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

Source: https://tracknation.in/story/antiviral-antifungal-and-antiparasitic-drugs-for-neet-pg-pharmacology-india-s-malaria-regimens-naco-art-tld-amphotericin (TrackNation — free UPSC notes with PYQs)

> NEET PG Pharmacology: national malaria treatment (chloroquine + primaquine, ACT, IV artesunate, pregnancy), NACO first-line ART (TLD) and antiretroviral toxicities, acyclovir, oseltamivir, sofosbuvir, amphotericin B, azoles, terbinafine, albendazole, ivermectin and praziquantel, with a diagram, hooks, vignette MCQs and cards.

## Start Here

🎯 **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

| **Drug**

 | **Key point (label / NACO)**

 |
| TLD (tenofovir + lamivudine + dolutegravir)

 | NACO first-line ART: one pill once a day

 |
| Tenofovir (TDF)

 | Hepatitis flare if stopped in HBV co-infection (boxed); bone density loss; reduce dose if CrCl < 50

 |
| Dolutegravir

 | Take 2 h before or 6 h after antacids, iron or calcium; neural tube defect rate similar to other regimens

 |
| Abacavir

 | Screen for HLA-B*5701 before starting (hypersensitivity)

 |
| Nevirapine

 | Boxed hepatotoxicity and skin reactions, mostly first 18 weeks; women with CD4 > 250 at higher risk

 |
| Zidovudine

 | Boxed anaemia, neutropenia, myopathy, lactic acidosis

 |
| Acyclovir

 | Renal failure (can be fatal)

 |
| Oseltamivir

 | Neuraminidase inhibitor; start within 48 h of symptoms; not a substitute for vaccination

 |
| Sofosbuvir

 | Boxed HBV reactivation (test HBV first); serious bradycardia with amiodarone

 |

## Antifungals and Anthelminthics

| **Drug**

 | **Key point (label)**

 |
| Amphotericin B (liposomal vs deoxycholate)

 | Liposomal form has fewer infusion, cardiovascular and kidney reactions; hypokalaemia

 |
| Fluconazole

 | Never with quinidine (QT); rare serious liver toxicity

 |
| Voriconazole

 | Visual disturbances incl. optic neuritis: monitor vision beyond 28 days

 |
| Terbinafine (oral)

 | Liver failure: check transaminases before starting

 |
| Albendazole

 | Neurocysticercosis, hydatid disease; pregnancy test first; marrow suppression

 |
| Ivermectin

 | Strongyloidiasis, onchocerciasis

 |
| Praziquantel

 | Schistosomiasis; contraindicated in ocular cysticercosis

 |

## 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

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

- Kills hypnozoites; prevents relapse.

- G6PD deficiency, pregnancy, infants, lactation.

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

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

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

- Retinal or visual-field changes.

- TLD once daily.

- HBV flare on stopping; BMD; renal dosing.

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

- HLA-B*5701 first.

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

- Anaemia, neutropenia, myopathy.

- Renal failure.

- Neuraminidase; within 48 h.

- HBV reactivation; amiodarone bradycardia.

- Liposomal: fewer kidney/infusion reactions; hypokalaemia.

- Visual disturbance.

- Liver failure; baseline LFTs.

- NCC, hydatid; pregnancy test; marrow.

- Schistosomes; not ocular cysticercosis.

- 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

**Answer: (b)** — Primaquine prevents relapse from liver hypnozoites.

**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

**Answer: (c)** — Hypnozoites can later cause relapse.

**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

**Answer: (c)** — Primaquine causes haemolysis in G6PD deficiency; contraindicated in known deficiency.

**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

**Answer: (b)** — NCVBDC ASHA module 2025.

**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

**Answer: (d)** — AL is used in the North-East; AS+SP in the rest of India.

**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

**Answer: (d)** — North-Eastern states use AL.

**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

**Answer: (c)** — ACT in second and third trimesters.

**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

**Answer: (d)** — IV preferred over IM.

**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

**Answer: (b)** — NACO 2021.

**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

**Answer: (d)** — Polyvalent cations reduce absorption (unless taken together with food).

**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

**Answer: (c)** — NACO noted the earlier concern; later data were reassuring.

**Q12.** Before starting abacavir, the label requires

- (a) HLA-B*1502 testing

- (b) screening for HLA-B*5701

- (c) TPMT testing

- (d) G6PD testing

**Answer: (b)** — To avoid hypersensitivity reactions.

**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

**Answer: (c)** — Boxed warning.

**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)

**Answer: (d)** — Viread boxed warning.

**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

**Answer: (b)** — Also myopathy and lactic acidosis.

**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

**Answer: (b)** — Acyclovir label.

**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

**Answer: (c)** — Neuraminidase inhibitor; not a substitute for vaccination.

**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

**Answer: (a)** — Also boxed: HBV reactivation — test for HBV first.

**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

**Answer: (b)** — AmBisome label.

**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

**Answer: (b)** — Vfend label.

**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

**Answer: (c)** — Liver failure has led to transplant or death.

**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

**Answer: (b)** — Also monitor blood counts (marrow suppression).

**Q23.** Praziquantel is contraindicated in a patient with

- (a) schistosomiasis

- (b) ocular cysticercosis

- (c) tapeworm in the gut

- (d) clonorchiasis

**Answer: (b)** — Dying parasites in the eye can cause irreversible damage.

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

- (a) fluconazole

- (b) praziquantel

- (c) chloroquine

- (d) ivermectin

**Answer: (d)** — Stromectol: strongyloidiasis and onchocerciasis.

### 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.