Clinical Pharmacology and Therapeutics Questions And
Answers With Verified Solutions (Graded A+) Latest
Update 2024/2025.
Problems of female oral contraceptives? - ANSWER Problems of patient compliance, daily 'peaks
and troughs', not absorption if vomiting or diarrhoea
Problems of female contraceptive transdermal patches - ANSWER Unsightly 'badge', which can
fall off.
Benefit and problem of female contraceptive IM injections - ANSWER Can't be forgotten, but
can't be removed.
Benefit and problem of female contraceptive IM implants - ANSWER Can't be forgotten, can be
removed by healthcarer, but not user.
Why can't progesterone itself be used in contraceptives? - ANSWER Oral bioavailability of <1%
due to first pass metabolism
Out of ethisterone, norethindrone and medroxyprogesterone acetate, which is more oral bioavailable? -
ANSWER Medroxyprogesterone acetate
Give 5 types of receptors that first-generation anti-psychotics may block - ANSWER D2
Rs,cholinergic, alpha-adrenergic, histaminergic, and serotonergic receptors.
Are anti-psychotics specific to a particular dopaminergic pathway? - ANSWER No
What side effects can blockage of D2 Rs lead to? - ANSWER 1. EPSs
2. Increased prolactin
Give 4 EPSs - ANSWER 1. Parkinsonian symptoms (inc tremor)
2. Dystonia (continuous spasms/contractions)
3. Akathisia (restlessness)
4. Tardive dyskinesia
What type of side effects does high prolactin result in? - ANSWER Sexual dysfunction (reduced
fertility) reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea.
What side effects can blockage of cholinergic Rs lead to? - ANSWER 1. Sedative effects
2. Antimuscarinic effects
3. EPSs
Whata re the 5 most common antimuscarinic effects? - ANSWER Dry mouth, constipation,
urinary retention, tachycardia and blurred vision
,What side effects can blockage of alpha-adrenergic Rs lead to? - ANSWER 1. Nasal conjestion
2. Sexual dysfunction in men
3. Hypotension
What side effects can blockage of histaminergic Rs lead to? - ANSWER 1. Drowsiness
What side effects can blockage of serotonergic Rs lead to? - ANSWER 1. Hypotension
2. Hypo/hyperthermia
Give 3 side effects of chlorpromazine that are due to chemical toxicity and cannot be predicted -
ANSWER 1. Blood dyscrasias (such as agranulocytosis and leucopenia)
2. Photosensitisation
3. Contact sensitisation and rashes
Which respiratory drugs have particularly poor compliance and why? - ANSWER Corticosteroids
Associated with significant morbidity
Media's portrayal of them is bad
How do corticosteroids work? - ANSWER 1. They are picked but by cortisone receptors in the
cytoplasm. HSP90 is released from the receptor at the same time.
2. They are taken into the nucleus
3. It binds to a GRE
4. Two things happen - 1 = Transrepression (stopping production of inflammatory cytokines and
mediators. 2 - Transactivation + Metabolic Effects (eg. weight gain, DM, etc)
Why do corticosteroids have metabolic side effects? - ANSWER We haven't developed a drug
that can cause transrepression without transactivation + metabolic effects
What are the main transcription factors that are involved in Il-5 production, eosinophil recruitment, etc?
- ANSWER AP-1
Nf-kB
Which corticosteroid binds to its receptor most avidly compared to the others? - ANSWER
Mometasone furoate
Compare fluticasone with dexamethasone in terms of affinity for R, first pass metabolism and systemic
bioavailability - ANSWER Fluticasone = high affinity for R (very potent), extensive first pass
metabolism, low systemic bioavailability
Dexamethasone = low affinity for R, low first pass metabolism, high systemic bioavailability
Is peak flow or symptoms a better predictor for steroid success? - ANSWER Symptoms
What else do steroids do besides anti-inflammatory actions that is useful in asthma? - ANSWER
Smooth muscle relaxation
Should you stat steroids early or later in asthma? Why? - ANSWER Early. Because if you delay
steroids, you get fixed airway obstruction
Give 2 benefits of inhaled corticosteroids in terms of hospital stay - ANSWER Decreases bed
days in hospital
Decreases risk of readmission to hospital
What 2 negative things can happen if the majority of the inhaled steroid sticks in the back of the throat,
instead of going into the lungs? - ANSWER Thrush
Systemic absorption
What is compliance? - ANSWER The extent to which a person's behaviour coincides wit medical
or health advice
Give 2 Short-Acting B2-adrenergic agonists - ANSWER Salbutamol
Terbutaline
Give 2 Long-Acting B2-adrenergic agonists - ANSWER Salmeterol
Formoterol
How do LABAs work in relation to SABAs? - ANSWER They are modifications of salbutamol
which stick t the R and keep triggering it over 6-12 hours
What is Seretide a combination of? What colour is the inhaler? - ANSWER Salmeterol and
fluticasone proprionate
Purple
When can and when can't use use a LABA without a steroid? - ANSWER CAN use a LABA without
a steroid in COPD
CAN'T use a LABA without a steroid in asthma
Which drugs affect the acute response in asthma and which affect the late phase response? -
ANSWER Acute = B2-agonists
Late = Steroids
Which drugs actually make asthma improve and which provide temporary relief of bronchospasm? -
ANSWER Steroids = improve
B2-agonists = temporary relief of bronchospasm
If a patient is not controlled on a standard dose of steroid, what should you do? - ANSWER Add
a LABA (don't just go for a higher dose of steroid)
, Which group of people do worse on Salmeterol? - ANSWER Those who have a B2-adrenoceptor
polymorphism (5-10% of people)
What s the single most important treatment for COPD and why (2 reasons)? - ANSWER Stop
smoking
Makes COPD worse
Stops steroids from being effective @ the epithelium
What other class of drugs can help to bronchodilate in COPD and in older patients with asthma? -
ANSWER Short/Long-term Muscarinic ANTagonists
What does the FEV1 need to be in COPD in order to give a steroid? - ANSWER <50%
Give 2 reasons why the role of steroids in COPD is debatable - ANSWER 1. High risk of
pneumonia
2. NNT = 44 patients for 3 years to prevent 1 exacerbation of COPD
Give 2 Xanthines and say which one can be injected in emergencies) - ANSWER 1. Theophylline
2. Aminophylline (can be injected)
What are theo and amino modified versions of? - ANSWER Caffeine
Give 4 uses of Xanthines - ANSWER 1. Second-line bronchodilator (after B2-agonist)
2. Nocturnal Asthma (as slow-release)
3. Acute Severe Asthma
4. Steroid-avoidance
Give 4 ways in which Xanthines work - ANSWER 1. Phosphodiesterase Inhibitors
2. Adenosine Receptor Antagonists
3. Increase catecholamine release
4. T-lymphocyte modulation
Give a common side effect of Xanthines and say why this happens - ANSWER GORD
What is the therapeutic range of Theophylline? - ANSWER 10-20 mcg/ml
Give 3 toxic effects of high-dose Theophlline - ANSWER 1. Increased gastric acid = nausea,
anorexia, etc
2. Tachycardia
3. Tremor
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