1. Anatomy
    2. 1. Thoracic cage
    2. Respiratory muscles and Movements
    3. External Nose and Nasal cavity
    4. Paranasal Air Sinuses
    5. Pharynx
    6. Larynx
    7. Trachea
    8. Brochopulmonary segments
    9. Pleura
    10. Lung
    11. Diaphragm
    12. Histology (Epiglottis, Trachea and Lungs)
  2. Biochemistry
    3. 13. Metabolism in the Lungs
    14. Synthesis of Surfactant system in Lungs
    15. Hyaline Membrane Disease (Infant Respiratory Distress Syndrome)
    16. Gaseous Transport and Haemoglobin
    17. Ion Electrolyte Balance
    18. Henderson Hasselbalch Equation
    19. Anion Gap (AG)
    20. Biological Oxidation
    21. Electrolyte Transport Chain
  3. Microbiology
    4. 22. Streptococcus pyogenes
    23. Corynebacterium diphtheria
    24. Streptococcus pneumonia
    25. Haemophilus influenzae
    26. Pseudomonas aeruginosa
    27. Microbacterium tuberculosis
    28. Bordetella pertussis
    29. Whooping cough
    30. Viruses
    31. Orthomyxo viruses
    32. Paramyxoviruses
    33. Respiratory Syncytial Virus (RSV)
    34. Adenovirus
    35. Rhinovirus
    36. Severe Acute Respiratory Syndrome (SARS)
    37. Histoplasma Capsulatum
    38. Aspergillus
    39. Cryptococcus neoformans
    40. Pneumocystis carinii
    41. Parasites
    42. Paragonimus westermani
  4. Pathology
    5. 43. Atelectasis
    44. Tuberculosis
    45. Chronic Obstructive Pulmonary Disease
    46. Emphysema
    47. Bronchial Asthma
    48. Bronchiectasis
    49. Acute Respiratory Distress Syndrome
    50. Hyaline Membrane Disease
    51. Pneumonia
    52. Pneumoconiosis
    53. Bronchogenic Carcinoma
    54. Pleural Lesions
  5. Pharmacology
    6. 55. Antitussives, Expectorants and Mucolytics or Therapy of Cough
    56. Drugs used in Bronchial Asthema
    57. Nasal Decongestants and Cold remedies or Therapy of Allergic Rhinitis
    58. Chemotherapy of Tuberculosis
  6. Physiology
    7. 59. Mechanism and Mechanics of Breathing
    60. Regulation of Respiration
    61. Pulmonary circulation
    62. Pulmonary Gas exchange
    63. Gas transport and Exchange
    64. Lung compliance
    65. Pulmonary Function Tests
    66. Spirometry
    67. Applied Respiratory Physiology
    68. Abnormal Breathing
    69. Artificial Respiration
    70. Lung Defense Mechanism
Pharmacology
58. Chemotherapy of Tuberculosis

1.

Write about Category I anti-tubercular drugs.

[2069]

➤

2.

Classify drugs used in tuberculosis. Write briefly about isoniazid: mode of action and enumerate its side effects.

[2068]

➤

3.

Write on:
(a) First and second line anti-tubercular drugs
(b) Adverse effects of rifampin

[2061, 2060]

➤

4.

What are the 1st line drugs of tuberculosis? What is DOTS? Write down the DOTS regimen treatment of tuberculosis.

[2060]

➤

5.

List the adverse effects of rifampicin.

[2059]

➤

6.

List anti-tubercular drugs. Give two important adverse effects of each.

[2058]

➤

7.

Briefly describe the mechanism of action and adverse effects of:
(a) Isoniazid
(b) Rifampicin

[2055]

➤

8.

Write down the short course chemotherapy of tuberculosis recommended by the national tuberculosis programme of Nepal.

[2054]

➤

9.

Enumerate first line antitubercular drugs with their mechanism of action.

(4)

[2072]

➤

10.

Outline the major adverse effects of any four first line antitubercular drugs.

(4)

[2070]

➤

11.

Enumerate first line antitubercular agents with mechanism of action and two specific adverse effects.

(5)

[2075]

➤

12.

Discuss the mechanism of action, uses and adverse effects of rifampicin.

[]

➤

13.

Describe management of recurrent case of pulmonary tuberculosis. If further investigations reveal resistance to both rifampicin and isoniazid, what will be your line of management? Outline it.

(5)

[2076]

➤

14.

List the drugs used in tuberculosis and describe the mechanism of action of any three drugs.

(5)

[2077]

➤

BACTERIAL CELL WALL FORMATION
graph TD A1[Arabinose + Galactose ] --> |Arabinosyl transferase → E inhibits it| A2[Arabinogalactan] B1[Acety CoA] --> |FAS-1→Z inhibits it| B2[Fatty acid chain] B2 --> |FAS-2 → H inhibits it| B3[Mycolic acid] A2 & B3 --> C[Cell wall]
FIRST LINE DRUGS
Table: 1st line drugs properties
Properties
Isoniazid (H)
Rifampicin (R)
Pyrazinamide (Z)
Ethambutol (E)
Streptomycin (S)
Bacteriocidal/ Bacteriostatic
Bacteriocidal
Bacteriocidal
Bacteriocidal
Bacteriostatic
Bacteriocidal
Site of killing
Both
Both
Intracellular only
Both
Extracellular only
Type of bacteria mostly killed
Fast growing
Sputer
Slow growing
-
-
Adverse effects
  1. Peripheral neuritis
  2. Hepatotoxicity (+)
  1. Red section
    1. Red saliva
    2. Red urine
    3. Red sweat
    4. Red vaginal secretion
  2. Hepatotoxicity (+)
  1. Hyperuricemia → Gout
  2. Hepatotoxicity (+++)
  1. Hyperuricemia
  2. Optic neuritis
  1. Ototoxicity
    1. Cochlear toxicity (Hearing → Permanent)
    2. Vestibule toxicity (Balancing → Temporary)
  2. Nephrotoxicity
  3. Neuromuscular blockade
  4. Hypersensistivity reactions
  5. Teratogenic
MOA
  1. Cell wall synthesis inhibitor
  2. InhA and KasA gene inhibitor
  3. Inhibit FAS-2 (Fatty acid synthetase 2)
  1. DNA synthesis inhibitor
  2. rpoB gene inhibitor
  3. Inhibit DNA dependent RNA polymerase
  1. Cell wall synthesis inhibitor
  2. pncA gene inhibitor
  3. Inhibit FAS-1 (Fatty acid synthetase 1)
  1. Cell wall synthesis inhibitor
  2. embAB gene inhibitor
  3. Inhibit Arabinosyl transferase
  1. Protein synthesis inhibitor
    1. Freeze initiation of protein synthesis
    2. Causes misreading of the code if initiation started
  1. PK
    1. Enzyme inhibitor
    2. CSF penetration
    3. Acetylation
    1. Enzyme inducer
    1. CSF penetration