Clinical Pharmacotheraputics Past Paper 2012 8th Semester University of Lahore

THE UNIVERSITY OF LAHORE-ISLAMABAD CAMPUS

SCHOOL OF PHARMACY

Subject: Clinical Pharmacotheraputics	Session:                 Pharm-D VIII-Semester
Total Marks:  25	Date: 17/11/2012
Time Allowed:  2.hrs	Paper:                    Mid-term
Name:	Roll No.

You are called to the bedside to see a patient withPrinzmetal’s angina who is having chest pain. The patienthad a cardiac catheterization 2 days prior showinga 60% stenosis of the right coronary artery with associatedspasm during coronary angiogram. The spasm wasrelieved with nitroglycerin infusion. Which of the followingadditional disorders is the patient most likely tohave?

A. Migraine

B. Peptic ulcer disease

C. Peripheral vascular disease

D. Reactive arthritis

E. Rheumatoid arthritis

A male patient with inflammatory bowel disease(IBD) comes to your office as a new patient. Reviewing themedical records, you note that he has had primarily rectaldisease. Macroscopic photographs from his most recentcolonoscopy show a lumpy, bumpy, hemorrhagic mucosawith ulcerations. Histology shows a process that is limitedto the mucosa, with the deep layers unaffected. There arecrypt abscesses. Which historic feature would be surprisingin a patient with this form of IBD?

A. Age 15–30

B. Current smoker

C. Fraternal twin sister does not have IBD

D. Identical twin brother does not have IBD

E. Intact appendix

A 46-year-old woman with a past medical historyof osteoporosis presents to the hospital because of hematemesis. She reports having bright-red bloody emesis for 2 h as well as seeing “coffee-grounds” in her emesis. However, you do not witness any vomiting in the emergency department. She takes calcium, vitamin D, andalendronate. Blood pressure is 108/60 mmHg, heart rate93 beats/min, and temperature 37.6°C. Her hematocrit is30% (baseline 37%). You request an emergent upper endoscopyand resuscitate the patient with fluids. What isthe role for immediate IV proton-pump inhibitor (PPI)

therapy in this patient?

A. It is contraindicated given her history of osteoporosis.

B. It should be initiated as this will decrease furtherbleeding.

C. It should be initiated only if high-risk ulcers areidentified at the time of endoscopy.

D. It will decrease her bleeding risk, length of hospitalization,likelihood to need surgery, and overall mortality.

E. There is no indication for immediate IV PPI therapy.

A 73-year-old woman presents to the emergencyroom with black tarry stools and symptoms

ofpresyncope when standing up. Digitalrectal examination confirms the presence ofmelena. She recently started using ibuprofenfor hip discomfort. Upper endoscopy confirmsthe diagnosis of a gastric ulcer. Which of the followingis the most likely explanation for thegastric ulcer?

(A) increasing acid production

(B) causing direct epithelial cell death

(C) promoting replication of Helicobacter pylori

(D) an antiplatelet effect

(E) inhibiting mucosal repair

Which are of proven benefit in Crohn'sdisease:

A. azathioprine

B. methotrexate

C. flagyl

D. 6-mercaptopurine

E. cyclosporine A

 

 

The cytochrome P450 hepatic microsomal enzyme system

A. is the major metabolic pathway for oxazepam.

B. is induced by phenobarbitone.

C. reacts with liver-kidney microsomal autoantibodies.

D. is inhibited by cimetidine

E. is responsible for the metabolism of bilirubin prior to conjugation

A middle aged female is referred because of two elevated gastrin levels (» 780). She has a past history of dyspepsia and has been on Ranitidine for years. Recent endoscopy shows atrophic mucosa in the fundus. The most likely cause for the increased gastrin

A .Ranitidine

B. Gastrinoma

C. Pernicious anaemia

D. Helicobacter pylori

Which of the following side effects is most likely to be reduced with the use of COX 2 inhibitors compared with NSAIDs?

A.Renal impairment

B.Peripheraloedema

C.Rash

D.Gastric ulceration

E.Headache

Make true and False? (5-Marks)

1) Pharmacodynamics Drug interactions have Delay onset of action.

2)Probenecid increase sectretion of Methotrixate.

3) Carbamazepine decreaseits own metabolism.

4) Digoxinadministered dose is metabolized by the intestinal flora

5)Loperamide is use for treatment of Upper GI bleeding.

Clinical Case (Part-B) (5-marks)

Chief Complaint

“My stomach has been hurting for the past few weeks. Over the weekend, I noticed my bowel movements were black and tarry.”

HPI

William Smith is a 62-year-old man who presents to the emergency department on Sunday evening complaining of intermittent burningepigastric pain for more than 2 months. His pain is non-radiating and

occurs to the right of his epigastrium. This pain changes in intensity and is worse with meals. He also has noticed intermittent belching,being bloated, being weak when walking, and complains of nausea

after eating. Since last Friday, he has been having black, tarry bowel movements. He does not have any history of PUD or GI bleeding andhas not experienced anorexia or vomiting.

PMH

COPD × 10 years, Type 2 DM × 10 years, Osteoarthritis × 15 years in the right shoulder

FH

His father died at age 55 of an acute MI and his mother died at age66 from lung CA. He has three siblings who are alive and well.

SH

Presently employed as an accountant. He is married and has three daughters. He still smokes a cigar occasionally despite his COPD,and he drinks a case of beer per week.

Meds

Metformin 500 mg po twice daily

EC aspirin 325 mg po once daily

Ipratropium MDI 2 puffs 4 times daily

Albuterol MDI 2 puffs PRN

Ibuprofen 200 mg 2 tablets PRN shoulder pain

Maalox 1 tablespoonful PRN stomach pain

Allergy

Penicillin—hives

ROS

Unremarkable except for complaints noted above

Physical Examination

Gen

Overweight man in moderate distress

VS

BP 120/62 right arm (seated), P 109, RR 18 reg, T 37.9°C; Wt 102,kg, Ht 5'9''

Skin

Warm and dry

HEENT

discs flat; no AV nicking, hemorrhages, or exudates

Chest

Bilateral rhonchi, faint wheezes

CV

S1 and S2 normal; no MRG

Abd

Normal bowel sounds and mild epigastric tenderness; liver size

normal; no splenomegaly or masses observed

Rect

Nontender; melenic stool found in rectal vault; stool heme (+)

Ext

Normal ROM except for restricted right shoulder movement

Labs

Na 144 mEq/L Hgb 9.2 g/dLCa 9.2 mg/dL

K 3.9 mEq/L Hct 26.2% Mg 2.0 mEq/L

Cl 98 mEq/L Plt 230 × 103/mm3 Phos 4.0 mg/dL

CO2 30 mEq/L WBC 8.4 × 103/mm3 Albumin 3.9 g/dL

BUN 10 mg/dL MCV 74 μm3Endoscopy showing a 6-mm ulcer in the gastric antrum.

SCr 1.1 mg/dLRetic 0.3%

FBG 154 mg/dL Fe 49 mcg/dL

CLINICAL COURSE (PART 1)

Q.1)What information (signs, symptoms, diagnostic tests, and laboratory values indicates the presence of peptic ulcer disease?

Q.2)Based on the patient’s presentation and the current medical assessment, design a Pharmacotherapeutic regimen to treat his gastric ulcer, anemia, and osteoarthritis?

CLINICAL COURSE (PART 2)

At the time of endoscopy, a biopsy of the gastric mucosa was takenand indicated the presence of inflammation and abundant H.pylori–like organisms

_Helicobacter pylori organisms fluoresce above gastricepithelial cells.

Q.3) Design a pharmacotherapeutic regimen for this patient’s ulcer that will accomplish the new treatment goals.(2)

Part-C (5-Marks)

Qno 1 a)What Investigation you will perform for confirmation of Crohn:s Disease? (2)

b)Write treatment plan for Crohn:s disease? (2)

c)write complications of Crohn: disease? (1)

OR

Q.n 2) Write Pharmacokinetic drug interaction in detail?