// ============================================================
// FILE: theory/pharmacology/complete_syllabus/complete_syllabus_paper1.js
// SUBJECT: Pharmacology | CHAPTER: complete_syllabus_Paper1 | DECK:Complete Syllabus Rapid Rivision
// ============================================================

var CARDS_Pathology_complete_syllabus_RapidRivision = [
  {
    "q": "[MAR 2022] 60 years old female, is a known HT and DM for the past 20 years has been admitted with the C/o progressive swelling in the face, abdomen and legs for the past 3 months. a) What is your diagnosis. b) Classify diuretics. c) Describe the mechanism of action, uses and adverse effects of high ceiling diuretics. d) Justify the rationality in combining high ceiling diuretics with ACE inhibitors.",
    "a": "Dx: nephrotic syndrome/diabetic nephropathy edema. Diuretics: high ceiling, thiazide, K-sparing, osmotic, CAI. High ceiling: inhibits Na-K-2Cl in TAL; uses-edema,HTN,pulmonary edema; AE-hypokalemia,ototoxicity,hyperuricemia. ACEI combo: blocks compensatory RAAS activation, synergistic."
  },
  {
    "q": "[MAR 2022] A 65 years old male on antipsychotic medications came with the C/o difficulty in walking, resting tremors and difficulty in swallowing. a) What is the diagnosis. b) How will you treat this patient. c) Describe the mechanism of action, importance of combination therapy and adverse effects of Levodopa.",
    "a": "Dx: drug-induced Parkinsonism. Tx: reduce/stop antipsychotic, anticholinergics (trihexyphenidyl). Levodopa: dopamine precursor via dopa decarboxylase; carbidopa combo prevents peripheral conversion, ↓AE, ↑CNS levels; AE-nausea,postural hypotension,dyskinesia,on-off."
  },
  {
    "q": "[MAR 2022] Mechanism of action and clinical uses of statins.",
    "a": "HMG-CoA reductase inhibitor, ↓cholesterol synthesis, ↑LDL receptor expression; uses-hyperlipidemia, CAD prevention."
  },
  {
    "q": "[MAR 2022] Pharmacovigilance.",
    "a": "Science of detecting/monitoring/preventing ADRs post-marketing; spontaneous reporting, signal detection."
  },
  {
    "q": "[MAR 2022] Therapeutic effects of atypical antipsychotics.",
    "a": "↓positive+negative symptoms, D2/5HT2A antagonism, fewer EPS than typicals."
  },
  {
    "q": "[MAR 2022] Brief phase II biotransformation reactions with suitable examples.",
    "a": "Conjugation: glucuronidation (morphine), sulfation, acetylation (INH), methylation, glutathione conjugation."
  },
  {
    "q": "[MAR 2022] Therapeutic uses of Adrenergic drugs.",
    "a": "Anaphylaxis, cardiac arrest, shock, nasal decongestion, asthma, local vasoconstriction with LA."
  },
  {
    "q": "[MAR 2022] Drugs used in prophylaxis of migraine.",
    "a": "Propranolol, flunarizine, amitriptyline, topiramate, valproate."
  },
  {
    "q": "[MAR 2022] Role of Leukotriene antagonists used in bronchial asthma.",
    "a": "Montelukast, zafirlukast block LTD4 receptors, ↓bronchoconstriction/inflammation, adjunct/prophylaxis."
  },
  {
    "q": "[MAR 2022] Brief the drugs used in hypertensive emergencies.",
    "a": "Sodium nitroprusside, labetalol, nicardipine, esmolol - rapid controlled BP reduction."
  },
  {
    "q": "[MAR 2022] Heparin versus warfarin.",
    "a": "Heparin-IV/SC, immediate, antithrombin-mediated, monitor aPTT, antidote protamine. Warfarin-oral, delayed, vit K antagonist, monitor INR, teratogenic."
  },
  {
    "q": "[MAR 2022] Complications of Spinal Anaesthesia.",
    "a": "Hypotension, post-dural puncture headache, urinary retention, total spinal/respiratory paralysis, infection."
  },
  {
    "q": "[AUG 2022] A 35-year-old woman was taking combined oral contraceptive pills. She was diagnosed as a case of Pulmonary tuberculosis and put on isoniazid, rifampicin, pyrazinamide and ethambutol combination therapy daily for 2 months followed by isoniazid and rifampicin thrice weekly for 4 months. In the 3rd month of treatment, she failed to have withdrawal bleeding during the gap period of contraceptive cycle. One week later her urinary pregnancy test was found to be positive. A. What is the reason for contraceptive failure? b. Explain Phase I biotransformation reaction with suitable examples. c. Name 4 enzyme inducers and explain the clinical relevance of Microsomal Enzyme Induction. d. Explain microsomal enzyme inhibition with suitable examples.",
    "a": "Reason: rifampicin induces CYP450, ↑OCP metabolism→failure. Phase I: oxidation/reduction/hydrolysis (e.g. phenytoin). Inducers: rifampicin,phenytoin,carbamazepine,phenobarbitone - cause drug failure/tolerance. Inhibition: cimetidine,ketoconazole,erythromycin - ↑toxicity of co-administered drugs."
  },
  {
    "q": "[AUG 2022] A 8-year-old boy was sent for neurologic evaluation because of episodes of apparent inattention. His mother gives a history of episodes of starring look which lasts for few seconds, and he immediately resumes his previous activity. He was diagnosed to have absence seizures. a. Describe the mechanism of action of the drug used in absence seizures? b. Mention the adverse effects, uses and drug interactions of the drug used in absence seizures. c. Treatment of status epilepticus.",
    "a": "Ethosuximide: blocks T-type Ca channels in thalamus; AE-GI upset,drowsiness; used only absence seizures. Status epilepticus: IV lorazepam/diazepam→phenytoin→phenobarbitone→anesthesia if refractory."
  },
  {
    "q": "[AUG 2022] Teratogenicity.",
    "a": "Drug-induced fetal malformation during critical period (organogenesis wk 3-8); e.g. thalidomide, valproate, isotretinoin."
  },
  {
    "q": "[AUG 2022] Drugs used in open angle Glaucoma.",
    "a": "Timolol, latanoprost, pilocarpine, acetazolamide, brimonidine."
  },
  {
    "q": "[AUG 2022] Fibrinolytic drugs.",
    "a": "Streptokinase, urokinase, alteplase - activate plasminogen to plasmin, dissolve clot."
  },
  {
    "q": "[AUG 2022] Mechanism of action and adverse effects of ACE inhibitors.",
    "a": "Inhibit ACE, ↓angiotensin II, ↓aldosterone; AE-dry cough,hyperkalemia,angioedema,first-dose hypotension."
  },
  {
    "q": "[AUG 2022] Preanesthetic medication.",
    "a": "Goals: anxiolysis, analgesia, antisialagogue, amnesia; drugs-midazolam,opioids,atropine/glycopyrrolate."
  },
  {
    "q": "[AUG 2022] Role of sympathomimetics used in Bronchial Asthma.",
    "a": "Salbutamol, terbutaline - β2 agonist bronchodilation via ↑cAMP."
  },
  {
    "q": "[AUG 2022] Antianxiety agents.",
    "a": "Benzodiazepines, buspirone - potentiate GABA-A/5HT1A partial agonism; uses-anxiety,short-term."
  },
  {
    "q": "[AUG 2022] Mechanism of action and adverse effects of Succinylcholine.",
    "a": "Depolarizing NMB, persistent depolarization; AE-hyperkalemia,malignant hyperthermia,apnea,bradycardia."
  },
  {
    "q": "[AUG 2022] Disease modifying anti-Rheumatic drugs (DMARDS).",
    "a": "Methotrexate, sulfasalazine, hydroxychloroquine, leflunomide - slow RA progression."
  },
  {
    "q": "[AUG 2022] Uses of Prostaglandins.",
    "a": "Labor induction, glaucoma, PDA closure, peptic ulcer protection, erectile dysfunction."
  },
  {
    "q": "[FEB 2023] A foot ball player sustained injury, developed swelling and pain in the right ankle, he could not walk he was applied with analgesic spray, he felt better. a) Brief the action of analgesic spray. b) Classify NSAIDS. c) Describe the mechanism of action, uses, adverse effects and contraindications of aspirin.",
    "a": "Spray: topical NSAID/counterirritant, local COX inhibition. NSAID classes: salicylates, propionic acid, acetic acid, oxicams, COX-2 selective. Aspirin: irreversible COX inhibition; uses-analgesic,antipyretic,antiplatelet; AE-GI bleed,Reye's; CI-peptic ulcer,children viral fever."
  },
  {
    "q": "[FEB 2023] While you had gone out for shopping in the mall you saw an elderly person shouting for help holding the chest. Being a medical student. a) What could be your diagnosis and how will you do first aid for this patient? b) Classify antianginal drugs. c) Describe the mechanism of action, uses and adverse effects of Nitrates.",
    "a": "Dx: MI; first aid-chew aspirin,rest,call emergency,sublingual GTN. Antianginals: nitrates,beta blockers,CCBs. Nitrates: NO-mediated venodilation↓preload; uses-angina; AE-headache,hypotension,tolerance."
  },
  {
    "q": "[FEB 2023] Define pharmacogenetics and brief with suitable examples.",
    "a": "Genetic variation altering drug response; e.g. G6PD deficiency-primaquine hemolysis, slow acetylators-INH."
  },
  {
    "q": "[FEB 2023] Management of Organophosphorus compound poisoning.",
    "a": "Decontamination, atropine titrated to dry secretions, pralidoxime, supportive/ventilatory care."
  },
  {
    "q": "[FEB 2023] Write the mechanism of action of Local anaesthetics. What is the Rationale of giving adrenaline with local anaesthetics?",
    "a": "LA: blocks voltage-gated Na channels, prevents depolarization. Adrenaline: vasoconstriction→↓systemic absorption, prolongs action, ↓bleeding."
  },
  {
    "q": "[FEB 2023] Treatment of status asthmaticus.",
    "a": "O2, nebulized salbutamol, IV corticosteroids, ipratropium, MgSO4 if severe."
  },
  {
    "q": "[FEB 2023] Mention the uses and contraindications of Morphine.",
    "a": "Uses-severe pain,MI,pulmonary edema; CI-head injury,respiratory depression,asthma."
  },
  {
    "q": "[FEB 2023] Therapeutic uses of fibrinolytics and contraindications to their use.",
    "a": "Uses-acute MI,stroke,PE; CI-active bleeding,recent surgery,hemorrhagic stroke history."
  },
  {
    "q": "[FEB 2023] Advantages and contra indications for parenteral iron therapy.",
    "a": "Advantage-bypasses GI intolerance/malabsorption; CI-active infection,liver disease,first trimester pregnancy."
  },
  {
    "q": "[FEB 2023] Treatment of acute gout.",
    "a": "NSAIDs, colchicine, corticosteroids - avoid starting allopurinol during acute attack."
  },
  {
    "q": "[FEB 2023] Clinical importance of microsomal enzyme induction.",
    "a": "Causes drug interactions, therapeutic failure, tolerance, altered dosing needs."
  },
  {
    "q": "[FEB 2023] Mechanism of action and adverse effects of high ceiling diuretics.",
    "a": "Inhibit Na-K-2Cl cotransporter in TAL of loop of Henle; AE-hypokalemia,ototoxicity,hyperuricemia,hypovolemia."
  },
  {
    "q": "[JUL 2023] A 25 year old lady is brought with complains of recurrent episodes of fits lasting for 2-3 minutes. She experiences aura before each episode. Description of fit by the husband corresponds to generalized tonic clonic seizure. a) Enumerate drugs used in Epilepsy. b) Explain the mechanism of action, therapeutic uses, adverse effects and Drug interactions of Phenytoin. c) Write briefly the management of febrile convulsions.",
    "a": "AEDs: phenytoin,carbamazepine,valproate,phenobarbitone,levetiracetam. Phenytoin: Na channel blockade; uses-GTCS,status epilepticus; AE-gingival hyperplasia,ataxia,hirsutism; enzyme inducer interactions. Febrile convulsion: antipyretics,rectal/IV diazepam if prolonged."
  },
  {
    "q": "[JUL 2023] A 60 year old male came with severe chest pain, sweating and his ECG showed features of myocardial infarction and investigations showed raised LDL. a) Discuss the drug therapy in myocardial infarction. b) Classify Hypolipidaemic agents. c) Discuss in detail the mechanism of action, uses and adverse effects of Statins.",
    "a": "MI therapy: aspirin,clopidogrel,thrombolytics/PCI,beta blockers,statins,ACEI. Hypolipidemics: statins,fibrates,bile acid resins,niacin,ezetimibe. Statins: HMG-CoA reductase inhibition; uses-hyperlipidemia; AE-myopathy,hepatotoxicity."
  },
  {
    "q": "[JUL 2023] Explain drug addiction with examples.",
    "a": "Compulsive drug use, tolerance, dependence, withdrawal; e.g. opioids, alcohol, benzodiazepines."
  },
  {
    "q": "[JUL 2023] A 70 years old male presented with complaints of weak stream of urine, sense of incomplete voiding and increased urinary frequency. On physical examination and ultrasound, he was diagnosed as having benign prostatic hypertrophy. a) What are the preferred drugs for this patient? b) What is the rational in using them?",
    "a": "Drugs: alpha-1 blockers (tamsulosin), 5-alpha reductase inhibitors (finasteride). Rationale: relax prostatic smooth muscle/shrink gland size."
  },
  {
    "q": "[JUL 2023] Classify drugs used in Gout. Explain the mechanism of action and adverse effects of Allopurinol.",
    "a": "Gout drugs: uricosurics(probenecid), xanthine oxidase inhibitors(allopurinol), colchicine, NSAIDs. Allopurinol: inhibits xanthine oxidase↓uric acid; AE-rash,hypersensitivity syndrome."
  },
  {
    "q": "[JUL 2023] Discuss First pass metabolism and its clinical significance with examples.",
    "a": "Hepatic/gut metabolism before systemic circulation↓bioavailability; e.g. propranolol, GTN, lidocaine - need alternate routes."
  },
  {
    "q": "[JUL 2023] Write the mechanism of action, uses and adverse effects of Baclofen.",
    "a": "GABA-B receptor agonist at spinal cord↓spasticity; uses-spasticity; AE-sedation,weakness,withdrawal seizures."
  },
  {
    "q": "[JUL 2023] Discuss the advantages of Fentanyl over Morphine and mention its uses.",
    "a": "More potent, faster onset/offset, less histamine release/hypotension; uses-anesthesia,severe pain."
  },
  {
    "q": "[JUL 2023] List out the antiplatelet agents and elaborate on their uses with rationale.",
    "a": "Aspirin,clopidogrel,prasugrel,ticagrelor,GPIIb/IIIa inhibitors; uses-ACS,stroke prevention,PCI stenting."
  },
  {
    "q": "[JUL 2023] Management of Hypertension in pregnancy.",
    "a": "Methyldopa, labetalol, nifedipine; avoid ACEI/ARB (teratogenic); MgSO4 for eclampsia."
  },
  {
    "q": "[JUL 2023] Explain the mechanism of action, adverse effects and role of Methylxanthines in Bronchial asthma.",
    "a": "Theophylline: phosphodiesterase inhibition↑cAMP, adenosine antagonism; AE-arrhythmia,seizures,narrow therapeutic index."
  },
  {
    "q": "[JUL 2023] Differentiate the mechanism of action of Spironolactone and Amiloride and what are their therapeutic uses.",
    "a": "Spironolactone: aldosterone receptor antagonist. Amiloride: ENaC channel blocker. Both K-sparing; uses-edema,HTN,hyperaldosteronism."
  },
  {
    "q": "[FEB 2024] A large scale Multi centered randomized double blind trials in 3000 patients was carried out to further establish the safety and efficacy of Drug X. a) What is the phase of this clinical trial? b) What is double blind trial? c) Write briefly about different phases of clinical trials. d) What is a pre clinical trial?",
    "a": "Phase III trial. Double blind: neither patient nor investigator knows treatment allocation. Phases I-IV: I-safety(healthy), II-efficacy/dose, III-large scale confirmatory, IV-post marketing. Preclinical: animal/in-vitro testing before human trials."
  },
  {
    "q": "[FEB 2024] A 70 year old woman came to OPD with complaints of pain in her right thigh muscle. Duplex Ultrasonography indicates the presence of deep vein thrombosis in the affected limb. The decision was made to treat this woman with Enoxaparin. a) Explain the mechanism and uses of Enoxaparin. b) Reason for preferring Enoxaparin over Heparin. c) Write in detail about Mechanism of action, uses and adverse effects of Heparin.",
    "a": "Enoxaparin(LMWH): factor Xa inhibition via antithrombin; uses-DVT/PE prophylaxis&Tx. Preferred: better bioavailability,longer half-life,no monitoring,less HIT/osteoporosis. Heparin: activates antithrombin III→inhibits IIa/Xa; AE-bleeding,HIT,osteoporosis."
  },
  {
    "q": "[FEB 2024] Define Bioavailability and write briefly on factors affecting oral bioavailability.",
    "a": "Fraction of drug reaching systemic circulation unchanged; factors-first pass metabolism,formulation,GI motility,food interaction."
  },
  {
    "q": "[FEB 2024] What determines decision making capacity and competency?",
    "a": "Understanding info, appreciating consequences, reasoning, communicating a choice consistently."
  },
  {
    "q": "[FEB 2024] Migraine prophylaxis.",
    "a": "Propranolol, flunarizine, amitriptyline, topiramate, valproate."
  },
  {
    "q": "[FEB 2024] Syndopa: a) What is the above FDC? b) Benefits of this Combination. c) ON - OFF effect of Levodopa.",
    "a": "FDC: levodopa+carbidopa. Benefits: ↓peripheral decarboxylation,↓dose needed,↓peripheral AE(nausea,hypotension). ON-OFF: fluctuating symptom control with chronic therapy."
  },
  {
    "q": "[FEB 2024] Explain: Anxiolytics before surgery.",
    "a": "Benzodiazepines (midazolam) reduce preop anxiety, provide sedation/amnesia."
  },
  {
    "q": "[FEB 2024] Advantages of Inodilators.",
    "a": "Dobutamine/milrinone: combined inotropic+vasodilator action, useful in heart failure/cardiogenic shock."
  },
  {
    "q": "[FEB 2024] Treatment of Alcohol withdrawal syndrome.",
    "a": "Benzodiazepines (chlordiazepoxide/diazepam), thiamine supplementation, supportive care."
  },
  {
    "q": "[FEB 2024] Uses and Contra indications of Opioids.",
    "a": "Uses-severe pain,MI,cough(codeine); CI-respiratory depression,head injury,paralytic ileus."
  },
  {
    "q": "[FEB 2024] Anti anxiety drugs.",
    "a": "Benzodiazepines, buspirone, SSRIs - GABA potentiation/5HT1A partial agonism."
  },
  {
    "q": "[FEB 2024] Role of Prostaglandins in therapeutics of Glaucoma.",
    "a": "Latanoprost/PGF2α analogues ↑uveoscleral outflow, ↓intraocular pressure, once daily."
  },
  {
    "q": "[MAY 2024] A 40 Yr old female presents with symptoms of tiredness, sadness, loss of interest, low energy, guilt, change in appetite, suicidal thoughts. a) What could be your probable diagnosis? b) Classify Antidepressant drugs. c) Discuss in detail about the mechanism of action, pharmacological actions, adverse effects and uses of Tricyclic antidepressants.",
    "a": "Dx: major depressive disorder. Classes: TCAs,SSRIs,SNRIs,MAOIs,atypicals. TCA: block NE/serotonin reuptake; AE-anticholinergic,cardiotoxicity,sedation; uses-depression,chronic pain,enuresis."
  },
  {
    "q": "[MAY 2024] 25 years old male with past history of asthma and complaints of coughing, shortness of breath even at night time, chest tightness, wheezing, suggestive of moderate persistent asthma. a) Enumerate the drugs used for bronchial asthma. b) Describe the mechanism of action, uses and adverse effects of inhaled bronchodilators in therapy. c) Write a note on Mast cell Stabilizers.",
    "a": "Asthma drugs: SABA/LABA,anticholinergics,ICS,LTRA,methylxanthines,mast cell stabilizers. Bronchodilators: β2 agonist/anticholinergic MOA; AE-tremor,tachycardia,dry mouth. Mast cell stabilizers(cromolyn): prevent mediator release, prophylaxis only."
  },
  {
    "q": "[MAY 2024] Name some second generation Antihistamines and its advantages.",
    "a": "Cetirizine, loratadine, fexofenadine - less sedation, no anticholinergic effect, longer action."
  },
  {
    "q": "[MAY 2024] Importance of carvedilol as therapeutic agent.",
    "a": "Non-selective beta+alpha1 blocker; use in heart failure, HTN - improves survival."
  },
  {
    "q": "[MAY 2024] Therapeutic index and its clinical significance.",
    "a": "TD50/ED50 ratio; measures drug safety margin, guides dosing caution for narrow TI drugs."
  },
  {
    "q": "[MAY 2024] Fixed dose combination of drugs.",
    "a": "Two+ drugs combined in fixed ratio; improves compliance, may complicate dose titration."
  },
  {
    "q": "[MAY 2024] Explain the principles of Autonomy and beneficence.",
    "a": "Autonomy: respect patient's right to self-decide. Beneficence: act in patient's best interest."
  },
  {
    "q": "[MAY 2024] Write briefly about Tramadol.",
    "a": "Weak opioid + monoamine reuptake inhibitor; moderate pain; AE-seizures,serotonin syndrome."
  },
  {
    "q": "[MAY 2024] Intravenous regional anaesthesia.",
    "a": "Bier's block - IV local anesthetic with limb tourniquet, for short limb surgeries."
  },
  {
    "q": "[MAY 2024] Mechanism of action and adverse effects of directly acting muscle relaxants.",
    "a": "Dantrolene: blocks Ca release from sarcoplasmic reticulum; AE-hepatotoxicity, weakness."
  },
  {
    "q": "[MAY 2024] Explain the pharmacological actions and adverse effects of Nifedipine.",
    "a": "CCB: vasodilation,↓BP,↓afterload; AE-flushing,ankle edema,reflex tachycardia,gingival hyperplasia."
  },
  {
    "q": "[MAY 2024] Therapeutic uses of digoxin and its adverse effects.",
    "a": "Uses-heart failure,AF/flutter rate control; AE-arrhythmia,visual disturbance(xanthopsia),GI symptoms,digitalis toxicity."
  },
  {
    "q": "[DEC 2024] A 30-year-old woman, who has recently joined work as a shift worker in a hospital comes with C/O difficulty in falling asleep and difficulty in maintaining the sleep. Due to disturbed sleep, she feels tired and lethargic the next day. She has no features suggestive of anxiety or depression. A diagnosis of Transient Insomnia is made. a) Classify the drugs used as Sedative hypnotics. b) Describe the mechanism of action of Benzodiazepines with a suitable diagram. c) Enumerate the adverse effects and uses of Benzodiazepines.",
    "a": "Classes: benzodiazepines,Z-drugs(zolpidem),barbiturates,melatonin agonists. BZD MOA: bind GABA-A receptor, ↑frequency of Cl channel opening, potentiate GABA. AE-sedation,dependence,amnesia; uses-insomnia,anxiety,seizures,muscle spasm."
  },
  {
    "q": "[DEC 2024] A farmer was brought to the Emergency with H/O spraying Malathion in his farm 2 hours back when he became unconscious. O/E, he was salivating and sweating profusely, tremors and muscle twitching present. Pulse- 96/min, BP-80/60 mmHg. Respiratory system- Bilateral Wheezes, CNS- Muscle weakness present. A diagnosis of Organophosphorus Compound Poisoning was made. a) Classify the Anticholinesterases. b) Describe the mechanism and clinical features of Anticholinesterase poisoning. c) Describe the management of this patient.",
    "a": "Classify: reversible(physostigmine,neostigmine) vs irreversible(OP compounds). Mechanism: AChE inhibition→ACh accumulation; features-muscarinic(SLUDGE),nicotinic(fasciculation,weakness),CNS(confusion,seizure). Management: decontamination,atropine,pralidoxime,ventilatory support."
  },
  {
    "q": "[DEC 2024] Management of Status epilepticus.",
    "a": "IV lorazepam/diazepam→IV phenytoin→phenobarbitone→general anesthesia if refractory."
  },
  {
    "q": "[DEC 2024] First order kinetics vs. zero order kinetics.",
    "a": "First order: constant fraction eliminated/time, most drugs. Zero order: constant amount eliminated/time, e.g. ethanol, high-dose phenytoin."
  },
  {
    "q": "[DEC 2024] Treatment of Smoking cessation.",
    "a": "Nicotine replacement therapy, bupropion, varenicline, counseling."
  },
  {
    "q": "[DEC 2024] Acute Paracetamol poisoning.",
    "a": "NAPQI accumulation→hepatotoxicity; treatment-N-acetylcysteine, activated charcoal if early."
  },
  {
    "q": "[DEC 2024] Pillars of Bioethics.",
    "a": "Autonomy, beneficence, non-maleficence, justice."
  },
  {
    "q": "[DEC 2024] Succinyl choline.",
    "a": "Depolarizing muscle relaxant; AE-hyperkalemia,malignant hyperthermia,apnea (in pseudocholinesterase deficiency)."
  },
  {
    "q": "[DEC 2024] Dabigatran.",
    "a": "Direct thrombin(IIa) inhibitor, oral anticoagulant, no routine monitoring, antidote idarucizumab."
  },
  {
    "q": "[DEC 2024] Potassium channel opener and its use in Angina.",
    "a": "Nicorandil: dual K-channel opener + NO donor, coronary vasodilation, angina prophylaxis."
  },
  {
    "q": "[DEC 2024] Spironolactone.",
    "a": "Aldosterone receptor antagonist, K-sparing diuretic; AE-gynecomastia,hyperkalemia."
  },
  {
    "q": "[DEC 2024] Naloxone.",
    "a": "Competitive opioid receptor antagonist, reverses opioid overdose/respiratory depression, short acting."
  },
  {
    "q": "[MAR 2025] 55-year-old male presented with the complaints of tightness and discomfort over middle part of chest, more so after exertion which gets relieved after 5-10 minutes of rest. His BP was 124/82mmHg, pulse 90/min. Stress test was positive, a diagnosis of classical angina was made and he was started on drugs. a) Enumerate the drugs used in angina. b) Discuss the mechanism of action, uses and adverse effects of Nitrates. c) Explain about Nitrate Tolerance and Dependence.",
    "a": "Angina drugs: nitrates,beta blockers,CCBs,nicorandil,ranolazine. Nitrates: NO-mediated venodilation↓preload; AE-headache,hypotension,tachycardia. Tolerance: sulfhydryl group depletion with continuous use, needs nitrate-free interval."
  },
  {
    "q": "[MAR 2025] A 45-year-old farmer brought with complaints of altered sensorium, breathlessness, Profuse sweating. Attender gives history of spraying of pesticides by him. a) What is the diagnosis? b) What other signs and symptoms you will look for? c) Explain in detail the specific management in this case. d) Add a note on ageing of enzyme.",
    "a": "Dx: OP poisoning. Look for-miosis,salivation,fasciculations,bradycardia,bronchorrhea. Management: atropine(titrate to dry secretions),pralidoxime,decontamination,supportive. Ageing: irreversible AChE-OP bond forms over time, pralidoxime ineffective after ageing."
  },
  {
    "q": "[MAR 2025] Explain the orders of kinetics with example.",
    "a": "Zero order: constant amount/time (ethanol,phenytoin high dose). First order: constant fraction/time (most drugs)."
  },
  {
    "q": "[MAR 2025] Write the mechanism of action, uses and adverse effect of Amiodarone.",
    "a": "Class III antiarrhythmic, K channel blocker (also Na/Ca/beta block); AE-thyroid dysfunction,pulmonary fibrosis,corneal deposits,hepatotoxicity."
  },
  {
    "q": "[MAR 2025] Give the rationale for combining Adrenaline with Lignocaine and write two contraindications for the use of adrenaline.",
    "a": "Rationale: vasoconstriction→prolongs action,↓bleeding,↓systemic toxicity. Contraindications: digital/end-artery blocks, uncontrolled HTN/thyrotoxicosis."
  },
  {
    "q": "[MAR 2025] Enumerate second generation Antihistamines. What are its advantages over First generation and write two therapeutic uses?",
    "a": "Cetirizine, loratadine, fexofenadine; advantage-non-sedating,no anticholinergic AE; uses-allergic rhinitis,urticaria."
  },
  {
    "q": "[MAR 2025] Describe the mechanism of action, uses and adverse effects of Sodium valproate.",
    "a": "↑GABA (inhibits GABA transaminase) + Na channel blockade; uses-all seizure types,bipolar,migraine prophylaxis; AE-hepatotoxicity,teratogenicity,weight gain."
  },
  {
    "q": "[MAR 2025] Pharmacotherapy of Status asthmaticus.",
    "a": "O2, nebulized salbutamol+ipratropium, IV corticosteroids, MgSO4, consider ventilation."
  },
  {
    "q": "[MAR 2025] Describe the therapeutic uses, adverse effects and contraindications of Morphine.",
    "a": "Uses-severe pain,MI,pulmonary edema; AE-respiratory depression,constipation,sedation; CI-head injury,asthma."
  },
  {
    "q": "[MAR 2025] Describe the therapeutic uses of Loop diuretics and what are its drug indications?",
    "a": "Uses-pulmonary edema,CHF,oliguric renal failure,hypercalcemia; indicated when rapid potent diuresis needed."
  },
  {
    "q": "[MAR 2025] List the parenteral iron preparations and write its indications.",
    "a": "Iron sucrose, ferric carboxymaltose, iron dextran; indications-oral intolerance/malabsorption,severe deficiency,CKD."
  },
  {
    "q": "[MAR 2025] Explain Autonomy and Maleficence in bioethics.",
    "a": "Autonomy: patient's right to self-determination. Non-maleficence: obligation to avoid causing harm."
  },
  {
    "q": "[JUL 2025] A 35-year-old woman presents with C/O Unilateral throbbing headache, which is sometimes preceded by vomiting, anorexia and seeing flashes of light. The headache progressively increases and she takes Tab. Paracetamol to relieve the pain. This headache is recurrent in nature and she gets 3 to 4 episodes in a month. A diagnosis of Migraine is made. a) Enumerate the drugs used to treat an acute attack of migraine. b) Describe the mechanism of action, adverse effects and pharmacokinetics of Sumatriptan. c) Name four drugs used in prophylaxis of Migraine.",
    "a": "Acute migraine: NSAIDs,triptans,ergotamine,antiemetics. Sumatriptan: 5HT1B/1D agonist→cranial vasoconstriction; AE-chest tightness,coronary vasospasm; PK-oral/SC,short half-life,poor oral bioavailability. Prophylaxis: propranolol,flunarizine,amitriptyline,topiramate."
  },
  {
    "q": "[JUL 2025] A 20-year-old male patient was brought by his parents with c/o talking to self. He had run away from his house a few days ago and rescued by his neighbours. He gives H/o hearing voices talking to him and commenting on him. He is unable to focus on his work, eat or sleep normally. At times the voice commands him to jump from height. A diagnosis of Paranoid Schizophrenia is made. a) Classify the Antipsychotic drugs. b) Describe the mechanism of action, adverse effects and uses of Chlorpromazine. c) Add a note on management of Drug induced Parkinsonism.",
    "a": "Classify: typical(chlorpromazine,haloperidol) vs atypical(risperidone,olanzapine). Chlorpromazine: D2 antagonist; AE-EPS,sedation,anticholinergic,postural hypotension; uses-psychosis,antiemetic. DIP management: dose reduction/switch to atypical, anticholinergics."
  },
  {
    "q": "[JUL 2025] Types of receptor antagonism with examples.",
    "a": "Competitive(reversible/irreversible), non-competitive, physiological, chemical antagonism; e.g. naloxone-morphine(competitive)."
  },
  {
    "q": "[JUL 2025] Transdermal therapeutic systems.",
    "a": "Patches delivering drug via skin for sustained release; e.g. nicotine, fentanyl, nitroglycerin patches."
  },
  {
    "q": "[JUL 2025] Treatment of Benign Hypertrophy of Prostate.",
    "a": "Alpha-1 blockers (tamsulosin), 5-alpha reductase inhibitors (finasteride)."
  },
  {
    "q": "[JUL 2025] Uses of Prostaglandins.",
    "a": "Labor induction, glaucoma, PDA closure, peptic ulcer protection."
  },
  {
    "q": "[JUL 2025] Elaborate on the principles of Beneficence and Non maleficence.",
    "a": "Beneficence: act for patient's benefit. Non-maleficence: avoid causing harm."
  },
  {
    "q": "[JUL 2025] Montelukast.",
    "a": "Leukotriene receptor antagonist, oral, used in asthma prophylaxis/allergic rhinitis."
  },
  {
    "q": "[JUL 2025] Halothane.",
    "a": "Inhalational general anesthetic; AE-hepatotoxicity,malignant hyperthermia,cardiac arrhythmia (sensitizes heart to catecholamines)."
  },
  {
    "q": "[JUL 2025] Parenteral iron preparations.",
    "a": "Iron sucrose, ferric carboxymaltose, iron dextran - for malabsorption/intolerance/severe deficiency."
  },
  {
    "q": "[JUL 2025] Rivaroxaban.",
    "a": "Direct factor Xa inhibitor, oral anticoagulant, fixed dose, no routine monitoring."
  },
  {
    "q": "[JUL 2025] Cognition enhancers.",
    "a": "Donepezil, rivastigmine, galantamine - cholinesterase inhibitors used in Alzheimer's disease."
  },
  {
    "q": "[OCT 2025] 32-year-old female presents with pulsatile headache restricted to one side of the head lasting for 20 hours associated with nausea, vomiting, sensitivity to light and sound. a) What is the probable diagnosis? b) Enumerate the drugs for the therapy of Migraine. c) Discuss in detail about the pharmacological actions, side effects and contraindications of TRIPTANS. d) Write a note on Flunarizine.",
    "a": "Dx: migraine. Drugs: NSAIDs,triptans,ergotamine,prophylactics. Triptans: 5HT1B/1D agonist→cranial vasoconstriction+↓neurogenic inflammation; AE-chest tightness,paresthesia; CI-IHD,uncontrolled HTN,pregnancy. Flunarizine: Ca channel blocker used for migraine prophylaxis."
  },
  {
    "q": "[OCT 2025] 24 year female after intake of Belladonna seeds experiences dry mouth, dry skin, decreased lacrimation, blurring of vision, palpitation and urinary retention. a) What is the treatment of above poisoning? b) Classify anti cholinergic drugs. c) Describe the pharmacological actions, uses and contraindications of Atropine.",
    "a": "Treatment: physostigmine, supportive/cooling, catheterize if retention. Classify: natural(atropine,hyoscine) vs synthetic(ipratropium,tropicamide). Atropine: mydriasis,↓secretions,tachycardia,antispasmodic; uses-OP poisoning,preanesthetic,bradycardia; CI-glaucoma,BPH."
  },
  {
    "q": "[OCT 2025] Clinical pharmacology of dopamine.",
    "a": "Dose-dependent action: low-renal vasodilation, medium-cardiac β1(inotropic), high-α1 vasoconstriction; use in shock."
  },
  {
    "q": "[OCT 2025] Zero order kinetics.",
    "a": "Constant amount of drug eliminated per unit time, independent of concentration; e.g. ethanol, phenytoin(high dose)."
  },
  {
    "q": "[OCT 2025] Describe the essential elements of Communication in patient care.",
    "a": "Empathy, clarity, active listening, informed consent, non-verbal cues, confidentiality."
  },
  {
    "q": "[OCT 2025] Endogenous opioid peptide.",
    "a": "Endorphins, enkephalins, dynorphins - act on mu/delta/kappa opioid receptors, modulate pain."
  },
  {
    "q": "[OCT 2025] Pentoxiphylline.",
    "a": "Hemorheologic agent, ↑RBC flexibility/↓blood viscosity; use in peripheral vascular disease/claudication."
  },
  {
    "q": "[OCT 2025] Halothane as general anaesthetic agent and its adverse effects.",
    "a": "Potent inhalational agent; AE-hepatotoxicity,malignant hyperthermia,cardiac arrhythmia,hypotension."
  },
  {
    "q": "[OCT 2025] Depolarizing blockers.",
    "a": "Succinylcholine - persistent depolarization, phase I block then phase II; AE-hyperkalemia,malignant hyperthermia."
  },
  {
    "q": "[OCT 2025] Clinical importance of prostaglandin analogues in labour.",
    "a": "Misoprostol/dinoprostone - cervical ripening, induction/augmentation of labor, PPH management (carboprost)."
  },
  {
    "q": "[OCT 2025] Omalizumab.",
    "a": "Anti-IgE monoclonal antibody, used in severe allergic asthma refractory to standard therapy."
  },
  {
    "q": "[OCT 2025] Therapeutic uses of vasopressin analogues and its side effects.",
    "a": "Desmopressin: diabetes insipidus, nocturnal enuresis, hemophilia A/vWD. Terlipressin: variceal bleeding. AE-water intoxication,hyponatremia,ischemia."
  }
]