basic pharmacology essay questions

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1. Introduction to Pharmacology

Pharmacology: the study of interaction of drugs with living systems.

Sub-Disciplines of Pharmacology

• Drug-Receptor Interactions
• Dose-Response Relationships
• Signal Transduction
• A bsorption
• D istribution
• M etabolism
• Rate of Drug Metabolism
• Drug-Induced Toxicity
• Drug-Induced Allergies

Pharmacology and the Pharmacist

Key Questions you should be asking as a Pharmacist :

• Where is the molecular site of action ?
• What are the body function changes caused by a drug (pharmacodynamics)?
• What is the relationship between the Dose vs. Effect ?
• How does a drug produce its effect ?
• What is the fate of the drug once it enters the body (pharmacokinetics)?
• What is the interplay between genetic makeup and drug response ?

Example: Beta 1 Blocker: Metoprolol Succinate (oral)

Drug Action: selective binding to cardiac muscle beta 1 adrenergic receptors that respond to norepinephrine (at higher doses, also inhibits bronchial and vascular smooth muscle by acting on beta 2 adrenergic receptors) to inhibit the binding of norepinephrine.

Drug Effect: reduced inotropic effect (contractility) and chronotropic effect (heart rate)

Fate of the Drug (pharmacokinetics): 12% protein binding and distribution 5.6 L/kg: hepatic metabolism (CYP2D6 mainly): <5% renal excretion: t 1/2 3-7 hours

Principles of Pharmacology - Study Guide Copyright © by Edited by Dr. Esam El-Fakahany and Becky Merkey, MEd is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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1.2: Introduction to Pharmacology

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• Page ID 10623

• Carl Rosow, David Standaert, & Gary Strichartz
• Massachusetts Institute of Technology via MIT OpenCourseWare

A drug is a chemical agent which can affect living processes. For purposes of this course we will mainly be talking about small molecules which affect cellular processes. Most of these are Xenobiotics (Gr. xenos - stranger) chemicals that are not synthesized by the body, but introduced into it from outside. There is inevitably a certain amount of ambiguity in this definition: Is oxygen or water a drug? How about Vitamin C in a glass of orange juice? How about an injection of Vitamin C to treat scurvy?

Pharmacology (Gr. pharmakon - a drug or poison, logos - word or discourse) is the science dealing with actions of drugs on the body ( pharmacodynamics ) and the fate of drugs in the body ( pharmacokinetics ). It overlaps with pharmacy , the science of preparation of drugs; much of it deals with therapeutics , the treatment of disease (by whatever means). Toxicology is the branch of pharmacology dealing with the "undesirable" effects of drugs on biological processes (in the case of a nerve gas the bad effect may be a desired one).

In order for a drug to work, it must enter the body and somehow be distributed in such a way that it gets to its site of action. In most cases the site of action is a macromolecular "receptor" located in the target tissue. Most drug effects are temporary, because the body has systems for drug detoxification and elimination. We will consider these issues broadly for now and go into more depth in individual lectures. As you read, refer to the figure below:

Overview of Pharmacokinetics - "What the body does to the drug"

• The drug may enter the body in a variety of ways: as an oral liquid, pill, or capsule; as an inhaled vapor or aerosol; absorbed through intact skin or a mucous membrane; injected into muscle, subcutaneous tissue, spinal fluid, or directly into the bloodstream. As we shall see, the physical properties of the drug and the specific way it is prepared greatly influence the speed of absorption.
• If the drug is given orally and swallowed, it must be absorbed from the GI tract into the portal circulation. If it is absorbed from the skin, mouth, lungs or muscle it will go directly into the systemic circulation. If drug is injected directly into the bloodstream (e.g., intravenous injection), 100% of it is available for distribution to tissues. This is not usually the case for other modes of administration. For example, drug which is absorbed via the portal circulation must first pass through the liver which is the primary site of drug metabolism (biotransformation). Some of the drug may therefore be metabolized before it ever reaches the systemic blood. In this case," first-pass " metabolism reduces the bioavailability to less than 100%.
• Once the drug is in the bloodstream a portion of it may exist as free drug, dissolved in plasma water. Some drug will be reversibly taken up by red cells and some will be reversibly bound to plasma proteins. For many drugs, the bound forms can account for 95-98% of the total. This is important because it is the free drug which traverses cell membranes and produces the effect. It is also important because protein-bound drug can act as a reservoir which releases drug slowly and thus prolongs its action.
• The unbound drug may then follow its concentration gradient and distribute into peripheral tissues. In some cases, the tissue contains the target site and in others the tissue is not affected by the drug. Sites of non-specific binding act as further reservoirs for the drug. This total volume of distribution determines the equilibrium concentration of drug after a specified dose.
• Tissue-bound drug eventually reenters the bloodstream where it perfuses the liver and kidneys. The liver metabolizes most drugs into inactive or less active compounds which are more readily excreted. These metabolites and some of the parent compound may be excreted in the bile and eventually may pass out of the body in the feces. Alternatively, some of the drug may be reabsorbed again, farther down the GI tract (the so-called enterohepatic cycle). Any biotransformed drug which is not excreted in bile passes back into the systemic circulation.
• Parent drug and metabolites in the bloodstream may then be excreted: most are filtered by the kidney, where a portion undergoes reabsorption, and the remainder is excreted in the urine. Some drugs are actively secreted into the renal tubule. Another route of excretion is the lung: Drugs like alcohol and the anesthetic gases are eliminated by this route. Smaller amounts of drug are eliminated in the sweat, tears and breast milk.
• Biotransformation may sometimes produce metabolites with a great deal of activity. Occasionally, we administer a parent drug which is inactive (a pro-drug) and only the metabolite has activity. [How might this be useful?]

Overview of Pharmacodynamics - "What the drug does to the body"

As stated above, the majority of drugs bind to specific receptors on the surface or interior of cells, but there are many other cellular components and non-specific sites which can serve as sites of drug action.

• Water can be a target. Osmotic diuretics like mannitol are not reabsorbed by the kidney, and the osmotic load they create in the renal tubule obligates the loss of water. Laxatives like magnesium sulfate work in the intestine by the same principle.
• Hydrogen ions can be targets. Ammonium chloride is sometimes used to acidify the urine. When it is taken orally, the liver metabolizes ammonium ion to urea, while the chloride is excreted in the urine. The loss of Cl- obligates the loss of H+ in the urine, thus the pH is lowered.
• Metal ions can be targets. Chelating agents like EDTA may be used to bind divalent cations like Pb++. Metal ions are most frequently drug targets in cases of poisoning.
• Enzymes are targets of many therapeutically useful drugs. Drugs may inhibit enzymes by competitive, non-competitive, or irreversible blockade at a substrate or cofactor binding site. Digitalis glycosides increase myocardial contractility by inhibiting the membrane enzyme, Na+-K+ - ATPase. Antimicrobial and antineoplastic drugs commonly work by inhibiting enzymes which are critical to the functioning of the cell. In order to be effective, these drugs must have at least someselective toxicity toward bacterial or tumor cells. This usually means that there is a unique metabolic pathway in these cells or some difference in enzyme selectivity for a common metabolic pathway. An example of this is the inhibition of folate synthesis by sulfonamides. These drugs are effective antibacterial agents because the bacteria depend upon folate synthesis, while the host doesn't. This example will be covered in detail in one of our case discussions.
• Nucleic acids are targets for antimetabolites and some antibiotics. In the case of 5- fluorouracil, the compound acts as a counterfeit substitute for uracil and becomes incorporated into a faulty mRNA. Antisense oligonucleotides are another very specific way to interfere with a restricted part of the genome.
• Some drugs, like general anesthetics, appear to act by non-specific binding to a macromolecular receptor target. These drugs are thought to alter the function of membrane proteins, in part, by disordering the structure of the surrounding lipid membranes. Their lack of specificity is reflected in very low chemical structural requirements. The general anesthetics include compounds as chemically diverse as nitrogen, xenon, halogenated ethers, and steroids. They exhibit very little stereoselectivity, that is, there are not marked differences in anesthetic activity between enantiomers.
• Finally, we have the drugs which act by binding to specific receptors . As you will see in lectures 2 and 6, these drugs have both high structural specificity and stereoselectivity, i.e. relatively small changes in chemical structure can radically alter the activity of these drugs.

Let us finish with some important definitions. These are concepts which we will return to repeatedly throughout the course.

• Agonist is a drug which binds to its "receptor" and produces its characteristic effect. A drug may be a full agonist or partial agonist , depending on the maximal effect it produces. An antagonist binds to the receptor without causing an effect, thereby preventing an active substance from gaining access. Antagonists, like enzyme inhibitors, may be competitive, non-competitive or irreversible.
• Dose-Response . The sine qua non of drug effect. Simply put, as the dose of drug increases, the response should increase. [What if the response increases, then decreases as the dose is raised?] The curve generated is usually sigmoidal when effect is plotted against log dose (Dr. Strichartz will discuss the theoretical basis for this). Effect may be measured as a graded variable (change in blood pressure, force of contraction) or as a quantal variable (number dead/alive). The slope of the curve is characteristic of the particular drug-receptor interaction. When two drugs act by the same receptor mechanism, we expect to see two parallel log-dose response curves.
• ED 50 . The median effective dose, or the dose which produces a response in 50% of subjects. If the response is death (lethality) we call it the LD 50 . The EC50 refers to concentration rather than dose. Similar abbreviations are used for other response levels: ED 99 , LD 1 , etc.
• Potency . A terribly misused word – the lay public uses it to mean “effectiveness.” The potency of a drug refers to the dose (actually the molar concentration) required to produce a specific intensity of effect. [We usually specify the ED50, why?] If the ED50of drug A and B are 5 and 10 mg, respectively, the Relative Potency of A is twice that of B. Relative potency specifically applies to the comparison of drugs which act by the same mechanism, and therefore have parallel dose-response curves.
• Efficacy . Also called Maximal Efficacy or Intrinsic Activity . This is the maximum effect of which the drug is capable. A potent drug may have a low efficacy, and a highly efficacious drug may have a low potency. For the clinician, efficacy is much more important than potency (within limits). Who cares if the pill contains 5 or 10 mg of drug?
• Affinity . This refers to the strength of binding between drug and receptor. It is quantified by the dissociation constant kD (covered in the next lecture).
• Selectivity . This refers to the separation between desired and undesired effects of a drug. In the ideal case, a drug is completely specific , and an effective dose does not elicit any undesired effect. Penicillin is an example of a highly selective drug, since it works specifically by inhibiting cell wall synthesis, and (other than allergic responses) it has very little effect on human cells at normal doses. Unfortunately, many therapeutic agents, like digoxin and theophylline, produce dose-related side effects near their therapeutic dose range. For some drugs like cancer chemotherapeutic agents, their selectivity is their dose-limiting property, i.e., they are given to kill tumor cells until they produce toxicity in normal cells as well.
• Therapeutic Window . For every drug, there exists some concentration which is just barely effective (the Effective Concentration ) and some dose which is just barely toxic (the Toxic Concentration ). Between them is the therapeutic window where most safe and effective treatment will occur.
• Therapeutic Index . This is the ratio of toxic to effective doses at the level of 50% response: TD 50 /ED 50 . In animal toxicology studies, it is usually the LD 50 /ED 50 . Another measure sometimes utilized is the Certain Safety Factor , which is TD 1 /ED 99.

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Portal : Questions for final examination in Pharmacology (1. LF UK, GM)

Q1. [ edit | edit source ]

a. A new drug is being developed and its manufacturers want to know its oral bioavailability: - What clinical reasons are there for determining oral bioavailability? - Should bioavailability be tested with only fasted subjects? If the answer is no, explain why - How would you go about measuring bioavailability in a group of 12 healthy subjects?

b. The relevance of the autonomic nervous system to clinical pharmacology and therapeutics using clinical examples to illustrate your answers (agonist’s antagonists, cholinergic receptors, adrenergic receptors, clinical use of adrenergic agonists and antagonists)

c. Describe drugs useful in the treatment and prophylaxis of migraine headache (asymptotic phase, prodromal phase and headache phase).

Q2. [ edit | edit source ]

a. An antihypertensive drug is given to 12 volunteers, the concentration of the drug is measured in the plasma, and its effect on blood pressure is recorded. The drug had a very short half-life (about 30 min) and was detectable for 2 hours. However, the effect on the diastolic blood pressure was maximal 30 min after dosing and returned to predose values after 12 hours. Give possible explanations for these findings

b. A slodier’s unit has come under attack with a nerve agent. The symptoms exhibited are skeletal muscle paralysis, profuse bronchial secretions, miosis, bradycardia and convulsions. What do you think about the kind of exposure? Discuss possible antidote, and the concept of antidote in general in cases of poisoning.

c. Drugs affecting bone and mineral homeostasis, drug treatment of osteoporosis.

Q3. [ edit | edit source ]

a. Pharmacokinetic principles and use in clinical practice, calculation of pharmacokinetic parameters, bioavailability and optimization of dosage regimen.

b. The nonsteroidal anti-inflammatory drugs (NASIDs) and acetaminophen are often effective in controlling pain. Other treatment strategies applied to the reduction of inflammation are targeted at immune processes (e.g. glucucorticoids, disease modifying antirheumatic drugs DMARDs) or treatment of gout acute episodes or chronic form. Discuss the pharmacology of the mentioned groups.

c. Major groups of drugs used in heart failure describing various targets and actions

Q4. [ edit | edit source ]

a. Transport mechanisms of drugs across biomembranes, various processes, compartmental pharmacokinetic models, zero and first order kinetic of elimination, drug absorption and bioavailability, Clinical relevance.

b. Describe the uses, mode of action and adverse effects of the following in general anaesthesia: Thiopental, Nitrous oxide, Halothane, Pancuronium, Neostigmine.

c. A 51-yr-old woman presented to the emergency department with tachycardia, shortness of breath, and chest pain. She had had shortness of breath and diarrhea for the last 2 days and was sweating and anxious. A relative reported that the patient had run out of methimazole 2 w earlier and a diagnosis of thyroid storm was made. Which drug(s) is useful adjuvant in the treatment of thyroid storm? Describe the pharmacology of drugs used in both hypo- and hyperthyroidism.

Q5. [ edit | edit source ]

a. Active and passive transport across biomembranes (including transport of ions and organic compounds in kidney’s tubules

b. A 56-year old overweight man complains of not sleeping well and feeling tired during the day. He tells his physician that his wife is the cause of the problem because she wakes him up several times during the night because of his loud snores. This appears to be a breathing-related sleep disorder, so you should probably write a prescription for, clorazepate, or flurazepam, or secobaerbital or triazolam or non of these agents. Comment and classify typical and atypical sedative hypnotic drugs.

c. Describe the appropriate drug treatment(s) for major common skin diseases; give major adverse effects of these drugs.

Q6. [ edit | edit source ]

a. Routes of drug administration (relationship between mode of administration to speed and duration of effect, and relation to drug pharmacokinetics). Give graphical illustrations.

b. Benzodiazepines, mode of action, molecular pharmacology, effect at organ level, adverse effects and therapeutic uses.

c. Anticoagulants and fibrynolytics, therapeutic indications.

Q7. [ edit | edit source ]

a. Main pharmacokinetic parameters affecting plasma drug level at steady state, rate constant of elimination, volumes of distribution, half-life time, total body clearance, renal and nonrenal clearance

b. Clinically important alcohols and their antagonists (drugs used to treat alcohol withdrawal, drugs to treat alcohol dependence, drugs used to treat acute methanol or ethylene glycol intoxication).

c. A 70-year-old woman is admitted to the emergency department because of a "fainting spell" at home. She appears to have suffered no trauma from her fall, but her blood pressure is 120/60 when lying down and 60/30 when she sits up. Neurologic examination and an ECG are within the normal limits when she is lying down. Questioning reveals that she has recently started taking "water pills" (diuretics) for a heart condition. Which drug(s) is the most likely cause of her fainting spell? Describe diuretic drug groups and various clinical uses.

Q8. [ edit | edit source ]

a. Drug distribution in the organism (volume of distribution and half life time, clearance etc., examples and significance for dosage adjustment)

b. Drugs used for treatment of epilepsy, mode of action, principles of antiepileptic administration, drug of choice and recent development in epilepsy drug treatment

c. Drugs used for the treatment of respiratory tract diseases; the modes of action, adverse effects and clinical use of drugs employed in the management of chronic asthma

Q9. [ edit | edit source ]

a. Drug biotransformation and significance for drug elimination, pharmacological and toxicological drug effects (types of biotransformation, enzyme induction and inhibition with examples).

b. Drug treatment for parkinsonism, potential drug use in other neurodegenerative diseases

c. Comment on the following drugs concerning receptor specificity and clinical uses advantages and disadvantages: propranolol, nidolol, timolol, pindolol, atenolol, acebutolol, carvedilol and labetalol.

Q10. [ edit | edit source ]

a. Drug elimination mechanisms (rate constants of elimination, half lifetime, total body clearance, renal and nonrenal clearance).

b. Discuss the difference in pharmacological profile between ACE inhibitors and AT1-receptor blockers. Prostaglandins, actions and their clinical uses.

c. Describe the pharmacology of drugs used in the treatment of angina pectoris including adverse effects.

Q11. [ edit | edit source ]

a. A dosage regimen is a plan for drug administration. An optimal dosage regimen results in the achievement of therapeutic levels of the drug in the blood without exceeding the minimum toxic concentration. Define maintenance dose, loading dose and how to calculate, therapeutic window and how to adjust the dose when elimination is altered by disease.

b. Centrally-acting skeletal muscle relaxants and neuromuscular blocking agents, therapeutic uses and side effects.

c. Major groups of drugs used in heart failure describing various targets and actions.

Q12. [ edit | edit source ]

a. A new drug is found to be eliminated entirely by renal excretion, with no prior metabolism. Its renal clearance (found from plasma and urine concentration data) in an experiment on six healthy subjects is found to be about 200 ml/min. What do these data tell you about the mode of excretion of the drug? Discuss various methods of drug elimination

b. Describe the probable mechanisms of action and major characteristics of tricyclic antidepressants, SSRIs, SNRIs, and serotonin 5-HT receptor antagonists.

c. Diabetes mellitus is treated with several parenteral formulations of insulin and oral or parenteral noninsulin antidiabetic agents. Outline these agents with mechanisms of actions and adverse effects.

Q13. [ edit | edit source ]

a. Significance of pharmacokinetic for optimizing drug dosage (relation between dose, concentration and drug effect, bioavailability, and therapeutic monitoring of blood levels)

b. Neuroleptics, antidepressants (including selective serotonin release inhibitors SSRI and selective noradrenaline release inhibitors SNRI)

c. Describe gonadal hormone agonists and antagonists: estrogens, antiesterogens SERMs (selective estrogen-receptor modulators), progestins, androgens and antiandrogens, hormonal contraceptives adverse effects

Q14. [ edit | edit source ]

a. Drug concentration-time course in the blood, single and multicompartmental model system for drug distribution.

b. An overview on drugs affecting behavior. Antianxiety drugs (molecular pharmacology and clinical uses)

c. Ms. Novotna has had myasthenia gravis for several years. She reports to the emergency department complaining of rapid onset of weakness of her hands, diplopia and difficulty swallowing. She may be suffering from a change in response to her myasthenia therapy, that is a cholinergic or myasthenic crisis. Which is the more appropriate drug for distinguishing between myasthenic crisis (insufficient therapy) and cholinergic crisis (excessive therapy)? Describe drugs appropriate for myasthenia gravis and therapeutic uses of cholinesterase inhibitors.

Q15. [ edit | edit source ]

a. Relationship between dose, plasma level of drug and effect (examples of monitoring drug plasma levels). Demonstrate with graphical presentations.

b. Within days of starting haloperidol treatment for a psychiatric disorder, a young male patient developed severe generalized muscle rigidity and a high temperature. In the emergency department, he was incoherent, with increased hearty rate, hypotension, and diaphoresis. He was diagnosed as suffering from Neuroleptic malignant syndrome. Outline drugs used for psychosis and bipolar disorders (classic and newer agents, adverse effects etc.).

c. Severe unwanted effects of antibiotic (allergic reactions, toxicity on nervous system, hematopoesis, cardiovascular and respiratory system with examples). Some strategies that can be adopted to reduce the risks of bacterial resistance to antibiotics development.

Q16. [ edit | edit source ]

a. From your pharmacodynamics and drug-receptor interactions define: Efficacy, potency, therapeutic index, graded dose response, quantal dose-response, spare receptors. Give examples and graphical representation whenever possible.

b. Outline pharmacologic strategies for dopaminergic therapy and other drugs used in Parkinson’s disease, mode of action, adverse effects.

c. Androgens and anabolic steroids, drugs used in prostatic hyperplasia.

Q17. [ edit | edit source ]

a. Signaling mechanisms and drug action

b. On the basis of opioids’ interaction with relevant receptor(s), classify these drugs with their mechanisms of action, pharmacodynamics, acute and chronic effects.

c. A newborn girl exhibited ambiguous genitalia, hyponatremia, hyperkalemia, and hypotension as a result of genetic deficiency of 21-hydroxylase activity. Treatments consisted of fluid and salt replacement and hydrocortisone administration. In this type of adrenal hyperplasia in which there is excess production of cortisol precursors, which of the follow describes the primary therapeutic effect of glucocorticoids administered (Increased adrenal estrogen synthesis, inhibition of the adrenal aldosterone synthesis, prevention of hypoglycemia, recovery of normal immune function or suppression of ACTH secretion). Describe corticosteroid agonists and antagonists.

Q18. [ edit | edit source ]

a. Quantitative aspect of drug-receptor interaction with graphical illustrations.

b. Nonopiate analgesics, and nonsteroidal anti-inflammatory compounds

c. Hormonal and nonhormonal drugs that are useful in the treatment of bone miniral disorders (e.g. Osteoporosis, rickets, osteomalacia, Paget’s disease).

Q19. [ edit | edit source ]

a. Define receptor-effector complex, graded dose response, quantal dose response relationships, antagonists and the difference between a pharmacologic antagonist and allosteric agonist/antagonist.

b. Discuss the concept of antidotes in he treatment of drug and heavy metal poisoning, giving examples.

c. Describe local and systemic antifungal agents in clinical applications.

Q20. [ edit | edit source ]

a. Drug treatment of DM. The management of hyperthyroidism

b. The sympathomimetic bronchodilators are drugs of choice in acute asthma. Compare the properties of direct- and indirect- acting sympathomimetics relative to the therapeutic goals in asthma. Outline drugs used in bronchial asthma and antitussive agents.

c. Effects of nitric oxide, and potential use of NO donors and inhibitors.

Q21. [ edit | edit source ]

a. The classic drug-receptor interactions and the involvement of signaling across the membrane with examples.

b. The adverse effects of corticosteroids

c. Classification of immunosuppressive and imunomodulating agents including cytokines and clinical uses

Q22. [ edit | edit source ]

a. Define intrinsic activity and affinity of a drug, competitive and noncompetitive antagonism and partial agonism (with graphical illustration)

b. A 47-year old man exhibited signs and symptoms of acromegaly. Radiologic studies indicated the presence of large pituitary tumor. Surgical treatment of the tumor was only partially effective in controlling his disease. Which drug is most likely to be used as pharmacologic therapy (somatotropin, desmopressin, leuprolide or octreotide). Outline drugs that mimic or block the effects o hypothalamic and pituitary hormones.

c. Antifungal and antiviral drugs

Q23. [ edit | edit source ]

a. The sympathomimetic bronchodilators are drugs of choice in acute asthma. Compare the properties of direct- and indirect- acting sympathomimetics relative to the therapeutic goals in asthma. Outline drugs used in bronchial asthma and antitussive agents.

b. Describe, giving examples, the mechanisms by which drugs used for cancer chemotherapy work. What adverse effects do the named drugs cause?

c. Uterotonics and tocolytics

Q24. [ edit | edit source ]

a. Metabolic pathway of NO biosynthesis, effects, potential use of NO donors and inhibitors.

b. A 56-year old man has hypertension and an enlarged prostate, which biopsy shows to be benign prostatic hyperplasia. Which drug would be the most appropriate initial therapy? Outline major drug groups used as antihypertensive medications.

c. Drugs used in the treatment of tuberculosis

Q25. [ edit | edit source ]

a. Receptor hypersensitivity and receptor desensitization (mechanisms, give examples)

b. A slodier’s unit has come under attack with a nerve agent. The symptoms exhibited are skeletal muscle paralysis, profuse bronchial secretions, miosis, bradycardia and convulsions. What do you think about the kind of exposure?, Discuss possible antidote, and the concept of antidote in general in cases of poisoning.

c. The gastrointestinal tract serves many important functions; digestive, excretory, endocrine, exocrine, and so on. These functions are the targets of several important classes of drugs. Describe drugs for acid-peptic disease, drugs for inflammatory bowel disease and antiemetics.

Q26. [ edit | edit source ]

b. Parasympathomimetics (direct and indirect acting compounds)

c. Classify beta-lactam antibiotics and other cell wall synthesis inhibitors: mode of actions and adverse effects.

Q27. [ edit | edit source ]

a. Main sites of drug actions (receptors, calcium channels, enzymes... etc.)

b. Local anesthetics, overview, uses, toxicity

c. Treatment of Helicobacter pylori infection, acid-suppressant drugs, drugs in the treatment of reflux oesophagitis

Q28. [ edit | edit source ]

b. The relevance of the autonomic nervous system to clinical pharmacology and therapeutics using clinical examples to illustrate your answers. (Agonists antagonists, cholinergic receptors, adrenergic receptors, clinical use of adrenergic agonists and antagonists)

c. Chemotherapy of cancer, classification of cytostatics, new development in anticancer drugs, resistance to the cytotoxic effects of anticancer agents

Q29. [ edit | edit source ]

a. Describe the stages of new drug development. Outline experimental and clinical research involved.

b. Antihypertensive agents, overview, ACE inhibitors (effect after chronic use, undesired effects)

c. A 56-year old overweight man complains of not sleeping well and feeling tired during the day. He tells his physician that his wife is the cause of the problem because she wakes him up several times during the night because of his loud snores. This appears to be a breathing-related sleep disorder, so you should probably write a prescription for, clorazepate, or flurazepam, or secobaerbital or triazolam or non of these agents. Comment and classify typical and atypical sedative hypnotic drugs.

Q30. [ edit | edit source ]

a. Relationship between dose and effect (define types of doses, therapeutic dose, toxic dose, therapeutic index. etc.). Illustrate your answer graphically

b. Skeletal muscle relaxants and clinical uses

c. Drug treatment for acid-peptic diseases; inflammatory bowel disease, laxatives, antispasmodics

Q31. [ edit | edit source ]

b. Congestive heart failure, cardiotonic drugs and other drugs with positive inotropic effect (importance, indications and risks), role of ACE inhibitors

c. Laxatives and antidiarrheal drugs

Q32. [ edit | edit source ]

a. Alteration in drug effects after chronic administration (tachyphylaxis, tolerance and drug dependence)

b. In spite of the fact that the drugs used for arrhythmias have very low therapeutic indices (and when feasible, non drug therapies are used), discuss major drug groups.

c. A 37-year old woman underwent segmental mastectomy for a breast tumor of 3-cm diameter. Lymph node sampling revealed 2 involved nodes. Because chemotherapy is of established value in her situation, she underwent postoperative treatment with antineoplastic drugs. Discuss various agents and adjunctive drugs of potential use and adverse effects. Outline various classes of anticancer drugs.

Q33. [ edit | edit source ]

a. Drug dependence (examples of drug abuse)

b. A 56-year old man has hypertension and an enlarged prostate, which biopsy shows to be benign prostatic hyperplasia. Which drug would be the most appropriate initial therapy. Outline major drug groups used as antihypertensive medications.

c. Tocolytics and uterotonics (compounds that stimulates uterine motility), classification and therapeutic uses.

Q34. [ edit | edit source ]

a. Describe adverse drug reactions and drug interactions

b. Describe the management of a patient presenting to his GP with a blood pressure 170/110 mmHg, with no other symptoms or signs of organ damage. Comment on adverse effects of prescribed drugs.

c. Immunosuppressive agents, relation between immunosuppressive therapy and cancer chemotherapy

Q35. [ edit | edit source ]

a. Relation between drug dose and clinical response with graphical illustrations

b. A 70-year-old man has a history of ulcer disease. He has recently experienced swelling and pain in the joints of his hands. His physician wants to begin therapy with an NSAID. Which drug might also be prescribed along with NSAID to reduce the risk of activating this patient’s ulcer disease? Describe major adverse effects of NSAIDs

c. Two patients are found to have serum cholesterol of 6. mmol/l and total cholesterol to HDL ratio of 4.2. The first is a 52-year -old man who has angina and smokes. The second is a 36-year old woman who is normotensive (systolic blood pressure of 128 mmHg and a nonsmoker. She is not diabetic. How would you treat each of these two patients? . Outline the pharmacologic profiles of drugs used in the treatment of hyperlipidemias

Q36. [ edit | edit source ]

a. Teratogenic and carcinogenic effects of drugs

b. Inhibitors of calcium ion channels pharmacologic profile and clinical pharmacology.

c. Cancer chemotherapy produces high rates of cure of diseases. On the other hand, some types of cancers are barely affected by currently available drugs. Discuss this statement (alkylating agents, antimetabolites, antitumor antibiotics, natural products, hormonal, imatinib, cetuximab etc) including drug combinations, adverse effects.

Q37. [ edit | edit source ]

a. Drug use and special dosage adjustments for children and elderly. Changes in drug pharmacokinetics (absorption, bioavailability, distribution and elimination)

b. Diuretics and uses in edematous and nonedematous indications

c. Drugs in thrombosis, bleeding disorders, and anemia including glycoprorteins that regulate stem cells in bone marrow for patients with blood cell deficiences.

Q38. [ edit | edit source ]

a. Untoward and side effects of drugs (give examples)

b. Summarize drugs that modulate immune function (mechanism of action, clinical applications, pharmacokinetics and toxicities.

c. An antihypertensive drug is given to 12 volunteers, the concentration of the drug is measured in the plasma, and its effects on blood pressure are recorded. The drug had a very short half-life (about 30 min) and was detectable for 2 hours. However, the effect on the diastolic blood pressure was maximal 30 min after dosing and returned to predose values after 12 hours. Give possible explanations for these findings.

Q39. [ edit | edit source ]

a. Phases of new drug development including preclinical and clinical testing

b. Toxicity of some metals and their derivatives and relevant antidotes (Pb, Hg, As, Cd, Fe)

c. The modes of action, adverse effects and clinical use of drugs employed in the management of chronic asthma. Drug use in other respiratory diseases.

Q40. [ edit | edit source ]

a. Pharmacokinetics and other differences between children and adults. Polypharmacy in the elderly

b. Histamine and antihistamines, clinical uses and side effects

c. Chemotherapy of mycobacterial infections almost always involves the use of drug combinations to delay the emergence of resistance and to enhance antimycobacterial efficacy. Discuss these drugs pharmacological profiles. - Adverse effects of antibiotics

Q41. [ edit | edit source ]

b. Classification of antihypertinsive drugs, status of beta-blockers among these drugs, and various clinical usefulness of beta-blockers.

c. Fluoroquinolones and quinolones and other drugs used for treatment of urinary tract infections

Q42. [ edit | edit source ]

a. Clinical pharmacokinetics, monitoring of drug plasma level and dosage adjustment. Describe phases of drug biotransformation with important clinical consequences.

b. The use of ACE inhibitors in cardiovascular disease.

c. Antiviral drugs can exert their actions at several stages of viral replication including viral entry, nucleic acid synthesis, late protein synthesis and processing and in the final stage of viral packaging and virion release. Describe these drug events in case herpes viruses (HSV), HIV, influenza, HBV and , HCV.

Q43. [ edit | edit source ]

a. Sources of drug information and type of information about available drugs

b. Describe the pharmacology of drugs used in the treatment of angina pectoris including adverse effects.

c. Discuss Drug treatments of urinary tract infections (UTIs) with the appropriate mechanisms of action.

Q44. [ edit | edit source ]

a. Classify cholinergic receptors and subtypes, agonists and antagonists

b. Based on existing differences in ribosomal subunits and in the chemical composition and functional specificities of component nucleic acids and proteins in mammalian cells and bacteria, several bacterial protein synthesis inhibitors were prepared. Discuss this statement with emphasis on adverse effects of main drugs.

Q45. [ edit | edit source ]

a. Drug use and risks before and during pregnancy and during breast-feed feeding

c. Chemotherapy of mycobacterial infections almost always involves the use of drug combinations to delay the emergence of resisitance and to enhance antimycobacterial efficacy. Discuss these drugs pharmacological profiles. - Outline drugs acting on fungi with mechanisms of action.

Q46. [ edit | edit source ]

a. Types of immune reactions due to drug applications (drug allergy, idiosyncrasy etc.), demonstrate your answers with clear examples.

b. Thrombolytics (fibrinolytics and their antagonists)

c. A 40-year old patient is about to undergo cancer chemotherapy with a highly emetogenic ( nausea and vomiting) drug combination. What antiemetic drug(s) most likely to be included in her regimen? Comment on the antiemetic drugs.

Q47. [ edit | edit source ]

a. Drug intoxication and general principles in patient treatment and specific antidotes

b. Ms. Novotna has had myasthenia gravis for several years. She reports to the emergency department complaining of rapid onset of weakness of her hands, diplopia and difficulty swallowing. She may be suffering from a change in response to her myasthenia therapy, that is a cholinergic or myasthenic crisis. Which is the more appropriate drug for distinguishing between myasthenic crisis (insufficient therapy) and cholinergic crisis (excessive therapy)?\ Describe drugs appropriate for myasthenia gravis and therapeutic uses of cholinesterase inhibitors.

c. Drugs used to combat malaria, amebiasis, toxoplasmosis and anthelmintic drugs (against nematodes, trematodes and cestodes).

Q48. [ edit | edit source ]

a. The pKa of bupivicaine is 8.3. In infected tissue at pH 6.3, calculate the percentage of the drug in the nonionised form. Outline characteristics of local anaesthetics ( classification, mode of action, adverse effects etc.)

c. Antimicrobial combinations, advantages and disadvantages, example of synergism and antagonism of individual combinations

Q49. [ edit | edit source ]

a. Pharmacotherapy during pregnancy and lactation

b. Drug treatment in hyperlipoproteinemias, classification, fibrates, statins etc.

c. Describe the appropriate drug treatments (s) for major common skin diseases; give major adverse effects of these drugs.

Q50. [ edit | edit source ]

a. A 25-year old man has a pheochromocytoma, blood pressure 190/120 mm Hg, and hematocrit of 50%. Pulmonary function and renal function are normal. His catecholamines are elevated, and he has a well-defined abdominal tumor on MRI. He has been scheduled for surgery. Which agent should not be included in anaesthesia protocol (desflurane, fentanyl, halothane, midazolam or thiopental). Try to outline major types of general anesthetics with administration techniques.

c. Classify and describe the pharmacological profiles of major drugs used in ophthalmology

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4 Basic principles of pharmacology

• Published: May 2011
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Pharmacodynamics

Pharmacodynamics is the consideration of the effect that a drug has on the body. Body functions are mediated by control systems which depend on:

Once drugs reach the area of their action they either work in a specific or non-specific manner.

Specific drug action:

Interaction with receptors on the cell membrane, interference with ion passage/channels through the cell membrane.

An ion is an atom (or group of atoms) that has lost one or more electrons (cation) or gained one or more electrons (anion).

An ion passage/channel is a selective pore in the cell membrane that allows the movement of ions in and out of the cell.

Drugs which block these channels, such as the calcium blocker nifedipine, interfere with ion transport and produce an altered physiological response.

Enzyme inhibition or stimulation

An enzyme is a protein acting as a catalyst in a specific biochemical reaction. Some drugs interact with enzymes in a similar manner to the drug–receptor mechanism. ACE inhibitors and aspirin act in this way. Insulin is destroyed by proteolytic enzymes.

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Basic Concepts in Pharmacology: What You Need to Know for Each Drug Class, Sixth Edition

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Evaluation of multiple-choice and short essay questions in pharmacology education

2023, Mediterrenean Journal of Pharmacy and Pharmaceutical Sciences

Multiple choice questions (MCQs) and short essay questions (SEQs) are common methods of the assessment of medical students in courses of pharmacology. Poorly constructed test items (questions) are widespread problem resulting in failing to assess learning objectives. It has been reported that there are 36.0% to 65.0% flawed test item in medical education assessment tool. Thus, the objective of this study was to evaluate MCQs by determining the item writing flaws (IWFs) and to evaluate the SEQs by determining the cognitive level of each item. Four pharmacology tests were administered to third year pharmacy students at

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Pakistan Journal of Medical Sciences

Sundus Tariq

Pak J Med Sci

DR MUKHTIAR BAIG , Nighat Huda , Sobia Ali

Objectives: To evaluate Multiple Choice and Short Essay Question items in Basic Medical Sciences by determining item writing flaws (IWFs) of MCQs along with cognitive level of each item in both methods. Methods: This analytical study evaluated the quality of the assessment tools used for the first batch in a newly established medical college in Karachi, Pakistan. First and sixth module assessment tools in Biochemistry during 2009-2010 were analyzed. Cognitive level of MCQs and SEQs, were noted and MCQ item writing flaws were also evaluated. Results: A total of 36 SEQs and 150 MCQs of four items were analyzed. The cognitive level of 83.33% of SEQs was at recall level while remaining 16.67% were assessing interpretation of data. Seventy six percent of the MCQs were at recall level while remaining 24% were at the interpretation. Regarding IWFs, 69 IWFs were found in 150 MCQs. The commonest among them were implausible distracters (30.43%), unfocused stem (27.54%) and unnecessary information in the stem (24.64%). Conclusion: There is a need to review the quality including the content of assessment tools. A structured faculty development program is recommended for developing improved assessment tools that align with learning outcomes and measure competency of medical students.

Journal of Health and Allied Sciences NU

swathi acharya

Introduction Student assessment by multiple-choice questions (MCQs) is an integral part of student evaluation in medicine. The medical teacher should be trained to construct an item with proper stem and valid options. Periodic item analyses will make the process of assessment more meaningful. Hence, we conducted the study to analyze MCQs (item analysis) tested on a batch of MBBS students in pharmacology in their three internal assessment examinations. Methods The study was conducted in the Department of Pharmacology of a medical college in Mangaluru on 150 students. The MCQs of the three internal assessment examinations (20 each) respectively were analyzed. We analyzed each question for difficulty index (DI), discrimination index (DsI), and distracter efficacy or functionality and expressed the percentage results. Results The DI was in an acceptable range of 60, 75, and 90%, respectively, in the three internal assessments. The percentage of “too difficult” questions was 10, 20, and ...

Acta Scientific Pharmaceutical Sciences

Wesam Ismail

Emmanuel Larbi

We retrospectively analyzed the results of 1243 written examination papers of students taking three courses in medical pharmacology. the examination paper consisted of two parts: part I was made up of multiple choice questions (MCQs), matching (match) and short answer questions (SA), while part II was made up of essay questions. The overall failure rates for courses I, II and III were 31%, 36.4% and 31.2% respectively. In the three courses around 12% of students obtained high grades (A and B), whereas 55% had low grades (C and D). IN course I, 1.8% of students obtained grade A, 13.1% grade B , 22.6% grade C and 32.1% grade D . Corresponding results in course II were 1.9%, 9.6%, 20% and 32.1% and in course III, 1.3%, 8.6% , 22.8% and 36.1% respectively. Female students generally performed on a par with males in overall score except in course II, where male students performed slightly better than females in overall score, MCQs, and matching questions. The comparison of grades and fail...

Bangladesh Journal of Physiology and Pharmacology

AFM SAIFUL ISLAM

International Journal of Basic & Clinical Pharmacology

Background: Multiple choice questions (MCQs) are a common method for formative and summative assessment of medical students. Item analysis enables identifying good MCQs based on difficulty index (DIF I), discrimination index (DI), distracter efficiency (DE). The objective of this study was to assess the quality of MCQs currently in use in pharmacology by item analysis and develop a MCQ bank with quality items.Methods: This cross-sectional study was conducted in 148 second year MBBS students at NKP Salve institute of medical sciences from January 2018 to August 2018. Forty MCQs twenty each from the two term examination of pharmacology were taken for item analysis A correct response to an item was awarded one mark and each incorrect response was awarded zero. Each item was analyzed using Microsoft excel sheet for three parameters such as DIF I, DI, and DE.Results: In present study mean and standard deviation (SD) for Difficulty index (%) Discrimination index (%) and Distractor efficie...

Education Research International

Ulrich Gergs

Multiple-choice questions are widely used in clinical education. Usually, the students have to mark the one and only correct answer from a set of five alternatives. Here, in a voluntary exam, at the end of an obligatory pharmacology exam, we tested a format where more than one alternative could be correct (N=544 students from three year groups). Moreover, the students were asked to rate each item. The students were unaware how many correct answers were contained in the questions. Finally, a questionnaire had to be filled out about the difficulty of the new tests compared to the one out of five tests. In the obligatory final exam, all groups performed similarly. From the results, we conclude that the new rating scales were a better challenge and could be adapted to assess student knowledge and confidence in more depth than previous multiple-choice questions.

Bangladesh Journal of Medical Education

Fatema Johora

Undergraduate pharmacology education has always been a topic of intense excitement and debate. This descriptive cross-sectional study was conducted to analyze the pharmacology written question papers (SAQ) of MBBS curriculum in last 10 years (January 2010 to November 2019). Total 131 question papers were collected, and reflection of curricular objectives and content coverage of pharmacotherapy of diseases of high burden were evaluated. Objective regarding factual knowledge (pharmacological effects, mechanisms of action, pharmacokinetic characteristics and adverse reactions of drugs) occupied about 80 percent of the questions throughout the last decade. Medicines used in diseases of high burden received very little weightage, which is consistent throughout the decade.

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Pharmacology Quizzes!

Below, we have put together over 150 pharmacology questions to test your understanding of the must-know facts to know for your next exam.

Pharmacology quizzes are the best way not only to test your knowledge of drugs and medicines, but also to help plug gaps and to identify strengths from weaknesses – guiding your future study plans and goals. Let’s get started.

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50 Questions!

General Pharmacology

The following five quizzes review the fundamentals of pharmacology – and examine everything from indications and mechanisms of action, to side effects, drug interactions, and basic aspects of clinical pharmacology.

30 Questions!

Drug Classes

Here, we review some of the pharmacology specifics behind some of the most widely prescribed drug classes – including NSAIDs, beta-blockers, and aminoglycosides.

• Aminoglycosides
• Beta-blockers

Mechanisms of Action

Mechanisms of action in pharmacology refer to how a drug works to exert its therapeutic effect. Here are three MCQ tests, each of which has 10 questions – covering a detailed range of must-know mechanisms of action.

Side Effects

Side effects are a must-know subject in clinical pharmacy. Here, we have put together three quizzes that cover a wide and diverse range of side effects from an even broader range of drugs and drug classes.

5 Questions!

Clinical Pharmacy

The following ten quizzes review the fundamentals of pharmacology – and examine everything from indications and mechanisms of action, to side effects, drug interactions, and basic aspects of clinical pharmacology.

Drug indications

Top tips when answering pharmacology mcqs.

Always re-read questions before answering.

Otherwise, you may miss important words such as “always” or “not” that can really transform the meaning of an MCQ.

Eliminate wrong answers.

Never jump in and answer immediately. Always review each answer and eliminate wrong answers before choosing the one you deem to be correct. This reduces the risk of error.

Avoid guessing.

Guessing should always be a last resort and should only be done once you have eliminated as many incorrect (or likely to be incorrect) answers. More detailed answers are more likely to be correct than broader answers.

Have confidence.

You probably know far more than you think you do, and with enough confidence, you can work answers out rather than sinking with worry and stress.

Have a plan.

There is nothing worse than having 10 minutes to go with 40 MCQs to answer. Time yourself and never spend more time than you need to on any one question. Come back to more difficult questions at the end.

Never leave the exam hall.

Too many pharmacy students leave the exam hall far too earlier because they have answered all questions. But you may have rushed and so there may be errors. Review, review, review – and maximize your result.

Trust instincts.

If, upon reading a question, an answer pops into your head and it happens to be an answer, you are probably correct. Try not to let other answers confuse you. If anything, try to think of correct answers first before reading the question answers.

Practice pharmacology quizzes.

The more practice you put in, the more gaps in your knowledge base you can plug. Study is effective, but practice is mastery. Always take the time to practice what you have learned.

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