Section A: 1. Answer a) f) below. a) Explain the use of enteric coated tablets and give an example of a marketed product. [2.

.5 marks] Oral medications sometimes have an enteric coating which controls where the medication is absorbed in the gastrointestinal tract. The enteric coating that covers the medication acts as a barrier which allows the medication to pass through the highly acidic pH of the stomach and then dissolve in the small intestine. Some drugs such as aspirin have an irritant effect on the stomach which can cause gastrointestinal bleeding and stomach ulcers, enteric coating can be used pass through the stomach unaltered and dissolve in the small intestine to reduce unfavourable effects. Some drugs such as omeprazole are damaged by the strong acidic conditions of the stomach, these drugs have an enteric coating that allow them to stay intact through the stomach where they can be absorbed by the stomach. b) A drug is said to have an extensive first pass metabolism. Explain what this means and what could be done to avoid the first pass effect of the drug. [3 marks] When a drug is said to have an extensive first pass metabolism, it means that only a small percentage of the active drug reaches the systemic circulation where it can fulfil its desired effect. Medication that is administered orally is absorbed by the digestive system and transported to the liver by the portal vein. A drug that has an extensive first pass metabolism is almost completely broken down by the liver, which greatly reduces the bioavailability of the drug. Since the drug has been almost completely metabolised by the drug only a small percentage of the drug is able to make it into the systemic circulation where it can therapeutic effect. To avoid the first pass effect of the drug, the drug can be administered through an alternative route such as sublingual, intramuscular, intravenous and suppository which allows the drug to be absorbed directly into the systemic circulation.

c) Drug therapy must be tailored to the individual. Explain how pregnancy can modify drug response in an
individual. [4 marks in total] Certain foods can effect drug absorbtion and smoking and drinking habits can induce p540 liver enzymes which can accelerate the metabolism of some drugs. An example of a drug food interaction is, grapefruit juice which inhibits P450 enzyme in the liver, which can inhibit the metabolism of certain drugs. Foods can

also increase drug toxicity such as tyramine rich foods like aged cheeses, yeasts extracts and Chianti wine. Food may also affects drug actions for example foods rich in vitamin K like Broccoli, Brussel sprouts and cabbage will reduce the effects of Warfarin by inhibiting vitamin K dependent clotting factors. d) Using your understanding of pharmacokinetics explain why it is important to have a good functioning
liver. [2.5 marks]

Pharmacokinetics is the way the body acts on the drug once it has been administered. This involves four processes; absorption, distribution, metabolism and excretion. Each process involves the drug taken moving across membranes; first from the site of administration into the blood stream, then once in the blood it must cross the membranes to reach their site of action then the final step it must cross membranes to finally undergo metabolism and excretion. Metabolism or biotransformation is the process of transformation of a drug within the body to make it more hydrophilic (water soluble) so that it can be excreted in the kidneys. The main organ for biotransformation is the liver. The liver performs Phase I reactions which are nonsynthetic were drugs are oxidized or reduced to more polar form. Or Phase II reactions, which are synthetic were the conjugation of a drug to a polar group occurs. As mentioned earlier P450 enzymes are the major 1

enzyme used for phase I. Some drugs undergo one or both phases and in some cases none when being metabolized. This is why it is important we have a fully functioning liver so drugs can be correctly metabolized and not cause toxicity so they can be excreted by the kidneys.
Pharmacokinetics involves absorption, distribution, metabolism of a drug e) Accurate administration of the drug is reliant on the 5 rights being adhered to. The 5 rights are giving the right drug, in the right dose, to the right person, by the right route and at the right time. Pick ONE 1 of the rights and explain this further by describing the importance of the right and what is needed to ensure that the right is achieved. [2 marks]

f) Define bioavailability of a drug and explain what effect breastfeeding will have on drug response in the
baby if the mother is on medication. [4 marks]

2. Comment on the following statements. a) Digoxin is the first line drug for heart failure. [2 marks]

Digoxin is used to treat arterial flutter, arterial fibrillation and congestive heart failure. For 200 years it has been the first line drug for heart failure, increasing the hearts force and contraction and decreasing AV conduction. Until recently, digoxin has fallen out of favour to other drugs such angiotensin-converting enzyme (ACE) inhibitors, beta blockers7 and, more recently, spironolactone (Aldactone) which is shown to prolong survival in patients with congestive heart failure. b) Therapeutic monitoring is essential for narrow spectrum drugs. [2 marks]

Narrow spectrum drugs in comparison to broad spectrum drugs have a narrow margin of safety, this means that there is a narrow therapeutic window between the drugs toxic and desired effect is small. Narrow spectrum drugs need to be monitored to insure that the drug does not produce a toxic effect while insuring the drug is able to administer a therapeutic effect. In relation to the drug morphine, morphine needs to be monitored to ensure the drug does not cause respiratory depression, coma and death (toxic effect) while the drug is still strong enough to relive pain (therapeutic effect). Therapuetic monitoring c) Age must be taken into consideration for drug therapy. d) Drugs should be discontinued if there are adverse effects. [2 marks] [3 marks]

3. Attach the drug label of a drug used in relief of pain and answer a) d) below. a) Define the term generic name of a drug and state the generic name of the drug on the drug label you have attached. [1.5 marks] b) Define the term brand name of a drug and state the brand name of the drug on the drug label you have attached. [1.5 marks]

c) What type of formulation is the drug? d) Who is the drug company producing this drug.

[0.5 marks] [0.5 marks]

4. The following are a list of common drugs that you are most likely to come in contact with. The generic name has been given. frusemide; heparin; ibuprofen; fluoxetine; morphine; warfarin; metformin; insulin; clozapine; clonazepam; risperidone; aluminium hydroxide; metoprolol; nifedipine; erythromycin; lithium carbonate Use your study guide and textbook to help you answer a) - e) below. a) For each of the drugs listed above, give a group name. [4 marks]

b) For each of the drugs listed above, give a therapeutic application for the drug.

[4 marks]

c) Choose SIX (6) of the drugs above and give the trade name or brand name of the drug. [1.5 marks] d) Why do you think it is better to learn the generic name of a drug rather than the trade or brand name of a drug? [1 mark] e) Give an example of a drug whose generic name is the same as their chemical name. [0.5 marks]

Part B: Drug Calculations

Calculate the following drug calculations. The questions are worth 1 mark each unless otherwise indicated. It is important to show all workings. 1. The Methicillin vial contains 1 g. Directions for preparation of this antibiotic are: Add 1.5 mL of water and shake vigorously. The reconstituted solution is 500 mg/mL. How much is required for 3 g dosage?

2. 3.

Benzylpenicillin contains 500,000 units/ mL. How many ml should be administered for 2.0 MU dosage? Digoxin 600 mcg IV STAT has been ordered. Available is Lanoxin (Digoxin) 0.5 mg/2 mL. How many mL of Lanoxin should be injected? 4. The prescription is: An IV of 1000 mL dextrose 5% (w/v) is to be administered over 6 hours using an administration set of 20 drops/mL.

a)

Work out the dpm to deliver 1000 mL dextrose 5% (w/v) over 6 hours.

b)
5.

After 3.5 hours 600 mL is left in the IV bag. Calculate what the flow rate should be set at to finish administration of the dextrose solution. [2 marks] You need to administer 1500 mL D5 Lactated Ringers solution over 8 hours using a set calibrated at 20 drops/mL. What is the flow rate in mL/hr?

6. An adult receives 500 mg tetracycline phosphate every 6 hrs. How many mg per dose are required for a child with a BSA of 0.83 m2. 7. A premature baby is prescribed 1 mg Konakion IM. The vial contains 2 mg per 0.2 ml. How many ml do you have to inject? 8. A week old baby is treated for a respiratory infection with amoxycillin. The normal dose is 25 mg/kg 8 hourly doses. The baby is 2000 g and is prescribed 50 mg 8 hourly. a) Is this a correct dose? [show your workings to support your answer] b) The vial contains 250 mg amoxicillin powder and 4.8 ml of water needs to be added to make a solution of 250 mg per 5 ml. How many ml do you have to inject to get the correct dose every 8 hours? c) The baby is doing well and putting on weight, what are the implications? d) The baby (3kg weight) needs surgery. After surgery Morphine is administered to the baby. The normal dose of morphine administered is 0.1 mg/kg. A continuous infusion is ordered with 10 mg of morphine in 50 ml Normal Saline 5% (w/v) running at 2 ml per hour. How many mg of morphine is delivered per hour? Is this a safe dose? [3 marks]

Part C: Case Study

Choose a patient/client, family member or friend that you know or have knowledge of that has had or is having pharmacological treatment. Note: The case study you have selected must include more than one drug in the pharmacological treatment. [24 marks total]

1) State the condition(s) of the person you have selected and outline the pathophysiology of the(se)
condition(s). the condition(s). [3 marks] [4 marks]

2) Name the drugs that are part of the pharmacological treatment and state their role in the treatment of

3) Choose ONE (1) of the drugs you have listed in 2) above and answer the following i) State generic name and brand name of the drug.
ii) State mode of action of the drug. iii) What is the drugs therapeutic indication? [1 mark] [1 mark] [0.5 marks]

iv) What are the routes of administration for the drug and associated formulations. Provide evidence. [3 marks] v) What is the dose for adults? Provide evidence. [1.5 mark]

vi) What are the common adverse reactions associated with the drug and how would you deal with them? [4 marks] vii) What drug and/or food interactions do you need to be concerned about? Choose one of the interactions you mention and explain what would happen and why. [4.5 marks] viii) This question is related to use of all drugs (not just the one you have selected). What are other issues would need to be considered when administering any drugs? [1.5 marks]