0:03 Well, hello everyone and welcome to our
0:06 week 2 tutorial that aims to make sure
0:08 that all of the students attending this
0:11 tutorial are going to do well in the
0:14 week 2 quiz. Obviously, you're going to
0:17 need to go through the module one in
0:19 order to do well, but this tutorial is
0:22 going to give you a really good idea of
0:25 the kind of questions and some exact
0:28 questions that you'll see in the quiz.
0:30 And just a reminder about the details of
0:33 the quiz uh so that you know exactly
0:36 what's happening. The quiz is this
0:40 coming Friday and it's worth 20% of your
0:43 grade in the unit. You will need to
0:46 access the quiz in assessment on the
0:49 side panel there in our Blackboard site.
0:51 Assessment assessment tests and
0:54 submission assessment one. go down to
0:57 assessment one and then you'll be uh
1:00 looking at a folder that uh starts
1:03 giving you prompts and agreements to
1:05 certain conditions that you'll have to
1:09 make sure to abide by. They're academic
1:11 integrity issues for the most part.
1:13 Okay, so sorry in advance for this next
1:15 bit, but I do have to tell you the rules
1:19 of the quiz right now. Some of the terms
1:21 and conditions that you'll agree to
1:24 include that you will not use artificial
1:27 intelligence. There are no screenshots
1:30 or photos of the quiz allowed at all. So
1:32 even if you have a question about the
1:34 quiz and you want to show me what's
1:36 happening to your screen, you will have
1:39 to email me or explain it in an email.
1:41 You will not be able to take a picture
1:44 of the screen or a screenshot of the
1:48 screen. That's uh strictly forbidden.
1:50 And uh you're not allowed to communicate
1:52 with anybody about the quiz, not during
1:56 the quiz time at all. So from 6:00 a.m.
1:59 to the next day, and you're not allowed
2:02 to give a copy of the quiz to a future
2:05 student. So all of those are academic
2:07 integrity issues, and you will have to
2:10 agree to those before you actually get
2:12 the to the quiz. If you don't agree to
2:14 them, then you don't actually get to the
2:18 quiz. And another important condition of
2:20 the quiz is that if you are not at one
2:24 of the SCU campuses, now this means that
2:27 if you are at one of the SCU campuses
2:29 taking the quiz, then this condition
2:32 does not exist. But if you are not at
2:36 one of the SCU campuses, you'll need to
2:39 agree that you have a backup computer or
2:41 some sort of a device that you can take
2:43 the quiz. So you have to have two
2:46 different devices to take the quiz. one
2:48 is your primary and second one is your
2:50 your backup and then you have to have a
2:53 backup internet connection. So what are
2:56 you going to do in case you have to have
2:59 a backup plan? So once you start the
3:02 quiz, you'll need to finish it in the 90
3:04 minutes allowed. Those are the rules
3:07 that have been agreed to by the board of
3:10 assessors. So, we do need to abide by the
3:11 the
3:15 rules. Once you go through those uh that
3:19 series of folders, uh you will have 60
3:21 minutes to take the quiz. The quiz
3:24 itself contains 32 multiplechoice
3:28 questions and each of those are worth
3:31 0.5% of your grade. That all adds up to
3:35 16 points or 16% of your grade. And then
3:38 there will be two twopoint questions
3:40 that I basically give you in this
3:45 tutorial. So altogether 20 points or 20%
3:47 of your grade in the
3:51 unit. So with that as an overview to the
3:53 actual quiz, let's talk about what we
3:55 will find in today's tutorial and why
3:57 it's so important in doing well in the
4:00 quiz. Today we're going to discuss a
4:02 number of multiplechoice quiz questions.
4:05 And for those I'll discuss the question
4:08 and I will discuss the answers that you
4:09 should actually give in order to be
4:11 successful in each one of those
4:13 questions. Each one of those questions
4:15 will have five different choices. In
4:17 most instances, the PowerPoints and the
4:20 PowerPoint notes don't have all five
4:24 choices in those. But uh I will give you
4:26 the other choices and you'll just have
4:28 to add to your study notes. The
4:29 university doesn't allow me to post in
4:32 notes that can be used in the quiz to
4:34 directly give students additional credit
4:36 because everybody would just download
4:38 the notes and not bother with the
4:40 mandatory tutorial. But I've got an easy
4:43 solution. I suggest that you print out
4:46 the PowerPoint notes and as we go
4:48 through the tutorial here, you can fill
4:50 in the blanks. Then your study notes are
4:53 going to become invaluable if you don't
4:55 remember the answers off the top of your
4:57 head. The other thing that we'll be
4:59 looking at today will be two twopoint
5:01 short answer questions. And importantly,
5:04 those two short answer questions will be
5:06 questions that you absolutely cannot get
5:08 the answer to anywhere else but this
5:10 tutorial. So for instance, I may ask
5:12 name the four most important side
5:14 effects of ACE inhibitors in the order
5:15 in which they were presented in week
5:18 five tutorial. Uh that's not one of the
5:19 questions, but anyway, that's the kind
5:22 of question. So that is a very specific
5:24 answer that you'll have to give in order
5:26 to get the credit for the two
5:28 points. And every student who decides
5:30 not to go to this tutorial or to watch
5:33 the video tutorial series is going to
5:34 complain about that. But those are the
5:38 rules and um you for instance will thank
5:39 me for it because you will have the
5:43 notes that um gives you the answers to a
5:46 good portion of your questions in the
5:48 quiz. So that's good news for each of
5:50 you who are here today. And unless you
5:52 have any questions about the process, I
5:54 think it's probably Does anybody have
5:56 any questions? Okay, nothing's coming
5:59 in. Let's start writing up our cheat
6:00 sheet for the
6:03 quiz. The first thing I want to remind
6:06 you about is that module O, so the
6:08 orientation module has three short
6:10 lessons that were included and there
6:13 will be at least one question from those
6:15 three in the quiz. The topics were
6:17 scheduling of drugs and if you recall
6:20 schedules two, three and four, four is
6:23 prescription only. Uh eight is a
6:26 controlled drug. Uh those are the most
6:28 important ones and if there's a question
6:30 on those, it'll have to do with those
6:34 schedules 2, three, four, and eight.
6:35 Medicinal formulations was another
6:37 topic. And one thing that always comes
6:39 up in a quiz about medicinal
6:42 formulations has to do with intericcoded
6:45 drugs. So interic coating is a coating
6:48 that is put on the drug in order for the
6:50 drug to get straight through the stomach
6:52 all the way into the small intestines
6:54 before it actually dissolves. And that
6:55 would be because of the fact that
6:58 perhaps the drug exposed to the acidic
7:00 environment of the stomach would degrade
7:02 really rapidly or for whatever reason it
7:04 might be a drug that's really hard on
7:07 the stomach wall. So for whatever reason
7:10 they'll put an entic coating on the
7:13 medication and when there is a interic
7:15 coating the question that always comes
7:18 up in quizzes is you know can it be
7:20 chewed or swallowed? Can it be uh
7:23 crushed? uh definitely never crush or
7:27 chew an intericcoated medication and
7:29 that would almost inevitably result in a
7:32 diminished efficacy of the drug and then
7:33 in some cases it would actually uh
7:37 result in damage to the stomach wall. So
7:39 that's probably the most important but
7:41 then you can find the list of med
7:46 medicine formulations in a module O and
7:48 there was a pretty much a handout that
7:50 you would be able to download. So I've
7:53 simplified an entire chapter by putting
7:55 it into a table and all that the most
7:57 important information about medicinal
7:59 formulations is in that
8:03 table. Okay. And the other quick lesson.
8:05 So that was two quick lessons in the
8:06 orientation module and the other one had
8:09 to do with pregnancy categories. The
8:10 most important thing that you need to
8:12 remember about pregnancy categories is
8:15 that the uh drugs get a bit more
8:17 problematic as they go from pregnancy
8:20 category A to pregnancy category C to D
8:23 to X. A is the safest and it's been
8:25 taken by a large number of pregnant
8:29 women. While pregnancy category D is
8:31 likely to result in harm to the fus and
8:34 pregnancy category X is togenic. So it
8:37 will cause birth defects. But the
8:40 pregnancy category B drugs is the one
8:43 that is not strictly hierarchical. In
8:44 other words, there's not enough
8:47 information about pregnancy category B
8:49 drugs to know for certain whether they
8:52 will eventually be a pregnancy category
8:55 A drug or pregnancy category C or D. The
8:57 other thing about the pregnancy
8:58 categories has to do with the fact that
9:00 you need to know that you're looking at
9:04 the Australian pregnancy categories. So
9:06 make sure that it's an Australian
9:08 pregnancy category in order for it to be
9:10 relevant to Australia. If the source
9:12 says for instance
9:15 FDA regulates this drug as pregnancy
9:17 category B or for for instance that has
9:19 to do with America. It doesn't have to
9:22 do with the B drugs in Australia. So uh
9:24 please make sure that when you're
9:26 looking at the pregnancy categories you
9:29 are using an Australian
9:34 source. Okay. So those were the three
9:36 little lessons that we had in the
9:38 orientation module and as we move to the
9:40 material presented in the weekly
9:42 modules. One of the questions that will
9:44 definitely be in the quiz will have to
9:45 do with
9:48 halflife. Now for this one and may not
9:50 give you this exact one but as I present
9:53 this I definitely I guarantee that if
9:56 you listen to this you will get the
9:58 answer to the question that I do choose
10:00 for the quiz. Okay. So listen carefully
10:02 to what I have to say about the
10:05 half-life and in this question and as
10:07 you go through that you'll know the
10:09 answer to that uh type of question that
10:12 half-life question that's in the quiz.
10:17 So at 12:00 noon Mr. SM has 8 milligrams
10:19 of drug in his system. The drug has a
10:21 halflife of 1 hour. Uh when is it
10:25 anticipated that he will have about 0.5
10:28 milligrams of drug in his system? So
10:30 that's uh going to have a number of
10:31 choices if this is the exact question
10:33 that I'm going to choose for being in
10:36 the quiz. So around 4:00, around 2:00,
10:40 3:00, 6:00 p.m., and 5:00 p.m. So in
10:42 order to really fully understand this,
10:43 what we need to do is take a look at
10:48 this graph. So here's the 8 mgram at 12
10:53 noon, and it is a and it has a 1 hour
10:55 halflife. So in the first halfife it
10:58 goes from eight milligrams down to four.
10:59 Everybody everybody's going to
11:02 understand that one. Now a lot of people
11:03 at this point will think that in the
11:05 second halfife it'll go down four more
11:07 milligrams and it'll be out of the
11:10 system completely in two half lives. But
11:12 that is incorrect. You need to look at
11:14 this graph right here and just get your
11:16 head around the fact that the second
11:19 halfife is going to basically begin the
11:23 clock ticking again. at 1:00 there's 4
11:25 milligrams in a system and that's going
11:28 to go down to 2 milligrams at 2:00. So
11:30 just note the fact that it's not a
11:33 linear thing, not with the standard way
11:34 that we excrete
11:37 medications, which is uh the first order
11:40 of kinetics. And the next halfife is
11:42 going to take it down to 1 milligram. Uh
11:44 and that's going to be at 3:00. The
11:48 fourth halfife takes it down to 0.5 mg.
11:50 and take this down because the point at
11:53 which there's only 5% remaining in the
11:56 system is 4.5 half- livives. The average
12:00 time that it takes to eliminate uh 95%
12:04 of the drug from the system is 4.5 half-
12:06 livives. So, does everybody understand
12:08 that it's not a linear thing? If it was
12:10 a linear thing, it would take only two
12:12 hours to eliminate the drug. But
12:14 basically it gets harder and harder to
12:16 eliminate the drugs when we have less of
12:17 the drug in our
12:20 system. So hopefully you have understood
12:23 that with respect to half-life and we
12:26 can go on to another question which is
12:30 likely to be in the final quiz. So the
12:33 next question has to do with linear dose
12:37 response versus a normal response curve.
12:38 And the question that will be seen in
12:41 the quiz has to do with you which of the
12:43 following exhibits a linear dose
12:46 response. And the answers that I'm
12:47 showing here on the PowerPoint are
12:50 calcium antacids, paracetamol, beta
12:53 blockers. And the two that are not seen
12:57 on the PowerPoint notes are opioids and
12:59 uh the last one is none of the drug
13:02 choices in this list exhibit a linear
13:05 dose response. So take some time to
13:07 write down those two additional choices.
13:11 Opioids and none of the drug choices in
13:13 this list exhibit a linear dose
13:16 response. In order to understand the
13:19 dose response curves, we should first
13:21 take the normal dose response. So
13:24 normally the response goes something
13:26 like this graph where the dose is on the
13:29 x axis right here and the response is on
13:31 the y- axis.
13:33 So if we took paracetamol as an example
13:35 because this is a really important one.
13:38 This is something that clients will
13:40 always uh have the wrong assumption
13:44 about and it's really a an important uh
13:46 safety issue. If we take paracetamol as
13:49 an example, the normal dose is going to
13:51 be in this range
13:55 here. But it's a weak analesic. So
13:57 you're not going to get more analesic
13:59 effects by taking more than the normal
14:01 dose. This is one of the reasons that um
14:03 you know people are overdosing so much
14:05 on paracetamol. Paracetamol is one of
14:07 well it's the number one cause of acute
14:10 liver failure because of the fact that
14:12 people think that the more you take the
14:14 greater the effect. But all you do when
14:17 you take more paracetamol is that you
14:20 actually get into this time right here
14:22 where you're going to experience more
14:25 side effects and not more for instance
14:27 analesic effects.
14:29 Now a linear dose response is
14:32 demonstrated with this graph. The
14:34 example that we used in the modules in
14:37 module one was the osmotic laxatives.
14:39 Osmotic laxatives very simplistically
14:41 speaking pull water into the small
14:43 intestine from the blood. It's an
14:45 osmotically active particle. It pulls
14:47 basic basically pulls it into the
14:50 intestines and then uh the person has
14:53 diarrhea or has looser stools or you
14:55 know depending on how much they take and
14:57 where they started from. But if you take
14:59 too much, the major side effect is going
15:02 to be diarrhea and also even dehydration
15:04 if you take too much. Uh and then even
15:06 electrolyte imbalances from that
15:09 dehydration because basically there's
15:10 too many electrolytes in your blood for
15:12 the amount of fluid that's left. If
15:13 you're actually, you know, pulling, just
15:15 think about, you know, pulling all of
15:17 that water, all of that fluid out of the
15:21 blood and into the git, well, you wind
15:25 up with diarrhea in the uh git and in
15:27 the system. you wind up with dehydration
15:31 and electrolyte imbalances. So, uh yes.
15:34 So, that one is an example of the rare
15:36 time in which we have a linear dose
15:40 response. The more you take, the more uh
15:43 the greater the the effect. Uh other
15:45 examples of drugs that have a linear
15:47 dose response are mainly those drugs
15:49 that are attempting to kill pathogens or
15:52 cancer cells. So for instance, radiation
15:55 therapy exhibits a linear dose response.
15:57 But of course, you have to be really
15:59 careful because if you're killing 100%
16:01 of the cancer cells, then you're
16:02 probably going to kill the patient as
16:05 well. Uh so let's go back to the
16:07 question and which one of the following
16:09 exhibits a linear dose response. Can
16:12 anybody tell me uh calcium antacids? Do
16:15 do those does paracetamol? Does uh beta
16:17 blockers or
16:20 opioids? Okay. Yeah, correct. None of
16:22 those will actually exhibit a linear
16:25 dose response. Uh if there was for
16:29 instance uh radiation therapy or osmotic
16:32 laxatives in that group of medications
16:35 then you would choose those. Okay. So
16:37 does everybody understand
16:41 that? Good. Well done. Uh so at this
16:42 point what I'm going to do is uh sneak
16:45 in the one of the twopoint questions.
16:48 So, the next question is about rebound
16:50 effects of medications. And it's going
16:52 to be that two-point question, one of
16:53 the two twop two-point questions that
16:55 we'll take today. And once again, the
16:57 only way you'll know how to answer this
16:59 question is to listen to it right here.
17:01 The question is going to be worded in
17:03 the tutorial. We discussed the rebound
17:05 effect that is seen in some medications
17:06 using the example that was given in the
17:09 compulsory tutorial. Explain the rebound
17:16 occurs. Okay. Yeah, I will post that in
17:20 the chat board and uh it's posted right
17:22 now. So in the tutorial we discussed the
17:24 rebound effect that is seen in some
17:26 medications using the example that was
17:28 given in the tutorial. Explain the
17:30 rebound effect and why it
17:33 occurs. And for this one I would just
17:35 want you to use the example that we used
17:38 in module one. Let's just be consistent
17:39 and you've already been exposed to this
17:42 example. We're looking at various we
17:45 were looking at various ant acids and we
17:46 were saying that each one of them
17:49 resulted in a rebound effect. Uh that
17:51 each one of those actually resulted in a
17:53 bit of hyper acidity. If you take an ant
17:56 acid, it's good, you know, because it
17:58 relieves the uh the heartburn and that
17:59 kind of thing for a short period of
18:01 time, but then there's a little bit of a
18:03 hyper acidity. But do you recall which
18:06 one was the worst of those? Yes,
18:08 exactly. It was the calcium uh ant
18:11 acids. So they have the
18:15 greatest neutralization of stomach acid,
18:17 but they are also the ones that exhibit
18:20 the very strongest rebound effect. So as
18:22 soon as you're kind of feeling like
18:25 you're the stomach is neutralizing,
18:27 what's happening there is that the the
18:30 parietal cells detect the fact that the
18:32 stomach has a neutral environment and it
18:36 wants to hyper secrete acid. So it gets
18:39 the pH more acidic as quickly as possible.
18:41 possible.
18:43 So in answer to that question, what
18:44 you're going to say is something
18:46 something to the effect of the calcium
18:48 based antacids are an example of a drug
18:50 that exhibits a strong rebound effect.
18:52 It occurs because the neutral
18:55 environment in the stomach is detected
18:57 and the body attempts to maintain
19:00 homeostasis through a hypers secretion of
19:02 of
19:06 acid. Yeah. Yeah. I do I I I don't want
19:09 you to use my words exactly. What I' I'd
19:11 like you to do is understand what what
19:13 we're what we're talking about. So what
19:16 I said was the calcium based antacids
19:17 are an example of a drug that exhibits a
19:20 very strong rebound effect. It occurs
19:22 because the neutral environment of the
19:24 stomach is detected by the parietal
19:26 cells and the body attempts to maintain
19:29 homeostasis through a hypers secretion
19:32 of acid. So the main thing is that you
19:34 realize that a lot of drugs result in
19:37 that kind of rebound effect. There's for
19:39 instance opioid analesics and
19:41 anti-depressants and benzoazipines. You
19:44 know when you take a bzzoazipene what is
19:46 going to happen is that you know you get
19:48 really relaxed. Those are like Xanax and
19:49 Valium and and that kind of thing. You
19:52 you get really relaxed and and all
19:53 anxieties are you know diminished and
19:55 that kind of thing but then there's a
19:58 bit of a um a rebound effect where
20:00 you're actually a bit more anxious
20:03 afterwards. Stimulants do that. um nasal
20:05 decongest decongestants do that a lot of
20:08 times. Beta blockers, cortosteroids,
20:11 there's a lot of medications that have
20:14 this type of rebound effect and it's
20:16 really because of the fact that the body
20:19 is trying to maintain homeostasis. So,
20:23 it's trying to get back to that norm and
20:25 uh and yeah, that's one of the reasons
20:27 that a lot of our medications aren't
20:30 going to be tolerated very well. But the
20:32 one that you use in the quiz, the
20:33 example that you use in the quiz is
20:36 definitely the calcium based ant acids.
20:37 And the reason is because it neutralizes
20:40 the stomach acids and then the parietal
20:42 cells go overtime trying to get the
20:44 stomach acid back to normal and
20:46 inevitably that results in a short-term hyper
20:48 hyper
20:50 acidity. Okay. Yeah. Just make sure that
20:52 you mention calcium based antacids and
20:54 homeostasis and you're about
20:56 threequarters of the way there for that question.
