NEET-PG 2025 - Pharmacology PYQs Practice Questions

Q: Benralizumab acts on which receptor?

IL 5. ***IL 5***- Benralizumab is a monoclonal antibody that specifically targets the **alpha subunit (IL-5Rα) of the Interleukin-5 Receptor** [1].- By blocking this receptor, it facilitates the depletion of **eosinophils** via **antibody-dependent cell-mediated cytotoxicity (ADCC)**, crucial for treating severe eosinophilic asthma [1].*IL4*- IL-4 is a key mediator of **Type 2 inflammation** often targeted by drugs like **Dupilumab**, which inhibits both IL-4 and **IL-13 signaling**.- Targeting IL-4 is generally aimed at reducing IgE production and overall Th2 response, a different mechanism than the eosinophil depletion mechanism of Benralizumab.*IL1*- IL-1 is a potent **pro-inflammatory cytokine** primarily associated with **autoinflammatory diseases** and targeted by agents like **Anakinra** (IL-1 receptor antagonist).- It is not the primary or specific therapeutic target in severe eosinophilic asthma, which involves Th2 mechanisms and eosinophil recruitment.*TNF alpha*- **TNF-alpha** is a major systemic inflammatory cytokine targeted by biological agents like **Infliximab** and **Etanercept** used in conditions such as **Rheumatoid Arthritis** and **Crohn’s disease**.- While inflammation is involved in asthma, TNF-alpha antagonists are not the standard specific treatment for severe eosinophilic asthma. [Practice more Pharmacology PYQs on OnCourse]

Q: A patient with tumor lysis syndrome has elevated uric acid levels. What is the mechanism of action of pegloticase?

Oxidises uric acid. ***Oxidises uric acid*** - Pegloticase is a recombinant pegylated uricase enzyme that directly catalyzes the conversion of highly insoluble **uric acid**. - It oxidizes uric acid into **allantoin**, which is a highly soluble compound easily excreted by the kidneys, effectively lowering serum uric acid levels. *Xanthine oxidase inhibition* - This is the mechanism of action for drugs like **allopurinol** and **febuxostat**, used to prevent the formation of uric acid. - These agents act upstream by inhibiting the enzyme responsible for synthesizing uric acid from xanthine and hypoxanthine. *URAT1 receptor inhibition* - URAT1 inhibitors (**lesinurad**) prevent the reabsorption of native uric acid from the renal tubules back into the bloodstream. - This mechanism is characteristic of **uricosuric agents**, which increase the renal clearance of uric acid. *Excretion of uric acid* - While pegloticase ultimately facilitates excretion (as allantoin), this option is too broad; its primary action is **enzymatic conversion**. - Direct excretion of native uric acid is increased by **uricosuric drugs** (e.g., probenecid), not by pegloticase's oxidative action. [Practice more Pharmacology PYQs on OnCourse]

Q: A woman diagnosed with migraine has a family history of coronary artery disease. What is the drug of choice for migraine prophylaxis?

Propranolol. ***Propranolol*** - **Propranolol** is a first-line drug for migraine prophylaxis, particularly favored in patients with co-existing conditions like hypertension, anxiety, or, as in this case, risk factors for **Coronary Artery Disease (CAD)**. - As a non-selective beta-blocker, it provides effective migraine prevention while potentially offering **cardioprotective benefits**, making it the safest and best choice here. *Topiramate* - **Topiramate** is also a first-line prophylactic agent, but it is often preferred when patients need to avoid weight gain or have co-existing seizure disorders. - It has no particular advantage over propranolol in lowering cardiac risk and is associated with common side effects such as cognitive impairment (**'fogginess'**) and **nephrolithiasis**. *Ergotamine* - **Ergotamine preparations** are severe vasoconstrictors and are used primarily for the **acute termination** of migraine attacks, not for long-term prophylaxis. - They are absolutely **contraindicated** in patients with established or high risk of **Coronary Artery Disease** (CAD) due to the risk of **myocardial infarction** and stroke. *Amitriptyline* - **Amitriptyline** (a TCA) is used for prophylaxis, especially in patients with co-existing **insomnia** or chronic **tension headaches**. - While effective, TCAs can have potential **cardiac side effects** (e.g., QTc prolongation, orthostatic hypotension) which makes **propranolol** a medically safer choice for patients with a family history of CAD. [Practice more Pharmacology PYQs on OnCourse]

Q: A patient is started on hydrochlorothiazide for hypertension and later develops renal stones. Which metabolic effect of hydrochlorothiazide is most likely responsible?

Hyperuricemia. ***Hyperuricemia*** * Hydrochlorothiazide causes **hyperuricemia** by competing with uric acid for secretion in the proximal tubule, leading to decreased uric acid excretion. * Elevated serum uric acid levels increase the risk of **uric acid stone formation**, which is a well-recognized adverse effect of thiazide diuretics. * This is why thiazides can precipitate gout attacks and increase uric acid stone risk. *Hypocalciuria* * HCTZ causes **decreased urinary calcium excretion** (hypocalciuria) by enhancing calcium reabsorption in the DCT. * This effect is **stone-PROTECTIVE**, not causative - thiazides are actually used therapeutically to prevent recurrent calcium stones. * This would NOT explain stone formation in this patient. *Hypomagnesemia* * While HCTZ can cause magnesium loss, hypomagnesemia is not a primary mechanism for stone formation with thiazide use. * Magnesium is actually a stone inhibitor, so low levels could theoretically contribute, but this is not the main mechanism. *Hypocitraturia* * HCTZ does not typically cause significant citrate wasting or hypocitraturia. * Hypocitraturia is more characteristic of **carbonic anhydrase inhibitors** and chronic metabolic acidosis, not thiazide diuretics. [Practice more Pharmacology PYQs on OnCourse]

Q: A patient presents with GERD. Which drug helps in contraction of LES and increases gastric emptying?

Metoclopramide. ***Metoclopramide*** - It is a **prokinetic agent** that acts as a D2 dopamine receptor antagonist, which increases esophageal tone, enhances peristalsis, and facilitates **gastric emptying**. - It specifically increases the pressure of the **Lower Esophageal Sphincter (LES)**, reducing reflux associated with GERD. *Pantoprazole* - This is a **Proton Pump Inhibitor (PPI)** that reduces acid production by irreversible inhibition of the H+/K+-ATPase pump in parietal cells [1], [2]. - It does not have any significant effect on **LES contraction** or **gastric motility**. *Vonoprazan* - This is a **Potassium-Competitive Acid Blocker (P-CAB)**, which directly and reversibly inhibits the H+/K+-ATPase pump. - Like other acid suppressants, it decreases acid secretion but does not improve **LES function** or **gastric emptying**. *Ranitidine* - This is an **H2 receptor antagonist** that blocks histamine receptors on parietal cells, leading to decreased acid secretion [3]. - It treats GERD by reducing acidity but has no direct action on **LES tone** or stomach **motility**. [Practice more Pharmacology PYQs on OnCourse]

Question 1

Benralizumab acts on which receptor?

Accepted Answer

IL 5

Answer

IL1

Answer

IL4

Answer

TNF alpha

Question 2

A patient with tumor lysis syndrome has elevated uric acid levels. What is the mechanism of action of pegloticase?

Accepted Answer

Oxidises uric acid

Answer

Urat-1 receptor inhibition

Answer

Xanthine oxidase inhibition

Answer

Excretion of uric acid

Question 3

A woman diagnosed with migraine has a family history of coronary artery disease. What is the drug of choice for migraine prophylaxis?

Accepted Answer

Propranolol

Answer

Topiramate

Answer

Ergotamine

Answer

Amitriptyline

Question 4

A patient is started on hydrochlorothiazide for hypertension and later develops renal stones. Which metabolic effect of hydrochlorothiazide is most likely responsible?

Accepted Answer

Hyperuricemia

Answer

Hypocitraturia

Answer

Hypocalciuria

Answer

Hypomagnesemia

Question 5

A patient presents with GERD. Which drug helps in contraction of LES and increases gastric emptying?

Accepted Answer

Metoclopramide

Answer

Vonoprazan

Answer

Ranitidine

Answer

Pantoprazole

Question 6

By what primary mechanism does hydrochlorothiazide help prevent the formation of calcium stones?

Accepted Answer

It increases calcium reabsorption in the distal convoluted tubule, leading to a decrease in urinary calcium excretion.

Answer

It directly dissolves existing calcium stones by altering urinary pH and increasing their solubility.

Answer

It increases the urinary excretion of citrate, which acts as a chelating agent.

Answer

It increases the filtration of calcium at the glomerulus, thereby reducing serum calcium levels.

Question 7

Patient came with fever headache and nuchal rigidity. LP shows gram-negative diplococci in gram stain. Which of the following will be used for chemoprophylaxis in close contacts of a patient with meningococcal meningitis?

Accepted Answer

Rifampicin

Answer

Amoxicillin

Answer

Doxycycline

Answer

Ethambutol

Question 8

A patient on hydrochlorothiazide develops renal stones. What explains this adverse effect?

Accepted Answer

Decreased urinary citrate

Answer

Increased urinary citrate

Answer

Decrease urinary calcium

Answer

Increase urinary calcium

NEET-PG 2025 — Pharmacology