Compare and contrast the mechanism of action, pharmacokinetics, pharmacodynamics, and adverse effects of digoxin and levosimendan.
This question provided candidates with a clear structure and headings that were often ignored.
Candidates wasted time on pharmaceutics, derivation (“foxglove” mentioned often) and dosing – these were not requested and scored no marks. Superficial answers such as “cardiac glycoside” or “calcium sensitiser” were not adequate. Responses such as “modest” for Vd are inadequate – marks could be gained for identifying at least the direction of the difference between the two agents. Likewise “hepatic metabolism and renal excretion” is inadequate. Both agents had quantitative and qualitative differences in outcome of metabolic products and the renal elimination of active drug. Confusing diagrams with inadequate labelling, arrows with two heads and the use of uncommon abbreviations without definition all served to confuse the examiners rather than help the candidate. Candidates should read the questions carefully.