K4.i · Pain Pharmacology

This VIVA will examine opioid pharmacology. What classifications of opioid receptors do you know?

This viva will explore your understanding of the pain pathways and analgesic medications. Define Pain and describe how pain is detected in response to a peripheral noxious stimulus?

This viva will assess your knowledge of opioids. What classification of opioid receptors do you know?

This viva will explore your knowledge of opioid pharmacology. How do opioids produce analgesia?

This viva will explore your knowledge of opioids and their pharmacology. What classifications of opioid receptors do you know?

This viva will explore opioid pharmacology. In what parts of the body do opioids act?

This viva is about paracetamol and its toxicity.

This viva will explore opioid pharmacology. What is the mechanism of action of morphine?

This viva will test your understanding of opioids. Describe the mechanism of action of opioids.

This viva will examine pain pathways and analgesic pharmacology. Define pain and describe how pain is detected in response to a peripheral noxious stimulus.

This viva will explore pharmacokinetics and opioids. Draw the concentration-time curve following an intravenous bolus of 100 ug fentanyl.

This viva tested knowledge of physiology and pharmacology changes of aging and in a more general discussion around opioid pharmacology.

This Viva tested knowledge of opioid pharmacology including classification and mechanism of action. It then explored pharmacodynamics and dose response curves.

This Viva tested knowledge of the pain pathways and analgesia. The first question asked candidates to describe what would be the immediate response to a cut to the hand.

This station will explore the pharmacology of opioid drugs. An elderly man has been admitted after an emergency laparotomy. He is on an infusion of morphine at 5 mg/hr. His serum creatinine has doubled overnight and he is oliguric. What are the pharmacological effects of morphine in this patient and how are they brought about? Similarly in this viva, candidates struggled with an applied knowledge of basic pharmacological principles relating to commonly used drugs. Mechanisms of action of opioids was also an area of weakness.

This viva will discuss dose response curves and the information that can be gained from them. Candidates were asked to draw a dose response curve for morphine and to describe the information that relates to it. Areas of basic pharmacology including ED50/potency, efficacy, effect of competitive and non competitive antagonists were also tested

This viva will test knowledge of pharmacokinetics and statistics Draw the concentration time curve for an intravenous bolus of fentanyl. At this Viva candidates were asked to draw a concentration – time curve for an intravenous bolus of fentanyl, to label it and describe the information relating to that curve. Candidates were also asked about volume of distribution, half-life and clearance. In the second part to this Viva candidates were shown and asked to describe various types of data, mean and median values, normal distribution and critical evaluation of a study.

This Viva will test knowledge of spinal cord anatomy, local anaesthetics and analgesics Draw a cross-sectional figure of the spinal cord, at the level of C3, and describe the functional anatomy and blood supply of the spinal cord at that level. Candidates were asked to draw a cross-sectional figure of the spinal cord, at the level of C3, and tested on their ability to describe the functional anatomy and blood supply of the spinal cord at that level. Candidates were also asked about local anaesthetic drugs, their mechanism of action, pain (and asked to define pain) and non-opioid analgesics, in particularly ketamine and the pharmacology of ketamine.

The initial information given to the candidates was – This station will explore your knowledge of the following areas: Neurophysiology and Opioid pharmacology Candidates were asked about cerebral blood flow, it’s measurement, regulation and opioids and their CNS effects

The initial information given to the candidates was - What is normal cerebral blood flow? This viva explored the candidates’ knowledge in relation to the following points Cerebral Blood Flow, it’s measurement and factors that alter it Cerebral Blood Flow and acute changes in altitude Morphine, typical dose, CNS effects and metabolites Examination feedback: There was good understanding of cerebral blood flow, and most candidates used figures to good effect during the viva. Areas of weakness were an understanding of the methods of measuring CBF and differential flow to the white and gray matter. Candidates also were less confident with the different CNS effects of morphine. Adapting factual knowledge to define what would happen in states of altered physiology was also handled poorly.

The initial information given to the candidates was - This station will explore the pharmacology related to analgesic medications. How will you classify non opioid analgesic agents? This viva explored the candidates’ knowledge in relation to the following points Classification of non opioids, mechanism of actions of non opioids Classification of opioids, mechanism of action, some aspects of their general pharmacology, contrasting fentanyl and morphine, tolerance to opioids Examination feedback: Generally candidates performed better at classifying non opioids in comparison to the opioids. There was also a lack of depth and breadth in knowledge related to opioid receptors