **Amoxicillin** is a penicillin-class antibiotic and is ineffective due to widespread resistance mediated by **plasmid-encoded beta-lactamases** (e.g., *penicillinase-producing Neisseria gonorrhoeae* or PPNG). - Penicillins are no longer recommended for the treatment of gonorrhoea in any setting because of this high resistance. *Incorrect: Tetracycline* - **Tetracycline** (or doxycycline) was historically used for gonorrhoea treatment but resistance has become common, rendering it unreliable as a first-line therapy. - It is currently used primarily to treat concurrent **Chlamydia trachomatis** infection, rather than gonorrhoea itself. *Incorrect: Vancomycin* - **Vancomycin** is a glycopeptide antibiotic primarily effective against **Gram-positive bacteria** (like MRSA) by interfering with cell wall synthesis. - *Neisseria gonorrhoeae* is a **Gram-negative bacterium**, and vancomycin is not effective for its treatment.

Q: In which condition erythropoietin will be useful for treatment?

Anemia in chronic kidney disease. ***Anemia in chronic kidney disease*** - **Erythropoietin (EPO)** deficiency is the primary cause of anemia in chronic kidney disease (**CKD**), as the damaged kidneys cannot produce adequate amounts. - Recombinant human EPO (**rHuEPO**) is the standard treatment to stimulate **erythropoiesis** in the bone marrow, correcting the anemia and improving quality of life. ***Anemia in myelodysplastic syndrome*** - While erythropoiesis-stimulating agents (ESAs) like EPO are occasionally used in lower-risk myelodysplastic syndrome (**MDS**) patients, especially those who are transfusion-dependent, the response rates are variable and dependent on underlying cytogenetics and serum EPO levels. - The primary defect in MDS involves abnormal **hematopoietic stem cell function** (a primary bone marrow failure) rather than just EPO deficiency, making treatment difficult. ***Nutritional anemia*** - This category, including **iron deficiency anemia** and **megaloblastic anemia** (Vitamin B12 or folate deficiency), is primarily treated by supplementing the specific deficient nutrient. - Giving EPO would be ineffective unless the underlying nutritional deficit is corrected, as the bone marrow lacks the necessary building blocks for red blood cell production. ***Aplastic anemia*** - Aplastic anemia is a condition of **pancytopenia** caused by bone marrow failure due to the destruction or suppression of hematopoietic stem cells, often immune-mediated. - The primary treatment involves **immunosuppressive therapy** (e.g., antithymocyte globulin) or **hematopoietic stem cell transplantation**, as erythropoietin production is usually adequate, and the bone marrow is simply unable to respond.

Question 1

Which of the following anti-epileptics is not given during pregnancy?

Accepted Answer

Valproate

Answer

Lamotrigine

Answer

Carbamazepine

Answer

Levetiracetam

Question 2

Which of the following statements is not true regarding benzodiazepines and barbiturates?

Accepted Answer

Flumazenil can be used for severe alcohol withdrawal symptoms

Answer

Both can be used as a sedative hypnotic

Answer

With alcohol it causes CNS depression

Answer

Both act on GABA-A

Question 3

Which of the following is the classical drug for clinical cure in malaria?

Accepted Answer

Chloroquine

Answer

Sulfadoxine-pyrimethamine

Answer

Artesunate

Answer

Primaquine

Question 4

Which of the following is not true regarding bempedoic acid?

Accepted Answer

It non-competitively inhibits ATP citrate lyase

Answer

It is a dicarboxylic acid

Answer

It is used when statins and diet cannot control dyslipidemia

Answer

It inhibits de-novo synthesis of liver cholesterol

Question 5

Which of the following is the treatment for complicated gonorrhoea due to penicillin-resistant Neisseria gonorrhoeae?

Accepted Answer

Ceftriaxone

Answer

Vancomycin

Answer

Tetracycline

Answer

Amoxicillin

Question 6

In which condition erythropoietin will be useful for treatment?

Accepted Answer

Anemia in chronic kidney disease

Answer

Nutritional anemia

Answer

Aplastic anemia

Answer

Anemia in myelodysplastic syndrome

INI-CET 2025 — Pharmacology