Pharmacology and Pharmacokinetics (E07U0A)

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General

The following subjects will be covered:

Introduction to pharmacology: Development (incl. notions of 'rational drug design'), evaluation and testing of new drugs (e.g. bioassay), brief overview of registration procedure and refunding.

Pharmacokinetics: Insights in kinetic processes of absorption, distribution and elimination, biotransformation/metabolism of drugs.

Pharmacodynamics and receptors (basics since receptor mechanisms are addressed extensively in cell biology and biochemistry).

Toxicology (introductory): General principles, toxicity of drugs: mechanisms

Pharmacology, with special attention to mechanisms of action of the different groups of pharmacological agents (no individual drugs will be discussed) related to: The autonomous and peripheral nervous system, the central nervous system, the cardiovascular system, the endocrine system, pain, fever and inflammation.

Cytostatics, biotechnological drugs (monoclonal antibodies).


Exam form

Final examination during examination period, closed book. Each student will do the complete exam with one of the course lecturers.

Oral with written preparation: 4 questions, the questions will include: 1. An open question. 2. Explanation of a case report or an article concerning the use of (a) drug(s). 3. Two questions with different parts/topics for which situation/explanation/justification of the answer is expected.

A minimum of 60 minutes is provided for written preparation of the exam. Afterwards the students can present themselves to the designated examiner for the oral part of the exam. All documents (including preparatory documents) have to be handed over to the examiner or the observer.


Files

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Examples_examquestion_pharmacology_2013 Examples of exam questions given by the professors (2013)

Pharmacology_forum_2012 Exam questions from the International master from the Medica-forum of 2012

Pharmacology_questions dutch master Exam questions from the Dutch master from the Medica-forum till 2012   exam questions from earlier years

Exam questions

(Click here to add examquestions.)

Exam questions '11-'12

1) Discuss the (nor)adrenergic synapse and the effect that different classes of drugs have on it.

2) A girl (15) is brought into the ER with the following symptoms: dizziness, headache, flushing, blurred vision, polyuria, polydipsia, attention deficit. Diabetes mellitus and diabetes insipidus have been ruled out. A medical history reveales the use of dexchlorfeniramine, an antihistamine. a) Explain the symptoms and give other symptoms related to antihistamines. b) Give possible indications for the prescription of this drug.

3) For the following drugs, give the working mechanism, receptor class and therapeutical use. For the working mechanism, choose from: irreversible inhibitor, competitive antagonist, non-competitive antagonist, agonist, reuptake inhibitor. Fentanyl, verapamil (CCB), simvastatin, leptocurare, benzodiazepines, ondansetron, metoclopramide, aspirin, venlafaxine (SNRI), naloxone

4) Right or wrong? Explain a) Xylocain is a good local anaesthetic for a tooth abcess b) TDM is needed for treatment with i) digoxin, ii) coumarins, iii) lithium c) Strong anti-emetics such as ondansetron and domperidone can pass the blood brain barrier d) Varenicline, a drug used in smoking cessation, is an antagonist of the muscarinic acetylcholine receptor e) fluoxetine and erythromycine have no effect on CYP metabolism

Exam questions '12 - 13'

1. General questions

Explain the side effects of NSAID's using their mechanism of action.

Give the autonomic effects of morphine. Give and explain the differences with pentazocine.

Explain the (nor)adrenergic synaps and discuss the effect on it by different classes of drugs.

2. Case study

Case, female, 15 years old, presents itself with dizzyness, blurred vision(accommodation disorder due to antimuscarinic effects), head ache, polydipsia and plyuria. She recieved an anti-histaminic earlier. Explain the side effects, which symptoms are expected and why she was prescribed an anti-histaminic.

3 patients with long QT-syndrome and asthma. Explain the use treatment for both conditions (beta-blockeers vs beta agonists) and the additional treatments for asthma.

Discuss the pharmacological components: A 40 year-old woman with schizoaffective disorder is treated with haloperidol and lithium. The lithium is replaced with carbamazepine. This results in deterioration of the patient, which disappears after dicontinuation of carbamazepine treatment. Blood test reveal altered haloperidol blood levels. This pharmacokinetic interaction has to be further investigated.

3.Statements

Opioids interfere with p.o. drugs; Atenolol, verapamil and alphablockers reduce Heart Rate; Antimuscarinica, CA-I en ß-blockers are used for glaucoma; Ezetimibe is an add-on drug Gucocorticoid treatment should not be stopped abruptly Depressed people with prostate hypertrophy should be treated with TCAs Reserpine can cause lowered heart rate and depression These drugs cause increased heart rate: i. Verapamil ii. Nifedipine iii. alpha1-blockers Ibuprofen is anti-indicated in heart failure Codeine can be used as an analgesic in patients with gastric ulcer Nifedipine, captopril, propanolol and nitroglyceride are drugs that decrease the heart rate Xylocaine can be used as an analgesic in patients with tooth abcesses 5mg of drug A has the same effect as 500 mg of drug B, this means drug A is more toxic than drug B and drug B has a shorter duration of action than drug A

4. Explain the interactions

haloperidol and ropinirol; captopril and spironolactone; cortisone and naproxen; alcohol and benzodiazepines; lithium and a low salt diet; alcohol and a benzodiazepam; fenytoine and fluvoxamine/fluoxetine; ezetimibe and a simvastatin

5.Give the mechanism of action, the receptor class and therapeutic use of the following drugs: Ondansetron, metoclopramide, fentanyl,...

Exam questions '13 - 14'

General questions

Discuss the benefits of ACE-inhibitors in heart failure

discuss the noradrenergic synaps and different drugs that act on it

Beta blockers indications and contra indications (plus diabetes, asthma and pregnancy)

Case Report

Case: diabetic woman with manic attack who was treated with several anti-epileptics.

Case: A girl (15) is brought into the ER with the following symptoms: dizziness, headache, flushing, blurred vision, polyuria, polydipsia, attention deficit. Diabetes mellitus and diabetes insipidus have been ruled out. A medical history reveales the use of dexchlorfeniramine, an antihistamine. a) Explain the symptoms and give other symptoms related to antihistamines. b) Give possible indications for the prescription of this drug.

case: 40 yo women with schizophrenic disorder was started on Lithium and Haloperidol. Lithium was substituted by Carbamezepine and the patient deteriorated because of drug interactions. What is the interaction and explain the drugs.

Statements

  1. A chronic therapy with glucocorticoids shouldn't be stopped abruptly.
  2. the use of TCA in chronic myopathy
  3. Metoclipramide can cause acute dystonia
  4. this drugs are strong inducers of Cyp450 enzymes: phenytoine, fluoxetine, lithium.
  5. These drugs can increase the heart rate i) difepidine ii) verapamil iii) alpha1 blocker
  6. Use of ibuprofen in pregnant women
  7. negative allosteric modulator of GABAa can be used to treat anti-convulsions
  8. abrupt stop of a2-agonist clonidine will lead to denervation hypersensitivity
  9. The therapeutic effect of omeprazole is directly correlated to plasma volume
  10. Acute dyskinesia which is caused by antipsychotica (neuroleptics) can be treated by L-DOPA
  11. Xylocaine for tooth abscess
  12. BDZs move the graph of response to GABA to the right
  13. Methylphenidate has potent addictive effect
  14. TDM for digoxine, warfarine, simvastatin, omeprazole

Table to fill in

Fill in working mechanism (competitive/irreversible antagonist, agonist, ion channel inhibitor, ...), receptor group, therapeutic use: leptocurares, omeprazole, aspirin, simvastatin, SNRI, lidocain, setron, fentanyl, naloxone.

Interactions

  1. morphine with L-dopa in mouth
  2. digoxin and thaizaid
  3. lithium and ACE inhibitor
  4. NSAID with spironolactone
  5. antihistamine + cyp-inhibitor
  6. paracetamol + codeine
  7. TCA + flunitrazepam
  8. ASA + rivaroxaban
  9. MAOI+tyramine
  10. phenytion+NSAID

Exam questions '14-'15

1) Describe the beneficial effects of ACE inhibitors in heart failure.

2) Discuss following case:

3) Discuss the following:

a) Codein is contraindicated in gastric ulcer

b) Glucocorticoids taken longer should not be stopped suddenly

c) Nifedipine, propranolol and captopril decrease the heart rate

d) Xylocain can be used as local anaesthetic in tooth abcess

e) Omeprazole has a half life of 15h that’s why it should only be taken once a day

4) Explain interactions

a) Phenytoin + NSAID

b) Morphine + L-DOPA oral

c) Lithium + thiazide

d) Haloperidol + spironolactone

e) Benzodiazepine overdose treated with flumazenil

Exam questions '15-'16

1)Indications and contra-indications beta-blockers

2) Case: list of drugs used in flight emergeny kit and we had to say the indications:

a) Atropine

b)Epinephrine

c)Antihistamines (oral and IV)

d)Dextrose (it’s a sugar and used when hypoglycemia)

e)Intravenous lidocaine

f)Aspirine

g)Nitroglycerine

h)bronchodilator inhaler

i)analgesic tablets (nonnarcotic)

3)Interactions

a)Morphine + L-DOPA (by mouth)

b)Carbamazepine + NSAID

c)Paracetamol (acetaminophen) + Codeine

d)TDM necessary for digoxin, lithium and omeprazole

e)MAO inhibitor + tyramine-rich food

Statements Xylocaine is not used for anaesthesia tooth abcess Depressive patients with glaucoma are best treated with TCA Nifedipine, propranolol and captopril decrease heart rate benzodiazepines move the concentration-effect curve to the left COX2-selective NSAIDs are safer than other NSAIDs

Exam questions '17-'18

Discuss Parkinson’s disease treatment

Case with 5 drugs you had to discuss

5 statements (~true/false)

+/- 10 Drugs: mechanism (agonist/antagonist/inh), receptor, indication