Questions Flashcards

1
Q

Low dose aspirin is an effective anti-coagulant that can reduce the risk of heart attacks and stroke
when administered chronically.
a) Describe its main pharmacological mechanism of action to prevent heart attacks. [3 marks]

b) Why is aspirin a relatively safe and effective medicine when used chronically as an anticoagulant? [3 marks]

A

A) Low-dose aspirin irreversibly inhibits the enzyme cyclooxygenase-1 (COX-1) in platelets, which decreases the synthesis of thromboxane A2, a molecule that promotes platelet aggregation and vasoconstriction. This action reduces the formation of blood clots in arteries, lowering the risk of heart attacks.

B) Aspirin is relatively safe and effective at low doses because it specifically targets platelet function, reducing clot formation without affecting the coagulation cascade. Additionally, the effects of aspirin are long-lasting due to the irreversible inhibition of COX-1 in platelets, which do not have nuclei and therefore cannot resynthesize the enzyme.

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2
Q

Draw a diagram showing the main processes involved in neurotransmission by noradrenaline.

A

For a diagram: Include the synthesis of noradrenaline from tyrosine, its storage in vesicles, release into the synaptic cleft upon stimulation, binding to adrenergic receptors (α and β receptors) on the postsynaptic membrane, and reuptake or breakdown by enzymes like monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT).

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3
Q

List TWO (2) common side effects observed when indirect sympathomimetic drugs are administered.

A

Common side effects include hypertension and tachycardia.

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4
Q

Cocaine is one of the many examples of a natural compound which has pharmacological effects in
human beings. It is somewhat unique, however, in that it has multiple targets in the central nervous
system as well as in the periphery, so routes of administration can be crucial.
a) Using a diagram for control and treated cases, what is the mechanism of action of cocaine within
the brain? [3 marks]
b) What is the origin of heroin and what is its mechanism of action in the brain? How can its use
lead to dependence? [3 marks] c) Why is the combination of heroin and cocaine avoided, even by addicts? [2 marks]
d) Cocaine was, perhaps, the original dental anaesthetic and it also reduced blood loss from
infected or injured areas in the mouth and throat.
What are the TWO (2) mechanisms of action involved to achieve these outcomes? [4 marks]

A

A) Platelet Activation:
Trigger: Injury exposes collagen and von Willebrand factor (vWF) in the blood vessel.
Adhesion: Platelets adhere to the injury site and are activated, releasing ADP and thromboxane A₂ (TXA₂).
Amplification: Released ADP binds to P2Y12 receptors on other platelets, activating them and recruiting more platelets.
Platelet Aggregation:
Fibrinogen Binding: Activated platelets express GPIIb/IIIa receptors, which bind fibrinogen, linking platelets together to form a clot.
Drug Interference:
P2Y12 Inhibitors (e.g., Clopidogrel): Block ADP from binding to P2Y12 receptors, preventing platelet activation and recruitment.
GPIIb/IIIa Inhibitors (e.g., Abciximab): Block the GPIIb/IIIa receptors, preventing fibrinogen binding and platelet aggregation.
B) Heroin is derived from morphine and acts as an opioid receptor agonist in the brain, particularly at mu-opioid receptors. Its use leads to dependence due to the release of dopamine in reward pathways, reinforcing drug-taking behavior.
C) The combination, known as a “speedball,” is avoided due to the opposing effects of heroin (depressant) and cocaine (stimulant), increasing the risk of severe cardiovascular effects like arrhythmias and death.
D) Local Anesthetic Mechanism: Cocaine blocks sodium channels on nerve cell membranes, preventing the initiation and transmission of nerve impulses. This leads to a localized loss of sensation by inhibiting the depolarization necessary for action potentials, thus numbing the area and providing anesthesia.
Vasoconstriction Mechanism: Cocaine causes vasoconstriction by stimulating the sympathetic nervous system and blocking the reuptake of norepinephrine at adrenergic nerve terminals. This leads to prolonged norepinephrine action, resulting in the narrowing of blood vessels, which reduces blood flow and minimizes bleeding in the affected area.

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5
Q

4 [Total Q4: 12 marks]
a) Complete the table below to indicate:
(i) what EACH of the following drugs / hormones is primarily used for, or used to treat in female
and male reproductive health; and
(ii) the principal intracellular mechanism of action of the drug / hormone. [7 marks]
b) Complete the following paragraph by filling in the blanks. [5 marks]
The female menstrual cycle is largely controlled by the ________________ that releases the hormone
_____________________ into the anterior pituitary. The anterior pituitary then releases the
gonadotrophins ___________________ and ___________________ which act on the ovaries to
regulate release of the hormones oestrogen and ____________________. This whole process is
dominantly controlled via a _____________________ feedback process that acts at the level of the
_________________ and pituitary. In the absence of the hormones ___________________ and
________________, however, ___________________ feedback dominates.

A

A) in picture
B) The female menstrual cycle is largely controlled by the hypothalamus that releases the hormone gonadotropin-releasing hormone (GnRH) into the anterior pituitary. The anterior pituitary then releases the gonadotrophins follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which act on the ovaries to regulate the release of the hormones oestrogen and progesterone. This whole process is dominantly controlled via a negative feedback process that acts at the level of the hypothalamus and pituitary. In the absence of the hormones oestrogen and progesterone, however, positive feedback dominates.

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6
Q

Four clowns are suffering from various ailments, as shown in the first row of the table. They meet
and decide that it would be funny to exchange the medications they were prescribed and take high
amounts of the following drugs:
 a histamine H2 receptor antagonist (ranitidine)
 a non-selective β-adrenoceptor antagonist (propranolol)
 a use-dependent sodium channel blocker (carbamazepine)
 an opioid receptor agonist (morphine)
 adrenaline
 a muscarinic acetylcholine receptor agonist (pilocarpine)
Complete the answers in the table on the next page:
a) Which medication(s) is/are EACH person taking for their disorders? (Row 2) [3 marks]
b) What are the mechanisms of action for the medication? (Row 3) [3 marks].
After exchanging their medications, they suffer from the drug-induced symptoms shown in Row 4.
c) Which drugs were taken by each patient and why? (Row 5) [6 marks]

A

Row 2: Drugs patients are supposed to take.

Epilepsy: Carbamazepine
Ulcer, severe pain: Ranitidine
Asthma: Adrenaline
Hypertension, dry mouth: Propranolol

Row 3: Mechanisms of action of the drugs.
Carbamazepine: Sodium channel blocker; stabilizes hyperexcitable neural membranes.
Ranitidine: H2 receptor antagonist; reduces stomach acid secretion.
Adrenaline: β-adrenergic agonist; bronchodilation for asthma.
Propranolol: Non-selective β-blocker; reduces blood pressure by decreasing heart rate.

Row 5: Drugs taken by mistake and reasons why.
Epilepsy patient: Took morphine by mistake, causing CNS depression and miosis due to opioid receptor activation.
Ulcer patient: Took pilocarpine by mistake, leading to increased salivation and GI effects due to muscarinic stimulation.
Asthma patient: Took propranolol by mistake, triggering bronchoconstriction due to β-blockade.
Hypertension patient: Took adrenaline by mistake, causing increased blood pressure due to vasoconstriction and β-adrenergic stimulation.

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7
Q

Briefly describe the molecular events that occur between activation and aggregation of platelets.
List TWO (2) drug classes other than aspirin that can interfere with this process and describe
their mechanisms of action. [6 marks]

A

Platelet activation begins with exposure to collagen and release of thromboxane A₂ (TXA₂).
TXA₂ and ADP from platelets attract additional platelets.
Aggregation occurs via the binding of fibrinogen to GPIIb/IIIa receptors.
Antiplatelet drugs: Thienopyridines block ADP receptors, preventing aggregation.
GPIIb/IIIa inhibitors: These drugs (e.g., abciximab) prevent fibrinogen cross-linking of platelets.
Mechanism: These drugs interrupt ADP pathways or block fibrinogen binding, reducing aggregation.

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8
Q

There are several mechanisms of action for antiepileptic drugs.
a) Explain the antiepileptic mechanisms of antiepileptic drugs acting at:
i. voltage-gated sodium channels [1 mark]
ii. voltage-gated calcium channels [1 mark]
b) Name the drug classes for phenobarbital and diazepam. [2 marks]
How do they act to suppress seizures? [1 mark]
c) What is ONE (1) other mechanism of action of antiepileptic treatments? [1 mark]

A

a) Voltage-gated sodium channels: Drugs prolong the inactivated state, reducing repetitive firing (e.g., phenytoin).
a) Voltage-gated calcium channels: Blocking T-type channels reduces neurotransmitter release, helpful in absence seizures (e.g., ethosuximide).
b) Phenobarbital: Barbiturate that enhances GABA activity, suppressing neuronal excitability.
b) Diazepam: Benzodiazepine that also enhances GABA, reducing seizure risk.
c) Other mechanism: GABAergic inhibition is increased by drugs like vigabatrin, preventing seizures.

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9
Q

Provide the words that would fill in the blanks in the following scenario by using the table provided
below to give your 1-2 word answer for each numbered blank.
A 24-year old man is found unconscious in a public park and is brought to a trauma centre. There are
no signs of injury and blood sugar is normal. He has needle track marks on his arms and is noted to
have small pupils and slow, shallow respiration. The doctor on duty thinks that the patient may have
injected __(1)__, and administers naloxone immediately. She remembers back to her pharmacology
course, in which she learned that the __(2)__ is the specific part of the brain that is involved in drug
dependence. She also remembers that users can develop __(3)__ to drug use, which drives them to
obtain greater doses of drugs more often to achieve their ‘high’. The specific subtype of receptors
involved in addiction is __(4)__ , as mice which have these receptors ‘knocked out’ do not display
addictive behaviour.
The duty doctor sees the patient a bit later, after the naloxone has had some effect, and she discusses
treatment options with him. While naloxone provides temporary relief due to its short __(5)__, she
recommends him to consider long-term treatment from a clinic near his home which runs a monitoring
__(6)__ program, in which he can check in daily for his medication. This treatment does not prevent
__(7)__, but can certainly alleviate some of the __(8)__ symptoms that he will experience once he
stops using the drug.
Afterwards, she goes to her office to have a much needed cup of coffee, reflecting on how caffeine
antagonises __(9)__ receptors, hopefully disrupting sleep patterns. Later in the evening at the trauma
centre, she will likely see patients who consume excess levels of alcohol. Alcohol acts as an allosteric
modulator of the __(10)__ receptors, leading to depressed brain function and judgement. Of the
enzymes involved in alcohol metabolism, one is also used by methanol (__(11)__). Ironically, the
treatment of infrequent methanol poisoning is to simply administer __(12)__, as it has a greater
affinity for this enzyme than methanol.

A

(1) Opioid: Based on symptoms of small pupils and shallow breathing.
(2) Nucleus accumbens: Brain area involved in drug dependence.
(3) Tolerance: Drives users to increase dosage.
(4) μ-opioid receptors: Linked to addictive behaviors.
(5) Half-life: Describes naloxone’s temporary relief.
(6) Maintenance: Monitoring program for addiction management.
(7) Cravings: Persistent even with treatment.
(8) Withdrawal: Symptoms that occur on drug cessation.
(9) Adenosine: Caffeine’s antagonistic target.
(10) GABA receptors: Alcohol’s depressive effect on brain.
(11) Alcohol dehydrogenase: Shared enzyme with methanol.
(12) Ethanol: Competes with methanol for metabolism.

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10
Q

A 20-year old man is having surgery to remove two impacted wisdom teeth under general anaesthesia.
He is healthy, has no known allergies and is taking no medication.
On the day of the surgery, he is given a benzodiazepine and fentanyl (an opioid), followed by
intravenous injection of propofol, with maintenance using isoflurane.
Answer a) and b) based on this information.
a) Briefly describe the rationale for use of EACH of these FOUR (4) medications. [4 marks]
b) The anaesthetist is also using nitrous oxide, in combination with the isoflurane.
What is the medical benefit of using these drugs together? [2 marks]

A

a) Atropine vs. β-adrenoceptor antagonist
Acetylcholine addition: Atropine will block response; β-blocker will not.
Noradrenaline addition: β-blocker will show a reduction in contraction.
b) Muscarine vs. acetylcholinesterase inhibitor
Acetylcholine test: Prolonged effect in acetylcholinesterase inhibitor presence.
Antagonist addition: Muscarine effects blocked by atropine.
c) Eye effects identification
Mydriasis, inability to read: Atropine.
Mydriasis, normal accommodation: Adrenaline.
Miosis, far objects blurred: Muscarine.
No change: Water.
d) Distinguishing Miosis Effects on Skeletal Muscle
Acetylcholinesterase inhibitor will increase skeletal muscle contraction.
Muscarine has no direct effect on skeletal muscle contraction.

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11
Q

A 20-year old man is having surgery to remove two impacted wisdom teeth under general anaesthesia.
He is healthy, has no known allergies and is taking no medication.
On the day of the surgery, he is given a benzodiazepine and fentanyl (an opioid), followed by
intravenous injection of propofol, with maintenance using isoflurane.
Answer a) and b) based on this information.
a) Briefly describe the rationale for use of EACH of these FOUR (4) medications. [4 marks]
b) The anaesthetist is also using nitrous oxide, in combination with the isoflurane.
What is the medical benefit of using these drugs together? [2 marks]

A

A)
Benzodiazepine: Helps calm the patient and reduce anxiety before surgery.
Fentanyl (Opioid): Provides strong pain relief during the surgery.
Propofol: Puts the patient to sleep quickly so the surgery can start.
Isoflurane: Keeps the patient asleep and comfortable throughout the surgery.

B) The combination of nitrous oxide with isoflurane provides a synergistic effect that enhances anesthesia while allowing for lower doses of isoflurane. This reduces the potential side effects associated with high-dose isoflurane alone, and nitrous oxide’s rapid onset and offset properties aid in a quicker recovery post-surgery, offering a balanced anesthetic profile.

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12
Q

a)
i. What are EACH of the drugs, levonorgestrel and mifepristone, mainly used for? [2 marks]
ii. What are the key pharmacological mechanisms of action that differentiate these TWO (2)
uses? [1 mark]
b) Why should oestrogen never be given without a progestin to women with a uterus? [1 mark]

A

a)
i. Levonorgestrel is mainly used as an emergency contraceptive to prevent pregnancy after unprotected intercourse.
Mifepristone is primarily used to terminate an early pregnancy, often in combination with a prostaglandin.
ii. The key difference in pharmacological mechanisms is that levonorgestrel works by inhibiting ovulation, while mifepristone blocks progesterone receptors, disrupting the uterine lining and making it inhospitable for pregnancy maintenance.

b) Oestrogen should never be given alone to women with a uterus because it can lead to the thickening of the endometrial lining, increasing the risk of endometrial cancer. Progestin is added to counteract this effect by opposing endometrial proliferation.

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13
Q

Provide the words that would fill in the blanks in the following scenario by using the table provided
below to give your 1-2 word answer for each numbered blank.
During the ______(1)______ phase of the menstrual cycle, low plasma concentrations of oestrogen
stimulate ______(2)______ release from the _____(3)______ via _______(4)_______ feedback.
This hormone then stimulates the recruitment of many _____(5)_______ follicles. Only the dominant
oestrogen secreting one develops into the _______(6)__________ that contains the ovum to be
released. The secondary and mature follicles produce and release ________(7)________. The high
plasma concentrations of this hormone stimulates the release of _______(8)________ via
_______(9)_______ feedback. The component of the combined oral contraceptive pill that inhibits
this part of the menstrual cycle is ______(10)________. High plasma concentrations of this
exogenous hormone inhibit the secretion of ______(11)_________, and to a lesser extent
_______(12)________ via _______(13)________ feedback. As a result, ________(14)________ and
______(15)________ are inhibited, preventing conception. The surge in this hormone then stimulates
the follicle to rupture and release the ovum. What remains of the follicle is called the
_______(16)_________.

A
  1. follicular
  2. gonadotropin-releasing hormone (GnRH)
  3. hypothalamus
  4. negative
  5. primary
  6. Graafian follicle
  7. oestrogen
  8. luteinizing hormone (LH)
  9. positive
  10. progestin
  11. follicle-stimulating hormone (FSH)
  12. luteinizing hormone (LH)
  13. negative
  14. ovulation
  15. follicle maturation
  16. corpus luteum
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14
Q

List FOUR (4) objectives of toxicology risk assessments. [4 marks]

A

Identify potential hazards: Determine whether a substance (chemical, drug, environmental toxin) has the potential to cause harm to humans, animals, or the environment.

Assess dose-response relationships: Establish the relationship between the dose of a toxicant and the severity or frequency of adverse effects, aiding in setting safe exposure levels.

Evaluate exposure levels: Quantify the extent of human or environmental exposure to the toxicant under typical conditions, including routes, frequency, and duration of exposure.

Characterize risk: Integrate hazard, dose-response, and exposure data to estimate the likelihood and severity of adverse health effects in specific populations or ecosystems.

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15
Q

According to the ICH guidelines, what are the THREE (3) main types of studies that are
required for Development Toxicity Testing (ICH 4.1)? [3 marks]

A

Fertility and Early Embryonic Development Studies: These studies assess the potential effects of a substance on reproductive performance, fertility, and early embryonic development from conception to implantation.

Embryo-Fetal Development Studies: This type of study evaluates potential adverse effects of a substance on fetal development, including structural abnormalities, growth, and survival, typically from implantation to the end of organogenesis.

Pre- and Postnatal Development Studies: These studies examine the impact of a substance on the development and health of offspring from late pregnancy through birth and lactation, covering growth, functional development, and reproductive performance.

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16
Q

What are the key features of physiological antagonists? [2 marks]

A

Physiological antagonists produce opposing effects by activating different receptors or pathways, rather than competing for the same receptor as the agonist. They counterbalance the initial effect through independent mechanisms, helping restore physiological balance without directly blocking the agonist’s receptor. This approach can effectively neutralize effects while maintaining receptor functionality.

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17
Q

a) Name a competitive antagonist of acetylcholine in the rat ileum. [0.5 mark]
b) Which receptor does acetylcholine and the competitive antagonist act on in the rat ileum?
[0.5 mark]
c) Name ONE (1) medicinal use of the competitive antagonist. [1 mark]

A

a) A competitive antagonist of acetylcholine in the rat ileum is atropine.

b) Acetylcholine and the competitive antagonist act on muscarinic receptors in the rat ileum.

c) One medicinal use of atropine is to reduce salivation and respiratory secretions during surgery.

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18
Q

A patient ingested high amounts of atropine and is referred to the Poison Centre.
a) Which drug class does atropine belong to? [1 mark]
b) List THREE (3) TYPICAL autonomic symptoms that you expect to observe at the heart, the
gastrointestinal tract and the eyes. [3 marks]
c) What is the antidote to atropine, and how does it act? Also name the drug class of the antidote.
[2 marks]

A

a) Atropine belongs to the drug class of antimuscarinic (or anticholinergic) agents and is a reversible competitive antagonist at muscarinic acetylcholine receptors.

b) Three typical autonomic symptoms due to atropine’s antimuscarinic effects:

Heart: Tachycardia (increased heart rate)
Gastrointestinal tract: Decreased motility, leading to constipation
Eyes: Mydriasis (pupil dilation) and difficulty focusing on near objects (cycloplegia)
c) The antidote to atropine is physostigmine. It acts by inhibiting acetylcholinesterase, which increases acetylcholine levels to counteract the effects of atropine. Physostigmine belongs to the cholinesterase inhibitor drug class.

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19
Q

Therapeutic Communities (TCs) are a common form of long-term residential treatment for substance
use disorders (SUDs). Residential treatment for SUDs started in the 1950s out of the self-help
recovery movement, which included groups like Alcoholics Anonymous. While originally designed
as a mutual self-help and drug-free alternative to medically oriented strategies used to address
addiction, they have adapted over time to address the treatment needs of different populations
(homeless individuals and those with psychiatric disorders) making use of professional staff with
substance abuse counselling or mental health training, some of whom themselves are in recovery.
TCs are now found in over 65 countries around the world.
a) What are the key features of the brain’s reward circuit? [3 marks]
b) Residents addicted to prescription opioids or heroin would experience very challenging
withdrawal symptoms if they suddenly stopped use without support.
What are TWO (2) possible opioid withdrawal symptoms? [2 marks]
c) How is the brain’s reward circuit affected by the presence of opioids or heroin used chronically?
[3 marks]d) Name a medication that might be used in pharmacological management of opioid withdrawal
and state if the drug is an agonist or antagonist on its target receptors. [2 marks]e) Why might living in a facility like Therapeutic Communities play a key role in breaking the
cycle of drug dependence and addiction? [2 marks]

A

a)
Involves the mesolimbic pathway, primarily the nucleus accumbens.
Dopamine release in response to rewarding stimuli.
Reinforces behaviors, leading to addiction when overstimulated.

b)
Nausea and vomiting.
Muscle aches and cramps.

c)
Decreased dopamine receptor sensitivity.
Reduced natural dopamine release, leading to dependence.
Need for higher doses to achieve the same reward sensation.

d)
Example: Methadone.
Receptor action: Agonist on opioid receptors.

e)
Provide structured, drug-free environment for recovery.
Support through counseling and peer interaction, helping to break dependence cycles.

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20
Q

a) Identify and list the labelled items 1-8 in the figure below to explain the intercellular and
intracellular mechanisms that stimulate erections. [4 marks]
b) In Australia, erectile dysfunction medications typically act via one of two specific pathways.
Name ONE (1) drug that acts on EACH of these two pathways and the primary ‘target’ for
EACH drug. [2 marks]

A

a)
1. Nitric oxide (NO) production in endothelial cells.
2. Guanylate cyclase activation by NO.
3. Cyclic GMP (cGMP) production.
4. Calcium channels (Ca2+ influx).
5. G-protein activation.
6. Adenylate cyclase production of cAMP.
7. Influx of Ca2+ through N-type Ca2+ channels.
8. Potassium channels (K+ efflux).

b)
Sildenafil: Targets phosphodiesterase-5 (PDE5) to increase cGMP levels.
Alprostadil: Acts on prostaglandin E1 receptors to increase cAMP.

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21
Q

25 Explain, using dot points, how tamoxifen works to inhibit the growth of breast cancer cells.
[6 marks]

A
  1. Tamoxifen is a selective estrogen receptor modulator (SERM).
  2. It competitively inhibits estrogen binding to receptors on breast cancer cells.
  3. This blocks estrogen’s proliferative effect on these cells.
  4. Reduces cancer cell division and tumor growth.
  5. Acts as an estrogen antagonist in breast tissue.
  6. Can act as an agonist in other tissues (e.g., bone), reducing side effects.
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22
Q

26 Describe FOUR (4) mechanisms by which two toxicants can interact and the functional
outcomes of each interaction. [4 marks]

A

Additive effect: Combined toxicant effect equals the sum of individual effects.
Synergistic effect: Combined effect is greater than the sum of individual effects.
Antagonistic effect: One toxicant reduces the effect of another.
Potentiation: One non-toxicant increases the toxicity of another toxicant.

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23
Q

27 List any FOUR (4) of Wilson’s general principles of teratology. [4 marks]

A

Susceptibility depends on the developmental stage at exposure.
Teratogenicity is dose-dependent.
Genotype of the fetus affects susceptibility.
Teratogens cause specific malformations in target organs.

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24
Q

28 Describe the TWO (2) main dose-response patterns of teratogenesis and how EACH of these
relates to teratogen severity. [4 marks]

A

Threshold response: Effect occurs only above a certain dose; high dose equals more severe defects.
No-threshold response: Any dose can cause defects, severity increases with dose.

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25
Q

Aspirin is one of the world’s most frequently used drugs. It is used as an analgesic, but also in more
recent times, as a treatment for heart disease.
a) Describe the mechanism by which aspirin can prevent heart attacks. [3 marks]
b) Why is aspirin a relatively safe and effective medicine when used chronically as an anticoagulant? [3 marks]

A

a)
Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1) in platelets.
This action blocks thromboxane A₂ synthesis, reducing platelet aggregation.
Reduced platelet aggregation prevents thrombus formation in arteries, lowering heart attack risk.

b)
Low-dose aspirin affects platelets without significant effects on prostacyclin in endothelial cells.
Its effects are irreversible due to lack of platelet nucleus, which limits clotting for platelet lifespan (7-10 days).
Low dosing minimizes gastrointestinal side effects and bleeding risks.

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26
Q

Antiepileptic and anti-dysrhythmic drugs can have different mechanisms of actions. Two different
mechanisms of actions pertaining to voltage-gated ion channels are shared between these drugs.
a) Briefly explain the two different mechanisms shared by antiepileptic and anti-dysrhythmic
drugs in the brain and heart, respectively. Include their effects on neurons and cells of the
heart (pacemaker cells and myocytes). [4 marks]
b) Name and briefly explain the mechanism of action of anti-epileptic drugs that act
allosterically on receptors found mostly on brain neurons. Name a common side effect of
these drugs. [2 marks]

A

a)
Sodium Channel Blockade: Both antiepileptic and anti-dysrhythmic drugs block voltage-gated sodium channels, reducing the rapid influx of sodium ions. In neurons, this helps prevent seizures by limiting abnormal firing, and in cardiac cells, it stabilizes the heart’s rhythm by slowing conduction.
Calcium Channel Blockade: These drugs also block voltage-gated calcium channels, decreasing excitatory neurotransmitter release in the brain to control seizures. In the heart, calcium channel blockade slows the heart rate and reduces contractility, aiding in dysrhythmia management.

b)
Benzodiazepines act as allosteric modulators on GABA(A) receptors, enhancing the inhibitory effect of GABA.
Common side effect: Sedation due to increased inhibitory action in the CNS.

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27
Q

Therapeutic communities (TCs) are a common form of long-term residential treatment for
substance use disorders (SUDs). Residential treatment for SUDs started in the 1950s out of the selfhelp recovery movement, which included groups like Alcoholics Anonymous. While originally
designed as a mutual self-help and drug-free alternative to medically oriented strategies used to
address addiction, they have adapted over time to address the treatment needs of different
populations (homeless individuals and those with psychiatric disorders) making use of professional
staff with substance abuse counselling or mental health training, some of whom themselves are in
recovery. TCs are now found in over 65 countries around the world.
a) What are the key features of the brain’s reward circuit? [3 marks]
Residents addicted to prescription opioids or heroin would experience very challenging withdrawal
symptoms if they suddenly stopped use without support.
b) What are TWO (2) possible opioid withdrawal symptoms? [2 marks]
c) How is the brain’s reward circuit affected by the presence of opioids or heroin when used
chronically? [3 marks]
d) Name a medication that might be used in pharmacological management of opioid withdrawal
and state if the drug is an agonist or antagonist on its target receptors. [2 marks]
e) Why might living in a facility like Therapeutic Communities play a key role in breaking the
cycle of drug dependence and addiction? [2 marks]

A

a)
The brain’s reward circuit involves key areas like the ventral tegmental area (VTA), nucleus accumbens, and prefrontal cortex.
Dopamine release from the VTA to the nucleus accumbens creates feelings of pleasure and reinforcement.
This circuit drives motivated behaviors and is activated by rewarding stimuli, including drugs.

b)
Muscle aches and restlessness.
Anxiety and sweating.

c)
Chronic opioid use leads to reduced dopamine production in the reward circuit, diminishing natural rewards.
Desensitization of opioid receptors reduces the drug’s effects, leading to tolerance.
Over time, users experience anhedonia (lack of pleasure) without the drug, reinforcing dependence.

d)
Methadone or buprenorphine may be used; they are agonists at opioid receptors, reducing withdrawal symptoms and cravings.

e)
TCs provide a supportive environment with structured routines and peer support, helping break addictive behaviors.
They address social and psychological aspects of addiction, fostering long-term recovery through community engagement and accountability.

28
Q

[Total Q20: 6 marks]
Fill in the blanks in the paragraph below to explain the intracellular mechanism by which these
erectile dysfunction drugs work to overcome erectile problems and explain why these medications
may not work in lifelong chronic smokers.
Nitric oxide released from NANC nerves stimulates activation of the enzyme
_________(a)___________ in cavernosal smooth muscle cells. This enzyme converts GTP to
_________(b)_______ which then activates protein kinase G. Protein kinase G then phosphorylates
a range of proteins that ultimately result in a decrease in intracellular ___(c)___________
concentrations that causes smooth muscle ______(d)__________. ________(e)____________ is
metabolised to 5’ GMP via action of the enzyme ______(f)__________. Oral erectile dysfunction
drugs act to inhibit this enzyme, thereby prolonging the action of the key regulator of smooth
muscle contractility. While these erectile dysfunction drugs are generally effective, they are often
ineffective in life long heavy smokers. This is because smoking causes damage to
______(g)__________ cells that respond by releasing ______(h)___________ that
______(i)___________ blood vessels and _______(j)__________ penile blood flow. Smoking also
causes an increase in _______(k)___________ nervous tone and increases exposure of cells to
superoxide and peroxy nitrite radicals that ultimately reduce ______(l)_________ activity.

A

a) Guanylate cyclase
b) cGMP
c) Calcium
d) Relaxation
e) cGMP
f) PDE5
g) Endothelial
h) Endothelin
i) Constrict
j) Reduce
k) Sympathetic
l) Nitric oxide

29
Q

a) List FOUR key steps or processes in the path to toxicity following drug or chemical
exposures. [4 marks]
b) What is the purpose of dose response assessments in toxicology risk assessments? List TWO
key steps involved in dose-response assessments. [2 marks]

A

a)
Absorption – Entry of the chemical or drug into the bloodstream after exposure.
Distribution – Movement of the substance throughout the body, reaching various tissues and organs.
Metabolism – Biotransformation of the substance, which may result in detoxification or activation to a toxic metabolite.
Excretion – Elimination of the substance or its metabolites from the body, primarily through urine or feces.

b)
Purpose: To determine the relationship between the dose of a substance and the magnitude of its toxic effect, helping assess the level of risk associated with exposure.
Two Key Steps:
1 Identify the threshold dose at which adverse effects begin to appear.
2. Establish the dose-response curve, showing the correlation between varying doses and the severity of toxic responses.

30
Q

[Total Q19: 6 marks]
Some antiepileptic and anti-dysrhythmic drugs have similar mechanisms of actions, such as effects
on voltage gated calcium channels. Briefly explain the effects of these antiepileptic drugs and antidysrhythmic drugs in the brain and in the heart, respectively. You need to state the cellular
mechanisms and the physiological wanted and unwanted side effects. To show the cellular effects on
the heart, sketch the changes in the action potentials in a) pacemaker cells and b) myocytes by voltagegated calcium channel blockers.

A

Mechanism and Effects in the Brain (Antiepileptic Drugs)
Cellular Mechanism: Voltage-gated calcium channel blockers reduce calcium influx into neurons, decreasing neurotransmitter release and neuronal excitability.
Physiological Effects: This helps prevent excessive neuronal firing, reducing the occurrence of seizures.
Side Effects: Common unwanted side effects include dizziness, fatigue, and ataxia, as the reduction in excitatory neurotransmission can affect normal brain functions.

Mechanism and Effects in the Heart (Anti-Dysrhythmic Drugs)
Cellular Mechanism: In cardiac cells, these drugs block calcium channels in pacemaker cells and myocytes, slowing depolarization and reducing contraction strength.
Physiological Effects: This action decreases heart rate and prevents abnormal rapid heart rhythms, particularly useful in treating tachycardia.
Side Effects: Unwanted effects include bradycardia (slow heart rate), hypotension, and potential heart block due to decreased cardiac excitability.

Sketch of Action Potential Changes:
In a visual diagram:
Pacemaker Cells: Blocking calcium channels delays the initial depolarization phase, resulting in a slower rate of rise in the action potential, which reduces heart rate.
Myocytes: Calcium channel blockers reduce the plateau phase of the action potential, leading to a decrease in contraction force.

31
Q
  1. [Total Q20: 6 marks]
    Describe the mechanism of the antithrombotic action of aspirin.
A

Inhibition of COX-1: Aspirin acetylates COX-1, preventing the enzyme from producing thromboxane A₂ (TXA₂), a potent promoter of platelet aggregation and vasoconstriction.

Irreversible Effect on Platelets: Since platelets lack a nucleus, they cannot synthesize new COX-1, resulting in a prolonged reduction in TXA₂ levels for the platelet’s lifespan (approximately 7-10 days).

Reduction in Platelet Aggregation: Lower levels of TXA₂ lead to decreased platelet aggregation, which reduces the likelihood of clot (thrombus) formation in blood vessels.

Selective Effect: While aspirin also affects COX-1 in endothelial cells, these cells can resynthesize the enzyme due to their nucleus, allowing for the continued production of prostacyclin (PGI₂), which opposes platelet aggregation.

Overall Balance: By selectively reducing TXA₂ while allowing PGI₂ production, aspirin creates an antithrombotic effect, reducing the risk of arterial clots that could lead to heart attacks or strokes.

Chronic Use: This effect makes low-dose aspirin particularly useful in the long-term prevention of thrombotic events in patients at risk for cardiovascular diseases.

32
Q

It is estimated that more than 150 people die every day from overdoses related to synthetic opioids.
Fentanyl has been involved in nearly two-thirds of all overdose deaths in the United States and is up
to 50 times stronger than heroin and 100 times stronger than morphine.
A. Why is fentanyl likely to be stronger than morphine? [2 marks]
B. What is the mechanism of action of opioids in cases of dependence? [5 marks]
C. A group of novel synthetic opioids, nitazenes, are emerging in illicit drugs in the United
States may be more powerful than fentanyl, 1,000 times more potent than morphine, and
may even require more doses of the medication naloxone to reverse an overdose, a new
study suggests. Most of the patients who overdosed on nitazenes received two or more
doses of the opioid overdose reversal drug naloxone, whereas most patients who overdosed
on fentanyl received only a single dose of naloxone. [5 marks]
* What is the mechanism of action of naloxone? [1 mark]
* Why might more doses of naloxone be needed if overdose of nitazenes has occurred?
[2 marks]
* Pharmacologically, why is it dangerous to mix opioids with cocaine? [2 marks]

A

a)
Higher Affinity for μ-Opioid Receptors: Fentanyl has a significantly higher binding affinity for μ-opioid receptors compared to morphine, meaning it binds more readily and with stronger effects.
Greater Lipid Solubility: Fentanyl is more lipid-soluble than morphine, allowing it to cross the blood-brain barrier faster, leading to quicker and more potent central nervous system effects.

b)
Binding to μ-Opioid Receptors: Opioids bind to μ-opioid receptors in the brain, spinal cord, and other parts of the body.
Inhibition of GABA Release: This binding reduces GABA release, a neurotransmitter that inhibits dopamine release.
Increased Dopamine Release: Reduced GABA activity leads to increased dopamine release in the brain’s reward pathways, especially in the nucleus accumbens.
Euphoria and Reinforcement: The surge in dopamine creates a pleasurable sensation or “high,” which reinforces drug-taking behavior.
Development of Dependence: Over time, the body adapts to the constant opioid presence, leading to tolerance and physical dependence.

c)
Mechanism of action of naloxone: Naloxone is an opioid receptor antagonist that reverses opioid effects by binding competitively to μ-opioid receptors.

Why might more doses of naloxone be needed for nitazene overdose? Nitazenes are highly potent and bind tightly to receptors, often requiring multiple naloxone doses to fully counteract their prolonged effects.

Why is it dangerous to mix opioids with cocaine? The combination strains the cardiovascular and respiratory systems, as cocaine’s stimulant effects can mask opioid-induced respiratory depression, increasing overdose risk once the stimulant effects diminish.

33
Q

Benign prostatic hyperplasia (BPH) is a condition that causes an enlargement of the prostate gland,
resulting in difficulty urinating, urinary incontinence and abdominal pain.
A. What are the biochemical and cellular processes that occur in the prostate to cause BPH and
in what region of the prostate do these changes begin? [5 marks]
B. Explain the mechanism by which finasteride and dutasteride alleviate the symptoms of BPH
[4 marks]
C. Some drugs have carcinogenic effects by acting on one of the 3 steps in the multistep model
of carcinogenesis. List (in order) the 3 steps in the multistep carcinogenesis model AND
briefly explain what occurs in these steps to lead to cancer formation. [3 marks]

A

a)
Hormonal Influence: Dihydrotestosterone (DHT), a potent androgen formed from testosterone by 5-alpha-reductase, stimulates prostate cell growth.
Cell Proliferation: Increased levels of DHT promote epithelial and stromal cell proliferation in the prostate.
Inflammation: Chronic inflammation in the prostate can contribute to cell hyperplasia.
Fibromuscular Changes: Accumulation of extracellular matrix components leads to increased fibromuscular mass.
Region Affected: These changes primarily begin in the transition zone of the prostate, where BPH-related enlargement originates.

b)
5-Alpha-Reductase Inhibition: Both finasteride and dutasteride inhibit the 5-alpha-reductase enzyme.
Reduction in DHT Levels: By inhibiting this enzyme, they lower the conversion of testosterone to DHT, reducing DHT levels in the prostate.
Decreased Cell Growth: Lower DHT levels slow down prostate cell proliferation.
Symptom Alleviation: This reduction in prostate size alleviates BPH symptoms like urinary retention and incontinence.

c)
Initiation: Genetic mutations occur in normal cells, often from carcinogens, resulting in permanent DNA damage.
Promotion: Cells with mutations are encouraged to proliferate due to growth-promoting signals, leading to clonal expansion of mutated cells.
Progression: Accumulated mutations and dysregulation of cellular processes cause the cells to become invasive and form malignant tumors.

34
Q

Which of the following statements regarding dysrhythmia is INCORRECT? [1.5 marks]
A Re-entrant circuits in heart tissue can form ectopic foci that lead to tachycardia
B Pacemaker activity is influenced by the sympathetic nervous system
C Bradycardia is only treated when symptoms are severe
D Typically the pacemaker activity of Purkinje fibres sets the heart rate
E Afterdepolarisations can promote tachycardia

A

Answer: D - Typically, the pacemaker activity of Purkinje fibers sets the heart rate.

Explanation: The SA node, not the Purkinje fibers, normally sets the heart rate. Purkinje fibers take over pacing only if the SA and AV nodes fail.

35
Q

Which of the following statements CORRECTLY describes how antidysrhythmic drugs can
affect the heart? [1.5 marks]
A Exogenous adenosine causes hyperpolarisation by enhancing the opening of voltagesensitive sodium channels
B Beta-adrenoceptor antagonists (e.g. atenolol) will facilitate the opening of potassium
channels and enhance potassium influx into cardiac cells
C Partial block of potassium channels will shorten the duration of the myocyte action
potential
D Blocking leaky potassium channels will lead to hyperpolarisation in autorhythmic cells
E Inhibition of funny sodium channels slows down pacemaker action potential generation
without directly affecting myocyte action potentials

A

Answer: E - Inhibition of funny sodium channels slows down pacemaker action potential generation without directly affecting myocyte action potentials.

Explanation: Funny sodium channels control pacemaker depolarization. Inhibiting them reduces heart rate without directly affecting myocytes.

36
Q

Which of the following statements about epilepsy treatments is CORRECT? [1.5 marks]
A Antiepileptic drugs reduce seizures in >90% of people with epilepsy
B Newer anti-epileptic medications are more effective in blocking seizures in people with
epilepsy than the older drugs
C People with many seizures can expect to live a normal life due to the many treatment
options available
D Older antiepileptic drugs often interfere with the metabolism of other drugs, such as
contraceptives
E It is always best to use two anti-epileptic medications to inhibit seizure generation in case
one drug fails

A

Answer: D - Older antiepileptic drugs often interfere with the metabolism of other drugs, such as contraceptives.

Explanation: Many older antiepileptic drugs induce liver enzymes, which can interfere with the metabolism of other drugs like contraceptives.

37
Q

Which of the following statements about epilepsy treatments is CORRECT? Epilepsy can be
controlled by drugs that [1.5 marks]

A increase muscarinic receptor activity
B increase glutamatergic receptor signalling
C increase GABAergic activity in the brain
D decrease potassium ion channel activity
E inhibit serotonin receptors

A

Answer: C - Increase GABAergic activity in the brain.

Explanation: Increasing GABAergic inhibition reduces neuronal excitability, which helps prevent seizures.

38
Q

Which one of the following processes contributes to the formation of a platelet plug following
rupture of the blood vessel wall? [1.5 marks]
A activation of P2X7 receptors by adenosine triphosphate (ATP)
B conversion of circulating fibrin to fibrinogen
C expression of GPIb/IIa and cross-linking of adjacent endothelial cells
D activation of arachidonic acid metabolism in platelets
E an increase in the production of prostaglandins by smooth muscle cells

A

Answer: D - Activation of arachidonic acid metabolism in platelets.

Explanation: Arachidonic acid metabolism leads to thromboxane A₂ production, which promotes platelet aggregation, aiding in plug formation.

39
Q

Warfarin is a widely used oral anticoagulant. However, treatment with warfarin is associated
with numerous issues, including the need for dose individualisation and a low margin of
safety. [1.5 marks]
Which one of the following does NOT contribute to the issues associated with warfarin
treatment?

A The half-life of warfarin can be affected by drugs which inhibit or induce CYP2C9
B Warfarin has a small distribution volume and is strongly bound to plasma albumin
C The effect of warfarin takes several days to develop due to the presence of clotting factors
II, VII, IX and X in the blood
D The peak pharmacological effect of warfarin occurs at the same time as the peak
concentration in the blood
E VKORC1 is a polymorphic gene and different haplotypes have different affinities for
warfarin

A

Answer: D - The peak pharmacological effect of warfarin occurs at the same time as the peak concentration in the blood.

Explanation: Warfarin’s peak effect is delayed as it takes time for existing clotting factors to be cleared, making its effect independent of blood concentration peaks.

40
Q

Glutamate is said to be the ‘common currency’ of amino acids within the central nervous
system as it can be enzymatically converted into other neurotransmitters by neurons with the
right enzymes. [1.5 marks]
Which of the following statements about glutamate and its receptors is CORRECT?
A glutamate is an inhibitory neurotransmitter as its activity contributes to hyperpolarisation
B glutamate can be enzymatically converted to glutamine, which has its own excitatory
receptors
C the NMDA receptor has a positive allosteric binding site for glutamate
D PCP and ketamine have binding sites within the pore of the NMDA receptor
E glutamate receptors are targets for tetanus toxin, which leads to excitation

A

Answer: D - PCP and ketamine have binding sites within the pore of the NMDA receptor.

Explanation: PCP and ketamine are NMDA receptor antagonists, binding within the receptor’s ion channel, blocking its activity.

41
Q

Cocaine differs from synthetic local anaesthetics in which ONE of the following ways?
[1.5 marks]
A Cocaine has an amide bond while the synthetic drugs have an ester bond
B Cocaine can block reuptake transporters for noradrenaline, while synthetics cannot do so
C Use of cocaine may lead to greater blood loss than the synthetic drugs
D Cocaine is a positive allosteric modulator of GABAA receptors while the synthetic drugs
are not
E Cocaine’s main access to sodium ion channels is via the hydrophobic pathway

A

Answer: B - Cocaine can block reuptake transporters for noradrenaline, while synthetics cannot do so.

Explanation: Cocaine has the unique property of blocking norepinephrine reuptake, which is not seen in synthetic anesthetics.

42
Q

The discovery of general anaesthetics opened new opportunities for patients requiring painful
surgeries and procedures. [1.5 marks]
Which of the following statements about general anaesthetic drugs is CORRECT?
A The “lipid expansion theory” is upheld today as these drugs are inserted into cell
membranes
B General anaesthetics may enhance GABAA and inhibit glutamate receptor function
C Key brain areas affected by general anaesthetics include motor and sensory cortices
D MEC, the minimal expiratory concentration, is the unit used in inhaled anaesthetics
E Inhalation anaesthetics will have a faster onset relative to injected anaesthetic

A

Answer: B - General anesthetics may enhance GABA_A and inhibit glutamate receptor function.
Explanation: General anesthetics typically enhance inhibitory GABAergic activity and reduce excitatory glutamatergic function, leading to CNS depression.

43
Q

When activated by morphine, mu opioid receptors in the spinal cord activate Gi proteins
resulting in _____________of adenylate cyclase and a reduction of cAMP concentration. This
leads to _______________ potassium ion conductance and ______________ calcium ion
conductance, resulting in potential inhibition of neurotransmitter release. [1.5 marks]
A stimulation, increasing, increasing
B inhibition, increasing, increasing
C inhibition, decreasing, decreasing
D inhibition, increasing, decreasing
E stimulation, decreasing, increasing

A

Answer: D - Inhibition, increasing, decreasing.

Explanation: Morphine inhibits adenylate cyclase, which raises potassium conductance and lowers calcium conductance, reducing neurotransmitter release.

44
Q

The main mechanism by which steroidal anti-inflammatory drugs (SAIDs) work to reduce
inflammation is by [1.5 marks]
A increasing the synthesis of annexins such as lipocortin
B inhibiting folic acid metabolism
C inhibiting cyclooxygenase (COX) enzymes
D directly inhibiting phospholipase C
E promoting neutrophil migration to sites of inflammation

A

Answer: A - Increasing the synthesis of annexins such as lipocortin.

Explanation: SAIDs increase annexin synthesis, which inhibits phospholipase A2, reducing inflammation.

45
Q

Drugs of dependence have been used for millenia in various cultures, and in modern times the
impacts of dependence and addiction is a significant health burden. [1.5 marks]
Which of the following statements is CORRECT regarding use of recreational drugs of
dependence?
A These drugs are likely to activate the reward pathway of the brain by increasing serotonin
release in key synapses
B Drug abuse liability can be affected by drug rapidity of onset, cost and purity
C The genetic links to specific drugs of dependence are largely unexplored
D Tolerance can develop from repeated drug use, with a shift of the concentration-response
curve to the left
E Rehabilitation is more effective when done in one’s own environment

A

Answer: B - Drug abuse liability can be affected by drug rapidity of onset, cost, and purity.
Explanation: Factors like rapid onset, low cost, and high purity can increase the likelihood of dependence and abuse.

46
Q

Which of the following does NOT correctly describe the mechanism by which tamoxifen
inhibits the growth of breast cancers? [1.5 marks]
A competitively inhibits estrogen binding to the estrogen receptor
B stimulates a conformational change in the estrogen receptor after binding
C prevents binding of coactivators to the DNA-bound estrogen receptor
D prevents transcription of certain genes in the nucleus
E is initially converted to the active metabolite 4-OH tamoxifen in the liver

A

Answer: B - Stimulates a conformational change in the estrogen receptor after binding.

Explanation: Tamoxifen acts as an estrogen receptor antagonist, not agonist, preventing estrogen from activating the receptor.

47
Q

Immediately before ovulation, high plasma concentrations of estrogen have a ___________
feedback effect on the ____________ to stimulate an LH surge. [1.5 marks]
A negative / hypothalamus and anterior pituitary gland
B positive / anterior pituitary gland
C negative / anterior pituitary gland
D positive / hypothalamus and anterior pituitary gland
E negative / hypothalamus

A

Answer: D - Positive / hypothalamus and anterior pituitary gland.

Explanation: High estrogen levels exert positive feedback on the hypothalamus and anterior pituitary, causing an LH surge.

48
Q

Which of the following CORRECTLY describes the mechanism of action of the erectile
dysfunction drug alprostadil (prostaglandin E1)? Alprostadil…. [1.5 marks]
A converts GTP to cyclic GMP
B activates protein kinase G
C activates adenylate cyclase
D increases intracellular calcium concentrations
E is a synthetic version of prostaglandin E1 that is released from NANC nerve terminals

A

Answer: C - Activates adenylate cyclase.

Explanation: Alprostadil increases cAMP by activating adenylate cyclase, which leads to smooth muscle relaxation and increased blood flow.

49
Q

Fetus’ are most sensitive to teratogens during ____________ that occurs during the
___________ period. [1.5 marks]
A blastocyst formation / implantation
B histogenesis / fetal
C organogenesis / fetal
D histogenesis / embryonic
E organogenesis / embryonic

A

Answer: E - Organogenesis / embryonic.

Explanation: Organogenesis during the embryonic period is the most critical time for teratogenic effects.

50
Q

A co-carcinogen is a chemical that…… [1.5 marks]
A enhances the effect of a carcinogen, but is not itself carcinogenic
B directly causes DNA mutations, triggering the first stage of carcinogenesis
C enhances the tumorigenic effect of carcinogens, but is not itself carcinogenic
D causes DNA mutations after initial activation/metabolism
E is alone carcinogenic, but its carcinogenic effects are enhanced when given with another
carcinogen

A

Answer: A - Enhances the effect of a carcinogen but is not itself carcinogenic.

Explanation: A co-carcinogen does not directly cause cancer but enhances the carcinogenic potential of other agents.

51
Q

The toxicological effect of drugs A and B that have the same toxicological profile is
increased more than the added effect of each of the drugs when given together. This is an
example of what type of pharmacodynamic interaction?
A additive
B functional antagonism
C antagonistic
D antagonism
E synergistic

A

Answer: E - Synergistic.

Explanation: A synergistic effect occurs when two drugs produce a combined effect greater than the sum of their individual effects.

52
Q

Which of the following statements regarding dysrhythmia is INCORRECT? [1.5 marks]
A Bradycardia is only treated when symptoms are severe
B Typically the pacemaker activity of Purkinje fibres sets the heart rate
C After depolarisations can promote tachycardia
D Re-entrant circuits in heart tissue can form ectopic foci that lead to tachycardia
E Pacemaker activity is influenced by the sympathetic nervous system

A

Answer: B - Typically the pacemaker activity of Purkinje fibers sets the heart rate.

Explanation: The SA node, not the Purkinje fibers, normally sets the heart rate. Purkinje fibers act as backup pacemakers.

53
Q

Which of the following statements CORRECTLY describes how antidysrhythmic drugs can
affect the heart? [1.5 marks]
A Exogenous adenosine causes hyperpolarisation by enhancing the opening of voltagesensitive Na+
channels
B β-adrenoceptor antagonists (e.g. atenolol) will facilitate the opening of Ca2+ channels
and enhance Ca2+ influx into cardiac cells
C Partial block of K+
channels will shorten the duration of the myocyte action potential
D Blocking leaky K+
channels will lead to hyperpolarisation in autorhythmic cells
E Blocking L-type voltage-sensitive Ca2+ channels can shorten the plateau phase of the
cardiac action potential

A

Answer: E - Blocking L-type voltage-sensitive Ca²⁺ channels can shorten the plateau phase of the cardiac action potential.

Explanation: Blocking L-type Ca²⁺ channels reduces calcium influx, shortening the plateau phase and helping to control dysrhythmias.

54
Q

Which of the following statements regarding epilepsy is INCORRECT? [1.5 marks]
A Driving a car is considered dangerous for people with uncontrolled epileptic seizures
B There is a social stigma associated with seizures in most societies
C Anti-epileptic drugs always reduce the occurrence of seizures in people with epilepsy
D People with epilepsy may have sensory seizures without changes in motor activity
E Motor seizures can lead to injury and potentially death

A

Answer: C - Anti-epileptic drugs always reduce the occurrence of seizures in people with epilepsy.

Explanation: Anti-epileptic drugs do not always prevent seizures in all patients; effectiveness varies widely.

55
Q

Which of the following statements regarding drugs to treat epilepsy is INCORRECT?
[1.5 marks]
A Newer antiepileptic drugs are often better tolerated than older drugs
B Older antiepileptic drugs often lead to hypertension
C Older antiepileptic drugs often have long and variable half lives, and it can be difficult
to find a suitable dose
D Most older antiepileptic drugs have teratogenic potential
E Many older antiepileptic drugs can have severe side effects

A

Answer: B - Older antiepileptic drugs often lead to hypertension.

Explanation: Older antiepileptic drugs typically cause CNS-related side effects, not hypertension.

56
Q

With regard to anticoagulants, which of the following statements is INCORRECT?
[1.5 marks]
A Warfarin is used intravenously or subcutaneously and is effective immediately
B Heparin is used intravenously or subcutaneously and is effective immediately
C Heparin forms a complex with anti-thrombin to inhibit thrombin and other clotting
factors
D Warfarin is used orally and has a delayed onset of action
E Warfarin inhibits the formation of vitamin K-dependent clotting factors

A

Answer: A - Warfarin is used intravenously or subcutaneously and is effective immediately.

Explanation: Warfarin is administered orally and has a delayed onset, as it requires time to inhibit vitamin K-dependent clotting factors.

57
Q

Fibrinolytic drugs, such as alteplase, [1.5 marks]
A increase the circulating levels of plasminogen in the circulation
B can be used to reopen occluded arteries many days after a patient has suffered a
myocardial infarction or stroke
C enhance the formation of fibrin to dissolve blood clots
D affect fibrin-bound plasminogen more than circulating plasminogen
E increase the activity of circulating plasmin inhibitors

A

Answer: D - Affect fibrin-bound plasminogen more than circulating plasminogen.

Explanation: Fibrinolytics like alteplase are more selective for fibrin-bound plasminogen, targeting clots directly.

58
Q

Which of the following statements is CORRECT regarding glycine and GABA and their
receptors? [1.5 marks]
A Glycine and GABA may both be cleared from synapses by neuronal and glial reuptake
transporters
B Glycine receptors and GABAA receptors are both activated by the date rape drug γhydroxybutyric acid (GHB)
C Glycine and GABA are both positive allosteric modulators of glutamate receptors
D Glycine receptors and GABAA receptors both allow the movement of sodium ions and
calcium ions down their concentration gradients
E Glycine and GABA are both excitatory neurotransmitters in their central nervous
system effects

A

Answer: A - Glycine and GABA may both be cleared from synapses by neuronal and glial reuptake transporters.

Explanation: Both glycine and GABA are inhibitory neurotransmitters cleared by reuptake mechanisms involving neurons and glial cells.

59
Q

Which of the following statements about local anaesthetics and their actions is CORRECT?
[1.5 marks]
A The hydrophobic pathway used by local anaesthetics requires the continuous use of
voltage-dependent ion channels
B Local anaesthetic blockade of ion channels does not exhibit use-dependence
C Lignocaine has an amide structure and is thought to cause allergic reactions in 1:100
patients
D Lignocaine causes vasodilation and is thus combined with adrenaline for
vasoconstriction in the injected area
E In cases of infection or tissue necrosis, local anaesthetics with high pKa values will
prove to be the most effective in providing relief

A

Answer: D - Lignocaine causes vasodilation and is thus combined with adrenaline for vasoconstriction in the injected area.

Explanation: Lignocaine can cause vasodilation, so adrenaline is added to prolong its effects by constricting blood vessels.

60
Q

Which of the following statements regarding general anaesthetics is most CORRECT?
[1.5 marks]
A Many general anaesthetics appear to cause their CNS depressant effects by enhancing
GABAA receptor function
B General anaesthetic effects on membrane fluidity are thought to be more important than
actions of cell membrane proteins
C Isomers of various general anaesthetics have equal potency
D If a general anaesthetic is a potent analgesic then it will likely be a potent skeletal
muscle relaxant
E Many general anaesthetics appear to exert their CNS depressant effects by inhibiting
GABAA receptor function

A

Answer: A - Many general anesthetics appear to cause their CNS depressant effects by enhancing GABA_A receptor function.

Explanation: Most general anesthetics potentiate GABA_A receptors, leading to CNS depression.

61
Q

Which of the following statements about the non-steroidal anti-inflammatory drugs (NSAIDs)
is CORRECT? [1.5 marks]
A Aspirin and paracetamol are analgesics, antipyretic and anti-inflammatory
B The selective COX-2 inhibitor, celecoxib, reduces cytokine-induced prostaglandin
production
C As the thromboxanes have protective effects on the gastric mucosa, aspirin causes
gastric toxicity
D Aspirin, paracetamol and ibuprofen are selective COX-1 inhibitors
E Inhibition of COX leads to reduced levels of prostaglandins, thromboxanes and
leukotrienes

A

Answer: B - The selective COX-2 inhibitor, celecoxib, reduces cytokine-induced prostaglandin production.

Explanation: COX-2 inhibitors like celecoxib reduce inflammation by inhibiting prostaglandin synthesis specifically in inflammatory pathways.

62
Q

Background
In 2018, the classification of codeine changed and patients now need a prescription to obtain
codeine from a pharmacy in Australia. Prior to this, there was concern about documented cases of
patients buying and taking high amounts of codeine from over the counter preparations, leading to
dependence.
Given your understanding of pharmacodynamics, pharmacokinetics and the pharmacology of
opioids, what is the basis of dependence on and abuse of codeine? [1.5 marks]
A Codeine is an agonist of non-opioid receptors, which is dangerous if opioids are also
used for pain relief
B Codeine is similar in structure to morphine, and has equal potency at the opioid
receptors
C Codeine is less potent than morphine at opioid receptors, and codeine is metabolised to
morphine
D Morphine is less potent than codeine at its receptors, making codeine more likely to be
abused
E Codeine prevents the metabolism of morphine, prolonging the effects of morphine on its
receptors

A

Answer: C - Codeine is less potent than morphine at opioid receptors, and codeine is metabolized to morphine.

Explanation: Codeine’s analgesic effect depends on its metabolism to morphine, contributing to its potential for abuse.

63
Q

When activated by morphine, µ-opioid receptors in the spinal cord activate Gαi resulting in
_____________ of adenylate cyclase and a reduction of cAMP concentration. This leads to
_______________ potassium ion conductance and ______________ calcium ion
conductance, resulting in an inhibition of neurotransmitter release. [1.5 marks]
A stimulation, decreasing, increasing
B inhibition, increasing, decreasing
C inhibition, increasing, increasing
D inhibition, decreasing, decreasing
E stimulation, increasing, increasing

A

Answer: B - Inhibition, increasing, decreasing.

Explanation: Opioids inhibit adenylate cyclase, increase K⁺ conductance, and reduce Ca²⁺ conductance, decreasing neurotransmitter release.

64
Q

Which of the following is NOT an effect of oral progestins? [1.5 marks]
A irregular menstrual or vaginal bleeding
B inhibition of luteinising hormone secretion
C reduction in androgen-dependent acne
D prevention of sperm entry into uterus
E reduced thickness of cervical mucus

A

Answer: E - Reduced thickness of cervical mucus.

Explanation: Progestins typically thicken cervical mucus, which helps prevent sperm entry, rather than reducing it.

65
Q

The main mechanism of action of P450 aromatase inhibitors, such as letrozole and anastazole,
is to [1.5 marks]
A inhibit estrogen binding to the estrogen receptor
B inhibit the mid-cycle luteinising hormone surge
C reduce estrogen synthesis
D reduce progesterone synthesis
E inhibit progesterone binding to its receptor

A

Answer: C - Reduce estrogen synthesis.

Explanation: Aromatase inhibitors block estrogen synthesis, particularly in hormone-sensitive breast cancer treatments.

66
Q

Early prenatal exposure to which of the following teratogens is most often characterised by
craniofacial dysmorphism? [1.5 marks]
A ethanol
B thalidomide
C retinol
D tobacco smoke
E diethyl stilbesterol (DES)

A

Answer: A - Ethanol.

Explanation: Ethanol exposure in pregnancy can cause fetal alcohol syndrome, marked by craniofacial abnormalities.

67
Q

What is generally considered to be the MOST EFFECTIVE exposure route for toxicity?
[1.5 marks]
A intramuscular
B intravenous
C dermal
D inhalation
E intraperitoneal

A

Answer: D - Inhalation.

Explanation: Inhalation provides rapid and effective entry into the bloodstream and central nervous system.