Case Study 1 (5 marks total) A hypothetical medication, called MedG, contains 200 mg of its active ingredient in an intestinesolvent capsule. The active ingredient is effectively transported across the intestinal mucosa, and therefore 85% of the ingested drug is absorbed and enters the portal circulation. The drug undergoes first-pass metabolism, in which process 55% of the drug passing through the liver gets metabolized and degraded into an inactive product. Question 1/1 Calculate MedG’s bioavailability and show your calculations. (2 marks) Once reaching the plasma, MedG is transported in a protein-bound form. Although the active ingredient has a high affinity to plasma albumin, its ability (i.e., affinity) to bind is not as high as that of a different drug, called MedA. Question 1/2 Explain what happens to the plasma concentration of the unbound fraction of MedG when administered together with MedA and provide your rationale. (2 marks) Question 1/3 Name the type of drug interaction that has occurred between MedG and MedA and provide your rationale. (1 mark) BIOL122 End-of-semester worksheet Semester 1, XXXXXXXXXXCase Study 2 (5 marks total) Sharon, a 72-year-old retired social worker, presents to the emergency room after falling in her home. She slipped in her kitchen and was unable to get up after her fall. Fortunately, her neighbour popped over for a cup of tea they previously arranged and found her on the floor. Sharon now experiences excruciating hip pain. On examination, she has bruising over her left hip. Range of motion in the left hip is greatly decreased, and the pain she experiences intensifies on rotation in either direction. An X-ray analysis reveals a hip fracture and probable low bone mass. Her history raises concern about osteoporosis. Question 2/1 Describe the most likely aetiology and pathogenesis of Sharon’s osteoporosis. (2 marks) Question 2/2 Explain how Sharon’s osteoporosis may have contributed to her present hip fracture. (1 mark) Question 2/3 Sharon is concerned that her daughter and granddaughter may also develop osteoporosis, and she asks for your advice. Describe possible strategies that might help prevent the development of osteoporosis. (2 marks) BIOL122 End-of-semester worksheet Semester 1, XXXXXXXXXXCase Study 3 (15 marks total) Chantal is a mildly obese, 65-year-old, retired nurse, who presents to the clinic to establish care. Her past medical history is notable for type 2 diabetes and hyperlipidaemia. In addition, she has a strong smoking history. Her father had suffered from hypertension for 20 years and eventually died of prostate cancer at the age of 72 years. Her mother, on the other hand, had dementia, which was first noticeable at the age of 65 years, and then she died as the result of stroke at the age of 78 years. A few weeks ago, Chantal was tidying up her little court and driveway, and she had to stop due to an awkward tightness in her chest. Fortunately, the pain did not last long and quickly disappeared when she stopped her physical activity. Chantal had been aware of her less-than-ideal lifestyle, and she was seriously considering starting some sort of physical exercise, but she could not adhere to this change as she felt out of breath soon after she commenced even the mildest of physical activity. Chantal wanted to find out what was going on with her, and therefore she arranged an appointment with her GP, who then referred her to a cardiologist. The cardiologist performed a thorough clinical examination, which revealed that Chantal had severe atherosclerosis affecting her coronary system, common carotid arteries, and main cerebral arteries. Question 3/1 Name all the risk factors from Chantal’s case that may have contributed to her advanced atherosclerosis. (2 marks) A medical student, who is completing their placement at the cardiology ward Chantal has been admitted to, diagnoses unstable (crescendo) angina, and recommends glyceryl trinitrate (GTN) for the treatment of this condition. Question 3/2 State if you agree with the medical student’s diagnosis and provide your rationale. (2 marks) Question 3/3 Explain the mechanism of action and significance of glyceryl trinitrate in the treatment of angina. (6 marks) Chantal is now under the care of her GP, who sees her on a regular basis to ensure that her atherosclerosis does not get worse. As part of these visits, Chantal’s blood pressure is regularly checked. Although her blood pressure has been in the acceptable range and has not posed additional concerns, today is different as a blood pressure of 170/90 mmHg is registered. Question 3/4 Discuss the implications of Chantal’s current blood pressure reading. (2 marks) Question 3/5 Describe the connection between hypertension and atherosclerosis. (2 marks) BIOL122 End-of-semester worksheet Semester 1, XXXXXXXXXXChantal has done a bit of a research into her hypertension and found an interesting piece of information on the website of an influencer who considers themselves as a health expert. The influencer published the following statement: ‘Beta receptor agonists cause smooth muscle relaxation and therefore induce systemic vasodilation. Systemic vasodilation, in turn, decreases total peripheral resistance and therefore reduces blood pressure.’ Before trying to take beta receptor agonists for her hypertension, however, Chantal asks you if you agree with the above statement. Question 3/6 State if you agree with the influencer’s statement and give your rationale. (1 mark) BIOL122 End-of-semester worksheet Semester 1, XXXXXXXXXXCase Study 4 (10 marks total) Sabrina is a 40-year-old, mildly obese woman, who is 28 weeks pregnant with her first child. On her 28-week routine pre-natal check-up, she is informed that she has gestational diabetes. She does not have a history of diabetes, and none of her known relatives ever suffered from diabetes, and therefore she is stunned by this news. In fact, she has not had any noteworthy symptoms apart from feeling a little thirstier than usual and having to urinate more frequently, which she assumed were normal parts of her pregnancy. The doctor has referred Sabrina to a dietician, put her on a healthy eating plan, has suggested light but regular exercise, and has told her they need to monitor her blood glucose levels for the remainder of the pregnancy. Five years after the successful birth of her beautiful baby girl, Chloe, Sabrina has noticed that her skin and mouth are regularly feeling dry, and her water intake has increased excessively. She is also urinating more frequently. She feels tired and lethargic most days and is starting to experience dizzy spells and blurred vision. She went to her doctor, who, after conducting appropriate tests, diagnosed her with type II diabetes. The GP suggested lifestyle changes, a healthier diet, more exercise, and prescribed metformin to help her manage her condition. Unfortunately, Sabrina has had difficulty maintaining the recommended changes to her diet and engage with regular physical exercise. Further, despite taking the prescribed metformin regularly, she is now experiencing several complications related to her diabetes. More specifically, her blurry vision has been getting more severe, she is experiencing numbness and tingling in her feet that makes it difficult to walk, and she is frequently experiencing urinary tract and skin infections. Sabrina is so disturbed by these complications that she returns to her doctor, who reviews and updates her management plan. Her doctor also prescribes insulin and informs Sabrina on its appropriate administration and dosages. Question 4/1 Discuss the link between Sabrina’s excess weight during her pregnancy and her gestational diabetes-related hyperglycaemia. For full marks, your answer should clearly address the pathophysiology of Sabrina’s gestational diabetes. (4 marks) Question 4/2 Discuss the link between Sabrina’s type II diabetes mellitus and her visual impairment (i.e., development of blurry vision). (4 marks) Question 4/3 Explain the doctor’s most likely rationale for prescribing insulin to help Sabrina manage her type II diabetes. For full marks, your answer should address the mechanism of action of insulin. (2 marks) BIOL122 End-of-semester worksheet Semester 1, XXXXXXXXXXCase Study 5 (10 marks total) Jack is a 26-year-old student, who was diagnosed with asthma at the age of 18. He is otherwise healthy and does not have any other known medical conditions. He works as a part-time delivery driver and has a moderate level of physical activity. Jack reports having symptoms of wheezing, shortness of breath, and chest tightness, which are particularly severe before and during thunderstorms. He also reports frequent night-time awakenings due to symptoms such as severe and exhausting cough. For the past three years, Jack has been using his Ventolin inhaler rather often. When consulting with his GP, Jacks reports on all of his symptoms; including persistent but nonproductive cough, wheezing, and breathing difficulties, which are particularly prominent during inhalation. As Jack explains, he feels like somebody is sitting on his chest, and he cannot take in as much air as he would need. His expiration, on the other hand, appears to be only mildly affected. After listening to Jack’s explanation, and considering his worsening condition, his GP has suggested that Jack should also use Salmeterol to better manage his asthma. Question 5/1 By reflecting on the pharmacodynamic properties of Salmeterol, discuss how administration of this drug would benefit Jack. (4 marks) Question 5/2 Based on your learning in Week 10 of Semester 1 2023, identify the sign or symptom in Jack’s case that is not typically present in patients suffering from an asthma attack and provide your rationale. (2 marks) During a particularly intense asthma attack, Jack could not find his inhaler and felt his condition was rapidly deteriorating. He noticed that his usual loud wheezing that always accompanied his acute asthma attacks was hardly audible. He did not understand what was happening as previously the disappearance of his wheezing always indicated that the asthma attack was almost over. However, on this occasion it felt much different, like something was seriously wrong. Jack started to panic. Question 5/3 Name the condition Jack most likely developed, explain the mechanism that most likely led to the disappearance of Jack’s wheezing, and describe the consequence of the condition. (3 marks) Jack’s partner noticed his ongoing asthma attack and found his inhaler, which then helped Jack manage this scary experience. Jack noted that he had developed tachycardia during his asthma attack, and his tachycardia got even more severe after he used his inhaler. Question 5/4 Explain the mechanism by which (i) Jack’s asthma attack and (ii) his inhaler administration caused tachycardia. (1 mark) BIOL122 End-of-semester worksheet Semester 1, XXXXXXXXXXCase Study 6 (5 marks total) John, a 70-year-old retired physician, was escorted to the emergency department by his wife, Dora, due to a serious fall that had occurred an hour ago. On admission, John was unable to remember how he ended up in the hospital and failed to provide any relevant medical history of his own. Dora explained to the attending specialist that, over the last couple of years, John had slowly lost interest in many things he once enjoyed, developed a profound difficulty in communication, found it difficult to find the right words, and forgot things far too often. Even more disturbingly, although he had always been a kind and caring person, especially towards her, he became aggressive and demonstrated frequent mood swings. In addition, there have been problems with John’s ability to maintain balance: he seemed to lose balance and even fall way more often than a couple of years ago. The attending specialist took care of the wound associated with the fall and referred John to a neurologist specialist. As part of the general examination pertaining to John’s recently developed forgetfulness and communication difficulties, the neurologist ordered a magnetic resonance imaging (MRI) scan of John’s brain, which revealed moderate-to-severe generalized cortical atrophy and profoundly enlarged lateral ventricles. After completing further physical, neurological, and cognitive tests, the neurologist prescribed donepezil (5 mg/day) for John. He also advised Dora that the medication was not expected to reverse John’s condition or to cure his disease but would hopefully slow down its further progress. Question 6/1 Name the condition John most likely suffers from and provide your rationale. (2 marks) Question 6/2 Explain why, in your opinion, donepezil may benefit John. (1 mark) To Dora’s relief, donepezil did, indeed, help in slowing down the progression of John’s disease, and he became more manageable since the start of the therapy. However, Dora has noticed that John’s skeletal muscles became rather stiff since starting to take donepezil; even muscle cramps developed on a couple of occasions. Dora wonders whether the increased muscle tone and occasional cramps might be occurring as the consequence of him taking this medication. Question 6/3 Considering the pharmacodynamic properties of donepezil, discuss if the effects Dora referred to (i.e., increased muscle tone and occasional cramps) should be considered adverse drug reactions, and if so, which type. (2 marks) BIOL122 End-of-semester worksheet Semester 1, XXXXXXXXXXCase Study 7 (10 marks total) Camille is a 28-year-old woman, who recently married her partner of 6 years, Blake, and they are wanting to start a family. Camille decides to visit her GP to discuss stopping her oral contraceptives and whether it is a good idea to take vitamins prior to conception. The GP performs a number of exams and checks, including measuring Camille’s blood pressure, HBA1c level, screening for STIs, a Pap smear, and breast examination. During the examination, the GP notices a lump in Camille’s left breast and therefore refers her for further testing, including an ultrasound examination and a mammogram. Unfortunately for Camille, these tests detect a circular lump with 2 cm in diameter in her left breast. Upon receiving the results, the doctor refers Camille to an oncologist. As part of the referral, the GP takes notes on Camille’s reproductive history including the following points: • Camille had her first period when she was 10. • She started oral contraceptives at the age of 14 to help regulate her period and lessen her period pain. • She has not been pregnant. • She has no known family history of breast cancer. Camille has a nervous 3-week wait to see the oncologist, and when she finally has her appointment, the oncologist sends her for a new ultrasound scan to see if there are any changes. Camille’s oncologist informs her that the abnormal growth has considerably increased in size and is now more than 5 cm in diameter. The oncologist advises Camille to undergo surgery, and after discussing Camille’s interest in starting a family and breastfeeding, it is decided that she will have a unilateral mastectomy. During surgery, changes in nearby lymph nodes are noted, and therefore it is decided that three lymph nodes that are closest to the left breast are also removed. Both the excised part of the breast tissue and all three lymph nodes are sent for histology, with the following results noted: • Invasive lobular carcinoma with marked anaplasia • Metastatic breast cancer cells are present in the first two lymph nodes, but the third was spared • The cancer cells express both oestrogen and progesterone receptors A whole-body PET-scan is also performed, which indicates the presence of tumour cells in Camille’s thoracic vertebrae and in her left lung. When the histology and PET results become available, the oncologist discusses the treatment options with Camille. Question 7/1 In her second ultrasound, the oncologist noticed signs of angiogenesis. Define angiogenesis and explain its significance in Camille’s case of breast cancer. (4 marks) BIOL122 End-of-semester worksheet Semester 1, XXXXXXXXXXQuestion 7/2 Discuss one potential treatment option for Camille after her surgery. In your answer you should 1. Provide a rationale for your chosen therapy; 2. Briefly describe the mechanism of action of the chosen intervention; 3. Explain its most likely adverse effects; and 4. Summarise any other considerations the patient needs to know. Your answer must be specific to Camille’s situation. (4 marks) After her surgery and further therapy, all goes well for Camille. However, she can’t help but notice that her entire left arm is much swollen, and her skin feels rather itchy and appears to be thicker than on the other arm. She is convinced that her swollen left arm may be related to the surgery she has undergone after the diagnosis of her breast cancer. Question 7/3 Discuss if Camille’s swollen left arm may, indeed, be the consequence of her mastectomy as she suspects. (2 marks)