Frequently Asked Question in General Pharmacology 

Q.1. Which of the following drugs inhibits the ATP-binding cassette? 

Ans. Verapamil

Q.2. Antacids mainly reduce the absorption of?

A. Acidic drugs

B. Basic drugs

Ans. Acidic drugs

• Antacids are basic drugs
• Neutralise HCl in stomach, neutralising the pH
• More acidic drugs are absorbed from stomach
  • Antiepileptics
    • Phenytoin
    • Valproate
  • NSAIDs
    •  Aspirin

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Q.3. If a drug has a very high first-pass metabolism in the liver. Is this given orally or not?

Ans. Either they are not given orally or they are given in very high oral doses.

Drugs having high first-pass metabolism

Drugs not given orally:

• Lignocaine
• Fentanyl
• Natural steroids
• Estrogen
• Progesterone
• Testosterone
• Hydrocortisone
• Aldosterone

High oral dose drug:

• Propranolol
• Morphine
• Verapamil
• Pethidine
• Salbutamol (Salbutamol is also given by syrups or tablets)
• Nitrates

Q.4. How to avoid (bypass) first-pass metabolism of the liver:

Ans: By giving a drug by all other systemic routes except oral. Sublingual, rectal, and all parenteral routes

Q.5. There is a drug known as Warfarin, which is highly lipid soluble and 99% protein (albumin) bound. What will be its Vd?

Ans. Low Vd→ plasma protein binding is always predominant over lipid solubility when determining Vd.

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Q.6. All antiepileptics increase each other's toxicity?

Ans: 

Phenytoin attaches to albumin

↓

Seizures persist

↓

Valproate is added

↓

They displace each other from albumin

↓

Increasing free fraction of the drug

↓

Increasing Vd

↓

Distributed to unwanted organs

↓

Harmful effects and toxicity

Q.7. Sulfonamides (Cotrimoxazole) is contraindicated in neonates and the last trimester of pregnancy?

Ans: 

Sulfonamides displace Bilirubin (endogenous toxin) from Albumin

↓

Bilirubin enters the neonatal brain (as the blood-brain barrier isn't fully formed)

↓

Neuronal damage (encephalopathy)

↓

Kernicterus

Q.8. Does aspirin cause hypoglycemia with tolbutamide (sulfonylureas)?

Ans:

Aspirin displaces Tolbutamide from albumin

↓

Increase free fraction

↓

Enters organs such as the pancreas

↓

Insulin release

↓

Hypoglycemia

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Q.9. If a drug has high Vd, there is no role of hemodialysis. Why?

Ans. High Vd drugs are not present in plasma. E.g., Digoxin (450L of plasma)

Q.10. If a drug has low Vd and high plasma protein binding, will hemodialysis be allowed?

Ans. No. Plasma protein will not allow the filtration of a drug. E.g., Warfarin (99% Albumin bound), Verapamil

Q.11. If a drug has low Vd and low plasma protein binding (free form), is hemodialysis allowed?

Ans. Yes

Drugs that require hemodialysis

Do hemodialysis	No role of hemodialysis
- Barbiturates - Lithium - Alcohols - Aspirin - Salicylates - Theophylline	- Amfetamine - Verapamil/Warfarin - Organophosphate - Imipramine (TCA: Tricyclic Antidepressant) - Digoxin - Amiodarone - Benzodiazepine (Diazepam) - Chloroquine : overall highest Vd

Q.12. The action of thiopentone is terminated by.

Ans: A. Redistribution into fats

B. Elimination into urine

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Q.13. Which skeletal muscle relaxant is safe in hepatic failure?

A. Atracurium

B. Succinylcholine

Ans. Atracurium

• Does not require any organ or enzyme for metabolism
• Used in most surgeries
• Even though succinylcholine is not degraded by the liver, as pseudocholinesterase is synthesized in the liver, leading to its deficiency in hepatic failure
  • Succinylcholine is not metabolized, causing respiratory paralysis due to its toxicity.

Q.14. Which drugs are excreted by sweat, saliva, and tears?

Ans. Lithium and metals like mercury

Q.15. Which antiepileptic drug gets excreted in the greatest amount in breast milk?

Ans. Levetiracetam

Q.16. Why does rifampin cause contraceptive failure?

Ans. Rifampicin increases the metabolism or degradation of estrogen by inducing CYP enzymes

Q.17. What is the drug that inhibits the OATP transporter?

Ans. Probenecid

• Probenecid is combined with cephalosporins and penicillin because:
  • Probenecid inhibits the excretion of penicillin and cephalosporins into the urine
  • They remain in the blood for a longer duration
  • Makes them longer acting by inhibiting the excretion

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Q.18. What drug is used to make urine acidic in the basic drug poisoning?

Ans. Ammonium chloride

Q.19. What is an antidote for amphetamine poisoning?

Ans. Ammonium chloride

Q.20. In case of an emergency, can you wait 4 to 5 days for the drug to exist in a patient's system?

Ans. No.

•  Initially, a high dose (loading dose) is given to achieve Css rapidly.
• To maintain it: Drug is given externally to counter the drug eliminated inside the body (maintenance dose) to achieve the target concentration level

Q.21. Is the structure of methotrexate like folic acid? True or false?

Ans. True

Q.22. Can we overcome the effect of methotrexate by folic acid? True or false?

Ans. False

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Q.23. What are the examples of inotropic receptors?

Ans: 

1. Na+: Excitatory

• Nicotic receptor (acetylcholine)
• 5HT receptor (serotonin) 3
• NMDA receptor (glutamate)

2. Cl-: Inhibitory

• GABA-A Cl- Channel
• Glycine-Cl- Channel

Q.24. What molecule controls our appetite in the brain and acts on the JAK-STAT receptor?

Ans.Leptin

Q.25. If there is a DNA mutation occurring inside the cell and there is a gain of function (excessive action), what is the result?

Ans. Uncontrolled cell division = Leads to cancer (Lung cancer: Mutation inEGFR)

Q.26. What are protein kinase inhibitor drugs used for?

Ans. Anti-cancer drugs (end with -nib)

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Q.27. Why does FSH/LH value reduce on prolonged/continuous action of GnRH agonist?

Ans. Desensitization of GnRH receptors on pituitary

Q.28. What is the reason for never stopping β blockers suddenly on your patient?

Ans. β receptors on SA node have become supersensitive and will result in rebound tachycardia/hypertension

Q.29. Phase 1 trial is not done for?

Ans. Phase 1 is not done to evaluate the efficacy of the drug

• To evaluate efficacy, the drugs must be tested on patients
• Phase 1 is done on healthy humans, so efficacy can not be evaluated

Q.30. Phase 1 trial is mainly done for?

Ans. Phase 1 trial is mainly done to evaluate the maximum tolerable dose of the drug. Because safety is done in all phases of clinical trials

Q.31. What is the minimum duration of the phase 4 trial for marketed drugs?

Ans. ≥ 2 years

• It is mandatory to continue the phase 4 trial at least 2 years after approval
• If the drug is harmful, phase 4 time will be extended

Overall summary of phases of clinical trials

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Q.32. After which phase of the clinical trial does the drug get approval for marketing?

Ans. Phase 3 clinical trial

Q.33. Which phase of clinical trials is done on approved drugs?

Ans. Phase 4 trial

Q.34. Among phases 1, 2, and 3, which phase of clinical trials has the maximum sample size?

Ans. Phase 3 clinical trial

Q.35. Among phases 1, 2, and 3, which phase of clinical trials is called a Multi-site trial?

Ans. Phase 3 clinical trial

Q.36. Among phases 1, 2, and 3, which phase of clinical trials is done on heterogeneous populations?

Ans. Phase 3 clinical trial

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Q.37. Among phases 1, 2, and 3, which phase of clinical trials gives the best data on the safety of a drug?

Ans. Phase 3 clinical trial

• Best safety data in Phase 3 > Phase 2 > Phase 1

Q.38. Among phases 1, 2, and 3, which phase of clinical trials has the best data on efficacy?

Ans. Phase 3 clinical trial

• Phase 3 > Phase 2 in efficacy
• Efficacy is not found in phase 1 clinical trials

Q.39. Among phases 1, 2, and 3, which phase of clinical trials is the most costly?

Ans. Phase 3 clinical trial—due to maximum sample size

Q.40. Among phases 1, 2, and 3, which phase of clinical trials has the highest failure rates?

Ans. Phase 2 clinical trials

• Efficacy is first found in phase 2—more chances of failure

Q.41 Among phases 1, 2, and 3, which phase of clinical trials did RCT with/without blinding?

Ans. Phase 3 and Phase 2 clinical trial

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