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KADI SARVA VISHWAVIDYALAYA - Advanced Pharmacology-II Exam Answers

SECTION-I (1 Mark Each)

1. One of the following drug is used in helminthiasis: Answer: c) Mebendazole Mebendazole is an antihelminthic drug used to treat intestinal worm infections (helminthiasis). Aripiprazole is an antipsychotic, Metronidazole is an antiprotozoal/antibacterial, and Itraconazole is an antifungal.
2. Deficiency of growth hormone leads to: Answer: b) Dwarfism Growth hormone (GH) deficiency in childhood results in dwarfism (short stature/growth retardation). Addison's disease is adrenal insufficiency, Cretinism is due to thyroid hormone deficiency in infancy, and Diabetes mellitus is due to insulin deficiency/resistance.
3. One of the following drug works as an anti-metabolite: Answer: b) Ketoconazole - Wait, re-reading the options:
  • a) Fluconazole
  • b) Ketoconazole
  • c) Amphotericin B
  • d) Griseofulvin
Answer: d) Griseofulvin Griseofulvin acts as an anti-metabolite - it is a structural analogue of guanine and interferes with nucleic acid synthesis in fungi. It disrupts the mitotic spindle by binding to fungal microtubules.
4. All of the following belong to Penicillinase-resistant penicillins EXCEPT:
  • a) Methicillin
  • b) Cloxacillin
  • c) Dicloxacillin
  • d) Carbenicillin
Answer: d) Carbenicillin Carbenicillin is an extended-spectrum (antipseudomonal) penicillin, NOT a penicillinase-resistant penicillin. Methicillin, Cloxacillin, and Dicloxacillin are all penicillinase-resistant penicillins.
5. State True or False: T3 is the drug of choice for hormone replacement therapy in hypothyroidism. Answer: FALSE T4 (Levothyroxine/thyroxine) is the drug of choice for hormone replacement therapy in hypothyroidism - not T3 (liothyronine). T4 has a longer half-life (~7 days), more stable plasma levels, and is peripherally converted to active T3 as needed.
6. One of the following is a somatostatin analogue used in treatment of variceal bleeding/esophageal varices:
  • a) Fenisteride
  • b) Tolbutamide
  • c) Octreotide
  • d) Amiloride
Answer: c) Octreotide Octreotide is a synthetic somatostatin analogue. It reduces portal blood pressure by causing splanchnic vasoconstriction and is used in acute variceal bleeding. Finasteride is a 5-alpha reductase inhibitor, Tolbutamide is a sulfonylurea, and Amiloride is a potassium-sparing diuretic.
7. State True or False: Insulin can be used in treatment of Type-2 diabetes mellitus also. Answer: TRUE Insulin can indeed be used in Type-2 diabetes mellitus - especially when oral hypoglycemics fail to achieve glycemic control, during acute illness, surgery, pregnancy (gestational DM), or when HbA1c is very high at diagnosis.
8. State True or False: Insulin Ispro (Insulin Lispro) belongs to rapid acting; recombinant PTH used in treatment of severe osteoporosis. Answer: TRUE (Both statements are true)
  • Insulin Lispro is a rapid-acting insulin analogue (onset 15 min, peak 30-90 min)
  • Recombinant PTH (Teriparatide) is used in severe osteoporosis as an anabolic agent
9. One of the following is a fourth generation cephalosporin:
  • a) Rapid acting
  • b) None of above
  • c) Cefoperazone
  • d) Cefepime (Cefpodoxime/Cefixime listed)
Answer: d) Cefepime Cefepime is a 4th generation cephalosporin with activity against both gram-positive and gram-negative organisms including Pseudomonas. Cefixime and Cefpodoxime are 3rd generation cephalosporins; Cefoperazone is also 3rd generation.

SECTION-II

10. Write in brief about signs and symptoms of diabetes mellitus. (10 marks)
Signs and Symptoms of Diabetes Mellitus:
Type-1 DM (Insulin-Dependent):
  • Abrupt onset, usually in young patients
  • Classic "3 Polys": Polyuria, Polydipsia, Polyphagia
  • Weight loss despite increased appetite
  • Fatigue and weakness
  • Ketoacidosis (DKA) - nausea, vomiting, abdominal pain, fruity breath, Kussmaul breathing
  • Blurred vision
Type-2 DM (Non-Insulin Dependent):
  • Gradual/insidious onset
  • May be asymptomatic for years
  • Polyuria, Polydipsia (less marked than Type-1)
  • Fatigue
  • Recurrent infections (skin, urinary tract, candidiasis)
  • Poor wound healing
  • Tingling/numbness in hands and feet (peripheral neuropathy)
  • Acanthosis nigricans (skin darkening in body folds)
Diagnostic Criteria:
  • Fasting blood glucose ≥ 126 mg/dL
  • Random blood glucose ≥ 200 mg/dL with symptoms
  • HbA1c ≥ 6.5%
  • 2-hr post-75g OGTT ≥ 200 mg/dL
Chronic Complications:
  • Macrovascular: CAD, stroke, peripheral artery disease
  • Microvascular: Retinopathy, nephropathy, neuropathy
  • Diabetic foot ulcers
OR (Alternative to Q10): Draw the diagram showing phase of insulin. Enlist signs and classify oral hypoglycemic drugs with brief mechanism of action. (20 marks)
Phases of Insulin Secretion:
  • Phase 1 (First-phase/acute): Rapid spike within 1-3 minutes of glucose stimulus - release of pre-formed insulin from secretory granules
  • Phase 2 (Second-phase/sustained): Prolonged plateau lasting as long as glucose stimulus persists - newly synthesized insulin
Oral Hypoglycemic Drug Classification:
ClassDrug ExamplesMechanism
SulfonylureasGlibenclamide, Glipizide, GlimepirideBlock ATP-sensitive K⁺ channels on beta cells → depolarization → insulin release
BiguanidesMetforminActivates AMPK → decreases hepatic gluconeogenesis, increases peripheral glucose uptake
Thiazolidinediones (Glitazones)Pioglitazone, RosiglitazoneActivate PPAR-γ receptors → increase insulin sensitivity in muscle and adipose
Alpha-glucosidase inhibitorsAcarbose, VogliboseInhibit intestinal alpha-glucosidase → delay carbohydrate digestion/absorption
DPP-4 Inhibitors (Gliptins)Sitagliptin, VildagliptinInhibit DPP-4 enzyme → increase GLP-1 and GIP levels → glucose-dependent insulin secretion
SGLT-2 InhibitorsDapagliflozin, EmpagliflozinBlock SGLT-2 in renal tubules → prevent glucose reabsorption → glycosuria
MeglitinidesRepaglinide, NateglinideSimilar to sulfonylureas but shorter-acting; stimulate insulin secretion
GLP-1 AgonistsExenatide, LiraglutideMimic GLP-1 → stimulate insulin, suppress glucagon, delay gastric emptying

Short Answer Questions (Section-II continued)

1. Write in brief about types of cancer cell and brief out - free radicals are generated in cell:
Cancer Cell Types:
  • Carcinoma (epithelial origin) - most common; e.g., adenocarcinoma, squamous cell carcinoma
  • Sarcoma (mesenchymal/connective tissue origin) - bone, muscle, cartilage
  • Lymphoma/Leukemia (hematopoietic origin)
  • Glioma (neural tissue)
Free Radical Generation in Cell: Free radicals (reactive oxygen species - ROS) are generated by:
  • Mitochondrial electron transport chain (superoxide O₂⁻)
  • NADPH oxidase activity
  • Xanthine oxidase
  • Cytochrome P450 reactions
  • Radiation and UV exposure
  • Inflammatory reactions (neutrophil respiratory burst)
Types: Superoxide (O₂⁻), Hydroxyl radical (•OH), Hydrogen peroxide (H₂O₂), Peroxyl radical (ROO•)
Damage caused: DNA mutation, lipid peroxidation, protein oxidation - contributing to carcinogenesis, aging, and cell death.
2. Enlist the characteristics of cancer cell. Classify anti-cancer drugs with suitable examples and normal cell cycle:
Characteristics of Cancer Cells:
  1. Uncontrolled, unlimited proliferation
  2. Loss of contact inhibition
  3. Anaplasia (dedifferentiation)
  4. Invasiveness and metastasis
  5. Angiogenesis (tumor vasculature formation)
  6. Resistance to apoptosis
  7. Telomerase activation (immortality)
  8. Aerobic glycolysis (Warburg effect)
Cell Cycle Phases: G0 → G1 → S (DNA synthesis) → G2 → M (mitosis)
Anti-cancer Drug Classification:
ClassPhaseExamples
Alkylating agentsNon-specificCyclophosphamide, Cisplatin, Busulfan
AntimetabolitesS-phaseMethotrexate, 5-Fluorouracil, Cytarabine
Vinca alkaloidsM-phaseVincristine, Vinblastine
TaxanesM-phasePaclitaxel, Docetaxel
Topoisomerase inhibitorsS/G2Doxorubicin, Etoposide, Irinotecan
Hormonal agentsVariableTamoxifen, Leuprolide, Flutamide
Targeted therapyVariableImatinib, Trastuzumab, Rituximab
3. Types of hypersensitivity reactions with suitable examples occurring due to free radicals / immunosuppressants. List out a few immunosuppressants:
Gell & Coombs Classification of Hypersensitivity:
TypeMechanismMediatorExamples
Type I (Immediate/Anaphylactic)IgE-mediated mast cell degranulationHistamine, leukotrienesAnaphylaxis, asthma, urticaria, drug allergy
Type II (Cytotoxic)IgG/IgM against cell-surface antigensComplement, ADCCHemolytic anemia, Goodpasture's, transfusion reactions
Type III (Immune complex)Antigen-antibody complex depositionComplementSerum sickness, SLE, post-streptococcal GN
Type IV (Delayed/Cell-mediated)T-lymphocyte mediatedCytokines (IL-2, IFN-γ)Tuberculin reaction, contact dermatitis, graft rejection
Common Immunosuppressants:
  1. Calcineurin inhibitors: Cyclosporine, Tacrolimus - inhibit IL-2 production
  2. Antimetabolites: Azathioprine, Mycophenolate mofetil - inhibit lymphocyte proliferation
  3. mTOR inhibitors: Sirolimus (Rapamycin), Everolimus
  4. Corticosteroids: Prednisolone, Dexamethasone - broad anti-inflammatory
  5. Biologicals: Basiliximab (anti-IL-2R), Infliximab (anti-TNF-α), Rituximab (anti-CD20)
  6. Alkylating agents: Cyclophosphamide - used in autoimmune diseases
Summary of MCQ Answers:
  1. c) Mebendazole
  2. b) Dwarfism
  3. d) Griseofulvin
  4. d) Carbenicillin
  5. False (T4/Levothyroxine is DOC, not T3)
  6. c) Octreotide
  7. True
  8. True (both parts)
  9. d) Cefepime
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