NEET-PG 2013 - Pharmacology Practice Questions

Q: Which prostaglandin inhibitor is used in the treatment of patent ductus arteriosus (PDA)?

Indomethacin. ***Indomethacin*** - **Indomethacin** is a non-steroidal anti-inflammatory drug (**NSAID**) that inhibits **prostaglandin synthesis**, particularly **prostaglandin E2 (PGE2)**. - **PGE2** helps keep the **ductus arteriosus** open in utero; by inhibiting its production, indomethacin facilitates the closure of a **patent ductus arteriosus (PDA)** in neonates. *Misoprostol* - **Misoprostol** is a **prostaglandin E1 (PGE1) analog** and is used to induce labor, treat gastric ulcers, and for medical abortions. - It would work to **maintain** rather than close the **ductus arteriosus** if used in a neonate with a heart defect requiring patency. *Dinoprostone* - **Dinoprostone** is a **prostaglandin E2 analog** used for cervical ripening and labor induction. - It is not used for closing a **PDA**; its prostaglandin agonistic action would likely keep the **ductus arteriosus open**. *PGE-2* - **Prostaglandin E2 (PGE2)** is a naturally occurring prostaglandin that helps maintain the patency of the **ductus arteriosus** in the fetus. - Administering **PGE2** would keep the **ductus arteriosus open**, which is the opposite of the desired effect when treating a **PDA**.

Q: Which drug is used to keep the patent ductus arteriosus (PDA) open?

PGE1. ***PGE1*** - **Prostaglandin E1** (**PGE1**, alprostadil) is used to maintain the patency of the **ductus arteriosus** in neonates with certain congenital heart defects [1], [2]. - It acts as a **vasodilator** on the smooth muscle of the ductus, preventing its closure and allowing for adequate blood flow prior to surgical correction [1], [2]. *PGI2* - **Prostaglandin I2** (**PGI2**, prostacyclin) is a potent **vasodilator** and **platelet aggregation inhibitor** [1]. - While it has cardiovascular effects, it is primarily used for conditions like **pulmonary hypertension** and not for maintaining ductal patency [1]. *PGF2̑* - **Prostaglandin F2̑** (**PGF2̑**) is involved in processes such as **uterine contractions** and **bronchoconstriction** [1], [2]. - It does not play a role in maintaining the patency of the ductus arteriosus. *PGH2* - **Prostaglandin H2** (**PGH2**) is an immediate precursor in the synthesis of various other prostaglandins and thromboxanes. - It is not directly administered as a drug to maintain ductal patency but is an intermediate in their synthesis.

Q: What is the drug of choice for the treatment of kala-azar?

Liposomal Amphotericin B. ***Liposomal Amphotericin B*** - It is currently considered the **drug of choice** for treating **visceral leishmaniasis (kala-azar)** due to its high efficacy and better tolerability profile compared to conventional amphotericin B. - The **liposomal formulation** allows for targeted delivery to macrophages, where *Leishmania* parasites reside, reducing systemic toxicity. *Amphotericin B* - While effective against *Leishmania*, conventional **Amphotericin B deoxycholate** is associated with significant **nephrotoxicity** and other severe side effects. - It is generally reserved for cases where liposomal amphotericin B is unavailable or as an alternative in specific clinical situations. *Quinine* - **Quinine** is an **antimalarial drug** primarily used for the treatment of *Plasmodium falciparum* malaria. - It has no significant efficacy against *Leishmania* species, which are the causative agents of kala-azar. *Paromomycin* - **Paromomycin** is an **aminoglycoside antibiotic** that can be used as an alternative treatment for visceral leishmaniasis, especially in combination therapies. - Although effective, it is generally not considered the first-line **drug of choice** globally, and its efficacy can vary by region.

Q: Which of the following drugs is useful in acute attack of gout ?

Piroxicam. ***Piroxicam*** - **Piroxicam** is a **non-steroidal anti-inflammatory drug (NSAID)**, which are the first-line treatment for acute gout attacks. - NSAIDs work by inhibiting **prostaglandin synthesis**, thereby reducing inflammation and pain associated with the acute crystal-induced arthritis. *Furosemide* - **Furosemide** is a loop diuretic that can **raise uric acid levels** by increasing reabsorption in the renal tubules. - Therefore, it would exacerbate **gout** and is contraindicated during an acute attack. *Sulfinpyrazone* - **Sulfinpyrazone** is a **uricosuric agent** used for chronic gout management to increase uric acid excretion. - It is **not used for acute attacks** as it can precipitate or worsen an attack by mobilizing uric acid crystals. *Allopurinol* - **Allopurinol** is a **xanthine oxidase inhibitor** used for long-term management of hyperuricemia and chronic gout. - Starting allopurinol during an **acute attack** can worsen or prolong the attack by causing rapid changes in serum uric acid levels.

Q: A patient has Cushing syndrome due to an adrenal tumor. Which drug should be given?

Ketoconazole. ***Ketoconazole*** - **Ketoconazole** is an antifungal agent that also inhibits several enzymes involved in **steroidogenesis**, including 17α-hydroxylase and 11β-hydroxylase. - This action helps to reduce the overproduction of **cortisol** in Cushing syndrome caused by an adrenal tumor. *Hydrocortisone* - **Hydrocortisone** is a glucocorticoid itself and would exacerbate the symptoms of **Cushing syndrome** by adding to the already elevated cortisol levels. - It is used for **cortisol replacement therapy** in conditions like Addison's disease, where cortisol levels are low. *Dexamethasone* - **Dexamethasone** is a potent synthetic glucocorticoid used to suppress **ACTH production** in cases of ACTH-dependent Cushing's syndrome (e.g., Cushing's disease) or to diagnose Cushing's syndrome. - In an adrenal tumor, which is **ACTH-independent**, dexamethasone would not reduce cortisol production but could instead worsen the hypercortisolism. *Spironolactone* - **Spironolactone** is an **aldosterone antagonist** and a weak antiandrogen, primarily used for conditions like hyperaldosteronism, heart failure, and hirsutism. - It has no direct effect on the overproduction of **cortisol** from an adrenal tumor in Cushing syndrome.

Q: What is the drug of choice for most forms of interstitial lung disease?

Corticosteroids. ***Corticosteroids*** - **Corticosteroids** are the **drug of choice** for many forms of **interstitial lung disease (ILD)** due to their potent **anti-inflammatory** and **immunosuppressive properties**, which help reduce lung inflammation and prevent fibrosis. - They are particularly effective in inflammatory ILDs such as **sarcoidosis**, **hypersensitivity pneumonitis**, and some **connective tissue disease-associated ILDs**. *Antibiotics* - **Antibiotics** are primarily used to treat bacterial and other microbial infections and are **not effective** against the **inflammatory and fibrotic processes** characteristic of most ILDs. - They might be used if there's a **secondary bacterial infection** complicating ILD, but not as primary treatment for the ILD itself. *Bronchodilators* - **Bronchodilators** work by relaxing the muscles around the airways, making them wider and easier to breathe through, which is beneficial in conditions like **asthma** or **COPD**. - They are **not primarily used** in ILD as the main problem is **inflammation and scarring of the lung tissue**, not reversible airway constriction. *Aspirin* - **Aspirin** is an **NSAID** with **anti-inflammatory**, **anti-platelet**, and **analgesic properties**, commonly used for pain relief, fever reduction, and cardiovascular protection. - It has **no established role** in the primary treatment of **interstitial lung disease**, as its anti-inflammatory effects are typically insufficient for the severe inflammation seen in ILD.

Q: What is the drug of choice for managing generalized tonic-clonic seizures (GTCS) during pregnancy?

Lamotrigine. ***Lamotrigine*** - **Lamotrigine** is considered **one of the preferred drugs** for managing epilepsy during pregnancy due to its relatively **low teratogenic risk** compared to older antiepileptic drugs. - Its established safety profile in pregnancy makes it a preferred option to balance seizure control and **fetal well-being**. - **Important Note:** For **GTCS specifically**, lamotrigine and levetiracetam are both considered appropriate first-line choices, with selection depending on individual patient factors and seizure control history. - Lamotrigine levels **decrease during pregnancy** and require monitoring and dose adjustments. *CBZ* - **Carbamazepine (CBZ)** is associated with an increased risk of **neural tube defects** and other congenital malformations when used during pregnancy, making it less favorable. - While effective for GTCS, its teratogenicity often leads to avoidance or careful consideration of alternatives in pregnant women. *Levetiracetam* - **Levetiracetam** is increasingly recognized as an **excellent choice for GTCS in pregnancy** with a favorable safety profile and growing evidence base. - Many recent guidelines and clinical practices favor levetiracetam as **first-line for GTCS** due to its low risk of major congenital malformations and good efficacy. - It is a **medically appropriate alternative** to lamotrigine, and in some contexts may be preferred, particularly for primary generalized epilepsy. *Valproate* - **Valproate** has the highest risk of **teratogenicity** among common antiepileptic drugs, including a significant risk of **neural tube defects**, developmental delay, autism spectrum disorder, and other anomalies. - Due to these significant risks, valproate is generally **contraindicated** in women of childbearing potential, especially during pregnancy, unless no other effective and safer alternative exists.

Q: Which of the following antiglaucoma medications can cause drowsiness?

Brimonidine. ***Brimonidine*** - **Brimonidine** is an **alpha-2 adrenergic agonist** [1] that can cause central nervous system depression, leading to side effects such as **drowsiness** and fatigue. - This systemic side effect is more common with the topical ophthalmic formulation due to systemic absorption. *Latanoprost* - **Latanoprost** is a **prostaglandin analog** that primarily works by increasing uveoscleral outflow, and its side effects are mainly localized to the eye (e.g., iris color change, eyelash growth). - It does not typically cause systemic side effects like drowsiness because its systemic absorption is minimal. *Dorzolamide* - **Dorzolamide** is a **topical carbonic anhydrase inhibitor** [1] that reduces aqueous humor production, and its most common side effects include local ocular irritation and a bitter taste. - While systemic carbonic anhydrase inhibitors can cause fatigue and drowsiness, the topical formulation has very limited systemic absorption, making drowsiness uncommon. *Timolol* - **Timolol** is a **non-selective beta-blocker** [1] that reduces aqueous humor production and can cause systemic side effects such as bradycardia, bronchospasm, and hypotension. - While some beta-blockers can cause fatigue, **drowsiness** as a prominent side effect is less common compared to alpha-2 agonists.

Q: The mechanism by which ergometrine stops postpartum hemorrhage is that it:

Increases tone of uterine muscle. ***Increases tone of uterine muscle*** - **Ergometrine** is an **ergot alkaloid** that directly stimulates **uterine smooth muscle contractions**. - These sustained contractions lead to **compression of blood vessels within the myometrium**, thereby reducing blood flow and controlling **postpartum hemorrhage**. *Causes vasoconstriction of uterine arteries* - While ergometrine does have some generalized **vasoconstrictive effects**, its primary mechanism of action in controlling postpartum hemorrhage is not mainly through direct vasoconstriction of large uterine arteries. - The crucial effect is the **sustained uterine contraction** which mechanically occludes blood vessels, rather than chemical constriction of the vessels themselves. *Induces platelet aggregation* - Ergometrine does not primarily act by inducing **platelet aggregation**; this is a function of specific clotting factors and platelet activators. - Its therapeutic effect against hemorrhage is mediated through its action on **uterine contractility**, not on the cellular components of coagulation. *Promotes coagulation* - Ergometrine does not directly promote the **coagulation cascade** or enhance the formation of fibrin clots. - Its mechanism of action is distinct from agents that affect intrinsic or extrinsic pathways of coagulation.

Question 1

Which prostaglandin inhibitor is used in the treatment of patent ductus arteriosus (PDA)?

Accepted Answer

Indomethacin

Answer

PGE-2

Answer

Misoprostol

Answer

Dinoprostone

Question 2

Which drug is used to keep the patent ductus arteriosus (PDA) open?

Accepted Answer

PGE1

Answer

PGI2

Answer

PGH2

Answer

PGF2α

Question 3

What is the drug of choice for the treatment of kala-azar?

Accepted Answer

Liposomal Amphotericin B

Answer

Amphotericin B

Answer

Quinine

Answer

Paromomycin

Question 4

Which of the following drugs is useful in acute attack of gout ?

Accepted Answer

Piroxicam

Answer

Furosemide

Answer

Sulfinpyrazone

Answer

Allopurinol

Question 5

A patient has Cushing syndrome due to an adrenal tumor. Which drug should be given?

Accepted Answer

Ketoconazole

Answer

Spironolactone

Answer

Hydrocortisone

Answer

Dexamethasone

Question 6

What is the drug of choice for most forms of interstitial lung disease?

Accepted Answer

Corticosteroids

Answer

Antibiotics

Answer

Bronchodilators

Answer

Aspirin

Question 7

What is the drug of choice for managing generalized tonic-clonic seizures (GTCS) during pregnancy?

Accepted Answer

Lamotrigine

Answer

CBZ

Answer

Levetiracetam

Answer

Valproate

Question 8

Which of the following antiglaucoma medications can cause drowsiness?

Accepted Answer

Brimonidine

Answer

Latanoprost

Answer

Dorzolamide

Answer

Timolol

Question 9

Which of the following statements about Selective Estrogen Receptor Modulators (SERMs) is correct?

Accepted Answer

Some SERMs can act as both agonists and antagonists on estrogen receptors.

Answer

Act as agonists on estrogen receptors.

Answer

Used to reduce the risk of hot flushes and thromboembolism.

Answer

Act as antagonists on estrogen receptors.

Question 10

The mechanism by which ergometrine stops postpartum hemorrhage is that it:

Accepted Answer

Increases tone of uterine muscle

Answer

Induces platelet aggregation

Answer

Promotes coagulation

Answer

Causes vasoconstriction of uterine arteries

NEET-PG 2013 — Pharmacology