Syllabus · Current · V5 (2025) · Concepts in Pharmacology
B3 · Variability of Drug Response
B3.iii · Physiological Variability in Drug Response
Describe variability in drug responses due to physiological changes with reference to the following: a. extremes of age (neonates, pediatrics and the elderly), b. extremes of body size (obesity), c. pregnancy including parturition and foetal, d. critical illness including sepsis, respiratory, cardiac, liver and renal failure
Written examination
SAQ history
Critical Illness Pharmacokinetics
2 exam appearances
Drug Response Variability — Ageing PK
1 exam appearance
Outline the pharmacokinetic consequences of old age. Illustrate your answer with examples.
53%
Drug Response Variability — Obesity PK
1 exam appearance
Describe the effects of obesity on drug pharmacology (70% of marks). Give examples of drugs that illustrate those effects (30% of marks).
36.4%
Drug Response Variability — Pregnancy PK
3 exam appearances
Outline the changes to drug pharmacokinetics and pharmacodynamics that occur at term in pregnancy.
7%
Liver — Drug PK
1 exam appearance
Drug Response Variability — Placental Transfer
2 exam appearances
Explain the factors which influence the transfer of drugs across the placenta to the foetus.
30%
Meropenem Pharmacology
1 exam appearance
Describe the following pharmacology of meropenem: (a) class and mechanism of action (25% of marks) (b) spectrum of activity (20% of marks) (c) indications for use (20% of marks) (d) pharmacokinetic and dosing considerations in critically ill patients (35% of marks)
19%
Renal Tubular Physiology — Drug Excretion/Dosing
3 exam appearances
Describe the role of the kidney in drug excretion and the factors affecting this (60% marks). Briefly outline how you would alter the dosing of a drug with high renal excretion in a patient with renal impairment (40% marks).
52%
Describe the role of the kidney in drug excretion and the factors affecting this (80% marks). Briefly outline how you would alter the dosing of a drug with high renal excretion in a patient with renal impairment (20% marks)
0%
Describe the role of the kidney in drug excretion, and the factors affecting this. Briefly outline how you would alter the dosing of gentamicin in a patient with H impairment.
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Oral examination
VIVA history
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2026A · VIVA 4
Relevant examiner prompts
How might the response to fasting differ in a neonate?
By what mechanism might a non-selective beta-blocker cause hypoglyaemia in a neonate?
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2026A · VIVA 7
Relevant examiner prompt
The ICU pharmacist tells you that your patient’s phenytoin level is low. Explain why this might happen?
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2026A · VIVA 8
Relevant examiner prompt
In critical illness we risk underdosing meropenem. Explain what patient and drug factors lead to this.
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2025B · VIVA 6
This viva will examine neuropharmacology. Describe the desirable and undesirable pharmacological properties of ketamine when used to intubate frail elderly people in the ICU?
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2025A · Day 1 · VIVA 3
This VIVA will examine pharmacokinetics and antimicrobial pharmacology. You are treating a patient in the ICU with intravenous vancomycin. The measured level is high. Why might the level be high?
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2020B · Day 1 · VIVA 7
This viva will explore your knowledge of physiology and pharmacology in the elderly. Consider the respiratory system: Why does efficiency of gas exchange diminish with aging?
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2019A · Day 1 · VIVA 1
This is the plasma concentration-time curve. Describe the features of this curve. What information does it give about a drug’s pharmacokinetic profile? (Image removed from report.)
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2016A · Day 1 · VIVA 8
This viva tested knowledge of physiology and pharmacology changes of aging and in a more general discussion around opioid pharmacology.
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2009A · VIVA 6
This viva will explore your knowledge of the pharmacokinetics in two areas: 1. Alcohol 2. Ageing What is the pharmacokinetics of alcohol metabolism?
Sources: objective text from the relevant CICM syllabus; historical SAQ and VIVA wording from CICM examiner reports.