Drugs in pregnancy and lactation

1. Discuss significance of pregnancy categories of drugs. 2. What are the major stages in pregnancy? 3. Define teratogenicity, dysmorphogenesis, congenital anomaly and idiosyncratic effects. 4. What are the major causes of idiosyncratic effects? 5. Name major patho-physiological conditions that ameliorate during pregnancy with respective medications used for treatment in each cases. What are their reasons and prevalence? 6. Classify congenital anomaly. What factors lead to congenital anomaly? 7. Deduce factors induce placental drug transfer. 8. Discuss impact of fetal exposure of Phenobarbital, Danazol, Alcohol, Cyproterone, Diuretics, Sulphonamides and ACE inhibitors. 9. Pharmacological effects on fetus are usually dose related and to some extent predictable give examples. 10. How premature birth is associated with NSAIDs? 11. What are the complications with NSAIDs during late pregnancy? What could be a safe and well tolerated alternative? 12. How milk secretion is altered by various agents in nursing mothers? 13. Why phenytoin needs a dose increase in managing seizures during pregnancy although related plasma protein got a major fall? 14. What should be the immediate step if dose declining of antidepressants or neuroleptics failed before parturition? 15. What are the impacts of altered protein binding during pregnancy? 16. What should be your advice in prescribing folic acid during pregnancy and sumatriptan and phenytoin in nursing mother? 17. Drug dose should be tapered to the lowest effective dose before and during conception give at least 4 examples where the concept cannot be implemented. 18. Give specific reasons of dose alterations due to altered hepatic and renal clearances during pregnancy?

Neonates
1. Discuss the following terms i. Normal gestation period ii. Neonatal period iv. Post-term baby v. LBW iii. Pre-term baby vii. ELBW

vi. VLBW

2. Demography (Discussions on high risk baby, prevalence) 3. Give examples of treating fetus with intensions not to treating pregnant mother. 4. Give examples of adverse effects in fetus during mothers treatment. 5. Why preterm babies need a swift wash while chlorhexidine is used during an antiseptic bath? 6. Oral absorption is erratic in any newborn baby- discuss other routs for appropriate absorption. 7. Discuss impact of size of body water pool in neonatal drug exposure. 8. Protein binding among preterm babies is predictablewhat should be the impact on acidic drugs? 9. What are the factors that generally affects neonatal drug metabolism? 10. Hepatic and renal function is slow among neonateswhat measures should be taken? 11. The amount of adepose tissues varies substantially between babies give examples. 12. Discuss Naloxone treatment in managing neonatal withdrawal effects. 13. What are the clinical manifestations and treatment options for RDS? 14. High inspired O2 concentration is not associated with pulmonary toxicity in neonates like adults; still they are not out of danger. What are the other possible adverse outcomes? 15. What are the implications of steroid therapies in pregnant women and in neonates? 16. Mechanical ventilation is not a comfortable experience discuss measures taken for neonates. 17. What are the major complications raised during neonatal PDA? 18. What are the serious potential side effects of IV Indomethacin in PDA management? 19. Discuss factors on which likelihood of BPD depends. 20. What are the treatment options for BPD? 21. Define terminologies associated with neonatal respiratory disorders (Hypoxia, Anoxia, Dyspnoea etc.) 22. What are the complicacies raised during neonatal apnoea? 23. Discuss priorities of stimulants in treating neonatal Apnoea. When it should be stopped?

24. What are the reasons behind Hypoxic Ischemic Encephalopathy (HIE)? 25. What are the treatment options for neonatal seizures? 26. Name pathogens responsible for major neonatal infections. 27. What are the clinical manifestations and treatment options for NEC in neonates? 28. Discuss role of Vit K in managing hemorrhagic diseases in newborn.

Pediatrics
1. What pathological conditions are on top in taking admission to pediatric care? 2. What are the factors involved in absorption from oral preparations? 3. Discuss impact of intra-osseous route as an alternative for IV route in pediatric patients. 4. Intra-nasal absorption is associated with both local and systemic effectgive examples. 5. Total body water and ECF volume decreases with ageis there any impact on drug distribution? 6. What are the advantages of needle free subcutaneous jet injections in treating children? 7. Compare rectal drug administration with oral rout for pediatric patients. 8. Discuss instances when buccal route gets priorities over oral route in pediatric care units. 9. What are the problems associated with oral route in children. 10. Discuss impacts of altered protein binding in several pediatric disease states. 11. Give a tabular representation of Theophyline doses among age groups? What it represents? 12. Renal clearance of Gentamicin is higher among premature infants explain. 13. Manufacturers rarely provide information on BSA basiscan you solve this by a single formula? 14. Body weight rather than surface area is important parameter for cytotoxic drugs- why? 15. Why Paracetamol overdose is less toxic to children than older adults? 16. What incidences give rise to nasogastric and gastrectomy administration? 17. What problems are associated with fluid overload during IV administration? 18. Discuss the following terminologies in the light of IV infusion in pediatric care unit i. ii. iii. Dead space Displacement volume Rate of infusion

Geriatrics
1. Prevalence of geriatric disorders and therapeutic class commonly prescribed. 2. Point out age related changes in elderly patients. 3. Age related rate of absorption is compromised but not extent of absorption what should be your suggestion for general treatment profile? 4. Why clinical effects of some drugs at therapeutic doses significantly enhanced in elderly patients? Give examples. 5. How age related physiological changes affect drug distribution in elderly patients? 6. How dose adjustment is correlated with hepatic and renal clearance in elderly patients? 7. Briefly describe age related pharmacodynamic changes in elderly patients. 8. What factors causes blunt responses to reflex tachycardia among elderly patients? 9. What are the impacts of frequency and amplitude of age related corrective movements in elderly
patients? Or what factor contributes to occurrence of fall in elderly?

10. What are possible reasons of accidental hypothermia in elderly? 11. How cholinergic transmission physiologically related with cognitive function? Why it is disrupted in elderly patients? 12. What are the possible impacts of visceral muscle functions impaired during old age? 13. Describe in brief about the age related changes in specific receptors and target sites. 14. Name major clinical disorders precipitate in elderly patients. 15. Give a short briefing on different forms of cognitive dysfunctions in elderly. 16. What are the possible treatment options of cognitive dysfunctions in elderly? Why Bromocriptine and other ergot derivatives should be avoided in elderly? 17. Explain the term Drug Holiday. Why it is essential in elderly? 18. How arterial fibrillation is associated with strokes in elderly? 19. What are the typical features and atypical symptoms of cardiac failure in elderly? What are the possible treatment options? 20. What are the pharmacological and non-pharmacological treatments of Hypertension in elderly? 21. What are the possible causes and treatment options of osteoporosis? 22. What are the different forms of leg ulcers common in elderly? How they are treated? 23. What are the complications associated with urinary incontinence in elderly patients?

24. Why constipation is common in elderly patients? How it is treated? 25. Principles and goals of drug therapy in elderly

Laboratory Data

1. Normal adult reference values measured in serum. 2. Describe reasons of positive and negative water balance inside human body. 3. What factors influence water balance in the body? 4. What factors are responsible for fluid exchange between capillaries and interstitial spaces? 5. How Aldosterone and ADH regulates kidney for water balance? 6. How you can replenish insensible water loss? 7. Distinguish features of ECF and ICF. 8. Give name of the trans-cellular fluids that are included in body spaces. 9. Major Intra- and extracellular ions (Na+, K+, Ca+2, HCO3- , PO4-2 Physiological role, excess and deficiency) 10. Examples of drugs to cause Na+ and K+ excess/ deficit. 11. What factors alleviate or excess serum creatinine, urea and uric acid? 12. Write a short note on Glycated Hemoglobin (HbA1C). 13. Name the markers of Liver function tests (LFTs) in general. What usually they stand for? 14. What are the causes of serum albumin fall? Describe in brief. 15. What is the fate of bilirubin? Why do they elevate during jaundice? 16. What are the reasons behind elevation of following enzymes a. Alkaline Phosphatase b. Transaminases c. Glutamyl Transpeptidase

17. Shortly describe the following cardiac markers a. Troponins b. Creatinin Kinase c. Lactate Dehydrogenase

18. Terminologies used in hematology (MCV, PCV, MCH, MCHC) 19. Hemoglobin, platelet, WBC count 20. Other blood tests like ESR, C-protein, BT, CT, INR, APTT, D-dimers, Coombss test. 21. Iron binding and storage proteins, Vit B12 and Folate.

Liver Disease
1. What are the different types of functions of liver? Give examples. 2. Deduce blood supply of hepato-portal circulation. 3. Define Acute and Chronic liver diseases. 4. Shortly describe prognosis of viral infections of liver. 5. Prevalence transmission profiles and treatment of hepatitis A, B and C. 6. Shortly describe acute and chronic HBV. 7. How Alcohol is associated with liver cirrhosis? 8. Which form of viral hepatitis is associated with liver transplantation? 9. How autoimmune hepatitis developed in men and women? 10. Vascular abnormalities (BCS, Constructive pericarditis and VOD) 11. How billiary obstruction and cholestasis developed? 12. Write short none on Gilberts syndrome, gynecomastia. 13. What are the patient complaints of CLDs? 14. What are the cutaneous and abdominal signs of CLDs? 15. Table 14.1 Physical signs of chronic liver diseases. 16. What are the complications of Portal hypertension? How it is associated with ascites and hepatic encephalopathy? 17. What are reasons behind swollen abdomen in CLDs? 18. Diagnosis of liver function. 19. What are the treatment options for pruritus? See also Table 14.3 20. Patient care in ascites. See also Table 14.5 21. How BBB is altered in hepatic encephalopathy? Therapeutic aim to treat encephalopathy. 22. Esophageal varices (treatment aim and management) 23. Liver transplantation