A 45-year-old man visits his GP clinic seeking sildenafil (Viagra) as he is nervous every time he is intimate with his new partner. He can still achieve his own erections and has morning erections. His recent NHS health screening blood tests were all normal, and he has normal blood pressure. The GP examines his medication history and advises him against using sildenafil. Which of the following medications listed below is not recommended to be used with sildenafil?
You assess a 52-year-old patient with hypertension who has been taking 2.5mg of ramipril for a month. He reports experiencing a persistent tickly cough that is causing him to lose sleep at night. Despite this, his blood pressure is now under control.
What recommendations would you provide to him?
Mrs Maple is an 80-year-old woman who takes warfarin for atrial fibrillation. You have prescribed a new medication for her as treatment for an infection. A repeat INR was taken 3 days after starting her treatment. The level was 6.5.
Which of the following medications is most likely to have caused this?
A 28-year-old man walks into the General Practice Surgery without an appointment, complaining of central chest pain radiating to his jaw.
On examination, he is agitated. His respiratory rate is 26 breaths per minute (normal range 12–20) and his pulse is 130 beats per minute (normal range 60–100).
An electrocardiogram (ECG) confirms an ST-elevation myocardial infarction (STEMI). An accompanying friend suspects that the patient took a drug around 30 minutes previously but is unsure what it was.
Which of the following drugs is most likely to be responsible for this patient’s symptoms?
An 80-year-old man has been taking warfarin for atrial fibrillation for the past 3 months but is having difficulty controlling his INR levels. He wonders if his diet could be a contributing factor.
What is the one food that is most likely to affect his INR levels?
A 50-year-old man presents for a routine check-up and inquires about the benefits and drawbacks of taking daily aspirin. He has normal blood pressure and his cholesterol and glucose levels are within normal limits.
What is the one accurate statement regarding the advantages and disadvantages of aspirin in primary prevention?
Which drug from the list provides the LEAST mortality benefit in chronic heart failure?
A 72-year-old woman is on ramipril, digoxin, metformin, quinine and bisoprolol. She has been experiencing mild ankle swelling lately. Following an echo, she has been urgently referred to cardiology due to moderate-severe aortic stenosis. Which of her medications should be discontinued?
A 55-year-old man presents after experiencing a panic attack at work. He reports feeling extremely hot and unable to concentrate, with a sensation of the world closing in on him. Although his symptoms have mostly subsided, he seeks medical attention. Upon examination, his pulse is 78 beats per minute, blood pressure is 188/112 mmHg, and respiratory rate is 14 breaths per minute. Fundoscopy reveals small retinal hemorrhages, but cardiovascular examination is otherwise unremarkable. The patient’s PHQ-9 score is 15 out of 27. What is the most appropriate course of action?
Sophie is a 65-year-old woman who has recently been diagnosed with atrial fibrillation after experiencing some palpitations. She has no other medical history and only takes atorvastatin for high cholesterol. She has no symptoms currently and her observations are stable with a heart rate of 75 beats per minute. Her CHA2DS2-VASc score is 0.
What would be the appropriate next step in managing Sophie’s condition?