Tutorials and Labs

Pharmacology and therapeutics

1. Provide a definition for ‘a drug’
2. Can you identify examples of drug target sites, and how heroin could access this?
3. Which drug will have greater selectivity between heroin and alcohol, and why?
4. Why might a more frequent heroin user inject a greater dose than a beginner, which
mechanisms account for this phenomenon?
5. Heroin and fentanyl are opioid antagonists but why would one cause euphoria and the other
unconsciousness and respiratory depression? Use a dose-response curve to explain this
6. What does ‘affinity’ and ‘efficacy’ mean? Explain what you understand by the term
‘structure-activity relationship’ and how might this relate to affinity and efficacy
7. How does the opioid antagonist naloxone restore an OD patient to consciousness, using a
dose-response to fentanyl explain? Differentiate between the four principal types of drug
antagonism
8. Show a dose-response curve with a full and partial agonist, and explain the difference in
curves
9. How would you define potency and how would you compare potency using a dose-response
curve?
10. Name the possible routes of administration, including their advantages and disadvantages
11. Why are excipients added to drug formulations? Give some examples of them.
12. Why is it important for a drug to be bioavailable?
13. Does the measurement of bioavailability always reflect that effectiveness of a drug?
14. What are possible factors that could affect bioavailability?
15. Summarise what pKa means
16. When would taking soluble aspirin be advantageous and why?
17. When would taking enteric-coated aspirin be advantageous and why?
18. Why is bioequivalence important when prescribing generic version of a drug with a narrow
therapeutic index?
19. How can good bioavailability be achieved for drugs that undergo extensive first-pass
metabolism?
20. What kind of illnesses could affect bioavailability of drugs?
21. Under what circumstances could a drug that undergoes 100% first pass metabolism be
therapeutically useful?
22. What were the effects of tropicamide and pilocarpine on pupil size, pupil reflex, and
accommodation?
23. Why is pilocarpine used as an anti-glaucoma medicine, and why has it been superseded by
other agents?
24. How does the sympathetic nerve system influence ocular function?
25. Explain how a sympathomimetic drug (dipivefrine) and a beta-blocker (timolol) can both
used to treat glaucoma
26. A toxic dose of heroin produces a similar effect on the eye as organophosphates, what is this
effect and how does the mechanism differ between the two drugs?
27. How do prostaglandin analogues (e.g. latanoprost) and carbonic anhydrase inhibitors (e.g.
acetazolamide) provide effective treatments for glaucoma?
28. What side groups of a drug would result in the following phase 2 reactions to take place: (i)
methylation, (ii) acetylation, (iii) sulfation, (iv) glucuronidation, (v) amino acid conjugation,
and (vi) glutathione conjugation?
29. The phase 1 metabolite of paracetamol is toxic. Explain how an acute poisoning case can
occur and how it is dealt with
 30. What drugs/ metabolites would you expect to find in bile, urine, and serum?
31. Explain the term pro-drug and give an example of this

Neuroscience and Mental Health

1. How does the deficiency of a patient post-stroke tell you about how the brain has been
affected?
2. What are the differences in the way extradural and subdural haemorrhages present?
3. Why does an aneurysm bursting in the cerebral cavity lead to, what patients describe as, the
worst headaches in your life?
4. What are the cranial nerves, including function, foramina entrances, sensory/ motor etc?
5. Name six cortical areas with specific functions
6. What do the following abbreviations mean: DR, FC, FG, IL, SG?
7. What anatomical feature distinguishes the thoracic section from the other levels of the
spinal cord?
8. A 25 year-old man fell from scaffolding and fractured his spine in the mid-thoracic region.
When examined he had no movement in the right leg and proprioception and sensation for
fine discriminative touch was impaired below T10 on the right.

However, he could feel pain and changes in temperature in his right leg. In contrast his left
leg moved normally, had normal touch sensation but retained no sensation for pain or
temperature.
a. What is the site and extent of the lesion?
b. Explain the pattern of symptoms in neuroanatomical terms.
c. Is he likely to recover the lost movement and sensation?
9. A 75 year-old patient had a stroke, the immediate signs of which were moderate weakness
and loss of sensation in the left hand and forearm. During the following weeks the weakness
and sensory disturbance resolved, but periodically he had strange sensations in his left hand,
such as sudden coldness or feeling of increased pressure. Occasionally the feeling spread up
his arm and sometimes these episodes were accompanied by jerking movements of the arm,
which he could not control.
a. What was the location of the infarct that led to the initial stroke symptoms?
b. What are the strange sensations and jerking movements a sign of?
c. What treatment could be given to reduce or prevent these involuntary movements?
d. What is likely to happen if the condition is left untreated?
10. Over a period of several days a 55 year-old man developed total paralysis of his body and
most of his face. He could not swallow or speak. Horizontal eye movements were impaired
but vertical eye movements and eye blinks were maintained.
a. Communication via a code of eye movements showed that he remained mentally
alert and that sensation over his whole body remained intact. A brainstem vascular
lesion was suspected.
b. Which pathway has been affected?
c. Why are vertical but not horizontal eye movements maintained?
d. Where in the brainstem is the lesion?
e. Why are sensation and consciousness not affected?
f. Which artery is most likely to have been involved?
11. What is somatotopy?
12. Why is it good for receptive fields of neurones to overlap?
13. Describe what two-point discrimination is and its clinical significance
14. Describe how lateral inhibition contributes to sensory awareness
Endocrinology
1. Describe how acromegaly may present
2. What three tests would be suggested for this patient to undergo
3. What would an oral glucose tolerance test (OGTT) show in a patient with acromegaly?
4. How does acromegaly cause diabetes mellitus?
5. What would a perimetry scan show in a patient with a tumour on their anterior pituitary
gland, and why?
6. What test could also confirm acromegaly?
7. What are appropriate treatments for acromegaly?
8. Explain the physiological basis for the water deprivation test?
9. How do the results after DDAVP administration identify the precise nature of diabetes
insipidus?
10. How could a lung tumour result in low serum [Na+] and low plasma osmolality, leading to
confusion and unsteadiness in the patient?
11. What is the treatment for the SIADH?
12. How can hyperthyroidism lead to lid lag?
13. What three symptoms suggest Grave’s, and why?
14. What are possible treatments for hyperthyroidism?
15. Tiredness, hard to focus, weight gain, all suggest?
16. What treatment is required for hypothyroidism?
17. How could you test to confirm Addison’s disease?
18. Why do we see hyperpigmentation in Addisonian patients?
19. How do you treat Addison’s, including in a crisis?
20. List through possible symptoms of Cushing’s, which symptoms are more outstanding than
others?
21. Why can you not take a patient off steroids after they have taken them for >2 weeks?
22. How could you test to distinguish between Cushing’s disease and syndrome?
23. If it is Cushing’s syndrome, what further investigations would you need?
24. How can you treat the possible causes of Cushing’s?
25. Explain how cabergoline, a dopamine agonist, treats a macroprolactinoma
26. If a patient is trying to conceive and they have elevated prolactin levels, why should they
stay on cabergoline, and once pregnant, how do you decide whether they continue taking it?
27. If a patient presents with low BMI and secondary amenorrhoea, what investigations would
you perform, and why?
28. If presenting with secondary amenorrhoea, what could the following mean:
(i) High oestrogen, low LH and FSH,
(ii) Low LH and FSH and low oestrogen,
(iii) High LH and GSH and low oestrogen?