LRR FMGE Pharmacology Part 1.pdf for last minute revision and

Fmge preparation must have

1. LRR for FMGE
Pharmacology
DAY 1
Dr. BHARATH KUMAR V D
-338%3%0
~
~

2. You are so close to victory....
Don’t dare to give up now..
Confidence is the key now

3. Topics
•RS
•GIT
•ANS
•GP
•RENAL
•CVS
•CNS

4. Plan of discussion
•MCQs
•Case based questions
•High yield points
•High yield Tables
•Remembering drug names
•Guess the drug
•Match the following questions
•Adverse effects of important drugs
•Drug interaction

5. Respiratory pharma

6. Which of the following is a leukotriene receptor antagonist used in
prophylaxis of bronchial asthma?
A.Formoterol
B.Montelukast
C.Aminophylline
D.Magnesium sulfate

7. Bronchodilators(relievers)
Drug MOA
Salbutamol
Terbutaline
Formoterol
Salmeterol
Ipratropium
Tiotropium
Aminophylline
Theophylline

8. Drugs used as controllers/prophylaxis in
asthma
Drug MOA
Montelukast
Nedocromil,
Na. cromoglycate
Zileuton
Omalizumab

9. •Salbutamol causes tremors and hyperglycemia ……. TRUE/FALSE
•Most common adverse effect of ICS is……………………

10. GIT Pharma

11. Drugs used in PUD
•………………..prazole
•…………………tidine
•…………………zepine
•Sucralfate

13. Have clarity…….
•……………prazole
•…………….piprazole
•……………bendazole
•…………..nidazole
•…………..conazole
•…………..ozole

14. High yield points
•DOC for Zollinger-Ellison syndrome?
•DOC for NSAID induced PUD?
•Most specific drug for NSAID induced PUD?
•Misoprostol not used in pregnant with PUD T/F

15. H. Pylori eradication
•PPI
•A
•B
•C
•T
•M

16. •Case 1: Pregnant nausea, vomiting in first trimester-drug used
•Case 2: Planning with friends to ascend rapidly to Lehfor jolly. drug used
prophylactically
•Case 3: Planning a trip to a hilly area with curvy roads, previous h/o
vomiting in the trips…drug for prophylaxis

17. •Case 4: metoclopramide was given, torticollis and upward rolling of
eyeball developed? What is the treatment

18. Anti-emetic drugs
•………..setron
•………..pitant
• “ nabi”

19. ANS Pharma

20. •………………. lol
•………………Chol
•…………..stigmine
•…………….zosin
•…………….osin

21. MCQ
A patient was given ampicillin 2g intravenously. After
that, the person developed rash on skin, hypotension and
difficulty in breathing. Adrenaline was given. The
antagonism between adrenaline and histamine is called
as?
A. Physiological
B. Physical
C. Competitive
D. Chemical

22. Concentration Uses
1:1000
(IM, SC and
nebulization)
Anaphylactic shock:
•1:1000
•0.3 to 0.5mg is used
•IM > SC
Given as nebulization
•Angioedema
•croup
•bronchospasmdue to anaphylaxis
1;10,000
(IV,IO ,
endotracheal)
•Cardiac arrest
•Anaphylactic shock
1:50,000 to
1:2,00,000
(local route)
With Local Anaesthetics
Mixed with Local Anaesthetics-prolongs action & toxicity
reduced

23. Graph

24. MCQ
IV Infusion of norepinephrine was given. Which of the following
effects are seen?
A.Increase in heart rate
B.Decrease in heart rate
C.Increase in mean arterial pressure
D.Decreased renal perfusion and reduced urine output

25. SVT/PSVT
SVT/PSVT plus bronchial asthma
Atrial fibrillation/flutter
Atrial fibrillation/flutter
With bronchial asthma

Ventricular tachycardia
Ventricular fibrillation
Long QT syndrome (torsade's de
pointes)

Congenital long QT Syndrome
Bradycardia
Heart block
LAST RESORT REVISION (LRR) - INICET
NOV 23
• A 14 day high speed revision event, where 19 subject specialists will help you revise the
entire syllabus in the most exam oriented manner
• What should you not expect from LRR
o LRR will not get you a top rank in INICET by Itself.
o LRR is not a replacement of the regular course
• What should you expect from LRA?
o LRR is a highly researched programme created by India’s top Medical faculty, it will
give you a fighting chance in the subjects that you otherwise would've left before the
exam.
o LRR will help you revise of the previous year topics along with other important
topics.
LRR DAY 1
Dr. BHARATH KUMAR V D
TOPICS
• ANS
• GP
• CVS
• RENAL
• CNS
• AUTACOIDS
ANS PHARMA
Q. A patient was given ampicillin 2g intravenously. After that, the person developed rash on
skin, hypotension and difficulty in breathing. This patient should be managed by?
a. 0.5 ml of 1:1000 adrenaline by intramuscular route
b. 0.5 ml of 1:1000 adrenaline by intravenous route
c. 0.5 ml of 1:10000 adrenaline by intramuscular route
d. 0.5 ml of 1:1000 adrenaline by intravenous route
Concentration Uses
1:1000
(IM, SC and
nebulization)
Anaphylactic shock:
•1:1000, 0.3 to 0.5mg is used
•Reverse hypotension, laryngeal oedema,
bronchospasm
•I.M is preferred and Subcutaneous route not
reliable in shock
Given as nebulization
•Angioedema, croup and bronchospasm
due to anaphylaxis
1;10,000 (IV,IO ,
endotracheal)
•Cardiac arrest
•Anaphylactic shock
1:50,000 to
1:2,00,000 (local
route)
With Local Anaesthetics
•Mixed with Local Anaesthetics- prolongs
action & toxicity reduced
GRAPH
GRAPH
Case 1: A patient of septic shock was given intravenous norepinephrine. The response to
this drug is best checked by:
A. Increase in heart rate
B. Decrease in heart rate
C. Increase in mean arterial pressure
D. Decreased renal perfusion and reduced urine output


Case 2: patient given atropine and now given noradrenaline for severe hypotension. Effect
on heart rate?
• Dopamine
o 1-2 µg/kg/min D1 action renal vasodilatation
o 2-10 µg/kg/min beta action increased cardiac output
o > 10µg/kg/min alpha action vasoconstriction
• Fenoldopam
• Dobutamine
• Dopexamine: D1,D2 agonist, beta 2 agonist
o Inhibit catecholamine uptake
• Alpha 2 agonist used in muscle spasm…
• Alpha 2 agonist used in ICU sedation…..
• Alpha 2 agonist used in HTN………..
• Drug used in overactive bladder and beta 3 agonist……….
• Drug used in orthostatic hypotension……….
GUESS THE DRUG?

26. •Dopamine
•1-2 μg/kg/minD1 action renal vasodilatation
•2-10 μg/kg/minbeta action increased cardiac output
•> 10μg/kg/minalpha action vasoconstriction
•Dobutamine
•Fenoldopam

27. Guess the drug?
•Alpha 2 agonist used in ICU sedation…..
•Alpha 2 agonist used in HTN………..
•Drug used in overactive bladder and beta 3 agonist……….
•Drug used in orthostatic hypotension……….

28. MCQ
A 50 year old female had undergone hysterectomy surgery.
Post-operatively she developed urinary retention. Which of the
following drug is useful in this condition ?
A. Bethanechol
B. Mirabegron
c. Flavoxate
D. Oxybutynin

29. MCQ
A 48year old patient was posted for surgery and was decided to given a
drug that decreases salivary secretion and reflex vagal activity during
surgery. Which of the following drug is used?
A. pirenzepine
B. glycopyrrolate
C. dicyclomine
D. clidinium

30. Myasthenia gravis
•Drug used to diagnose………………
•Anticholinergic drugs used to treat?
•Are aminoglycosides avoided in this patient ?

31. Alzheimer’s disease
•Ga
•R
•D
•Memory

32. A 51 year old farmer is brought to the primary health centre
with alleged history of consumption of pesticide30 minutes
ago. He is vomiting, sweating profusely with excess salivation,
anxious and his pupils are constricted. What is the antidote for
this poisoning ?
A.Physostigmine
B.Atropine
C.Glucagon
D.Naloxone

33. Poison/overdose antidotes
organophosphorus and
carbamate poisoning
Atropine/belladonna/ Datura
poisoning
digoxin
cyanide toxicity
benzodiazepines, z drugs
and beta carboline

34. Drug Antidote
Metoprolol
Valproate hyperammonemia
ethylene glycol, methanol
Opioids
Ca2+ channel blockers toxicity
TCA overdose
Lignocaine overdose
MgS04
=>
Ca
·
gluconate
Nall
xone
↑
-
Glucagon Coral]
->
Carnitine
- -
->
N
-
-
-
omepizale
a
Iconol
=
-
==
-
-
Naloxone(I
.
V]
Ca
·
gluconate
~
Natlos
-
20%
Intralipid

35. What is false regarding cocaine toxicity and its management
A. heart rate is increased
B. blood pressure is increased
C. Can cause vasoconstriction
D. Cocaine toxicity causes miosis

36. MCQ
A 45-year-old man had performance anxiety and migraine headache.
Propranololwas used in this patient. What comorbid condition listed
below you should very cautious, while using propranolol in this
patient?
A. Essential tremor
B. akathisia
C. Hypertension
D. Bronchial asthma

37. Beta blocker
•Cardio-selctivebeta blocker
•Non-selective beta blocker
•Alpha plus beta blocker
•Shortest acting
•Longest acting
•Closes K channel
•Beta blocker overdose……..antidote

38. Contraindications
Disease Drug
Headinjury with cerebral
haemorrhage
Mannitol
Pulmonary oedema/LVFMannitol
Bronchial asthma Morphine
cholinergicdrugs
Histamine
Adenosine
Carboprost (PG F2 alpha)
propranolol
IHD, Uncontrolled HTNCocaine
amphetamine
sumatripatan
ergots
Biliary colic Morphine

39. MCQ
Which of the following non selective alpha blocker is used in clonidine
withdrawal reaction and cheese reaction?
A.phenoxybenzamine
B.Phentolamine
C.Prazosin
D.Tamsulosin

40. MCQ
Which of the following drugs used in glaucoma, the
mechanism of action is incorrectly matched?
A.Latanoprost---increases uveoscleraloutflow
B.Dipivefrine ----decreases aqueous humor
production
C.Pilocarpine ----causes mydriasis and increases
trabecular outflow
D.Dorzolamide----carbonic anhydrase inhibitor

41. Miotics Mydriatics
Active Active
Passive Passive

42. •Anti-glaucoma drug causing increased uveoscleral outflow
and causing macular edema, iris pigmentation and
growth of eyelashare ……………
•Rho kinase inhibitor used in glaucoma is…………….
•DOC for acute congestive glaucoma is………………..

43. MCQ
A 58 year old male patient had BMI of 31. His physician started him on
a drug for managing obesity. Patient started passing fat in stools.
Which was the drug given to above patient?.
A.Liraglutide
B.Lorcaserin
C.Orlistat
D.Topiramate

45. Match the following
Adverse effects Drug
•Dry mouth
•Blurring of vision
•urinary retention
•constipation
•tachycardia
Alpha blockers
•Postural hypotension
•Inhibition of ejaculation
•Nasal congestion
Anti-cholinergics
•Bradycardia
•Hypoglycaemicunawareness
•Erectile dysfunction
•Heart block
•Fatigue
Beta blockers

46. LRR for FMGE
Pharmacology
DAY 1
Dr. BHARATH KUMAR V D
-338%3%0

47. General pharma

48. General pharma
•100% bioavailability is seen with……..route
•Rate of drug absorption given by…………….and extent of
absorption given by......
•AUC is useful in calculating……………….
•Routes having first pass metabolism are………

50. •Loading dose depends on …………………..
•maintenance dose depends on ………………….
•weakly basic drugs bind…………………..weakly acidic drug bind…………..
•drugs undergoing Hoffman’s elimination…….

51. •ED 50 is a measure of drug………………….
•LD50/ED 50 is……………….
•TD50 Means………………………
•Therapeutic index is a measure of drug……………….
↑
w
Potency
.
LD50
-
- -
TherapeuticIndex
ED50
Earth
Dosetokill
50%
%
wi
animals
Safety
-

52. Kinetics of elimination
Parameters First order
kinetics
Zero order kinetics
Eliminatedin unit time
Eliminationrate
Half life
Clearance
Warfarin
Alcohol and Aspirin
Theophylline
Tolbutamide
Phenytoin
-
/mixed/saturation
&
FractionAmountSero
=
↑
ER2P
.
C
.
ERConstant
C Y4t
<P
.
Ca
-
&
C YXC
+
p
.
C4
Most
drugs

53. A 28 year old patient is on OCPs. She is now diagnosed with TB which is
drug sensitive TB. What advice will you give to her?
A. Increase dose of OCPs
B. decrease dose of OCPs
C. Use barrier method of contraception
D. Treat TB late

55. Identify true statement from Log DRC
A.Drug B is most efficacious
B.Drug A and B are equally potent
C.Drug C is most potent
D.Dug A is most potent

56. Graph

57. Antagonism
•Antagonism between adrenaline and histamine
is……………………………………….
•Antagonism between heparin and protamine sulfate
is………………….
•Antagonism between atropine and ACh is……………………..
•Antagonism between
diazepam and bicucullineis…………….

58. Graph
competitive vs non-competitive antagonism
A
[Agonist]
.
[
At
]••
[
At
]
&
↓ R
-
S
R↓ E
-
S
E↓
D
-
4PS
P-
↓
->

59. Enzyme inhibitionVmax Km
Competitive same increase
Non-Competitive Decrease same

60. •Essential drugs depends on SANE-Safety, affordability, need and
efficacy TRUE/FALSE
•Ketamine is a Schedule X drug T/F

62. Clinical trial
•Phase I trial is done to test mainly……
•Maximum drug failure occurs in ………………phase
•Proof of concept is in…………..trial
•Maximum tolerated dose is found in…………phase
•Human healthy volunteers are involved in ……….trail
•Post marketing surveillance is done in…………phase

63. Clinical trail
•Dose ranging studies usually done in……………….phase
•RCT, Blinded, Multiple centre, 20-30 patients in …………………phase
•RCT, Blinded, 1-2 centre, 3-5 patients in …………………phase
•Investigation new drug application is before phase…………….

64. •In Aspirin poisoning , urine should be……………, to remove
by causing ionization of the drug
•In Amphetamine poisoning , urine should be……………, to
remove by causing ionization of the drug
•Muscarinic receptors are ion channel receptor
TRUE/FALSE

65. MCQ
A 34 year old female was given levothyroxine for hypothyroidism.
Which of the following is correct regarding the mechanism of action of
levothyroxine?
A. activate IP3/DAG/Calcium cascade
B. act by increasing c AMP
C. activate tyrosine kinase enzyme
D. activate nuclear transcription factor

66. Second messengers are
Ion channel Nuclear receptor TK JAK STAT

67. A drug was used during pregnancy and the newborn had
the following features as in image. which of the following
drug resulted in the above condition?
A.Valproate
B.Lithium
C.Thalidomide
D.Phenytoin

68. Guess the teratogenic drug
Teratogenicity Drug
Phocomelia / seal limb deformity
Mobeius syndrome
Foetal goitre
cardiac abnormalities(Ebstein’sanomaly)
Foetalhypotonia
Mental retardation
growth retardation
Micrognathia
small face
Renal agenesis
Misoprostol
~
-
Lithium
-
-
- Fetal
-
-
alcohol
O
Syndr
-
-
C
ACEG/ARBs

69. Teratogenecity Drug
Neural tube defects
Cleft lip and palate
heart defects
microcephaly
micro dactyl(small digits)
Depressed nose
eye and hand defects
skeletal abnormality(stippled epiphysis)
Cutis aplasia congenital(scalp defect)

70. •Drugs for rare disease/ rare condition is called……………………
•Expiry date in a drug label means?

71. Renal and CVS

72. •……………..dipine
•…………….pril
•…………….sartan
•…………….kiren
•……………..none
Amlo-CCBs(DHPs]
-
ACEO
-
-
-
ARBs
Alis
-
Renin
O
--Amui
-
=
OPDE3
-
RacuteCHF

73. •…………………entan
•…………………endan
•…………………zolamide
•…………………vaptan
•…………………pressin
EndothelinBos
-
-antagonit
Th
Levision
-
Ca
.
Sensitizer
-
⑫
acuteCHF
Aceta
CAQ
-
Tol--V2
receptor
antagonist

74. DilWaloKi Drug
•Minoxidil
•Alprostadil
•Nicorandil
•Diltiazem

75. Which of the following diuretic is preferred in a patient with road traffic
accident with head injury and raised ICP?
A.Furosemide
B.Mannitol
C.Spironolactone
D.Acetazolamide

76. •Patient had LVF with pulmonary edema, diuretic of choice
is……….
•Patient had cirrhosis of liver and developed ascites,
Diuretic of choice in this patient is………………………………..
•Diuretic causing gynecomastia is…………………
•Diuretic causing ototoxicity is……….

77. •Diuretic causing hypercalcemia is……………….
•Loop Diuretics looses all ions T/F
•Diuretic, which can prevent calcium renal stones and treat
osteoporosis is………………………..
•Which diuretic causes ototoxicity?

78. •DOC for Neurogenic diabetes insipidus is…………………
•DOC for Nephrogenic diabetes insipidus is……………..
•DOC for SIADH is……………….
•Thiazides are used for both Neurogenic and Nephrogenic
diabetes insipidus T/F
•DOC lithium induced diabetes insipidus………………………….

79. •V 1 selective drug used for esophageal varices is……………….
•V 2 selectivedrug used in nocturnal enuresis, bed wetting,
von willebrand disease and Hemophilia A is………………..

80. Which of the following statements is false regarding drugs
used in CHF?
A. Amrinone is a PDE 3 Inhibitor used in acute CHF
B. Lisinopril prolongs longevity in chronic CHF patients
C. Bisoprolol is started with standard dose in chronic CHF
D. Nesiritideis a BNP analogue given parenteral
⑦
me w ~
⑦
-w
wa um ~E ⑦
- -
-
-
-
-
- -
-
-
⑦

81. Drugs decreasing mortality/ increasing longevity
in chronic CHF
S
A
B

82. Digoxin
•Digoxin mechanism of action in Heart failure is……………………..
•Digoxin mechanism of action in atrial fibrillation is……………………..
•Hypocalcemia, Hypomagnesemia and hypercalcemia can increase digoxin
toxicity…T/F
•Renal failure/thyroid dysfunction/ verapamil/quinidine/amiodarone can
increase digoxin toxicity……..T/F
•All arrhythmias are seen with digoxin toxicity
except……………………………….

83. Digoxin toxicity management
•Most common arrhythmia in digoxin toxicity is……………………………….
•Most specific arrhythmia in digoxin toxicity is……………………………….
•Dialysis not useful in digoxin toxicity………………. T/F
•Antidote for digoxin toxicity is………………………………………………….
•Digoxin induced supraventricular tachycardia (SVT)
is……………………………..
•Digoxin induced ventricular tachycardia (VT) is………………………………….

84. Guess the drug?
Used in angina pectoris
•Drug 1
•Inhibits late Na channel
•Drug 2
•Inhibits funny Na channel and causes vision impairment
•Drug 3
•Inhibits Pfox(partial fatty oxidation)
•Drug 4
•Opens K channel mainly and used in angina

85. PSVT
PSVT plus bronchial asthma
Atrial fibrillation/flutter
(rate control)
Atrial fibrillation/flutter
With bronchial asthma
Bradycardia
Heart block

86. Ventricular tachycardia
Ventricular fibrillation
Long QT syndrome
(torsade's de pointes)
Congenitallong QT Syndrome

87. Class I Sodium channel blockers
Class II Beta blockers
Class III K Channel blockers
class IV Calcium Channel blockers

88. Which of the following anti-arrhythmic can cause drug
induced lupus?
A.Lidocaine
B.Amiodarone
C.Procainamide
D.Verapamil

89. Guess the drug?
Adverse effects Drug
Lung fibrosis
Blue man syndrome
corneal micro deposits
Rash
allergy
Gynaecomastia
xanthopsia
Drug induced lupus
Dry cough
Angioedema
hyperkalaemia
hypotension

90. Guess the drug?
Adverse effects Drug
Gumhyperplasia
Pedal oedema
Constipation
Headache
Tachycardia
Tolerance
flushing
constipation
Monday disease
Anti-angina drug with vision impairment

91. HTN
•First line drugs for HTN
•Resistant HTN

92. HTN
•Case 1: HTN plus BPH, Preferred Anti-hypertensive is
•Case 2: A patient is having anxiety and migraine, which
antihypertensive is preferred………

93. Contraindications
Disease Drug
Pregnancy
Hyperkalaemia
Bilateral renal artery stenosis
h/o angioedema
Anti-hypertensive?

94. HTN
•Case 3: patient has gout and HTN, preferred ARB is?
•Case 4 : pregnant patient with seizures and BP of
210/110mmHg?

96. •Case 5: Patient is a k/c/o DMT2, HTN and has microalbuminuria drug
preferred is?
•Enalapril /amlodipine
•Case 6: patient is on anti-hypertensive and develops dry cough and
angioedema. Drug is?
•Captopril/nitroglycerine

97. Which of the following used in pulmonary hypertension acts by
blocking endothelin receptor?
A.Bosentan
B.sildenafil
C.Nifedipine
D.Riociguat

98. Autacoids

99. Gout
•Case: acute gout, DOC is……………………
•Case: acute gout, NSAID contraindicated?.................
•Case: acute gout, drug used which acts by inhibiting
both neutrophil chemotaxis and microtubule
polymerization ?

100. Gout
•Case: DOC for Chronic gout?
•Case: Drugs which increase uric acid excretion is
urine?

101. Gout
•Case: chronic gout, enzyme used in management?
•Case: Tumor lysis syndrome with hyperuricemia ,
enzyme used in management to lower uric acid levels?

102. MCQ
Drug used to treat erectile dysfunction and to open PDA also is?
A.Misoprostol
B.Alprostadil
C.Dinoprost
D.Dinoprostone
E.Carboprost
F.Latanoprost
G.Iloprost
H.Epoprostenol, treprostenil

103. Migraine
DOC for acute attack of migraine is…………………
5HT1B/1D Agonist used in acute attack of migraine
is……………
Most common drug used in prophylaxis……………….
Antimigraine drug given, patient came with low pulse and
ischemia of lower limb
Drug and treatment of the condition

104. Migraine
•CGRP Antagonist used in acute attack of migraine is……………
•CGRP Antagonist used in prophylaxis of migraine is……………..
•5HT1F agonist used in acute attack of migraine is………………

105. MCQ
Tofacitinib is used in the treatment of Rheumatoid arthritis and the
drug is ?
A. TNF-α inhibitor
B. Inhibitor of Janus kinases
C. IL-6 receptor blocker
D. Dihydrofolate reductase inhibitor

106. Drug Target
Infliximab
Certolizumab
Adalimumab
Golimumab
Etarnacept
Rituximab
Tocilizumab
sarilumab
Abatacept
Belatacept
Tofacitinib
Barcitinib
-
-
TNFL
-
-
G
- -
antagonist
- -O
-
220
-
IL6#
-
-
Six
CD
80/86G
-
JAKO
Jakson

107. •Calcineurin inhibitor used in organ transplant
are…………………………………
•m TOR inhibitor used in medicated stent
is……………………….
•Drug inhibiting dihydroorotatedehydrogenase is and used in
rheumatoid arthritis is …………………………
Tyclosporine
,
Tacrolimus
-
Sirolimus
.
-
Teflunomide
-

108. THANK YOU
TETTERTON