NATIONAL UNIVERSITY OF SINGAPORE

SECOND PROFESSIONAL (PART II) EXAMINATION

FOR THE DEGREE OF M.B.,B.S.

PHARMACOLOGY

Wednesday, 13 March 2002                                                                                              Time Allowed: 3 hours

SECTION B

INSTRUCTION TO CANDIDATES

1.    Answer all six (6) questions.

2.    All questions carry equal marks.

3.    You must use a separate answer book for each question.

4.    Write your matriculation number on each answer number.

1.    A 45-year-old man had been suffering from duodenal ulcer disease. He was treated with cimetidine whenever he experienced epigastric pain. During his latest attack of pain, he informed his doctor that he did not wish to have further treatment with cimetidine because he felt unwell while on cimetidine. He was sent for a breath test which confirmed that he had Helicobacter pylori infection. He was given triple therapy with omeprazole, clarithromycin and metronidazole.

(a)    What is the pharmacological basis for the use of cimetidine to treat duodenal ulcer disease?

(b)    What side effects may have prompted the patient to reject treatment with cimetidine?

(c)    What is the role of omeprazole in the treatment of duodenal ulcer and what is its mode of action?

(c)    What side effects would you warn the patient of when prescribing metronidazole?

2.    A 30-year-old known asthmatic patient had defaulted from follow-up. He was not taking any regular treatment for his asthma and he had had several attacks recently. He visited a clinic during his latest acute asthmatic attack which, on evaluation, was not severe.

(a)    What drug would you use to treat his acute attack?

(b)     What is the mechanism of action of this drug?

(c)    How would you administer this drug? Give reason(s) for choosing this route of administration.

(d)    What are the adverse reactions associated with the use of this drug?

(e)    What would be an appropriate drug for maintenance therapy? What is its mechanism of action?

3.    A 70-year-old man, who was mildly overweight, was found to have a fasting blood glucose of 9.5 mmol/L (normal range: 4.0 - 7.8). His doctor recommended regular exercise with diet control for 2 months. At the end of this period, his fasting blood glucose remained unchanged. He was diagnosed as having Type 2 diabetes mellitus and was started on chlorpropamide.

(a)    How does chlorpropamide act?

(b)    What are the potential adverse effects associated with the use of this drug?

(c)    Is there increased risk of adverse effects in this patient? If so, why?

(d)    Is there a better choice of drug for this patient? Give reason(s) for your choice.

4.    A 58-year-old female patient was found on routine check-up to have the following readings on her lipid panel - cholesterol 6.9 mmol/L (desirable: < 5.2); HDL 1.0 mmol/L (desirable >0.9); LDL 3.8 mmol/L (desirable: < 3.4); triglyceride 1.9 mmol/L (desirable: <2.3). Despite appropriate dietary restrictions for 3 months, her biochemical parameters remained essentially unchanged.

(a)    Which drug would you choose to treat this patient? Give reason(s) for your choice.

(b)    What is the mechanism of action of this drug?

(c)    What are the potential adverse effects associated with the use of this drug?

5.    A 68-year-old man, who was diagnosed as having carcinoma of the colon 2 years ago, presented with metastatic lesions to the liver and spine. He had severe pain and suicidal idea. He did not want chemotherapy and radiotherapy.

(a)    What would be your objectives in the palliative management of this patient?

(b)    What are the drugs that you would use to achieve these objectives?

(c)    What are the factors that you would consider in determining your choice of pharmacological treatment?

(d)    What are the adverse effects of the drugs you have chosen for him?

6.    A 53-year-old Chinese lady complained of intermittent chest pain which came on whenever she ran for the bus. This had remained fairly constant for the last 6 months. Her doctor told her that she had chronic stable angina pectoris.

(a)    Name 2 types of drugs that may be used to treat her chest pain.

(b)    What are the mechanisms of action of these two drugs?

(c)    Can the two drugs be used concurrently? If so, what would be the advantage(s)?

(d)    How would the therapeutic approach differ if her angina was unstable?

** END OF PAPER **