SECTION D; SHORT ANSWER QUESTIONS (40 marks)

INSTRUCTIONS:

 This section consists of eight (8) questions.

 Write your answer in the space provided

 Marks to be awarded for each correct response are shown to specific question.

1. In Tanzania, treatment regimens of Tuberculosis involves two phases, mention drugs

which must be included in intensive phase; (4 MARKS)
i. Rifampicin symbolized by R
ii. Isoniazid symbolized by H
iii. Pyrazinamide symbolized by Z
iv. Ethambutol symbolized by E
v. Streptomycin symbolized by
2. Outline principles of management of mycobacterium tuberculosis infection; (5
MARKS)
i. Cure the disease
ii. Prevent death
iii. Avoid TB recurrence
iv. Prevent development of drug resistant organisms and toxicity.
v. Prevent transmission of TB in the community
3. Mention FIVE examples of beta blockers (5 marks)
i. propanol
ii. atenelol
iii. labetalol
iv. bisoprolol
v. carvedolol
vi. pindolol

4. Mention three factors which should be considered in related to patient Before starting
antibacterials (3 marks)
i. History of allegies
ii. renal and hepatic function
 iii. age
iv. severity of infection
v. ability to tolerate oral medication
vi. Whether taking other medication
vii. If female, whether pregnant, breast-feeding or taking an oral contraceptive.
viii. Duration of therapy, dosage, and route of administration depend on site, type and
severity of infection and response

5. Mention five factor which determine amount and rate of drug absorption ( 5 marks)
i. Physical nature of the dosage form
ii. Presence of food in the stomach
iii. Composition of the gastrointestinal content
iv. Gastric or intestinal pH
v. Gastrointestinal motility
vi. Mesenteric blood flow
vii. Concurrent drug administration

6. Mention five (5) Nucleoside reverse transcriptase Inhibitors used in treatment of HIV
infection ( 5 marks)
i. Abacavir
ii. Didanosine
iii. Emtricitabine
iv. Lamivudine
v. Stavudine
vi. Tenofovir
vii. Zalcitabine
viii. Zidovudine

7. A). Anti-fungal can be classified into three categories based on mechanism of action
mention them ( 3 marks )

i. Drugs that act by altering cell membrane permeability

ii. Drugs that block nucleic acid (DNA) synthesis
iii. Drugs that disrupt microtubule function and inhibit mitosis
B). Mention four antifugal drugs you know ( 4MARKS EACH)
i. Flucytosine
ii. Griseofulvin
iii. Ketoconazole
 iv. Miconazole
v. Clotrimazole
vi. Fluconazole
vii. itraconazole
8. A).MentionFirst line regime for HIV treatment ( 3 MARKS)
i. Tenofovir
ii. Lamivudine
iii. Efevirenz

B). Mention any three classes of anti-HIV drugs ( 3 marks)

i. Nucleoside reverse transcriptase inhibitor

ii. Non-nucleoside reverse transcriptase inhibitors
iii. Nucleotide reverse transcriptase inhibitor
iv. Protease inhibitors.
v. Fusion inhibitors.
vi. Integrase inhibitors

SECTION E: GUIDED ESSAY QUESTIONS (30 marks)

INSTRUCTIONS

 This section consists of two (2) questions which are supposed to be answered in a
NARRATIVE way
 Answer both questions.
 Each question must start on a new page
 Bulleting and numbering is NOT ALLOWED.
 Write your answer on the empty pages of this question paper

1. Explain six ( 6) causes of drug resistance in TB patients. ( 15 marks)

INTRODUCTION- 2 MARKS
Tuberculosis is a disease caused by Mycobacteria tuberclosis belongs to mycobacteriaceae
family, this bacteria haveunusal waxy coating due to mycolic acid on the cell surface which
makes impermeable to gram stain as a result of ziehl-neelsen, they are highly aerobic,
Characterized by caseating granuloma containing langahans giant cells which have horseshoe
pattern of nuclear.
Diagnosis is made by tuberculin skin test, acid fast stain, culture ( LJ media) and PCR.
 The following are the causes of drug resistance in tuberculosis patients.ANY 6
POINTS@ 2 MARKS
i. Too low drug dose
ii. Drug interactions resulting in too low drug dose
iii. Inadequate combination of drugs
iv. Too short duration of treatment
v. Monotherapy
vi. Patient does not take all TB drugs as prescribed
vii. Irregular and selective intake of drugs
viii. Use of sub-standard anti-TB drugs
ix. Adding a single drug to treatment regimen when treatment is failing

Conclusion- 1 MARK
Any relevant conclusion

2. Explain the four parameters of pharmacokinetics

INTRODUCTION- 2 MARKS
Refers to what the body does to the drug. It is a quantitative study of absorption,
distribution, metabolism, and elimination (ADME) of chemicals in the body, as well as
the time course of these effects.

The following are the four parameters of pharmacokinetics MARK ANY 4 POINTS
@ 3 MARKS

i. Absorption is the movement of drug across cellular membrane [barriers],

Also can be defined as the passage of drug from its site of administration into
plasma, Must be considered for all routes of administration except for the
intravenous route.For drug to traverse cellular barrier (e.g. gastrointestinal
mucosa, blood brain barrier, renal tubule, and placenta) requires crossing lipid
membrane.
ii. Distribution and Binding to Plasma Protein
When drug enters the blood stream is rapidly diluted and transported throughout
the body, For drug to act it should move from the blood to tissue.
Factors affecting drug distributions includes:Protein binding, Cardiac
outputRegional blood flow, Inflammation in the case of antibiotics, which
increases vascularity and permeability of the tissues to the drugs and increases the
rate of passage of drugs.Specialized membrane selectivity e.g. blood-brain barrier
 (BBB) and blood cerebrospinal fluid barriers. This membrane is highly selective
for lipid-soluble drugs.
iii. Metabolism/ Bio-Transformation
Drug metabolism or biotransformations are the chemical reactions that are
responsible for the conversion of drugs into other products (metabolites) within
the body before and after they have reached their sites of action.
As noted previously, drug dissolve in gastric fluid and in order to diffuse across
membrane they must be lipid soluble.
The higher the solubility in lipids compared to solubility in water the more rapidly
will the drug diffuse into the tissue.
iv. Excretion
Most drugs are excreted by the kidney, either unchanged or after metabolism.
Kidney plays major role in drug elimination, Other organ involved in drug
excretion includes Bile, Skin, Intestine, Lung, Mammalian gland and Prostate.
Rate of excretion varies greatly between drugs, some being excreted within hours
or two and others days or weeks.
Conclusion- 1 MARK
ANY RELEVANT CONCLUSION