1. (a) Why are drugs given parenterally instead of orally? (10 marks)

    (b) What are the advantages and disadvantages of subcutaneous injections? (7 marks)

    (c) Name THREE examples of the use of intradermal injection. (3 marks)

2.  A 69-year-old lady had type 2 diabetes mellitus (“T2DM”) for 10 years and received metformin monotherapy (1000 mg twice daily). She also had obesity with body mass index of 28 kg/m², moderate high blood pressure (150/92 mmHg), hyperlipidaemia, moderate chronic kidney disease (creatinine clearance (“CrCl”) 44 ml/min/1.73 m²) with macroalbuminuria and osteoporosis.

(a) She presented at the clinic with a hemoglobin A1c (“HbA1c”) 8.1%. Discuss the benefits on metabolic control and/or cardiovascular outcomes, adverse effects, and contraindications of each of the following add-on therapies: sulphonylureas, glitazones, dipeptidyl peptidase-4 (“DPP-4”) inhibitors and sodium-glucose cotransporter-2 (“SGLT2”) inhibitors. (12 marks)

(b) Suggest FIVE therapeutic treatment strategies which are known to reduce the progression of diabetes-related kidney disease. (5 marks)

(c) As her renal function declines to CrCl <30 ml/min/1.73 m², discuss THREE pharmacotherapeutic strategies for the management of diabetes mellitus. (3 marks)

3.  Tony Tse, a 33-year-old taxi driver, went to see his family doctor for his runny nose and clear nasal discharge. He said he has experienced these symptoms annually around spring time, adding that he has also suffered from irritated and itchy eyes. He reported no significant medical history and said he did not use other nonprescription or prescription medications. The doctor has now diagnosed him to have allergic rhinitis. He was prescribed combination therapy cetirizine-pseudoephedrine tablets to relieve his symptoms. 

(a) Regarding cetirizine:

(i) Name the class of drugs. (2 marks)

(ii) How does it work? (2 marks)

(iii) What are the advantages? (2 marks)

(b) Regarding pseudoephedrine:

(i) Name the class of drugs. (2 marks)

(ii) How does it work?  (2 marks)

(iii)What are the advantages? (2 marks)

(c) Later on, the family doctor realized that Tony suffered from childhood asthma before. Name the class of drugs with mechanism of action that are NOT recommended as a first line medication to treat allergic rhinitis, but may be helpful in those people who have both asthma and allergic rhinitis. State the route of administration. (4 marks)

(d) There is a common class of drugs which can be added in patients with severe allergic rhinitis symptoms affecting their quality of life. However, patients are sometimes hesitant to use it due to the fear of its adverse effects. Name this class of drugs with mechanism of action and address patients’ concern. (4 marks)

4. A 56-year-old lady diagnosed with colorectal cancer underwent a left hemicolectomy. She was started on opioid analgesics in the postoperative period. She is suffering from postoperative nausea and vomiting and is unable to tolerate oral medications or fluids. 

(a)   Name THREE classes of antiemetic agents. (3 marks)

(b)   Explain the mechanism of action of metoclopramide. (2 marks)

(c) What are the side effects of metoclopramide? In what conditions is metoclopramide contraindicated? (6 marks)

(d)   What is the mechanism of action of prochlorperazine as an anti-emetic? (2 marks)

(e)   Name THREE drugs that may interact with prochlorperazine. (3 marks)

(f)    Explain the mechanism of action ondansetron. (2 marks)

(g)    What are the potential adverse effects of ondansetron? (2 marks)

5. Wai Keung is 13 years old and is in the second year of secondary school. He is struggling with his education. His teacher reports that Wai Keung is unable to sit still in class and fidgets constantly. His Mother also reports that he is unable to concentrate on his homework. Following assessment by an educational psychologist, he was referred to the paediatric service for assessment of Attention Deficit Hyperactivity Disorder (“ADHD”).

(a) In accordance with the Diagnostic and Statistical Manual of Mental Disorders 5 (“DSM—5”), the core symptoms of ADHD are inattentiveness, hyperactivity and impulsivity. In addition to Wai Keung’s symptoms, what other examples of ADHD symptoms are frequently experienced by children with ADHD? (3 marks)
(b) Wai Keung is subsequently diagnosed with ADHD. Which non- pharmacological and licensed pharmacological treatments are available in Hong Kong? (5 marks)
(c) Wai Keung has received non-pharmacological intervention with limited effects, he continues to experience impairments to his education and family life. Therefore, his parents have decided to try pharmacological treatment. They seek your advice on the available pharmacological treatment. Based on the current evidence and Wai Keung’s situation, which pharmacological treatment would you recommend? Explain the pharmacology, pharmacokinetic profile, efficacy and safety profile as requested by his parents so that they can discuss this further with the paediatric team. (12 marks)