1
Q
SBA: What legislative act primarily governs the control of poisons in the UK?
A
Answer: The Poisons Act 1972.
2
Q
SBA: What was the purpose of the Deregulation Act 2015 in relation to the Poisons Act?
A
Answer: To respond to terrorism threats by introducing ‘regulated’ and ‘reportable’ substances.
3
Q
SBA: What is required to supply regulated substances under the Poisons Act?
A
Answer: An Explosives Precursors and Poisons (EPP) licence or a recognised non-GB licence.
4
Q
SBA: How must poisons be stored in retail premises?
A
Answer: In a cupboard or drawer reserved solely for poisons or partitioned from accessible areas.
5
Q
SBA: What is the reporting timeframe for suspicious transactions involving reportable substances?
A
Answer: Within 24 hours.
6
Q
SBA: Which organisation enforces the Poisons Act 1972?
A
Answer: The General Pharmaceutical Council (GPhC).
7
Q
SBA: What is completely denatured alcohol (CDA) primarily used for?
A
Answer: Heating, lighting, cleaning, and general domestic use.
8
Q
SBA: What is the mechanism of action of industrial denatured alcohol (IDA)?
A
Answer: Not for consumption; used in manufacturing (e.g., hand sanitizers).
9
Q
SBA: What label must be included on chemicals classified as hazardous under GB CLP regulations?
A
Answer: Hazard pictograms, signal words, and precautionary statements.
10
Q
SBA: Which category under drug precursor regulations includes substances like piperonal used to produce methamphetamine?
A
Answer: Category 1.
11
Q
EMQ: Match the poison classification to its description.
A
Regulated substances: Require EPP licences for specific activities.
Reportable substances: Require monitoring and reporting of suspicious transactions.
Exempt substances: Medicinal and veterinary products.
12
Q
EMQ: Match the requirement to its regulated substance.
Record of purchase:
Report suspicious transactions:
Storage:
A
Record of purchase: Name and address of purchaser, quantity, and purpose.
Report suspicious transactions: Within 24 hours to authorities.
Storage: Partitioned storage inaccessible to customers.
13
Q
EMQ: Match the class of denatured alcohol to its use.
A
Completely denatured alcohol (CDA): General domestic use.
Industrial denatured alcohol (IDA): Manufacture of hand sanitizers.
Trade-specific denatured alcohol (TSDA): Industry-specific applications.
14
Q
EMQ: Match the hazard classification to its example
A
Physical hazard: Flammable liquid.
Health hazard: Carcinogenic substances.
Environmental hazard: Harmful to aquatic life.
15
Q
EMQ: Match the chemical regulatory requirement to its description.
A
Labelling: Signal words, hazard pictograms, and precautionary statements.
Safety Data Sheets: Provided to purchasers of hazardous chemicals.
Packaging: Child-resistant fastenings and tactile warnings.
16
Q
What are the key requirements for the sale and supply of regulated poisons?
A
Answer: Must be sold through lawful retail pharmacy businesses under pharmacist supervision, with a record of purchaser details and purpose.
17
Q
Describe the classification of denatured alcohols and their use cases.
A
Answer:
CDA: Heating, lighting, and cleaning.
IDA: Manufacturing (e.g., hand sanitizers).
TSDA: Trade-specific purposes. (2 marks)
18
Q
What are the labelling requirements for hazardous chemicals under GB CLP?
A
Answer: Must include hazard pictograms, signal words (‘Warning’ or ‘Danger’), and precautionary statements. (2 marks)
19
Q
Explain the reporting obligations for suspicious transactions involving reportable substances.
A
Answer: Suspicious transactions must be reported within 24 hours to the anti-terrorism hotline (0800 789321) or local authorities. (2 marks)
20
Q
List two examples of drug precursors and their potential misuse.
A
Answer:
Piperonal (used to produce methamphetamine).
Acetic anhydride (used to produce heroin). (2 marks)
21
Q
SBA: What are the four main functions of the gastrointestinal (GI) system?
A
Answer: Ingestion, digestion, absorption, and elimination.
22
Q
SBA: What is the function of the pyloric sphincter in the stomach?
A
Answer: It prevents backflow of intestinal contents and regulates chyme movement into the small intestine.
23
Q
SBA: What enzyme is secreted by the salivary glands for carbohydrate digestion?
A
Answer: Amylase.
24
Q
SBA: What is the primary function of bile salts in digestion?
A
Answer: Emulsification of fats for absorption.
25
SBA: Which structure in the small intestine is specialized for nutrient absorption?
Answer: Villi.
26
SBA: What is the role of parietal cells in the stomach?
Answer: Secretion of hydrochloric acid and intrinsic factor.
27
SBA: What is the function of the enteric nervous system in the GI tract?
Answer: Regulates GI motility and secretion independently of the central nervous system.
28
SBA: What is the primary role of goblet cells in the intestines?
Answer: Secretion of mucus to protect the intestinal lining.
29
SBA: What triggers the cephalic phase of digestion?
Answer: Sensory stimuli such as the sight, smell, or thought of food.
30
SBA: Which hormone stimulates the gallbladder to contract and release bile?
Answer: Cholecystokinin (CCK).
31
EMQ: Match the GI structure to its primary function.
Stomach: Protein digestion via pepsin.
Small intestine: Nutrient and water absorption.
Large intestine: Water and electrolyte absorption.
32
EMQ: Match the GI secretion to its function.
Bicarbonate: Neutralizes stomach acid in the duodenum.
Pepsinogen: Converted to pepsin for protein digestion.
Intrinsic factor: Facilitates vitamin B12 absorption.
33
EMQ: Match the accessory organ to its contribution.
Liver: Bile production for fat digestion.
Pancreas: Secretion of digestive enzymes and bicarbonate.
Gallbladder: Storage and concentration of bile.
34
EMQ: Match the motility type to its description.
Peristalsis: Propels food forward through the GI tract.
Segmentation: Mixes chyme and digestive enzymes in the intestines.
Gastrocolic reflex: Triggers mass movement in the large intestine.
35
EMQ: Match the immune defense to its mechanism.
M cells: Transport antigens to immune cells in Peyer’s patches.
Lysozyme: Breaks down bacterial cell walls in saliva.
Gastric acid: Kills ingested pathogens.
36
What are the main anatomical regions of the GI tract?
Answer: Mouth, oral cavity, oesophagus, stomach, small intestine (duodenum, jejunum, ileum), large intestine, rectum, and anus. (2 marks)
37
Describe the key roles of the stomach in digestion.
Answer:
Secretes gastric acid and enzymes for protein digestion.
Mixes food into chyme using peristaltic movements.
Secretes intrinsic factor for vitamin B12 absorption. (2 marks)
38
What are the accessory organs of digestion, and what do they contribute?
Answer:
Liver: Produces bile.
Pancreas: Secretes digestive enzymes and bicarbonate.
Gallbladder: Stores and concentrates bile. (2 marks)
39
Explain the role of the enteric nervous system in regulating digestion.
Answer: Controls GI motility, secretion, and local reflexes independently of the CNS. (2 marks)
40
What protective mechanisms exist in the GI tract to prevent damage?
Answer:
Mucus secretion protects the lining.
Gastric acid kills pathogens.
Immune cells in Peyer’s patches initiate immune responses. (2 marks)
41
SBA: What is the primary site of drug absorption in the GI tract?
Answer: Small intestine.
42
SBA: What enzyme digests carbohydrates into monosaccharides?
Answer: Amylase.
43
SBA: What condition is caused by decreased lactase activity?
Answer: Lactose intolerance.
44
SBA: What is the primary mechanism for passive diffusion of drugs across membranes?
Answer: Movement down the concentration gradient.
45
SBA: Which vitamins are absorbed with dietary fats?
Answer: Fat-soluble vitamins (A, D, E, K).
46
SBA: What is the role of bile salts in fat digestion?
Answer: Emulsify lipids to form micelles for absorption.
47
SBA: What percentage of an acidic drug is unionized in the stomach (pH 1.5)?
Answer: Approximately 100%.
48
SBA: Which transporters mediate active absorption of hydrophilic drugs?
Answer: Organic anion and cation transporters (OATs and OCTs).
49
SBA: What determines the ionization of a drug in the GI tract?
Answer: The pH of the GI tract and the pKa of the drug.
50
SBA: What is the pharmacokinetic measure of oral drug absorption efficiency?
Answer: Bioavailability (F).
51
EMQ: Match the macronutrient to its site of absorption.
Carbohydrates: Small intestine (as monosaccharides).
Proteins: Small intestine (as amino acids and di/tri-peptides).
Fats: Small intestine (as fatty acids and monoglycerides).
52
EMQ: Match the factor to its effect on drug absorption.
Gastric emptying rate: Faster emptying increases absorption.
Presence of food: Can delay absorption of some drugs.
First-pass metabolism: Reduces bioavailability of some drugs.
53
EMQ: Match the nutrient to its absorption process.
Glucose: Sodium-glucose transporter (SGLT).
Fructose: GLUT5 transporter.
Vitamin B12: Requires intrinsic factor for absorption in the ileum.
54
EMQ: Match the GI pH to its drug absorption effect.
Stomach (pH 1.5): Favors absorption of weak acids.
Small intestine (pH 5.3-6): Optimal for weak bases.
Blood (pH 7.4): Maintains equilibrium for drug distribution.
55
EMQ: Match the digestion aid to its role.
Bile salts: Emulsify fats into micelles.
Pancreatic enzymes: Breakdown carbohydrates, proteins, and fats.
Mucosal enzymes: Final breakdown of disaccharides and peptides.
56
Describe the absorption process of carbohydrates, proteins, and fats in the GI tract.
Answer:
Carbohydrates: Broken into monosaccharides by amylase; glucose absorbed via SGLT2.
Proteins: Digested to amino acids and di/tri-peptides by proteases; absorbed via sodium-dependent transporters.
Fats: Emulsified by bile salts, digested by lipase into fatty acids/monoglycerides, absorbed via micelles. (3 marks)
57
What factors affect passive drug diffusion in the GI tract?
Answer:
Drug concentration gradient.
Lipid solubility of the drug.
Membrane thickness and surface area. (2 marks)
58
Explain the role of pH in drug absorption in different parts of the GI tract.
Answer:
Acidic drugs: Absorbed in the stomach.
Basic drugs: Absorbed in the small intestine.
Ionization depends on pKa and local pH. (2 marks)
59
What are the advantages of oral drug absorption?
Answer:
Large surface area of the small intestine.
Rich vascularization.
Long dwell time in the tract. (2 marks)
60
What is bioavailability, and how is it calculated?
Answer: The proportion of the administered dose that reaches systemic circulation; calculated as AUC (oral)/AUC (IV). (1 mark)
61
SBA: What is the main role of the gut-associated lymphoid tissue (GALT) in the GI tract?
Answer: Provides immune defense by stimulating IgA production and modulating inflammatory responses.
62
SBA: What is the primary function of bile salts in preventing GI infections?
Answer: Disrupt microbial membranes and aid in the elimination of pathogens.
63
SBA: Which bacterial pathogen is associated with pseudomembranous colitis?
Answer: Clostridium difficile.
64
Answer: Clostridium difficile.
Answer: Causes electrolyte and fluid loss, leading to watery diarrhea.
65
SBA: Which gut flora disruption is commonly caused by tetracycline use?
Answer: Microbiota dysbiosis.
66
SBA: Which component of the lipopolysaccharide (LPS) in Gram-negative bacteria is responsible for endotoxin activity?
Answer: Lipid A.
67
SBA: What is the first-line treatment for mild-to-moderate C. difficile infection?
Answer: Oral vancomycin.
68
SBA: What is the primary mechanism by which probiotics support gut health?
Answer: Compete with pathogens for colonization sites and enhance mucosal immunity.
69
SBA: Which diagnostic method detects C. difficile toxins in stool samples?
Answer: PCR-based assays.
70
SBA: What is the primary risk factor for C. difficile infection?
Answer: Prolonged use of broad-spectrum antibiotics.
71
EMQ: Match the pathogen to its associated infection.
Vibrio cholerae: Severe watery diarrhea ("rice-water stools").
Clostridium difficile: Pseudomembranous colitis.
Norovirus: Acute viral gastroenteritis.
72
EMQ: Match the bacterial toxin to its mechanism of action.
Enterotoxin A: Disrupts tight junctions and causes cytoskeleton disruption.
Pore-forming toxin: Causes leakage of cellular contents.
Superantigen toxin: Overactivates T cells, leading to cytokine storm.
73
EMQ: Match the GI microbiota function to its description.
Structural function: Enhances the epithelial barrier lining.
Metabolic function: Synthesizes vitamins and ferments dietary fibers.
Protective function: Colonization resistance and immune activation.
74
EMQ: Match the treatment to its GI infection severity.
Mild C. difficile infection: Oral vancomycin.
Recurrent C. difficile infection: Oral fidaxomicin.
Life-threatening C. difficile infection: Oral vancomycin plus IV metronidazole.
75
EMQ: Match the toxin type to its properties.
Exotoxin: Heat-labile, secreted by living bacteria.
Endotoxin: Heat-stable, part of Gram-negative bacterial cell wall.
76
What are the key pathophysiological features of Clostridium difficile infection?
Answer:
Disruption of gut microbiota allows colonization by C. difficile.
Toxins A and B damage epithelial cells, leading to increased permeability, inflammation, and diarrhea.
Severe cases cause pseudomembranous colitis and toxic megacolon. (2 marks)
77
What are the primary risk factors for C. difficile infection?
Answer:
Prolonged broad-spectrum antibiotic use.
Hospitalization.
Advanced age or immunosuppression. (2 marks)
78
What diagnostic methods are used to confirm C. difficile infection?
Answer:
Stool PCR for toxin genes.
Detection of toxins A and B using immunoassays.
Colonoscopy to identify pseudomembranes in severe cases. (2 marks)
79
Describe the treatment options for mild-to-moderate and severe C. difficile infections.
Answer:
Mild-to-moderate: Oral vancomycin or fidaxomicin.
Severe: Oral vancomycin with IV metronidazole.
Discontinue causative antibiotics when possible. (2 marks)
80
What preventive measures can reduce the risk of GI infections?
Answer:
Judicious use of antibiotics.
Hand hygiene and infection control in healthcare settings.
Probiotics in high-risk patients (controversial). (2 marks)
81
SBA: What is the primary cause of GORD?
Answer: Weakening or relaxation of the lower oesophageal sphincter.
82
SBA: What is the main risk factor for GORD?
Answer: Obesity.
83
SBA: What is the first-line pharmacological treatment for GORD?
Answer: Proton Pump Inhibitor (PPI).
84
SBA: Which symptom requires urgent referral in GORD?
Answer: Unintentional weight loss.
85
SBA: What is the mechanism of action of PPIs?
Answer: Irreversible inhibition of the H+/K+ ATPase pump in gastric parietal cells.
86
SBA: What is the role of H2 receptor antagonists in GORD management?
Answer: Reduce gastric acid secretion by blocking histamine H2 receptors.
87
SBA: Which bacterium is most commonly associated with peptic ulcer disease?
Answer: Helicobacter pylori.
88
SBA: What is the key diagnostic test for H. pylori infection?
Answer: Carbon-13 urea breath test.
89
SBA: What antibiotics are commonly used in first-line triple therapy for H. pylori eradication?
Answer: Amoxicillin and clarithromycin.
90
SBA: What is a potential side effect of long-term PPI use?
Answer: Risk of fractures.
91
EMQ: Match the pharmacological therapy to its role in GORD management.
PPI: First-line therapy for reducing acid secretion.
H2RA: Alternative therapy when PPI is inadequate.
Antacids: Immediate symptom relief.
92
EMQ: Match the condition to the diagnostic test.
GORD: Clinical diagnosis based on symptoms.
H. pylori: Urea breath test.
Peptic ulcer: Endoscopy.
93
EMQ: Match the treatment regimen to the condition.
GORD with red flag symptoms: Refer for endoscopy.
H. pylori eradication: Triple therapy with PPI and two antibiotics.
NSAID-induced ulcer: Discontinue NSAID and start PPI.
94
EMQ: Match the complication to its cause.
Perforation: Peptic ulcer eroding through the stomach lining.
Gastrointestinal bleeding: Erosion of blood vessels at the ulcer site.
Gastric obstruction: Inflammation or scarring blocking food passage.
95
EMQ: Match the antibiotic to its key consideration in H. pylori treatment.
Clarithromycin: Avoid if recent macrolide use.
Metronidazole: Avoid alcohol due to disulfiram-like reaction.
Tetracycline: Avoid in children under 12 years old.
96
What are the key diagnostic methods for GORD, peptic ulcers, and H. pylori infection?
Answer:
GORD: Based on clinical symptoms, endoscopy for red flags.
Peptic ulcers: Endoscopy and urea breath test if H. pylori suspected.
H. pylori: Carbon-13 urea breath test or stool antigen test. (2 marks)
97
Outline the lifestyle modifications recommended for GORD management.
Answer:
Weight loss.
Avoid triggers like alcohol, coffee, and fatty foods.
Eat smaller, frequent meals and avoid eating before bedtime.
Elevate the head of the bed. (2 marks)
98
Describe the first-line pharmacological treatments for GORD and peptic ulcers.
Answer:
GORD: PPI for 4-8 weeks, H2RA if PPI ineffective.
Peptic ulcers: PPI or H2RA therapy, with eradication of H. pylori if present. (2 marks)
99
What are the complications of untreated peptic ulcers?
Answer:
Bleeding, perforation, gastric obstruction, and risk of peritonitis or sepsis. (2 marks)
100
What is the triple therapy for H. pylori eradication?
Answer: PPI + amoxicillin + clarithromycin or metronidazole for 7-14 days. (2 marks)
101
SBA: What is the main advantage of granules over powders in tablet formulation?
Answer: Granules have better flowability and uniformity.
102
SBA: What is the function of a filler in tablet formulations?
Answer: Provides sufficient bulk volume for compression.
103
SBA: Which excipient improves the flow of powders during tableting?
SBA: Which excipient improves the flow of powders during tableting?
104
SBA: What is the role of a disintegrant in a tablet?
Answer: Facilitates tablet breakup to release the active ingredient.
105
SBA: Which process involves the removal of void spaces during tablet compression?
Answer: Compression.
106
SBA: What is the purpose of wetting agents in tablet formulations?
Answer: Enhance water uptake and improve disintegration.
107
SBA: What is the most common lubricant used in tablet manufacturing?
Answer: Magnesium stearate.
108
SBA: What is capping during the tableting process?
Answer: Separation of the upper segment of a tablet from the main body.
109
SBA: What is the Heckel plot used to evaluate in tablet formulation?
Answer: The compressibility and deformation properties of a powder.
110
SBA: What causes mottling in tablet formulations?
Answer: Unequal distribution of colorants or dye migration during drying.
111
EMQ: Match the excipient to its role in tablet formulation.
Filler: Lactose, adds bulk for compression.
Binder: PVP or starch, provides cohesiveness.
Disintegrant: Croscarmellose sodium, promotes tablet breakup.
112
EMQ: Match the tablet defect to its cause.
Capping: Improper compression settings.
Sticking: Insufficient lubrication.
Mottling: Uneven dye distribution.
113
EMQ: Match the compaction step to its description.
Compression: Reduction in bulk volume by removing air.
Consolidation: Formation of interparticulate bonds.
Decompression: Pressure release during tablet ejection.
114
EMQ: Match the type of granulation to its description.
Wet granulation: Involves a liquid binder.
Dry granulation: Compresses powder without liquid.
Direct compression: Uses pre-compressed excipients.
115
EMQ: Match the additive to its purpose.
Antioxidant: Prevents drug oxidation (e.g., ascorbic acid).
Buffer: Maintains pH (e.g., sodium bicarbonate).
Sweetener: Improves taste (e.g., aspartame).
116
What are the main processes in tablet manufacture?
Answer: Compression (reducing bulk volume), consolidation (forming interparticulate bonds), and ejection (removing tablets from the die). (2 marks)
117
Describe the functions of three common excipients used in tablets.
Answer:
Filler: Provides bulk for compression (e.g., lactose).
Disintegrant: Promotes tablet breakup (e.g., starch).
Binder: Adds cohesiveness (e.g., PVP). (2 marks)
118
What are the advantages of granules over powders in tablet manufacturing?
Answer: Granules flow better, reduce dust, and provide uniformity. (2 marks)
119
What are the common defects in tablet manufacture, and how can they be addressed?
Answer:
Capping: Adjust compression force.
Sticking: Increase lubrication.
Mottling: Improve mixing of dyes. (2 marks)
120
xplain the role of the Heckel plot in tablet formulation.
Answer: Evaluates compressibility and deformation; larger Heckel constants indicate plastic deformation. (2 marks)
121
SBA: What is the British Pharmacopoeia (BP) acceptable friability limit for tablets?
SBA: What is the British Pharmacopoeia (BP) acceptable friability limit for tablets?
122
SBA: What test evaluates the resistance of a tablet to abrasion or mechanical stress?
Answer: Friability test.
123
SBA: Which factor primarily influences the hardness of a tablet?
Answer: Compression force during tableting.
124
SBA: What is the main purpose of the content uniformity (CU) test in tablets?
Answer: To ensure each dosage unit contains the intended amount of active ingredient.
125
SBA: What is considered a passing result for a tablet disintegration test?
Answer: All six tablets disintegrate within the specified time, except for insoluble fragments.
126
SBA: What media are typically used in dissolution testing to simulate gastric and intestinal fluids?
Answer: Hydrochloric acid (pH 1.5–3.5) for gastric and phosphate buffer (pH 6–7.4) for intestinal fluids.
127
SBA: At what temperature is the dissolution test typically performed?
Answer: 37°C.
128
SBA: What is the significance of determining disintegration time for a tablet?
Answer: It predicts how quickly the tablet will dissolve and release the drug for absorption.
129
SBA: What is the most common failure mode in a friability test?
Answer: Cracking, cleavage, or breakage of the tablet.
130
SBA: What is the key difference between the CU and mass variation (MV) tests?
Answer: CU measures the active ingredient, while MV focuses on weight consistency.
131
EMQ: Match the test to its purpose.
Content uniformity: Ensures consistent active ingredient content.
Friability: Assesses resistance to abrasion or mechanical stress.
Hardness: Measures resistance to crushing or breaking.
132
EMQ: Match the tablet defect to its cause.
Capping: Insufficient compression force.
Friability failure: Low binder concentration.
Mottling: Uneven dye distribution.
133
EMQ: Match the test outcome to its requirement.
Friability: Mass loss ≤1%.
Disintegration: Complete disintegration within specified time.
Dissolution: Predetermined percentage of drug released at specific intervals.
134
EMQ: Match the factor to its impact on tablet quality.
Binder concentration: Affects hardness and friability.
Lubricant concentration: Influences weight variation and disintegration.
Compression force: Impacts hardness and friability.
135
EMQ: Match the dissolution medium to its purpose.
Hydrochloric acid: Simulates gastric fluid.
Phosphate buffer: Simulates intestinal fluid.
Water: Neutral medium for dissolution.
136
Describe the friability test and its BP standard.
Answer: Friability assesses resistance to abrasion. Tablets are tumbled for 100 rotations, and mass loss should not exceed 1%. (2 marks)
137
What is the purpose of the content uniformity test?
Answer: Ensures each dosage unit has an active ingredient content within ±15% of the average dose. (2 marks)
138
How is tablet hardness evaluated, and why is it important?
Answer: Measures resistance to crushing using diametral compression. Affects tablet durability and handling. (2 marks)
139
xplain the dissolution test procedure and its relevance.
Answer: Tablets are placed in a dissolution medium at 37°C, with paddles rotating at 50 rpm. Samples are taken at specified intervals to ensure drug release meets specifications. (2 marks)
140
What are the consequences of a tablet failing the disintegration test?
Answer: Indicates poor bioavailability or delayed onset of therapeutic action. (2 marks)
141
SBA: What is the primary function of the myenteric plexus in the enteric nervous system?
Answer: Regulates GI motility, such as peristalsis.
142
SBA: Which neurotransmitter is primarily associated with the "rest-and-digest" response of the gut?
Answer: Acetylcholine.
143
SBA: What percentage of the body’s serotonin is synthesized in the gut?
Answer: 95%.
144
SBA: What is the role of ghrelin in the gut-brain axis?
Answer: Stimulates hunger by signaling the hypothalamus.
145
SBA: Which phase of digestion is initiated by the sight or smell of food?
Answer: Cephalic phase.
146
SBA: What is the primary function of GLP-1 in digestion?
Answer: Enhances insulin secretion and promotes satiety.
147
SBA: What type of reflex is triggered by local stimuli within the gut?
Answer: Short reflex.
148
SBA: Which gut microbiota-derived metabolites influence brain function?
Answer: Short-chain fatty acids (SCFAs).
149
SBA: What is the primary role of the vagus nerve in the gut-brain axis?
Answer: Facilitates bidirectional communication between the gut and brain.
150
SBA: What triggers the release of CCK from the duodenum?
Answer: Presence of fats and partially digested proteins.
151
EMQ: Match the reflex type to its characteristic.
Short reflex: Local control by the ENS.
Long reflex: Involves the CNS via the vagus nerve.
152
EMQ: Match the GI hormone to its function.
Gastrin: Stimulates gastric acid secretion.
Secretin: Stimulates bicarbonate release and inhibits gastric acid secretion.
Motilin: Coordinates migrating motor complexes during fasting.
153
EMQ: Match the gut-brain axis component to its role.
Microbiota: Produce neurotransmitters like serotonin.
ENS: Controls local GI motility and secretions.
Vagus nerve: Transmits signals between the gut and CNS.
154
EMQ: Match the digestive phase to its activity.
Cephalic phase: Anticipatory mechanisms like salivation.
Gastric phase: Secretion of gastric acid and motility.
Intestinal phase: Coordination of intestinal motility and enzyme release.
155
EMQ: Match the neurotransmitter to its function.
Substance P: Excites smooth muscle contraction.
Nitric oxide: Relaxes smooth muscle.
Vasoactive intestinal peptide (VIP): Inhibits smooth muscle contraction.
156
Describe the primary components of the gut-brain axis.
Answer:
ENS (enteric nervous system): Controls local motility and secretion.
CNS: Modulates gut activity via long reflexes.
Microbiota: Influences mood and immunity via metabolites. (2 marks
157
Explain the role of short and long reflexes in gut motility.
Explain the role of short and long reflexes in gut motility.
158
What is the role of the gut microbiota in mood regulation?
Answer: Microbiota produce serotonin and SCFAs, which modulate brain function and emotional states. (2 marks)
159
How do hormones regulate digestion in the gut-brain axis?
Answer:
CCK: Stimulates bile and enzyme secretion.
Secretin: Stimulates bicarbonate release.
GLP-1: Enhances insulin release and promotes satiety. (2 marks)
160
What are the clinical implications of gut-brain axis dysfunction?
Answer: Associated with conditions like irritable bowel syndrome (IBS), anxiety, and neurodegenerative disorders. (2 marks)
161
SBA: What is the primary action of antacids in the stomach?
Answer: Neutralization of stomach acid by reacting with hydrochloric acid (HCl).
162
SBA: Which antacid component can cause constipation as a side effect?
Answer: Aluminium hydroxide.
163
SBA: What is the mechanism of action of H2 receptor antagonists?
Answer: Block histamine H2 receptors on parietal cells, reducing cAMP and gastric acid secretion.
164
SBA: Which PPI binds covalently to the H+/K+ ATPase pump?
Answer: Omeprazole.
165
SBA: What is the primary risk associated with long-term use of PPIs?
Answer: Nutrient deficiencies such as B12, calcium, and magnesium.
166
Answer: Nutrient deficiencies such as B12, calcium, and magnesium.
Answer: Gastro-oesophageal reflux disease (GORD).
167
SBA: What is the recommended combination therapy for H. pylori eradication?
Answer: PPI with two antibiotics (e.g., amoxicillin and clarithromycin).
168
SBA: Which enzyme is inhibited by cimetidine, potentially causing drug interactions?
Answer: Cytochrome P450.
169
SBA: How long can a PPI inhibit gastric acid secretion following a single dose?
Answer: Up to 36 hours.
170
SBA: What is the primary physiological stimulus for acid secretion in the stomach?
Answer: Gastrin, histamine, and acetylcholine.
171
EMQ: Match the drug class to its primary action.
Antacids: Neutralizes stomach acid.
H2 antagonists: Blocks histamine receptors to reduce acid secretion.
PPIs: Irreversibly inhibit the proton pump.
172
EMQ: Match the drug to its common side effect.
Aluminium hydroxide: Constipation.
Magnesium hydroxide: Diarrhea.
Calcium carbonate: Hypercalcemia.
173
EMQ: Match the mechanism to the therapeutic outcome.
Neutralization of HCl: Rapid symptom relief in dyspepsia.
Blocking H2 receptors: Reduces basal and stimulated acid secretion.
Proton pump inhibition: Long-lasting acid suppression.
174
EMQ: Match the therapy to its clinical application.
Antacids: Short-term relief of heartburn.
H2 receptor antagonists: Mild GORD symptoms.
PPIs: Peptic ulcer disease and erosive oesophagitis.
175
EMQ: Match the long-term risk to the treatment.
Antacids: Electrolyte imbalances and rebound acid hypersecretion.
H2 antagonists: Drug interactions via P450 inhibition.
PPIs: Increased risk of fractures and infections.
176
Describe the mechanism of action of antacids, H2 receptor antagonists, and PPIs.
Answer:
Antacids: Neutralize stomach acid to increase pH.
H2RAs: Block histamine receptors on parietal cells, reducing acid production.
PPIs: Irreversibly inhibit the H+/K+ ATPase pump, preventing acid secretion. (3 marks)
177
What are the common side effects of these drug classes?
Answer:
Antacids: Constipation (aluminium), diarrhea (magnesium), hypercalcemia (calcium).
H2RAs: Drug interactions (e.g., cimetidine inhibiting P450).
PPIs: Nutrient deficiencies, increased infection risk. (2 marks)
178
Outline the clinical indications for each therapy.
Answer:
Antacids: Rapid relief of mild dyspepsia.
H2RAs: GORD and mild peptic ulcer disease.
PPIs: Peptic ulcers, severe GORD, H. pylori eradication. (2 marks)
179
Explain the risks of long-term PPI use.
Answer: Nutrient malabsorption (B12, calcium), bone fractures, infection risk, and possible drug interactions via CYP2C19 inhibition. (2 marks)
180
What is the NICE-recommended treatment for H. pylori?
Answer: Triple therapy: PPI + amoxicillin + clarithromycin or metronidazole. (1 mark)
181
SBA: What is the primary objective of tablet coating?
Answer: Protect the active pharmaceutical ingredient (API) and modify drug release.
182
SBA: Which type of tablet coating is the most popular and involves spraying a liquid polymer-based formulation?
Answer: Film coating.
183
SBA: What is the main purpose of enteric coatings?
Answer: To resist dissolution in the stomach and allow release in the intestines.
184
SBA: Which polymer is commonly used for sustained-release film coatings?
Answer: Ethyl cellulose.
185
SBA: What is the role of plasticizers in film coatings?
Answer: Reduce film brittleness and improve flexibility.
186
SBA: Which type of coating involves successive applications of sucrose-based formulations?
Answer: Sugar coating.
187
SBA: What is the key feature of compression coating?
Answer: Encases a preformed tablet with granular material for modified release.
188
SBA: What is the purpose of colourants in film coatings?
Answer: Enhance appearance, identification, and uniformity.
189
SBA: What is the main environmental concern with using organic solvents in film coatings?
Answer: Contribution to global warming and potential safety hazards.
190
SBA: Which newer coating technology uses low energy and high coating efficiency?
Answer: Vacuum film coating.
191
EMQ: Match the coating type to its purpose.
Film coating: Protects API and modifies release.
Sugar coating: Taste masking and appearance enhancement.
Enteric coating: Prevents stomach irritation by delaying release to the intestine.
192
EMQ: Match the excipient to its role in tablet coating.
Plasticizer: Improves flexibility of the coating.
Colourant: Provides uniform appearance and identification.
Solvent: Dissolves polymers for spray application.
193
EMQ: Match the polymer to its use in coatings.
Hydroxypropyl methylcellulose (HPMC): Immediate-release film coating.
Cellulose acetate phthalate (CAP): Enteric coating.
Ethyl cellulose: Sustained-release coating.
194
EMQ: Match the coating defect to its cause.
Sticking: Over-wetting during spraying.
Chipping: Over-drying of the tablet surface.
Uneven colour: Improper mixing of colourants.
195
EMQ: Match the coating process to its description.
Fluid-bed coating: Combines coating and drying in one step.
Conventional pan coating: Rotating tablet bed with liquid spray.
Compression coating: Encases tablet with granular material.
196
Describe the main types of tablet coatings.
Answer:
Film coating: Polymer-based spray; protects API and modifies release.
Sugar coating: Multi-step process for taste masking and appearance.
Enteric coating: Prevents dissolution in the stomach.
Compression coating: Granular material encases the tablet. (3 marks)
197
What are the key ingredients in film coating formulations?
Answer: Polymers, plasticizers, colourants, and solvents. (2 marks)
198
Explain the role of enteric coatings.
Answer: Protect acid-sensitive drugs, prevent stomach irritation, and deliver API to the intestine. (2 marks)
199
What are common defects in tablet coating, and how are they addressed?
Answer:
Sticking: Adjust spray rate.
Chipping: Optimize drying conditions.
Uneven colour: Improve mixing. (2 marks)
200
What environmental and safety concerns exist with solvent-based coatings?
Answer: Solvents contribute to greenhouse effects and pose flammability risks. Alternatives like water-based coatings are preferred. (1 mark)
201
SBA: What is the primary function of parietal cells in the stomach?
Answer: Secrete hydrochloric acid (HCl) and intrinsic factor for vitamin B12 absorption.
202
SBA: Which phase of digestion involves the brain preparing the stomach for food by stimulating gastric secretions?
Answer: Cephalic phase.
203
SBA: What is the role of gastrin in gastric physiology?
Answer: Stimulates gastric acid secretion and motility.
204
SBA: Which type of diarrhea involves the presence of unabsorbed nutrients pulling water into the gut?
Answer: Osmotic diarrhea.
205
SBA: What is the first-line pharmacological treatment for functional dyspepsia according to NICE guidelines?
Answer: Proton Pump Inhibitors (PPIs).
206
SBA: What is the hallmark feature of gastroparesis?
Answer: Delayed gastric emptying in the absence of mechanical obstruction.
207
Answer: Delayed gastric emptying in the absence of mechanical obstruction.
Answer: Mass movement contractions.
208
SBA: What is the main side effect of stimulant laxatives like bisacodyl?
Answer: Cramping and abdominal pain.
209
SBA: Which neurotransmitter is primarily involved in stimulating gut motility?
Answer: Acetylcholine.
210
SBA: What is the primary diagnostic test for H. pylori in dyspeptic patients?
Answer: Urea breath test.
211
EMQ: Match the GI condition to its primary symptom.
GORD: Heartburn and regurgitation.
Peptic Ulcer Disease: Epigastric pain relieved by eating.
Gastroparesis: Nausea, bloating, and early satiety.
212
EMQ: Match the pharmacological agent to its primary use.
Omeprazole: Reduces gastric acid secretion in GORD.
Domperidone: Improves gastric emptying in gastroparesis.
Bisacodyl: Stimulates bowel movement in constipation.
213
EMQ: Match the reflex to its mechanism.
Defecation reflex: Stretching of the rectal wall stimulates peristalsis.
Gastrocolic reflex: Food in the stomach triggers colon contractions.
Enterogastric reflex: Acid in the duodenum inhibits gastric secretion.
214
EMQ: Match the treatment to the condition.
Antacids: Heartburn relief in GORD.
Prokinetic agents: Delayed gastric emptying in gastroparesis.
Osmotic laxatives: Constipation due to insufficient water retention.
215
EMQ: Match the hormone to its role in digestion.
Secretin: Stimulates bicarbonate release to neutralize stomach acid.
Cholecystokinin (CCK): Stimulates bile and pancreatic enzyme secretion.
Motilin: Coordinates migrating motor complexes during fasting.
216
Outline the structure of the alimentary canal.
Answer: Four layers: mucosa, submucosa, muscularis externa, and serosa. (2 marks)
217
What are the phases of gastric acid secretion regulation?
Answer: Cephalic phase (vagal stimulation), gastric phase (stretch receptors and gastrin), intestinal phase (inhibitory hormones like secretin). (2 marks)
218
Explain the role of the colon in water absorption and motility.
Answer: Absorbs water and electrolytes; uses segmental and mass movements for propulsion. (2 marks)
219
Describe the pharmacological management of dyspepsia.
Answer: First-line therapy is a PPI; if symptoms persist, H. pylori eradication or lifestyle changes (smaller meals, avoiding trigger foods). (2 marks)
220
What are the red flags in GI conditions that necessitate urgent referral?
Answer: Unintentional weight loss, blood in stools, persistent vomiting, difficulty swallowing, and anemia. (2 marks)
221
SBA: What is the role of TPMT (thiopurine methyltransferase) testing before starting thiopurine therapy?
Answer: To identify patients at risk of myelosuppression and adjust dosage accordingly.
222
SBA: What percentage of Caucasians have undetectable TPMT activity?
Answer: 0.3%.
223
SBA: Which gene polymorphism affects the metabolism of PPIs like omeprazole?
Answer: CYP2C19 polymorphism.
224
SBA: How does genetic variation in CYP2C19 affect PPI plasma levels?
Answer: Loss-of-function alleles increase plasma levels, while *17 alleles decrease plasma levels.
225
SBA: Which drug class does azathioprine belong to?
Answer: Immunosuppressants.
226
SBA: What is a potential side effect of azathioprine in patients with low or absent TPMT activity?
Answer: Severe myelosuppression.
227
SBA: Which condition is most commonly associated with the use of azathioprine?
Answer: Inflammatory bowel disease (Crohn’s disease and ulcerative colitis).
228
SBA: What enzyme system metabolizes most PPIs?
Answer: Cytochrome P450 (mainly CYP2C19 and CYP3A4).
229
SBA: Which metabolite is responsible for the active immunosuppressive effects of azathioprine?
Answer: 6-thioguanine nucleotides (6-TGN).
230
SBA: What is the primary genetic test recommended by NICE before azathioprine therapy?
Answer: TPMT activity test.
231
EMQ: Match the enzyme to its role in drug metabolism.
TPMT: Metabolizes thiopurines to inactive metabolites.
CYP2C19: Metabolizes PPIs like omeprazole.
CYP3A4: Metabolizes a broad range of drugs, including azoles.
232
EMQ: Match the pharmacogenomic application to its benefit.
Optimized dosage: Tailoring drug therapy to individual needs.
Avoiding adverse effects: Identifying patients at risk of myelosuppression.
Predicting efficacy: Determining response to PPIs based on CYP2C19.
233
EMQ: Match the drug to its genetic consideration.
Azathioprine: TPMT polymorphism testing required.
Omeprazole: CYP2C19 polymorphism affects metabolism.
Thioguanine: Less commonly used due to severe myelosuppression risks.
234
EMQ: Match the condition to its associated genetic factor.
IBS: Serotonin transporter gene polymorphisms.
IBD: TPMT enzyme activity variations.
GORD: CYP2C19 polymorphisms affecting PPI efficacy.
235
EMQ: Match the drug interaction to its outcome.
Rifampin: Induces CYP2C19, reducing omeprazole plasma levels.
Voriconazole: Inhibits CYP2C19, increasing omeprazole plasma levels.
St John’s Wort: Induces CYP3A4, lowering PPI efficacy.
236
Explain the role of CYP2C19 polymorphisms in PPI therapy.
Answer:
Loss-of-function alleles (*2–*9) increase PPI plasma levels, enhancing efficacy.
*17 alleles lead to rapid drug clearance, reducing efficacy. (2 marks)
237
Why is TPMT testing recommended before starting azathioprine therapy?
Answer: Identifies patients with low or absent TPMT activity who are at risk of severe myelosuppression. (2 marks)
238
What are the clinical implications of genetic testing for thiopurines in IBD management?
Answer:
Adjust doses for patients with reduced enzyme activity.
Use alternative treatments if TPMT activity is undetectable. (2 marks)
239
Describe the role of pharmacogenomics in IBS treatment.
Answer: Variations in serotonin transporter genes (SLC6A4) affect response to serotonergic agents like SSRIs. (2 marks)
240
What are the ethical considerations in implementing pharmacogenomics in clinical practice?
Answer:
Ensuring informed consent and patient privacy.
Addressing cost and accessibility of genetic testing. (2 marks)
241
SBA: What is the most common subtype of IBS according to the Rome IV classification?
Answer: IBS-D (Diarrhoea predominant).
242
SBA: Which laxative should be avoided in IBS due to its gas-producing effects?
Answer: Lactulose.
243
SBA: What is the first-line pharmacological treatment for IBS-C?
Answer: Bulk-forming laxatives (e.g., Ispaghula).
244
SBA: What is the gold standard test to confirm coeliac disease?
Answer: Positive coeliac serology followed by a small intestinal biopsy.
245
SBA: Which drug is used to manage diarrhoea in IBS-D?
Answer: Loperamide.
246
SBA: What is the only effective treatment for coeliac disease?
Answer: A strict gluten-free diet.
247
SBA: What is the primary mechanism of action of Linaclotide in IBS?
Answer: Increases fluid secretion and promotes stool passage.
248
SBA: What is the hallmark symptom of diverticulitis?
Answer: Severe abdominal pain, usually in the lower left quadrant.
249
SBA: Which antidepressant class is used off-label to manage pain in IBS?
Answer: Tricyclic antidepressants (e.g., Amitriptyline).
250
SBA: What dietary advice is recommended for patients with diverticular disease?
Answer: High-fibre diet, increased fluid intake, and regular exercise.
251
EMQ: Match the condition to its primary diagnostic test.
IBS: Diagnosis of exclusion based on Rome IV criteria.
Coeliac disease: Coeliac serology and intestinal biopsy.
Diverticular disease: CT scan if complications suspected.
252
EMQ: Match the drug to its primary use.
Linaclotide: Severe IBS-C unresponsive to other laxatives.
Loperamide: Diarrhoea in IBS-D.
Alverine citrate: Abdominal pain or spasm in IBS.
253
EMQ: Match the GI disorder to its symptom.
IBS: Abdominal bloating and alternating stool frequency.
Diverticulitis: Fever, rectal bleeding, and severe LLQ pain.
Coeliac disease: Steatorrhoea, weight loss, and fatigue.
254
EMQ: Match the treatment to its associated precaution.
Loperamide: Avoid in acute UC or conditions inhibiting peristalsis.
Lactulose: Avoid in IBS due to gas production.
Linaclotide: Contraindicated in GI obstruction or pregnancy.
255
EMQ: Match the management approach to the condition.
IBS: Diet and lifestyle changes; avoid trigger foods.
Coeliac disease: Strict gluten-free diet and nutritional monitoring.
Diverticulitis: Oral antibiotics (e.g., co-amoxiclav) for uncomplicated cases.
256
Outline the pharmacological and non-pharmacological management of IBS.
Answer:
Non-pharmacological: Diet and lifestyle changes, low-FODMAP diet, stress management.
Pharmacological:
IBS-C: Bulk-forming laxatives, Linaclotide if refractory.
IBS-D: Loperamide, antispasmodics (e.g., Mebeverine).
Pain: Tricyclic antidepressants. (3 marks)
257
What are the steps in diagnosing coeliac disease?
Answer:
Persistent unexplained GI symptoms.
Coeliac serology: Check for IgA tTG and total IgA levels.
Small intestinal biopsy if serology positive. (2 marks)
258
How is diverticular disease managed in uncomplicated cases?
Answer:
High-fibre diet and fluids.
Avoid NSAIDs and opioids.
Bulk-forming laxatives for symptom control. (2 marks)
259
What red flags in IBS warrant further investigation?
Answer:
Unexplained weight loss, rectal bleeding, anemia, persistent vomiting, or family history of bowel cancer. (2 marks)
260
What is the NICE-recommended management for diverticulitis?
Answer:
Mild: Oral antibiotics like co-amoxiclav, fluids, and rest.
Severe or complicated: Hospital admission and IV antibiotics. (1 mark)
261
SBA: What is the hallmark histological feature of Crohn's disease?
Answer: Skip lesions and transmural inflammation.
262
SBA: What is the hallmark histological feature of ulcerative colitis?
Answer: Continuous mucosal inflammation starting from the rectum.
263
SBA: What is a potential life-threatening complication of ulcerative colitis?
Answer: Toxic megacolon.
264
SBA: Which test is used to differentiate between inflammatory bowel disease and irritable bowel syndrome?
Answer: Faecal calprotectin.
265
SBA: What is the first-line treatment for mild to moderate ulcerative colitis?
Answer: Aminosalicylates (e.g., mesalazine).
266
SBA: What is the recommended management for severe Crohn’s disease not responsive to corticosteroids?
Answer: Biologics (e.g., infliximab or adalimumab).
267
SBA: Which extra-intestinal symptom is more common in Crohn's disease than ulcerative colitis?
Answer: Erythema nodosum.
268
SBA: What is the key risk factor for developing Crohn's disease?
Answer: Smoking.
269
SBA: Which thiopurine metabolizing enzyme should be tested before starting azathioprine in IBD patients?
Answer: Thiopurine methyltransferase (TPMT).
270
SBA: What is the recommended treatment for maintaining remission in Crohn's disease after surgical resection?
Answer: Azathioprine and 3 months of metronidazole.
271
EMQ: Match the IBD subtype to its key feature.
Ulcerative colitis: Limited to the colon and rectum.
Crohn’s disease: Can affect any part of the GI tract.
Both: Associated with increased colorectal cancer risk.
272
EMQ: Match the complication to its IBD subtype.
Toxic megacolon: Ulcerative colitis.
Fistula formation: Crohn’s disease.
Pyoderma gangrenosum: More common in Crohn’s disease.
273
EMQ: Match the treatment to its indication.
Aminosalicylates: Mild to moderate ulcerative colitis.
Corticosteroids: Acute exacerbation of IBD.
Biologics: Severe or refractory IBD.
274
EMQ: Match the test to its purpose.
Colonoscopy: Diagnosing IBD and assessing severity.
Faecal calprotectin: Differentiates IBD from IBS.
TPMT testing: Assessing suitability for azathioprine.
275
EMQ: Match the drug to its primary side effect.
Azathioprine: Bone marrow suppression.
Corticosteroids: Cushing’s syndrome and weight gain.
Biologics: Increased infection risk.
276
Describe the key symptoms of ulcerative colitis and Crohn’s disease.
Answer:
UC: Bloody diarrhoea, tenesmus, left lower quadrant pain.
CD: Abdominal pain, non-bloody diarrhoea, weight loss, perianal disease. (2 marks)
277
What diagnostic tests are used to confirm IBD?
Answer:
Faecal calprotectin, colonoscopy with biopsy, imaging (CT/MRI for Crohn’s disease). (2 marks)
278
Outline the first-line treatments for mild to moderate UC and CD.
Answer:
UC: Aminosalicylates (e.g., mesalazine).
CD: Budesonide or glucocorticoids. (2 marks)
279
What are the common extra-intestinal manifestations of IBD?
Answer: Arthritis, erythema nodosum, uveitis, pyoderma gangrenosum. (2
280
What is the recommended management for severe IBD?
Answer:
Corticosteroids, biologics (e.g., infliximab), or surgery for complications. (2 marks)
281
SBA: What is the most common cause of acute diarrhoea in adults?
Answer: Viral gastroenteritis.
282
SBA: What is the first-line treatment for cholestatic pruritus?
Answer: Colestyramine.
283
SBA: Which laxative class is first-line for constipation in pregnancy?
Answer: Bulk-forming laxatives (e.g., Ispaghula husk).
284
SBA: What is the gold standard treatment for symptomatic gallstones?
Answer: Laparoscopic cholecystectomy.
285
SBA: Which dietary supplement is recommended alongside orlistat therapy to prevent deficiencies?
Answer: Vitamin and mineral supplements.
286
SBA: What is the primary pharmacological treatment for acute anal fissures?
Answer: Bulk-forming laxatives.
287
SBA: What is the mechanism of action of lactulose in constipation?
Answer: Osmotic effect increases water content in stools and decreases ammonia-producing organisms.
288
SBA: What is the recommended non-drug management for haemorrhoids?
Answer: Increase dietary fibre and fluid intake.
289
SBA: Which pancreatic enzyme replacement therapy is used in exocrine pancreatic insufficiency?
Answer: Pancreatin (lipase, amylase, protease).
290
SBA: Which drug is used to manage severe pain in biliary colic if NSAIDs are contraindicated?
Answer: Intramuscular opioid (e.g., morphine).
291
EMQ: Match the GI condition to its primary treatment.
Cholestasis: Colestyramine.
Gallstones: Laparoscopic cholecystectomy.
Exocrine pancreatic insufficiency: Pancreatic enzyme replacement therapy.
292
EMQ: Match the laxative to its mechanism of action.
Bulk-forming: Absorbs water to form a gel-like mass.
Stimulant: Increases intestinal motility.
Osmotic: Draws water into the bowel lumen.
293
EMQ: Match the drug to its precaution.
Orlistat: Avoid in pregnancy; monitor fat-soluble vitamin levels.
Lactulose: Avoid in patients with galactose intolerance.
Senna: Avoid near term in pregnancy.
294
EMQ: Match the symptom to its GI condition.
Pruritus, jaundice, pale stools: Cholestasis.
Diarrhoea, steatorrhoea: Exocrine pancreatic insufficiency.
Severe LLQ pain: Diverticulitis.
295
EMQ: Match the complication to its cause.
Toxic megacolon: Ulcerative colitis.
Gallstone pancreatitis: Gallstones obstructing the bile duct.
Anal fissures: Chronic constipation.
296
Describe the primary treatment goals for acute diarrhoea.
Answer: Prevent dehydration, restore fluid and electrolyte balance, and manage symptoms (e.g., loperamide for rapid control). (2 marks)
297
What are the pharmacological options for constipation?
Answer:
Bulk-forming laxatives for first-line treatment.
Osmotic laxatives (e.g., lactulose) if stools remain hard.
Stimulant laxatives (e.g., bisacodyl) for inadequate emptying. (2 marks)
298
Outline the non-drug management for gallstones.
Answer: Dietary adjustments (low-fat meals), pain management (e.g., paracetamol), and monitoring for complications. (2 marks)
299
What are the complications of untreated symptomatic gallstones?
Answer: Biliary colic, acute cholecystitis, pancreatitis, and obstructive jaundice. (2 marks)
300
How is colestyramine used in cholestatic pruritus?
Answer: Binds bile acids in the intestine to form an insoluble complex, reducing serum bile acid levels and pruritus. (2 marks)
301
SBA: What is the primary advantage of capsules over tablets?
Answer: Easier to swallow due to their smooth and slippery surface.
302
SBA: What is the main material used in hard gelatin capsule shells?
Answer: Gelatin derived from animal bones and hides.
303
SBA: Which type of capsule is typically used for hygroscopic drugs?
Answer: HPMC (vegetarian) capsules.
304
SBA: What is the key difference between hard and soft capsules?
Answer: Hard capsules consist of two parts (cap and body), while soft capsules are one-piece and hermetically sealed.
305
SBA: What is a common issue with hydrophobic drug particles in hard gelatin capsules?
Answer: Slow dissolution due to poor penetration of GI fluids.
306
SBA: What is the primary advantage of suppositories in drug delivery?
Answer: They bypass first-pass metabolism and are useful when oral administration is not possible.
307
SBA: Which condition is commonly treated with rectal suppositories containing 5-aminosalicylic acid?
Answer: Ulcerative colitis.
308
SBA: What is the key quality control concern in suppository manufacturing?
Answer: Ensuring uniform drug dispersion in each unit.
309
SBA: What type of base is used in suppositories that dissolve in the rectum?
Answer: Water-soluble bases such as polyethylene glycol (PEG).
310
SBA: Which of the following is a common reason for a suppository breaking during manufacture?
Answer: Poured at too high a temperature.
311
EMQ: Match the capsule type to its characteristic.
Hard gelatin capsules: Two-piece shells; suitable for powders and granules.
Soft gelatin capsules: One-piece shell; suitable for liquids or oils.
HPMC capsules: Vegetarian, suitable for moisture-sensitive drugs.
312
EMQ: Match the capsule excipient to its function.
Plasticizers (e.g., glycerol): Increase flexibility of the capsule shell.
Colourants: Aid in product identification and appearance.
Hydrophilic diluents: Improve dissolution of hydrophobic drugs.
313
EMQ: Match the suppository application to its benefit.
Local effect (e.g., haemorrhoids): Direct action at the application site.
Systemic effect (e.g., pain relief): Bypasses first-pass metabolism.
Prolonged effect (e.g., night pain relief): Slow drug release over time.
314
EMQ: Match the manufacturing issue to its cause.
Broken suppository: Poured at too high a temperature.
Uneven drug distribution: Insufficient stirring during mixing.
Sticking to the mould: Inadequate lubricant application.
315
EMQ: Match the quality test to its purpose.
Dissolution test: Ensures drug release in simulated GI conditions.
Weight variation: Confirms uniformity between units.
Content uniformity: Verifies consistent drug dosage.
316
What are the advantages of capsules over tablets?
Answer: Easier to swallow, tasteless, can contain multiple dosage forms (e.g., granules, liquids), and allow modified drug release. (2 marks)
317
Explain the differences between hard and soft capsules.
Answer:
Hard capsules: Two-piece shells, used for powders or granules.
Soft capsules: Single-piece shells, used for liquids or oily drugs. (2 marks)
318
What are the key quality control tests for capsules?
Answer: Dissolution, content uniformity, weight variation, and visual inspection. (2 marks)
319
Describe the advantages of suppositories in drug delivery.
Answer: Bypass first-pass metabolism, suitable for patients with nausea/vomiting, and provide both local and systemic effects. (2 marks)
320
What are the common issues in suppository manufacturing, and how can they be resolved?
Answer:
Broken suppositories: Avoid overheating during pouring.
Sticking: Proper application of lubricant to the mould.
Uneven drug distribution: Ensure continuous stirring during mixing. (2 marks)
321
SBA: What is the primary mechanism of action of proton pump inhibitors (PPIs)?
Answer: Inhibit H+/K+-ATPase in parietal cells to reduce gastric acid secretion.
322
SBA: What is the key use of antacids in GI disorders?
Answer: Neutralize stomach acid to relieve symptoms of heartburn and indigestion.
323
SBA: Which receptor is targeted by H2 receptor antagonists?
Answer: Histamine H2 receptors on parietal cells.
324
SBA: What is the primary mechanism of action of promotility agents like domperidone?
Answer: Enhance acetylcholine activity to increase GI motility.
325
SBA: What is the first-line treatment for ulcerative colitis with mild-to-moderate disease?
Answer: Aminosalicylates (e.g., mesalazine).
326
SBA: Which enzyme activates prodrugs like azathioprine in the treatment of IBD?
Answer: Thiopurine methyltransferase (TPMT).
327
SBA: What is the mechanism of action of loperamide in managing diarrhoea?
Answer: Binds to opioid receptors in the gut to decrease motility.
328
SBA: What is the primary purpose of using water-soluble bases in suppositories?
Answer: Facilitate dissolution in rectal fluids for drug absorption.
329
SBA: Which component in antidiarrhoeals like atropine acts as an anticholinergic?
Answer: Atropine blocks acetylcholine receptors to reduce GI motility.
330
SBA: What is the role of azoreductase in the activation of aminosalicylate prodrugs?
Answer: Cleaves azo bonds to release active 5-ASA in the colon.
331
EMQ: Match the drug to its primary indication.
Omeprazole: Peptic ulcers and GORD.
Mesalazine: Ulcerative colitis.
Loperamide: Acute non-infectious diarrhoea.
332
EMQ: Match the mechanism to the drug class.
Antacids: Neutralize gastric acid.
PPIs: Inhibit H+/K+-ATPase.
Promotility agents: Increase acetylcholine activity in GI smooth muscle.
333
EMQ: Match the drug to its mechanism of action.
Loperamide: Opioid receptor agonist in the gut.
Domperidone: D2 receptor antagonist.
Scopolamine: Blocks muscarinic acetylcholine receptors.
334
EMQ: Match the treatment to the GI condition.
Aminosalicylates: First-line for mild to moderate ulcerative colitis.
PPIs: Severe GORD or peptic ulcers.
Antibiotics (e.g., metronidazole): Bacterial overgrowth or anaerobic infections.
335
EMQ: Match the drug to its side effect.
Loperamide: Constipation.
PPIs: Hypomagnesemia.
Aminosalicylates: Nephrotoxicity.
336
What are the key drugs used in managing acid-peptic diseases?
Answer: PPIs (e.g., omeprazole), H2 receptor antagonists (e.g., ranitidine), and antacids. (2 marks)
337
Outline the mechanism and use of promotility agents.
Answer: Enhance acetylcholine activity or block inhibitory neurotransmitters to treat gastroparesis and constipation. Examples: Domperidone, metoclopramide. (2 marks)
338
What is the primary use of aminosalicylates in GI disease?
Answer: Treat mild-to-moderate ulcerative colitis by reducing inflammation in the colon. (2 marks)
339
What are the mechanisms of action of antidiarrhoeals?
Answer:
Opioid receptor agonists (e.g., loperamide): Slow gut motility.
Anticholinergics (e.g., atropine): Reduce intestinal secretions and motility. (2 marks)
340
What are the key differences between hard and soft gelatin capsules?
Answer: Hard capsules: Two-piece structure for powders/granules. Soft capsules: Single-piece, suitable for liquids/oils. (2 marks)
341
SBA: What is the primary purpose of using protecting groups in drug synthesis?
Answer: To prevent unwanted side reactions and ensure chemoselectivity.
342
SBA: What is a common protecting group for alcohols?
Answer: Silyl ethers (e.g., TBS, TBDMS).
343
SBA: Which reagent is commonly used for the deprotection of benzyl ethers?
Answer: Hydrogenation with H₂ and Pd/C.
344
SBA: Why are acetals commonly used to protect aldehydes and ketones?
Answer: They are stable under basic conditions and easily removed by acid hydrolysis.
345
SBA: What is the preferred protecting group for primary amines in peptide synthesis?
Answer: Boc (tert-butyloxycarbonyl).
346
SBA: What is the mechanism of protection for carboxylic acids using esters?
Answer: Conversion into less reactive esters to block electrophilicity.
347
SBA: Which condition can deprotect carbamates like Boc?
Answer: Strong acids, such as HCl or TFA.
348
SBA: What type of prodrug improves water solubility of a poorly soluble drug?
Answer: Carrier prodrug with a hydrophilic group.
349
SBA: What is a key advantage of using Fmoc over Boc as a protecting group?
Answer: Fmoc is removed under basic conditions, avoiding acid-sensitive reactions.
350
SBA: Which prodrug strategy can minimize GI bleeding caused by aspirin?
Answer: Esterification of aspirin into a prodrug form like acetylsalicylic acid.
351
EMQ: Match the protecting group to its functional group.
Alcohols: Silyl ethers (e.g., TBDMS).
Aldehydes/Ketones: Acetals/Ketals.
Amines: Carbamates (e.g., Boc, Fmoc).
352
EMQ: Match the deprotection method to the protecting group.
Boc: Strong acids like HCl or TFA.
Fmoc: Basic conditions (piperidine).
Benzyl ethers: Hydrogenation with H₂ and Pd/C.
353
EMQ: Match the prodrug to its purpose.
Lipophilic carriers: Improve BBB penetration (e.g., for CNS drugs).
Ester prodrugs: Increase water solubility (e.g., enalapril).
Antibody-directed enzyme prodrug therapy: Target cancer cells.
354
EMQ: Match the protecting group to its challenge.
Silyl ethers: Require specific reagents for removal (e.g., TBAF).
Acetals: Susceptible to acidic hydrolysis.
Carbamates: May require strong acids for deprotection.
355
EMQ: Match the drug alliance to its mechanism.
Clavulanic acid: Inhibits β-lactamase to protect penicillins.
Ritonavir: Inhibits CYP3A4 to enhance lopinavir levels.
Adrenaline with procaine: Constriction of blood vessels to localize action.
356
Why are protecting groups used in drug synthesis?
Answer: To prevent undesired reactions, guide chemoselectivity, and improve reaction yields. (2 marks)
357
List examples of protecting groups for alcohols, aldehydes, and amines.
Answer:
Alcohols: Silyl ethers, acetals.
Aldehydes/Ketones: Acetals/Ketals.
Amines: Carbamates (e.g., Boc, Fmoc). (2 marks)
358
Describe the deprotection conditions for Boc and Fmoc groups.
Answer:
Boc: Strong acids like HCl or TFA.
Fmoc: Basic conditions like piperidine. (2 marks)
359
What are prodrugs, and what are their uses?
Answer: Inactive compounds converted into active drugs in the body. Used to improve solubility, stability, absorption, or reduce toxicity. (2 marks)
360
Provide an example of a drug alliance and its mechanism.
Answer: Clavulanic acid protects penicillins by inhibiting β-lactamase enzymes. (2 marks)
Pharmacy - Year 2
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