fin nov 12 sph2014

FINAL SEMESTER EXAMINATION

(NOVEMBER 2012 SESSION)

PHARMACOLOGY AND TOXICOLOGY SPH2014

LECTURER :……………………………………………………………………………

MATRIC NO : …………………………………………. PROGRAMME : ..…………………………………… VENUE : …………………………………………. FEBRUARY / MARCH 2013 DURATION : 3 HOURS

INSTRUCTIONS:

1. Candidates must read all questions carefully. 2. The examination script consists of the followings:

Part Types of Questions

Instruction Answer Sheets to be Used

A 20 MCQ Answer ALL questions

OMR sheet

B 5 Short Answers Answer ALL questions

Question paper

C 4 Essays Answer TWO(2) questions ONLY

Answer booklet

THIS EXAMINATION SCRIPT CONTAINS 11 PAGES INCLUDING THE FRONT COVER

DO NOT OPEN THE EXAMINATION SCRIPT UNTIL FURTHER INSTRUCTION

CONFIDENTIAL SPH2014

SPH2014 PHARMACOLOGY AND TOXICOLOGY 1/10

PART A

(20 marks) Time : 30 minutes

INSTRUCTION This part consists of TWENTY (20) questions. Answer ALL questions on the OMR sheet

provided.

1. Which of the following statements BEST describes pharmacodynamic?

A. The study of absorption, metabolism and excretion of drugs. B. The study of biological and therapeutic effects of drugs. C. The study of methods of new drug development. D. The study of mechanisms of drug action.

2. The FDA assigns the letters A, B, C, D and X to drugs approved for human use.

These classifications are about _______________________. A. amount of dosage reduction needed as serum creatinine clearance fall B. fetal risks when given to pregnant woman C. the number of unlabeled uses for a drug D. relative margin of therapeutic index

3. What is characteristic of oral administration method?

A. Fast onset effect. B. The sterilization of medical forms is obligatory. C. A drug reaches the blood and passing the liver. D. Absorption depends on GI secretion and motor function.

4. Which of the following statements is NOT characteristic of sublingual administration?

A. Spitting out the medicine tablet can terminate its action. B. It avoids first pass hepatic metabolism process. C. Its usefulness is limited to treat local condition. D. It has rapid onset of action.

5. If tubular urine is made more acid ___________________________.

A. excretion of weak acid is reduced B. excretion of weak base is reduced C. excretion of weak acid is increased D. excretion of weak base is increased

6. In case of liver disorders accompanied by a decline in microsomal enzyme activity the duration of action of some drugs is ________________________. A. enlarged B. decreased C. remained unchanged D. changed insignificantly



7. Which of the following statements is NOT related to log dose response curve?

A. The graph has a sigmoid shape. B. It is the same for different effects of a single drug. C. It can be used to determine the potency and efficacy of a drug. D. Its slope can provide valuable information regarding dose range.

8. An antagonist is a substance that _______________________________.

A. binds to the receptors without directly altering their functions B. interacts with plasma proteins and does not produce any effect C. binds to the receptors and initiates changes in cell function, producing sub

maximal effect D. binds to the receptors and initiates changes in cell function, producing

maximal effect 9. In present of competitive antagonist _____________________________.

A. maximum can be achieved only if the antagonist binds to the nonspecific sites of tissue

B. maximum can be achieved only if the antagonist is having intrinsic activity C. the maximum can be achieved by increasing the concentration activity D. the maximum response of agonist can never be achieved

10. Which of the following statements BEST describes idiosyncrasy reaction of a drug?

A. A type of drug antagonism. B. A type of hypersensitivity reaction. C. Quantitatively exaggerated response. D. Unpredictable and qualitatively abnormal reaction of a drug.

11. A 40-year-old hypertensive patient while taking antihypertensive drugs suffered from

a precipitous fall in blood pressure and fainting on initial administration. It is commonly seen with ________________________. A. Verapamil B. Nifedipine C. Thiazide D. Atenolol

12. Mr. Kyung with an infectious disease is being treated with an aminoglycosides

antibiotic. Which of the following diuretics should be avoided for this patient? A. Metolazone B. Furosemide C. Acetazolamide D. Spironolactone

13. All of the following statements concerning angiotensin converting enzyme (ACE)

inhibitors are true EXCEPT

A. they act by inhibiting the ability of renin to convert angiotensinogen to angiotensin I.

B. they are effective first-line agents in the treatment of chronic heart failure. C. they reduce secretion of aldosteron. D. they decrease afterload.



14. A 56-year-old woman complains of chest pain following any sustained exercise. She is diagnosed with atherosclerotic angina. She is prescribed sublingual nitroglycerin for treatment of acute chest pain. Which of the following adverse effects is likely to be experienced by this patient? A. Throbbing headache B. Sexual dysfunction C. Hypertension D. Bradycardia

15. All of the following statements concerning side effects of antihypertensive drugs

EXCEPT A. beta blocker can induce bronchospam in asthmatic patient. B. calcium channel blockers decreases heart rate. C. thiazides increases blood uric acid. D. cough maybe intolerable with ACEIs.

16. A 55-year-old patient suffering from persistent dry cough for the last 2 months due to

unknown reasons wants to get a drug without having constipating effect like ________________. A. codeine B. pholcodein C. hydrocodone D. dextromethorphan

17. A 10-year-old child suffers from exercise induced asthma. Which is the MOST

suitable first line drug for regular prophylactic therapy? A. Inhaled beclomethasone dipropionate B. Inhaled sodium cromoglycate C. Oral theophylline D. Oral salbutamol

18. A patient takes an acute, massive overdose of aspirin without proper intervention can

be fatal. Which of the following would you expect in the late stages of aspirin poisoning? A. Hypothermia B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory alkalosis

19. Which of the following is the primary cause of death from massive acetaminophen

overdose? A. A-V conduction disturbances B. Acute nephropathy C. Status epilepticus D. Liver failure



20. A family home has clogged furnace that is producing carbon monoxide. Which family member is likely to be at the highest risk for poisoning? A. Billy, the son who is in 1st grade. B. Ms. Nguyen, the mother who works at home. C. Baby Shea, who is going to be in preschool next year. D. Karla, the nanny who cares for the toddler every weekday morning.



PART B

(50 marks) Time : 1 hour 30 minutes

INSTRUCTION This part consists of FIVE (5) questions. Answer ALL questions in the spaces provided.

1. DK, a 59-year-old man, was admitted to the local hospital with a chief complaint of

palpitations and occasional dizziness. He has a history of asthma, diabetes, and hypertension. His current medications include nifedipine, chlorthalidone, and prednisone. On admission, EKG monitoring revealed atrial fibrillation with a ventricular rate of 165 beats/minute. DK was given 0.5 mg of digoxin intravenously. After the second dose, his ventricular rate decreased to100 beats/minute.

(a) How would you advice him for non pharmacological measures to control his

hypertension and diabetes?

(2 marks)

(b) Identify TWO (2) possible side effects of nifedipine.

(2 marks)

(c) Prior to discharge, DK was started on oral digoxin dosed at 0.25 mg daily. However his serum potassium level was very low. In your opinion, why hypokalemia is a predisposing factor to digitoxin toxicity?

(2 marks)

(d) Discuss management of digoxin toxicity.

(4 marks)



2. Mrs. Hwang a 61-years-old bank executive who complains of difficulty sleeping and difficulty climbing stairs because of easy fatigue and shortness of breath. She is not sleeping well. Her personal history reveals that she has smoked 15 cigarettes per day since she was a teenager and she has one or 2 glasses of wine per day. Her past history includes essential hypertension and an anterior wall myocardial infarction at age 59. Her family history is unremarkable save for type II diabetes and obesity in her mother and one sister.

(a) Identify the risk factors of Mrs. Hwang’s cardiovascular disease.

(3 marks)

(b) Current medication includes propranolol 50 mg twice daily and

hydrochlorothiazide 25 mg daily. What are cardiovascular effects did propranolol produces?

(2 marks)

(c) If she is also suffering from bronchial asthma, should her doctor continue with the prescription of propranolol? Support your answer.

(3 marks)

(d) Give TWO (2) example of side effect of propranolol should she be warned about.

(2 marks)



3. 62-year-old man, with a history of chronic obstructive pulmonary disease, was admitted to emergency room with severe theophylline toxicity (peak level 85 mg/L) after consuming at least 20 tablets of 250 mg of sustained release preparation of theophylline. (a) Identify the therapeutic effect of theophylline.

(2 marks)

(b) Predict his probable signs and symptoms in the emergency room.

(3 marks)

(c) The serum creatinine level was 114 mmol/L (normal 55-100 mmol/L). He was

subsequently admitted to the intensive care unit where he was started by on high volume continuous venovenous haemofiltration. Describe TWO (2) others

alternative treatment for theophylline toxicity.

(4 marks)

(d) Theophylline has been used for several decades for treatment of reversible airway obstruction. In your opinion, why theophylline still remains an important cause of intoxication?

(1 mark)



4. A 70-year-old retired man presented to the Emergency Department following a house fire. The flat below his had caught fire during the night, awakening the patient and his family. Smoke rose through the floors and windows, and the patient and his wife were exposed to significant smoke inhalation. Following rescue by the fire brigade and initial high-flow oxygen therapy by the ambulance service, the man arrived at hospital drowsy and less responsive than he had been at the scene. Examination revealed no evidence of external burns, facial burns, singed nostril hair, hoarseness or overt evidence of airway obstruction. However the patient was expectorating carbonaceous sputum. Blood results were unremarkable apart from a COHb level of 9% (NR < 2%), compared with his wife who had no symptomatology or clinical signs, but an initial COHb level of 11%.

(a) What is carbon monoxide and how is it produced?

(2 marks)

(b) Discuss on the mechanism of carbon monoxide poisoning.

(2 marks)

(c) Describe FOUR (4) major clinical features of carbon monoxide poisoning.

(4 marks)

(d) Suggest the MOST appropriate treatment for these patient.

(2 marks)



5. Mr. Sinclair, a 20-year-old male, presented to the emergency department with a one-hour history of deliberate organophosphorous insecticide poisoning. He had a past medical history of a previous episode of self-poisoning and a vague history of current family problems. The patient had excess sputum production, signs of respiratory distress and crackles throughout the chest on auscultation

(a) What are organophosphates?

(2 marks)

(b) Discuss TWO (2) common routes of exposure for organophosphorous

insecticide poisoning.

(4 marks)

(c) Describe mechanism of toxicologic damage caused by organophosphorous

insecticide poisoning in human.

(4 marks)



PART C

(30 marks) Time : 1 hour

INSTRUCTION This part consists of FOUR (4) questions. Answer TWO (2) questions only in the answer

booklet provided.

1. A diuretic is drug that elevates the rate of urination and thus provides a means of

forced diuresis. There are several categories of diuretics. All diuretics increase the excretion of water from bodies, although each class does so in a distinct way.

Based on your knowledge, draw a structure of nephron and label site of action for each diuretics. Discuss the mechanism of action, clinical indications and adverse effects of loop diuretics and carbonic anhydrase inhibitor.

(15 marks)

2. Contrast between the purpose, symptoms, generic ingredient, mechanism of action and side effects of antitussives and expectorants.

(15 marks)

3. Paraquat is the trade name one of the most widely used herbicides in the world.

Paraquat, a viologen, is quick-acting and non-selective, killing green plant tissue on contact. It is also toxic to human beings and animals.

Discuss mechanism of action, clinical signs, diagnosis and treatment of paraquat poisoning.

(15 marks)

4. Pre-clinical testing as well as clinical trials are important in making sure adverse effects or toxicity can be reduced. Of all toxicity, teratogenecity, carcinogenicity, mutagenicity as well as drug induced diseases are the major concern. Explain these types of toxicity with ONE (1) example for each.

(15 marks)

END OF QUESTION PAPER

fin nov 12 sph2014

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