1.

A 38-year-old lady presented with recurrent menorrhagia and was found to have iron deficiency anaemia. She is not a vegetarian and has no other medical illness. Treatments with iron sulphate (“FeSO4” ) 300 mg twice daily was commenced.

a) What advice (e.g. lifestyle modifications) would you recommend her regarding her FeSO4 treatment? (2 marks)

b) Discuss the adverse effects of FeSO4 (3 marks)

c) If she could not tolerate the current FESO4 therapy, list TWO approaches which may improve her tolerance to FeSO4 (2 marks)

d) Name ONE alternative form of oral iron which could be associated with better tolerance and discuss the reason for it. (2 marks)

She did not tolerate oral iron therapy and was noticed to have progressive drop in her haemoglobin with worsening symptom. She is recommended to have intravenous iron therapy.

e) List THREE parenteral iron preparations and discuss the major structural feature differentiating these products (4 marks)

f) Discuss the adverse effects of intravenous iron therapy and their management. (7 marks)

2.

A 68 year old gentleman complains of lower urinary tract symptoms (“LUTS”)

Including frequency and weak stream of urination was diagnosed to have benign prostatic hyperplasia (“BPH“).

a) Discuss the nonpharmacological management (including education and lifestyle advice) for patients with BPH. (2 marks)

b) List TWO classes of drugs commonly used to treat BPH. For EACH class: 

i) Give ONE example;

ii) Discuss the mechanisms of action; and

iii) Discuss the potential adverse effects.

(12 marks)

His LUTS improved after medication. However, he had an episode of common cold and took some medications. He developed acute retention of urine afterwards.

c) Name TWO classes of drugs which could cause his retention of urine.

For EACH class:

i) Give ONE example; and

ii) Discuss the mechanism of causing the retention. 

(6 marks)

3.

An 80-year-old man came to the pharmacy to renew his prescription medications, which he had been taking for years. These were prazosin, metoprolol, diltiazem and ramipril. He was happy with these medications because his blood pressure reading at the hospital was usually around 120/60 mm Hg. However, he revealed that he was frequently waken up by nightmares, and felt faint when he got out of bed to go to the toilet. He also coughed terribly in the night.

a) For what disease did he take these medications? (1 mark)

b) Was 120/60 mm Hg and appropriate blood pressure for him? (3 marks)

c) To which drug class does prazosin belong? What adverse effect might it cause in this patient? What could be done to reduce this adverse effects? (4 marks)

d) To which drug class does metoprolol belong? Which TWO adverse effects might it cause in this patience? (3 marks)

e) Which drug is an alternative to metoprolol with less adverse effect? (1 mark)

f) To which drug class does diltiazem belong? Name TWO common adverse effects. With which of the other drug might it interact? (4 marks) 

g) To which drug class does ramipril belong? Which TWO adverse effects might its cause in this patient? What alternative drug might reduce these adverse affects? (4 marks)

4.

A 66 year old man with early Parkinson’s disease had mild right-sided hand tremor and bradykinesia. Rasagiline 1 mg was prescribed.

a) Discuss the mechanism of action and adverse effects of rasagiline, and dietary advice. (3 marks)

b) Rasagiline could not reduce his hand tremor. Benzhexol (Artane) 1 mg twice Daily was prescribed. List TWO common adverse effects associated with the use of Benzhexol. (2 marks)

c) The patient did not tolerate Benzhexol for treatment of tremor. Name ONE alternative medication and list TWO common adverse effect. (3 marks)

d) The patient was prescribed increasing dosage of levodopa as the Parkinson‘s disease progressed, he experienced marked nausea. What dietary advice can alleviate his gastrointestinal (“GI”) upset? Name ONE medication that can help reduce nausea. (2 marks)

e) After five years of levodopa treatment the patient experienced frequent ineffective periods, the “off” symptom. Discuss FOUR pharmacotherapeutic strategies for motor fluctuations. (4 marks)

f) After 15 years of diagnosis of Parkinson’s disease, the patient experienced psychotic features with auditory hallucination and confused speech which could be due to the use of high dose dopaminergic medications. He was advised to stop some of the parkinsonian medications. Name ONE rare but severe complication that may occur during abrupt stopping of dopaminergic medications. (1 mark)

g) His psychotic symptoms persisted despite reducing dose of dopaminergic medications. Atypical antipsychotic was prescribed. Discuss with explanation whether quetiapine or risperidone is a better treatment option. (2 marks)

h) The patient also experienced significant postural hypotension. Name TWO non-pharmacological management to orthostatic hypotension. Name ONE adverse effect with fludrocortisone. (3 marks)

5.

Tom is a 43-year-old man with two months of productive cough, six kilograms of weight loss and night sweats. He has a pleasant appearance and you learn that he is a keen basketball fan. In the initial investigation, a chest x-ray shows a cavitary mass in the right upper lobe, and sputum microscopy shows positive acid-fast bacilli.

a) Name the respiratory disease most likely caused by acid fast bacteria. (2 marks)

b) List the anti-bacterial drug used at first line in this patient with the mechanisms of action. (12 marks)

c) What is the rationale to use such a drug combination in this patient? (2 marks)

d) State the mechanism of resistance that may develop with the drugs used. (4 marks)