Mastering Pharmacology for NEET-PG and INI-CET in Just 4 Days

Daily Targets

  • Read/Revise 3–4 hours.
  • Solve 120–150 MCQs/day (30 per block, timed) with an error log.
  • Make 4–6 mini‑cards/day (MOA one‑liners, DOCs, antidotes, class AEs, contraindications).

Day 1 — General Pharmacology, Pharmacokinetics/Dynamics, Autonomic & Autacoids

General principles

  • Drug naming: chemical, generic, brand; prodrugs; orphan drugs.
  • Routes: oral, sublingual, IV/IM/SC, inhalational, transdermal, rectal, intrathecal; first‑pass effect concept.
  • Clinical trials: phases 0–IV (concept level); evidence hierarchy; pharmaco‑vigilance (ADR reporting).
  • Prescription essentials; OTC vs schedule drugs; medication errors basics.

Pharmacokinetics (ADME)

  • Absorption: bioavailability (F); factors affecting; P‑gp.
  • Distribution: Vd formula; plasma protein binding; compartments; blood–brain/placental barriers.
  • Metabolism: Phase I (oxidation/reduction/hydrolysis; CYP450); Phase II (UGT, acetylation, sulfation, methylation, glutathione); first‑pass metabolism.
  • Enzyme inducers: rifampin, carbamazepine, phenytoin, phenobarbital, St John’s wort, smoking, chronic alcohol.
  • Enzyme inhibitors: macrolides, azoles, isoniazid, cimetidine, ritonavir, grapefruit juice, acute alcohol.
  • Excretion: clearance (Cl), half‑life (t½), steady state (≈4–5 t½), loading vs maintenance dose, zero‑ vs first‑order elimination.

Pharmacodynamics

  • Receptors: GPCR (Gs/Gi/Gq), ion‑channels, RTK, nuclear; spare receptors.
  • Agonists/partial agonists/antagonists (competitive/non‑competitive); inverse agonists.
  • Dose–response curves: potency vs efficacy; shift with competitive antagonism (right shift, same Emax); non‑competitive (↓Emax).
  • Therapeutic index/window; idiosyncrasy; tachyphylaxis; tolerance.

Pharmacogenetics & special populations

  • HLA‑B57:01 (abacavir), HLA‑B15:02 (carbamazepine), slow acetylators (INH), G6PD deficiency (oxidant drugs), pseudocholinesterase deficiency.
  • Pregnancy/lactation: teratogens overview (ACEi/ARB, warfarin, isotretinoin, valproate, thalidomide, methotrexate); safer picks (penicillins/cephalosporins, heparin, labetalol, methyldopa, PTU 1st tri).
  • Elderly, renal/hepatic impairment — dose adjustments (concepts).

Autonomic pharmacology — overview

  • Receptors: M1–M3; α1, α2; β1, β2, β3; D1, D2.
  • Baroreceptor reflex interplay; end‑organ effects mapping.

Cholinergic drugs

  • Direct agonists: bethanechol (atony), pilocarpine (glaucoma/xerostomia).
  • Indirect (AChE inhibitors): edrophonium (Dx), neostigmine/pyridostigmine (MG), physostigmine (atropine toxicity), rivastigmine/donepezil (Alzheimer’s), organophosphates (toxicology).
  • Antimuscarinics: atropine (cholinergic tox, bradycardia), ipratropium/tiotropium (COPD), oxybutynin/solifenacin (OAB), scopolamine (motion sickness), tropicamide (mydriasis) — classic AEs (dry as a bone… ).
  • Antidote set for organophosphate: atropine + pralidoxime (early); diazepam for seizures.

Adrenergic drugs

  • Agonists:
    • α1: phenylephrine (decongestant, hypotension).
    • α2: clonidine (HTN), dexmedetomidine (sedation).
    • β1: dobutamine (cardiogenic shock), isoproterenol (β1/β2).
    • β2: salbutamol/albuterol (asthma), terbutaline (tocolysis concept).
    • Mixed: epinephrine (anaphylaxis), norepinephrine (septic shock), dopamine (dose‑dependent).
  • Antagonists:
    • α‑blockers: prazosin/tamsulosin (BPH), phenoxybenzamine/phentolamine (pheochromocytoma).
    • β‑blockers: cardioselective (metoprolol/atenolol), non‑selective (propranolol), with ISA (pindolol), with α‑block (carvedilol, labetalol); uses/AEs (bronchospasm, masking hypoglycemia).

Autacoids & anti‑inflammatory (intro)

  • Histamine (H1/H2) actions; H1 blockers: 1st gen (sedation, anticholinergic) vs 2nd gen (less sedating).
  • PGs/Leukotrienes overview; COX‑1/COX‑2; NSAIDs (ibuprofen, diclofenac), COX‑2 inhibitor (celecoxib) — AEs (renal, GI, CV); acetaminophen (N‑acetylcysteine antidote).

Day‑1 MCQs focus

  • Loading/maintenance dose math; Vd/Cl/t½; enzyme inducer vs inhibitor lists; dose–response shifts; receptor–effector mapping; organophosphate management; β‑blocker selectivity; first vs second‑gen antihistamines.

Day 2 — Cardiovascular, Renal, Respiratory, GI & Endocrine

Antihypertensives

  • RAAS blockers: ACEi (cough/angioedema—↑bradykinin), ARB (no bradykinin), renin inhibitor (aliskiren).
  • Calcium channel blockers: DHP (amlodipine) vs non‑DHP (verapamil/diltiazem) — vascular vs cardiac selectivity.
  • Diuretics used in HTN: thiazides (chlorthalidone), loop (furosemide) — AEs (hypo‑K⁺, metabolic alkalosis), K⁺‑sparing (spironolactone/eplerenone; gynecomastia with spirono).
  • Sympatholytics: β‑blockers; α2 agonists (clonidine); α1 blockers (prazosin) — first‑dose hypotension.
  • Vasodilators: hydralazine (arteriolar; drug‑induced lupus), minoxidil (hypertrichosis), nitroprusside (cyanide risk), nitrates (venodilators; tolerance).
  • Special situations: HTN in pregnancy (labetalol, methyldopa, nifedipine, hydralazine), hypertensive emergencies (nitroprusside, labetalol, nicardipine).

Antianginal & heart failure

  • Nitrates: MOA (NO→cGMP); AEs (headache, hypotension); contraindicated with PDE‑5 inhibitors.
  • β‑blockers: ↓O₂ demand; post‑MI benefit.
  • CCBs: variant angina (DHP).
  • HF regimen: ACEi/ARB/ARNI (sacubitril/valsartan), β‑blockers (metoprolol/carvedilol/bisoprolol), MRA (spironolactone/eplerenone), SGLT2 inhibitors (added CV/renal benefits), diuretics for symptoms; hydralazine–nitrate in selected.
  • Inotropic support (acute): dobutamine, milrinone.

Antiarrhythmics (Vaughan‑Williams)

  • Class I (Na⁺ block): IA (quinidine/procainamide—QT↑), IB (lidocaine—post‑MI VT), IC (flecainide—proarrhythmic in structural disease).
  • Class II β‑blockers.
  • Class III (K⁺ block): amiodarone (multi‑organ AEs—thyroid, lung, liver, cornea), sotalol (QT↑, torsades).
  • Class IV (Ca²⁺ block): verapamil/diltiazem (SVTs).
  • Others: adenosine (PSVT DOC—very short t½), MgSO₄ (torsades DOC), atropine (bradycardia).

Diuretics (renal pharmac)

  • Sites & transporters:
    • PCT (CA inhibitors—acetazolamide; glaucoma, altitude sickness; metabolic acidosis),
    • Loop (NKCC—furosemide; ototoxicity),
    • DCT (NCC—thiazides; hyper‑Ca²⁺),
    • CD (ENaC—amiloride; MRA—spironolactone).

Respiratory pharmacology

  • Asthma: SABA (salbutamol), LABA (salmeterol) + ICS (budesonide/fluticasone), LAMA (tiotropium), leukotriene modifiers (montelukast), theophylline (narrow TI), omalizumab (anti‑IgE concept).
  • COPD: LAMA/LABA ± ICS (in select); roflumilast concept.
  • Cough: antitussives (dextromethorphan), mucolytics (acetylcysteine), expectorants (guaifenesin).

GI pharmacology

  • Acid peptic: PPIs (omeprazole), H2 blockers (ranitidine/famotidine concept), antacids (drug interactions), sucralfate.
  • H. pylori triple/quadruple therapy concept.
  • Antiemetics: 5‑HT3 antagonists (ondansetron), D2 blockers (metoclopramide—EPS), H1, antimuscarinics; NK1 antagonists (aprepitant) awareness.
  • Prokinetics: metoclopramide/domperidone; macrolides (motilin) concept.
  • Diarrhea: ORS cornerstone; loperamide (symptomatic), racecadotril concept; dysentery antibiotics per etiology (concept only).
  • Constipation: osmotic (PEG, lactulose), stimulant (senna), stool softeners.

Endocrine

  • Diabetes:
    • Insulins (rapid/short/intermediate/long); AEs (hypoglycemia, weight gain).
    • Oral/other: metformin (↓hepatic gluconeogenesis; lactic acidosis risk), sulfonylureas (hypoglycemia), DPP‑4 inhibitors, GLP‑1 RA (weight loss, GI AEs), SGLT2 inhibitors (glycosuria, mycotic infections), thiazolidinediones (fluid retention).
  • Thyroid: levothyroxine; antithyroid (methimazole, PTU—1st tri); iodides; radioiodine (contra in pregnancy).
  • Adrenals: glucocorticoids (AEs: Cushingoid, osteoporosis, infections), mineralocorticoids (fludrocortisone).
  • Reproductive: OCPs/contraceptives basics; SERMs (tamoxifen/raloxifene), antiandrogens (finasteride, flutamide), PDE‑5 inhibitors (sildenafil; contraindications), uterotonics (oxytocin, misoprostol).
  • Bone: bisphosphonates (esophagitis), denosumab, teriparatide; calcium/vitamin D.

Day‑2 MCQs focus

  • ACEi vs ARB AEs; CCB selectivity; diuretic site→AE; antiarrhythmic class uses/AEs; HF drug survival benefits; asthma ladder; metformin vs SGLT2 vs GLP‑1 differences; PPI interactions.

Day 3 — CNS: Anesthesia, Sedatives, Antiepileptics, Psych, Analgesia, Movement Disorders, Drugs of Abuse

General anesthesia

  • Inhalational agents: MAC concept; potency vs solubility; halothane (hepatotoxic), enflurane (seizures), isoflurane/sevoflurane (modern), nitrous oxide (diffusion hypoxia).
  • IV agents: propofol (rapid on/off, hypotension), etomidate (adrenal suppression), ketamine (dissociative, ↑BP/HR), thiopental (ultra‑short barbiturate), dexmedetomidine.
  • Adjuncts: opioids, benzodiazepines, antiemetics.
  • Local anesthetics: amides (lidocaine, bupivacaine) vs esters (procaine); use‑dependency; toxicity (CNS, cardiotoxic with bupivacaine); addition of epinephrine.

Sedatives/hypnotics & anxiolytics

  • Benzodiazepines (GABA‑A ↑frequency); barbiturates (↑duration); Z‑drugs (zolpidem); melatonin agonists (ramelteon).
  • AEs: dependence, tolerance; flumazenil reversal (seizure risk if mixed OD).

Antiepileptics

  • Na⁺ channel blockers: phenytoin (gingival hyperplasia, ataxia), carbamazepine (hyponatremia, agranulocytosis), lamotrigine (rash).
  • GABAergic: valproate (teratogenic), phenobarbital, benzodiazepines.
  • Others: levetiracetam (behavioral), ethosuximide (absence), topiramate (stones, cognitive slowing).

Antipsychotics & mood stabilizers

  • Typical: D2 antagonists (haloperidol) — EPS, NMS.
  • Atypical: clozapine (agranulocytosis, myocarditis, seizures), risperidone (↑prolactin), olanzapine (metabolic), quetiapine, aripiprazole.
  • Mood stabilizers: lithium (tremor, hypothyroid, nephrogenic DI, Ebstein anomaly; monitor levels), valproate, carbamazepine, lamotrigine.

Antidepressants & anxiolytics

  • SSRIs (sertraline, fluoxetine), SNRIs (venlafaxine), TCAs (anticholinergic, cardiotoxic—NaHCO₃ antidote), MAOIs (tyramine crisis), bupropion (avoid in seizures), mirtazapine (weight gain/sedation).
  • Serotonin syndrome (triad; cyproheptadine).

Analgesics — opioids & adjuvants

  • Opioids: morphine, fentanyl, methadone, tramadol; MOA (μ agonists); AEs (resp depression, constipation, miosis); tolerance except miosis/constipation.
  • Antagonists: naloxone (OD), naltrexone (dependence/ETOH).
  • Neuropathic pain: gabapentin/pregabalin, duloxetine, TCAs.

Movement disorders

  • Parkinson’s: levodopa/carbidopa (wearing‑off, dyskinesias), dopamine agonists (pramipexole), MAO‑B inhibitors (selegiline), COMT inhibitors (entacapone), amantadine, anticholinergics (trihexyphenidyl) for tremor.
  • Huntington’s (tetrabenazine), essential tremor (propranolol/primidone).

Migraine

  • Acute: triptans (5‑HT1B/1D), NSAIDs, antiemetics;
  • Prophylaxis: β‑blockers, topiramate, valproate, CGRP mAbs (concept).

Drugs of abuse & management

  • Alcohol withdrawal (benzodiazepines), opioid withdrawal (clonidine/lofexidine, buprenorphine), stimulant intoxication management (benzodiazepines), cannabis, hallucinogens (supportive).

Day‑3 MCQs focus

  • MAC vs solubility; local anesthetic toxicity; AED drug of choice by seizure type & AEs; clozapine monitoring; lithium red flags; serotonin syndrome vs NMS; opioid effects vs tolerance; triptan contraindications.

Day 4 — Antimicrobials, Antiprotozoals/Antihelminthics, Antifungals, Antivirals, TB/Leprosy, Anticancer, Immunopharmacology & Toxicology

Principles of antimicrobial therapy

  • Bactericidal vs bacteriostatic; concentration vs time‑dependent killing; post‑antibiotic effect.
  • Empiric vs targeted; de‑escalation; MIC/MBC; PK/PD.

Cell wall agents

  • Penicillins: natural (G/V), antistaph (nafcillin), aminopenicillins (ampicillin/amoxicillin), anti‑pseudomonal (piperacillin); β‑lactamase inhibitors (tazobactam, clavulanate).
  • Cephalosporins: generations 1→5 with spectra highlights (1st—skin; 3rd—CNS/serious G‑; 4th—pseudomonas; 5th—MRSA coverage with ceftaroline).
  • Carbapenems (imipenem—seizures risk; meropenem); monobactam (aztreonam).
  • Glycopeptides: vancomycin (MRSA; red man syndrome), daptomycin (myopathy).

Protein synthesis & nucleic acid agents

  • 30S: aminoglycosides (gentamicin—nephro/ototoxicity), tetracyclines (doxycycline—photosensitivity, teeth).
  • 50S: macrolides (QT↑, CYP interactions), clindamycin (C. difficile risk), chloramphenicol (aplastic anemia), linezolid (thrombocytopenia, serotonin syndrome).
  • DNA/RNA: fluoroquinolones (tendonopathy, QT), rifampicin (orange fluids, inducer), metronidazole (disulfiram reaction), TMP‑SMX (hyper‑K⁺, SJS/TEN).

Anti‑TB & anti‑leprosy

  • First‑line TB: isoniazid (neuro/hepatotoxic; give B6), rifampicin (induces CYP), pyrazinamide (hyperuricemia, hepatotoxic), ethambutol (optic neuritis).
  • Regimens: intensive + continuation phases (concept); MDR‑TB awareness.
  • Leprosy: dapsone (hemolysis in G6PD), rifampicin, clofazimine; MDT regimens (paucibacillary vs multibacillary concept).

Antifungals

  • Polyenes (amphotericin B—nephrotoxicity; electrolyte wasting).
  • Azoles (fluconazole, voriconazole—visual disturbances), echinocandins (caspofungin—β‑glucan), flucytosine (bone marrow suppression).

Antivirals

  • Herpes: acyclovir/valacyclovir (TK activation; crystal nephropathy).
  • CMV: ganciclovir (myelosuppression), foscarnet (nephrotoxicity, electrolyte issues).
  • Influenza: neuraminidase inhibitors (oseltamivir) concept.
  • Hepatitis antivirals (concept only); HIV ART classes: NRTIs (tenofovir, abacavir), NNRTIs (efavirenz), PIs (ritonavir‑boosted), INSTIs (dolutegravir); AEs & interactions at a glance.

Antiprotozoals & antihelminthics

  • Malaria: blood schizonticides (ACTs—artemether–lumefantrine), primaquine for hypnozoites (G6PD caution), severe malaria (IV artesunate concept).
  • Amoebiasis/giardiasis: metronidazole + luminal agents.
  • Leishmaniasis (amphotericin B/miltefosine concept), toxoplasmosis (pyrimethamine + sulfadiazine + leucovorin), filariasis (DEC), strongyloidiasis (ivermectin), cestodes (praziquantel, albendazole depending on species).

Anticancer pharmacology (snapshot)

  • Alkylators (cyclophosphamide—hemorrhagic cystitis; MESNA), platinum (cisplatin—nephro/ototoxic), antimetabolites (MTX—leucovorin rescue; 5‑FU—hand‑foot), antimicrotubules (vincristine—neuro; paclitaxel—neuropathy), topoisomerase inhibitors (etoposide—AML risk), anthracyclines (doxorubicin—cardiotoxic; dexrazoxane).
  • Targeted: imatinib (BCR‑ABL), trastuzumab (cardiotoxic), bevacizumab (bleeding/wound healing), rituximab (infusion reactions).
  • Immunotherapy: checkpoint inhibitors (PD‑1/PD‑L1, CTLA‑4) — immune‑related AEs.

Immunosuppressants & biologics

  • Calcineurin inhibitors (cyclosporine, tacrolimus—nephrotoxicity), mTOR inhibitor (sirolimus), antimetabolites (azathioprine/mycophenolate), glucocorticoids, anti‑TNF (infliximab) — infection risk.

Toxicology & antidotes (must‑memorize)

  • Acetaminophen — N‑acetylcysteine.
  • Opioids — naloxone.
  • Benzodiazepines — flumazenil (caution with mixed OD).
  • TCA cardiotoxicity — sodium bicarbonate.
  • Digoxin — digoxin Fab fragments; correct K⁺.
  • β‑blocker — glucagon; high‑dose insulin (concept).
  • CCB — calcium, high‑dose insulin.
  • Heparin — protamine; warfarin — vitamin K ± PCC.
  • Iron — deferoxamine; lead — EDTA/succimer; arsenic/mercury — dimercaprol/succimer.
  • Methanol/ethylene glycol — fomepizole/ethanol.
  • Cyanide — hydroxocobalamin or nitrites + thiosulfate (protocol concept).
  • Theophylline — charcoal, β‑blockers for tachyarrhythmias.
  • Serotonin syndrome — cyproheptadine; NMS — dantrolene/bromocriptine.
  • Malignant hyperthermia — dantrolene.
  • Organophosphates — atropine + pralidoxime; carbamates (no oxime typically).

Day‑4 MCQs focus

  • β‑lactam spectra by generation; vancomycin vs daptomycin uses; macrolide interactions; FQ AEs; RIPE AEs; ART class AEs; malaria regimens; key antidote pairs; oncologic drug unique toxicities.

Rapid Revision (Last Evening)

  • Kinetics formulas (Vd = Dose/C₀; Cl = (0.693×Vd)/t½; LD = (Css×Vd/F); MD = (Css×Cl/F)).
  • CYP inducers vs inhibitors list.
  • Receptor–G‑protein map (α1 Gq, α2 Gi, β1/β2 Gs; M1/M3 Gq, M2 Gi; D1 Gs).
  • DOC lightning round: anaphylaxis—epinephrine; PSVT—adenosine; torsades—MgSO₄; acute angle‑closure—acetazolamide; organophosphate—atropine+pralidoxime; β‑blocker OD—glucagon; CCB OD—calcium/HIET; TCA arrhythmia—NaHCO₃; cyanide—hydroxocobalamin; digoxin—Fab; methanol—fomepizole; acetaminophen—NAC.
  • HF survival drugs set; antiarrhythmic class ladder; diuretic site→electrolyte effect; asthma ladder; insulin vs non‑insulin chart (mentally); AED by seizure type; antidepressant pearls (serotonin syndrome vs NMS); TB RIPE AEs; cephalosporin generations cues.

Practice Pattern (all days)

  • Timed MCQ blocks → immediate review → write one rule learned from each error.
  • Vignette flow: identify system/pathogen → pick DOC/class → check contraindications/major AEs → recall antidote if needed.
  • Mini‑cards to carry: inducers/inhibitors; receptor–G protein map; DOC & antidote pairs; diuretic sites; RIPE AEs; cephalosporin generations; ART classes; antiarrhythmic ladder; HF survival set; anesthesia MAC/solubility clues.
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