Review of Pharmacology (9th Ed.) - Jaypee Brothers Medical

783 Pages·2016·9.34 MB·English

by  Gupta S.

Review of
Pharmacology
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Ninth Edition
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Gobind Rai Garg MBBS MD
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(Gold Medalist)
Ex-Assistant Professor (Pharmacology)
MA MC, Delhi, India
- Director
Ayus h Institute of Medical Sciences
9 Delhi, India
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Sparsh Gupta MBBS MD
r (Gold Medalist)
i Assistant Professor (Pharmacology)
h VMMC and Safdarjung Hospital, Delhi, India
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The Health Sciences Publisher

New Delhi | London | Panama | Philadelphia
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© 2015, Gobind Rai Garg and Sparsh Gupta
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those
of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective
owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter
in question. However, readers are advised to check the most current information available on procedures included and check information from
the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse
effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the
author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are
required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have
been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
Inquiries for bulk sales may be solicited at: [email protected]
Review of Pharmacology
Sixth Edition: 2012
Seventh Edition: 2013
Eighth Edition: 2014
Ninth Edition: 2015
ISBN : 978-93-5152-887-6
Printed at
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Dedicatedi to
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My parents, wife Praveen and sweetheart kids Ayush and Samaira
U —Gobind Rai Garg
My family members and my teachers (Shri SK Suri and Ms V Gopalan)
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—Sparsh Gupta

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Preface to the Ninth Edition
We want to thank all the readers for the overwhelming response and great appreciation of the earlier editions of this book. To
meet the expectations of students, we have tried to further improve this ninth edition. G
Dear friends, the apprehension regarding the ‘National Eligibility Cum Entrance Test (NEET)’ has now been taken care of
as the examination pattern has not been modified drastically. Cracking the NEET and other important PG entrance examinations
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require a thorough knowledge and understanding of the subject. Readers of this book have got an edge over others because of strong
theory and conceptual questions. This along with the key points given under the heading of various boxes in the chapters has
helped many students to get extremely good ranks in NEET 2012, 2013 and 2014. As onVe-liner questions are being asked in the
NEET, the students need to revise the most important information in the last few days. Keeping this in mind, we have added
‘high yield points’ separately as boxes on the side of every page. Boxes are labeledd as for Key points, for mnemonics,
for definition, N for new drugs and ? for controversial questions. However, we will recommend students to read the
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theory of each subject thoroughly, which is must. The questions have been asked as one-liners in last year which may not be the
case next year and further in AIIMS and PGI exams you need to be well-vtersed with the theory. Therefore, we will re-emphasize
that there is no substitution of knowledge. If you know the subject thioroughly, you can answer any type of question.
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In our constant endeavour to improvise the book, there has been incorporation of important additions in almost all chapters
along with the section of ‘Recent questions asked by National Board’.
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In this ninth edition, we have added a lot of mnemonics, diagrams and flow charts to make learning interesting and easier.
Another salient feature of this edition is the addition of DRUG OF CHOICE in every chapter.
The question bank of every chapter has been divid ed into subtopics. It will help students to solve MCQs after reading the
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theory of a particular topic of a chapter.
For getting a grasp on the NEET questions in a better way, a new chapter ‘History of Pharmacology’ and a new section
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‘Image Based Questions’ have also been added.
We have fully revised the book and corrected the typographical and some other errors present in the previous editions.
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Further, we have also expanded some of the old topics. As in previous editions, the questions from ten different state PG entrance examinations
have also been incorporated at the end of ervery chapter.
Questions from latest entrancie examinations of AIIMS have been added. Several other questions have been incorporated
from PGI, DPG and other state PGh entrance examinations.
To make the contents of the book more authentic, we have provided appropriate references to all the explanations.
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In some topics, there are contradictions between different books. In such a situation, we have quoted the text from
Harrison’s Principles of Internal Medicine, 18th edition.
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To help the students understand the Pharmacology in an easy and interesting way, Dr Gobind Rai Garg has started his
own institute named ‘Ayush Institute of Medical Sciences’. It is the only institute which is meant for teaching Pharmacology
only. Dr Gobind Rai Garg himself conducts separate classes for MBBS students (Jan-Feb) and those preparing for PG entrance
examinations (March-April and July-August). For details, you can contact on the E-mail ID provided or at 09990044695.
We must admit hereby that despite keeping an eagle’s eye for any inaccuracy regarding factual information or typographical
errors, some mistakes must have crept in inadvertently. You are requested to communicate these errors and send your valuable
suggestions for the improvement of this book. Your suggestions, appreciation and criticism are most welcome.
April 2015 Gobind Rai Garg
Sparsh Gupta
E-mail: [email protected]
[email protected]
https://kat.cr/user/Blink99/
Preface to the First Edition
Pharmacology is one of the most difficult and at the same time most important subject in various postgraduate entrance
examinations.
As we experienced it ourselves, most of the students preparing for postgraduate entrance examinations are in a dilemma,
whether to study antegrade or retrograde. Antegrade study takes a lot of time and due to bulky textbooks, some important
questions are likely to be missed. In a retrograde study, the students are likely to answer the frequently asked MCQs but new
questions are not covered. We have tried to overcome the shortcomings of both of the methods while keeping the advantages
intact.
In this book, we have given a concise and enriched text in each chapter followed by MCQs from various postgraduate
entrance examinations and other important questions likely to come. The text provides the advantage of antegrade study in a
short span of time.
After going through the book, it will be easier for the student to solve the questions of most recent examinations, which are
given at the end of the book.
More and more questions about new drugs are being asked in the entrance examinations nowadays. These NEW DRUGS
have been covered along with the text and a separate chapter has been added at the end. Salient features of the new drugs along
with the reference in the text have been included in this chapter.
Recently, the questions are being asked from SOME EMERGING TOPICS like anti-obesity drugs, anti-smoking drugs,
drugs for erectile dysfunction and nitric oxide. All these topics have been discussed in a separate chapter.
Large number of questions about first choice drugs is being incorporated in the entrance examinations. To cover these
questions, a separate chapter entitled “DRUGS OF CHOICE” has been added.
Important ADVERSE EFFECTS caused by drugs have also been included.
It is very difficult and at times very confusing to remember large number of drugs and adverse effects. To make learning
easy, several easy to grasp MNEMONICS have been given throughout the text.
Despite our best efforts, some mistakes might have crept in, which we request all our readers to kindly bring to our notice.
Your suggestions, appreciation and criticism are most welcome.
Gobind Rai Garg
Sparsh Gupta
E-mail: [email protected]
[email protected]
https://kat.cr/user/Blink99/
Acknowledgments
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When emotions are profound, words sometimes are not sufficient to express our thanks and gratitude. With these few words,
we would like to thank our teachers at University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, for the
foundation they helped to lay in shaping our careers. R
We are especially thankful to Dr KK Sharma, Ex-Professor and Head, Department of Pharmacology, UCMS, who is a father
figure to whole of the department. V
We would also like to acknowledge the encouragement and guidance of Dr CD Tripathi (Director-Professor and Head,
VMMC), Dr SK Bhattacharya (Professor and Head, NDMC Medical Colleged and Hindu Rao Hospital), Dr Uma Tekur
(Director-Professor, MAMC), Col Dr AG Mathur (Professor and Head, ACMS), Dr Vandana Roy (Director-Professor and
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Head MAMC) and Dr Shalini Chawla (Professor, MAMC), all in the department of Pharmacology, in the completion of this
book.
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We feel immense pleasure in conveying our sincere thanks to alil the residents of department of Pharmacology at MAMC
and UCMS for their indispensable help and support. n
No words can describe the immense contribution of our parents, Ms Praveen Garg, Ms Ruhee, Ms Anju, Mr Rohit Singla,
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Mrs Komal Singla, Mr Nitin Misra and Ms Dhwani Gupta, without whose support this book could not have seen the light of
the day.

Although it is impossible to acknowledge the contribution of all individually, we extend our heartfelt thanks to:
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• Dr Sapna Pradhan, Associate Professor (Pharmacology), ACMS, Delhi.

• Dr Bhupinder Singh Kalra, Assistant Pr9ofessor (Pharmacology), MAMC, Delhi.
• Lt Col (Dr) Sushil Sharma, Associate Professor (Pharmacology), AFMC, Pune.
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• Lt Col (Dr) Dick BS Brashier, Associate Professor (Pharmacology), AFMC, Pune.
• Dr Nitin Jain, DCH, DNB (Pedriatrics), Delhi.
• Dr Sushant Verma, MS (Geineral Surgery), MAMC, Delhi.
• Dr Kapil Dev Mehta, MDh (Pharmacology), UCMS, Delhi.
• Dr Saurabh Arya, MD (Pharmacology), UCMS, Delhi.
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• Dr Deepak Marwah, MD (Pediatrics), MAMC, Delhi.
• Dr Shubh Vatstya, MD (Medicine), MAMC, Delhi.
• Mr Rajesh Sharma, MBA.
• Dr Puneet Dwivedi (DA), Hindu Rao Hospital, Delhi.
• Dr Sandeep Agnihotri, DVD, Safdarjang Hospital, Delhi.
• Dr Harsh Vardhan Gupta MD, Pediatrics, Patiala.
• Mr Tarsem Garg, LLB, DM, SBOP.
• Dr Pardeep Bansal, MD (Radiodiagnosis), UCMS, Delhi.
• Dr Pankaj Bansal, MS (Orthopedics), RML Hospital, Delhi.
• Dr Pradeep Goyal, MD (Radiodiagnosis), LHMC, Delhi.
• Dr Rakesh Mittal, MS (Surgery), Safdarjung Hospital, Delhi.
• Dr Amit Miglani, DM (Gastroenterology), PGI, Chandigarh.
• Dr Sachin Gupta DA, DMC (Ludhiana).
• Dr Reenu Gupta DGO BMC (Bangalore).
• Dr Shiv Narayan Goel, MCh (Urology), KEM, Mumbai.
• Dr Anurag Aggarwal (DA, MD Anesthesia, MAMC).
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Review of Pharmacology
• Dr Kamal Jindal, MD (Physiology), LHMC, Delhi.
• Dr Gaurav Jindal, MD (Radiodiagnosis), Resident, Boston, USA.
• Dr Saket Kant, MD (Medicine, UCMS), DM (Endocrinology, BHU).
• Dr Mukesh Kr Joon, DM (Cardiology), Udaipur, Rajasthan.
• Dr Sonal Pruthi, UCMS, Delhi.
• Dr DJ Mohanty, Lecturer, MS (Surgery), UCMS, Delhi.
• Dr Amit Garg, MD (Psychiatry), GB Pant Hospital, Delhi.
• Dr Ravi Gupta, MD (Psychiatry), GTB Hospital, Delhi.
• Dr Shashank Mohanty, MD (Medicine), Udaipur, Rajasthan.
• Dr Amit Shersia, MS (Orthopedics), MAMC, Delhi.
• Dr Mohit Gupta, DCP, DNB (Pathology), Delhi.
• Dr Mayank Dhamija, DCH, DNB (Pediatrics), DNB (Hemato-oncology), Delhi.
• Dr Nitin Kumar, NDMC Medical College and Hindu Rao Hospital, Delhi.
Last but not the least, we would like to thank Shri Jitendar P Vij (Group Chairman), Ms Chetna Malhotra Vohra
(Associate Director), Ms Saima Rashid (Project Manager), Dr Vinod Kumar (Editor) of M/s Jaypee Brothers Medical
Publishers (P) Ltd, New Delhi, India, publishers of this book and the entire PGMEE team for their keen interest,
innovative suggestions and hardwork in bringing out this edition.
April 2015 Gobind Rai Garg
Sparsh Gupta
From the Publisher’s Desk
We request all the readers to provide us their valuable suggestions/errors (if any)
at: [email protected]
so as to help us in further improvement of this book in the subsequent edition.
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References
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• Harrison’s Principles of Internal Medicine, 18th edition
• Goodman and Gilman’s The Pharmacological Basis of Therapeutics, 12th edition
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• Katzung’s Basic and Clinical Pharmacology, 12th edition
• HL Sharma and KK Sharma’s Principles of Pharmacology, 2nd edition V
• KD Tripathi’s Essentials of Medical Pharmacology, 7th edition
• Current Medical Diagnosis and Treatment 2015 d
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SYMBOLS USED IN BOXES ON ‘HIGH YIELD POINTS’
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• Key points
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• Definition
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• N New drug
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• Controversial question
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Contents
1. History of Pharmacology 1
2. General Pharmacology 3
Chapter Review 3
Multiple Choice Questions 20
Explanations 37
3. Autonomic Nervous System 55
Chapter Review 55
Multiple Choice Questions 77
Explanations 94
4. Autacoids 111
Chapter Review 111
Multiple Choice Questions 126
Explanations 138
5. Cardiovascular System 149
Chapter Review 149
Multiple Choice Questions 176
Explanations 196
6. Kidney 215
Chapter Review 215
Multiple Choice Questions 222
Explanations 229
7. Endocrinology 235
Chapter Review 235
Multiple Choice Questions 268
Explanations 289
8. Central Nervous System 313
Chapter Review 313
Multiple Choice Questions 342
Explanations 368
9. Anaesthesia 397
Chapter Review 397
Multiple Choice Questions 415
Explanations 425
10. Hematology 437
Chapter Review 437
Multiple Choice Questions 450
Explanations 459
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