A 38-year-old man is admitted to a psychiatric unit with an acute episode of psychosis. After assessment, he is diagnosed with schizophrenia. He has no medical history and is not taking any regular medications. The consultant psychiatrist plans to initiate pimozide 2 mg daily. What baseline investigation and regular monitoring are required for this medication?
A 10-year-old girl with a history of hayfever and eczema was brought to the Emergency Department, feeling unwell after being stung by a bee. The attending doctor immediately gave this girl a shot of adrenaline (epinephrine).
Which of the following is adrenaline injected to treat?
How is the distribution of a drug throughout the body quantified?
A new drug, Rosinox, is being tested to improve pain control in patients with connective tissue diseases. The company conducting the study wants to determine the appropriate dosage for the drug.
They have found that if a patient takes 500 mg of the drug orally, only 250 mg reaches the systemic circulation.
What is the term used to describe the percentage of the drug that reaches the systemic circulation?
A middle-aged man comes into the surgery because he is unhappy with a new drug that he started in the last 2 months. He claims it gives him pain in the middle of his chest and he has felt more bloated recently.
Which one of the following is most likely to account for these symptoms?
A 65-year-old man, who is taking long-term warfarin for atrial fibrillation, comes to the surgery for review. He has had a recent review at the Cardiology Clinic and you understand that he has had some of his long-term medication changed. He also has type II diabetes and has recently been started on medication for neuropathy. In addition, he is following a ‘juicing diet’ to lose weight.
Investigations:
Investigation Result Normal value
Haemoglobin 131 g/l 135–175 g/l
White cell count (WCC) 5.7 × 109/l 4–11 × 109/l
Platelets 201 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.9 mmol/l 3.5–5.0 mmol/l
Creatinine 115 µmol/l 50–120 µmol/l
International normalised ratio (INR) 4.9 (previously 2.1)
Which one of the following medications/dietary changes is most likely to be responsible?
A 55-year-old, previously healthy man, receives percutaneous intervention for coronary disease as an outpatient. He is prescribed secondary preventive and symptomatic medications upon discharge. However, a few days after starting the new medications, he develops itchy raised bumps on his upper limbs and trunk. There is no involvement of mucosa and he is otherwise well. His symptoms improve with antihistamine. Which medication is the most likely cause of his condition?
A 67-year-old woman visits her GP practice, reporting a rash and itching that have persisted for a few weeks. She feels fine otherwise and has no additional symptoms. Her medical history includes hypertension, a heart attack, and type 2 diabetes. Amlodipine, losartan, aspirin, bisoprolol, and metformin are among her medications.
During the examination, a urticarial rash is present throughout her body.
Which of her medications is the probable culprit?
A 54-year-old man with a history of diabetes, hypertension and atrial fibrillation presents to the emergency department feeling extremely unwell. He has experienced multiple episodes of diarrhea and has vomited once. Norovirus is suspected. Upon arrival, his blood pressure is 130/70 mmHg and all other observations are stable. His baseline creatinine from 3 months ago was 90 µmol/l. The following are his blood results:
Na+ 138 mmol/l
K+ 5.5 mmol/l
Urea 21 mmol/l
Creatinine 156 µmol/l
Which of his regular medications should be discontinued immediately based on these findings?
A 50-year-old patient presents for follow-up after being admitted to the hospital. The patient complains of experiencing itchy, raised red bumps on their skin. These symptoms began about 24 hours after taking their discharge medication for the first time and have progressively worsened over the past few days. The patient has no prior history of this type of reaction. Upon examination, faint pink raised patches are observed on the trunk and upper arms. Which medication is the most probable cause of the patient’s symptoms?