Syllabus · Historical · V4 (2023) · Pharmacokinetics
Pharmacokinetics
B.vi · Pharmacokinetics
Describe the concepts of effect-site concentration and context sensitive half-time.
Written examination
SAQ history
Drug Half-life
1 exam appearance
Oral examination
VIVA history
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2026A · VIVA 7
Relevant examiner prompts
A patient has been on a 3-day infusion of propofol and fentanyl. Explain what happens to the plasma concentrations after the infusions are ceased?
What is CSHT and what factors influence fentanyl’s?
How does context-sensitive half time differ from elimination half-life, and which is more clinically useful in ICU?
Explain strategies to mitigate fentanyl’s long CSHT in ICU.
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2008A · VIVA 1
of this drug. Candidates were expected to discuss administration, bioavailability, metabolism, excretion and half life of captopril. Candidates were then asked to compare it to the longer acting ACE inhibitors and discuss their advantages and/or disadvantages in ICU patients. The Viva then explored the candidate’s knowledge of dosing intervals, plasma concentration times curves and effect time curves in relation to ACE inhibitors. Candidates were expected to know why these curves differed, (avid enzyme binding), and thus why the dosing intervals for ACE inhibitors are so long in relation to their half lives. The concepts of Emax, EC50 and Therapeutic index were required. Candidates were then asked to discuss the mechanism of action of ACE inhibitors and their cardiovascular, endocrine, renal and CNS effects. Drug interactions and adverse effects were expected knowledge. Syllabus, General Pharmacology I and II, ACE inhibitors, C2b2f. References : Katzung B.G.'s'Basic and Clinical Pharmacology' Brunton L.L. Goodman and Gilman’s ' The pharmacological basis of Therapeutics'.
Sources: objective text from the relevant CICM syllabus; historical SAQ and VIVA wording from CICM examiner reports.