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Question 1
Incorrect
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A 56-year-old woman with a lengthy history of rheumatoid arthritis presents to the clinic with a chief complaint of dyspnea. During the examination, her oxygen saturation is found to be 92% on room air, and spirometry reveals a restrictive pattern accompanied by a decreased transfer factor. Which medication is the most probable cause of her symptoms?
Your Answer: Ciclosporin
Correct Answer: Methotrexate
Explanation:The use of methotrexate as well as other anti-rheumatoid drugs like sulfasalazine and gold may lead to the development of lung fibrosis in patients. This patient is currently experiencing pulmonary fibrosis which could be attributed to the use of methotrexate.
Drugs that can lead to lung fibrosis
Lung fibrosis is a condition where the lung tissue becomes scarred and thickened, making it difficult for the lungs to function properly. There are several drugs that can cause lung fibrosis as a side effect. These drugs include amiodarone, which is used to treat heart rhythm problems, cytotoxic agents such as busulphan and bleomycin, which are used to treat cancer, and anti-rheumatoid drugs like methotrexate and sulfasalazine. Nitrofurantoin, an antibiotic used to treat urinary tract infections, and ergot-derived dopamine receptor agonists like bromocriptine, cabergoline, and pergolide, which are used to treat Parkinson’s disease, can also cause lung fibrosis. It is important to be aware of the potential side effects of these drugs and to discuss any concerns with a healthcare provider. Proper monitoring and management can help prevent or minimize the risk of lung fibrosis.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 2
Correct
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A patient in their early 50s with type 2 diabetes mellitus and chronic heart failure (NYHA class II) presents for a check-up. Their diabetes is currently managed through diet, but their HbA1c has increased to 64 mmol/mol (8.0%). Which of the following medications should be avoided due to contraindication?
Your Answer: Pioglitazone
Explanation:Medications to Avoid in Patients with Heart Failure
Heart failure is a serious condition that requires careful management of medications. Some medications can exacerbate heart failure and should be avoided. Thiazolidinediones, such as pioglitazone, are contraindicated as they cause fluid retention. Verapamil has a negative inotropic effect and should be used with caution. NSAIDs and glucocorticoids can also cause fluid retention and should be used with caution. However, low-dose aspirin is an exception as many patients with heart failure also have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks. Class I antiarrhythmics, such as flecainide, have a negative inotropic and proarrhythmic effect and should be avoided. It is important for healthcare providers to be aware of these medications and to carefully consider their use in patients with heart failure.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 3
Correct
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A 50-year-old man with a history of ischaemic heart disease complains of myalgia. He has been taking aspirin, simvastatin, and atenolol for a long time. A creatine kinase test is performed due to his statin use, and the results show:
Creatine kinase 1,420 u/l (< 190 u/l)
The patient's symptoms appeared after starting a new medication. Which of the following is the most probable cause of the elevated creatine kinase levels?Your Answer: Clarithromycin
Explanation:The interaction between statins and erythromycin/clarithromycin is significant and frequent, and in this case, the patient has experienced statin-induced myopathy due to clarithromycin.
Statins are drugs that inhibit the action of an enzyme called HMG-CoA reductase, which is responsible for producing cholesterol in the liver. However, they can cause some adverse effects such as myopathy, which includes muscle pain, weakness, and damage, and liver impairment. Myopathy is more common in lipophilic statins than in hydrophilic ones. Statins may also increase the risk of intracerebral hemorrhage in patients who have had a stroke before. Therefore, they should be avoided in these patients. Statins should not be taken during pregnancy and should be stopped if the patient is taking macrolides.
Statins are recommended for people with established cardiovascular disease, those with a 10-year cardiovascular risk of 10% or more, and patients with type 2 diabetes mellitus. Patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago, are over 40 years old, or have established nephropathy should also take statins. It is recommended to take statins at night as this is when cholesterol synthesis takes place. Atorvastatin 20mg is recommended for primary prevention, and the dose should be increased if non-HDL has not reduced for 40% or more. Atorvastatin 80 mg is recommended for secondary prevention. The graphic shows the different types of statins available.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 4
Correct
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A 64-year-old woman with a history of recurrent deep vein thrombosis due to antiphospholipid syndrome comes in for evaluation. She has been on warfarin for the past 8 years, with a desired INR range of 2.0 - 3.0. Her INR control is typically excellent, but her most recent reading was 1.2. What could be the reason for her current INR level?
Your Answer: Recent rifampicin as she was a contact of a patient with meningococcal meningitis
Explanation:Rifampicin induces P450 enzymes.
P450 Enzyme System and its Inducers and Inhibitors
The P450 enzyme system is responsible for metabolizing drugs in the body. Induction of this system usually requires prolonged exposure to the inducing drug, unlike P450 inhibitors, which have rapid effects. Some drugs that induce the P450 system include antiepileptics like phenytoin and carbamazepine, barbiturates such as phenobarbitone, rifampicin, St John’s Wort, chronic alcohol intake, griseofulvin, and smoking, which affects CYP1A2 and is the reason why smokers require more aminophylline.
On the other hand, some drugs inhibit the P450 system, including antibiotics like ciprofloxacin and erythromycin, isoniazid, cimetidine, omeprazole, amiodarone, allopurinol, imidazoles such as ketoconazole and fluconazole, SSRIs like fluoxetine and sertraline, ritonavir, sodium valproate, and acute alcohol intake. It is important to be aware of these inducers and inhibitors as they can affect the metabolism and efficacy of drugs in the body. Proper dosing and monitoring can help ensure safe and effective treatment.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 5
Incorrect
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What statement regarding the pharmacology of trimethoprim is correct? Choose only one option from the list.
Your Answer: It may cause marrow depression and microcytic anaemia
Correct Answer: It can be combined with sulfamethoxazole for synergistic reasons
Explanation:Understanding Trimethoprim: Uses, Synergy, and Potential Side Effects
Trimethoprim is an antimicrobial drug that is commonly used to treat urinary tract infections and prevent Pneumocystis jirovecii pneumonia. It works by inhibiting the reduction of dihydrofolic acid to tetrahydrofolic acid, which is essential for bacterial DNA synthesis. While it is often combined with sulfamethoxazole for synergistic reasons, serum level monitoring is not required for dosage guidance. However, caution should be exercised in individuals with a predisposition to folate deficiency, as trimethoprim can lower folic acid levels and lead to megaloblastic anemia. While hepatic toxicity has not been reported, it is important to be aware of potential side effects when using this medication.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 6
Correct
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Which of the following is the least commonly associated with cocaine toxicity?
Your Answer: Metabolic alkalosis
Explanation:Understanding Cocaine Toxicity
Cocaine is a popular recreational stimulant derived from the coca plant. However, its widespread use has resulted in an increase in cocaine toxicity cases. The drug works by blocking the uptake of dopamine, noradrenaline, and serotonin, leading to a variety of adverse effects.
Cardiovascular effects of cocaine include coronary artery spasm, tachycardia, bradycardia, hypertension, QRS widening, QT prolongation, and aortic dissection. Neurological effects may include seizures, mydriasis, hypertonia, and hyperreflexia. Psychiatric effects such as agitation, psychosis, and hallucinations may also occur. Other complications include ischaemic colitis, hyperthermia, metabolic acidosis, and rhabdomyolysis.
Managing cocaine toxicity involves using benzodiazepines as a first-line treatment for most cocaine-related problems. For chest pain, benzodiazepines and glyceryl trinitrate may be used, and primary percutaneous coronary intervention may be necessary if myocardial infarction develops. Hypertension can be treated with benzodiazepines and sodium nitroprusside. The use of beta-blockers in cocaine-induced cardiovascular problems is controversial, with some experts warning against it due to the risk of unopposed alpha-mediated coronary vasospasm.
In summary, cocaine toxicity can lead to a range of adverse effects, and managing it requires careful consideration of the patient’s symptoms and medical history.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 7
Correct
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A 52-year-old man has recently been diagnosed with type 2 diabetes mellitus. He was prescribed medication but a few days later he complained of stomach cramps and loose stools.
Which of the following medications is most likely responsible for these symptoms?Your Answer: Metformin
Explanation:Side Effects of Common Oral Diabetic Medications
Managing diabetes often involves the use of oral medications to help control blood sugar levels. However, these medications can come with side effects that need to be considered when choosing a treatment plan. Here are some common side effects of four oral diabetic medications:
Metformin: The most common side effects of metformin are abdominal pain, anorexia, diarrhea, nausea, taste disturbance, and vomiting. There is also a risk of developing lactic acidosis, particularly in patients with a history of heart failure and concomitant use of drugs that can acutely impair renal function.
Furosemide: Furosemide is a less likely option due to its potential to exacerbate diabetes and cause hypokalemia, which can be dangerous in certain patients. It can also cause urinary retention in patients with enlarged prostates.
Gliclazide: Gliclazide can encourage weight gain and may cause hypoglycemia if the dosage is excessive.
Pioglitazone: Pioglitazone should be used with caution in patients with cardiovascular disease or in combination with insulin due to an increased risk of heart failure, particularly in elderly people.
It is important to be familiar with these side effects to ensure patient compliance with medication and to choose the most appropriate treatment plan for each individual.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 8
Correct
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Which one of the following statements regarding metformin is not true?
Your Answer: Increases endogenous insulin secretion
Explanation:Sulphonylureas possess the characteristic of enhancing the secretion of insulin produced naturally within the body.
Metformin is a medication commonly used to treat type 2 diabetes mellitus. It belongs to a class of drugs called biguanides and works by activating the AMP-activated protein kinase (AMPK), which increases insulin sensitivity and reduces hepatic gluconeogenesis. Additionally, it may decrease the absorption of carbohydrates in the gastrointestinal tract. Unlike other diabetes medications, such as sulphonylureas, metformin does not cause hypoglycemia or weight gain, making it a first-line treatment option, especially for overweight patients. It is also used to treat polycystic ovarian syndrome and non-alcoholic fatty liver disease.
While metformin is generally well-tolerated, gastrointestinal side effects such as nausea, anorexia, and diarrhea are common and can be intolerable for some patients. Reduced absorption of vitamin B12 is also a potential side effect, although it rarely causes clinical problems. In rare cases, metformin can cause lactic acidosis, particularly in patients with severe liver disease or renal failure. However, it is important to note that lactic acidosis is now recognized as a rare side effect of metformin.
There are several contraindications to using metformin, including chronic kidney disease, recent myocardial infarction, sepsis, acute kidney injury, severe dehydration, and alcohol abuse. Additionally, metformin should be discontinued before and after procedures involving iodine-containing x-ray contrast media to reduce the risk of contrast nephropathy.
When starting metformin, it is important to titrate the dose slowly to reduce the incidence of gastrointestinal side effects. If patients experience intolerable side effects, modified-release metformin may be considered as an alternative.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 9
Correct
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A 26-year-old woman with bipolar disorder presents to the GP clinic for a medication review as she plans to conceive. She is currently prescribed lithium as a mood stabilizer. What potential fetal abnormality should be considered with this medication?
Your Answer: Ebstein's anomaly
Explanation:Cardiac foetal abnormalities, specifically Ebstein’s anomaly, can be caused by lithium. Chloramphenicol is linked to ‘Grey baby’ syndrome, while ACE inhibitors, alcohol, carbamazepine, valproate, and warfarin are associated with craniofacial abnormalities. Carbamazepine and valproate are also linked to neural tube defects.
Harmful Drugs and Medical Conditions for Developing Fetuses
During pregnancy, certain drugs and medical conditions can harm the developing fetus. These harmful substances and conditions are known as teratogens. Some of the teratogens that can cause harm to a developing fetus include ACE inhibitors, alcohol, aminoglycosides, carbamazepine, chloramphenicol, cocaine, diethylstilbesterol, lithium, maternal diabetes mellitus, smoking, tetracyclines, thalidomide, and warfarin.
ACE inhibitors can cause renal dysgenesis and craniofacial abnormalities in the fetus. Alcohol consumption during pregnancy can lead to craniofacial abnormalities. Aminoglycosides can cause ototoxicity, while carbamazepine can cause neural tube defects and craniofacial abnormalities. Chloramphenicol can cause grey baby syndrome, and cocaine can lead to intrauterine growth retardation and preterm labor.
Diethylstilbesterol can cause vaginal clear cell adenocarcinoma, while lithium can cause Ebstein’s anomaly (atrialized right ventricle). Maternal diabetes mellitus can cause macrosomia, neural tube defects, polyhydramnios, preterm labor, and caudal regression syndrome. Smoking during pregnancy can lead to preterm labor and intrauterine growth retardation. Tetracyclines can cause discolored teeth, while thalidomide can cause limb reduction defects. Finally, warfarin can cause craniofacial abnormalities in the fetus.
It is important for pregnant women to avoid exposure to these harmful substances and conditions to ensure the healthy development of their fetus.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 10
Correct
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Among the drugs listed, which one is the most probable cause of diarrhoea as a side effect? Please select only one option.
Your Answer: Lansoprazole
Explanation:Gastrointestinal Side Effects of Common Medications
Lansoprazole, a proton pump inhibitor, is known to cause gastrointestinal disturbances such as abdominal pain, constipation, flatulence, nausea, vomiting, and diarrhea. This is because it reduces the acidity of the stomach, allowing bacterial flora to proliferate.
Amitriptyline, a tricyclic antidepressant, can cause abdominal pain, anorexia, constipation, increased appetite, nausea, and weight gain or loss. However, it is not associated with diarrhea.
Calcium carbonate, a calcium supplement, can commonly cause gastrointestinal disturbances but is not known to cause diarrhea.
Carbamazepine, an anticonvulsant, commonly causes nausea and vomiting, and rarely constipation and diarrhea. The rarity of diarrhea as a side effect suggests that an alternative option may be more appropriate.
Codeine phosphate, an opioid analgesic, can cause constipation, nausea, and vomiting, but is not known to cause diarrhea.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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