Clinical Pharmacotherapeutics Past Paper Pharm D 2013 university of Lahore

THE UNIVERSITY OF LAHORE-ISLAMABAD CAMPUS

SCHOOL OF PHARMACY

Subject: Clinical Pharmacotheraputics	Session:                 Pharm-D
Total Marks:  15	Date: 10/1/13
Time Allowed:  45min	Paper:
Name:	Roll No.

A	B	Answers
A 55-year-old man presents with increasingshortness of breath, decreased urine output,malaise, nausea, and vomiting. He has ahistoryof hypertension, chronic renal failure, and coronary artery disease. His laboratory data reveal very high urea and creatinine, consistent with acute on chronic renal failure. He also noteshaving intermittent “twitching” in his arms and legs that started recently.	(A) simple partial seizure
A 24-year-old woman complains of havingintermittent bouts of smelling burning rubberfollowed by lip smacking and chewing ovements as observed by others. During these spells, she does not respond to questions. There has never been any complete loss of consciousness during these episodes either. An MRI of thebrain reveals temporal lobe sclerosis	(B) complex partial seizures
A teenager has a long history of “daydreaming”in school. EEG reveals evidence of a generalized seizure disorder, but there has never been a history of convulsive muscular activity.	(C) tonic-clonic (grand mal) seizures
A23-year-old woman has a history of repetitiveinvoluntary movements of her right hand associated with abnormal facial movements. At times, the movements spread to involve theentire arm.	(D) absence (petit mal) seizures
This form of epilepsy almost always starts in childhood.	(E) myoclonic seizures
	F) status epilepticus

Match the Column (5)

A 73-year-old woman is admitted to hospitalwith right-sided hemiparesis and expressive

Aphasia. CT scan of the brain reveals a stroke in the right middle cerebral artery territory. Whichof the following is the most common cause ofischemic stroke?

(A) cerebral hemorrhage

(B) cerebral embolism

(C) arteritis

(D) dissecting aneurysm

(E) hemorrhage into atherosclerosis

A 37-year-old man is witnessed by his family to havea generalized tonic-clonic seizure at a party. He does nothave a known seizure disorder. There is no history ofhead trauma, stroke, or tumor. The patient is unemployed,married, and takes no medication. Physical examinationshows no skin abnormalities and no stigmata ofchronic liver or renal disease. The patient is postictal. Hisneck is difficult to maneuver due to stiffness. His whiteblood cell count is 19,000/ìL, hematocrit 36%, and platelets200,000/ìL. Glucose is 102 mg/dL, sodium 136 meq/dL, and creatinine 0.8g/dL. Urine toxicology screen is positive for cocainemetabolites. Which next step is most appropriate in thispatient’s management?

A. Electroencephalogram (EEG)

B. Intravenous loading with antiepileptic medication

C. Lumbar puncture

D. Magnetic resonance imaging

E. Substance abuse counseling

All the following have been shown to reduce the riskof atherothrombotic stroke in primary or secondary preventionexcept

A. aspirin

B. blood pressure control

C. clopidogrel

D. statin therapy

E. warfarin

Type B adverse drug reactions:

a. are reactions that are unrelated to the drug

b. occur as a part of the normal pharmacological profile of the particular drug

c. are a subgroup of adverse drug events

d. relate to type B hypersensitivity reactions

Risk factors for adverse drug reactions include:
A. Topical administration (compared with parenteraladministration)
B. Low dose (compared with high dose)
C. Frequent, intermittent dosing frequency (comparedwith prolonged, continuous dosing)
D. No previous exposure (compared with previousadministration)
E. All of the above

CLINICAL CASES:

Chief Complaint

“My right arm feels like it’s frozen. I can barely move it.”

HPI

Carson Johnson is a 67-year-old African-American man who presentsto the emergency room at 8:45 AM after noticing a suddenonset of weakness in his right arm. He woke up at 7:15 AM and wentto the bathroom to brush his teeth. While walking from thebathroom to the kitchen, he noticed general weakness and hadtrouble saying “good morning” to his son, Willis, with whom helives. His son immediately brought him to the ER. While in the ER,

he started experiencing some dysarthria and began to have a rightsidedfacial droop. He denied any dizziness, vomiting, or headache.

PMH

Hypertension, diagnosed 10 years ago

Hyperlipidemia

Two different TIAs in the past, last in 2002

FH

Father passed away at age 87 from a stroke; mother passed away from“old age” at age 82. Brother, age 61, also has HTN. Son, age 34, has DM.

SH

Denies ETOH use, admits to occasional cocaine use, quit smoking 20years ago. Lives with son.

Meds

Ramipril 5 mg po daily

Atorvastatin 10 mg po daily

Atenolol 50 mg po daily

Aspirin EC 81 mg po daily

Allergy

Paracetamol (rash), adhesive tape

Review of systems

Denies headache. Vision is blurry.

Physical Examination

Gen

lying in bed, responsive but sluggish; looks tired. Speechis slurred.

VS

BP 172/92, P 92, RR 21, T 98.6°, O2 Sat 94% on room air; Wt 90 kg,

Ht 5'8''

SkinWarm, dry

Neck(+) carotid bruits on the left side, (–) lymphadenopathy

ChestLungs clear to auscultation bilaterally

CV S1 & S2 normal, no S3 or S4

AbdSoft, non-tender, non-distended, (+) BS(Bowel sound)

Neuro (+) dysarthria, right-sided facial droop

Carotid dopplers: reduced flow, moderate to severe carotid stenosis;65% stenosis of right carotid, 50% stenosis of left carotid

Echocardiogram: no evidence of LV thrombus, ejection fraction 55–60%; overall unremarkable

EKG: Tachycardic sinus rhythm

Q.No1)What will be your Assessments for this case? Also write down symptom’s and related Lab values which support your Assessments?(3)

Q.No2)What pharmacotherapeutic regimen would you recommend for the acute treatment of stroke in this patient (include drug, dose, route, frequency, and duration)? (2)

OR

Q.No.1) what are adverse drug reactions? Write down different types? (2)

Q.No.2) Write down Mechanism of Pharmacokinetic Adverse drug Reactions? (3)