Integrated Physiology and Pharmacology Exam Guide for BIOM2052

Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 1 of 22 This exam paper must not be removed from the venue Venue ____________________ Seat Number __________ Student Number |__|__|__|__|__|__|__|__| Family Name ____________________ First Name ____________________ School of Biomedical Sciences EXAMINATION Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry This paper is for St Lucia Campus students. Examination Duration: 90 minutes Reading Time: 10 minutes Exam Conditions: This is a Closed Book examination - no written materials permitted Casio FX82 series or a calculator on the UQ approved list permitted During reading time - write only on the rough paper provided This examination paper will be released to the Library Materials Permitted In The Exam Venue: (No electronic aids are permitted e.g. laptops, phones) None Materials To Be Supplied To Students: 1 x Multiple Choice Answer Sheet Additional exam materials (e.g. answer booklets, rough paper) will be provided upon request. Instructions To Students: Students are required to write their Name and Student Number on the front cover and each new section of the examination paper, as well as the MCQ marking sheet. For Examiner Use Only Question Mark Total _________

Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 2 of 22 Instructions for Completing your MCQ Answer Sheet 1. The computer answer sheet must be handled with care. [Do not curl, crease, fold, staple or pin.] 2. Use only HB or B pencils . Press firmly. [Do not use any H-grade pencil, ball-point pens, or ink pens.] 3. • Print your surname and initials (without full stops) in the line of large boxes under the headings "SURNAME" and "INITS". • Shade in completely the corresponding box beneath each letter. [If your surname consists of two or more words, is hyphenated (-), or has an apostrophe ('), shade the blank box above the A at the top of the surname area.] • Repeat this procedure for "STUDENT NUMBER". 4. Complete, in the space provided: "COURSE CODE" and "DATE". 5. Complete the answer boxes by shading the appropriate box completely . Do not extend the shading outside the box area. 6. Take care when making corrections. Erased marks must be completely erased . 7. Ask for a new answer sheet if you have made too many erasures. Check List ➢ Have you completed the "Surname" and indicated at least one initial? ➢ Is your "Student Number" indicated correctly? ➢ Have you indicated the "Course code" and the "Date" in the space provided? ➢ Have you shaded ONE response only to every multiple-choice question on your exam paper? ➢ Have you completely erased all unwanted marks? Good Luck! S A M P L E O N L Y

Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 3 of 22 …….…..…..…….…...……. …………….…………………...………… ………….. Student Number Surname Initials SECTION A – MULTIPLE CHOICE Recommended time = 42 minutes Number of questions = 28 _______________________________________________ ➢ Only ONE correct response is possible for each question ➢ For each question indicate your answer (A – E) in the corresponding numbered space on the computer answer sheet ➢ Each question carries equal marks ________________________________________________________________________________ 1 G protein-coupled receptors (GPCRs) [1.5 marks] A are directly involved in ion passage through the membrane B contain a single transmembrane spanning domain C induce very rapid (millisecond) cellular effects D result in the production of a second messenger which mediates the intracellular response E are mainly located in the cell cytosol [55863] 2 Considering the effects of repeated oral dosing with a drug at different dose levels and frequency, which of the following statements is INCORRECT? [1.5 marks] A More frequent administration of smaller doses will result in less variation of the drug plasma levels over each dosing interval B The smallest dosing interval of a drug that is rapidly absorbed will result in a plasma concentration profile similar to an intravenous infusion C If a patient showed drug toxicity, it would be better to halve the dose until the plasma concentration is in the safe range than to stop administration completely for that period D Less frequent administration of drugs (e.g. once daily compared with four times daily) is likely to result in greater patient compliance with the dosing regimen E Less frequent administration of large doses can result in the plasma levels fluctuating outside the safe therapeutic range during each dosing interval [55891]

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Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 4 of 22 Background Information for Questions 3 & 4 The graph below shows the response of airway smooth muscle tissue to increasing concentrations of isoprenaline, in the presence of 0 (blue line), 10 -8 M, 10 -7 M and 10 -6 M of a β -adrenoceptor antagonist drug. Answer Questions 3 & 4 based on this information. 3 The EC 50 of isoprenaline in the airway smooth muscle tissue is closest to [1.5 marks] A 3.2 x 10 -8 M B a value that cannot be determined from the information provided C 1 x 10 -9 M D 3.2 x 10 -11 M E 50% [55842] 4 What type of antagonism of the responses of the tissue to isoprenaline is shown with the increasing doses of the β -adrenoceptor antagonist (red curves)? [1.5 marks] A chemical B reversible competitive C non-competitive D pharmacokinetic E irreversible competitive [55852] 5 Which of the following hormones is NOT a polypeptide hormone? [1.5 marks] A insulin B prolactin C oxytocin D thyroxine E growth hormone [52944]

Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 5 of 22 6 Enlarged extremities and thickening soft tissues can be characteristic of which of the following endocrine disorders? [1.5 marks] A gigantism B prolactinomas C Addison’s disease D acromegaly E diabetes mellitus [55427] 7 Prolactin signalling involves [1.5 marks] A cyclic AMP B cyclic GMP C Janus kinase (JAK) D protein kinase A E phospholipase C [52945] 8 Which of the following statements is CORRECT in relation to the posterior pituitary hormones oxytocin and vasopressin? [1.5 marks] A Oxytocin and vasopressin are secreted by the large-bodied neurons of the hypothalamus and released into the median eminence B Oxytocin and vasopressin are secreted by the small-bodied neurons of the hypothalamus and released into the posterior pituitary C Oxytocin and vasopressin are expressed in both the supraoptic and paraventricular nuclei of the hypothalamus D A single hypothalamic neuron that produces oxytocin is also capable of producing vasopressin E Oxytocin and vasopressin bind to steroid receptors in their target cells for biological action [38383] 9 Which of the following statements is CORRECT with regard to the secretion of growth hormone? Growth hormone secretion is [1.5 marks] A continuous, but levels depend on pulse frequency or amplitude B pulsatile, and levels depend on pulse frequency and amplitude C continuous, and levels do not depend on pulse frequency or amplitude D pulsatile, but levels do not depend on pulse frequency or amplitude E continuous in response to activation by somatostatin [36989]

Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 6 of 22 10 Which of the following statements is CORRECT regarding gonadal hormones? [1.5 marks] A Follicle stimulating hormone (FSH) inhibits the enzyme aromatase for the production of oestradiol from testosterone B Luteinising hormone (LH) activates the enzyme aromatase for the production of oestradiol from testosterone C Gonadotropin releasing hormone (GnRH) activates the enzyme aromatase for the production of oestradiol from progesterone D Luteinising hormone (LH) inhibits the enzyme aromatase for the production of oestradiol from testosterone E Follicle stimulating hormone (FSH) activates the enzyme aromatase for the production of oestradiol from testosterone [37168] 11 Which of the following statements about the metabolism of local anaesthetics is MOST correct? [1.5 marks] A Amide forms of local anaesthetics are metabolised in the liver by plasma esterases B Ester forms of local anaesthetics are metabolised by cytochrome P450 enzymes C Metabolism of local anaesthetics is independent of their structure D Amide and ester local anaesthetics may compete with each other for metabolism E Metabolism of esters occurs in the plasma and of amides in the liver [52807] 12 Local anaesthetics are not as effective when tissues are inflamed, because [1.5 marks] A tissue pH is more likely to be acidic, so the local anaesthetic is predominantly in the charged form B greater efficacy of anaesthetic block of signalling may impair voluntary movement C inflammation of the myelin sheath impairs absorption of the drug D nociceptor activation exceeds the ability of local anaesthetics to reduce signalling E inflammatory mediators render the local anaesthetic ineffective [52901] 13 Which of the following statements about general anaesthetics is CORRECT? [1.5 marks] A Actions of the general anaesthetics on cell membrane organisation and function appear to be more important than actions on cell membrane proteins B If a general anaesthetic is a potent analgesic, then it will be a potent skeletal muscle relaxant C Many potent volatile liquid general anaesthetics have low oil:H 2 O partition coefficients D Many general anaesthetics appear to exert their central nervous system depressant effects by acting on GABA-operated chloride channels E Isomers of various general anaesthetics have equal anaesthetic potency [15209]

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Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 7 of 22 14 The formal unit used to quantify amounts of inhaled general anaesthetics is called the __________________, which is equal to ___________________________. [1.5 marks] A inhalation per two heart beats; the concentration at which 50% of patients do not respond to noxious stimuli B partial pressure; parts per million inhaled relative to other gases which are mixed into the gases C AMC; the bolus of gas under pressure of 760 mm Hg D MAC; the concentration at which most patients experience amnesia and inhibition of learning E MAC; the concentration at which 50% of patients do not respond to skin incision [35771] 15 When activated by morphine, μ opioid receptors in the spinal cord activate G α i resulting in _____________ of adenylate cyclase and a reduction of cAMP concentration. This leads to _______________ potassium ion conductance and ______________ calcium ion conductance, resulting in an inhibition of neurotransmitter release. [1.5 marks] A inhibition, increasing, decreasing B inhibition, decreasing, decreasing C stimulation, increasing, increasing D stimulation, decreasing, increasing E inhibition, increasing, increasing [36507] 16 The opioid analgesic, codeine, is combined with the analgesic, paracetamol, [1.5 marks] A to decrease excretion of codeine in the urine B for relief of mild to moderate pain such as headache, minor joint pain and musculoskeletal complaints C for long-term treatment of moderate pain, because tolerance does not develop to these combinations D for initial therapy in severe pain, such as during myocardial infarction E to improve the oral bioavailability of codeine [21131] 17 The ‘cheese reaction’ is characterised by flushing of the skin, sweating, and tachycard ia when taking oral antidepressants. It is directly related to the effect of [1.5 marks] A tyramine, which binds to muscarinic receptors of the adrenal glands, triggering a sympathetic response B monoamine oxidase B, which degrades monoamines in the gut, indirectly causing a sympathetic response C tyramine, which displaces noradrenaline from presynaptic vesicles, leading to a sympathetic response D tyramine, which stimulates monoamine oxidases A and B in the periphery, leading to a sympathetic response E acetylcholine, which binds to nicotinic receptors in the sympathetic ganglia, and triggers a sympathetic response [49422]

Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 8 of 22 18 Benzodiazepines [1.5 marks] A bind to a specific site on the GABA-operated chloride channel to decrease the affinity of the GABA A receptor for GABA B bind to GABA A receptors to increase the frequency of opening of GABA-operated chloride channels C increase the release of GABA from postsynaptic GABAergic neurones D bind to a specific site on the GABA-operated chloride channel to increase the affinity of the GABA A receptor for GABA E directly bind to GABA-operated chloride channels to increase the frequency of opening of the channels [15382] 19 Which of the following statements regarding the treatment of patients with emphysema is INCORRECT? [1.5 marks] A Inhaled short-acting β 2 -adrenoceptor agonists are useful to reduce the incidence of exacerbations B Lung volume reduction surgery can have beneficial effects in some patients with emphysema C Antibiotic therapy is required if the patient also develops a chest infection D Treatment options are palliative and are not a cure, even if the patient quits smoking E Inhaled corticosteroids should be used as ongoing anti-inflammatory therapy in most patients [55757] 20 In the use of drugs that interact with leukotriene receptors, such as montelukast, in managing asthma, these drugs are [1.5 marks] A competitive antagonists at CysLT-receptors B reserved for treating patients with severe asthma C used to provide more rapid relief of asthma symptoms than that provided by β 2 - adrenoceptor agonists D only administered by inhalation E agonists at the receptors for LTC 4 , LTD 4 and LTE 4 [55758] 21 The primary objective of prokinetic drugs for the treatment of gastro-oesophageal reflux disease (GORD) is to [1.5 marks] A increase dopamine release to enhance its inhibitory effect on motor neuron function in the myenteric plexus B increase serotonin release with drugs such as ondansetron to enhance the inhibitory effect on motor neuron function in the myenteric plexus C antagonise the effects of serotonin at 5-HT 3 - and 5-HT 4 -receptors to increase the firing rate of the motor neurons, resulting in increased gastrointestinal muscle contraction D decrease acetylcholine release to enhance gastrointestinal smooth muscle contraction E increase acetylcholine release by various mechanisms to enhance motor neuron firing and contraction of gastrointestinal smooth muscle [44841]

Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 9 of 22 22 Phenothiazines are used as anti-emetic medications, because they act as [1.5 marks] A antagonists at dopamine D 2 -receptors in the myenteric plexus B antagonists at dopamine D 4 -receptors in the amygdala C agonists at dopamine D 2 -receptors in the chemoreceptor trigger zone D antagonists at dopamine D 2 -receptors in the chemoreceptor trigger zone E antagonists at cannabinoid CB 1 -receptors in the vestibular complex [39019] 23 What percentage of cases of hypertension fall into the category of primary hypertension? [1.5 marks] A approximately 5% B approximately 10% C approximately 20% D approximately 50% E approximately 90% [55371] 24 Which of the following is NOT a recommendation for the treatment of heart failure? [1.5 marks] A angiotensin II antagonists B inotropic agents C angiotensin converting enzyme stimulators D angiotensin converting enzyme inhibitors E loop diuretics [55372] 25 Nitric oxide bioavailability [1.5 marks] A is increased in experimental heart failure B is reduced in obesity-related hypertension C is too difficult to measure in obesity-related hypertension D remains unaltered in obesity-related hypertension E is increased in obesity-related hypertension [47413] 26 Which of the following statements regarding control of blood pressure is INCORRECT? [1.5 marks] A Heart rate and stroke volume can influence blood pressure B Activation of the parasympathetic nervous system increases heart rate and therefore increases blood pressure C Cardiac output and total peripheral resistance influence mean arterial pressure D Activation of the sympathetic nervous system increases blood pressure E Angiotensin II increases total peripheral resistance [47414]

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Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 10 of 22 27 Vancomycin resistance has arisen from [1.5 marks] A a modification of the pentapeptide in peptidoglycan that prevents vancomycin binding B a mutation in transpeptidase that prevents vancomycin binding to its target site C acquisition of a plasmid-encoded enzyme that degrades the drug D bacteria that modify the cross-linking pentapeptide from D-Ala-Lac to D-Ala-Ala E increased expression of drug-importing proteins on the bacterial membrane [55767] 28 Which of the following is NOT a target of antiviral drugs? [1.5 marks] A dihydropteroate synthetase B RNA polymerase C DNA polymerase D HIV protease E reverse transcriptase [55772]

Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 11 of 22 SECTION B – SHORT ANSWER Recommended time for this section is sixteen (16) minutes [LL] ................................................................ ……………………… TOTAL Student Number Surname 29 [Total Q29: 4 marks] [55761] A drug has an oral bioavailability of 50% and a variation in the effective dose between patients of 20%. a) Discuss the factors that can lead to relatively low oral bioavailability of drugs. [3 marks] b) How does low bioavailability result in a high inter-individual variation in the effective dose of the drug? [1 mark] 30 Select TWO (2) factors that can cause variable drug responses, and for EACH of the two factors briefly discuss the possible reasons for the variable response including at least one example. [4 marks] [55841] /16

Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 12 of 22 31 [Total Q31: 4 marks] [55744] A 35-year-old female patient, Maya, presents at your practice with oro-pharyngeal candidiasis (also known as ‘thrush’). The medical history finds that the patient has bronchial asthma and is using a combination inhaler that includes both a corticosteroid and a long-acting β 2 -adrenoceptor agonist. a) How do EACH of the TWO (2) drugs in the combination inhaler act to control the ‘early phase’ and ‘late phase’ of asthma? [3 marks] b) What advice would you give the patient to prevent the reoccurrence of the candidiasis? [1 mark] 32 What was the Nobel Prize winning discovery that changed the understanding of the cause of most cases of peptic ulcers and what have been the consequent changes in peptic ulcer therapy for patients? [4 marks] [55744]

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Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 13 of 22 SECTION C – SHORT ANSWER Recommended time for this section is eight (8) minutes [PC] ................................................................ ……………………… TOTAL Student Number Surname 33 [Total Q33: 8 marks] [56040] a) Describe what a stalk section is. [0.5 mark] b) List the anterior pituitary hormones. [2.5 marks] c) Following a stalk section experiment, i) state what happens to the level of EACH anterior pituitary hormone (increase versus decrease) [2.5 marks] and ii) list the hormones responsible for this regulation by the hypothalamus [2.5 marks] /8

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Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 15 of 22 SECTION D – SHORT ANSWER Recommended time for this section is eight (8) minutes [MM] ................................................................ ……………………… TOTAL Student Number Surname 34 [Total Q34: 8 marks] [55190] Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually used for pain on the lower part of the pain scale (0-3). For moderate pain, combinations of NSAIDs and mild-moderate opioids can be used. Answer a) - c) based on this background information. a) In brief, what is the mechanism of action for NSAIDs? [4 marks] b) Some opioids are classified as ‘strong’, while others are ‘mild or moderate’. Why might this be so? [2 marks] c) What are the possible advantages of co-packaging a NSAID or paracetamol with a moderate opioid? [2 marks] /8

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Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 17 of 22 SECTION E – SHORT ANSWER Recommended time for this section is eight (8) minutes [NR] ................................................................ ……………………… TOTAL Student Number Surname 35 [Total Q35: 8 marks] [55422] a) Describe the composition of the glomerular filtration barrier. [4 marks] b) Discuss how EACH of the following conditions influences glomerular filtration rate (GFR): i) severe burns [2 marks] ii) urinary tract obstruction [2 marks] /8

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Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 19 of 22 SECTION F – SHORT ANSWER Recommended time for this section is eight (8) minutes [LR] ................................................................ ……………………… TOTAL Student Number Surname 36 [Total Q36: 8 marks] [55774] a) Despite our best efforts to combat infections with antimicrobial drugs, the development of antimicrobial resistance is a major health problem. Briefly describe TWO (2) molecular mechanisms that bacteria can use to become resistant to antimicrobial drugs [3 marks] and give an example antibiotic for EACH mechanism [ 1 mark] . b) A patient has a nasty oral fungal infection that requires immediate treatment. The drugs you have available are amphotericin , ketoconazole and flucytosine . You know that drug combinations can increase the effectiveness of treatment. Of the three antifungal drugs available to you, which TWO (2) would you combine? Give a brief explanation for your answer based on the mechanisms of action for each drug. [4 marks] END OF PAPER /8

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Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 21 of 22 ROUGH WORK ➢ This page is provided for rough working ONLY ; it does not form part of the assessment. ➢ DO NOT answer any part of your question paper here. Additional paper is available on request from the Supervisor if the space provided is insufficient.

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Semester One Final Examinations, 2021 BIOM2052 Integrated Physiology and Pharmacology for Dentistry Page 22 of 22 COMMENTS ➢ This page is available for you to make any anonymous comments or constructive criticisms of questions in this test. It will be detached before the paper is marked. ➢ DO NOT answer any part of your question paper here. Additional paper is available on request from the Supervisor if the space provided is insufficient.

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