Newer drugs and recent approvals

54 NEET-PG practice questions on Newer drugs and recent approvals, part of Pharmacology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium

   Four months after starting fortnightly dupilumab injections for severe atopic dermatitis, a college student's eczema has cleared, but she complains of red, itchy, watery eyes in both eyes. Her vision is normal. She does not wear contact lenses and has no purulent discharge. This drug blocks a receptor shared by which two cytokines?

   1. AIL-12 and IL-23
   2. BIL-4 and IL-13
   3. CIL-17A and IL-17F
   4. DIL-5 and IL-3

   Show answerHide answer

   Answer: B · IL-4 and IL-13

   Dupilumab is a monoclonal antibody against the IL-4 receptor alpha subunit, which is shared by the IL-4 and IL-13 receptors; blocking it suppresses type 2 inflammation in atopic dermatitis, asthma, chronic rhinosinusitis with polyps and eosinophilic oesophagitis. Conjunctivitis is its commonest distinctive adverse effect, particularly in atopic dermatitis, and transient eosinophilia also occurs.

   • A: The shared p40 subunit of IL-12 and IL-23 is targeted by ustekinumab.
   • C: IL-17 is targeted by secukinumab and ixekizumab.
   • D: IL-5 is targeted by mepolizumab and its receptor by benralizumab.

   Remember this

   Dupilumab blocks IL-4R-alpha (IL-4 and IL-13 signalling); conjunctivitis is a typical adverse effect.

2. Question 2 · Easy

   Nirsevimab, a single intramuscular dose given to infants before their first RSV season, works by which action?

   1. AInhibitor of the RSV polymerase
   2. BInterferon inducer in the airway
   3. CLong-acting antibody against the RSV F protein
   4. DLive attenuated RSV vaccine

   Show answerHide answer

   Answer: C · Long-acting antibody against the RSV F protein

   Nirsevimab is a monoclonal antibody against the pre-fusion F (fusion) protein of RSV, with an Fc modification that extends its half-life so that one dose protects for about five months. It is passive immunisation and reduces medically attended RSV lower respiratory infection and admissions in infants. It replaced monthly palivizumab in many countries.

   • A: It does not inhibit viral polymerase.
   • B: It does not induce interferon.
   • D: It is passive antibody, not a vaccine.

   Remember this

   Nirsevimab is a long-acting anti-RSV F protein antibody; one dose covers a season.

3. Question 3 · Medium

   Statin-associated muscle pain has made a woman with familial hypercholesterolaemia stop three different statins. Her doctor prescribes an oral prodrug that inhibits ATP-citrate lyase and is activated only in the liver. Her LDL cholesterol is 196 mg/dL on ezetimibe alone, and her liver enzymes are normal. Which adverse effect is most characteristic of this drug?

   1. AHypoglycaemia
   2. BMyopathy with high CK
   3. CRaised uric acid and gout
   4. DSteatorrhoea

   Show answerHide answer

   Answer: C · Raised uric acid and gout

   Bempedoic acid inhibits ATP-citrate lyase, upstream of HMG-CoA reductase in cholesterol synthesis. It is activated by an acyl-CoA synthetase present in the liver but not in skeletal muscle, so it rarely causes myalgia and suits statin-intolerant patients. It competes with urate for renal tubular transport and raises uric acid, causing gout, and tendon rupture has been reported.

   • A: It does not lower glucose.
   • B: Bempedoic acid is not activated in muscle, so myopathy is uncommon.
   • D: Steatorrhoea is an effect of orlistat.

   Remember this

   Bempedoic acid is liver-activated (little myalgia) but raises uric acid and can cause gout.

4. Question 4 · Medium

   A pharmacology quiz on direct oral anticoagulants lists: 1. Apixaban directly inhibits factor Xa. 2. Dabigatran etexilate is a prodrug. 3. DOACs are preferred over warfarin for mechanical heart valves. 4. Rivaroxaban acts by binding antithrombin. Which statements are correct?

   1. A1 and 2 only
   2. B2 and 3 only
   3. C1, 3 and 4 only
   4. D1, 2 and 4 only

   Show answerHide answer

   Answer: A · 1 and 2 only

   Apixaban, rivaroxaban and edoxaban bind factor Xa directly without needing antithrombin; it is fondaparinux and the heparins that act through antithrombin. Dabigatran etexilate is a prodrug hydrolysed by esterases to dabigatran, a direct thrombin inhibitor. DOACs are contraindicated, not preferred, with mechanical valves.

   • B: Statement 3 is wrong: DOACs are contraindicated with mechanical valves.
   • C: Statements 3 and 4 are both wrong.
   • D: Statement 4 is wrong: rivaroxaban needs no antithrombin.

   Remember this

   DOACs act directly on Xa or thrombin without antithrombin; they are not used for mechanical valves.

5. Question 5 · Medium

   LDL cholesterol remains 128 mg/dL in a man with a previous MI despite maximum-dose atorvastatin and ezetimibe. His cardiologist recommends an injection given on day 1, at 3 months and then every 6 months, which works by RNA interference in the liver. He is 61 and adheres to his diet and tablets. Which drug is it?

   1. ABempedoic acid
   2. BEvolocumab
   3. CAlirocumab
   4. DInclisiran

   Show answerHide answer

   Answer: D · Inclisiran

   Inclisiran is a small interfering RNA conjugated to GalNAc so that it is taken up by hepatocytes, where it degrades PCSK9 mRNA and stops PCSK9 synthesis. More LDL receptors survive, and LDL falls by about half; its long action allows twice-yearly maintenance doses. Evolocumab and alirocumab achieve a similar effect as monoclonal antibodies that bind circulating PCSK9 and are injected every 2-4 weeks.

   • A: Bempedoic acid is an oral ATP-citrate lyase inhibitor.
   • B: Evolocumab is a monoclonal antibody against PCSK9 injected every 2-4 weeks.
   • C: Alirocumab is also an anti-PCSK9 antibody, not an siRNA.

   Remember this

   Inclisiran is an siRNA that silences hepatic PCSK9 synthesis, given every 6 months.

6. Question 6 · Medium

   Weekly subcutaneous tirzepatide is prescribed for a man with type 2 diabetes and obesity. His physician explains that it differs from semaglutide because it acts on two receptors. He had used liraglutide before but stopped because weight loss was modest. His HbA1c is 8.9% and BMI 37 kg/m2. Which two?

   1. AGIP and glucagon receptors
   2. BGIP and GLP-1 receptors
   3. CGLP-1 and amylin receptors
   4. DGLP-1 and glucagon receptors

   Answer and explanation in LearnFree account

7. Question 7 · Hard

   Nirmatrelvir-ritonavir is planned for a high-risk man with mild COVID-19 on day 2 of symptoms. He takes simvastatin 40 mg, metformin and amlodipine 5 mg, and his eGFR is 72 mL/min/1.73 m2. He is 68, with hypertension and obesity (BMI 32 kg/m2), and was not vaccinated in the past year. Which change to his usual medicines is most appropriate during the 5-day course?

   1. AContinue simvastatin and check CK on day 5
   2. BReplace simvastatin with lovastatin
   3. CReplace simvastatin with atorvastatin 80 mg
   4. DWithhold simvastatin until a few days after the course

   Answer and explanation in LearnFree account

8. Question 8 · Easy

   Orlistat causes oily stools and fat-soluble vitamin deficiency because it inhibits which enzyme?

   1. AHMG-CoA reductase
   2. BIntestinal alpha-glucosidase
   3. CPancreatic and gastric lipase
   4. DHormone-sensitive lipase

   Answer and explanation in LearnFree account

9. Question 9 · Medium

   An obesity clinic is choosing a drug for a man with BMI 36 kg/m2, hypertension controlled on amlodipine and a history of generalised tonic-clonic seizures, now controlled on levetiracetam. He drinks no alcohol, takes no opioids and has no eating disorder. His HbA1c is 6.1%. Which anti-obesity drug is contraindicated in him?

   1. ALiraglutide 3 mg daily
   2. BSemaglutide 2.4 mg weekly
   3. CNaltrexone-bupropion
   4. DOrlistat

   Answer and explanation in LearnFree account

10. Question 10 · Easy

    Which agent specifically reverses the anticoagulant effect of dabigatran?

    1. AVitamin K1
    2. BProtamine sulphate
    3. CAndexanet alfa
    4. DIdarucizumab

    Answer and explanation in LearnFree account

11. Question 11 · Medium

    In the casualty, a man on apixaban for atrial fibrillation has a large intracerebral haemorrhage on CT; he took his last dose 4 hours ago. GCS is 12 and BP is 168/96 mmHg. His INR is 1.3 and platelets are 2.1 lakh/µL. Which specific reversal agent acts as a decoy for this drug?

    1. ATranexamic acid
    2. BFresh frozen plasma
    3. CAndexanet alfa
    4. DIdarucizumab

    Answer and explanation in LearnFree account

12. Question 12 · Medium

    In the pre-anaesthetic clinic, a man listed for elective cholecystectomy says he injects semaglutide every Sunday for obesity. He has had bloating and early satiety since the dose was increased. His last dose was three days ago, and he fasted for 8 hours as told. What is the main anaesthetic concern with this drug?

    1. ASevere hypoglycaemia during surgery
    2. BProlonged block with suxamethonium
    3. CResistance to non-depolarising relaxants
    4. DRetained gastric contents and aspiration at induction

    Answer and explanation in LearnFree account

13. Question 13 · Easy

    Urine dipstick shows glucose 3+ in a patient on empagliflozin whose fasting blood glucose is 104 mg/dL. What does this mean?

    1. AA false-positive dipstick from ketones
    2. BAn expected effect of the drug
    3. CPoor control needing a dose increase
    4. DA renal tubular disorder

    Answer and explanation in LearnFree account

14. Question 14 · Medium

    LVEF 30% is reported in a non-diabetic tailor with heart failure who remains breathless on climbing one flight of stairs despite sacubitril-valsartan, bisoprolol and spironolactone at target doses. His eGFR is 58 and potassium 4.6 mmol/L. His BP is 112/70 mmHg and pulse 64/min in sinus rhythm. Which drug should be added to reduce heart failure admissions and death?

    1. AIvabradine
    2. BHydralazine with isosorbide dinitrate
    3. CDapagliflozin
    4. DDigoxin

    Answer and explanation in LearnFree account

15. Question 15 · Medium

    Serum lipase 980 U/L (normal < 60) is reported in a woman eight weeks after starting liraglutide for weight loss. She has severe epigastric pain radiating to the back and vomiting. Ultrasound shows no gallstones, she does not drink alcohol and her triglycerides are normal. What should be done about the drug?

    1. AWithhold it until pain settles, then restart
    2. BContinue it with a proton pump inhibitor
    3. CStop it and do not restart any GLP-1 agonist
    4. DSwitch to semaglutide after recovery

    Answer and explanation in LearnFree account

16. Question 16 · Medium

    After 30 months of natalizumab for relapsing multiple sclerosis, a teacher develops progressive right-sided weakness, aphasia and behavioural change over three weeks without fever. MRI shows asymmetric, non-enhancing white matter lesions in the left frontoparietal lobe, unlike her earlier MS plaques. Her anti-JCV antibody is positive. Which diagnosis must be confirmed now?

    1. AProgressive multifocal leukoencephalopathy
    2. BHerpes simplex encephalitis
    3. CPrimary CNS lymphoma
    4. DAn acute MS relapse

    Answer and explanation in LearnFree account

17. Question 17 · Medium

    Screening of a 12-year-old boy whose brother has type 1 diabetes shows two islet autoantibodies with abnormal glucose tolerance but no symptoms (stage 2 disease). A drug approved to delay progression to clinical (stage 3) type 1 diabetes is offered. His HbA1c is 5.9%. His parents ask whether any drug can delay the need for insulin. Which is it?

    1. AAbatacept, a CTLA-4 fusion protein
    2. BSitagliptin, a DPP-4 inhibitor
    3. CRituximab, an anti-CD20 antibody
    4. DTeplizumab, an anti-CD3 antibody

    Answer and explanation in LearnFree account

18. Question 18 · Hard

    Memory complaints for 2 years in a retired professor, with an MMSE of 24/30 and amyloid PET positive, lead his family to ask about lecanemab. He takes apixaban for atrial fibrillation, and his baseline MRI shows two microbleeds. APOE testing shows one e4 allele. He still manages his finances with help, walks daily and lives with his wife, who supervises his medicines. His BP is 132/80 mmHg, his CHA2DS2-VASc score is 4 and he has never had a stroke or a fall. Which concern most strongly argues against starting lecanemab now?

    1. AHis single APOE e4 allele
    2. BLack of benefit in mild cognitive impairment
    3. CRisk of brain haemorrhage with anticoagulation
    4. DInteraction of lecanemab with apixaban metabolism

    Answer and explanation in LearnFree account

19. Question 19 · Medium

    Mitral valve replacement with a mechanical (bileaflet) prosthesis was done three weeks ago in a woman with rheumatic heart disease, and she is in sinus rhythm. She asks whether she can take dabigatran instead of warfarin to avoid INR checks. Her INR has been unstable, between 1.8 and 4.2, over the past three weeks. What is the correct advice?

    1. AContinue warfarin with INR monitoring
    2. BSwitch to dabigatran after 3 months
    3. CChange to aspirin with clopidogrel
    4. DSwitch to apixaban, which is safer in valves

    Answer and explanation in LearnFree account

20. Question 20 · Hard

    Weekly tirzepatide for obesity was started a month ago in a lawyer who relies on a combined oral contraceptive pill. The dose is due to rise from 2.5 mg to 5 mg next week. She has no plans for pregnancy and no history of thrombosis or migraine. She weighs 96 kg, her BMI is 36 kg/m2, and she has polycystic ovary syndrome with irregular cycles that have recently become regular. She does not smoke and her BP is 124/80 mmHg. She asks whether her pill will still work. Besides warning her about nausea, what contraceptive advice is most appropriate?

    1. AStop the pill as tirzepatide raises oestrogen levels
    2. BChange to the progestogen-only pill
    3. CNo change: tirzepatide does not interact with the pill
    4. DAdd a barrier method for 4 weeks after each dose rise

    Answer and explanation in LearnFree account

21. Question 21 · Hard

    Two months after starting apixaban 5 mg twice daily for a pulmonary embolism, a factory worker is diagnosed with sputum-positive, rifampicin-sensitive pulmonary tuberculosis. Weight-band daily HRZE is to begin. His renal and liver function are normal and he has no bleeding. What is the best plan for his anticoagulation?

    1. ADouble the dose of apixaban
    2. BAdd aspirin to the apixaban
    3. CChange to enoxaparin while he takes rifampicin
    4. DContinue apixaban and check the INR weekly

    Answer and explanation in LearnFree account

22. Question 22 · Hard

    Antiphospholipid syndrome was diagnosed in a woman after an unprovoked femoral vein thrombosis; lupus anticoagulant, anticardiolipin and anti-beta-2 glycoprotein I antibodies were all positive on two occasions 12 weeks apart. She was discharged on rivaroxaban and wants to stay on it to avoid INR checks. She is not pregnant. What is the best long-term anticoagulant?

    1. AWarfarin with a target INR of 2-3
    2. BSwitch to apixaban 5 mg twice daily
    3. CAspirin 75 mg daily alone
    4. DContinue rivaroxaban at the same dose

    Answer and explanation in LearnFree account

23. Question 23 · Medium

    During a diabetes clinic review, a woman on oral semaglutide 7 mg for three months shows almost no fall in HbA1c. She takes the tablet with her breakfast tea and her other morning medicines. She has no nausea, and her weight has not changed; she is a primary school teacher who leaves home early. What is the most important advice?

    1. ATake it fasting with a sip of water, 30 minutes before food
    2. BTake it at bedtime with milk
    3. CTake it with breakfast to reduce nausea
    4. DCrush the tablet and mix it into a spoonful of curd at breakfast

    Answer and explanation in LearnFree account

24. Question 24 · Hard

    On the second day after a laparoscopic cholecystectomy, a man with type 2 diabetes on metformin and empagliflozin (both continued until the evening before surgery) has vomiting, abdominal pain and deep sighing respiration. He has eaten little since the operation. Capillary glucose is 182 mg/dL, pH 7.12, HCO3 9 mmol/L, anion gap 24 mmol/L, and blood beta-hydroxybutyrate 5.8 mmol/L (normal < 0.6). Serum lactate is 1.4 mmol/L. He is drowsy but oriented. His BP is 104/66 mmHg, pulse 116/min and urine ketones 3+; serum potassium is 4.4 mmol/L and creatinine 1.3 mg/dL. What is the most appropriate treatment?

    1. AIV sodium bicarbonate until pH exceeds 7.3
    2. BIV fluids alone, as glucose is below 250 mg/dL
    3. CSubcutaneous insulin only if glucose exceeds 250 mg/dL
    4. DStop empagliflozin; IV fluids, insulin infusion and IV dextrose

    Answer and explanation in LearnFree account

25. Question 25 · Medium

    Consider these statements about denosumab for postmenopausal osteoporosis: 1. Its dose must be reduced in chronic kidney disease. 2. It is a monoclonal antibody against RANKL. 3. It is given subcutaneously every 6 months. 4. Stopping it without follow-on therapy can cause rebound multiple vertebral fractures. Which statements are correct?

    1. A1 and 4 only
    2. B1, 2, 3 and 4
    3. C2, 3 and 4 only
    4. D1, 2 and 3 only

    Answer and explanation in LearnFree account