Erythromycin is given to treat intestinal hypomotility by binding to motilin receptors. It activates these receptors, which are G protein-coupled receptors involved in gastrointestinal motility. Erythromycin is the most commonly used macrolide antibiotic for this purpose due to its potent motilin receptor activating properties. It is used to treat conditions like diabetic gastroperesis and dyspepsia that involve reduced gastrointestinal motility.
2. 1) Erythromycin is given in intestinal hypomotility:
A Because it binds to motilin receptors
B Increases gastric acid secretion
C Improves digestion
D None
3. Ans. A Because it binds to motilin receptors
Macrolides a group of versatile antibiotics with motilin receptor activating
property shared by all the member of the group.
Erythromycin is however most potent and is hence most commonly used for
this purpose.
Erythromycin is used in diabetic gastroperesis and dyspepsia for its motilin
receptor activating activity.
Motilin receptor is a G protein coupled receptor.
4. -It inhibits Translocation of tRNA by acting on 50S Ribosome.
-Erythromycin
-Azithromycin
-Clarithromycin
-Telithromycin
5. -DOC in : 1) Diphtheria
2) Pertussis
3) Campylobacteria jejuni
4) Prophylaxis of Rheumatic fever in Penicillin allergic Patients
10. 2) All are true except: (DNB Dec 2011)
A Cefoperazone is antipseudomonas
B Cefoxitin has no anti anaerobic activity
C Ceftazidime is Group III cephalosporin
D Cephalosporin act by inhibiting cell wall synthesis
11. Ans. B cefoxitin has no anti-anerobic activity.
This is answer by exclusion.
Cephalosporin; similar to penicillins act by inhibiting the cell wall
synthesis.
Ceftazidime is III generation cephalosporin which has strong anti-
pseudomonal activity similar to cefoperazone.
One of the important feature of II generation compounds – some drugs
like cefoxitin are having activity against the anaerobes like B. fragilis. Thus
this statement is false.
12. Fazol (Cefazoline) is a lorry driver (Cefloridine) . He works very hard and
has become thin(Cephalothin) . He has Red watch (CephRadine) and
Lux soap ( CephaLexine) . He wears green Drawer (Cefodroxine)
-Main activity against Gram +ve organism and mild activity against Gram –ve
and anaerobes (except bacteroides)
13. 1) Cefixime
2) Ceftriaxone
3) Ceftazidime
4) Ceftazoxime
5) Ceftibuten
6) Cefoperazone
7) Cefpodoxime
Me
One
Ten
3rd generation
Except Cefuroxime which is a 2nd
generation
-More active against Gram -ve
-Ceftoperazone and ceftazidime are active against
Pseudomonas. Rest of 3rd gen. is not active.
21. 3. Which cephalosporins can be used in ↓GFR
A Cefuroxime
B Ceftriaxone
C Ceftazidime
D Cefoperazone
22. Ans. D Cefoperazone
Cefoperazone is almost totally eliminated by bile.
Therefore, it could be used in case of reduced GFR.
Ceftrixone too can be used, but has partial elimination by bile.
Hence, if we are to choose one option between these, we shall choose
cefoperazone
Cefoperazone is one of the drug of choice for pseudomonas infection.
23. 4. Patients is given tacrolimus. The antibiotic not given is all except
A Gentamycin
B Cisplatin
C Rifampicin
D Vancomycin
24. Ans. C Rifampicin
Rifampin is a potent enzyme inducer.
The drug has the chance of inducing the metabolism.
This might reduce the efficacy of tacrolimus.
Rest of the drugs have nephro or ototoxicity.
Though, these too have the potential to interact with tacrolimus but with
rifampin such interaction is more likely.
25. 5. A girl on sulphonamides developed abdominal pain and presented to
emergency with seizure. What is the probable cause?
A Acute intermittent porphyria
B Congenital erythropoietic porphyria
C Infectious mononucleosis
D Kawasaki’s disease
26. Ans. A Acute intermittent porphyria
a. Acute intermittent porphyria is an autosomal dominant disorder.
b. Acute intermittent porphyria, which causes abdominal pain and
neurologic symptoms, is the most common acute porphyria.
c. Sulmonamides and barbuitures are most common agents precipitating
acute intermittent porphyria.
d. Acute intermittent porphyria is due to a deficiency of the enzyme
porphobilinogen deaminase (also known as hydroxymethylbilane synthase)
that leads to accumulation of the heme precursors delta-aminolevulinic
acid and porphobilinogen initially in the liver.
f. Abdominal pain is the most common symptom, is usually steady and
poorly localized, but may be cramping.
27. Sulfadoxine -Longest acting
- Used along with Artesunate and
Pyrimethamine in Chloroquine
Resistant Malaria
Sulfadiazine -Used along with Pyrimethamine in
Toxoplasmosis
Sulfasalazine -Used in
1) Ulcerative colitis
2) Rheumatoid Arthritis
-Sulfadiazine
- Silver Sulfadiazine is used in
BURNS
28. B - Bone marrow suppression
I - Insoluble in Urine (Crystalluria)
K - Kernicterus in Newborn
A - Aplastic Anemia
S - Steven Johnson Sx
H - Hemolysis in G6PD deficient patient
30. -Sulfamethoxazole + Trimethoprim in ratio of 5;1 in tablet
-But in circulation ratio changes to 1:20
-DOC in : 1) Nocardiosis
2) Pneumocystitis
31. 6. CELL wall synthesis is inhibited by? (DNB Dec 2010)
A Erythromycin
B Lomefloxacin
C Cefipime
D Tetracycline
32. C) Cefipime
Cell wall
Synthesis
Inhibition
Protein synthesis
Inhibition
Cell metabolism
Inhibition
DNA Synthesis
Inhibition
Penicillin Aminoglycosides Sulfonamides Quinolones
Cephalosporins Macrolides Trimethoprim
Vancomycin Tetracyclines
Carbapenems Linezolid
Cycloserine Chloramphenicol
Fosfomycin
33. 7. Which of the following drug is not used for Methicillin Resistant Staph.
Aureus (MRSA).?
A Cefaclor
B Cotrimoxazole
C Ciprofloxacin
D Vancomycin
34. Ans. A Cefaclor
Drugs used for MRSA:
Vancomycin
Chloramphenicol
Linezolid
Minocycline
Doxycycline
Trimethoprim - sulfamethoxazole
Fluoroquinolones
36. -Oldest Penicillin
-It is lipid soluble drug and thus has RAPID oral absorption
-It is rapidly destructed by acid
-After parenteral administration, It is rapidly eliminated due to tubular
secretions by pumps. Hence it is very short acting drug.
-To increase its duration of action, one of following are added:
1) Probenicid : It inhibits tubular pumps
2) Procaine
3) Benzathine
Makes penicillin water soluble and thus slows its release from
site
37. Q. Longest Acting Penicillin
Ans. Penicillin G
-Duration of action of 28days
-Hence is a drug of choice for Prophylaxis Of Rheumatic fever given once in a
month.
38. PENICILLIN G is DOC for following conditions
B Bacillus Anthrax
L Leptospirosis
A Actinomyces
S Streptococcus
T Treponema pallidum(Syphilis)
My Meningococcus
Penicillin Pertenue(Yaws)
G Gas gangrene
Benzathine Penicillin is used for all stages of Syphilis except Neurosyphilis
Where Aqueous Penicillin is used.
44. MC S/E = Hypersensitivity
JARISCH HERSCHEIMER REACTION
-Acute febrile reaction to Treponemal antigens released due to destruction of
Bacteria By penicillin treatment.
-C/F: 1) Fever
2) Myalgia
3) Arthralgia
4) Worsening of cutaneous lesions
45. 8. Drug effective in pseudomonas infection is
A Piperacillin
B Amoxicillin
C Tetracycline
D Vancomycin
46. A Piperacillin
C - Carbepenams
Colistim
Ciprofloxacin
Cephalosporins ; 3rd gen.: Ceftazidime and Cefoperazone
4th generation
5th geneartion
A -Aminoglycosides
P -Penicillins : 1) Piperacillin
2) Azlocillin
3) Mazlocillin
4) Carbenicillin
5) Ticarcillin
47. 9. All of the following are TRUE about Penicillin G EXCEPT (AIIME Nov 2009)
A Can be given orally
B Main mechanism of action is cell wall synthesis inhibition
C Probenecid decreases its secretion
D Effective against Gram-positive bacteria
48. Ans. A Can be given orally
a. Antibacterial spectrum: PcG is a narrow spectrum antibiotic; activity is
limited primarily to Gram-positive bacteria and few others.
b. Penicillin G is acid labile—destroyed by gastric acid. So it is not given
orally
c. The pharmacokinetics of PnG is dominated by very rapid renal excretion;
about 10% by glomerular filtration and the rest by tubular secretion.
d. Tubular secretion of PnG can be blocked by probenecid; higher and longer
lasting plasma concentrations are achieved.
e. Penicillin act by inhibiting cell wall synthesis.
f. They are bactericidal drugs.
49. 10. Which of the following is nephrotoxic?
A Streptomycin
B Ciprofloxacin
C Piperacillin
D Cefotaxime
50. Ans. A Streptomycin
Common properties of aminoglycoside antibiotics:
a. All are used as sulfate salts, which are highly water soluble; solutions are
stable for months.
b. They ionize in solution; are not absorbed orally; distribute only
extracellularly; do not penetrate brain or CSF.
c. All are excreted unchanged in urine by glomerular filtration.
d. All are bactericidal and more active at alkaline pH. They act by interfering
with bacterial protein synthesis.
e. All are active primarily against aerobic Gram-negative bacilli and do not
inhibit anaerobes.
g. They have relatively narrow margin of safety.
h. All exhibit ototoxicity and nephrotoxicity.
51. -Active only against Gram –ve organisms
-They require ATP and Oxygen for its function. Hence not effective against
Anaerobes (Bacteroides)
-Water soluble drugs, Hence has poor oral absorption
-Inhibits 30S Ribosomes.
52.
53. DOC : Plague and Tularaemia
Used in Inhalational route for
Treatment of Pseudomonas associated
With Cystic Fibrosis
55. Auditory Toxicity Vestibulotoxic
K- Kanamycin Gentamycin
A- Amikacin Streptomycin
N - Neomycin
- In hindi ear is called as KAN
-Nephrotoxicity : Max. with Neomycin
-Neuromuscular toxicity : Max. with Neomycin
-Ototoxicity : Damage to Outer Hair Cell
-Accidental Intraocular administration of Gentamicin can cause Maculopathy.
56. 12. Which of the following antibiotics inhibit protein synthesis?
A Doxycycline
B Nitrofurantoin
C Cephalosporin
D Penicillin
57. Ans. A Doxycycline
Mechanism of action of various antibiotics
a. Inhibit cell wall synthesis: Penicillin’s, Cephalosporins, Cycloserine,
Vancomycin and Bacitracin.
b. Inhibit protein synthesis: Tetracyclines, Chloramphenicol,
Erythromycin, Clindamycin and Linezolid.
f. 5 Inhibit DNA gyrase: Fluoroquinolones, ciprofloxacin and others.
g. Interfere with DNA function: Rifampin metronidazole.
h. Interfere with intermediary metabolism: Sulfonamides, sulfones, PAS,
trimethoprim, pyrimethamine, ethambutol.
58. DRUGS FEATURES
Tetracyclines Resistance is being
developed
Doxycycline
Demeclocyclines -Maximum Photosensitivity
-Maximum Diabetes
Insipidus
Oxytetracyclines
Chlortetracyclines
Minocyclines Maximum vestibular toxicity
59. K - Kidney failure
A -Anti anabolic
P - Photosensitivity
I - Diabetes Insipidus
L - Liver failure
D -Pigmentation of Dentition and bone
E - Expired drugs can cause Fanconi Sx
V - Vestibulotoxicity
- C.I in pregnancy and childrens.
60. S - SIADH (Demeclocycline)
R - Rickketsia (DOC)
I - Inguinale Granuloma
L - LGV (DOC)
A - Atypical Pneumonia ( DOC : Macrolides)
N -None
K - Cholera (DOC)
A - Amoebiasis
- Also a DOC for Pleurodesis and Pericardiodesis
61. -Acts on 50S ribosome
-S/E :
1) Bone marrow suppression
2) Grey baby Syndrome
62.
63.
64. 13. TRUE about the Side-effects of Tetracycline include all of the following
EXCEPT
A Can cause Pseudotumor cerebri
B NOT teratogenic if used during pregnancy
C Discoloration of teeth may occur
D Superinfection can occur
65. Ans. B NOT teratogenic if used during pregnancy
Adverse effects of tetracycline
a. Irritative effects: Tetracyclines can cause epigastric pain, nausea, vomiting
and diarrhea by their irritant property.
b. Dose related toxicity
i. Liver damage: Fatty infiltration of liver and jaundice occurs occasionally.
ii. Kidney damage: A reversible Fanconi syndrome
iii. Phototoxicity
iv. Teeth and bones: Given during late pregnancy or childhood, tetracyclines
can cause temporary suppression of bone growth. The ultimate effect on
stature is mostly insignificant, but deformities
v. and reduction in height are a possibility with prolonged use.
vi. Anti anabolic effect
vii. Increased intracranial pressure
viii. Diabetes insipidus
ix. Vestibular toxicity
c. Hypersensitivity
d. Superinfection
66. 14. A patient on antimicrobial therapy develops the following signs and
symptoms that ultimately are found to be drug-induced ; cough , dyspnea,
and pulmonary infiltrates ; neutropenia and bleeding tendencies; and
paresthesias. Which of the following is the most likely cause of this patient’s
symptoms?
A Amoxicillin
B Azithromycin
C Ciprofloxacin
D Nitrofurantoin
67. Ans. D Nitrofurantoin
a. Although several of the antimicrobial agents listed here can cause one of
the adverse responses noted here, nitrofurantoin is the most likely cause.
b. GI side effects (anorexia, nausea, vomiting) are the most common side
effects caused by this drug, which is still widely used for managing acute
lower urinary tract infections (e.g., many strains of E. coli, staphylococci
streptococci, Neisseria, Bacteroides).
c. Acute pulmonary reactions to nitrofurantoin are an uncommon side effect
of therapy and can cause minor or life-threatening pulmonary dysfunction.
d. Symptoms include fever, chills, cough, pleuritic chest pain, dyspnea.
Rarely, pleural effusion and/or pulmonary hemorrhage may occur.
e. Diagnosis is made by clinical suspicion and exclusion of other causes of
respiratory compromise. Chronic toxicity ofd drug presents as pulmonary
infiltrates after an year or so of the drig treatment.
f. It should promptly be discontinued. If this is not sufficient, then the
condition should be treated by corticosterioids.
g. The drug can also cause acute or subacute pulmonary reaction such as
those described: e.g. various hematologic reactions (in particular,
leukopenia and thrombocytopenia) and peripheral sensory and motor
neuropathies.
69. -Orally not effective except in Pseudomembranous colitis
-I.V - Histamine = Red Man Sx
-S/E : Nephrotoxic
Ototoxic
-Not effective against Pseudomonas
-Uses : 1) DOC in MRSA
2) Pseudomembranous colitis
70. -MC cause = 3rd generation Cephalosporins > Clindamycin
-Max. risk with = Clindamycin
-MC bacteria cause = Clostridium difficile
-DOC for Pseudomembranous colitis : Metronidazole > Vancomycin
71. 15. A patient requires an antibiotic that is most effective against P. aeruginosa.
Which of the following is the quinolone of choice?
A Ciprofloxacin
B Enoxacin
C Lomefloxacin
D Norfloxacin
72. Ans. A Ciprofloxacin
Ciprofloxacin is highly effective against P. aeruginosa.
Others in the fluoroquinolone class have less activity toward P. aeruginosa,
although they are effective against many other common gram-negative
organisms.
It is a potent enzyme inhibitor and participates in several of the clinically
significant drug interactions.
73. -DNA Gyrase Inhibitor
-Bactericidal
-Effective orally
-Wide spectrum
-Effective against MRSA and Pseudomonas
-Excreted in Kidneys except Pefloxacin and Moxifloxacin .
Hence C.I in Renal failure
74. DRUGS FEATURES
Norfloxacin Used in UTI
Gatifloxacin Causes Dysglycemia
( Withdrwan from market)
Sparfloxacin Longest acting
Travofloxacin Hepatotoxic
Moxifloxacin -longest acting
-Safe in Renal failure
-Respiratory FQs
-Effective against Anaerobes
75. SIDE EFFECT FEATURE
Tendinitis Common in elderly
Nausea and Vomiting MC S/E
Pseudomembranous colitis
Cartilage defect Hence C.I in pregnancy and
Children
QT Prolongation Maximum with Sparfloxacin
Photosensitivity Except
P - Pefloxacin
M - Moxyfloxacin
T - Trovafloxacin
76. Oh - Ofloxacin
My - Moxifloxacin
God - Gatifloxacin
Love - Levofloxacin
77. QT3
Q - Quinidine
T - Thioridazine
T - TCAs
3 - Class 3 AntiArrhythmics ; Amiodarone/ Procainamide/Diisopyramide
78. 1) Polymyxin- B
2) Polymyxin – E (Colistin)
3) Daptomycin : DOC for VRSA
79. Minimum Inhibitory
Concentration
Lowest concentration of
drug which inhibits visible
growth after 24hrs of
Incubation.
Time dependent Killing
(TDK)
Effects persist only for the
time for which concentration
of drug is above MIC.
Hence has short Post
antibiotic effect
Beta lactams
Vancomycin
Concentration dependent
killing (CDK)
It depends only on
concentration but not on
MIC.
So effect is seen even after
drug concentration is below
MIC.
Hence it has prolonged post
antibiotic effect.
Fluoroquinolones
Aminoglycosides
Both CDK & TDK Beta lactams
FQs
Aminoglycosides
Macrolides
80. 17) Streptomycin and other aminoglycosides inhibit bacterial protein
synthesis by binding to which of the following?
A 30S ribosomal particles
B DNA
C mRNA
D RNA polymerase
81. Ans. A 30S ribosomal particles
a. The bactericidal activity of streptomycin and other aminoglycosides
involves a direct action on the 30S ribosomal subunit, the site at
which these agents both inhibit protein synthesis and diminish the
accuracy of translation of the genetic code.
b. Proteins containing improper sequences of amino acids (known as
nonsense proteins) are often nonfunctional. Streptomycin is used in
treatment rhinoscleroma, pelvic inflmmatory diseases, brucella and
resistant tuberlosis.
82. 19. Which of the following drugs is primarily used in pneumonia caused
by P. carcinii? (AIIMS May 2010)
A Carbenicillin
B Metronidazole
C Nifurtimox
D Pentamidine
83. Ans. D Pentamidine
Both trimethoprim-sulfamethoxazole and pentamidine are effective in
pneumonia caused by P carinii. This protozoal disease usually occurs in
immunodeficient patients, such as those with AIDS.
Nifurtimox is effective in trypanosomiasis and metronidazole in amebiasis
and leishmaniasis, as well as in anaerobic bacterial infections.
Penicillins are not considered drugs of choice for this particular disease
state.
84. 21. Compared with most other cephalosporins, the administration of
cefoperazone, or cefotetan is associated with a higher incidence of which of
the following? (AIPG 2009)
A Acute heart failure
B Acute renal failure
C Bleeding tendencies in patients taking warfarin
D Hypertension
85. Ans. C Bleeding tendencies in patients taking warfarin
a. Cefmetazole and cefotetan, both second-generation cephalosporins, and
cefoperazone (third generation) can interfere with hepatic vitamin K
metabolism, leading to what amounts to a deficiency ot vitamin K-dependent
clotting factor activity.
b. Because this is the general mechanism by which warfarin exerts its
anticoagulant effects, combined use of one of these cephalosporins can cause
further (and potentially dangerous) prolongations of the International
Normalized Ratio (or prothrombin time); the clinical consequence can be
spontaneous, prolonged, or excessive bleeding.
c. One should also be cautious when these cephalosporins are given to
patients taking aspirin or other antiplatelet drugs (e.g., clopidogrel) or
thrombolytics.
d. Although most cephalosporins are excreted unchanged by the kidneys,
renal failure (especially severe and acute) seldom occurs with these or other
cephalosporins.
86. 22. The Amikacin differs from gentamicin mainly in that it: (AIIME Nov 2012)
A Does not require monitoring of blood levels during therapy
B Exerts significant bactericidal effects against anaerobes too
C Has broadest spectrum against gram-negative bacilli
D Lacks ototoxic potential
87. Ans. C Has broadest spectrum against gram-negative bacilli
a. Amikacin stands out among all the aminoglycosides in two main ways: it
has the broadest spectrum against gram-negative bacilli, and it is least
susceptible to bacterial enzymes that inactivate aminoglycosides and lead
to resistance.
88. 23. Resistance to Methicillin in the microorganism given in picture is due to
A. Beta lactamase
B. Efflux
C. Altered Penicillin binding protein
D. Mec A gene
89. C) Altered Penicillin binding protein
-Grape like clusters in gram stain is due to Staphylococcus aureus,
in which resistance is seen due to Penicillinase production
-But in Penicillinase Resistant penicillin like Methicillin , Resistance
is due to Altered penicillin binding protein.
90. 24. DOC for the given condition is
A. Ceftriaxone
B. Piperacillin
C. Carbapenems
D. Ceftazidime