PROFESSIONAL EXAMINATION OF COUNCIL IN TERMS OF THE

PHARMACY ACT, 1974 (ACT 53 OF 1974)

APPLIED PHARMACOLOGY AND TOXICOLOGY EXAMINATION

23 MAY 2018

TIME ALLOWED: Three (3) hours

MAXIMUM MARKS: 80

PASS MARK: 40

APPLIED PHARMACOLOGY AND TOXICOLOGY

EXAMINER:

MODERATOR:

NO. OF PAGES: 22

CANDIDATES PLEASE NOTE:

(a) Ensure that you have the correct question paper for your examination.
(b) Ensure that all your details as requested on the cover page are filled in
correctly.
(c) There is 15 minutes reading time for this paper.
(d) Do not commence writing until you are told to do so.
(e) The marks allocated to each question must be borne in mind when
answering
(f) All multiple choice questions are worth one mark.
(g) There is no negative marking for incorrect answers.
(h) There is only one correct answer per multiple choice question, therefore
select only one option per question.
(i) Questions can be answered in any given order within the given time.
(j) All questions must be answered.

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Date: ------------------------------------------------------------------------------------------------------------

Marks awarded
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Examiner Moderator

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Examiner Moderator

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 SECTION A [20 MARKS]

MULTIPLE CHOICE QUESTIONS

For questions 1 to 40 only circle the letter a, b, c or d to indicate the most correct answer.
Each correct answer counts for ½ (half) mark.

1. Which of the following is true for non-competitive antagonism?

a) Antagonist binds to the same receptor recognition site as the agonist and prevents it
from binding.

b) Antagonist interrupts the chain of events leading to production of a response to the

agonist.

c) Antagonist produces an effect that is the exact opposite of the agonist effect.

d) Antagonism can be overcome by increasing the dose of the agonist.

2. Which of the following drugs is not contraindicated in patients with porphyria?

a) Spironolactone

b) Ibuprofen

c) Methyldopa

d) Ketoconazole

3. Which of the following agents is least likely to produce nephrotoxicity in patients?

a) Minoxidil

b) Vancomycin

c) Simvastatin

d) Amphotericin B

4. Which of the following is a specific antidote for Methotrexate toxicity?

a) Leucovorin

b) Mesna

c) Amifostine

d) Filgastrim
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5. Which statement is not true for aspirin poisoning?
a) Repeated doses of activated charcoal significantly increase the aspirin clearance
b) Gastric lavage is indicated
c) The plasma salicylate concentration increases more than proportionally with increasing
dose
d) Force alkaline diuresis is recommended to counteract the acidosis

6. Which of the following agents is used in the diagnosis of Cushing's syndrome?

a) Bupropion

b) Ethanol (alcohol)

c) Dexamethasone

d) Clopidrogel

7. Which of the following drugs is best indicated for the management of status epilepticus?

a) Phenytoin

b) Vigabatrin

c) Clonazepam

d) Ethosuximide

8. Which of the following agents is not indicated for the treatment of Parkinson's disease?

a) Orphenadrine

b) Levodopa

c) Amantadine

d) Sulpiride

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9. Which of the following antipsychotic agents is best suited for poorly compliant patients?

a) Fluphenazine

b) Haloperidol

c) Clozapine

d) Risperidone

10. Which of the following drugs would be absolutely contraindicated when prescribed with
clozapine?
a) Aspirin
b) Fluoxetine
c) Carbamazepine
d) Venlafaxine

11. Which of the following statements does not describe the pathophysiology of endogenous
depression?

a) Incidence is usually not in response to external stresses

b) Results from a decrease in monoamine levels in the CNS

c) Results from defective post synaptic monoamine receptors in the CNS

d) Involves the neurotransmitter 5-hydroxytryptamine (5-HT)

12. The proposed mechanism of action of the tricyclic antidepressants is that they

a) have intrinsic adrenergic activity

b) can stimulate dopamine receptors

c) prevent the reuptake of synaptic neurotransmitters

d) bind to centres of stimulation in the brain

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13. Which of the following is not an approved use for amitriptyline?

a) Endogenous depression

b) Nocturnal enuresis

c) Anxiety disorders

d) Obsessive compulsive disorder

14. Fluoxetine

a) is used as an adjunct treatment for pain

b) selectively blocks neuronal uptake of noradrenaline

c) is more cardiotoxic than imipramine

d) is less sedative than amitriptyline

15. Which of the following statements is true for the drug levodopa?

a) It is unable on its own to enter nerve terminals in the basal ganglia.

b) It is directly antagonised by bromocriptine.

c) It may produce dystonic reactions in patients.

d) It is a pro-drug that is oxidized by MOA to form dopamine.

16. Which of the following antimicrobial agents is used in the treatment of uncomplicated UTI in
pregnancy?

a) Metronidazole

b) Nalidixic acid

c) Ciprofloxacin

d) Erythromycin

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17. Which of the following statements is incorrect about protease inhibitors?

a) Are highly effective as antiretroviral agents when used alone

b) Inhibit protease enzymes responsible for cleavage of viral polyproteins

c) Are only effective when used in combination with other agents

d) Are potent cytochrome P450 enzyme inducers

18. Which of the following antiretroviral drug groups has the least drug-drug interactions?
a) Protease inhibitors
b) Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
c) Entry inhibitors
d) Nucleoside reverse transcriptase inhibitors (NRTIs)

19. Isoniazid is a primary anti-tubercular agent that

a) requires pyridoxine supplementation
b) may discolour the tears, saliva, urine, or faeces orange-red
c) causes ocular complications that are reversible if the drug is discontinued
d) may be ototoxic and nephrotoxic

20. Which of the following statements best describes the mechanism of action of
antimetabolites?

a) Alkylates cell DNA by binding to N7 guanine base

b) Inhibit enzymes involved in the synthesis of purines

c) Cause intercalation of DNA by binding to dexoxyribose-phosphate backbone

d) Increase production of superoxide and hydroxyl radicals that lead to DNA strand
breakage

21. Which of the following antimicrobial agents is indicated for the treatment of infections due to
anaerobes such as Clostridia sp?

a) Fusidic acid
b) Amikacin
c) Norfloxacin
d) Linezolid

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22. Which of the following antimicrobial agents has a time-dependent killing effect?

a) Ofloxacin

b) Erythromycin

c) Vancomycin

d) Metronidazole

23. All of the following factors may increase the risk of nephrotoxicity from gentamicin therapy
EXCEPT:

a) Prolonged courses of gentamicin therapy

b) Concurrent amphotericin B therapy

c) Trough gentamicin levels below 2μg/ml

d) Concurrent cisplatin therapy

24. Which of the following antibiotics has a concentration dependent killing effect?
a) Vancomycin
b) Erythromycin
c) Tobramycin
d) Ceftazidime

25. Which of the following antibiotics has a post-antibiotic effect?

a) Gentamicin
b) Imipenem
c) Penicillin G
d) Vancomycin

26. Which of the following statements is true for trimethoprim?

a) It is less potent than sulfamethoxazole

b) Inhibits the enzyme dihydropteroate synthetase

c) Adverse effects can be reduced by co-administration of folic acid

d) Stimulates purine synthesis

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27. Sulfonamides increase the risk of neonatal kernicterus because they
a) Decrease the production of plasma albumin

b) Increase the turnover of red blood cells

c) Inhibit the metabolism of bilirubin

d) Compete for bilirubin binding sites on plasma albumin

28. Which antibiotic would you recommend for a patient with an infection caused by
Mycoplasma pneumoniae?
a) Ceftazidime
b) Penicillin G
c) Erythromycin
d) Ampicillin

29. Which antifungal agent can be used to treat infections due to Aspergillus spp.?
a) Fluconazole
b) Itraconazole
c) Amphotericin B
d) All of the above

30. Which of the following agents shows cytotoxicity that is cell-cycle specific?
a) Dactinomycin
b) Methotrexate
c) Cisplatin
d) Doxorubicin

31. Which of the following agents is best suited for an obese type II diabetic patient?

a) Gliclazide

b) Rosiglitazone

c) Acarbose

d) Metformin

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32. Which of the following drugs would not increase the chances of myopathy when co-
administered with Simvastatin?

a) Colestyramine

b) Cimetidine

c) Bezafibrate

d) Ketoconazole

33. Nifedipine is preferred to atenolol for the treatment of angina in patients with the following
co-morbidities EXCEPT?

a) Heart block

b) Diabetes

c) Anxiety

d) Peripheral vascular disease

34. Which of the following antihypertensive agents is also indicated for the treatment of angina
pectoris?

a) Hydrochlorothiazide

b) Methyldopa

c) Verapamil

d) Enalapril

35. The anticoagulant activity of warfarin can be potentiated by all of the following EXCEPT:
a) Rifampicin

b) Aspirin
c) Cimetidine
d) Disulfiram

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36. Which of the following pharmacological approaches is not effective for prophylaxis of DVT?
a) Subcutaneous low-dose heparin
b) Aspirin
c) Adjusted-dose heparin
d) Fixed low-dose or adjusted-dose warfarin

37. Which of the following Non-Steroidal Anti-inflammatory agents produces the least gastro-
intestinal irritation with long term use?

a) Celecoxib

b) Ibuprofen

c) Piroxicam

d) Aspirin

38. Probenicid alters the half-life of which of the following agents?

a) Gentamicin
b) Penicillin
c) Rifampin
d) Doxycycline

39. Which of the following drugs is not indicated in the treatment Cushing's disease?
a) Etomidate
b) Prednisone
c) Ketoconazole
d) Mitotane

40. Which of the following agents is not indicated for the treatment for thyrotoxicosis?
a) Propranolol

b) Carbimazole

c) Iodine

d) Tri-iodothyronine

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 SECTION B [60 MARKS]

Write the answers for this section in the spaces provided. Answer all questions.

Question 1 [20 marks]

Using the principles underlying the pharmacological actions of drugs, explain why/how the
scenarios below may have occurred.

a) Mr A, a patient on clozapine presents with dry mouth and ileus.

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b) Mr B experiences dizziness and syncope when getting up from the bed while on prazocin.

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c) Mrs C's warfarin dose had to be increased when she was placed on first-line anti-TB
treatment.

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d) Ms D was treated for neuropathic pain a few weeks ago. She is now upset that she is
pregnant even though she was on an oral contraceptive.

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e) Mr E on treatment for DVT with enoxaparin develops petechiae following diagnosis of

acute renal impairment.

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f) Mr F experiences an acute gout attack after mistakenly taking his wife's diuretic.

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g) Mr G diagnosed with heart failure and on treatment with digoxin has to be defibrillated
after his heart stopped beating following administration of propranolol.

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h) Ms H experiences sweating, agitation and confusion after her psychologist changed her
antidepressant medication to moclobemide 5 days after stopping her fluoxetine
treatment.

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i) I with previously controlled type II diabetes experiences hyperglycaemia when placed on
an antihypertensive for the treatment of hypertension.

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j) Breakthrough seizures occurred in J on the antiepileptic carbamazepine when first-line

HAART was initiated following HIV diagnosis.

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Question 2 [8 marks]

MNG is a 34-year-old male presenting with complaints of neck stiffness, nausea, severe
headaches and photophobia. Lumbar puncture is requested and the patient is started on
empiric treatment while awaiting lumbar puncture results.

a) What constitutes empiric treatment in this case? (1)

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b) Why is it necessary to start empiric treatment? (3)

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Lumbar puncture results indicate Cryptococcal infection and an Elisa test is positive for HIV.

c) What treatment algorithm will you follow for the management of meningitis in this patient.
(4)
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Question 3 [6 marks]

A 29-year-old female patient is on second line treatment for HIV infection and is recently being
treated for hypertension and hypercholesterolemia. She currently presents with symptoms of
myopathy and acute renal impairment. The patient is on the following drugs.

Tenofovir 300 mg OD

Lamivudine 150 mg BD

Lopinavir-ritonavir (400 mg, 100 mg) BD

Hydrochlorothiazide 12.5 mg OD

Enalapril 5 mg OD

Simvastatin 20 mg N

a) Which of the antiretroviral agents would be implicated in renal impairment in this patient?
(1)

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b) Suggest an alternative anti-retroviral regimen for this patient. (1)

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c) Which agents are implicated in the development of myopathy? (1)

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d) Describe the mechanisms by which the drugs in (c) above produce myopathy. (2)

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 ______________________________________________________________

e) Suggest changes to this patient's therapy to prevent/reduce the incidence of myopathy. (1)

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Question 4 [14 marks]

Mr K a 67-year-old male was brought to the emergency unit by his son. He says his father had
just taken his antihypertensive medication for the first time and fell over and hit his head when
he tried getting up. He also complains of nocturnal dyspnoea for one week and +1 pitting oedema
in the lower legs. X-ray shows dilated myocardium and a diagnosis of CCF is made.
Labs: BP 162/102 HR 95 RR 25

a) Which antihypertensive agent(s) could have produced the syncope (fainting)? Describe how
this agent would produce this effect. (2)

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b) Which antihypertensive agents would be beneficial for the treatment of Mr K? Explain how
these agents would be effective in treating both hypertension and CCF. (5)

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c) Which antihypertensive agents would be contraindicated in treating Mr K? (2)

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d) Provide four typical clinical signs and symptoms that can be observed from a patient with CCF.
(2)

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e) What is the general desired outcomes of treating CCF? (3)

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Question 5 [12 marks]

As part of your duties at a drug information centre, give the antidote and mechanism for the
antidote effect for the following cases of poisoning or drug overdose encountered?

a) An adult male discovered non-responsive three hours after Morphine overdose.

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b) An adult female calls in four hours after ingesting 20 tablets of paracetamol.

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c) An infant is found after accidental ingestion of diazepam tablets.

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d) An ICU patient erroneously given an overdose of Digoxin.

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e) A case of Iron overdose.

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f) An attempted homicide using Cyanide.

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g) Accidental ingestion of methanol sold as locally brewed alcohol.

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h) A farm worker poisoned by organophosphate contact.

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