EXAMINATION PAPER: ACADEMIC SESSION 2021/2022

Campus Medway
Faculty Engineering and Science
Department Medway School of Pharmacy
Stage THREE
Exam Session May 2022
COURSE CODE PHAM 1129
COURSE TITLE Integrated Therapeutics:
Brain, Psychiatry and Eyes
Examination Type Main Assessment
Duration of examination 3 hours

Instructions to Candidates
THE PAPER IS DIVIDED INTO THREE SECTIONS

SECTION A: This section is specifically designed to assess depth of knowledge

• Answer ONE out of TWO questions
• 23 % weighting
• Allow 40 minutes to complete this section.

SECTION B: This section is specifically designed to assess depth of knowledge

• Answer TWO out of THREE questions
• 47 % weighting
• Allow 1 hour 20 minutes to complete this section.

Additional Information
Calculators are allowed to be used during this exam.
The pass mark for this assessment is 50 %.

Page 1 of 8
SECTION A - Answer ONE out of TWO questions

Question 1

You are the owner of a small community pharmacy chain in a university city. The
local public health department has recently published its new Pharmaceutical Needs
Assessment (PNA). This document highlights the need for a new pharmacy close to
the university campus.
a) Explain the term PNA and outline the steps must be undertaken to develop this
assessment. In your answer you should make links to the current NHS
contractual framework.
[50 marks]

b) Which three (3) services would you propose to meet the needs of university
students and why would you choose these services? Give examples of two (2)
medicines / products would you need to supply for each service. Your answer
should include an explanation of the legal steps might be needed to permit such
supplies and how can you ensure that only students receive the new free public
health services?
[50 marks]

Total 100 MARKS

Page 2 of 8
SECTION A – cont'd

Question 2
Ms G is a 19 year old woman with generalised tonic-clonic epilepsy which was
diagnosed when she was 6 years old. For 10 years her seizures were well controlled
on sodium valproate. However, when she was aged 16 an attempt was made to
change her to another anti-seizure medicine. Her pharmacy medication record over
the next 3 years shows she tried 5 different anti-seizure medicines, sometimes on
their own and at other times in combination. Her prescriptions included both
lamotrigine, which was stopped after 6 months and levetiracetam which was stopped
after only a few weeks. In all cases the medicines failed to control her seizures
and/or gave her intolerable side effects.

Today she presents a prescription for sodium valproate again (as Epilim®). It is
being started at a dose of 300 mg twice a day, increasing by 200 mg every 3 days
until she reaches the dose she was on before, which was 1200 mg twice a day.

a) Why might Michelle have been taken off of sodium valproate when she was 16
years old given how well her seizures were controlled at that time? What kind of
side effects might she have experienced with the other anti-seizure medicines
she took? Why does the prescription for sodium valproate need to be titrated up
again? What action does the community pharmacist need to take to ensure that
that Michelle is taking the medication safety and within its license?
[70 marks]

b) It is 6 months later. Michelle tells you that she is off to university at last, having
had to defer her place last year because she was having so many seizures. She
has some questions for you:

‘The consultant said that even though the sodium valproate has stopped my seizures
again, when I leave home, I need to watch out for seizure triggers. I didn’t know what
she meant. What sort of things trigger seizures?

Page 3 of 8
Michelle continues ‘The consultant also said that I needed to make sure I never
forget to take my medicines once my mum isn’t there to remind me. I wondered if it
might be worth me getting one of those muti-compartment reminder things – or is
there something better? My mum would kill me if I had a big seizure just because I
forgot my Epilim® but I think I might if I’m really busy or if I sleep late or something.
What happens if I just forget to order the Epilim® from the doctors?

Write what you would say in answer to Michelle’s three questions: you need to comment on
what things might trigger seizures, whether you think a multi-compartment aid would be a
good idea (and if not suggest an alternative). How might she avoid forgetting to order her
prescription and what can she do if she does?

[30 marks]
Total 100 MARKS

END OF SECTION A

PROCEED TO SECTION B

Page 4 of 8
SECTION B - Answer TWO out of THREE questions

Question 3

Mrs H attends the Pain Clinic today complaining of a new onset of pain. She
describes a pain that is ‘stinging’ in quality going down her back. Mrs H has been
attending the clinic for the past year with back pain after sustaining a back injury
following an accident earlier last year.

Over the past year, she has been placed on a combination of oral analgesics to
control her pain. She is currently on the following:

• Paracetamol 1 g four times a day

• Naproxen 500 mg twice daily
• Morphine modified release 30 mg twice daily

Mrs H reports that her pain is affecting her physical and mental wellbeing. She also
suffers from intermittent migraine. She was on prophylactic treatment, but this was
tapered off due to a decline in the frequency of her headache attacks.

She is an accountant working in the city. She is married with two sons below the
age of 10 years. She does not smoke, but drinks wine occasionally when socialising
at work or with friends.

She has no other medical conditions and is allergic to penicillin.

a) Classify this patient’s pain and discuss the rationale for her current drug therapy
regimen. In view of her new pain onset, what additional medication would you
add to this patient pain treatment regimen and why?
[30 marks]
b) With reference to her original back pain injury, discuss how pain signals are
collected, transmitted, interpreted, and modulated in the central nervous system
(CNS).
[20 marks]

c) A pharmaceutical company is currently developing new drugs for the treatment of

pain.
Describe the clinical studies that are required to establish the clinical effectiveness of
a new drug. Include in your answer details of the purpose of the studies, the length
of the studies, the types of subjects used and the timing of the studies relative to
other required activities.

[35 marks]

Page 5 of 8
c) d)The company is developing two new drugs - one for the treatment of moderate
pain associated with rheumatoid arthritis and one for the treatment of pain
associated with migraine. How would you expect the clinical studies for these two
drugs to differ? Suggest a suitable drug that you would use as comparator agent
in each study.
[15 marks]

Total 100 MARKS

Page 6 of 8
Question 4

a) Discuss the pharmacological mechanism of action of antipsychotics with

examples from typical and atypical groups, with the aid of diagrams, in the
management of positive and negative symptoms of schizophrenia and the
development of adverse drug reactions.
[50 marks]

b) Describe the binding of the phenothiazine class of antipsychotic agents to the

dopamine receptor.
[10 marks]
c) With the aid of the phenothiazine general structure, discus the structure
activity relationships (SAR) of the phenothiazine class of antipsychotic agents.

Phenothiazine general structure

[40 marks]

Total 100 MARKS

Page 7 of 8
Question 5

Parkinson's disease is a neurodegenerative condition and most common movement

disorder.
a) Discuss in detail the use of L-DOPA (rather than dopamine), carbidopa,
entacapone and selegiline in the pharmacotherapy of Parkinson’s disease.
[50 marks]

b) Discuss the potential future therapeutic strategies for Parkinson’s disease.

[50 marks]

Total 100 MARKS

END OF SECTION B

END OF EXAMINATION

Page 8 of 8