Pharmacology

Q1Tom is observed for 6hr at the hospital emergency department, and is discharged with a prescription for inhaled budesonide. This drug has been trialed as a means of preventing relapse of

acute asthma following hospital emergency department discharge (see Rowe BH, et al. Inhaled Budesonide in Addition to Oral Corticosteroids to Prevent Asthma Relapse Following Discharge

From the Emergency Department: A Randomized Controlled Trial. JAMA. 1999;281(22):2119-2126).
Based on the results of this study, what is the number needed to treat for budesonide?
Answer:

Q2Describe the specific meaning of the NNT value you have just calculated (maximum of 50 words).

Q2Following a short stay in hospital, Robert is discharged with a number of new medications including an anti-platelet drug called prasugrel. It is common to use dual anti-platelet therapy for at

least 6 months following a myocardial infarction in order to reduce the risk of a second myocardial infarction. For many years a combination of aspirin and clopidogrel has been used for this

purpose. However, the use of a newer anti-platelet drug prasugrel in place of clopidogrel is now being considered.

Over 12 months, it is expected that prasugrel will cost $407 more per person treated than clopidogrel. It is estimated that if prasugrel is used a person will have 13.325 QALYs on average,

whereas if clopidogrel is used a person will have 13.300 QALYs on average. QALYs are a measure of life expectancy that has been adjusted for quality of life.

What is the incremental cost-effectiveness ratio of prasugrel? (i.e. cost per QALY)
Answer:

Question text
Ipilimumab is a new targeted therapy for metastatic melanoma and is also being considered for addition to Robert’s hospital’s formulary. It has been estimated that the incremental cost-

effectiveness of ipilimumab is $100,000 per QALY.

If there is only enough funding to add either prasugrel or ipilimumab to the formulary, which would you choose solely on the basis of cost-effectiveness? Explain your reasoning (maximum of 100

words)

Q3 Selectivity
Adrenoceptor agonists may be used in the pre-hospital setting for the treatment of a number of cardiovascular and respiratory conditions including cardiac arrest and acute asthma.
Question:
Concisely explain how the receptor selectivity of adrenoceptor agonists impacts on the therapeutic efficacy of these drugs and contributes to the potential for adverse effects caused by these

drugs (maximum of 200 words).

Q4 Drug – Target Interactions
A novel allosteric modulator that activates the enzyme phosphodiesterase-5 is currently under development as a pre-hospital treatment for severe acute hypotension.

Question:
Discuss the theoretical molecular interactions and clinical consequences that would result from co-administering this drug to an individual currently being treated in the community with an

organic nitrate such as isosorbide mononitrate and hypothesis a pre-hospital indication where it would be appropriate to administer the new drug to an individual being treated with isosorbide

mononitrate. (maximum 150 words

Q5 ORGANOPHOSPHOROUS EXPOSURE
Geoffrey is the proprietor of a restaurant in Victoria Square. In an attempt to eradicate a recent cockroach infestation he closes the restaurant for fumigation by an ‘unauthorised’ pest control

agent. Geoffrey is advised not to enter the restaurant for 24 hours post fumigation. Geoffrey soon realises he has left the weeks takings in the restaurant safe and enters the restaurant 2 hours

after the fumigation process. Ten minutes after entering the restaurant Geoffrey develops the following signs and symptoms: bradycardia, salivation, profuse sweating, watery eyes, blurred

vision, wheezing and breathlessness, diarrhea, and skeletal muscle twitching and convulsions.

Question:
a). Identify the mechanism by which high-dose organophosphate’s cause toxicity in humans and briefly discuss how TWO of Geoffrey’s symptoms are linked to the pharmacological properties of

organophosphates. (Maximum 150 words)

FOLLOW-UP
A passer-by notices that Geoffrey is in distress and calls 000. As the attending paramedic, you administers oxygen to maintain Geoffrey’s airway, midazolam (5 mg IV) to control Geoffrey’s

convulsions, and atropine (2 mg IM) repeated every 5 minutes for 20 minutes.

Question:
b). Briefly discuss the mechanism of action of atropine and identify why repeated dosing is required for a 20 minute duration. (Maximum 50 words)

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