ANS SOL • Neostigmine is also used for post 9. Ans.

(d) Apraclonidine (Ref: Drug

operative paralytic ileus and post Facts and Comparisons 2006/2257;
operative urinary retention. KDT
1. Ans. (b) Cholinergic (Ref: Katzung 5. Ans. (b) Pilocarpine (Ref: Katzung 8th/e p168)
13th/90; KDT 8th/e p112) 13/e p161) Apraclonidine is a sympathomimetic
Postsynaptic receptors on the Miotics-like pilocarpine act by agent used in open angle glaucoma.
ganglia are NM receptors which are increasing the trabecular outflow. It
cholinergic. Drugs for Glaucoma Mechanism of decreases aqueous secretion. It can
Remember Action result in upper lid retraction as an
• All preganglionic fibres (Both Brimonidine Reducing aqueous adverse
sympathetic as well as production and Increasing effect. It can also result in ocular
parasympathetic) secrete ACh uveoscleral allergy (less likely with brimonidine).
• Post-ganglionic parasympathetic flow Both
fibres secrete ACh. Latanoprost Increase the uveoscleral apraclonidine and brimonidine can
• Post-ganglionic sympathetic fibres outflow cause CNS depression and apnea in
secrete mostly nor-adrenaline. Pilocarpine Increases trabecular neonates and are contra-indicated in
2. Ans. (b) M2 (Ref: Goodman outflow children less than 2 years of age.
Gillman 12th/e p; Katzung 12th/e Betaxolol Reduces aqueous 10 Ans. (b) Postganglionic
p100; KDT secretion by ciliary body sympathetic from cervical
8th/e p113) 6. Ans. (a) Brimonidine: Decreases sympathetic chain (Ref:
Methacholine is a non-selective aqueous production (Ref: KDT 8th/e Ganong 23/e p261, 265)
muscarinic agonist. It has maximum p168) Constrictor pupillae (circular muscle
agonist Drug Mechanism of action in of iris) is supplied by postganglionic
action on M2 receptors. glaucoma parasympathetic fibres from Edinger
Relatively selective agonist of Apraclonidine/Brimonidine Decrease Westphal nucleus whereas dilator
cholinergic receptors are: aqueous production pupillae (radial muscle of iris) is
• M1 selective: Oxotremorine Latanoprost Increase uveoscleral supplied by sympathetic fibres of
• M2 selective: Methacholine outflow cervical
• M3 selective: Bethanechol Miotics (Pilocarpine) Increase sympathetic chain.
3. Ans. (d) Competitive and trabecular outflow 11. Ans. (b) Trochlear (Ref: Katzung
irreversible (Ref: Goodman Gillman Beta blockers (Timolol/betaxolol) 11/e p78; KDT 8th/e p105)
12th/e p242; Decrease aqueous production Parasympathetic cranial nerves are
Katzung 12th/e p106; KDT 8th/e Carbonic anhydrase inhibitors III (oculomotor), VII (facial), IX
p110) (acetazolamide) (glossopharyngeal) and X (vagus).
Both organophosphates and Decrease aqueous secretion. 12. Ans. (a) Timolol (Ref KDT 8th/e
carbamates cause competitive 7. Ans. (b) Bradycardia (Ref: KDT p167)
inhibition of 8th/e p114) Timolol is a non-selective beta
acetylcholineesterase by binding to Cholinomimetic drug will cause blocker and can precipitate acute
esteratic site. However bradycardia as an adverse effect and attacks of
organophosphates are irreversible thus asthma in a susceptible individual via
and most carbamates (except cannot be used for its treatment. blockade of b2 receptors. Betaxolol
carbaryl and propoxur) are 8. Ans. (a) Organophosphate is a
reversible inhibitors. Thus, the type poisoning (Ref: Katzung 12/e p110) cardioselective beta blocker and is
of These are characteristic features of less likely to cause this adverse
inhibition of acetyl cholinesterase anti-cholinestearse effect.
caused by organophosphates is (organophosphate and 13. Ans. (c) Cholinergic (Ref: Katzung
competitive & irreversible. carbamate) poisoning. 10/e p76; KDT 8th/e p104)
4. Ans. (d) Partial heart block (Ref: Features of Organophosphate • Autonomic ganglia (both
KDT 8th/e p119-122) poisoning: sympathetic as well as
• Cholinergic drugs decrease the • Muscarinic symptoms: Pin point parasympathetic)
conduction from atrium to ventricle, pupil, salivation, lacrimation, release ACh that stimulates the NN
thus should be avoided in partial urination, defecation, nicotinic receptors on the
heart block gastrointestinal distress, vomiting, postganglionic
• Cholinergic drugs like pilocarpine bronchospasm, bradycardia fibres.
and physostigmine are used in • Nicotinic symptoms: Fasciculations 14. Ans. (b) VI (Ref: Katzung 10/e
angle closure glaucoma and fibrillations of muscle, p75; KDT 8th/e p105)
• Neostigmine tachycardia, tachypnea • Parasympathetic system is
(acetylcholineesterase inhibitor, a • CNS symptoms: Temors, giddiness, craniosacral in outflow. Cranial part
cholinergic drug) is ataxia, coma involves III (oculomotor), VII (facial),
used for treatment of myasthenia • Red tears: Due to accumulation of IX (glossopharyngeal) and X
gravis porphyrin in the lacrimal glands (vagus) nerves whereas sacral
portion includes S2 to S4.
15. Ans. (b) Noradrenaline (Ref: • Vesamicol block the transport of Quarternary ammonium compounds
Katzung 10/e p76; KDT 8th/e p104) ACh into the synaptic vesicles. are water soluble and thus cannot
• Neurotransmitter secreted at end • Botulinum toxin inhibits the cross
organ effectors of sympathetic release of acetylcholine. blood brain barrier. Neostigmine is a
system is mostly nor-adrenaline • Acetylcholine esterase is inhibited quarternary derivative whereas
(except in sweat glands and hair by organophosphates and physostigmine is a tertiary amine.
follicle, where it is acetylcholine) carbamates. 26. Ans. (d) Therapy with
whereas it is acetyl-choline at • Pralidoxime reactives ACh. pralidoxime should ideally be
parasympathetic system. 21. Ans. (a) It is a quarternary monitored by measuring
16. Ans. (d) Metoprolol (Ref: ammonium compound; (e) It blood cholinesterase levels. (Ref:
Katzung 10/e p103, 152; KDT 8th/e possesses agonistic KDT 6/e p105, Drug facts and
p162) action on NM receptors (Ref: KDT comparisons
• Metoprolol is a beta blocker with 8th/e p/116; Lee 12/e p217) 2010/599)
local anaesthetic activity. Such beta • Neostigmine is a reversible • Pralidoxime is ACh esterase
blockers are not indicated in cholinesterase inhibitor. It is a reactivator used for
glaucoma. quarternary ammonium compound. organophosphate
• Apraclonidine (alpha 2 agonist), (lipid insoluble agent), so it poisoning.
timolol (beta blocker without local does not cross blood-brain-barrier. • Blood cholinesterase levels can be
anaesthetic activity) and pilocarpine • It is partly hydrolyzed by serum used to monitor therapy, however
(directly acting miotic) are used cholinesterase and partly excreted RBC cholinesterase levels better
in glaucoma. unchanged by the kidneys. reflect ACh esterase activity than
17. Ans. (b) Brimonidine (Ref: • It possesses some agonistic action serum or plasma levels because with
Goodman & Gilman 12/e p1788; on NM receptors. chronic exposure to
KDT 8th/e p168) 22. Ans. (d) It interferes with the organophosphates, serum levels
• Apraclonidine and brimonidine can action of acetyl cholinesterase (Ref: may return to normal but RBC
cross blood brain barrier and Katzung 11/e levels remain depressed.
may result in CNS depression and p105) • Chlorinated pesticides like DDT are
apnea in neonates. These are Neostigmine acts by inhibiting the CNS stimulants and their
therefore contra-indicated in enzyme acetylcholinesterase. This overdose is treated by diazepam like
children less than 2 years. enzyme is drugs. Pralidoxime has no role
18. Ans. (d) Reactivation of AChE involved in degradation of ACh, in their treatment.
enzyme (Ref: Katzung 10/e p116; consequently neostigmine increases • Nerve gases used in warfare act by
KDT 8th/e the inhibiting acetyl cholinesterase.
p123) synaptic level of ACh. Muscle Atropine and oximes are used for
• Pralidoxime and diacetylmonoxime weakness can be improved by their treatment.
are cholinesterase regenerator stimulation of NM receptors at • When atropine and pralidoxime
compounds used for muscle end plate due to increased are used together, the signs of
organophosphate poisoning. ACh. atropinization may occur earlier than
19. Ans. (a) Edrophonium (Ref: KDT 23. Ans. (c) Cause muscles to relax might be expected when
8th/e p120-121) and be unable to contract (Ref: KDT atropine is used alone.
Myasthenia gravis can be 8th/e 27. Ans. (a) Tacrine (Ref: KDT 8th/e
differentiated from cholinergic crisis p375) p119, 518)
with the help of Drugs competing with Ach at Because of hepatotoxicity, and
a short acting anticholinesterase neuromuscular junction are requirement of frequent dosing,
agent, edrophonium. It improves the competitive or nondepolarizing tacrine is less
symptoms in myasthenia gravis neuromuscular blockers. These often used than other agents.
whereas worsens the condition in drugs are used as muscle 28. Ans. (b) Esteratic site of AChEs
cases of relaxants. In contrast to depolarizing (Ref: KDT 8th/e p123)
cholinergic crisis. Neostigmine is muscle relaxants, these donot cause • The active region of
used for the treatment of initial Acetylcholinesterase (AChE) has two
myasthenia. fasciculations. sites, i.e.
20. Ans. (a) Hemicholinium prevents 24. Ans. (d) Memantine (Ref: KDT an anionic site and an esteratic site.
the release of acetylcholine from the 8th/e p518-19) Anticholinesterase poisoning
storage • Donepezil, rivastigmine, like Organophosphate compounds
vesicles; (b) Botulinum toxin gallantamine and tacrine are binds to esteratic site of AChE.
increases the ACh release; (d) cholinergic 29. Ans. (b) Edrophonium (Ref: KDT
Vesamicol inhibits (due to inhibition of cholinesterase 8th/e p121)
the uptake of choline (Ref: KDT enzyme) drugs useful for • Drug used in ameliorative test
8th/e p110-111) Alzheimer’s disease. (tensilon test) for myasthenia gravis
• Hemicholinium blocks choline • Memantine is an NMDA blocker, is edrophonium. It is a cholinergic
uptake (the rate limiting step in ACh used for Alzheimer’s disease. drug and can be used for diagnosis
synthesis). 25. Ans. (d) Quarternary structure of myasthenia gravis because of its
(Ref: KDT 8th/e p116) short duration of action (10 – 30
min.) Bethanechol acts on muscarinic 62. Ans. (c) Glycopyrrolate (Ref. KDT
30. Ans. (d) Is a competitive receptors only whereas 8th/e p124)
antagonist of acetylcholine (Ref: KDT physostigmine The structure of tertiary and
8th/e p122) increases ACh, thus can stimulate quarternary amines can be depicted
Atropine acts as an antagonist at both muscarinic and nicotinic as
muscarinic receptors. It has no receptors. Neuromuscular junction • As seen in the diagram,
activity on contains NM receptors, thus will be quarternary amines are ionized and
nicotinic receptors and do not affected by physostigmine but not thus
interfere with the release of ACh. by bethanechol. water soluble. These drugs are not
31. Ans. (c) Malathion Poisoning 48. Ans. (a) Pralidoxime (Ref: KDT able to cross the blood brain
(Ref: KDT 8th/e p123) 8th/e p123) barrier.
• Pralidoxime is cholinesterase Oximes are ineffective in carbamate • Atropine, hyoscine and
reactivator useful for poisoning. Rather, these can worsen physostigmine are tertiary amines
organophosphate the poisoning due to weak (thus
(malathion, parathion) poisoning. anticholinesterase activity of its lipid soluble) and can cross the blood
32. Ans. (b) Opiates (Ref: KDT 8th/e own. brain barrier whereas
p120, 501) 49. Ans. (b) Carbaryl (Ref: KDT 8th/e glycopyrrolate is quarternary amine
Causes of Pin-Point Pupil p123) and cannot cross blood brain
• Opioids Poisoning 50. Ans. (d) Absence of pulmonary barrier.
• Organophosphate Poisoning secretions (Ref:
• Carbamate Poisoning [Link])
• Carbolic acid Poisoning 51. Ans. (b) Shorter acting than
• Pontine Hemorrhage edrophonium (Ref: KDT 8th/e p116-
33. Ans. (c) Neostigmine (Ref: KDT 121)
8th/e p120) 52. Ans. (a) Bronchial smooth muscle
34. Ans. (a) Pralidoxime (Ref: (Ref: KDT 8th/e p113) 63. Ans. (b) Glycopyrrolate (Ref: KDT
Katzung 11/e p121; KDT 8th/e p123) 53. Ans. (d) Naltrexone (Ref: KDT 8th/e p124)
35. Ans. (b) Carbamate poisoning 8th/e p122-123) • Glycopyrrolate is a quarternary
(Ref: Katzung 11/e p106-107; KDT 54. Ans. (c) Organophosphate ammonium compounds and is thus
8th/e p123) poisoning (Ref: KDT 8th/e p123) water soluble and unable to
36. Ans. (c) Rapidly destroyed in the 55. Ans. (d) Pralidoxime (Ref: KDT penetrate BBB.
body (Ref: Katzung 11/e p97) 8th/e p123) 64. Ans. (b) Prolongs A-V conduction
37. Ans. (c) Acetylcholine (Ref: KDT 56. Ans. (c) Increasing aqueous (Ref: Katzung, 11/e p113-123)
8th/e p104-105) humor outflow (Ref: KDT 8th/e • Muscarinic antagonists will
38. Ans. (a) Edrophonium (Ref: KDT p170) produce actions opposite to
8th/e p119) 57. Ans. (d) Sympathetic cholinergic parasympathetic system, thus it will
39. Ans. (c) Physostigmine (Ref: KDT (Ref: KDT 8th/e p104) decrease gastric as well as
8th/e p119) 58. Ans. (b) Tachycardia (Ref: KDT respiratory secretions.
40. Ans. (a) Physostigmine (Ref: KDT 8th/e p114) • Action of ACh through muscrainic
8th/e p120) 59. Ans. (d) Myasthenic ptosis (Ref: receptors is to increase the AV
41. Ans. (c) Brimonidine (Ref: KDT KDT 7/e p110) conduction, thus resulting in
8th/e p168) 60. Ans. (b) Latanoprost (Ref: bradycardia. Antagonist will thus
42. Ans. (b) Betaxolol (Ref: KDT Katzung 12th/e p328; KDT 8th/e result in opposite effect i.e. shorten
8th/e p168) p169) the AV conduction.
43. Ans. (b) Parathion (Ref: KDT PGF2α agonists like Latanoprost can • ACh via muscarinic receptors cause
8th/e p123) cause iris pigmentation contraction of sphictor pupillae
44. Ans. (c) Decreasing breakdown of (heterochromia muscle and result in miosis.
acetylcholine (Ref: KDT 8th/e p101) iridis) and growth of eyelashes Muscarinic antagonists will have
45. Ans. (c) Edrophonium (Ref: KDT (hypertrichosis) as adverse effects. opposite effect i.e. mydriasis.
8th/e p116, Katzung 11/e p104) 61. Ans. (d) Endrin (Ref: KDT 7/e However, this mydriasis is a passive
Physostigmine, neostigmine and p105) effect due to relaxation of
pyridostigmine are carbamates by Endrin is an organochlorine whereas constrictor pupillae. These agents
chemical all other drugs in the options like themselves do not cause contraction
nature, whereas edrophonium is an baygon of radial muscle of iris;
alcohol. (contains carbaryl), Tik 20 (contains however, they stop the
46. Ans. (a) Aminoglycosides (Ref: diazinon) and parathion are counteracting effect of sphincter
KDT 8th/e p795) acetylcholinesterase inhibitors pupillae
Aminoglycosides can result in (organophosphates or carbamates). and allow the radial muscle to do its
neuromuscular blockade that can Atropine is work.
aggravate myasthenia gravis. drug of choice for anticholinesterase Therefore, although both (b) and (d)
47. Ans. (b) Neuromuscular junction poisoning. There is no specific can be the answers, if only one
(Ref: Katzung 11/e p98) antidote option
for organochlorine poisoning.
need to be choosen, We will • Ipratropium and tiotropium are Atropine is longest acting (5-6 days)
definitely go with answer as (b). antimuscarinic drugs used for whereas tropicamide is the shortest
65. Ans. (a) Atropine (Ref: Modi’s treatment of bronchial asthma and acting
Medical Jurisprudence and COPD by inhalational route. (15-60 min) mydriatic.
Toxicology. 23rd, • Antimuscarinic drugs are contra- 77. Ans. (c) Muscarinic receptor
2005/92, 403, 429-430, Goodman indicated (relative) in patients with inhibition (Ref: KDT 8th/e p124)
and Gilman 12/e p234-235) – Glaucoma especially angle closure • Oxybutynin is a synthetic
These are the characteristic features glaucoma anticholinergic agent.
of anti-cholinergic overdose. – History of BHP (urinary retention) 78. Ans. (a) Increase bowel sound
66. Ans. (a) Anticholinergic (Ref: 71. Ans. (b) Ipratropium (Ref: (Ref: KDT 8th/e p132)
Katzung 11/e p122) Katzung 10/e p115; KDT 8th/e p129) • Atropine is an anticholinergic drug.
67. Ans. (b) Scopolamine • Ipratropium is an anticholinergic It decreases bowel sounds.
hydrochloride (Ref: J Psychiatry and drug which is used for the 79. Ans. (c) Excessive salivation (Ref:
Law [Link] 447- treatment of COPD and bronchial KDT 8th/e p132)
471) asthma. Atropine is an anticholinergic drug.
Controlled administration of 72. Ans. (a) Atropine (Ref: KDT 8th/e Its toxicity causes:
intravenous hypnotics to obtain p132) • Dry mouth (and not excessive
information from • Treatment of choice for rapid salivation)
subjects who are unable or unwilling onset type of mushroom poisoning is • Hot skin
to provide it otherwise, is known as atropine. • Dilated pupil and photophobia
Narcoanalysis or Narcosynthesis. 73. Ans. (c) Neostigmine (Ref: KDT • Excitement
Drugs used for narcoanalysis are: 8th/e p130) • Flushing of skin
– Ethanol • Cholinergic drugs increase GI • Hypotension → cardiovascular
– Scopolamine motility. Neostigmine is an inhibitor collapse
– Temazepam of the enzyme AChE (which is • Convulsions and coma
– Barbiturates like Thiopentone and responsible for the breakdown of 80. Ans. (a) Hyoscine (Ref: KDT 8th/e
Amobarbital ACh). It thus acts like a cholinergic p132)
These drugs are also known as truth agent. Hyoscine is used for the
drug or truth serum. • Glycopyrrolate and atropine are prophylaxisof motion sickness
• Phenobarbitone is not used, rather anticholinergic drugs; thus reduce whereas other drugs
amobarbital is used for GI motility. Fentanyl is an opioid and listed in the question are used for
narcoanalysis. can cause constipation. the treatment of vomiting.
68. Ans. (d) Duloxetine (Ref: 74. Ans. (b) Glycopyrrolate (Ref: 81. Ans. (d) Increased bowel sounds
Principles of Pharmacology, 1/e Morgan’s Anaesthesia 3/e p210, (Ref: KDT 8th/e p132)
p157, 159; KDT 211; KDT 8th/e Atropine is an anticholinergic drug. It
8th/e p124) p128) will decrease GI motility. Atropine
• Anticholinergic drugs decrease the • All of these drugs possess flushing is seen in overdose, the
motility of urinary tract and anticholinergic properties. exact mechanism of which is not
thus may result in urinary retention • Glycopyrrolate cannot cross blood known.
(therefore contra-indicated brain barrier, therefore does not 82. Ans. (a) Mydriasis is required
in BHP). produce central action. without cycloplegia (Ref: KDT 8th/e
• Dicyclomine, flavoxate and • Atropine sulphate can cross blood p148)
oxybutynin are useful for the brain barrier whereas atropine 83. Ans. (d) Physostigmine (Ref: KDT
treatment methonitrate is a quarternary 8th/e p122)
of urinary incontinence due to ammonium compound and is devoid 84. Ans. (d) Pirenzepine (Ref: KDT
detrussor instability (urge of 8th/e p112)
incontinence) central action. 85. Ans. (d) Phenylepherine (Ref:
• Tolterodine, darifenacin and 75. Ans. (d) Mydriasis (Ref: Katzung KDT 8th/e p148)
solefenacin are selective M3 11/e p117) 86. Ans. (b) Inhibition of sweating
antagonists that are also useful for • Atropine is an anticholinergic drug. (Ref: KDT 8th/e p108)
urinary incontinence. It causes increased heart rate. 87. Ans. (a) Muscarinic (Ref: KDT 6/e
• Duloxetine is an SSRI used for the • Atropine causes mydriasis and p111)
treatment of depression decreased sweating. 88. Ans. (c) Neostigmine (Ref: KDT
69. Ans. (a) Closure of Ca++ channels • No consistent or marked effect on 8th/e p119)
at the presynaptic membrane (Ref: BP, though hypotension may 89. Ans. (a) Atropine (Ref: KDT 8th/e
Katzung 10/e p90; KDT 8th/e p110) occur due to histamine-release and p131)
Botulinum toxin acts by inhibiting direct vasodilator action (at high 90. Ans. (a) Mucous and pharyngeal
the calcium mediated exocytosis of dose); tachycardia and vasomotor secretions (Ref: KDT 8th/e p125,
ACh centre stimulation tend to rise BP. 126)
from the vesicles in the synapse. 76. Ans. (b) Tropicamide (Ref: 91. Ans. (c) Bradycardia (Ref: KDT
70. Ans. (c) Urinary retention (Ref: Katzung 11/e p124) 8th/e p126)
Katzung 10/e p117; KDT 8th/e p128, 92. Ans. (a) Glaucoma (Ref: KDT
132) 8th/e p132)
93. Ans. (c) To prevent overdosage Decoding the graph 107. Ans. (a) Phentolamine followed
and discourage opioid dependence Drug A: It increases systolic as well by adrenaline (Ref: KDT 8th/e p143)
(Ref: KDT as diastolic BP and cause Intravenous injection of adrenaline
8th/e p733) bradycardia. These properties normally causes increase in blood
94. Ans. (c) Presynaptic blockade suggest that it is nor-epinephrine. pressure
(Ref: KDT 8th/e p110) Increased BP lead to reflex (α effect) followed by prolonged fall
95. Ans. (b) Bronchoconstriction bradycardia due to vagal stimulation. (b2 effect). If it is administered after
(Ref: KDT 8th/e p126) This giving a blockers (like
96. Ans. (c) Timolol eye drops (Ref: reflex decrease in heart rate can be phentolamine), only fall in BP is
CMDT 2014/175) prevented by anti-muscarinic drugs seen. This is called vasomotor
97. Ans. (c) Hypothermia (Ref: KDT like atropine. After giving atropine, reversal of Dale.
8th/e p132) same dose of nor-epinephrine
Atropine poisoning is associated produces tachycardia instead of
with hyperthermia (not bradycardia because of its direct
hypothermia) action
98. Ans. (b) Atropine (Ref: KDT 8th/e only.
p132) Drug B: It increases systolic BP,
99. Ans. (d) Glaucoma (Ref: KDT slighltly decreases diastolic BP and
8th/e p132) cause tachycardia. These features
100. Ans. (d) Trimethaphan (Ref: suggest the drug to be epinephrine. 108. Ans. (d) Alpha 1 receptors (Ref:
KDT 8th/e p135) Drug C: It increases systolic BP, Katzung 13th/142, 144)
101. Ans. (a) Beta 1 and Beta 2 markedely decreases diastolic BP Dopamine is used in CHF for its
agonist (Ref: KDT 7th/e p130) and stimulatory effects on beta 1
The features shown are: cause severe tachycardia. These receptors. It has
Tachycardia (due to beta 1 findings suggest drug C to be dose dependent effects as follows
stimulation), increase in systolic BP isoproterenol (isoprenaline). Receptor
(due to beta 1 105. Ans. (a) 8 (Ref: See below) stimulated
stimulation), decrease in diastolic BP Amount of dopamine required to be Action Dose required
(due to beta 2 stimulation) and infused (@10 micro/kg/min) = 80 × D1 Renal vasodilation 1–2
tremors 10 mg/kg/min
(due to beta 2 stimulation). From = 800 micro g/min b1
these features, it seems the drug is = 0.8 mg/min Cardiac stimulation 2–10 mg/kg/min
beta 1 and Amount of dopamine in 250 mL of a1
beta 2 agonist. solution Vasoconstriction > 10 mg/kg/min
102. Ans. (a) Adrenaline 0.5 mL of = 200 mg × 2 Therefore, in CHF, it is used at a dose
1:1000 solution by intramuscular = 400 mg of 2-10 mcg/kg/min. Thus, dopamine
route (Ref: Amount of dopamine in 1 mL stimulates D1 and beta 1 receptors
Harrison 19th/e p2117) solution but not alpha 1 receptors.
• Drug of choice for anaphylactic = 400/250 mg 109. Ans. (b) Increases renal blood
shock is adrenaline. = 1.6 mg flow (Ref: Goodman Gilman 12th/e
• Route of choice is intramuscular > Or p355; KDT
subcutaneous 1.6 mg dopamine present in 8th/e p146)
• Concentration of choice is 1:1000 = 1 mL solution Dopamine has dose dependent
• If repeated injections by 0.8 mg dopamine present in actions
intramuscular route are not = 0.5 mL solution Low dose (1-2 mcg/kg/min): It
effective, then So, solution should be infused @ 0.5 stimulates only D1 receptors leading
intravenous adrenaline (1:10000) is mL per min. to renal
given As 1 mL = 16 drops vasodilation and thus increase in
103. Ans. (c) High dose adrenaline So, infusion should be started at 8 renal blood flow.
followed by alpha 1 block (Ref: KDT drops per min. Medium dose (2-10 mcg/kg/min): It
7th/e p131) 106. Ans. (b) Presynaptic alpha 2 stimulates both D1 and beta 1
Vasomotor reversal of Dale is fall in receptors (Ref: Katzung 13th/148- receptors
blood pressure noted with high dose 149) means it will lead to inotropic action
of Action of adrenaline in anaphylactic also.
adrenaline when the person is shock by different receptors is High dose (>10 mcg/kg/min): It
treated with alpha blockers. It is due Receptor Action Use stimulates D1, beta 1 and alpha 1
to unopposed Alpha 1 Vasoconstriction Increase in receptors
beta 2 action. diastolic BP resulting in additional
104. Ans. (b) The effect on heart rate Beta 1 Cardiac stimulation Increase vasoconstriction.
in graph A can be prevented by systolic BP 110. Ans. (d) Beta-3 (Ref: KDT 8th/e
antimuscarinic Beta 2 Bronchodilation Reverse p139, 142)
agents (Ref: Goodman and Gilman bronchoconstriction
12th/283)
Beta 3 receptors are present on for obstructive sleep apnea. • It is done by infusion of
adipose tissue (cause lipolysis), Remember, continous positive dobutamine to increase myocardial
coronary artery airway oxygen
(cause vasodilation) and on urinary pressure (cPAP) is the treatment of demand.
bladder (cause relaxation). choice for this disorder. 121. Ans. (a) Ephedrine (Ref: Current
111. Ans. (a) Centrally acting α2 Modafinil is approved only as Diagnosis And Treatment-obstetrics
agonist (Ref: KDT 8th/e p412, adjunctive treatment. And
Katzung 12th/445) 116. Ans. (c) Phenylephrine (Ref: Gynecology, 2008)
Dexmedetomidine is a highly Harrison /18th/e p377-378) Vasopressors act by stimulating
selective central α2- adrenergic Alpha blockers are used in erectile alpha adrenergic receptors. This
agonist (like dysfunction not alpha agonists vasoconstriction can lead to fetal
clonidine). It is the active S- (phenyephrine). hypoxia by reducing uteroplacental
enantiomer of medetomidine (used Drugs useful in the management of perfusion.
in erectile dysfunction (ED) Vasopressors acting predominantly
veterinary medicine). • Phosphodiesterase inhibitors by alpha receptors can also increase
112. Ans. (b) Hyperalgesia (Ref: – Sildenafil uterine
Goodman and Gilman 12th/296; – Vardenafil tone and further aggaravate the
Katzung – Tadalafil fetal hypoxia. Phenylephrine,
12th/176; KDT 8th/e p140) – Udenafil methoxamine
• Alpha 2 agonists cause analgesia, • PGE1 analog – Alprostadil and mephentermine are all alpha
not the hyperalgesia. • Aviptadil agonists and can cause this side
• Clonidine is used for treatment of 117. Ans. (b) 1 : 1000 for inhalational effect so not
hypertension. It decreases blood route (Ref: Drug Facts and preferred in pregnant female.
pressure by acting on central alpha 2 Comparisons, Ephedrine on the other hand
adrenergic receptors. 2010/837) possess beta adrenergic activity also
• Dexmedetomidine is another alpha For inhalational route, adrenaline is and result in
2 receptor agonist that is used to used in a concentration of 1:100 for less vasospasm (due to beta 2
produce sedation and anxiolytic treatment of bronchial asthma by mediated vasodilation) and is
state by action on alpha 2 receptors nebulizer. considered as the
in the brain. It can also produce Concentration of adrenaline for vasopressor of choice in pregnant
analgesia by acting on alpha 2 different routes and indications females especially for the treatment
receptors in spinal cord. Route and Indication Concentration of
113. Ans. (c) Epinephrine (Ref: of Adrenaline required hypotensive complication of regional
Goodman and Gilman 12th/277; Bronchial asthma, inhalational 1:100 anaesthesia.
KDT 8th/e p142) Anaphylactic shock, intramuscular 122. Ans. (a) Stimulation of lipolysis
• Epinephrine is having both alpha (1 1:1000 (Ref: Katzung 10/e p86; KDT 8th/e
and 2) and beta (1 and 2) Anaphylactic shock, subcutaneous p139)
agonist property. 1:1000 Lipolysis is mediated by b3 receptors
• Dobutamine stimulates only beta 1 Anaphylactic shock, intravenous whereas other actions are done by
whereas phenylephrine acts only 1:10000 stimulation of b2 receptors.
on alpha 1 receptors. Cardiac arrest, intravenous 1:10000 123. Ans. (a) Hypertensive
• Fenoldopam does not act on alpha With Local anaesthetics, emergencies (Ref: Katzung 10/e
or beta receptors, rather it is D1 subcutaneous 1:200000 p133, 174)
agonist. 118. Ans. (b) A vasodilator in treating • Fenoldopam is a D1 agonist useful
114. Ans. (d) Noradrenaline (Ref: coronary artery stenosis during for i.v. treatment of hypertensive
KDT 8th/e p142) angio emergencies.
• Dobutamine is selective beta 1 procedures (Ref: CMDT-2010/1434- 124. Ans. (b) Conversion of tyrosine
agonist, fenoldopam is selective D1 1435) to DOPA (Ref: Katzung 10/e p78;
agonist whereas phenylephrine acts Tolazoline and phentolamine are KDT 8th/e
only on alpha1. NA can act on alpha receptor blockers, therefore p136)
alpha1, alpha2 and beta1 receptors produce • Rate limiting enzyme in
115. Ans. (c) Obstructive sleep apnea vasodilation. norepinephrine synthesis is tyrosine
(Ref: [Link]; KDT 8th/e p517) 119. Ans. (b) Salmeterol (Ref: KDT hydroxylase that catalyses the
• Modafinil is a sympathomimetic 8th/e p243 & 5th/200) conversion of tyrosine to dopa. In
drug and is alpha and beta agonist Salmeterol is a long acting β2 agonist ACh synthesis, rate limiting step is
in brain. The drug also acts upon whereas albuterol (salbutamol), uptake of choline by the
several other receptors. It has brain pirbuterol and orciprenaline are neurons.
activating properties and is the drug short acting agents. 125. Ans. (d) Hypokalemia (Ref: KDT
of choice for narcolepsy. 120. Ans. (b) Dobutamine (Ref: 8th/e p149 and Principles of
• Modafinil can also be used for Harrison 17/e p1399-1400) pharmacology
sleep disorders in shift workers. • Pharmacological stress testing is by HL Sharma and KK Sharma
• Recently, FDA has approved done in individuals who are not able 2007/168)
modafinil as an adjunctive treatment to exercise.
• β2 agonists cause a brief spell of fenoldopam are the exogenous hemorrhage due to uncontrolled rise
hyperkalemia followed by (synthetic) catecholamines. in blood pressure.
hypokalemia. 130. Ans. (b) Methyldopa (Ref: KDT 135. Ans. (d) 1-2 μg/kg/min (Ref:
• These do not cause hypoglycemia. 8th/e p612) Harrison 17th/1453)
However, β2 blockers delays the Methyl dopa itself is not an a2 Dose of Dopamine Effects
recovery from hypoglycemia. agonist but it is converted to an 1-2 micro gm/kg/min Renal
126. Ans. (b) Hypoglycemia (Ref: active vasodilation (Renal dose)
KDT 8th/e p149) metabolite a-methyl norepinephrine 2-10 micro gm/kg/min Stimulates β-
• β2 agonists are the inhaled which possesses a2 agonistic 1 receptors of heart
bronchodilators used for the action. All other drugs listed in the > 10 μ gm/kg/min Stimulates
management of bronchial asthma. question are a2 agonists for the peripheral α receptor s leading to
• Tremor is the dose related adverse treatment of hypertension. vasoconstriction
effect of these drugs. 131. Ans. (c) Benign hyperplasia of 136. Ans. (a) 120 seconds (Ref:
• Brief hyperkalemia followed by prostate (Ref: KDT 8th/e p150-152) Lawrence 9/e p453)
hypokalemia is an important a2 agonists like apraclonidine and Dobutamine is an inotropic drug
adverse effect of these agents. brimonidine are useful for the which has onset of action = 1-2 min.
• β2 agonists do not cause treatment of glaucoma. Clonidine is Peak action = 1-10 min.
hypoglycemia. also used for the management of Duration of action = < 10 min.
127. Ans. (d) Erectile dysfunction hypertension. Dexmedetomidine is a Half life = 2 min.
(Ref: KDT 8th/e p150-151) centrally acting α2 agonist 137. Ans. (c) Sedation (Ref: KDT
• Erection of penis requires indicated for sedation of initially 8th/e p243)
increased blood supply by means of intubated and mechanically • Side effects of salbutamol :
vasodilatation. This can be produced ventilated 1. Palpitation
by α-blockers and not by patients. 2. Muscle tremors
agonists. Other drugs for erectile 132. Ans. (a) Renal vasodilatory 3. Hypokalemia
dysfunction are phosphodiesterase effect (Ref: Katzung 11/e p137) 4. Nervousness
inhibitors like sildenafil and tadalafil. Dopamine acts on D1, b1 and a1 5. Ankle edema
• Sympathomimetic agents are receptors. Stimulation of D1 138. Ans. (b) Subcutaneous
positive inotropic agents and can be receptors adrenaline (Ref: KDT 8th/e p150)
used for the treatment of acute cause renal vasodilation, which is 139. Ans. (c) Reuptake (Ref: KDT
decompensated heart failure. useful clinically to improve renal 8th/e p137)
Dopamine and dobutamine are perfusion in shock with oligouria. Endogenous adrenaline action is
particularly suited for this purpose. 133. Ans. (c) Ephedrine (Ref: KDT terminated mainly by reuptake
• These agents can be used for the 8th/e p147) whereas
treatment of hypotension • Ephedrine acts directly as well as exogenous agent is metabolized by
(dopamine) as well as hypertension indirectly through release of COMT and MAO.
(clonidine). noradrenaline. 140. Ans. (b) Anaphylactic shock
128. Ans. (a) IV noradrenaline Latter increases systolic (β1) as well (Ref: KDT 8th/e p150)
increases systolic and diastolic BP as diastolic (α1 • Epinephrine is the agent of choice
and causes action) blood pressure. This is due to for the treatment of anaphylactic
tachycardia (Ref: Katzung 10/e lack of β2 mediated shock. It increases BP by a action and
p132) vasodilation. causes bronchodilation by β2
Noradrenaline increases blood • Adrenaline transiently increase action.
pressure (both systolic and diastolic) diastolic BP which later on decreases • For bronchial asthma, selective β2
which lead due to its β2 stimulatory action. agonists like salbutamol are
to reflex activation of baroreceptors 134. Ans. (a) The usual dose is 0.5-1 preferred.
resulting in bradycardia. Adrenaline mg by IM route (Ref: KDT 8th/e • For glaucoma, a prodrug of
increases systolic BP and cause p150) epinephrine, dipivefrine is useful (as
tachycardia. It has negligible effect • Adrenaline 0.5 ml of 1 : 1000 adrenaline cannot cross corneal
on diastolic solution (i.e., 0.5 mg) by i.m. route membrane).
BP. However both rise and fall have is drug of choice for anaphylactic • Treatment for PVD is  blockers.
been noted. For details, see text. shock. It can also be used by 141. Ans. (b) COMT (Ref: KDT 8th/e
129. Ans. (b) Dobutamine (Ref: s.c. route p137)
Principles of pharmacology by HL • If not responding, it can be Endogenous adrenaline action is
Sharma and KK repeated after 5 minutes (not 2-4 terminated mainly by reuptake
Sharma 2007/172) hours). In desperate circumstances whereas
• Dopamine, adrenaline and i.v. route can be used but it exogenous agent is metabolized by
nonadrenaline are endogenous must be diluted 10 times (i.e., 1 : COMT and MAO.
catecholamines. 10000 concentration is used), 142. Ans. (a) 1 receptors are
• Isoprenaline, dipivefrine, therefore same solution cannot be usually presynaptic (Ref: KDT 8th/e
dobutamine, ibopamine, utilized, However, in rare p140)
dopexamine and circumstances, i.v. adrenaline can
result in cerebral
Presynaptic sympathetic receptors 170. Ans. (b) Ephedrine (Ref: KDT 179. Ans. (d) Propranolol (Ref:
are usually α2. Other statements are 8th/e p147) Goodman & Gilman 11/e p286)
true. 171. Ans. (d) Phenylephrine (Ref: 180. Ans. (c) Sotalol (Ref: KDT 8th/e
143. Ans. (a) Dopamine (Ref: KDT KDT 8th/e p148) p162)
8th/e p146) 172. Ans. (b) Obesity (Ref: KDT 8th/e Lipid insoluble β-blockers like
144. Ans. (b) Yohimbine (Ref: KDT p149) sotalol, atenolol, nadolol etc are
8th/e p140) 173. Ans. (d) Methylphenidate (Ref: excreted
145. Ans. (a) Adrenaline (Ref: KDT KDT 8th/e p152) by the kidney and should be avoided
8th/e p143) 174. Ans. (b) 1.5-2.5 kg (Ref: in renal failure. Beta blockers
146. Ans. (a) a2 (Ref: KDT 8th/e Practical Manual of Pharmacology contraindicated in renal failure are:
p612) by Dinesh Badyal A–Atenolol
147. Ans. (b) β2 selectivity (Ref: KDT 1st ed/75) N–Nadolol
8th/e p243) Important points regarding rabbits S–Sotalol
148. Ans. (b) Diastolic (Ref: KDT used in pharmacological studies 181. Ans. (a) Carvedilol (Ref:
8th/e p143) • Scientific name: Oryctalagus Goodman & Gilman 11/e p285, 286;
149. Ans. (a) Tremors (Ref: KDT cuniculus KDT 8th/e p165)
8th/e p242) • Adult weight: 1.5-2.5 Kg Third generation β-blockers possess
150. Ans. (b) ADHD (attention deficit Age suitable for experiment: 5-6 additional vasodilator activity
hyperkinetic disorder) (Ref: KDT months apart from their α-blocking action.
8th/e p152) 175. Ans. (a) Adrenaline Carvedilol and labetalol block α
151. Ans. (a) Agonist of D1 and D2 Adrenaline is oxidized to produce receptors also and cause
receptors (Ref: KDT 8th/e p147) adrenochrome which can cause vasodilation.
152. Ans. (a) Adenyl cyclase (Ref: black 182. Ans. (b) It is most effective in
KDT 8th/e p55) pigmentation of conjunctiva. new onset decompensated heart
153. Ans. (a)  blocker (Ref: KDT Remember pigmentation of iris is failure (Ref:
8th/e p143) caused by KDT 8th/e p164-165)
154. Ans. (a) Reserpine (Ref KDT latanoprost • Beta blockers are absolutely
8th/e p614) 176. Ans. (a) Epinephrine (Ref: KDT contraindicated in decompensated
155. Ans. (d) Gastrointestinal 8th/e p114, 144) (acute)
sphincter contraction (Ref KDT 8th/e Pilocarpine is a heart failure.
p140) parasympathomimetic drug. It • In compensated heart failure,
156. Ans. (a) Isoprenaline (Ref KK causes contraction of sphincter these agents should be initiated at
Sharma 1/e p172) pupillae and result in miosis. very
157. Ans. (c) Can produce CNS Epinephrine results in contraction of low doses and the dose should be
stimulation (Ref KDT 8th/e p611) dilator increased gradually.
158. Ans. (d) All of the above (Ref: pupillae and result in mydriasis. • If used in this manner, long term
KDT 8th/e p611-612) 177. Ans. (a) Adrenaline (Ref: use of β-blockers can decrease
159. Ans. (a) Ephedrine (Ref: Goodman Gilman 12th/e p188, 285; the mortality in CHF patients.
Katzung 11/e p134) Katzung 12th/e • Carvedilol is the most commonly
160. Ans. (b) Cardiac output (Ref: p90; KDT 8th/e p144) used beta blocker in CHF due
KDT 8th/e p147) Decrease in tone, amplitude and to its antioxidant and antimitogenic
161. Ans. (a) Causes increase in GI frequency of intestinal contractions property.
Ischemia (Ref. KDT 7th/134) seen in the graph depicts the drug to 183. Ans. (c) Carvedilol has alpha
Dopamine causes vasodilation in be a depressant drug. Important agonistic and selective β1 blocking
renal and splanchnic vessels by depressants drugs on intestinal action (Ref:
stimulating D1 smooth muscle are KDT 8th/e p165)
receptors. sympathomimetics • Labetalol and carvedilol are
162. Ans. (a) Adrenaline (Ref: KDT like adrenaline and directly acting blockers of both α as well as β-
8th/e p143) drugs like papaverine. As the receptors.
163. Ans. (b) Alpha 2 (Ref: KDT 8th/e depressant effect of the drug was • Esmolol is the shortest acting and
p611) abolished by propranolol, it must be nadolol is the longest acting β-
164. Ans. (b) Fludrocortisone (Ref: mediated by beta receptors. So, the blocker.
CMDT 2014/941) likely drug among the options seem • Atenolol is not lipid soluble. It is
165. Ans. (d) Intramuscular (Ref: KDT to be adrenaline. excreted by the kidney. These
8th/e p150) 178. Ans. (c) Lupus erythematosus agents are longer acting than lipid
166. Ans. (d) Tyrosine (Ref: KDT (Ref: KDT 8th/e p156-157) soluble β-blockers like
8th/e p140) Prazosin is a selective a1 blocker and metoprolol.
167. Ans. (d) Greater than 10 can be used for treatment of 184. Ans. (d) Timolol (Ref: Katzung
mg/kg/min (Ref: KDT 8th/e p146) pheochromocytoma, peripheral 11/e p157)
168. Ans. (c) Beta 1 (Ref: KDT 8th/e vascular disease, benign hyperplasia 185. Ans. (d) Prazosin (Ref: Harrison
p142) of 17/e p2752)
169. Ans. (a) Clonidine (Ref: KDT prostate and hypertension. It is the Prazosin is used for treatment of
8th/e p140) drug of choice for scorpion sting. scorpion sting.
186. Ans. (a) Hypothyroidism (Ref: 201. Ans. (b) Phenoxybenzamine 223. Ans. (a) Prazosin (Ref: Harrison
KDT 8th/e p164-165) (Ref: KDT 8th/e p154-155) 20th/e p3329)
• Beta blockers are used to treat 202. Ans. (c) Hydrolysis by blood • Scorpion sting is a dreadful medical
hyperthyroidism (not esterase (Ref: KDT 8th/e p141) emergency.
hypothyroidism). 203. Ans. (d) All of above (Ref: KDT • Scorpion stings cause a wide range
• These are the only drugs that offer 8th/e p160-161) of symptoms, from severe local
prophylactic benefits in a patient 204. Ans. (d) Phenoxybenzamine reactions to cardiovascular,
of varices who has never bled. binding to alpha adrenergic receptor respiratory and neurological
187. Ans. (b) Variant angina (Ref: (Ref: manifestations.
KDT 8th/e p161) Katzung 10/e p16; KDT 8th/e p154- • Alpha-receptors play vital role in
• Propranolol worsens variant 155) the pathogenesis of cardiac failure
angina, due to unopposed α • Phenoxybenzamine is an and pulmonary edema due to
receptor irreversible (covalent) antagonist at scorpion sting.
mediated coronary constriction. alpha • Prazosin is a selective alpha-1
• For indications of β-blockers, refer receptors. All other drugs mentioned adrenergic receptor blocker. It
to text. are reversibly interacting with dilates
188. Ans. (b) Parkinsonian tremor their receptors. veins and arterioles, thereby
(Ref: KDT 8th/e p164) 205. Ans. (a) Atenolol (Ref. KDT reducing pre-load and left
Propranolol is useful in the 8th/e p153) ventricular
management of tremor due to 206. Ans. (a) Acute CHF (Ref: KDT impedance without rise in heart rate
overdose of 8th/e p160) and renin secretion. It also
sympathomimetic agents (β2 207. Ans. (c) Pindolol (Ref: KDT 8th/e inhibits sympathetic outflow in
mediated). Metoprolol as well as p158) central nervous system. It enhances
propranolol 208. Ans. (a) Atropine (Ref: KDT insulin secretion, which is inhibited
are effective in essential or familial 8th/e p160) by venom action. It has also
tremor (β1 mediated). β-blockers are • Dopamine, adrenaline and been found useful even in cases with
ineffective in intention tremor and isoprenaline act by stimulating b1 hypotension. Thus, its
rest (parkinsonian) tremors. receptors in heart. As patient has b- pharmacological properties can
189. Ans. (c) COPD (Ref: KDT 8th/e blocker overdose, these are likely antagonize the hemodynamic,
p160-161) to be ineffective hormonal and metabolic effects of
Timolol is a non-selective β-blocker. • Atropine can increase heart rate in scorpion venom action.
It can prevent β2 mediated this person by blocking 224. Ans. (a) Edrophonium (Ref: KDT
bronchodilation and thus worsen the parasympathetic action on heart. 8th/e p120)
condition in patients of bronchial 209. Ans. (c) Yohimbine (Ref: KDT • Patients with myasthenia gravis
asthma and COPD. 8th/e p156) may present in the emergency with
190. Ans. (b) Partial heart block (Ref: 210. Ans. (a) Tamsulosin (Ref: KDT muscle weakness. This could be
KDT 8th/e p160-161) 8th/e p156) because of the aggravation of their
β-blockers are contraindicated in 211. Ans. (a) Tamsulosin (Ref: KDT primary problem (myasthenic crisis)
partial or complete heart block as 8th/e p156) or due to the overdose of the
they 212. Ans. (d) All of the above (Ref: drugs like neostigmine (cholinergic
cause bradycardia. KDT 8th/e p160-161) crisis). The etiology of the two
191. Ans. (c) Butoxamine (Ref: 213. Ans. (c) Betaxolol (Ref: KDT conditions is important to
Katzung 11/e p160) 8th/e p168) understand because in myasthenic
192. Ans. (c) Masks the 214. Ans. (d) Partial AV block (Ref: crisis,
hypoglycemic symptoms (Ref: CMDT KDT 8th/e p161) there is deficiency of acetylcholine
2010/402) 215. Ans. (a) Atenolol (Ref: KDT whereas in cholinergic crisis,
193. Ans. (a) Esmolol (Ref: KDT 8th/e 8th/e p162-163) there is excess of acetylcholine.
p163) 216. Ans. (a) Phentolamine (Ref: KDT • Edrophonium is an inhibitor of the
194. Ans. (c) Tamsulosin (Ref: KDT 8th/e p155) enzyme acetylcholinestrase and
8th/e p156) 217. Ans. (c) Nasal blockage (Ref: thus, increases the concentration of
195. Ans. (d) All (Ref: KDT 8th/e KDT 8th/e p160-161) acetylcholine at the
p160) 218. Ans. (b) Carvedilol (Ref: KDT neuromuscular junction. The
196. Ans. (a) Carvedilol (Ref: KDT 8th/e p165) increased availability of ACh causes
8th/e p165) 219. Ans. (b) IV atropine (Ref: KDT dramatic improvement in the
197. Ans. (a) Propranolol (Ref: 8th/e p131) symptoms of patients with
Katzung 11/e p 162) 220. Ans. (a) Timolol maleate (Ref: myasthenic
198. Ans. (a) Esmolol is mainly KDT 8th/e p167) crisis.
metabolized in liver (Ref: KDT 8th/e 221. Ans. (c) Metoprolol (Ref: KDT • In contrast, the symptoms of
p141) 8th/e p161) patients with cholinergic crisis
199. Ans. (a) a1A (Ref: KDT 8th/e 222. Ans. (a) A-V block (Ref: KDT worsen
p156) 8th/e p161) with edrophonium (because it
200. Ans. (d) Pindolol (Ref: KDT ANSWERS TO RECENT QUESTIONS further increases ACh in cholinergic
8th/e p162)
crisis). The drug, therefore, is useful
to clinically differentiate the
actual cause of muscle weakness in
an emergency situation.
• The reason for preferring
edrophonium over other inhibitors
of
acetylcholinesterase is its short
duration of action. This may be
desirable for patients presenting
with cholinergic crisis as the
worsening in
their condition would be only for a
short time.
225. Ans. (b) Brimonidine (Ref:
Goodman and Gilman 13th/e p1259)
Brimonidine causes CNS depression
in newborn babies and can result in
apnea, so it is contraindicated in
such patients.
Ocular adverse effects of anti-
glaucoma drugs
Drug Adverse Effect
Miotics (Pilocarpine) Cataract
Stenosis of nasolacrimal system
PGF2 analogs (Latanoprost)
Heterochromia iridis
Growth of eyelashes
Cystoid Macular Edema
Apraclonidine Lid retraction
Brimonidine CNS depression and
apnea in newborn
Adrenaline Conjunctival
pigmentation
226. Ans. (d) Inj atropine (Ref: KDT
8th/e p131)
• We need to immediately reverse
the bradycardia by giving atropine.
227. Ans. (c) Vasopressin (Ref:
Harrison 19th/1769)
228. Ans. (d) Vasoconstriction (Ref:
KDT’s 8th/140)
229. Ans. (c) Topiramate (Ref: FDA
New drugs)
230. Ans. (b) Chlorpropamide (Ref:
Harrison’s 19th/e pg. 2397)
231. Ans. (c) Intravenous (Ref:
Harrison’s 19th/e pg.1769)