It is quite possible to spend the entire ten minutes writing an answer to a SAQ and score zero. To avoid this, your SAQ (and viva) should consist of verifiable facts which are specific to the question asked.
Let us consider how we could achieve a zero score in the hypothetical question: “Write short notes on novifentanil”
We could start with a definition:
- Drug: a medicine or other substance which has a physiological effect when ingested or otherwise introduced into the body.
Now we can segue into some value judgements:
- Novifentanil is a useful drug.
- I recommend it
- It is cheap and readily available. (An answer often given in vivas: So are THC, crack and ice)
- Novifentanil is potent
We will now conclude with some statements which are worthless because they could be applied to (almost) any drug.
- The intravenous preparation is a sterile clear colourless solution
- When given intravenously it has 100% bioavailability
- When given orally it is absorbed in the gut and undergoes first pass metabolism
- It is metabolised in the liver
- Metabolites are excreted in the kidneys
- It acts on receptors
- Side effects include nausea, vomiting rash and rarely anaphylaxis
- Contraindications include allergic reaction
We could alternatively score high marks by covering the same issues:
- potent: Compare the potency with other drugs in this class. Does the potency have any other implications, such as altering time to peak effect?
- useful: What is it particularly useful for compared with other drugs in the same class?
- clear colourless solution: Why is it clear?
- Is it intrinsically water soluble, is it an ionisable acid or base, is it dissolved in an additive such as propylene glycol?
- What problems might the additives cause?
- Is it safe to give it neuraxially?
- Will it exhibit ion-trapping?
- first pass metabolism: Does this imply anything about whether or not the drug is effective orally?
- metabolism: It is very easy to get lost in the metabolic pathways. Some of the important things to figure out are:
- are there any active metabolites
- is there any genetic / drug interaction consequences of the pathways which are used? What will this imply in patients with liver disease? If it is metabolised by an enzyme such as CYP3A4 where you probably won’t see many interactions this is also important. (There are some exceptions to this such as St John’s Wort.)
- excreted renally: Does it have active metabolites? Is it excreted unchanged renally? Is it reabsorbed or secreted? If none of these, how is it affected by renal failure?
- receptors: state which ones and what effects these cause
- Side effects:
- are they different or the same as other drugs in the same class?
- are there any specific side effects which you need to mention?
- are there any class specific side effects that this drug does not exhibit?
- I recommend it: are there any specific indications for which it is recommended?