Clinical Pharmacology and Drug Toxicity Practice Questions

Q: Drug Induced Lupus is caused by all except

Procaine. ***Procaine*** - While **procainamide**, a derivative of procaine, is a known cause of **drug-induced lupus (DIL)**, **procaine** itself is not typically implicated. - Procaine is a **local anesthetic** and its mechanism of action does not commonly lead to the immunological reactions seen in DIL. *Hydralazine* - **Hydralazine** is a well-established cause of **drug-induced lupus (DIL)**, particularly with higher doses and prolonged use. - It frequently results in the development of **anti-histone antibodies**, a hallmark of DIL. *Sulphonamides* - Various **sulphonamide antibiotics** (e.g., sulfasalazine, sulfamethoxazole) are known to induce **lupus-like syndromes**. - These drugs can trigger immune responses leading to symptoms characteristic of **systemic lupus erythematosus (SLE)**. *Isoniazid* - **Isoniazid**, an anti-tuberculosis medication, is a recognized cause of **drug-induced lupus (DIL)**. - It often leads to the formation of **anti-histone antibodies** and clinical manifestations resembling spontaneous lupus.

Q: All of the following drugs cause amorphous whorl like corneal deposits except:

Indomethacin. ***Indomethacin*** - While indomethacin can cause various ocular side effects, **corneal deposits** are not typically described as the **amorphous whorl-like type** seen with the other listed drugs. - Ocular side effects of indomethacin more commonly include **corneal opacities** and **retinal changes** but not the specific **"cornea verticillata"** pattern. *Chlorpromazine* - **Chlorpromazine** can cause **corneal and lenticular deposits**, but these are typically described as **fine granular or stellate deposits** rather than the classic whorl pattern. - While these deposits can accumulate in the corneal epithelium, they do not characteristically present with the **"cornea verticillata"** (whorl keratopathy) pattern seen with amiodarone and chloroquine. - The deposits are generally benign but can lead to visual disturbances. *Amiodarone* - **Amiodarone** is a classic cause of **cornea verticillata**, or **whorl keratopathy**, with amorphous, whorl-like deposits in the corneal epithelium. - These deposits occur in **>90% of patients** on long-term therapy and are typically benign and rarely affect vision. - The whorl pattern is highly characteristic and reversible upon drug discontinuation. *Chloroquine* - **Chloroquine** (and hydroxychloroquine) commonly causes **corneal deposits** known as **cornea verticillata**, which appear as gray-brown, whorl-like opacities in the corneal epithelium. - While these deposits are usually asymptomatic, high doses or prolonged use can lead to visual blurring or halos. - The whorl pattern is a characteristic finding with this class of drugs.

Q: Not true about thalidomide:

Has no antiangiogenesis action against tumour. ***Has no antiangiogenesis action against tumour*** - Thalidomide is known to possess **anti-angiogenic properties**, meaning it inhibits the formation of new blood vessels, which is crucial for tumour growth. This makes the statement "has no antiangiogenesis action against tumour" incorrect. - Its anti-angiogenic effects are one of the mechanisms proposed for its use in certain cancers, such as **multiple myeloma**. *Causes phocomelia* - **Phocomelia**, a severe birth defect characterized by malformed or absent limbs, is the most infamous **teratogenic effect** of thalidomide. - This adverse effect led to its withdrawal from the market in the early 1960s. *Still has restricted clinical use* - Despite its teratogenic risks, thalidomide has been reintroduced with strict regulations due to its unique immunomodulatory and anti-inflammatory properties. - It is currently used in the treatment of conditions like **multiple myeloma**, **erythema nodosum leprosum**, and certain autoimmune diseases. *Not tested in pregnant animals before introduction* - A significant reason for the thalidomide tragedy was the **lack of robust teratogenicity testing** in pregnant animals before its widespread introduction to the market. - If such testing had been adequately conducted, its severe teratogenic effects might have been identified earlier, preventing widespread harm.

Q: An otherwise healthy 32-year-old woman comes to the physician because of severe headaches and visual disturbances. Physical examination shows papilledema. Which of the following medications is most likely implicated in the development of the suspected diagnosis in this patient?

Oral contraceptive pill. ***Oral contraceptive pill*** - **Oral contraceptive pills** are a common risk factor for **idiopathic intracranial hypertension (IIH)**, especially in young, obese women. - IIH presents with symptoms like **severe headaches**, **visual disturbances**, and **papilledema** due to increased intracranial pressure. *Doxycycline* - **Tetracycline antibiotics**, including doxycycline, can induce **IIH** as a side effect. - However, the patient is described as "otherwise healthy" and there is no indication of an infection for which doxycycline would be prescribed. *All-trans retinoic acid* - **Retinoids** like all-trans retinoic acid (ATRA) are a known cause of **IIH**, particularly when used for leukemia or severe acne treatment. - The patient, however, is an "otherwise healthy" 32-year-old woman, making ATRA use less likely in the absence of relevant conditions. *Lithium* - **Lithium** can cause various neurological side effects and rarely has been linked to cases of **IIH**. - This patient has no history of psychiatric illness, making lithium exposure unlikely.

Q: Which of the following can be safely given in a kidney patient?

Fluconazole. ***Fluconazole*** - Fluconazole **can be safely given in kidney patients with appropriate dose adjustment** based on the patient's **creatinine clearance**. - It is primarily cleared renally (80% unchanged in urine), so dose reduction is necessary to prevent accumulation and toxicity in patients with impaired kidney function. - Unlike NSAIDs, fluconazole does not directly harm the kidneys or reduce renal blood flow, making it a safer choice when dose-adjusted appropriately. *Ibuprofen* - **NSAIDs** like **ibuprofen** are generally avoided in kidney patients due to their potential to cause **acute kidney injury (AKI)** by inhibiting prostaglandin synthesis, leading to renal vasoconstriction. - They can worsen existing kidney disease or induce new onset kidney damage, especially in patients with compromised renal function. - Risk of **hyperkalemia**, **fluid retention**, and **worsening of hypertension** in CKD patients. *Ketorolac* - **Ketorolac** is a potent **NSAID** that is **contraindicated in patients with renal impairment** (CrCl <50 mL/min). - Its use can lead to significant **renal vasoconstriction** and reduction in **glomerular filtration rate (GFR)**, posing a high risk for **acute kidney injury**. - Has the highest risk of renal adverse effects among commonly used NSAIDs. *Acetylsalicylic acid* - **Acetylsalicylic acid (aspirin)** at analgesic/anti-inflammatory doses can be harmful to kidney patients. - Like other NSAIDs, it can inhibit **renal prostaglandins**, leading to decreased renal blood flow and potential for **kidney damage**. - While low-dose aspirin (75-100mg) for cardioprotection may be used cautiously in stable CKD, higher doses should be avoided.

Q: Na content (mEq/L) in Normal saline is:

154. ***154*** - Normal saline, or 0.9% sodium chloride, contains **154 mEq/L of sodium (Na+)** and 154 mEq/L of chloride (Cl-). - This concentration is nearly **isotonic** with plasma, making it a common intravenous fluid for volume repletion. *135* - This value is close to the lower end of the normal range for **serum sodium concentration** (typically 135-145 mEq/L) in the human body. - It does not represent the sodium content of normal saline solution. *130* - This sodium concentration is **hypotonic** relative to normal plasma. - It is not the standard sodium content found in 0.9% normal saline. *111* - This value is significantly **hypotonic** and would indicate hyponatremia if it were a serum sodium level. - It is much lower than the sodium content of normal saline.

Q: All of the following can cause SLE-like syndrome except

Penicillin. ***Penicillin*** - Penicillin is known to cause **drug-induced hemolytic anemia**, **allergic reactions**, and **serum sickness-like reactions**, but not typically an SLE-like syndrome. - While it can induce certain autoimmune phenomena, it does not commonly trigger the specific constellation of symptoms and autoantibodies associated with drug-induced lupus. *Isoniazid* - **Isoniazid** is a well-known cause of **drug-induced lupus erythematosus**, particularly in slow acetylators. - It can lead to positive **antinuclear antibodies (ANAs)** and clinical symptoms mimicking SLE. *Hydralazine* - **Hydralazine** is a classic drug associated with **drug-induced lupus**, often presenting with **arthralgias**, **myalgias**, and **fever**. - It commonly induces **anti-histone antibodies** and **ANA** without significant renal or central nervous system involvement. *Sulphonamide* - **Sulfonamides** (such as sulfasalazine) can induce an **SLE-like syndrome** and are recognized causes of drug-induced lupus. - They are associated with the development of **autoantibodies** and systemic symptoms similar to spontaneous SLE.

Q: Which of the following drugs shows nephrotoxicity during administration?

Tacrolimus. ***Tacrolimus*** - **Tacrolimus** is a calcineurin inhibitor and a well-known cause of **nephrotoxicity**, which can manifest as acute kidney injury or chronic renal dysfunction [1], [4]. - Its mechanism involves vasoconstriction of afferent arterioles and direct tubular toxicity, leading to reduced glomerular filtration. *Azathioprine* - **Azathioprine** is an immunosuppressant primarily associated with **bone marrow suppression** (leukopenia, thrombocytopenia) and **hepatotoxicity**, not typically nephrotoxicity [2]. - While it can cause renal impairment in rare cases, it is not a primary mechanism of action. *Mycophenolate mofetil* - **Mycophenolate mofetil (MMF)** is an immunosuppressant that primarily causes **gastrointestinal side effects** (diarrhea, nausea) and **myelosuppression**. - It is generally considered **renal-sparing** and is often used in situations where calcineurin inhibitors are contraindicated due to nephrotoxicity. *Leflunomide* - **Leflunomide** is an immunosuppressant used in rheumatoid arthritis, known for causing **hepatotoxicity**, **hypertension**, and **teratogenicity** [3]. - While it can affect various organ systems, direct and significant nephrotoxicity is not a prominent adverse effect.

Q: Which of the following causes teratogenicity?

Vitamin A. ***Vitamin A*** - Excessive intake of **Vitamin A (retinoids)**, particularly during early pregnancy, is a known cause of **teratogenicity**. - It can lead to various birth defects, including **craniofacial abnormalities**, **cardiac defects**, and **central nervous system malformations**. *Vitamin E* - **Vitamin E** is generally considered safe during pregnancy and has no known teratogenic effects at recommended dosages. - It functions as an **antioxidant** and is important for cell protection. *Vitamin D* - While **Vitamin D** is essential for proper fetal development, excessive intake is not typically associated with teratogenicity but can cause **hypercalcemia** in the mother and fetus. - Mild to moderate supplementation is often recommended during pregnancy for bone health. *Vitamin C* - **Vitamin C** is a water-soluble vitamin and is not considered teratogenic, even at higher doses, as excess amounts are readily excreted. - It plays a crucial role in **collagen synthesis** and immune function during pregnancy.

Q: Alkalinization of urine is done in the management of poisoning with:

Aspirin. ***Aspirin*** - Alkalinization of urine is done in **aspirin overdose** to promote the **excretion of salicylic acid**, which is acidic. - By increasing the urine pH, more of the acidic aspirin metabolites become **ionized**, reducing their reabsorption in the renal tubules and increasing their elimination. *Morphine* - Morphine elimination is primarily through **hepatic metabolism** (glucuronidation) and subsequent renal excretion of inactive metabolites. - Urinary pH manipulation has **little impact** on its clearance. *Amphetamine* - Amphetamine is a **weak base**, and its excretion is enhanced by **acidification of urine**. - Alkalinization of urine would **increase reabsorption** and reduce its elimination, which is the opposite of what is desired in toxicity. *Atropine* - Atropine is primarily eliminated through **hepatic metabolism and renal excretion** of both unchanged drug and metabolites. - Manipulation of urinary pH has **minimal clinical utility** in enhancing its elimination.

Question 1

Drug Induced Lupus is caused by all except

Accepted Answer

Procaine

Answer

Hydralazine

Answer

Sulphonamides

Answer

Isoniazid

Question 2

All of the following drugs cause amorphous whorl like corneal deposits except:

Accepted Answer

Indomethacin

Answer

Chlorpromazine

Answer

Amiodarone

Answer

Chloroquine

Question 3

Not true about thalidomide:

Accepted Answer

Has no antiangiogenesis action against tumour

Answer

Causes phocomelia

Answer

Still has restricted clinical use

Answer

Not tested in pregnant animals before introduction

Question 4

An otherwise healthy 32-year-old woman comes to the physician because of severe headaches and visual disturbances. Physical examination shows papilledema.

Which of the following medications is most likely implicated in the development of the suspected diagnosis in this patient?

Accepted Answer

Oral contraceptive pill

Answer

Doxycycline

Answer

All-trans retinoic acid

Answer

Lithium

Question 5

Which of the following can be safely given in a kidney patient?

Accepted Answer

Fluconazole

Answer

Ibuprofen

Answer

Ketorolac

Answer

Acetyl salicylic acid

Question 6

Na content (mEq/L) in Normal saline is:

Accepted Answer

154

Answer

135

Answer

130

Answer

111

Question 7

All of the following can cause SLE-like syndrome except

Accepted Answer

Penicillin

Answer

Isoniazid

Answer

Hydralazine

Answer

Sulphonamide

Question 8

Which of the following drugs shows nephrotoxicity during administration?

Accepted Answer

Tacrolimus

Answer

Azathioprine

Answer

Mycophenolate mofetil

Answer

Leflunomide

Question 9

Which of the following causes teratogenicity?

Accepted Answer

Vitamin A

Answer

Vitamin E

Answer

Vitamin D

Answer

Vitamin C

Question 10

Alkalinization of urine is done in the management of poisoning with:

Accepted Answer

Aspirin

Answer

Morphine

Answer

Amphetamine

Answer

Atropine

Clinical Pharmacology and Drug Toxicity — MCQs

Clinical Pharmacology and Drug Toxicity — MCQs

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