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Paper II — 2019 July (Supplementary) (2010 Scheme) — Q2

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Paper II
2019 July (Supplementary) (2010 Scheme)

Question

Mrs. Mala aged 30 is a known epileptic was on treatment with Tab. Phenytoin for the past 3 yrs. She was taking oral contraceptive pills for the last 6 months. She did not get her menstrual cycle for the past 2 months. On investigation, her pregnancy was confirmed  What is the therapeutic problem  Why she became pregnant in spite of taking oral contraceptive pills  Name 2 other drugs which will have problems with phenytoin.  Add a note on emergency contraception. (1+2+1+2)

Q26 marksEssays

Answer

Therapeutic problem

  • Contraceptive failure due to a drug interaction between phenytoin and the oral contraceptive pill, resulting in an unplanned/unwanted pregnancy in a woman on a teratogenic antiepileptic drug

Why she became pregnant despite OCPs

  • Phenytoin is a potent hepatic microsomal (CYP450) enzyme inducer
  • It significantly increases the metabolism of the oestrogen and progestin components of the oral contraceptive pill, lowering their plasma levels below the threshold needed for reliable contraceptive efficacy — leading to breakthrough ovulation and contraceptive failure

Two other drugs with interaction problems with phenytoin

  • Warfarin (phenytoin alters its metabolism/protein binding — unpredictable anticoagulant effect)
  • Corticosteroids (phenytoin reduces their efficacy via enzyme induction)

Note on emergency contraception

  • Used after unprotected intercourse to prevent unwanted pregnancy
  • Levonorgestrel (single high dose within 72 hours) — most commonly used, though efficacy may be reduced in patients on enzyme-inducing drugs like phenytoin (higher dose or alternative method needed)
  • Ulipristal acetate — effective up to 120 hours
  • Copper IUD — most effective, unaffected by enzyme induction, can be inserted up to 5 days after intercourse
  • Mechanism: primarily inhibits/delays ovulation; not effective once implantation has occurred
  • Given the enzyme-induction interaction established in this case, the copper IUD is the most reliable emergency contraceptive option for a patient on phenytoin, since hormonal methods are also subject to reduced efficacy from the same enzyme induction
  1. 1Pharmacotherapy and Adverse Effects

Other Years Asked

  1. 1A male labourer aged 27 years was brought to the emergency department with signs and symptoms of rapid and shallow breathing, headache, vertigo, severe abdominal pain, dyspnea, motor incoordination, and slurred speech. He had a history of consuming illicit liquor 8 hours before he was brought to the emergency department. He was conscious and complained of blurred vision, fatigue and palpitation. On examination, he was found to have moderate retinal edema and blurring of the disc without any change in the fields of vision. (2022 July (Supplementary) (2019 Scheme)Essay · 15 marks
  2. 2Classify Opioid analgesics. Write the pharmacological effects, therapeutic uses, adverse effects and contraindications of Morphine. (4+3+3+3+2)2022 February (2019 Scheme)Essay · 15 marks
  3. 310. The patient is stabilized with oxygen and other supportive measures but his chest pain persists.2024 December (Supplementary) (2019 Scheme)Essay · 10 marks
  4. 4Define Pharmacodynamics. Explain the various factors modifying drug action with examples. (2+8)2025 March (Supplementary (SAY)) (2019 Scheme)Essay · 10 marks
  5. 5A 55-year-old male patient was recently diagnosed as suffering from hepatocellular carcinoma with metastases to bone. He complains of severe, excruciating pain in the abdomen and spine. He has complained of sleeplessness and mood swings for the past one month. The oncologist prescribes him an opioid analgesic drug to relieve his pain and also induce sleep and reduce apprehension of pain.2025 March (Supplementary (SAY)) (2019 Scheme)Essay · 10 marks
  6. 6Enumerate opioid receptors. Write the uses, adverse effects and contra indications for Morphine. Briefly describe the management of Morphine poisoning. (1+5+2)2024 March (Supplementary) (2019 Scheme)Short Essay · 8 marks
  7. 7(2022 February (2019 Scheme)Short Essay · 8 marks
  8. 8Factors modifying drug action.2022 July (Supplementary) (2019 Scheme)Short Essay · 8 marks
  9. 9(2023 July (Supplementary) (2019 Scheme)Short Essay · 8 marks
  10. 10(2024 March (Supplementary) (2019 Scheme)Short Essay · 8 marks
  11. 11Explain chemoprophylaxis with examples. Write two different HIV prophylaxis regimens. (4+4)2022 February (2019 Scheme)Short Essay · 8 marks
  12. 12A drug addict is found in a state of stupor with flaccidity of muscles, shallow breathing, fall in BP and pinpoint pupils. A diagnosis of Morphine overdose is made.2025 August (Supplementary) (2010 Scheme)Essay · 6 marks
  13. 13Explain the factors modifying drug action. Briefly describe newer drug delivery systems (3+3)2024 August (Supplementary) (2010 Scheme)Essay · 6 marks
  14. 14Read the clinical problem and answer the following questions: A 28 years old woman having two children wanted to follow a contraceptive method. Patient was advised to take oral contraceptive pills. She is a known case of pulmonary tuberculosis for which she is on Rifampicin 450mg. INH300mg and ethambutol 300mg per day.2015 September (Supplementary) (2010 Scheme)Essay · 6 marks
  15. 15Name two selective and two nonselective cyclooxygenase 2 (COX-2) inhibitors. Enumerate four uses of aspirin along with the dose required. Describe the adverse effects and drug interactions of aspirin. (2+2+2)2021 May (Supplementary) (2010 Scheme)Essay · 6 marks
  16. 16Read the clinical problem and answer the following question: Master. Vijay, 12 years had severe fever for the past 3 days and he was under treatment with antibiotics and analgesics. He developed severe pain in the stomach after taking the analgesics and he was admitted to the Hospital for severe gastritis2016 February (2010 Scheme)Essay · 6 marks
  17. 17Read the case history and answer the following questions. A 25 years old man had a gradual onset of delusions and auditory hallucinations. He was taken to a psychiatrist who started him on tab. haloperidol 2mg twice daily. A few weeks later although he improved clinically he developed stiffness and rigidity of upper and lower limbs.2016 October (Supplementary) (2010 Scheme)Essay · 6 marks
  18. 18Name three drug groups with two examples each used in treatment of Rheumatoid arthritis. Briefly describe DMARD (3+3)2024 December (Supplementary) (2019 Scheme)Short Essay · 6 marks
  19. 19mt.  What is your probable diagnosis  What is the line of management  What are the specific antidotes. How they are useful. (1+2+1+2)2019 February (2010 Scheme)Essay · 6 marks
  20. 20After injecting succinylcholine I.V. to have muscle relaxation during a surgical procedure, a patient developed prolonged apnoea. What could be the probable cause. What is the management for the above condition. (2+4)2025 March (Supplementary (SAY)) (2019 Scheme)Short Essay · 6 marks
  21. 21A 24year old man is brought to the hospital with complaints of unconsciousness , sustained contractions (toni2013 April (2010 Scheme)Essay · 6 marks
  22. 22Classify the drugs used in Gout. Explain the mechanism of action and adverse effects of Allopurinol. (2+4)2025 March (Supplementary (SAY)) (2019 Scheme)Short Essay · 6 marks
  23. 23Enumerate the iron preparations and add a note on the indications of parenteral iron therapy. (3+3)2025 March (Supplementary (SAY)) (2019 Scheme)Short Essay · 6 marks
  24. 24day for his ischaemic heart disease. Subsequently he developed joint pains for which he was administered tab. aspirin 300mg thrice daily after food. One week later he was brought to casualty in a state of shock due to severe haemetemesis.2014 September (Supplementary) (2010 Scheme)Essay · 6 marks
  25. 25Read the case history and answer the following questions: A 25 years old lady reported to the hospital with complaints of low grade fever since 10 days and weakness, fatigue, cough & expectoration since one month. Sputum was found to be positive for AFB and X-ray chest showed fibrotic changes in the left upper lobe. (2+2+2)  What is the treatment regimen to be followed for the patient  Explain the mechanism of action and adverse effects of Rifampicin  What would you advise if the lady was pregnant2019 February (2010 Scheme)Essay · 6 marks
  26. 26Classify NSAIDs. Mention the therapeutic uses and adverse effects of salicylates. (2+2+2=6)2016 October (Supplementary) (2010 Scheme)Essay · 6 marks
  27. 27What should be the line of management of hypertension in this patient (2+2+2)2018 July (Supplementary) (2010 Scheme)Essay · 6 marks
  28. 28Treatment of organophosphorous poisoning.2024 June (Supplementary) (2019 Scheme)Short Answer · 4 marks
  29. 29Management of Iron poisoning.2023 January (Supplementary) (2019 Scheme)Short Answer · 4 marks
  30. 30Discuss the types of communication and its importance in Health care settings.2025 March (Supplementary (SAY)) (2019 Scheme)Short Answer · 4 marks
  31. 31Pharmacological management of Opium (Morphine) dependence.2023 January (Supplementary) (2019 Scheme)Short Answer · 4 marks
  32. 32Pharmacotherapy of Anaphylactic shock with rationale for use of each drug.2024 March (Supplementary) (2019 Scheme)Short Answer · 4 marks
  33. 33Discuss the role of empathy in patient care.2025 March (Supplementary (SAY)) (2019 Scheme)Short Answer · 4 marks
  34. 34Anxiety disorders.2023 January (Supplementary) (2019 Scheme)Short Answer · 4 marks
  35. 35Pharmacological basis of Adrenaline in Anaphylactic shock.2024 June (Supplementary) (2019 Scheme)Short Answer · 4 marks
  36. 36Fixed drug combination of drugs2024 March (Supplementary) (2019 Scheme)Short Answer · 4 marks
  37. 37Pharmacotherapy of Rheumatoid arthritis.2023 January (Supplementary) (2019 Scheme)Short Answer · 4 marks
  38. 38Enumerate four factors that modify drug action giving suitable examples for each.2024 December (Supplementary) (2019 Scheme)Short Answer · 4 marks
  39. 39Describe the role of autonomy, beneficence and justice as guiding principles in patient care.2024 December (Supplementary) (2019 Scheme)Short Answer · 4 marks
  40. 40Uses of glucocorticoids2016 February (2010 Scheme)Short Note · 3 marks
  41. 41Therapeutic uses and adverse effects of morphine and its congeners2022 May (Supplementary) (2010 Scheme)Short Note · 3 marks
  42. 42Interferon alfa2015 September (Supplementary) (2010 Scheme)Short Note · 3 marks
  43. 43Paracetamol2023 March (Supplementary) (2010 Scheme)Short Note · 3 marks
  44. 44Morphine – therapeutic uses and adverse effects2024 August (Supplementary) (2010 Scheme)Short Note · 3 marks
  45. 45Treatment of smoking cessation2019 February (2010 Scheme)Short Note · 3 marks
  46. 46Therapeutic uses of glucocorticoids.2015 September (Supplementary) (2010 Scheme)Short Note · 3 marks
  47. 47Physiological antagonism.2017 August (Supplementary) (2010 Scheme)Short Note · 3 marks
  48. 48Morphine2022 October (Supplementary) (2010 Scheme)Short Note · 3 marks
  49. 49Uses of chloroquine2016 February (2010 Scheme)Short Note · 3 marks
  50. 50Clonidine2019 July (Supplementary) (2010 Scheme)Short Answer · 1 mark
  51. 51Rationale for use of methadone in morphine dependence therapy2018 July (Supplementary) (2010 Scheme)Short Answer · 1 mark
  52. 52Tachyphylaxis. Give examples2018 February (2010 Scheme)Short Answer · 1 mark
  53. 53Furosemide in acute pulmonary edema2021 May (Supplementary) (2010 Scheme)Short Answer · 1 mark
  54. 54Tapering dose of Glucocorticoids after prolonged therapy rather than stopping it abruptly2023 March (Supplementary) (2010 Scheme)Short Answer · 1 mark
  55. 55The primary mechanism of action of H2-receptor antagonists in the treatment of GERD is2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Case) · 1 mark
  56. 56Heparin2023 July (Supplementary) (2010 Scheme)Short Answer · 1 mark
  57. 57The known side effect of long-term use of proton pump inhibitors (PPIs) is2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Case) · 1 mark
  58. 58The following drugs promote gastrointestinal transit and speed up gastric emptying by enhancing coordinated propulsive (prokinetic) activity:2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  59. 59Which is the diuretic of choice in treatment of acute congestive glaucoma2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Case) · 1 mark
  60. 60Adrenaline in anaphylactic shock2021 February (Supplementary) (2010 Scheme)Short Answer · 1 mark
  61. 61The adrenergic antagonists used to treat benign prostatic hyperplasia (BPH) are:2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Multi) · 1 mark
  62. 62Teratogenicity2017 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
  63. 63Chloroquine2019 February (2010 Scheme)Short Answer · 1 mark
  64. 64The anticoagulant of choice in pregnancy is:2025 March (Supplementary (SAY)) (2019 Scheme)MCQ · 1 mark
  65. 65Warfarin2024 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
  66. 66Methotrexate in Rheumatoid arthritis.2025 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
  67. 67The drug preferred as an adjunctive therapy in GERD by accelerating gastric emptying is2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Case) · 1 mark
  68. 68Idiosyncrasy2017 February (2010 Scheme)Short Answer · 1 mark
  69. 69Explain why morphine is contraindicated in patients with head injury.2016 February (2010 Scheme)Short Answer · 1 mark
  70. 70Which of the following is a potential side effect of the use of prostaglandin analogues like latanoprost2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Case) · 1 mark
  71. 71Diazepam2019 July (Supplementary) (2010 Scheme)Short Answer · 1 mark
  72. 72Discuss the rationale for the use of adrenaline in anaphylactic shock2013 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  73. 73Young’s formula.2016 October (Supplementary) (2010 Scheme)Short Answer · 1 mark
  74. 74Rationale for the combined use of aluminium and magnesium salts in antacid preparations.2015 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  75. 75Name the antidote in poisoning due to paracetamol and methanol2013 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  76. 76The following opioid is contraindicated in myocardial infarction as an analgesic due to its sympathomimetic properties:2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  77. 77Anaphylactic shock.2014 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  78. 78The following are the examples of idiosyncrasy: 1. Chloramphenicol producing aplastic anemia 2. Aspirin producing gastric irritation 3. INH producing hepatotoxicity 4. Atypical pseudocholinesterase resulting in succinylcholine apnea2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  79. 79Causing teratogenicity2016 February (2010 Scheme)Short Answer · 1 mark
  80. 80Magnesium hydroxide and Aluminium hydroxide combination as antacid2025 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
  81. 81Immunotherapy for Rh negative woman with Rh positive baby2015 February (2010 Scheme)Short Answer · 1 mark
  82. 82Which of the following is the most common adverse effect of long-term use of oral contraceptives2025 March (Supplementary (SAY)) (2019 Scheme)MCQ · 1 mark
  83. 83Adverse effects of metoclopramide2014 March (2010 Scheme)Short Answer · 1 mark
  84. 84Rationale for use of frusemide in acute pulmonary edema2014 March (2010 Scheme)Short Answer · 1 mark
  85. 85Morphine2021 December (Supplementary) (2010 Scheme)Short Answer · 1 mark
  86. 86Mebendazole2024 August (Supplementary) (2010 Scheme)Short Answer · 1 mark
  87. 87Mention the antidote in over dosage of morphine2014 March (2010 Scheme)Short Answer · 1 mark
  88. 88Clonidine2021 December (Supplementary) (2010 Scheme)Short Answer · 1 mark
  89. 89Assertion (A): Sulphonamide’s can cause kernicterus in newborns. Reason (R): Drugs with low plasma protein binding can cause hemolysis.2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (A/R) · 1 mark
  90. 90All of the following are adverse effects of oral iron therapy EXCEPT:2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  91. 91The adverse effects of following antimicrobials are WRONGLY paired:2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  92. 92The anticancer agents causing renal toxicity as adverse effect are:2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Multi) · 1 mark
  93. 93Two advantages of human insulin2014 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  94. 94The guide for calculating the dose of parenteral iron is:2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  95. 95Morphine2021 May (Supplementary) (2010 Scheme)Short Answer · 1 mark
  96. 96Allopurinol2019 February (2010 Scheme)Short Answer · 1 mark
  97. 97Febrile convulsions in a child aged six years.2016 October (Supplementary) (2010 Scheme)Short Answer · 1 mark
  98. 98Allopurinol2019 July (Supplementary) (2010 Scheme)Short Answer · 1 mark
  99. 99Mr. Taylor’s symptoms are poorly controlled with over-the-counter antacids. Which of the following is the most appropriate next step in his treatment2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Case) · 1 mark
  100. 100Levamisole2021 February (Supplementary) (2010 Scheme)Short Answer · 1 mark
  101. 101The following anthelmintics are effective against Wuchereria bancrofti and Brugiya malayi acting as microfilaricidal:2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  102. 102Teratogenecity with one example.2015 February (2010 Scheme)Short Answer · 1 mark
  103. 103Comment on the interactions produced by oral contraceptive pills and rifampicin.2017 February (2010 Scheme)Short Answer · 1 mark
  104. 104Two uses and two adverse effects of morphine.2016 October (Supplementary) (2010 Scheme)Short Answer · 1 mark
  105. 105The following statements concerning the use of lithium in the management of bipolar affective disorder is TRUE: 1. Excessive intake of sodium chloride enhances the toxicity of lithium 2. Lithium alleviates the manic phase of bipolar disorder in 24 hours 3. Lithium dosage may need to be reduced in patients taking diuretics 4. Lithium has narrow margin of safety and requires therapeutic drug monitoring2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  106. 106The ability of a drug to cause fetal abnormalities when administered to a pregnant lady is referred to as:2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  107. 107Pharmacovigilance2015 September (Supplementary) (2010 Scheme)Short Answer · 1 mark
  108. 108Which drugs are used as part of post-exposure prophylaxis (PEP) in HIV exposure2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (Multi) · 1 mark
  109. 109Anti malignancy drugs producing gouty arthritis2015 February (2010 Scheme)Short Answer · 1 mark
  110. 110The following anticancer drugs are purine antagonists:2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  111. 111Assertion (A): Bedaquiline is used along with clofazimine in XDR TB. Reason (R): Two drugs acting on same target can antagonize each other.2025 March (Supplementary (SAY)) (2019 Scheme)MCQ (A/R) · 1 mark
  112. 112Assertion (A): Levodopa is combined with carbidopa. Reason (R): Levodopa-carbidopa combination reduces involuntary movements and postural hypotension.2024 December (Supplementary) (2019 Scheme)MCQ · 1 mark
  113. 113 Phenobarbitone as Hypnotic. Name the following (Two examples for each): (5x1=5)2025 August (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  114. 114 mini pill (progesterone only pill) in a lactating mother Name the following (Two examples for each) (5x1=5)2025 August (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  115. 115Orphan drugs2020 February (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  116. 116Losartan in Pregnancy induced hypertension2024 August (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  117. 117Methadone in morphine addiction2021 February (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  118. 118 Spironolactone in patients using Lisinopril Name the following (Two examples for each): (5x1=5)2019 July (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  119. 119DMARD’S2023 March (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  120. 120Allopurinol in Acute Gout Name the following (Two examples for each): (5x1=5)2022 October (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  121. 121 Cisplatin in choriocarcinoma Name the following (Two examples for each) (5x1=5)2022 October (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  122. 122 Nalbuphine in morphine poisoning2019 February (2010 Scheme)Short Answer · 0.3 marks
  123. 123 Rifampicin in Tuberculosis in AIDS patients.2025 March (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  124. 124Immunomodulators2023 March (Supplementary) (2010 Scheme)Short Answer · 0.3 marks
  125. 125Drugs used in Rheumatoid arthritis2022 February (2019 Scheme)Short Answer · 0.2 marks
  126. 126Ciprofloxacin in urinary tract infection in a pregnant lady.2024 June (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  127. 127 Cephalexin in prophylaxis of recurrent cystitis in pregnancy Name the following (Two examples for each): (8x1=8)2022 July (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  128. 128Drugs causing tachyphylaxis2023 January (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  129. 129Immuno stimulants.2023 January (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  130. 130Drugs used to treat Morphine poisoning.2023 July (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  131. 131Allopurinol for the treatment of Acute gout Name the following (Two examples for each): (8x1=8)2024 March (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  132. 132Amoxicillin n pharyngitis for a 5-year-old child2022 February (2019 Scheme)Short Answer · 0.2 marks
  133. 133Noradrenaline in Anaphylactic shock2023 January (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  134. 134 Losartan in pregnancy induced hypertension. Name the following (Two examples for each): (8x1=8)2023 July (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  135. 135Drugs with low therapeutic index.2024 June (Supplementary) (2019 Scheme)Short Answer · 0.2 marks
  136. 136Treatment of rheumatoid arthritis.2024 June (Supplementary) (2019 Scheme)Short Answer · 0.2 marks

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