OZ

EMEDIC
 PHARMPHARMACOLOGY
ACOLOGY

General Pharmacology
Most common process of Absorption:
Simple/passive diffusion  Non-ionized drugs absorb

pK Value:
pH at which a drug is 50% ionized and 50% non-ionized

First pass metabolism in liver  ORAL ROUTE (all other route Bypass liver)

Drugs undergoing high FPM  NTG, Propranolol & Lignocaine

BIO-AVAILABILITY (F)
T-max :

C-max :

AUC :

BA of i.v. route  100%

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PHARMACOLOGY
PHARMA COLOGYDFX
DFX- WORKBOOK
- WORKBOOK 2023

VOLUME OF DISTRIBUTION. (Vd)

Chloroquine  Highest Vd (15000 L)

Bulls eye maculopathy

FORCED ALKALINE DIURESIS

 WEAK ACIDIC DRUG POISONING

 BY SODIUM BICARBONATE

FORCED ACIDIC DIURESIS

 WEAK ALKALINE DRUG POISONING

 BY AMMONIUM CHLORIDE

2
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PHARMACOLOGY
PHARMA COLOGY DFX - DFX - WORKBOOK
WORKBOOK 2023

Antidotes
PHARMA COLOGY DFX - WORKBOOK 2023

Amfetamine  Antidotes
Verapamil (CCB) 
Amfetamine
Warfarin  
Verapamil (CCB) 
Warfarin
Digoxin
Benzodiazepine 
Digoxin 
Benzodiazepine glycol 
Methanol/ethylene

Methanol/ethylene
TCA poisoning  glycol 
Propranolol (beta blocker) 
TCA poisoning 
Propranolol (beta blocker) 

PRO DRUGS ACTIVE FORM

INACTIVE DRUG ACTIVE FORM ACTIVE DRUG
PRO DRUGS ACTIVE FORM
INACTIVE DRUG ACTIVE FORM ACTIVE DRUG
PREDNISONE FLUOXETINE

LEVODOPA
PREDNISONE ALLOPURINOL
FLUOXETINE

ENALAPRIL
LEVODOPA DIAZEPAM
ALLOPURINOL
(All ACE INHIBITORS)

ENALAPRIL SPIRONOLACTONE
DIAZEPAM
(All ACE INHIBITORS)

CODEINE
SPIRONOLACTONE

PRIMIDONE
CODEINE

PRIMIDONE
Which ACE inhibitors are NOT PRO-DRUGS  Captopril, Lisinopril
Which ACE inhibitors are NOT PRO-DRUGS  Captopril, Lisinopril

3
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PHARMACOLOGY
PHARMA COLOGYDFX
DFX- WORKBOOK
- WORKBOOK 2023

CYP ENZYME INDUCER

CYP ENZYME INHIBITOR

METABOLISM

Drug interaction
CYP3A4
Estrogen XXXXXX

Cisapride CYP3A4
Astemizole XXXXX
Terfinadine
CYP2C19
Clopidogrel (prodrug) Active Form

CYP2D6
Tamoxifen (prodrug) Active Form

4
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PHARMACOLOGY
PHARMA COLOGY DFX -DFX - WORKBOOK
WORKBOOK 2023

INOTROPHIC RECEPTORS GPCR/ PROTEIN KINASE RECEPTORS INTRACELLULAR RECEPTORS

METABOTROPHIC RECEPTORS

…..Tyrosine Kinase Receptors….. CYTOPLASMIC:

…..JAK-STAT……
•
• CYTOKI
NUCLEAR:
HYPOTHALAMIC •
MONES

ITUITARY HORMONES
EPT GH, PROLACTIN)

IOTENSIN RECEPTORS

Pentameric rosette
7 transmembrane (serpentine helical)

Elimination constant.

Constant fraction eliminated Constant amount eliminated

Half life constant

Pure zero order: alcohols

Psuedo-zero order: Phenytoin

5
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PHARMACOLOGY
PHARMAPHARMA
COLOGYDFX - WORKBOOK
DFX
COLOGY- WORKBOOK 2023
DFX - WORKBOOK 2023

FORMFU
OLRAM
SULAS

• LOADING DOSE = Vd
• LOADING ✕ Target
DOSE = Vd ✕Conc.
Target Conc.

• MAINTENANCE DOSE = CL
• MAINTENANCE ✕ Target
DOSE = CL ✕Conc . Conc .
Target

Target Conc.
Target Css =
Conc. achieved to 5 half
after 4 after
Css = achieved 4 tolives
5 half lives

•• HALF
Half life• LIFE
0.693life=(𝑉𝑉𝑉𝑉=𝑉𝑉𝑉𝑉𝑉𝑉𝑉𝑉0.693
= Half = 𝑐𝑐𝑐𝑐0.693/k
𝑉𝑉𝑉𝑉𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑/(𝑉𝑉𝑉𝑉𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑉𝑉𝑉𝑉𝑐𝑐𝑐𝑐𝑉𝑉𝑉𝑉𝑐𝑐𝑐𝑐𝑙𝑙𝑙𝑙𝑉𝑉𝑉𝑉𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑑𝑑𝑑𝑑𝑙𝑙𝑙𝑙𝑑𝑑𝑑𝑑)𝑑𝑑𝑑𝑑𝑑𝑑𝑑𝑑/ 𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑐𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙𝑙) = 0.693/k

Antagonist Antagonist Antagonist Antagonist

type? type? Type? Type?
Right shift in DRCshift in DRC
Right Reduce slope of DRC
Reduce slope of DRC

Vmax (response) Vmax  Reduced

Vmax (response) Vmax  Reduced
unchanged unchanged

Km (dose) 
Km (dose)  Km (dose) 
Km (dose) 
IncreasedIncreased unchanged unchanged

• ACTIVATED•CHARCOAL:
ACTIVATEDPHYSICAL ANTAGONIST
CHARCOAL: PHYSICAL ANTAGONIST

• PROTAMINE• SULFATE-->
PROTAMINE HEPARIN ANTIDOTE:
SULFATE--> CHEMICAL
HEPARIN ANTIDOTE: CHEMICAL
ANTAGONISTANTAGONIST

6 6
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PHARMACOLOGY
PHARMA COLOGY DFX -DFX - WORKBOOK
WORKBOOK 2023

Category X Teratogenic dugs

PHOCOMELIA

EBSTEIN ANOMALY
(CARDIAC MALFORMATION)

RENAL AGENESIS

CHONDRODYSPLASIA PUNCTATA

APLASIA CUTIS

BONE, TEETH AND CARTILAGE DEFECT

SPINA BIFIDA (NTD)

SATISFY PRIORITY HEALTHCARE NEEDS OF MAJORITY OF POPULATION

SHOULD NOT BE COMBINED WITH OTHER DRUGS

DUMMY DRUG (NO ACTIVE INGREDIENT)

DRUGS FOR RARE SISEASE (< 1PER 5 LAKH POPULATION) ,

PRESCRIPTION DRUGS

GIVEN UNDER MEDICAL SUPERVISION

NARCOTIC AND PSYCHOTROPHIC DRUGS (E.G KETAMINE)

7
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PHARMACOLOGY DFX - WORKBOOK
PHARMA COLOGY DFX - WORKBOOK 2023

1 DOSE
trial SAFETY

2 +
trial BLINDING
3 confirmatory RCT +
trial DOSE

4 LABEL

Pharmacovigilance  Monitor Adverse drug reaction

THERAPEUTIC INDEX

Safety margin of drug

Therapeutic range values
Phenytoin 10-20 mg/dl
Digoxin 0.6 – 2.0 ng/ml
Theophylline 5 – 15 mg/dl
Lithium 0.5 – 1.2 meq/ml

8
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PHARMACOLOGY DFX - WORKBOOK
ANS

DIAG OF

GRAVIS

test

MYESTHENIA GRAVIS

PHARMA COLOGY DFX - WORKBOOK 2023

disease
Cholinergic
enhancers
9
Donepezil

BLOCKER
Memantine
10
PHARMACOLOGY DFX - WORKBOOK

PHARMA COLOGY DFX - WORKBOOK 2023

10

oliguria

shock
 HT - Pregnancy

11
PHARMACOLOGY DFX - WORKBOOK
PHARMA COLOGY DFX - WORKBOOK 2023

HT - Pregnancy

Very effective in

Very effective in CCF

DOC

DOC

PERFORMANCE
HOCM AKATHESIA

PERFORMANCE ANXIETY
HOCM AKATHESIA

ANXIETY

12
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PHARMACOLOGY DFX - WORKBOOK
PHARMA COLOGY DFX - WORKBOOK 2023

ADHD

Zonisamide
Setmelanotide
Topiramate

Orlistat
Bupropione

Liraglutide Phenteramine
Semaglutide
Naltrexone

13
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PHARMACOLOGY DFX - WORKBOOK
ANTI ARRHYTHMIC DRUG

DOACs/VKA

PHARMA COLOGY DFX - WORKBOOK 2023

SVT
14

For acute SVT To prevent recurrance

AVOID-
BETA BLOCKERS
14
PHARMACOLOGY DFX - WORKBOOK

AVOID-
BETA BLOCKERS
CCB
DIGOXIN

WPW syndrome

Flecainide –Class Ic
Procainamide – class Ia

Radio frequency abalation

15
 15
PHARMACOLOGY DFX - WORKBOOK

AMIODARONE

Blue man syndrome

PHARMA COLOGY DFX - WORKBOOK 2023

Torsades de pointes Polymorphic Ventricular Tachycardia

16

IV. Magnesium sulphate

(MgSO4)

CACLIUM GLUCONATE

FOR CONGENITAL QT-

16 PHARMA COLOGY DFX - WORKBOOK 2023
PHARMACOLOGY DFX - WORKBOOK

HYPERKALEMIA EMERGENCY
Insulin + glucose
Calcium gluconate
Salbutamol

18
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PHARMACOLOGY
PHARMA COLOGY DFX -DFX - WORKBOOK
WORKBOOK 2023

For
For rapid symptom
rapid symptom Disease modifying drugs drugs?

CCF
Disease modifying
relief
relief ?Furosemide CCF Beta blockers
Morphine
ACEI, ARBs, spirinolactone

Sacubitril/valsartan
Sacubitril/valsartan
Nesiritide- BNP
Neprilysin (neutral endopeptidase )
Neprilysin (neutral endopeptidase )

Omapatrilat, sampatrilat ACE

DM HYPERTENSION

19
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PHARMACOLOGY
PHARMA COLOGYDFX
DFX- WORKBOOK
- WORKBOOK 2023

Bil renal artery stenosis

DIURETICS

cirrhosis of stones DIURETICS

liver
Rapid symptom relief Caused by
Indicate
Loop
Disease modifying
Treated by

Contra C/I
indicated

20
 PHARMA COLOGY DFX - WORKBOOK 2023 19
PHARMACOLOGY DFX - WORKBOOK

Mountain sickness
Useful for treating
HIRSUTISM
PCOD
DIURETICS

Aerosol- Nephrogenic DI
Cystic fibrosis
Lithium DI-
Improves
mucocilliary
secretion

CCB

flow

flow
RANOLAZINE

OXIDANT

21
20
BLOOD
PHARMACOLOGY DFX - WORKBOOK

THROMBOLYTIC AGENTS

THROMBOLYTIC A G E N TS

PARENTERAL ANTICOAGULANTS

22
Hypercoagulation &
dermal necrosis
21
PHARMACOLOGY
PHARMA COLOGY DFX -DFX - WORKBOOK
WORKBOOK 2023

Hypercoagulation &
dermal necrosis

Purple toe syndrome

Immediate haemostasis
Phytonadione( vit Purple
K1) toe syndrome
- FRESH FROZEN PLASMA
Immediate haemostasis
Phytonadione( vit K1)
- FRESH FROZEN PLASMA

NEWER ORAL ANTICOAGULANTS

DIRECT IIa INHIBITORS DIRECT Xa INHIBITORS

NEWER ORAL ANTICOAGULANTS
APIXABAN
DABIGATRAN RIVAROXABAN
EDOXABAN
DIRECT IIa INHIBITORS BETRIXABAN
DIRECT Xa INHIBITORS
Reversal?
APIXABAN
DABIGATRAN Reversal?
RIVAROXABAN
EDOXABAN
BETRIXABAN
Reversal?
P HA RMA C O LO GY DFX - WORKBOOK 2023

Reversal?

COX2

VORAPAXAR PGI2
ATOPAXAR

Protease
activated

23

23
22
Protease
PHARMACOLOGY DFX - WORKBOOK
activated

HMG CoA+ Acetate

Mevalonic acid

Cholesterol

24
 23
PHARMACOLOGY
PHARMA COLOGY DFX -DFX - WORKBOOK
WORKBOOK 2023

Diet
cholesterol

Intestine

BRONCHODILATORS
CYP1A2

METHYL
β2 AGONIST

Tremor
Seizure
Diuresis
ICS + LABA Arrhythmia

BLOCKER

Ipratropium-

bronchospasm

Challenge test

25
24
PHARMACOLOGY DFX - WORKBOOK
PHARMA COLOGY DFX - WORKBOOK 2023

MOEBIUS SYNDROME

VI &VII

Vit B12 deficiency

Gastric bezoars
Anticholinergics?

ONDANSETRAN + DEXAMETHASONE

Neuro Kinin 1 antagonist

LATE PHASE VOMITING
APREPITANT
FOSAPREPITANT
ROLAPITANT
NEUPITANT

Canabinoids
PALONOSETRON NABILONE
DRONABINOL
Anti emetic +
appeitte stimulant

27
 25
PHARMACOLOGY DFX - WORKBOOK
PHARMA COLOGY DFX - WORKBOOK 2023

Sea sickness- Mountain sickness-

Motion sickness-
Morning sickness-

ACUTE DYSTONIA

ANTI EMETICS- ADRs

28
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PHARMACOLOGY DFX - WORKBOOK 3202 KOOBKROW - XFD Y G O L O C A M R A H P

CENTRALLY ACTING DRUGS

ANTI-EPILEPTICS DRUGS
ANTI-EPILEPTICS DRUGS

SGURD SCITPELIPE-ITNA

PHA RMA CO LO GY DFX - WORKBOOK 2023

Type First line drugs

P HA RMA CO LO GY DFX - WORKBOOK 2023
GTCS (Major epilepsy, Grand mal epilepsy)
Type First line drugs
Absence (Minor epilepsy, Petit mal epilepsy)
GTCS (Major epilepsy, Grand mal epilepsy)
29

Atypical absence
Myoclonic,
Absence (Minor epilepsy, Petit mal epilepsy)
Atonic,
Tonic seizures
Atypical absence
Myoclonic, 92

Atonic,
Focalseizures
Tonic seizures
29

Focal seizures

PREGNANCY

PREGNANCY
FEBRILE SEIZURES

INFANTILE SPASM

FEBRILE SEIZURES
INFANTILE SPASM + TUBEROUS
SCLEROSIS
INFANTILE SPASM
LENNOX GESTAUT SYNDROME
INFANTILE SPASM + TUBEROUS
SCLEROSIS
STATUS EPILEPTICUS

LENNOX GESTAUT SYNDROME

STATUS EPILEPTICUS
 27
PHARMACOLOGY DFX - WORKBOOK

Oxcarbazepine:
less autoinducer, less SJS  preferred in children
more SIADH

• VOMITING
• ALOPECIA
• LIVER TOXIC (<2 YEARS)
• PANCREATITIS, PCOS (GENDER)
• RASHES
• OBESITY
• AMMONIA INCREASE
• TREMORS
• ENZYME INHIBITOR

Divalproex: better git absorption

MOST TERATOGENIC

NEURAL TUBE DEFETCS

PHARMA COLOGY DFX - WORKBOOK 2023

• SV2A INHIBITOR inhibit glutamate

release
• NOOTROPHIC (increase Memory)
• ANTIOXIDANT (Neuroprotective)

32
• BILATERAL VISUAL FIELD CONTRACTION

Drugs requiring eye check up

 • ANTIOXIDANT (Neuroprotective)
28
PHARMACOLOGY DFX - WORKBOOK

• BILATERAL VISUAL FIELD CONTRACTION

Drugs requiring eye check up

1. Vigabatrin
2. Ezogabine (retigabine)
3. Topiramate

PHARMA COLOGY DFX - WORKBOOK 2023

PARKINSONS DISEASE Toxin: MPTP toxin
MANAGEMENT OF PARKINSONISM Drug induced Parkinson
PHARMA COLOGY DFX - WORKBOOK 2023

Benzhexol
MANAGEMENT OF PARKINSONISM Drug induced
Biperiden Parkinson
Functional impairment: LEVODOPA (OVERALL DOC) > ROPINROLE/PRAMIPEXOLE
Benztropine
Promethazine
Benzhexol
Biperiden
Functional impairment: LEVODOPA (OVERALL DOC) > ROPINROLE/PRAMIPEXOLE
Benztropine
Promethazine

D2 blockers

33 D2 blockers

Galactorrhoea

Psychosis
Galactorrhoea

Psychosis Parkinson Disease

Parkinson Disease
 29
PHARMACOLOGY
PHARMA COLOGY DFX -DFX - WORKBOOK
WORKBOOK 2023

VALBENAZINE

EPS- Trihexyphenidyl

AKATHESIA- Propranolol

MNS- Dantrolene

TARDIVE DYSKINESIA

35
30
PHARMACOLOGY
PHARMA COLOGYDFX
DFX- WORKBOOK
- WORKBOOK 2023

PHARMA COLOGY DFX - WORKBOOK 2023

ANTI PSYCHOTICS
36

Metabolic syndrome Less/ no metabolic syndrome

36
Ziprasidone
 ANTI PSYCHOTICS Ziprasidone
Clozapine
Olanzapine Aripiprazole
Quitiapine Asenapine 31
PHARMACOLOGY DFX - WORKBOOK

Metabolic syndrome Less/ no metabolic syndrome

Clozapine Ziprasidone
Olanzapine Aripiprazole
Quitiapine Asenapine

PHARMA COLOGY DFX - WORKBOOK 2023

TYRAMINE

Cheese
reaction
37

37
32
PHARMACOLOGY DFX - WORKBOOK

Depression OCD PTSD

DEPOXETINE
Fluoxetine- least withdrawal
Premature
Es citalopram- highly selective DOC Ejaculation

Bulimia
P P
A M
N T
I S
C

PHARMA COLOGY DFX - WORKBOOK 2023 38

Non-selectively inhibiting
reuptake of NE & 5HT
 33
PHARMACOLOGY DFX - WORKBOOK

Ag

PHARMA COLOGY DFX - WORKBOOK 2023

Neuropathy pain
Fibromyalgia
Stress incontinence
39

NDRI
34
PHARMACOLOGY DFX - WORKBOOK

NDRI

ADHD
Obesity
Smoking control
ADR
Seizure
More
PHARMA COLOGY DFXanxiogenic
- WORKBOOK 2023

40

For opioid deaddiction

For alcohol deaddiction

For treating opioid For treating alcohol

Withdrawal symptom Withdrawal symptom

To prevent relapse
 PHARMA COLOGY DFX - WORKBOOK 2023
Irreversible COX inhibitor (suicide inhibitor)?
Autacoids
• REYE’s SYNDOME IN CHILDREN ASPIRIN hepaticDFX
PHARMACOLOGY failure
- WORKBOOK
Autacoids 35

• SAMPTARS TRIAD (Aspirin + asthma + ethmoidal polyp)

AUTACOIDS

NSAIDs NSAIDs
Irreversible COX inhibitor (suicide inhibitor)?
Irreversible COX inhibitor (suicide inhibitor)?
• REYE’s SYNDOME IN CHILDREN ASPIRIN hepatic failure
• SAMPTARS TRIAD (Aspirin + asthma + ethmoidal polyp)
• REYE’s SYNDOME IN CHILDREN ASPIRIN hepatic failure
• SAMPTARS TRIAD (Aspirin + asthma + ethmoidal polyp)

NON-SELECTIVE COX INHIBITORS

NON-SELECTIVE COX INHIBITORS

Longest
Longest
Intravenous NSAID

Closure of PDA NON-SELECTIVE COX INHIBITORS

Intravenous NSAID
Longest
Closure of PDA
Intravenous NSAID

Closure of PDA

PARACETAMOL (ACETAMINOPHEN) PCM: safest NSAID in RENAL FAILURE

PCM: safest NSAID in CHILDREN

CYP2E1
PCM NAPQI centrilobular necrosis with
HEPATOTOXIC periportal sparing

PARACETAMOL (ACETAMINOPHEN)
FULMINANT HEPATIC FAILURE: PCM: safest NSAID in REN

PARACETAMOL (ACETAMINOPHEN)
PCM: safest NSAID in CHI
ISONIAZID – 200 µg/mL at 4 h and

CYP2E1
- 30 µg/mL at 15 h PCM
PCM
Antidote: N-acetylcysteine (DOC) NAPQI centrilobular necrosis with PCM
Methionine HEPATOTOXIC periportal sparing
MONITOR
Rumack-Matthew nomogram
CYP2E1 FULMINANT HEPATIC FAILURE:
PCM NAPQI centrilobular necro
ISONIAZID HEPATOTOXIC
– 200 µg/mL at 4 h and periportal sparing
- 30 µg/mL at 15 h

Antidote: N-acetylcysteine (DOC) FULMINANT HEPATIC FAILURE:

42
Methionine MONITOR
Rumack-Matthew no
ISONIAZID – 200 µg/mL at 4 h and
36
PHARMACOLOGY DFX - WORKBOOK
PHARMA COLOGY DFX - WORKBOOK 2023

Poisoning-Gangrene
Ergotism
St Anthony’s fire,
ACUTE

VASO CONSTRICTORS

Ergot Alkaloids 5HT1B/D Agonist-

Be careful Triptans
Ergotamine HT Sumatriptan

IHD
suppress nausea, oral, S/C, nasal
Dihydroergotamine
Frovatriptan
long half life
C/I-
Pregnancy Zolmitriptan
Oral, intranasal

Beta
CGRP antagonist Blockers
ropranolol
Olcegepant MC
Telcagepant
CCB-
ERENUMAB Verapamil
FREMANEZUMAB Flunarizine
GALCANEZUMAB
EPTINEZUMAB

TCA Anti-Convulsants
Valproate
Lasmiditan
Amitryptaline
Gabapentin
Topiramate

43
 37
PHARMACOLOGY DFX - WORKBOOK

Lead, Arsenic, Mercury Iron

Desferrioxamine
BAL Dexrazoxane
Deferiprone
Deferasirox
Chelating agents

BAL- C/I –
Iron, Cadmium
Kayser–Fleischer ring

COPPER

Zinc, Trietine
Tertrathiomolybtad

PHARMA COLOGY DFX - WORKBOOK 2023

HORMONES

INJECTABLE INSULIN
ULTRASHORT/
Rapid
LONG 44

NASAL INSULIN
DRY POWDER
INHALATION

PHARMA COLOGY DFX - WORKBOOK 2023

Semaglutide Only ORAL GLP-1 analogue Teduglutide  GLP-2 analogue

Use: Short Bowel syndrome

38
PHARMACOLOGY DFX - WORKBOOK
PHARMA COLOGY DFX - WORKBOOK 2023

ANTI-HYPERGLYCEMIC AGENTS: ACTING AT PERIPHERAL ORGANS

ACTING AT PERIPHERAL ORGANS
CLASS ADVERSE EFFECTS

BIGUANIDES

ALPHA GLUCOSIDASE
INHIBITORS

THIAZOLIDINEDIONES

SGLT-2 INHIBITORS

ONE LINER MCQ’s

GESTATIONAL DM •

DM + PCOS •
DIABETIC NEUROPATHY •

NO DOSE MODIFICATION IN RENAL •

FAILURE

ANTI-OBESITY DRUG •

47
 PHARMA COLOGY DFX - WORKBOOK 2023

Antithyroid drug Lugols iodine  5% Iodine + 10% KI 39

PHARMA COLOGY DFX - WORKBOOK 2023PHARMACOLOGY DFX - WORKBOOK

PROPYLTHIOURACIL
Antithyroid drug
• HYPERTHYROID IN PREGNANCY (1st trimester) Sialorrhea, sialadenitis
Lugols iodine  5% Iodine + 10% KI
• THYROID STORM
PROPYLTHIOURACIL
• HYPERTHYROID Carbimazole (Prodrug)
IN PREGNANCY (1st trimester)
IODINE-131 Methimazole (active)
Sialorrhea, sialadenitis
DESTROY STORM
• THYROID THYROID : BY BETA RAYS
HALF LIFE: 8 DAYS

IODINE-131 Carbimazole (Prodrug) Methimazole (active)

DESTROY THYROID : BY BETA RAYS
HALF LIFE: 8 DAYS

Drugs for osteoporosis DOC FOR OSTEOPOROSIS:

“BISPHOSPHONATE”  inhibit FPPS enzyme

Drugs for osteoporosis ALENDRONATE

DOC FOR OSTEOPOROSIS:
IBANDRONATE
ZOLENDRONATE (longest/MOST POTENT)
“BISPHOSPHONATE”  inhibit FPPS enzyme

ALENDRONATE
Reflux Esophagitis
IBANDRONATE
Osteonecrosis
ZOLENDRONATEof mandible POTENT)
(longest/MOST

Reflux Esophagitis
DENOSUMAB: block RANK RECEPTORS
Osteonecrosis of mandible
ROMOSUZUMAB: block SCLEROSTIN

Bisphosphonate  Maximum 5 years (femur fracture)

DENOSUMAB: block RANK RECEPTORS
ROMOSUZUMAB: block SCLEROSTIN
Teriparatide  Maximum 2 years (Osteosarcoma)

Bisphosphonate  Maximum 5 years (femur fracture)

fastest Calcium lowering agent for Hypercalcemia?
PHARMA COLOGY DFX - WORKBOOK 2023
Teriparatide  Maximum 2 years (Osteosarcoma)

fastest Calcium lowering agent for Hypercalcemia?

STEROIDS
1. MOST POTENT/LONGEST GLUCOCORTICOIDS: BETAMETHASONE OR DEXAMETHASONE

2. MOST POTENT TOPICAL GC: BETAMETHASONE OR CLOBETASOL (0.05%)

ADRENAL INSUFFICIENCY: HYDROCORTISONE + FLUDROCORTISONE

FETAL LUNG MATURATION: BETAMETHASONE OR DEXAMETHASONE

48

48
 • VERY: Vancomycin
40 • FAMOUS: Fosfomycin
PHARMACOLOGY DFX - WORKBOOK

ANTIMICROBIAL
PHARMA COLOGY DFX - WORKBOOK 2023

Cell wall inhibitors

• Beta lactams (penicillin, cephalosporin, carbapenem, monobactam)
• Bacitracin
• Cycloserine
• VERY: Vancomycin
• FAMOUS: Fosfomycin

ANTI-PSEUDOMONAL PENICILLINS?
BETA LACTAMASE INHIBITORS?
•

ANTI-PSEUDOMONAL PENICILLINS?
BETA LACTAMASE INHIBITORS?
•

53
X - WORKBOOK 2023
41
PHARMACOLOGY DFX - WORKBOOK

CEPHALOSPORINS
CEPHALOSPORINS

• Surgical Prophylaxis:
• Anti-psuedomonas:
•PHARMA
MRSA: COLOGY DFX - WORKBOOK 2023
• Meningococci, Gonococci, Typhoid, Hemophilus:

CEPHALOSPORINS
RENAL SAFE
• Surgical Prophylaxis:
• Anti-psuedomonas:
• MRSA:

? • DISULFIRAM
Meningococci, LIKE Hemophilus:
Gonococci, Typhoid, REACTION
RENAL SAFE
HYPOFIBRINEMIA
? DISULFIRAM LIKE REACTION
 WARFARIN BLEEDING
HYPOFIBRINEMIA
 WARFARIN BLEEDING

Doc for penicillin allergy?

Doc for penicillin allergy?

MRSA
 PHARMA COLOGY DFX - WORKBOOK 2023

42
PHARMACOLOGY DFX - WORKBOOK

Drugs

PABA FOLIC ACID TetraHydroFolate

COMBINATION

SYNERGISM Require FOLINIC ACID supplementation

Cotrimoxazole Sulfadiazine + Pyrimethamine

 Trimethoprim + Sulfamethoxazole (1:5)
DOC Pneumocystis, Burkholderia
DOC  Toxoplasma gondi

PHARMA COLOGY DFX - WORKBOOK 2023

Protein synthesis inhibitors Inhibit methionine t-RNA

BLOCK TRANSLOCATION
SUBUNIT
BLOCK PEPTIDYL TRANSFERASE

Block A SITE
inhibit t-RNA attachment Block Initiation

55
 43
PHARMACOLOGY DFX - WORKBOOK

RED MAN SYNDROME

(Histamine release)
(Histamine release)

TOOTH DISCOLORATION

• TENDINITIS, PHARMA COLOGY DFX - WORKBOOK 2023

• EPILEPSY,
• QT PROLONG

Tuberculosis Orange red urine

INSANITY (psychosis, memory loss)

• First line drugs: HRZE

56

CYP + PGP INDUCER

Failure of effect of Eye defects (optic neuritis):

Contraceptive, warfarin, digoxin
ACETYLATION

PYRIDOXINE Deficiency
(inhibit Pyridoxal phosphokinase)
SIDEROBLASTIC ANEMIA

Most Hepatotoxic: :
44
PHARMACOLOGY DFX - WORKBOOK

New drugs for MDR/XDR TB PSUEDO-JAUNDICE

BEDAQUILINE: INHIBIT myc ATP SYNTHASE PANUVEITIS
DELAMANID : INHIBIT MYCOLLIC ACID
PRETOMANID: INHIBIT MYCOLLIC ACID

PHARMA COLOGY DFX - WORKBOOK 2023

FMUCORMYCOSIS
UNGAL 
ESOPHAGEAL
CANDIDIASIS- PHARMA COLOGY DFX - WORKBOOK 2023

MUCORMYCOSIS 
ESOPHAGEAL
CANDIDIASIS-

Cryptococcal meningitis  L-AMB + FLUCYTOSINE

Cryptococcal meningitis  L-AMB + FLUCYTOSINE

ANTI-HIV Drugs
58

ANTI-HIV Drugs
 PHARMA COLOGY DFX - WORKBOOK 2023

CANCER
CANCER PHARMACOLOGY DFX - WORKBOOK
45

CYTOTOXIC AGENTS
CELL-CYCLE NON-SPECIFIC CELL-CYCLE SPECIFIC
1. ALKYLATING AGNETS
Bleomycin, etoposide, doxorubicin
NITROGEN MUSTARDS:

Vincristine, paclitaxel

NITROSUREAS:
Hydroxyura
Antimetabolite (methotrexate, 5FU)
2. PLATINUM COMPOUNDS Topotecan
Etoposide

Asparaginase, Palbociclib

Not
seen
Anemia  Rec. Erythropoietin with
Leucopenia
Thrombocytopenia:

60
46 PHARMA COLOGY DFX - WORKBOOK 2023
PHARMACOLOGY DFX - WORKBOOK

SIADH
Cerebellar toxicity:
Ototoxicity
Most emetogenic:

Pulmonary fibrosis:
Cardiotoxicity:

Nephrotoxicity:
Hemorrhagic cystitis:

Glove stock neuropathy: Paclitaxel

Foot drop neuropathy: Vincristine
PHARMA COLOGY DFX - WORKBOOK 2023

Hand foot syndrome

Pulmonary fibrosis

Damage Type 1 cells

Flagellate pigmentation Damage Type 2 cells

Ichthyosis

MONOCLONAL ANTIBODIES
 47
PHARMACOLOGY DFX - WORKBOOK

MONOCLONAL ANTIBODIES
Suffix: -mab

Source: - momab (MOUSE), >95% mouse

-ximab (CHIMERIC) 50% mouse & 50% human
-zumab (HUMANIZED) > 95% human
-mumab (FULLY HUMAN) 100% human
PHARMA COLOGY DFX - WORKBOOK 2023

Gum hypertrophy
TACROLIMUS  MACROLIDE ANTIBIOTIC

IMMUNOSUPPRESSANTS
Hirsutism

mTOR INHIBITORS:
MYCOPHENOLATE
CALCINEURIN INHIBITORS (OKT-3)
CYCLOSPORIN
TACROLIMUS (FK-506)
Cardiac stents
S/E: NEPHROTOXIC
HYPERKALEMIA
62

THALIDOMIDE PHOCOMELIA

MOST DANGEROUS S/E

• TYPE 2 LEPRAE REACTION (ENL) NEUROTOXICITY

LEVAMISOLE  IMMUNOSTIMULANT + ANTHELMENTHIC (ASCARIASIS)

MITOMYCIN-C
LENALIDOMIDE
POMALIDOMIDE
ENDOTRACHEAL STENOSIS
INTRAVESICAL INJECTION Bladder cancer

MITOMYCIN-C
BCG VACCINE
DFX PYQ’s

Q1. A 68 year old male cancer patient on chemotherapy developed neutropenia. Which
of the following drug is used to increase the immunity in this person?
a. Filgrastim b. Darbopoeitin
c. Oprelvekin d. Iron dextran

Q2. Which of the following statements about drugs is false?

a. Drug C is more potent than drug B b. Drug B is more efficacious than D

c. Drug D is least potent d. Drug C is more efficacious than Drug A

Q3. A girl with known case of BPD is on lithium therapy. Which statement is incorrect
in respect of lithium?
a. Hemodialysis not useful in lithium overdose
b. Lithium can decrease thyroid level
c. Lithium toxicity can be exacerbated by thiazide
d. Lithium is fetotoxic if given to pregnant female

Q4. Drugs providing relief from cardiac remodelling and increasing longevity?
a. Metoprolol b. Torsemide
c. Prazosin d. Furosemide

Q5. Drugs used for chemo induced nausea and vomiting?

a. Granisetron + Dexamethasone+ aprepitant
b. Dexamethasone +metoclopramide + domperidone
c. Prochlorperazine+ granisetron + domperidone
d. Doxylamine + granisetron + aprepitant

Q6. A 38 year old college professor suffering from depression comes to you with
complaints of unable to get involved in process of intercourse with his wife. Which
of the following anti-depressant is best to be prescribed to him:
a. Imipramine b. Escitalopram
c. Bupropion d. Venlafexine

Q7. Which of the following anti-dyslipidemic drug work by stimulating PPAR alpha –
a. Gemfibrozil b. Simvastatin
c. Ezetimibe d. Colestipol
 49
PHARMACOLOGY DFX - WORKBOOK
Q8. A female patient was having pain in her great toe (metatarsal joint) with swelling
and redness present over it. She was treated with a proper drug therapy but her
uric acid still coming out to be high. Which of the following drug can be given for
fast elimination of drug from the body?
a. Allopurinol b. Febuxostat
c. Colchicine d. Probenecid

Q9. A drug launched in market is in phase of marketing survillence is found to be

associated with side effects. Which of the following parameter will tell us about
drug safety
a. LD50/ED50 b. ED50/LD50
c. TD75/ED25 d. ED25/TD75

Q10. Dicoumarol mechanism of action:

a. Anti-thrombin Ill stimulation
b. Inhibition of vit K dependent clotting factor II/VIl/IX/X
c. Direct inhibitor of factor Xa by binding to active site
d. Direct factor IIa inhibitor

Q11. A female visits the OPD to get rid of tobacco addiction. Which of the following drug
will you prescribe?
a. Vareniciline b. Naloxone
c. Disulfiram d. Flumazenil

Q12. A known hypertensive patient came to emergency department with complaints of

palpitations and shortness of breath. Her BP was 220/140. Among the option given
below, which drug should not be used in treatment of this patient?
a. I.V Nitro prusside b. IV Esmolol
c. IV. Nicardipine d. I.V. Mannitol

Q13. A patient with history of drug abuse presented to emergency in comatose state.
Vitals recorded were: Respiratory rate 8/min, BP: 90/60 mmHg, Pulse 52 bpm. On
examination, there was pin point pupil. What is the probable poisoning agent in
this patient?
a. Cocaine b. Morphine
c. Alcohol d. Tricyclic antidepressant

Q14. A known patient of bronchial asthma was started on treatment with an anti-
glaucoma drug. During the course of treatment, asthma worsened. Which drug is
likely responsible for these symptoms?
a. Timolol b. Brimonidine
c. Latanoprost d. Pilocarpine

Q15. A patient developed COVID-19 pneumonia and was treated. Few months later,
patient presented with nasal congestion and swelling of face. There were black
lesions on the nose bridge. A diagnosis of mucormycosis was made. What is the
drug of choice for this condition?
a. Fluconazole
b. Dexamethasone
c. Amphotericin B
d. Azithromycin
50
PHARMACOLOGY DFX - WORKBOOK
Q16. A patient presented with unstable angina and was started on 325 mg aspirin. What
is correct about mechanism of action of this drug at this dose?
a. It acts by inhibiting aggregation of platelets
b. It acts by Inhibiting COX-1 in both endothelium and platelets
c. It acts as a fibrinolytic agent
d. It acts as an anti-coagulant agent

Q17. A patient with head and neck cancer is planned to receive radiotherapy. Which of
the following anticancer drugs can result in increase in risk of toxicity caused by
radiation treatment?
a. Cisplatin b. Cyclophosphamide
c. Irinotecan d. Procarbazine

Q18. A patient was started on lamotrigine 50 mg daily for treatment of epilepsy. Gradually,
the dose of the drug is increased every 1-2 weeks to reach the final dose of 200
mg per day. This step up titration of lamotrigine dose is done in order to prevent or
minimize the development of
a. Sedation b. Sudden death
c. Weight gain d. Skin rash

Q19. Drug of choice for Legionnaire's disease is:

a. Azithromycin b. Tigecycline
c. Streptomycin d. Amoxycillin

Q20. A patient with history of snake bite presented in emergency with symptoms of
fatigue and irritability. Ten vials of antivenom were administered intravenously but
the patient is still having difficulty in swallowing, ptosis and respiratory distress.
What should be the next line of management?
a. Atropine and neostigmine b. Nebulizer with salbutamol
c. IV hydrocortisone d. Antihistamines

Q21. What is the Drug of choice for Hyperthyroidism in first trimester of Pregnancy?
a. Phosphorus iodine b. Methimazole
c. Propylthiouracil d. Carbimazole

Q22. A patient presented to hospital with chest pain. ECG of the patient confirms it to be
non ST elevation myocardial infarction. Which of the following drug useful in this
patient acts by inhibiting platelet aggregation?
a. Clopidogrel b. Streptokinase
c. Low molecular weight heparin d. Warfarin

Q23. A patient with chronic stable angina presents with pedal edema, breathlessness
and other symptoms of heart failure. Which of the following drug can increase
longevity in this patient?
a. Nifedipine b. Digoxin
c. Lisinopril d. Torsemide

Q24. A female washing clothes in cold water exhibited color change of her hands from
pallor to red. Which of the following drug is best suited for this patient?
a. ACE inhibitor b. Calcium channel blockers
c. Thiazides d. Alpha blockers
 51
PHARMACOLOGY DFX - WORKBOOK
Q25. Which of the following enzyme is involved in peripheral conversion of T4 to T3?
a. 3’ deiodinase b. 5’ deiodinase
c. Catalase peroxidase d. Thyroid peroxidase

Q26. A 25 year old female presented with mania. History revealed that her father is taking
medications for bipolar disorder. Which of the following drug will you prescribe for
this patient?
a. Sodium valproate b. Lithium
c. Carbamazepine d. Lamotrigine

Q27. What does LD50 signifies

a. It is the dose at which 50% of animals will die
b. It is the dose at which 50 animals will die
c. It is the dose at which 50% patients will get the desired response
d. It is drug, that will be effective at 50% dose

Q28. Which of the following drug used for pain relief in arthritis acts by both opioid and
non-opioid mechanisms?
a. Paracetamol b. Tramadol
c. Ketorolac d. Diciofenac

Q29. A 25 year old male has frequent visits to rural areas and need to eat outside food.
During one such visit, he developed loose stools. Which of the following drug
should be used to manage this case?
a. Metronidazole b. Diphenoxylate
c. Loperamide d. Octreotide

Q30. All of the following are Side effects of Ritodrine except?

a. Hypoglycemia b. Tachycardia
c. Hypotension d. Pulmonary edema

Q31. Which of the following anticoagulant is contraindicated in first trimester of

pregnancy?
a. Low molecular weight heparin b. Warfarin
c. Unfractionated Heparin d. Enoxaparin

Q32. A patient suffering for rectal carcinoma and on chemotherapy drugs develops
severe profuse diarrhea. Which of the flowing drug can be given to control this
diarrhea:
a. Ofloxacin b. Atropine
c. Octreotide d. Loperamide

Q33. Which drug Which Drug acts on the area marked?

a. Epinephrine b. Norepinephrine
c. Isoprenaline d. Dopamine

Q34. A 10 year old girl who was being prescribed iron supplements in form of syrup
has consumed it in high dose and now having abdominal pain, vomiting. Which
Antidote can be used to treat this patient?
a. Desferroxamine b. Iron dextran
c. Dimercaprol d. Succimer
52
PHARMACOLOGY DFX - WORKBOOK
Q35. A female of 28 years of age comes to OPD with complaints of dropping of eyelid
in evening time. This patient is almost symptom free in morning and muscle
weakness increases during evening time. As a physician you have noticed that
patient symptoms improve after neostigmine. What is your most appropriate
diagnosis?

a. Myasthenia gravis b. Lambort eaton myasthenia syndrome

c. Duchenne muscular dystrophy d. Dermatomyositis

Q36. Which of the following correctly describes the Phenomenon of vasomotor reversal
of Dale?
a. Repeated administration of ephedrine decreases its effect on blood pressure
b. High dose of acetylcholine after pre-treatment with atropine produces increase in blood pressure
and heart rate
c. A patient pre-treated with Phentolamine develops severe hypotension on administration of
adrenaline
d. Increase in pulse pressure is produced by intravenous administration of isoprenaline

Q37. A patient comes to you with breathlessness, dry cough with reduced exercise
capacity. On X ray examination, diagnosis of pulmonary fibrosis is made. Which of
the following drug can be used for the treatment of this condition:
a. Imatinib b. Perfinidone
c. Doxapram d. Rofumilast

Q38. Which Drug acts on area 2?

a. Aliskiren b. Telmisartan
c. Eplerenone d. Enapril

Q39. A truck driver with HIV positivity develops cryptococcal meningitis. Which drug is
best to start:
a. Liposomal amphotericin B b. Fluconazole + Flucytosine
c. Flucytosine d. Fluconazole
 53
PHARMACOLOGY DFX - WORKBOOK
Q40. Best treatment for Acromegaly?
a. Lanreotide depot b. Octreotide I/V
c. Terlipressin d. Somatostatin

Q41. A 50 year old, patient of type 2 diabetes mellitus was controlled on oral hypoglycemic
drugs, This patient presented to hospital with hypoglycemia, Which among the
following drugs can result in hypoglycemia in this patient?
a. Metformin b. Voglibose
c. Vildagliptin d. Glipizide

Q42. A patient is taking platinum based anti-cancer therapy for treatment of ovarian
cancer. Which of the following drug should be used to prevent the nausea and
vomiting in this patient?
a. Domperidone b. Promethazine
c. Palonosetron d. Metoclopramide

Q43. In a patient with pregnancy induced hypertension, Drug used for treatment is
a. Hydralazine b. Alpha methyl dopa
c. Lisinopril d. Telmisartan

Q44. A female patient was treated with clindamycin and developed diarrhea most
probably pseudomembranous colitis. Which of the following is the likely organism
responsible for this?
a. Clostridium perfringens b. Clostridium difficile
c. Clostridium tetani d. Clostridium septicum

Q45. Mechanism of action of doxycycline is:

a. DNA gyrase inhibitor b. Cell wall synthesis inhibitor
c. Protein synthesis inhibitor d. DNA dependent RNA polymerase inhibitor

Q46. A 56 year old patient who is a known case of hypertension was being treated with
antihypertensive drugs. He is having chronic cough since 2 weeks. He was started
on antimicrobials but cough did not resolve which of the following antihypertensive
drug may induce chronic cough in this patient?
a. Lisinopril b. Minoxidil
c. Propranolol d. Amlodipine

Q47. A 30 year old man travelled to Assam. After coming back to his hometown Delhi,
he developed fever, chills and rigors and altered sensorium. The peripheral smear
demonstrated the presence of P. falciparum. What is the treatment of choice for
this patient?
a. Chloroquine, Sulfadoxine pyrimethamine
b. Intravenous Artesunate
c. Quinine
d. Primaquine

Q48. À person presented to emergency in comatose state after consuming some

unknown poison. Excessive sweating is apparent and on examination there is
bradycardia and BP is 80/60 meHg. Which of the following is antidote for treatment
of this patient?
a. Neostigmine b. Atropine
c. Physostigmine d. N-acetylcysteine
54
PHARMACOLOGY DFX - WORKBOOK
Q49. A patient has developed tuberculosis in which mycobacterium is resistant to
rifampicin, isoniazid, kanamycin and levofloxacin. This tuberculosis is referred to
as
a. MDR TB b. Rifampicin resistant TB
c. Drug resistant TB d. Extremely drug resistant TB

Q50. A 2S year old male presented to emergency with head trauma due to road traffic
accident. In hospital, the patient developed seizures. Emergency CT scan revealed
widespread cerebral edema. Which of the following is diuretic of choice for cerebral
edema in this patient?
a. Mannitol b. Spironolactone
c. Furosemide d. Hydrochlorthlazide

Q51. A 28 year old male went to Ladakh, developed shortness of breath. Which of the
following drug will you use for the treatment of mountain sickness at high altitude?
a. Acetazolamide b. Hydrochlorthiazide
c. Epleronone d. Salbutamol

Q52. À professor in medical college is teaching students about the adverse effects of a
drug. Which of the following drug can cause Gynaecomastia in men?
a. Spironolactone b. Propranolol
c. Misoprostol d. Oxytocin

Q53. What is the mechanism of action of tPA?

a. Promote Fibrinolysis b. Inhibition of factor V and VIl
c. Inhibition of factor Ill and V d. Activation of anti-thrombin Ill

Q54. Which of the following drug will you omit from the prescription of a patient with
XDR tuberculosis in pregnancy?
a. Kanamycin b. Cycloserine
c. Moxifloxacin d. Linezolid

Q55. Which of the following is an adverse effect of orlistat?

a. Suicidal tendancy b. Steatorrhea
c. Weight gain d. Hyperglycemia
 EMEDICOZ

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