Sample Copy. Not for Distribution. · *Pathology selected system notes Simplified form of most of...

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Success

Simplified For You!


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Success

Simplified For You!

A Guide for Medical Students

Pharmacology Short

Questions(More Than 450)

Forensic Medicine And Toxicology Short Questions(More Than 250)

Pathology Notes

Mihir A.Tejura

Student at

Amcmet Medical College, Ahmedabad

[email protected]

EDUCREATION PUBLISHING (Since 2011)

www.educreation.in


iv


v

Author’s note ______________________________________________________

Greetings to all my dear juniors enjoying golden period of 2nd

year!

This year might be very phasic for you-amalgamation of

enjoyment in the beginning and difficulty in coping up all at the

end.

Short questions-CASH MARKS!- we always struggle to get

answers to these tricky but important questions or find previous

years papers short questions but still they remain a mystery!

Short questions,FDCs,definitions in Pharmacology and Forensic Medicine and Toxicology would help you in Theory

exam and Practical as well(definitions, sq, concepts in viva

voce)

A topic might be 2-3 pages long in textbook BUT HAS 5-6 IMPORTANT POINTS which you are expected to remember -

this book has such EXAM ORIENTED ANSWERS to questions

of minor systems of pathology which are ignored by many

students.

All questions are important for examination and viva point of

view.(Includes important previous year question paper

questions also, material is prepared with the help of standard

textbooks.)

It’s an endeavor to simplify success for my dear juniors so that you guys can enjoy golden period and crack exams at the same

time!

Enjoy college life to the fullest-you won’t get these memorable

days back!

Work smartly! Stay happy!

Would love to hear from you,

Mihir A Tejura

AMCMET MEDICAL COLLEGE,AHMEDABAD.

[email protected]


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Extending my sincere gratitude to Almighty,my

family,teachers and professors,seniors and friends!

For

Scoring good marks easily in university examination

by short questions prepared from the book. Preparing easily for practical examination questions

like FDCs,short questions in Pharmacology and

definitions,short questions in Forensic medicine

Practice mcq based questions-quick revision for competitive examination.


vii

The Book Includes ______________________________________________________

*Pharmacology-

Short questions likely to be asked in university exams

Mcq based questions

Viva questions

*Forensic medicine

Short question likely to be asked in university exams

Mcq based questions

Viva questions(definitions especially)

*Pathology selected system notes

Simplified form of most of important questions of selected

system for you to remember IMPORTANT points of any question easily.

Included systems

Male reproductive system and prostate

Female genital tract

Breast

Skin

Endocrine

Musculoskeletal systems, Nervous system


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Contains ______________________________________________________

456 pharmacology short questions!

259 forensic medicine short questions!

26 most important and expected questions from

pathology selected systems!

Indeed success simplified for you!!


Success Simplified For You!

1

General Pharmacology ______________________________________________________

1) Drug is any substance or product that is used or intended to

be used to modify or explore physiological system or

pathological states for benefit of recipient.

2) Pharmacotherapeutics is application of pharmacological

information together with knowledge of the disease for its

prevention or cure.

3) Non proprietary name is name accepted by competent scientific body such as United States Adopted Name Council

which are kept uniform. (Also k/a generic name)

e.g.phenothiazines

4) Proprietary name Name assigned by manufacturer and is his

property or trademark and are catchy,short,easy to remember

and suggestive.e.g.LOPRESOR.

5) Essential drug are druf which satisfy the priority healthcare

needs of the population which are selected with due regard to

public health relevance,evidence on efficacy and safety and

comparative cost effectiveness.

6) Orphan drugs for diagnosis/treatment/prevention of RARE

disease or conditionfor which there is no reasonable expectation

that the cost of developing and marketing will be recovered

from salews of that drug.e.g.Digoxin immue Fab,liothyronine,calcitonin,sodium nitrite,protamine sulphate.

7) Limitations of oral route; Slow action/ Unpalatable/ Nausea;

Vomiting/ Not in uncooperative pt/ Streptomycin not absorbed/ 1st pass metabolism

8) TTS;Transdermal therapeutic systems; Adhesive patches

which deliver drug at constant rate into systemic circulation via stratum cornuem with drug in reservoir between an occlusive


Mihir A.Tejura

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backing film and rate controlling micropore membrane with

adhesive patch having priming dose of drug.

9) Bioavailability refers to rate and extent of absorbtion of drug

from dosage form as determined by its concentration-time

curve in blood or by its excretion in urine/Fraction of

administered dose of drug that reaches the systemic circulation in unchanged form.

10) Apparent volume of distribution Presuming that the body

behaves as a single homogenous compartment with volume V into which drug gets immediately and uniformly distributed

V= dose administered/plasma concentration

11) Factors affecting Vd;

Lipid;water partition coefficient

pKa of drug

Degree of plasma protein binding

Affinity of different tissues

Fat;lean body mass ratio

Dz like CHF,uremia,cirrhosis.

12) Redistribution

Highly lipid soluible drugs given iv or by inhalation initially get distributed to organs with high blood flow e.g.

brain,heart,kidney-later less vascular nut more bulky tissues

take up the drug-plasma conc falls and drug is withdrawn from

these sites e.g.M/Imp=THIOPENTONE anesthetic action

13) Plasma protein binding

To

albumin=Acidic=Barbiturates,BZD,NSAIDS,Tetracyclines,Sulfon

amides

To a1-acid gp=basic=b-blocker,lignocaine,verapamil,prazosin

14) Prodrug

Drug which are inactive as such but need conversion in body to active metabolites

15) Advantages

More stable



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Better bioavailability or other desirable pharmacokinetic

properties

Less side effects and toxicity

16) e.g.

levodopa-dopamine

enalapril-enalaprilat

prednisone-prednisolone

becampicillin-amipicillin

17) CYP3A4/5

Biotransformation of largest number of drugs/inhibition of this

isoenzyme by erythromycin,clarithromycin,keto/itraconazole

responsible for important drug interaction with

terfenadine,astemizole and cisapride.

Inducers-Rifampicin,barbituarates.

18) CYP2D6

Metabolizes TCAs,SSRIs,Antiarrythmics,b-blocker.

Inhibition of it results in failure of conversion of codeine to morphine(no analgesio)

19) Microsomal enzymes

Monooxygenases,cytochromeP450,glucoronyl transferases, located on smooth endoplasmic reticulum,liver and

kidney,intestine mucosa and lungs.

20) Microsomal enzyme induction

Many drugs,carcinogens and insecticides interact with DNA and

increase synthesis of microsomal enzyme protein cytochrome

P450 and glucuronyl transferases.

e.g. Anticonculsants -phenobarbitone,rifampin induce CYP3A

isoenzymes

Isoniazid and chronic alcohol consumption induce CYPE1.

21) Hoffmann elimination

Inactivation of drug in body fluids by SPONTANEOUS molecular rearrangement without agency of any enzyme e.g. atracurium.

22) First pass metabolism


Mihir A.Tejura

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Metabolism of drug during its passage from the site of

absorbtion into systemic circulation.

Intestinal wall/liver/skin/lungs=sites

High 1st pass metabolism= Isoprenaline/ lignocaine/

hydrocortisone/ testosterone=not oral Propranolol/ verapamil/

salbutamol/ morphine/ nitrogycerine

23) Clearance

Theoretical volume of plasma from which drug is completely

removed in unit time

Cl=Rate of elimination/C

24) Order of kinetics

1st order =Rate of elimination proportional to drug conc.

E.g.Most of drugs\

Clearnce constant/constant fraction eliminated

O order= rate irrespective of drug conc e.g.Ethyl alcohol,@high

dose-theophylline/warfarin/phenytoin

Clearance decreases with time/constant amt. eliminated.

25) Plasma half life

Time taken for plasma concentration to be reduced to half of its

original valkue

T1/2=0.693*V/C

26) Steady state plasma conc=dose rate/Clearnce

Dose rate=(target Cpss*CL) /F

27) Plateu principle

Constant dose repeated until progressively rate of elimination

balances rate of amount of drug administered over dose

interval. Subsequently plasma conc plateus and fluctuates

about an avg. steady state level AFTER 4-5 halflives mostly.

28) Loading dose

Single or few quickly repeted dose given in the BEGINNING to

attain target concentrion rapidly

= target Cp*V/f



5

29) maintenance dose dose that is to be repeated at specified

intervals after attainment of target Cpss so as to maintain same

by balancing elimination.

30) Receptor

Specific binding site with functional correlate situated on

surface or inside effector cell and specific agonist combine to initiate characteristic response

31) Agonist

Activates receptor to produce an effect similar to that of physiological signal molecule.

32) Inverse agonist

Activates receptor to produce an effect in opposite direction to that OF PHYSIOLOGICAL SIGNAL molecule

33) Partial agonist

Activates receptor to produce submaximal effect but

antagonizes the action of full agonist.

34) Ligand

Molecule which attaches selectively to particular receptor or

sites

(only affinity without regard to functional change)

35) Affinity

Ability of drug to combine with receptor

36) Intrinsic activity

Ability of drug to activate/induce conformational change in

receptor after receptor occupation

37) GPCR

Large family of cell membrane receptors which are linked to

effector via one or more GTP-activated proteins for response

effectuation.(7 alpha-helical)

38) Therapeutic window phenomenon


Mihir A.Tejura

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Unusual feature where optimal therapeutic effect is exerted

only over narrow range of plasma drug concentration,both

below and above the range,beneficial effects are suboptimal.

e.g. Tricyclics imipramine

Clonidine

Glipizide.

39) Potency/efficacy

Drug potency is amount of drug needed to produce certain

response

Position of DRC indicative(right more=less potent)

40) Efficacy

Maximal response that can be elicited by drug

Upper limit of DRC indicative

41) Therapeutic index

The gap between therapeutic effect DRC and adverse effect

DRC defines safety margin/therapeutic index of drug.

TI=median lethal dose/median effective dose

=LD50(in 50%population) /ED50

42) Synergism

When action of one drug is facilitated or increased by pther

Additive=aspirin+paracetamol

Supradditive=acetylcholine

+physostigmine,levodopa+carbidopa/benserazide

43) Antagonism

One drug decreases/inhibits action of another

Physical=charcoal

Chemical=KMnO4 oxidizes alkaloids,Tannins+alkaloid,Chelating

agents

Physiological=DIFFERENT RECEPTORS=histamine and Adr,

Glucagon and inuslin

Pharmacological=SAME RECEPTOR e.e.g anticholinergic

44) FDC advantage

Convenience/better pt compliance

Synergism



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Therapeutic effect add/side effect not add

Side effected counteracted by other

45) FDC disadvantages

Useless drugs added

Individual Dose adjustment not possible

Half life not match]

Adverse effect not ascribed to single

C/I to one is C/I whole

46) Pharmacogenetics

Variation in drug response d/t genetic variation in amount/

isoform pattern of drug metabolizing enzymes and variation in

target organ sensitivity

e.g. Atypical pseudocholinesterase prolonged succinyl choline apnoea

G6PD deficient hemolysis with primaquine/sulfonamides

Malignant hyperthermia by halothane

Acute intermittent porphyria by barbiturates

47) Placebo

Inert substance given in garb of medicine working by

psychological effect producing similar response of active drug

48) AMBS dose reduction in renal failure

Ciprofloxacin,Cotrimoxazole,Carbenicillin,Cefotaxime,Metronida

zole

49) Tachyphylaxis

Rapid development of tolerance-doses of drug repeated in quick

succession result in marked reduction in response

Indirectly acting drugs e.g. Ephedrine,tyramine,nicotine.

50) Adverse drug effect

Augmented

Bizarre

Continous

Delayed

End of dose

F-foetopathic/teratogenic


Mihir A.Tejura

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51) Idiosyncrasy

Genetically determined abnormal reactivity to a chemical

e.g. barbiturates causes excitement and mental confusion Quinine/ quinidine causes cramps. diarrhoe

52) Teratogenic drugs

Thalidomide phocomelia,multiple defects.

Methotrexate,Androgens,progestins,tetracyclines,warfarin,phen

ytoin,lithium.

53) Drug induced disease/iatrogenic disease

Physician induced

Functional disturbances caused by drugs which persists even

after offending drug has been withdrawn/ eliminated/ Peptic

ulcer by salicylates/ corticosteroids

Parkinsonism by phenothiazines

Hepatitis by isoniazid

DLE by hydralazine.

______________________________________________________

ANS 1) Cotransmission

Neurons release more than one active substance when

stimulated

Besdides Ach and NA,neurons elaborate purines(ATP,

adenosine), peptides (VIP, NPY, substance P), Nitric oxide, prostaglandin as co transmitter.

2) Botulinus toxin

Inhibit RELEASE thereby interfering with cholinergic

transmission

3) Black widow spider toxin

Induces MASSIVE RELEASE and depletion.

4) True/pseudocholineestarase

True Pseudo

Distribution All cholinergic

sites,RBCs,gray

Plasma , liver,

intestine, white



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matter matter

Hydrolysis Ach fast

Methacholine slower

Ach slow

Methacholine Not hydrolyse

Inhibition More sensitive to physostigmine

More sensitive to OP

Function Termination of Ach action

Hydrolysis of ingested esters

5) Bethanechol

Postoperative/ Postpartum non obstructive urinary retention,

neurogenic bladder atony, congenital megacolon and

gastroesophageal reflux.

6) Pilocarpine

Cholinomimetic alkaloid used primarily in open angle glaucoma,

counteract mydriatics, break adhesions of iris with lens.

Long acting sustained delivery system ‘OCUSERT’ for OD application

7) Mushroom poisoning

-Early=muscarine type

d/t inocybe

muscarinic actions reversed by atropine

-Hallucinogenic/anticholinergic

d/t isoxazole in A.muscaria

Atropine is C/I

-Phalloidin=late mushroom poisoning

d/t peptide toxins found in A.phalloides,galerina

Inhibit RNA and protein synthesis

8) Physostigmine

Anticholineesterase rapidly Absorbed from g.i.t. and parenteral

sites(also penetrates cornea freelyand crosses BBB)

Neostigmine

Poor oral absorbtion/no cornea penetration/not cross BBB

Pyridostigmine

Resemble neostigmine but less potent/longer acting

9) Edrophonium


Mihir A.Tejura

10

BRIEF duration of action(action like neostigmine)

Diagnostic agent for myasthenia gravis and for postoperative

decurarization.

10) AChEs used in Alzheimers dz

Tacrine

Rivastigmine

Donezepil

Galantamine

11) Why timolol and not propranolol used for open angle glaucoma’

Timolol is topically used and propranolol used for systemic

administration

Higher LOCAL concentration can’t be achieved by systemic concentration and side effects produced by systemic

propranolol

Ocular b blocker are lipophilic with high ocular capture.

12) Topical b blocker preferred over miotic?

No pupil size change

No induced myopia

No headache d/t spasm

No fluctuation in i.o.t.

Convenient/OD enough.

13) Timolol

Prototype of ocular B blocker is nonselective(b1+b2)

Betaxolol B1 selective blocker thus less……..brochopulmonary/

cardiac/ metabolic side effects.

14) Brimonidine

Clonidine congener α2 selective and more lipophilic than apraclonidine

Reduces aq. Production and increase uveoscleral outflow.

15) Edrophonium test

Inject 2mg iv

Improvement then myasthenic crisis

Worsening then cholinergic crisis


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