1
Q
What are orphan drugs used for?
A
Rare diseases; development is low due to low profitability.
2
Q
What is an orphan receptor?
A
A receptor with an unknown ligand.
3
Q
Criteria for essential drugs?
A
Inexpensive, non-toxic, easily available, efficacious, safe, and single molecule (not FDC).
4
Q
What are prescription/legend drugs?
A
Drugs that require a prescription (under Schedule H).
5
Q
What are spurious drugs?
A
Drugs that do not produce the expected effect because the drug component is falsified.
6
Q
What are misbranded drugs?
A
Drugs with incorrect or missing information on the label.
7
Q
What are adulterated drugs?
A
Drugs that contain unwanted additives.
8
Q
Define rational drug use.
A
Right drug for right disease & patient; at right dose, duration & route with correct monitoring.
9
Q
Main mechanism of drug absorption?
A
Passive diffusion along the concentration gradient.
10
Q
Where is maximum drug absorption in the GIT?
A
Small intestine due to large surface area.
11
Q
Drugs with poor oral absorption?
A
Large molecules like proteins and -tide/-ase/-mab drugs.
12
Q
Purpose of enteric coating?
A
Protects drug from acidic pH of the stomach.
13
Q
Define bioavailability.
A
Extent of drug absorption; calculated as AUC oral / AUC IV.
14
Q
Function of ABC transporters?
A
Efflux of drugs in intestine, liver, BBB to limit drug exposure or enhance excretion.
15
Q
Name some p-GP substrates.
A
Digoxin, Loperamide, Cyclosporine, Clarithromycin, etc.
16
Q
Name p-GP inducers.
A
Rifampicin, Phenytoin, Carbamazepine.
17
Q
What is volume of distribution (Vd)?
A
Apparent volume in which a drug is distributed; Vd = Dose IV / Initial PC.
18
Q
Significance of high Vd?
A
Drug mainly in tissues, not accessible to dialysis.
19
Q
Drugs with high Vd?
A
BAD DOC: Benzodiazepines, Amphetamines, Digoxin, Opioids, etc.
20
Q
What protein binds acidic drugs?
A
Albumin.
21
Q
What protein binds basic drugs?
A
Alpha-1-acid glycoprotein.
22
Q
Phase I reactions?
A
Drug inactivation via oxidation; CYP3A4 is most common enzyme.
23
Q
Phase II reactions?
A
Make drugs water-soluble; glucuronidation by GT is common.
24
Q
Drugs metabolized by plasma esterase?
A
Procaine, Esmolol, Succinylcholine, etc.
25
Main organ of drug excretion?
Kidney; drug must be ionized & water-soluble.
26
Ion trapping examples for toxicity management?
Alkalinize urine for acidic drugs (Aspirin), acidify for basic drugs (Amphetamines).
27
Zero order kinetics examples?
Phenytoin, Alcohol, Theophylline, Warfarin.
28
First order kinetics?
Constant proportion of drug eliminated per hour; most drugs follow this.
29
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30
What is drug affinity?
Tendency of a drug to bind to its receptor; high affinity means lower dose needed.
31
Define drug efficacy.
Maximum effect a drug can produce; more important than potency.
32
Define drug potency.
Dose required to produce an effect; high potency = lower dose.
33
Left shift in dose-response curve (DRC) indicates?
Increased potency.
34
Height of DRC indicates?
Efficacy of the drug.
35
Parallel dose-response curves suggest?
Drugs act on the same receptor.
36
What is ED50?
Dose at which 50% of the population shows the desired effect.
37
What is TD50?
Dose at which 50% of the population shows toxic effects.
38
What is LD50?
Dose at which 50% of animals die (lethality).
39
How is Therapeutic Index (TI) calculated in humans?
TI = TD50 / ED50.
40
How is TI calculated in animals?
TI = LD50 / ED50.
41
What is the significance of a low TI?
Small change in dose can cause toxicity (e.g., lithium).
42
What is the therapeutic window?
Range between minimum effective and minimum toxic concentration.
43
What is a full agonist?
Binds to receptor and produces maximum effect.
44
What is a partial agonist?
Binds to receptor and produces submaximal effect.
45
What is an antagonist?
Binds to receptor but has no effect (blocks agonist).
46
What is an inverse agonist?
Binds to receptor and produces opposite effect of agonist.
47
What is physical antagonism?
Antagonism due to physical binding (e.g., charcoal in alcohol toxicity).
48
What is chemical antagonism?
Antagonism via chemical reaction (e.g., heparin and protamine).
49
What is physiological antagonism?
Two drugs act on different receptors to produce opposite effects (e.g., histamine vs adrenaline).
50
What is competitive antagonism?
Reversible binding to same receptor; DRC shifts right, no change in efficacy.
51
What is non-competitive antagonism?
Irreversible or allosteric binding; efficacy decreases, DRC height decreases.
52
Examples of ligand-gated ion channels?
GABA-A, NMDA, AMPA, 5HT3, Nicotinic receptors.
53
Examples of enzyme-linked receptors?
Insulin, IGF-1, EGFR, VEGFR.
54
Examples of nuclear receptors?
Glucocorticoid, Estrogen, Thyroid, Vitamin D, PPAR.
55
What are GPCR examples for Gs?
β1 (Dobutamine), β2 (Salbutamol, Ritodrine).
56
What are GPCR examples for Gq?
α1, M1, M3 → activate phospholipase C → IP3 & Ca2+.
57
What are GPCR examples for Gi?
M2 (Heart) → inhibitory, open K+ channels.
58
Role of G12/13?
Activates Rho-kinase → smooth muscle contraction.
59
Phases of clinical trial: Phase I?
Toxicity, PK/PD studied in healthy volunteers.
60
Phases of clinical trial: Phase II?
Efficacy and dose response in patients.
61
Phases of clinical trial: Phase III?
Confirm efficacy/safety in large patient group; drug is marketed after.
62
Phases of clinical trial: Phase IV?
Post-marketing surveillance.
63
What is Phase 0?
Microdosing phase; not mandatory.
64
What is Phase V?
Pharmacoepidemiology studies.
65
Types of ADRs: Type A?
Augmented effects (dose dependent).
66
Types of ADRs: Type B?
Bizarre effects (immune mediated, not dose related).
67
Types of ADRs: Type C?
Chronic dose and duration dependent (e.g., steroids → HPA suppression).
68
Types of ADRs: Type D?
Delayed effects (e.g., teratogenicity).
69
Types of ADRs: Type E?
End-of-use or withdrawal symptoms.
70
What is pharmacovigilance?
Monitoring and reporting of ADRs.
71
What is VIGIBASE?
Largest pharmacovigilance database (Sweden).
72
What is Therapeutic Drug Monitoring (TDM)?
Monitoring plasma drug levels for drugs with narrow therapeutic index.
73
Drugs requiring TDM?
Digoxin, Lithium, Theophylline, Aminoglycosides, Cyclosporine.
74
Digoxin therapeutic range?
0.5–0.9 ng/mL.
75
Lithium therapeutic range?
0.6–1.0 mEq/L for prophylaxis, 1.0–1.5 for treatment.
76
Theophylline therapeutic range?
5–15 mg/L.
77
What is pharmacogenetics?
Study of genetic variations affecting drug response.
78
NAT2 slow acetylators linked to?
Drug-induced SLE (e.g., Hydralazine, Isoniazid).
79
Drugs causing hemolysis in G6PD deficiency?
Dapsone, Nitrofurantoin, Primaquine, etc.
80
CYP2C19 polymorphism affects?
Clopidogrel activation.
81
CYP2C9 polymorphism affects?
Warfarin metabolism.
82
CYP2D6 polymorphism affects?
Antidepressants and opioids metabolism.
83
Drugs metabolized by acetylation (Mnemonic: HIPS Dance)?
Hydralazine, Isoniazid, Procainamide, Sulfonamides, Dapsone.
84
Pregnancy drug category X?
Contraindicated, teratogenic (e.g., Thalidomide).
85
Pregnancy drug category D?
Risk present but may be used if benefit outweighs (e.g., Valproate).
86
Which category is safest in pregnancy?
Category A > B > C.
87
Which neurotransmitter does the parasympathetic nervous system use?
Acetylcholine (ACh)
88
Which neurotransmitter does the sympathetic nervous system primarily use?
Norepinephrine (NE)
89
Which organs use dopamine (D1) and acetylcholine as exceptions in the sympathetic system?
Renal blood vessels (D1), adrenals & sweat glands (ACh)
90
Which toxin blocks ACh release?
Botulinum toxin
91
Which drugs inhibit presynaptic Ca²⁺ channels and reduce ACh release?
Aminoglycosides
92
What is the DOC for tics in Tourette syndrome?
Tetrabenazine
93
What are the DOCs for tardive dyskinesia?
Deutetrabenazine, Valbenazine
94
Which drug is used for Alzheimer’s dementia to increase cognition?
Donepezil
95
What drug is used for narcoanalysis by reducing cognition?
Scopolamine (DOC: Thiopentone)
96
Which drug causes active miosis via parasympathomimetic action?
Pilocarpine (DOC for closed angle glaucoma)
97
Which drugs cause passive mydriasis via parasympatholytic action?
Tropicamide, Atropine, Homatropine, Cyclopentolate
98
Which drug causes active mydriasis via sympathomimetic action?
Phenylephrine
99
Which drugs cause passive miosis via sympatholytic action?
Phenoxybenzamine, Prazosin
100
What is the DOC for post-op urinary retention and bladder atony?
Bethanechol, Neostigmine
101
What is the DOC for overactive bladder (urge incontinence)?
Mirabegron (β3 agonist)
102
Which drugs are anticholinergics used for urge incontinence?
Fesoterodine, Darifenacin, Oxybutynin, Solifenacin, Tolterodine, Trospium
103
Which drug is preferred in stress incontinence?
Duloxetine (SNRI)
104
Which drug is used in the Tensilon test for diagnosing myasthenia gravis?
Edrophonium
105
What is the DOC for myasthenia gravis management?
Pyridostigmine
106
Why is atropine given before edrophonium/neostigmine?
To prevent muscarinic side effects
107
What is the treatment for organophosphorus poisoning?
Atropine + Pralidoxime
108
Which drugs are contraindicated in closed angle glaucoma?
Tropicamide, Atropine (cause mydriasis)
109
What is the DOC for bronchial asthma/COPD bronchodilation (anticholinergic)?
Tiotropium
110
Name β2 agonists used for bronchodilation.
Salbutamol, Terbutaline, Formeterol, Salmeterol, Olodaterol, Vilanterol
111
Which β2 agonists are fast-acting?
SABA: Salbutamol, Terbutaline; Formoterol
112
What are the cardiovascular effects of β1 stimulation?
↑HR, ↑AV conduction, ↑Contraction
113
What is the DOC for bradycardia or AV block?
Atropine (Max 3 mg)
114
What is the IM dose of epinephrine for anaphylaxis?
0.3–0.5 mg (1:1000 dilution)
115
What is Dale’s vasomotor reversal?
Epinephrine + α-blocker → ↓BP due to unopposed β2
116
What is re-reversal of Dale’s phenomenon?
Epinephrine + β-blocker → ↑↑BP due to unopposed α1
117
What is the DOC for cheese reaction or clonidine withdrawal hypertension?
Phentolamine
118
What is the DOC for anaphylactic shock?
Epinephrine
119
What is the DOC for hypertensive crisis in pheochromocytoma?
Phenoxybenzamine
120
What is the DOC for urinary retention and post-op ileus?
Bethanechol
121
What is the DOC for myasthenia gravis long-term management?
Pyridostigmine
122
What is the antidote for anticholinergic (atropine, datura) poisoning?
Physostigmine
123
What are signs of β-blocker toxicity?
Bronchospasm, Bradycardia, CNS effects
124
What is used to treat β-blocker overdose?
Glucagon
125
What are side effects of α-blockers?
Postural hypotension, Ejaculation abnormality, Floppy iris syndrome
126
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127
What is the DOC for supraventricular tachycardia (SVT/PSVT)?
Adenosine (6 mg IV rapid push for adults)
128
What are the ABCD drugs for SVT?
Adenosine, Beta blockers, CCB (Diltiazem/Verapamil), Digoxin
129
Which drug is DOC for digoxin/ischemia-induced VT/VF?
Lidocaine
130
What is the DOC for congenital/acquired long QT syndrome?
Magnesium sulfate
131
Drug of choice for WPW syndrome?
Procainamide (acute), Flecainide (chronic), TOC: radiofrequency ablation
132
Anti-arrhythmics causing QT prolongation and torsades?
Quinidine, Procainamide, Sotalol, Amiodarone, Ibutilide, Dofetilide
133
What is the DOC for atrial fibrillation rate control?
Beta blockers
134
What is the DOC for atrial fibrillation rhythm control?
Amiodarone
135
What are the DOCs for angina relief (acute)?
Sublingual nitroglycerin (NTG)
136
Which drugs reduce angina frequency (long-term)?
Beta blockers, CCBs, Ivabradine, Ranolazine, Nicorandil, Trimetazidine
137
What is the DOC for Prinzmetal angina?
CCBs
138
Side effect of long acting nitrates?
Postural hypotension
139
MOA of Ivabradine?
Inhibits funny current (If) in SA node → ↓HR without ↓contraction
140
MOA of Ranolazine?
Inhibits late inward Na+ current
141
Unique side effect of Ivabradine?
Luminous phenomena (colored halos), ↑Risk of A-fib
142
Unique benefits of Ranolazine?
↓Insulin resistance (↓HbA1c), ↓A-fib risk
143
What is the DOC in acute LV failure?
IV Dobutamine (maintains HR, no ↑O2 demand)
144
Name two PDE3 inhibitors used in acute HF.
Milrinone, Inamrinone
145
MOA of Nesiritide?
BNP analog → vasodilation, diuresis (via cGMP); metabolized by neprilysin
146
Chronic HF: First-line symptomatic drug?
Furosemide
147
Drugs that reduce mortality in CHF (Mnemonic: SHIVA Beta)?
Sacubitril, Spironolactone, SGLT2 inhibitors, Hydralazine, Ivabradine, Vericiguat, β-blockers
148
Drugs contraindicated with neprilysin inhibitors (sacubitril)?
ACE inhibitors (↑ risk of angioedema)
149
Preferred β-blockers in CHF (BCMN)?
Bisoprolol, Carvedilol, Metoprolol, Nebivolol
150
Which RAAS blocker is DOC for HTN in young (<55 yrs)?
ACEI/ARB
151
Which drug is DOC for HTN in elderly (≥55 yrs)?
CCB
152
Which drug is DOC in HTN with BPH or anxiety-related disorders?
Prazosin
153
Name IV drugs for hypertensive emergency (HELEN Dance)?
Hydralazine, Esmolol, Lasix, Enalapril, Labetalol, NTG, Nicardipine (DOC)
154
Oral DOC for hypertensive urgency?
Clonidine
155
What is the DOC for hypertensive crisis in pregnancy?
Labetalol
156
Best β-blocker for post-MI patients?
Metoprolol
157
Statins with high intensity doses?
Atorvastatin 40–80 mg, Rosuvastatin 20–40 mg
158
Which statin is safest in liver disease?
Pravastatin
159
Which lipid-lowering drug is DOC in pregnancy and children?
Bile acid binding resins (e.g., Colesevelam)
160
MOA of PCSK-9 inhibitors?
Prevent LDL receptor degradation → ↓LDL
161
Examples of PCSK-9 inhibitors?
Evolocumab, Alirocumab
162
Which RNA drug inhibits PCSK-9 synthesis?
Inclisiran
163
Which drugs block MTP and are used in familial hypercholesterolemia?
Lomitapide
164
Name a drug that ↓TG & platelet aggregation, ↓CV mortality.
Icosapent ethyl
165
Which hypolipidemic drug ↑HDL the most?
Niacin
166
Common side effect of niacin?
Flushing (prevent with aspirin), hepatotoxicity, insulin resistance
167
MOA of Ezetimibe?
Blocks NPC1L1 receptor → ↓cholesterol absorption
168
Anti-lipid drugs safe in renal impairment?
Atorvastatin, Rosuvastatin (at low doses), Colesevelam
169
Front
Back
170
What is the MOA of Carbonic Anhydrase Inhibitors?
Block carbonic anhydrase in proximal tubule (PCT).
171
Which drug is DOC for acute mountain sickness?
Acetazolamide
172
Which drug is used in familial hypokalemic periodic paralysis?
Acetazolamide or Dichlorphenamide
173
Side effects of carbonic anhydrase inhibitors?
↓K+, metabolic acidosis, renal stones, rash, BM suppression, ↑NH3
174
Why are CA inhibitors contraindicated in liver cirrhosis?
Risk of hepatic encephalopathy due to NH3 accumulation
175
MOA of loop diuretics?
Block Na⁺-K⁺-2Cl⁻ pump in thick ascending limb
176
Which loop diuretic is DOC for pulmonary edema?
Furosemide
177
Which loop diuretic is longest acting?
Torsemide
178
Which loop diuretic is most potent?
Bumetanide
179
Which loop diuretic is most ototoxic?
Ethacrynic acid
180
When are loop diuretics most useful?
When GFR < 40
181
Side effects of loop diuretics?
↓K+, metabolic alkalosis, ↑uric acid, ↑glucose, ↓Mg²⁺, ↓Ca²⁺
182
Loop diuretics contraindication?
With aminoglycosides due to ototoxicity
183
MOA of thiazide diuretics?
Block Na⁺-Cl⁻ cotransporter in distal convoluted tubule (DCT)
184
Uses of thiazides?
HTN with edema, nephrogenic DI, other edemas
185
Which thiazide is long acting and preferred in HTN?
Chlorthalidone
186
Which thiazide has hepatic excretion?
Indapamide
187
Which thiazide works even when GFR < 40?
Metolazone (as add-on)
188
Effect of thiazides on calcium?
↑Ca²⁺; used in HTN with osteoporosis or renal stones
189
Contraindications of thiazides?
HTN with DM or gout (↑uric acid & glucose)
190
Name aldosterone antagonists (K⁺-sparing diuretics)
Spironolactone, Eplerenone
191
Name ENaC blockers (K⁺-sparing diuretics)
Amiloride
192
Uses of spironolactone/eplerenone?
DOC in resistant HTN & cirrhotic edema (+ furosemide)
193
Uses of amiloride?
Lithium-induced DI, Liddle syndrome
194
Side effects of K⁺-sparing diuretics?
↑K⁺, metabolic acidosis, gynecomastia (spironolactone)
195
MOA of osmotic diuretics?
Cause solute-free water loss in PCT and loop of Henle
196
Uses of Mannitol (Mnemonic: ABCDE)?
Acute glaucoma, Braking of diuretics, Cerebral edema, Dialysis disequilibrium, Expected renal failure
197
Side effects of Mannitol?
↑/↓K⁺, ↑/↓Na⁺, pulmonary edema
198
Contraindication for Mannitol?
Existing renal failure
199
Name vasopressin antagonists
Conivaptan, Tolvaptan, Mozavaptan
200
Uses of vasopressin antagonists?
SIADH (3rd line)
201
Side effects of vasopressin antagonists?
Hypokalemia, hepatotoxicity (Tolvaptan)
202
Name vasopressin analogs
Vasopressin, Terlipressin, Desmopressin
203
Uses of vasopressin analogs?
Central DI, Nocturnal enuresis, vWD, Hemophilia A
204
Which vasopressin analog is DOC for acute variceal bleeding?
Terlipressin
205
Which vasopressin analog is preferred for vWD and Hemophilia A?
Desmopressin
206
Front
Back
207
DOC for Parkinson's disease in <65 years
D2 agonist (Pramipexole, Ropinirole, Rotigotine)
208
DOC for Parkinson’s in ≥65 years
Levodopa + Carbidopa
209
Drug for Parkinson’s with On-Off phenomena
Entacapone (COMT inhibitor)
210
DOC for Dyskinesia in Parkinson’s
Amantadine
211
Antipsychotic safe in Parkinson’s psychosis
Pimavanserin (5HT2A inverse agonist)
212
MAO-B inhibitor used in Parkinson’s
Selegiline
213
New Alzheimer’s drug targeting β-amyloid
Aducanumab, Lecanemab, Donanemab
214
First line drug for Alzheimer's
Donepezil (Cholinesterase inhibitor)
215
Add-on drug if no response to Donepezil
Memantine (NMDA antagonist)
216
DOC for ALS (Amyotrophic Lateral Sclerosis)
Riluzole
217
Anti-epileptic safe in pregnancy
Levetiracetam < Lamotrigine
218
Most teratogenic anti-epileptic
Valproate (→ neural tube defects)
219
DOC for GTCS and myoclonic seizures
Valproate
220
DOC for absence seizures
Ethosuximide
221
DOC for partial seizures
Carbamazepine
222
DOC for seizure in neonates
Phenobarbital
223
DOC for alcohol withdrawal seizures
Lorazepam
224
DOC for status epilepticus
Lorazepam
225
DOC for infantile spasm with tuberous sclerosis
Vigabatrin
226
Treatment for West syndrome (without TS)
ACTH
227
Anti-epileptic causing SJS with HLA B1502
Carbamazepine
228
Anti-epileptic causing weight loss
Topiramate
229
Anti-epileptic causing PCOS and hepatotoxicity
Valproate
230
DOC for trigeminal neuralgia
Carbamazepine
231
DOC for peripheral neuropathic pain
Pregabalin or Gabapentin
232
DOC for resistant schizophrenia
Clozapine
233
Anti-psychotic with no D2 action
Pimavanserin (acts on 5HT2)
234
Anti-psychotic causing least EPS
Clozapine
235
Antipsychotic with maximum hyperprolactinemia
Risperidone
236
Mnemonic for Clozapine side effects
SAMOSA: Sialorrhea, Agranulocytosis, Myocarditis, Obesity, Sedation, Angle glaucoma
237
Drugs with zero weight gain
ABCZ: Aripiprazole, Brexpiprazole, Cariprazine, Ziprasidone
238
DOC for acute mania
Aripiprazole + Lithium
239
DOC for bipolar mania prophylaxis
Lithium
240
DOC for rapid cycling BPD
Valproate
241
Least teratogenic drug in BPD
Lamotrigine
242
Drugs for depression with suicidal tendencies
Life can end: Lithium, Clozapine, ECT
243
Drugs for postpartum depression
Brexanolone (IV), Zuranolone (oral), Ketamine (nasal)
244
Antidepressant for premature ejaculation
SSRIs/SNRIs
245
Drug causing serotonin syndrome
MAO-I + SSRI/SNRI; Rx = Cyproheptadine + Lorazepam
246
Drug causing cheese reaction
MAO-I + Tyramine (Rx: Phentolamine)
247
SNRI causing max anxiety/seizures
Bupropion
248
Antidepressant causing priapism
Trazodone
249
DOC for ADHD
Methylphenidate
250
DOC for ADHD with Tourette's
Clonidine
251
DOC for ADHD with family h/o drug abuse
Atomoxetine/Reboxetine
252
DOC for Huntington's chorea
Tetrabenazine
253
DOC for Rett syndrome
Trofinetide
254
DOC for Friedrich’s ataxia
Omaveloxolone
255
DOC for opioid withdrawal
Methadone, Buprenorphine
256
DOC for relapse prevention in opioid use
Naltrexone
257
DOC for opioid-induced constipation
Methylnaltrexone
258
DOC for post-op ileus
Alvimopan
259
DOC for opioid overdose
Naloxone
260
DOC for labour analgesia
Morphine (C/I: Head trauma)
261
DOC for narcolepsy
Modafinil
262
DOC for insomnia
Zolpidem, Suvorexant
263
DOC for alcohol de-addiction
Naltrexone, Acamprosate, Disulfiram
264
DOC for smoking cessation
Varenicline, Bupropion, Nicotine patch
265
Anti-craving drugs for alcohol dependence
Topiramate, Baclofen, Ondansetron
266
Front
Back
267
DOC for Listeria meningitis
Ampicillin
268
DOC for Pseudomonas infections (penicillin)
Piperacillin
269
Penicillinase-resistant penicillins
Cloxacillin, Methicillin
270
DOC for MRSA
Vancomycin
271
DOC for VRSA
Daptomycin
272
DOC for surgical prophylaxis
Cefazolin (1st gen cephalosporin)
273
DOC for Typhoid (oral)
Cefixime
274
DOC for Typhoid (parenteral)
Ceftriaxone
275
DOC for Gonorrhea
Ceftriaxone
276
DOC for Pseudomonas (3rd gen cephalosporin)
Ceftazidime
277
DOC for Pseudomonas (non-3rd gen)
Cefoperazone
278
Which cephalosporins cover MRSA?
5th gen: Ceftobiprole, Ceftaroline
279
DOC for HSV/VZV
Oral Valacyclovir > Acyclovir
280
DOC for HSV encephalitis
IV Acyclovir
281
DOC for CMV retinitis
Valganciclovir > Ganciclovir
282
DOC for CMV pneumonia
IV Ganciclovir
283
DOC for recurrent laryngeal papillomatosis
Cidofovir (intralesional)
284
DOC for Bird flu or Influenza A/B
Oseltamivir (oral)
285
DOC for RSV
Ribavirin
286
DOC for RSV prophylaxis
Palivizumab or Nirsevimab
287
DOC for Hepatitis B (in hepatic decompensation)
Tenofovir
288
DOC for Hepatitis C
Direct-acting antivirals: Sofosbuvir, Velpatasvir
289
DOC for non-albicans candidiasis
Oteseconazole (recurrent vaginal)
290
DOC for Aspergillosis
Voriconazole
291
DOC for Onychomycosis
Terbinafine
292
DOC for T. capitis
Griseofulvin (oral with fatty food)
293
DOC for fungal corneal ulcer
Natamycin
294
DOC for Kala-azar
IV Amphotericin B with 5% dextrose
295
DOC for strongyloides
Ivermectin
296
DOC for neurocysticercosis
Prednisolone followed by Albendazole
297
DOC for schistosoma & fluke infections
Praziquantel
298
DOC for visceral leishmaniasis
Liposomal amphotericin B
299
DOC for West African trypanosomiasis
Oral Fexinidazole
300
DOC for Chagas disease
Benznidazole
301
DOC for cryptosporidiosis
Nitazoxanide
302
DOC for toxoplasmosis
Sulfadiazine + Pyrimethamine
303
DOC for giardiasis, amoebiasis, trichomoniasis
Metronidazole
304
DOC for uncomplicated malaria (non-pregnant)
Chloroquine x3d + Primaquine x14d or Tafenoquine
305
DOC for severe falciparum malaria
IV Artesunate
306
Malaria in 1st trimester pregnancy
Quinine + Clindamycin
307
Malaria in 2nd trimester pregnancy
ACT (Artemisinin-based combo therapy)
308
Front
Back
309
DOC for Type 2 DM with cardiovascular benefit
Empagliflozin (SGLT2-i) or GLP-1 agonists
310
DOC for Type 1 diabetes
Insulin
311
Insulin with fastest onset
Insulin Aspart > Lispro
312
Long-acting insulins
Glargine, Degludec, Detemir
313
Insulin preferred in pregnancy
Insulin Lispro, Regular, NPH
314
DOC for DKA and HHS
Regular insulin IV
315
Which oral drug improves insulin sensitivity?
Metformin
316
Metformin contraindications
Renal failure (eGFR <30), acidosis, alcohol use
317
Metformin side effects
Lactic acidosis, B12 deficiency, weight loss
318
DOC for obesity with T2DM
GLP-1 agonists (Semaglutide, Liraglutide)
319
GLP-1 agonist side effects
Nausea, vomiting, pancreatitis
320
DOC for diabetes with recurrent UTI risk
Avoid SGLT2 inhibitors
321
DOC for diabetes + ASCVD/HF/CKD
SGLT2 inhibitors (Empagliflozin, Dapagliflozin)
322
First-line drug for hypothyroidism
Levothyroxine
323
DOC for myxedema coma
IV Levothyroxine
324
DOC for hyperthyroidism in 1st trimester
Propylthiouracil
325
DOC for hyperthyroidism in 2nd/3rd trimester
Methimazole
326
DOC for thyroid storm
Propranolol + Propylthiouracil + Hydrocortisone + Lugol’s iodine
327
Side effects of thionamides
Agranulocytosis, hepatotoxicity, rash
328
Bone resorption inhibitors (anti-osteoclast)
Bisphosphonates, Denosumab, Estrogen, Calcitonin
329
DOC for osteoporosis with fracture
Teriparatide or Abaloparatide
330
DOC for postmenopausal osteoporosis with breast cancer risk
Raloxifene
331
Vitamin D analogs used in CKD
Calcitriol, Paricalcitol
332
DOC for adrenal crisis
IV Hydrocortisone + fluids
333
Long-acting steroid
Dexamethasone
334
DOC for congenital adrenal hyperplasia
Hydrocortisone + Fludrocortisone
335
Drugs causing adrenal suppression
Steroids, Ketoconazole, Etomidate
336
DOC for Cushing’s disease (medical management)
Metyrapone or Ketoconazole
337
Drugs for hyperaldosteronism
Spironolactone, Eplerenone
338
DOC for acromegaly
Octreotide
339
DOC for hyperprolactinemia
Cabergoline > Bromocriptine
340
Front
Back
341
DOC for acute bronchial asthma attack
Inhaled β2 agonist (Salbutamol)
342
DOC for persistent asthma (controller)
Inhaled corticosteroids (ICS)
343
DOC for exercise-induced asthma
Montelukast (taken before exercise)
344
DOC for asthma prophylaxis in children
Montelukast
345
Long-acting β2 agonists (LABA)
Salmeterol, Formoterol
346
Ultra-long acting β2 agonists (ULABA)
Indacaterol, Olodaterol, Vilanterol
347
DOC for COPD (long-term)
LAMA (Tiotropium, Aclidinium)
348
Drugs used in severe eosinophilic asthma
Mepolizumab, Benralizumab (anti-IL-5)
349
DOC for asthma + allergic rhinitis
Montelukast
350
Side effects of β2 agonists
Tachycardia, tremors, hypokalemia
351
ICS with least systemic absorption
Ciclesonide
352
ICS causing oral candidiasis
Beclomethasone, Budesonide (prevent with rinsing)
353
DOC for COPD with frequent exacerbations
Roflumilast (PDE4 inhibitor)
354
MOA of Theophylline
Non-selective PDE inhibitor → ↑cAMP
355
Drugs interacting with Theophylline
Ciprofloxacin, Erythromycin, Cimetidine ↑ levels
356
DOC for aspirin-induced asthma
Leukotriene receptor antagonists (Montelukast)
357
DOC for dry cough
Dextromethorphan
358
DOC for productive cough
Expectorants (Guaifenesin)
359
Drugs used in cystic fibrosis
Ivacaftor, Lumacaftor, Tezacaftor, Dornase alfa
360
DOC for idiopathic pulmonary fibrosis
Nintedanib, Pirfenidone
361
Antitussive acting centrally
Codeine, Dextromethorphan
362
Mucolytic agents
Acetylcysteine, Bromhexine, Ambroxol
363
Expectorant action
Increases respiratory secretions (e.g., Guaifenesin)
364
MOA of Montelukast
Blocks leukotriene D4 at CysLT1 receptor
365
Front
Back
366
DOC for acute gout attack
NSAIDs (Indomethacin preferred)
367
Second-line drugs for acute gout
Colchicine, Steroids
368
DOC for chronic gout (urate lowering)
Allopurinol or Febuxostat
369
DOC for tumor lysis syndrome
Rasburicase
370
Xanthine oxidase inhibitors
Allopurinol, Febuxostat
371
Uricosuric drugs
Probenecid, Lesinurad
372
MOA of Colchicine
Inhibits microtubule polymerization in neutrophils
373
Drugs causing gout
Thiazides, Loop diuretics, Pyrazinamide, Niacin
374
DOC for rheumatoid arthritis (RA)
Methotrexate
375
RA drug safe in pregnancy
Sulfasalazine
376
Biologic DMARDs in RA
Etanercept, Infliximab, Adalimumab, Tocilizumab
377
Anti-TNF drugs
Etanercept, Infliximab, Adalimumab
378
IL-6 receptor blocker used in RA
Tocilizumab
379
DOC for ankylosing spondylitis
NSAIDs (Indomethacin), then anti-TNF agents
380
MOA of aspirin
Irreversible COX-1 & COX-2 inhibitor
381
Side effects of aspirin
GI bleeding, tinnitus, Reye’s syndrome in children
382
DOC for PDA closure
Indomethacin or Ibuprofen
383
COX-2 selective NSAID
Celecoxib
384
Risk of COX-2 inhibitors
↑ CV risk (thrombosis)
385
DOC for dysmenorrhea
NSAIDs
386
MOA of misoprostol
PGE1 analog → ↑mucus, ↓acid, uterine contraction
387
DOC for medical abortion
Mifepristone + Misoprostol
388
DOC for postpartum hemorrhage
Carboprost (PGF2α analog)
389
5HT1 agonists used in migraine
Sumatriptan, Rizatriptan
390
5HT2 antagonists
Cyproheptadine, Methysergide
391
DOC for carcinoid syndrome diarrhea
Octreotide
392
DOC for serotonin syndrome
Cyproheptadine
393
Leukotriene receptor antagonists
Montelukast, Zafirlukast
394
5-Lipoxygenase inhibitor
Zileuton
395
Anti-histamines 1st generation
Chlorpheniramine, Diphenhydramine, Hydroxyzine
396
Anti-histamines 2nd generation
Loratadine, Fexofenadine, Cetirizine
397
Difference between 1st & 2nd gen antihistamines
1st gen = sedating, cross BBB; 2nd gen = non-sedating
398
Front
Back
399
DOC for H. pylori eradication
PPI + Clarithromycin + Amoxicillin/Metronidazole (Triple therapy)
400
Alternative H. pylori regimen
Bismuth + Tetracycline + Metronidazole + PPI (Quadruple therapy)
401
DOC for NSAID-induced ulcer
Misoprostol
402
Antacid safe in renal failure
Aluminum hydroxide
403
Side effect of magnesium hydroxide
Diarrhea
404
Side effect of aluminum hydroxide
Constipation
405
DOC for Zollinger-Ellison syndrome
PPIs (e.g., Omeprazole)
406
Side effects of long-term PPI use
Hypomagnesemia, fractures, ↑C. diff risk
407
MOA of sucralfate
Forms protective barrier over ulcers; requires acidic pH
408
Sucralfate interaction
Avoid with PPIs/H2 blockers (needs acid for activation)
409
DOC for motion sickness
Scopolamine (anticholinergic patch)
410
DOC for chemotherapy-induced vomiting
5HT3 antagonists (Ondansetron)
411
DOC for postoperative nausea/vomiting
Ondansetron
412
Antiemetic with prokinetic effect
Metoclopramide
413
MOA of metoclopramide
D2 antagonist; ↑GI motility
414
Side effects of metoclopramide
Extrapyramidal symptoms (EPS), hyperprolactinemia
415
MOA of domperidone
Peripheral D2 blocker; less CNS side effects
416
DOC for constipation in IBS
PEG or Lubiprostone
417
DOC for opioid-induced constipation
Methylnaltrexone
418
Laxatives that are bulk forming
Psyllium, Methylcellulose
419
Osmotic laxatives
Lactulose, PEG, Magnesium salts
420
Stimulant laxatives
Bisacodyl, Senna
421
Antidiarrheals used in IBS-D
Loperamide, Eluxadoline
422
DOC for secretory diarrhea (e.g., VIPoma, carcinoid)
Octreotide
423
Antibiotic for traveler's diarrhea
Azithromycin > Ciprofloxacin
424
DOC for hepatic encephalopathy
Lactulose (traps NH3 in gut)
425
DOC for esophageal variceal bleed
Octreotide (reduces portal pressure)
426
MOA of rifaximin in hepatic encephalopathy
↓Ammonia-producing gut flora
427
Front
Back
428
DOC for ischemic stroke prophylaxis
Low-dose Aspirin
429
DOC for anticoagulation in pregnancy
Low molecular weight heparin (Enoxaparin)
430
Antidote for heparin toxicity
Protamine sulfate
431
MOA of heparin
Activates antithrombin III → inhibits factors IIa (thrombin) and Xa
432
Monitoring parameter for unfractionated heparin
aPTT
433
Monitoring parameter for LMWH
Anti-Xa assay (if needed)
434
DOC for long-term oral anticoagulation
Warfarin
435
Monitoring parameter for warfarin
INR
436
Antidote for warfarin toxicity
Vitamin K (phytonadione), FFP in emergencies
437
MOA of warfarin
Inhibits vitamin K epoxide reductase → ↓factors II, VII, IX, X
438
Bridge therapy in anticoagulation
Start heparin along with warfarin until INR is therapeutic
439
Novel oral anticoagulants (NOACs) for AF
Dabigatran, Rivaroxaban, Apixaban
440
Antidote for dabigatran
Idarucizumab
441
Antidote for factor Xa inhibitors
Andexanet alfa
442
DOC for DVT prophylaxis post-hip/knee surgery
Rivaroxaban or LMWH
443
MOA of alteplase (tPA)
Converts plasminogen to plasmin → fibrinolysis
444
Time window for alteplase in stroke
Within 4.5 hours of onset
445
Antiplatelet drugs inhibiting COX
Aspirin
446
Antiplatelet drugs inhibiting ADP receptor
Clopidogrel, Prasugrel, Ticagrelor
447
Antiplatelet drug with reversible binding
Ticagrelor
448
GPIIb/IIIa inhibitors
Abciximab, Tirofiban, Eptifibatide
449
DOC for anemia in CKD
Erythropoietin analogs (Epoetin alfa, Darbepoetin)
450
Monitoring for erythropoietin therapy
Hb level (target <12 g/dL)
451
DOC for iron deficiency anemia
Oral ferrous sulfate
452
Parenteral iron preparations
Iron sucrose, Ferric carboxymaltose
453
Adverse effects of IV iron
Anaphylaxis (esp. with iron dextran)
454
DOC for megaloblastic anemia
Vitamin B12 and folic acid
455
Drugs causing folate deficiency
Phenytoin, Methotrexate, TMP-SMX
456
Drugs causing hemolysis in G6PD deficiency
Sulfa drugs, Dapsone, Nitrofurantoin, Primaquine
457
MOA of desmopressin in vWD
Releases vWF from endothelium
458
Front
Back
459
DOC for immunosuppression in renal transplant
Tacrolimus + Mycophenolate mofetil (MMF)
460
MOA of calcineurin inhibitors (CNI)
Inhibit IL-2 transcription by blocking calcineurin
461
Examples of calcineurin inhibitors
Cyclosporine, Tacrolimus
462
Side effects of cyclosporine
Nephrotoxicity, hirsutism, gum hypertrophy
463
Side effects of tacrolimus
Nephrotoxicity, neurotoxicity, diabetes
464
MOA of MMF (Mycophenolate mofetil)
Inhibits IMP dehydrogenase → ↓de novo purine synthesis
465
Side effects of MMF
Diarrhea, leukopenia, teratogenicity
466
MOA of azathioprine
Prodrug of 6-MP → inhibits DNA synthesis in rapidly dividing cells
467
Interaction of azathioprine
↑Toxicity with allopurinol (xanthine oxidase inhibitor)
468
MOA of sirolimus (rapamycin)
mTOR inhibitor → inhibits IL-2 response (not synthesis)
469
Unique use of sirolimus
Prevention of restenosis in coronary stents
470
MOA of thalidomide/lenalidomide
Immunomodulators; inhibit TNF-α, ↑IL-10
471
DOC for erythema nodosum leprosum
Thalidomide
472
Biologics used in RA unresponsive to MTX
Etanercept, Infliximab, Adalimumab
473
MOA of anti-TNF drugs
Bind and neutralize TNF-α
474
Screening before starting biologics
Test for latent TB (Mantoux/IGRA)
475
IL-6 receptor blocker used in RA
Tocilizumab
476
JAK inhibitor used in RA
Tofacitinib
477
DOC for acute graft-versus-host disease
High-dose corticosteroids
478
DOC for chronic GVHD
Steroids + calcineurin inhibitors
479
Uses of rituximab
CD20+ B-cell malignancies, autoimmune diseases (RA, SLE)
480
Adverse effects of rituximab
Infusion reaction, reactivation of Hep B
481
MOA of natalizumab
α4-integrin blocker (used in MS, Crohn’s)
482
Risk with natalizumab
PML (progressive multifocal leukoencephalopathy)
483
Front
Back
484
DOC for CML (Chronic Myeloid Leukemia)
Imatinib (BCR-ABL tyrosine kinase inhibitor)
485
DOC for GIST (Gastrointestinal Stromal Tumor)
Imatinib
486
DOC for HER2+ breast cancer
Trastuzumab
487
DOC for ER+ breast cancer (premenopausal)
Tamoxifen
488
DOC for ER+ breast cancer (postmenopausal)
Letrozole, Anastrozole (aromatase inhibitors)
489
DOC for prostate cancer
Leuprolide + Flutamide or Bicalutamide
490
DOC for testicular cancer
BEP regimen (Bleomycin, Etoposide, Cisplatin)
491
DOC for Hodgkin's lymphoma
ABVD regimen (Adriamycin, Bleomycin, Vinblastine, Dacarbazine)
492
DOC for non-Hodgkin lymphoma
CHOP regimen (Cyclophosphamide, Doxorubicin, Vincristine, Prednisone)
493
DOC for ALL (Acute Lymphoblastic Leukemia)
Vincristine + L-asparaginase + Steroids
494
MOA of methotrexate
Inhibits dihydrofolate reductase → ↓DNA synthesis
495
Rescue drug for methotrexate toxicity
Leucovorin (folinic acid)
496
Side effects of methotrexate
Hepatotoxicity, pulmonary fibrosis, myelosuppression
497
MOA of 5-FU
Pyrimidine analog; inhibits thymidylate synthase
498
Leucovorin with 5-FU
Enhances effect
499
MOA of cyclophosphamide
Alkylating agent; cross-links DNA
500
Adverse effect of cyclophosphamide
Hemorrhagic cystitis (prevent with Mesna)
501
MOA of cisplatin
Forms DNA crosslinks
502
Adverse effects of cisplatin
Nephrotoxicity, ototoxicity, peripheral neuropathy
503
Prevention of cisplatin nephrotoxicity
Hydration + Amifostine
504
MOA of bleomycin
Generates free radicals → DNA strand breaks
505
Major toxicity of bleomycin
Pulmonary fibrosis
506
MOA of doxorubicin
Topoisomerase II inhibitor, intercalates DNA, generates ROS
507
Major toxicity of doxorubicin
Cardiotoxicity (prevent with Dexrazoxane)
508
Microtubule inhibitors
Vincristine, Vinblastine, Paclitaxel, Docetaxel
509
Major toxicity of vincristine
Peripheral neuropathy
510
Major toxicity of vinblastine
Bone marrow suppression
511
MOA of etoposide
Topoisomerase II inhibitor
512
MOA of irinotecan
Topoisomerase I inhibitor
513
DOC for colorectal cancer
FOLFOX (5-FU + Leucovorin + Oxaliplatin)
514
Checkpoint inhibitors in cancer
Nivolumab, Pembrolizumab (PD-1 inhibitors)
515
Front
Back
516
DOC for vitamin B6 deficiency seizures
IV Pyridoxine
517
DOC for INH-induced neuropathy
Pyridoxine
518
Antidote for methanol/ethylene glycol poisoning
Fomepizole
519
Antidote for acetaminophen poisoning
N-acetylcysteine
520
Antidote for organophosphate poisoning
Atropine + Pralidoxime
521
Antidote for benzodiazepine overdose
Flumazenil
522
Antidote for opioid overdose
Naloxone
523
Antidote for iron poisoning
Deferoxamine
524
Antidote for cyanide poisoning
Hydroxycobalamin > Sodium thiosulfate + Amyl nitrite
525
Antidote for lead poisoning
EDTA or Dimercaprol (BAL); oral = DMSA
526
Antidote for arsenic/mercury poisoning
Dimercaprol (BAL)
527
Antidote for copper toxicity (Wilson’s disease)
Penicillamine > Trientine
528
DOC for Wilson’s disease
Zinc acetate (maintenance), Penicillamine (initial)
529
DOC for cyanide poisoning (burn patients)
Hydroxycobalamin
530
DOC for TCA overdose
Sodium bicarbonate
531
DOC for scabies and lice
Permethrin
532
DOC for vitamin K deficiency bleeding in newborns
Vitamin K1 (phytonadione) IM
533
First-generation H1 antihistamines
Diphenhydramine, Hydroxyzine, Promethazine
534
Second-generation H1 antihistamines
Loratadine, Fexofenadine, Cetirizine
535
Drugs causing SJS/TEN
Lamotrigine, Allopurinol, Sulfa drugs, Carbamazepine
536
DOC for drug-induced Parkinsonism
Trihexyphenidyl
537
DOC for insomnia
Zolpidem, Suvorexant
538
DOC for post-op nausea and vomiting
Ondansetron
539
Disinfectant for mucous membranes
Chlorhexidine
540
DOC for hyperkalemia with ECG changes
IV Calcium gluconate + Insulin + Dextrose
541
DOC for Torsades de Pointes
IV Magnesium sulfate
542
DOC for lithium-induced nephrogenic DI
Amiloride
543
Treatment for serotonin syndrome
Cyproheptadine + Benzodiazepines
544
Treatment for neuroleptic malignant syndrome
Dantrolene or Bromocriptine
FMGE
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