DHYEY GPAT 09/09/2023

 

DHYEY GPAT 2024 MCQ SERIES WITH EXPALAINATION

* BOLD CHARACTER IS RIGHT ANSWER FOR THE QUESTION



1. Ritonavir inhibits metabolism of the following drugs except: 
(A) Amiodarone 
(B) Phenobarbitone 
(C) Cisapride 
(D) Midazolam 

EXPLAINATION :
Ritonavir is a powerful inhibitor of CYP3A4, thus the metabolism of substrates of this enzyme will be inhibited by ritonavir. Important substrates of CYP3A4 are: 
  • Amiodarone 
  • Terfenadine
  • Astemizole
  • Cisapride 
  • Cyclosporine
  • Tacrolimus 
  • Lovastatin and other statins 
  • Calcium channel blockers 
  • Midazolam 
  • Protease inhibitors


2. Alkaline diuresis is done for treatment of poisoning due to:
(A) Morphine 
(B) Amphetamine 
(C) Phenobarbitone 
(D) Atropine 

EXPLAINATION :
Phenobarbitone is a barbiturate which is a derivative of barbituric acid (weakly acidic drug) and its excretion can be enhanced by making the urine alkaline. Morphine, atropine and amphetamines are basic drugs.

3. The mitochondrial enzyme involved in the metabolism of clopidorgel and proton pump inhibitors is: 
(A) CYP 2A 
(B) CYP 2B 
(C) CYP 3A4
(D) CYP 2C20

EXPLAINATION :
Clopidogrel and proton pump inhibitors are metabolized mainly by CYP2C19 and by CYP3A4. Due to this reason there is potential of interaction between these two drugs

4. Which of the following is wrongly matched regarding drug elimination?
(A) Calcium channel blockers: CYP3A4 
(B) Carvedilol: CYP2D6 
(C) Digoxin: P-glycoprotein 
(D) Simvastatin: Glucuronide conjugation 

EXPLAINATION :
Table 7-3 in Goodman and Gilman 12/e p159 clearly writes that CYP2D6 is involved in metabolism of beta blockers and CYP3A4 in calcium channel blockers’ metabolism. P-glycprotein polymorphism decreases AUC of digoxin. Pg 1976 of Goodman and Gilman writes that ‘ irreversible oxidative metabolites of simvastatin are produced by CYP3A enzymes.’ Another important thing that a student may get confused with is that simvastatin metabolites can be glucuronide conjugated.This is true but the drug no longer remains simvastatin. Clinical importance of this is that if another drug or substance induces UGT glucuronyl transferase, it will not affect the activity of simvastatin. On the other hand if a drug is directly conjugated with glucuronide molecules, the inducers of UGT enzyme will affect the plasma concentration of the drug.

5. Which of the following is a prodrug? 
(A) Enalapril 
(B) Clonidine 
(C) Salmeterol 
(D) Acetazolamide

EXPLAINATION :
All ACE inhibitors are prodrugs except captopril and lisinopril.



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