Section 1 Vaccines case

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QUESTION

There are two articles for guided reading provided with this task.

Mrs JO is the mother of baby OO, who was due to have his first set of primary vaccinations at 8 weeks old. However, you were informed in the vaccines case that Mrs JO was reluctant to have the baby vaccinated.

 

Mrs JO now comes to see you in the pharmacy. She has received the appointment date from the clinic for OO’s vaccines, but she doesn’t know whether to go ahead. She asks if you can provide some written information about the risks and benefits of vaccination. Write an email back to Mrs JO using the template below, providing factual information about the known risks and benefits of routine vaccination in infants. Your answer should be non-judgemental and show empathy towards Mrs JO. (15 marks. The word limit for part B is 250 words).

Dear Mrs JO,

Section 2 Breast cancer case

Mrs DD, 48 years old, is referred to the breast clinic with a self-detected lump.

FH Mother died from triple negative breast cancer when she was young.
Has two daughters.

SH Smokes 10 cigarettes a day since the age of 21 gave up smoking 15 years ago.

PMH caesarean section (x2)
Type 2 diabetes
BRCA2 mutation positive
Peri-menopausal (Hot flushes, breast tenderness)
Osteoporosis

DH Alendronic acid 70 mg once a week
Metformin 500 mg once a day

HPC She has presented with a lump in the right breast. Worried about carcinoma of the breast. Carcinoma detected on mammogram.

Mrs DD’s mammogram

ANSWER THE FOLLOWING TWO QUESTIONS

Calculate the probability that Mrs DD has breast cancer, and the probability that the result is a false positive? Given that: –

1% of women between the ages of 40-50 years have breast cancer (and therefore 99% do not).
80% of mammograms detect breast cancer when it is there (and therefore 20% miss it).
10% of mammograms detect breast cancer when it is not there (and therefore 90% correctly return a negative result).
Women with a BRCA2 mutation have a 26% chance of contracting breast cancer during their lifetime.

(15 marks)

 

 

 

 

 

(b) Immunotherapy—checkpoint inhibitors. The diagram above shows an interaction between a T cell and an antigen presenting cell and between a T cell and a tumour cell. In the table below fill in A-H. Please assume the T cell is a T-helper cell. Name two drugs that can block C and D above. (10 marks)

Diagram letter
A T CELL RECEPTOR
B MHC
C CD-28
D B7-1
E CTLA-4
F CD80
G PD-L1
H PD-1

What drugs block C and D?

 

 

 

Section 3 Spectrum Disorders-From Autism to OCD
Priadel prolonged-release tablets: how their formulation affects patient use

How to complete this report electronically:
Please insert your answers in the boxes provided
The boxes will expand to accommodate long answers
Do not alter any other aspect of the template
Please see assessment criteria on My Studies

The dissolution profile of six whole and six crushed prolonged release lithium tablets has been determined using the BP paddle apparatus and flame photometry. The data are presented in Table 1.

Table 1: Cumulative proportions of Li2CO3 released from six crushed and six whole tablets of Priadel 200 mg prolonged-release tablets.
Time (minute) Cumulative proportion of Li2CO3 released relative to nominal dose for crushed tablets (%) Cumulative proportion of Li2CO3 released relative to nominal dose for whole tablets (%)
Mean Standard deviation Mean Standard deviation
0 1 0.4 1 0.5
10 69 1.3 17 0.5
20 85 2.2 33 0.9
30 90 2.3 54 3.3
40 92 2.1 68 1.1
50 91 3.2 79 1.1
60 92 2.1 90 2.2

On the same set of axes, plot mean cumulative proportion of Li2CO3 released against time for the crushed and the whole tablets. Include error bars on the vertical axis only. Include a legend for the figure. (6 marks)

 

 

 

Look up the list of excipients in Priadel prolonged-release tablets. (see section 6.1 of the Summary of Product Characteristics (SPC) https://www.medicines.org.uk/emc/product/13162/smpc). Briefly identify the role each excipient plays in these tablets and state which excipient(s) is/are most likely to affect the release characteristics and how. (180 words) (9 marks)
Glycerol monostearate:
Glycerol distearate
Mannitol (E421)
Acacia spray dried
Sodium laurilsulfate (E487)
Magnesium stearate
Maize starch
Sodium starch glycolate (Type A)

 

A carer of a patient comes into the community pharmacy to collect the patient’s monthly Priadel prescription. The carer asks you if it is possible to crush the Priadel prolonged-release tablets as the patient can no longer swallow but requires the medicine for their bipolar disorder.
Explain your recommendations to the carer and provide a rationale for your answer (this should include the therapeutic, pharmaceutical science and patient factors that have influenced your decision). (200 words) (10 marks)

 

 

 

Section 4 Epilepsy and Sleep Disorders case

Mrs XY (60 kg) has been suffering with Tonic-Clonic generalised seizures for 6 months. Her seizures have been moderately controlled on phenytoin sodium 200 mg once daily. A level taken in the last few days was reported at 7.2 mg/L. The patient’s serum albumin is 30 g/L. The neurologist has increased the dose of phenytoin to 250 mg / day to achieve a target corrected phenytoin concentration of 18 mg/L, which they hope will provide better seizure control.

Calculate the corrected phenytoin concentration based on the patient’s serum albumin level (5 marks)

Calculate the plasma concentration that a dose of 250 mg daily would achieve in this patient. Explain why a 25% increase in dose produces a disproportionate increase in plasma concentration. Is this dose appropriate? (5 marks)

Calculate a new maintenance dose of phenytoin sodium to achieve a steady state phenytoin concentration of 18 mg/L (5 marks)

Suggest an oral loading dose of phenytoin sodium to rapidly achieve this new steady state level (5 marks)

Briefly state, (i) what additional parameters should be monitored when administering phenytoin intravenously, and (ii) why? (5 marks)

Useful information

〖[Phen]〗_corr=〖[Phen]〗_actual/(0.9([alb]/44)+0.1)

Dose rate=(V_max C_p)/(S(K_m+C_p))

C_p=(Dose ×S×F)/V

Population = 4 mg/L
Phenytoin target concentration = 10-20 mg/L
S=0.9 phenytoin Na
F=1.0
= 0.6 L/kg
Cp = 10-20 mg/L

 

 

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