Antiviral, Antifungal and Antiparasitic Drugs for NEET PG Pharmacology: India's Malaria Regimens, NACO ART (TLD), Amphotericin

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🎯 Exam priority: Very high. Expect: the vivax and falciparum regimens in India, primaquine and G6PD, severe malaria, first-line ART, abacavir and HLA-B*5701, nevirapine hepatotoxicity, amphotericin and potassium, praziquantel in eye cysticercosis.

CBME mapping: PH 8.5–8.9. Indian sources: national malaria guidelines (2014) and the NCVBDC ASHA module (2025); NACO HIV care and treatment guidelines (2021).

Malaria (National Programme)

Malaria treatment in India's national programme. Drawn by TrackNation.

• Vivax: chloroquine 25 mg/kg over 3 days + primaquine 0.25 mg/kg daily for 14 days (hypnozoites cause relapse).

• Falciparum: ACT for 3 days — AS+SP in most of India, artemether-lumefantrine in the North-East — plus single-dose primaquine (0.75 mg/kg in 2014) on day 2.

• Severe: artesunate 2.4 mg/kg IV (preferred) or IM at 0, 12 and 24 hours, then daily.

• Primaquine: not in G6PD deficiency, pregnancy, infants or lactating women — haemolysis. Chloroquine: contraindicated with retinal or visual-field changes.

HIV and Other Antivirals

Antifungals and Anthelminthics

Traps the Examiner Sets

• Check G6PD before primaquine; never in pregnancy.

• Falciparum in the first trimester: quinine (2014 national guideline); ACT later.

• Stopping tenofovir in HBV co-infection can cause a hepatitis flare.

• Abacavir: HLA-B*5701 first. Nevirapine: women with high CD4 at risk.

• Sofosbuvir with amiodarone → bradycardia.

Memory Hooks & Shortcuts

Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.

• 🧠 Vivax: 3 of CQ, 14 of PQ — chloroquine 3 days, primaquine 14 days

• 🧠 PQ spares the Pregnant, the Pups (infants), the Pale (G6PD) — primaquine contraindications

• 🧠 NE gets AL — artemether-lumefantrine in the North-East

• 🧠 2.4 at 0-12-24 — IV artesunate schedule

• 🧠 TLD: Take one, Lifelong, Daily — first-line ART

• 🧠 Aba-cavir: B-57 before — HLA-B*5701 screening

• 🧠 Prazi spares the eye — not in ocular cysticercosis

Rapid-Revision Cards

• Vivax (India)

  CQ 25 mg/kg over 3 d + PQ 0.25 mg/kg × 14 d.

• Primaquine role

  Kills hypnozoites; prevents relapse.

• Primaquine don'ts

  G6PD deficiency, pregnancy, infants, lactation.

• Falciparum (India)

  AS+SP 3 d + single PQ day 2; AL in North-East.

• Severe malaria

  IV artesunate 2.4 mg/kg at 0, 12, 24 h, then daily.

• Malaria in pregnancy

  1st trimester quinine; 2nd/3rd ACT (2014).

• Chloroquine no-go

  Retinal or visual-field changes.

• NACO first line

  TLD once daily.

• Tenofovir

  HBV flare on stopping; BMD; renal dosing.

• Dolutegravir

  Separate from Ca/Fe/antacids (2 h before, 6 h after).

• Abacavir

  HLA-B*5701 first.

• Nevirapine

  Hepatotoxicity/rash; women CD4 > 250; first 18 wk.

• Zidovudine

  Anaemia, neutropenia, myopathy.

• Acyclovir

  Renal failure.

• Oseltamivir

  Neuraminidase; within 48 h.

• Sofosbuvir

  HBV reactivation; amiodarone bradycardia.

• Amphotericin

  Liposomal: fewer kidney/infusion reactions; hypokalaemia.

• Voriconazole

  Visual disturbance.

• Terbinafine

  Liver failure; baseline LFTs.

• Albendazole

  NCC, hydatid; pregnancy test; marrow.

• Praziquantel

  Schistosomes; not ocular cysticercosis.

• Ivermectin

  Strongyloides, onchocerciasis.

Sources

Facts in this article were checked against these documents.

• Guidelines for Diagnosis and Treatment of Malaria in India, 3rd edition — National Institute of Malaria Research / NVBDCP, MoHFW, July 2014

• Malaria training module for ASHA — National Center for Vector Borne Diseases Control, MoHFW, 2025

• National Guidelines for HIV Care and Treatment — National AIDS Control Organisation, MoHFW, 2021

• Prescribing labels: Viread, Tivicay, Ziagen, nevirapine, Retrovir, acyclovir, Tamiflu, Sovaldi, AmBisome, Diflucan, Vfend, terbinafine, Albenza, Stromectol, Biltricide, primaquine, chloroquine — DailyMed, US National Library of Medicine, current labels, accessed November 2026 (link)

• Competency Based Undergraduate Curriculum, Pharmacology (PH 8.5–8.9) — National Medical Commission, 2024

Test Yourself: Practice Questions

Twenty-four questions in NEET PG style, most of them clinical vignettes.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. A 30-year-old in Odisha has P. vivax malaria; G6PD is normal. The national regimen is

• (a) artesunate alone

• (b) chloroquine for 3 days + primaquine 0.25 mg/kg daily for 14 days

• (c) chloroquine alone

• (d) quinine for 7 days

Q2. Primaquine is given in vivax malaria to

• (a) kill blood schizonts faster

• (b) prevent anaemia

• (c) eliminate dormant liver hypnozoites and prevent relapse

• (d) treat fever

Q3. A man never tested for G6PD develops haemolytic anaemia soon after starting primaquine. The cause is

• (a) blackwater fever from chloroquine

• (b) allergy to chloroquine

• (c) haemolysis from G6PD deficiency

• (d) hepatitis

Q4. Primaquine should not be given to

• (a) children over 8

• (b) pregnant women, infants, lactating women and G6PD-deficient people

• (c) adult men

• (d) anyone with vivax

Q5. Uncomplicated P. falciparum malaria in Madhya Pradesh is treated in the national programme with

• (a) doxycycline alone

• (b) primaquine for 14 days alone

• (c) chloroquine for 3 days

• (d) artesunate + sulfadoxine-pyrimethamine for 3 days + single-dose primaquine

Q6. A patient in Assam has uncomplicated falciparum malaria. The national ACT there is

• (a) AS + SP

• (b) chloroquine

• (c) mefloquine alone

• (d) artemether-lumefantrine

Q7. A woman with falciparum malaria is 9 weeks pregnant. The 2014 national guideline advises

• (a) ACT in the first trimester

• (b) primaquine

• (c) quinine in the first trimester

• (d) no treatment

Q8. A man has severe falciparum malaria. The national severe-malaria drug and dose is

• (a) oral chloroquine

• (b) IV quinine only after 3 days

• (c) oral primaquine

• (d) IV artesunate 2.4 mg/kg at 0, 12 and 24 h, then daily

Q9. A newly diagnosed adult with HIV starts NACO first-line ART. The regimen is

• (a) zidovudine monotherapy

• (b) TLD: tenofovir + lamivudine + dolutegravir, one pill daily

• (c) nevirapine + stavudine

• (d) abacavir alone

Q10. A patient on TLD takes it with an iron-calcium supplement and his viral load stays detectable. The label advice is to take dolutegravir

• (a) at bedtime with antacid

• (b) twice weekly

• (c) with the supplement

• (d) 2 hours before or 6 hours after such supplements

Q11. A woman on dolutegravir asks about birth defects. Current label data show

• (a) it must be stopped before conception

• (b) a very high defect rate

• (c) neural tube defect rates similar to other regimens

• (d) no data

Q12. Before starting abacavir, the label requires

• (a) HLA-B*1502 testing

• (b) screening for HLA-B*5701

• (c) TPMT testing

• (d) G6PD testing

Q13. A woman with HIV and CD4 380 is started on nevirapine and develops rash and hepatitis in week 6. The label notes

• (a) men are at higher risk

• (b) this is expected and harmless

• (c) life-threatening hepatotoxicity and skin reactions, more in women with CD4 > 250, mostly in the first 18 weeks

• (d) it occurs only after 2 years

Q14. An HIV/HBV co-infected patient stops tenofovir and develops a hepatitis flare. The label calls this

• (a) immune reconstitution only

• (b) lactic acidosis

• (c) tenofovir hepatotoxicity

• (d) post-treatment exacerbation of hepatitis (boxed)

Q15. A patient on zidovudine has a haemoglobin of 6.5 g/dL. The label's boxed warning covers

• (a) QT prolongation

• (b) haematologic toxicity (anaemia, neutropenia)

• (c) nephrotoxicity

• (d) pancreatitis only

Q16. An elderly patient on high-dose oral acyclovir for zoster develops acute kidney failure. The label

• (a) says acyclovir protects kidneys

• (b) reports renal failure with acyclovir, sometimes fatal

• (c) says this never happens

• (d) blames zoster alone

Q17. Oseltamivir for influenza works best if started

• (a) only in children

• (b) after 7 days

• (c) within 48 hours of symptom onset

• (d) only after a positive culture

Q18. A hepatitis C patient on amiodarone starts a sofosbuvir regimen and faints with a pulse of 38. The label warns of

• (a) serious symptomatic bradycardia with amiodarone

• (b) anaemia

• (c) hypoglycaemia

• (d) seizures

Q19. Compared with conventional (deoxycholate) amphotericin B, liposomal amphotericin causes

• (a) no hypokalaemia ever

• (b) fewer infusion, cardiovascular and kidney adverse events

• (c) more kidney toxicity

• (d) more fevers

Q20. A patient on voriconazole for 6 weeks reports blurred vision. The label advises

• (a) ignoring it

• (b) monitoring visual function beyond 28 days (optic neuritis, papilloedema)

• (c) adding fluconazole

• (d) doubling the dose

Q21. Before oral terbinafine for nail fungus, the label requires

• (a) an ECG

• (b) a G6PD test

• (c) baseline liver transaminases (risk of liver failure)

• (d) audiometry

Q22. A woman of reproductive age with neurocysticercosis is to start albendazole. First,

• (a) check G6PD

• (b) obtain a pregnancy test

• (c) start primaquine

• (d) do an audiogram

Q23. Praziquantel is contraindicated in a patient with

• (a) schistosomiasis

• (b) ocular cysticercosis

• (c) tapeworm in the gut

• (d) clonorchiasis

Q24. A patient needs treatment for strongyloidiasis. A labelled oral drug is

• (a) fluconazole

• (b) praziquantel

• (c) chloroquine

• (d) ivermectin

Active Recall

From memory: give India's treatment for vivax, uncomplicated falciparum, severe malaria and malaria in pregnancy with primaquine contraindications; NACO first-line ART and the key warnings for tenofovir, dolutegravir, abacavir, nevirapine and zidovudine; and the main points for acyclovir, oseltamivir, sofosbuvir, amphotericin, voriconazole, terbinafine, albendazole, praziquantel and ivermectin.