Q2c. 

If this patient were to retry COCs, what

counseling points could reduce her previous adverse effects (nausea and

breakthrough bleeding)?

Q2b. Which intrauterine device should be avoided

 in

this patient, and why?

Q2i. 

Explain the

pharmacological basis of nausea associated with combined oral contraceptives

and how it can be minimized. (2 marks)

Q2h. 

Explain the pharmacological mechanism of action of the

levonorgestrel-releasing intrauterine system. (2 marks)

Q1b. 

Certain antidiabetic agents exert

their therapeutic effects independently of insulin secretion or action.

Describe the key structural features, pharmacophores, and mechanisms of action

of insulin-independent antidiabetic agents and explain how their chemical

properties relate to their pharmacological effects. (4 marks)

Case Study: (12 marks)

Mr. Ahmed, a 52-year-old male, presents to the outpatient clinic for

routine follow-up.

Chief Complaints

• Increased fatigue over 3 months
• Polyuria and nocturia
• Occasional blurred vision

Medical History

• Type 2 Diabetes Mellitus

  (diagnosed 5 years ago)

• Hypertension (8 years)
• Dyslipidemia

Current Medications

• Metformin 1000 mg BID
• Amlodipine 5 mg OD
• Atorvastatin 20 mg OD

Social History

• Sedentary lifestyle
• BMI: 31 kg/m² (obese)
• Smoker (10 pack-years)

Clinical & Laboratory Findings

• BP: 142/88 mmHg
• HbA1c: 8.7%
• Fasting plasma glucose: 168 mg/dL
• eGFR: 72 mL/min/1.73m²
• LDL-C: 110 mg/dL

Additional Clinical Notes

• No history of cardiovascular

  disease

• No hypoglycemia episodes reported

• Mild peripheral neuropathy

  symptoms

Q1a. Analyze the patient’s current clinical status and evaluate an appropriate

individualized treatment plan based on recent IDF guidelines. Justify your

therapeutic choices. (4 marks)

Q1d. 

Compare the risk of hypoglycemia

between SGLT2 inhibitors and sulfonylureas.

Q1c. 

Explain the pharmacological mechanism

of action of Empagliflozin and justify its use in this patient. (4 marks)