BSc (Hons) Nursing (Adult Health) BSc (Hons) Nursing (Mental Health)

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1 LEEDS METROPOLITAN UNIVERSITY FACULTY OF HEALTH COURSE: BSc (Hons) Nursing (Adult Health) BSc (Hons) Nursing (Mental Health) DATE: 6 th September 2010 EXAMINATION TIME: LEVEL: EXAMINERS: 1hr 30min Three Dr S Martin CRN: 6693 TITLE OF EXAMINATION: Introduction to Non-Medical Prescribing... Notes for candidates: Attempt ALL questions Section A (30 marks): 30 multiple choice questions Section B (20 marks): 2 short answer questions from a choice of 4. Section A - Instructions Choose the response that best completes the statement or answers the question. CIRCLE the appropriate letter on this paper. When you have completed all of the questions, transfer your answers to the pink EDPAC sheet. Submit both the question paper and the EDPAC sheet at the end of the exam. Section B - Instructions Answer 2 questions in the answer book provided.... PLEASE INSERT YOUR STUDENT NUMBER AND COURSE BELOW YOU MUST HAND IN THIS EXAM SCRIPT AT THE END OF THE EXAM Student number:... Course:...

2 SECTION A Attempt ALL of the questions in this section. 1 The study of the way in which a drug is distributed around the body is an example of: A) Pharmacotherapeutics B) Pharmacodynamics C) Pharmaceutics D) Pharmacogenetics E) Pharmacokinetics 2 Cell membrane receptors, ion channels, nuclear receptors, carriers and aqueous pores and are composed largely of: A) Amino acids B) Connective tissue C) Polysaccharides D) Nucleic acids E) Lipids 3 Volume of distribution is: A) Equal to the volume of total body water B) The volume of the extracellular fluid into which drug is distributed C) A term relating amount of drug in the body to the plasma drug concentration D) The total volume of the body E) The volume of the body minus the blood volume 4 Bicarbonate, starch, talc, gelatin and lactose are examples of: A) Diluents B) Excipients C) Disintegrating agents D) Coating agents E) Aggregating agents

3 5 Therapeutic range is best defined as: A) The concentration range over which the drug lacks toxicity but is effective B) The concentration of drug that is effective in 50% of patients C) Any drug concentration below the toxic range D) The concentration range over which the drug binds to the site of action E) The concentration range over which the drug produces observable effects 6 Glyceryl trinitrate (a drug used to treat angina) is administered sublingually because if given by the oral route: A) It decreases gastrointestinal motility, thereby causing constipation B) It is degraded by enzymes in the stomach C) It is not absorbed by the intestine D) It causes nausea and vomiting E) It is extensively metabolized before it reaches the systemic circulation 7 The sharp fall in plasma levels of a drug within the first few minutes following its intravenous administration is due to: A) Renal excretion B) First-pass metabolism C) Systemic metabolism D) Distribution E) Fat deposition 8 Very large molecules (macromolecules) that are able to cross cell membranes usually do so by means of: A) A transport protein B) Aqueous pores C) Receptor-operated ion channels D) Direct diffusion through lipid E) Pinocytosis

4 9 The bioavailability of a drug: A) Is a term applied only to oral administration B) Will be unaffected by changes in formulation C) May be affected by liver damage D) Is defined as the ratio of the actual blood concentration attained to that required to produce a pharmacological effect after a particular dose has been given. E) Is not influenced by the action of enzymes in the intestinal mucosa 10 The partition coefficient of a drug measures: A) Its potency at the receptor B) Its fat/water solubility ratio C) Its concentration in the blood compared with that in the tissue D) The rate of elimination of the substance E) The amount that reaches the brain 11 Which of the following conditions would favour transfer of a drug across the placenta: A) High degree of ionization B) Low lipid solubility C) Large maternal/foetal drug gradient D) High molecular weight E) High degree of protein binding 12 The antibiotic, tetracycline, is known to accumulate in: A) Fat (adipose tissue) B) Calcified tissues C) The placenta D) The brain E) The kidneys 13 A volume of distribution of 14 litres for a drug suggests that it is present in: A) The vascular compartment only B) Both intracellular and extracellular compartments C) The intracellular compartment only D) The transcellular compartment E) The extracellular compartment only

5 14 Binding of drugs to plasma proteins: A) Increases the fraction of drug eliminated by filtration in the kidney B) Reduces the amount available to work on the site of action C) Involves mainly binding to globulin D) Increases the pharmacological activity of the drug E) Is greater in the presence of a second drug 15 General anaesthetics tend to be distributed into: A) The liver B) Bone C) The kidneys D) Lung tissue E) Adipose tissue 16 The placental barrier: A) Is impermeable to nicotine B) Is a more effective barrier to drugs than the blood brain barrier C) Is composed largely of discontinuous capillaries D) Is permeable to phenytoin E) Is impermeable to alcohol 17 Vasodilators such as nifedipine work by acting on ion channels. The ion channel involved is a: A) Calcium channel B) Sodium channel C) Potassium channel D) Chloride channel E) Non-specific ion channel 18 Steroid hormones and closely related drugs act on: A) Enzymes involved in production of proteins B) Transport proteins associated with gene function C) Receptors located in the nucleus D) Receptor-operated ion channels E) Cell membrane receptors which stimulate or inhibit gene activity

6 19 HMG-CoA reductase is an enzyme which is inhibited by: A) Aspirin and similar drugs B) Grapefruit juice C) Antidepressants D) Penicillins E) Statins 20 Which of the following does NOT work by acting on a protein in the cell membrane: A) Cocaine B) Beta-blockers C) Calcium channel blockers D) Vincristine (a vinca alkaloid) E) Acetylcholine 21 Salbutamol, used to treat asthma, promotes bronchodilation in the same way as adrenaline. It works by: A) Acting on G-protein coupled receptors B) Stimulating GABA-A receptors in the CNS C) Acting on beta-1 receptors in the bronchioles D) Acting on transport proteins E) Opening ion channels 22 One of the main classes of antidepressant drugs works by inhibiting: A) A neurotransmitter transport protein in the brain B) Acetylcholine breakdown in the brain C) HMG-CoA reductase D) Breakdown of neurotransmitters by enzymes in the liver E) Serotonin release from nerve endings in the brain 23 Acetylcholinesterase inhibitors: A) Have been used in place of monoamine oxidase inhibitors to treat depression B) Can be used as a treatment of Alzheimer s disease C) Block nicotinic acetylcholine receptors in the brain D) Are used to reduce acetylcholine levels in treatment of myasthenia gravis. E) Are useful for treatment of Parkinson s disease

7 24 In the metabolism of paracetamol, the toxic intermediate is normally converted to non-toxic substances by: A) Glycine conjugation B) Glucuronide conjugation C) Glutathione conjugation D) Methylation E) Phase I metabolism 25 The main purpose of metabolism is to render drugs: A) Less toxic B) More lipophilic C) Less pharmacologically active D) More pharmacologically active E) More hydrophilic 26 The enzymes involved in phase 2 metabolism are: A) Located in the smooth endoplasmic reticulum and the cytosol B) Located in smooth endoplasmic reticulum only C) Located in the cytosol only D) Part of the P450 enzyme system E) Located mainly in mitochondria 27 The half-life of a drug: A) Is measured from the graph of time against drug effect B) Can be increased by inhibition of metabolic enzymes in the liver C) Can be equivalent to the EC50 for some drugs D) Cannot be used to determine the interval between doses E) Represents 50% of the time required for complete elimination of the drug 28 Phase 1 metabolism often involves: A) Conjugation reactions B) Addition of a reactive chemical group C) Enzymes present in the cytosol of liver cells D) Increasing the lipid solubility of a drug to promote excretion E) All of the above

8 29 Pharmacogenetic variation in drug response can result from: A) Drug overdose B) Repeated administration of the same drug over a long period C) Overactive non-specific protein binding D) A lack of certain metabolic enzymes E) Impairment of a drug s metabolism by other drugs 30 Tardive dyskinesia, an effect associated with the use of antipsychotic drugs, is an example of a.. adverse reaction. A) Type E B) Type D C) Type C D) Type B E) Type A

9 Section B (20 marks) Answer TWO of the questions in this section (20 marks) 1. Compare the characteristics of Type A and Type B adverse drug reactions, giving appropriate examples of named drugs in your answer. (10 marks) 2. Explain the difference between agonists, antagonists, and enzyme inhibitors. For each type give an example of a drug that exerts its therapeutic effects by acting in this way. You may use diagrams in your answer. (10 marks) 3. With respect to drug distribution, outline the structure and function of the blood brain barrier and briefly discuss the features that contribute to its effectiveness. Include a diagram in your answer. (10 marks) 4. Explain how the absorption of drugs administered by the oral route drugs can be affected by ph. Use appropriate examples of named drugs in your answer. (10 marks) END OF PAPER