Mount Kenya University · School of Pharmacy · Department of Pharmacology and Clinical Pharmacy
Paper details
- Unit: MBPL 4400, Clinical Pharmacology I, MBChB Year 4. University Examination 2022/2023, main exam.
- Sitting: Wednesday 25 January 2023, 2:00 PM, 2 hours. By the timetable this is Trimester 2 (January to April).
- Sections: A, MCQs (the paper says 30 marks, but 10 questions are printed). B, 14 short questions at 5 marks each. C, three case questions, answer any one.
- Answers: written by OmpathStudy for revision. They are not the official MKU marking scheme.
- Topics tested: asthma drugs, cough, immunosuppressants, local anaesthetics and muscle relaxants, statins, fibrinolytics, antihypertensives, heart failure, arrhythmia, anticoagulants, antiepileptics, lithium, antipsychotics, contraceptives, schizophrenia with diabetes, chronic heart failure, atrial fibrillation.
Section A: Multiple choice questions
1. A non-sympathomimetic drug given by aerosol that most likely promotes bronchodilation with few systemic effects:
- A. Salmeterol
- B. Atropine
- C. Isoproterenol
- D. Ipratropium bromide
2. Effective in asthma but most likely to cause tachycardia and arrhythmias:
- A. Salmeterol
- B. Atropine
- C. Isoproterenol
- D. Ipratropium bromide
3. Which class is not primary therapy of asthma and is used as an alternative when first-line regimens fail to control it?
- A. SABAs
- B. ICSs
- C. Leukotriene modifiers
- D. LABAs
4. What drug therapy should be available to ALL asthma patients (intermittent and persistent)?
- A. Low-dose ICS
- B. PRN SABA
- C. LABA
- D. Leukotriene antagonist
5. Dextromethorphan is an:
- A. Analgesic
- B. Antitussive
- C. Expectorant
- D. Antihistaminic
6. Codeine is used clinically as:
- A. Analgesic
- B. Antitussive
- C. Antidiarrhoeal
- D. All of the above
7. Which agent suppresses both B and T lymphocytes by inhibiting de novo purine synthesis?
- A. Methotrexate
- B. Mycophenolate mofetil
- C. Prednisone
- D. Tacrolimus
8. Regarding local anaesthetic agents:
- A. Lignocaine is also a Vaughan Williams group 1A antiarrhythmic
- B. At normal tissue pH the larger fraction of local anaesthetic is the uncharged form
- C. The duration of action of procaine is increased in liver disease
- D. Local anaesthetics block conduction in small myelinated axons before other axons
9. The skeletal muscle relaxant with the longest duration of action:
- A. Suxamethonium
- B. Mivacurium
- C. Vecuronium
- D. Pancuronium
10. Regarding nondepolarising muscle relaxants:
- A. Jaw and eye muscles are paralysed before limb and trunk muscles
- B. Rocuronium is the most potent
- C. Atracurium is a steroid derivative
- D. Vecuronium blocks cardiac muscarinic receptors and increases heart rate
Section B: Short questions (5 marks each)
1. Three main non-lipid (pleiotropic) effects of statins
2. Mechanism of action of fibrinolytics
3. One drug class least likely to cause orthostatic hypotension, and why
4. Justify each drug
5. Omeprazole versus ranitidine in acid reflux
6. Warfarin versus enoxaparin
7. Beta blockers in angina versus arrhythmia
8. The four main classes affecting the RAAS
9. Sodium and calcium channel blockers as antiepileptics
10. Lithium: main indication, adjunct and why
11. Main limitation of antipsychotics in schizophrenia
12. Three ways of achieving immunosuppression for a transplant
13. Therapeutic role of oral contraceptives
14. Metformin, alendronate and levothyroxine
Section C: Case questions (answer any one)
Question 1. A 32-year-old woman with schizophrenia and type 1 diabetes has gained 6 kg and her glucose is high. On olanzapine 15 mg, Insuman Comb 25 insulin, naproxen and omeprazole. Fasting glucose 8 mmol/L, HbA1c 75 mmol/mol, BMI 26.
(a) Which medicine is contributing to the weight gain and poor diabetes control? (4 marks)
(b) Antipsychotics least likely to cause extrapyramidal side effects (2 marks)
(c) Aripiprazole or olanzapine, and how to switch (2 marks)
(d) Assessment of her diabetes (2 marks)
Question 2. Mrs A, 52, adriamycin-induced cardiomyopathy and chronic heart failure on captopril, bisoprolol, furosemide and spironolactone
(a) Statin? (3 marks)
(b) BP 90/55, pulse 80, asymptomatic, no postural drop. Adjust the antihypertensives? (1 mark)
(c) Ankle oedema and breathlessness at Christmas: management (2 marks)
(d) Main limitation of dihydropyridine CCBs here (1 mark)
(e) Digoxin: why, and its limitation compared with ACE inhibitors (1 mark)
(f) Concerns with an opioid or a skeletal muscle relaxant for severe back pain (2 marks)
Question 3. A 74-year-old woman, fatigue, irregular pulse 120, atrial fibrillation, EF 20% with global hypokinesis (earlier 40%), on lisinopril, metoprolol XL and aspirin
(a) Medications to control the rate acutely (2 marks)
(b) What "restoring sinus rhythm" and "rate control" mean (2 marks)
(c) Which strategy and why (2 marks)
(d) Anticoagulation (2 marks)
(e) Four antiarrhythmic choices in LV dysfunction without heart failure (2 marks)