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Question 1
Correct
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A 65-year-old woman is admitted to hospital with community-acquired pneumonia. She has developed acute kidney injury. Her blood results show the following:
Test Result Reference range
Potassium (K) (mmol/l) 6.0 3.5-5.3
Creatine (Cr) (μmol/l) 220
Male: 80-110
Female: 70-100
Which of the following of her medications should be stopped immediately?
Your Answer: Ramipril
Explanation:Medication and Renal Impairment: Considerations and Dose Adjustments
When prescribing medication for patients with renal impairment, it is important to consider the potential for inducing or worsening kidney damage. Here are some considerations and dose adjustments for commonly prescribed medications:
Ramipril: This ACE inhibitor has the potential to cause hypotension, which can lead to impaired kidney function. In patients with stable renal impairment, a maximum daily dose of 5 mg can be considered. The initial dose should not exceed 1.25 mg daily if eGFR is <30 ml/min per 1.73 m2. Bisoprolol: This medication is not associated with inducing or worsening kidney damage. However, the dose should be reduced if eGFR is lower than 20 ml/min per 1.73 m2 (maximum 10 mg daily). Paracetamol: At therapeutic doses, paracetamol is not associated with kidney damage. However, in overdose, it can cause renal damage. The minimum interval between doses should be six hours if eGFR is <30 ml/min per 1.73 m2. Fluticasone with salmeterol: Neither component of this inhaler is associated with kidney damage and does not require dose adjustment in patients with renal disease. Simvastatin: Statins should be used with caution in patients with renal impairment, as the likelihood of muscle toxicity increases with higher doses. Doses >10 mg daily should be used with caution if eGFR is lower than 30 ml/min per 1.73 m2.
In summary, medication dosing and selection should be carefully considered in patients with renal impairment to avoid potential kidney damage and ensure optimal therapeutic outcomes.
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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 70-year-old male has been admitted to the cardiology ward following his presentation to the emergency department with palpitations and dyspnoea. After further investigations, he was diagnosed with atrial fibrillation and prescribed digoxin for rate control. What is the recommended frequency for routine drug monitoring in this case?
Your Answer: No routine monitoring required
Explanation:Digoxin levels do not require regular monitoring, unless there is suspicion of toxicity. As this patient is commencing digoxin and has no signs of toxicity, routine monitoring is unnecessary. It is not necessary to measure digoxin levels every month until they have stabilized, nor is it appropriate to monitor the drug every 2 weeks for the first 3 months. Routine monitoring is also not required annually throughout the course of treatment.
Understanding Digoxin and Its Toxicity
Digoxin is a medication used for rate control in atrial fibrillation and for improving symptoms in heart failure patients. It works by decreasing conduction through the atrioventricular node and increasing the force of cardiac muscle contraction. However, it has a narrow therapeutic index and requires monitoring for toxicity.
Toxicity may occur even when the digoxin concentration is within the therapeutic range. Symptoms of toxicity include lethargy, nausea, vomiting, anorexia, confusion, yellow-green vision, arrhythmias, and gynaecomastia. Hypokalaemia is a classic precipitating factor, as it allows digoxin to more easily bind to the ATPase pump and increase its inhibitory effects. Other factors that may contribute to toxicity include increasing age, renal failure, myocardial ischaemia, electrolyte imbalances, hypoalbuminaemia, hypothermia, hypothyroidism, and certain medications such as amiodarone, quinidine, and verapamil.
Management of digoxin toxicity involves the use of Digibind, correction of arrhythmias, and monitoring of potassium levels. It is important to recognize the potential for toxicity and monitor patients accordingly to prevent adverse outcomes.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 3
Incorrect
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Which of the following is a contraindication to using a triptan for treating migraines in elderly patients?
Your Answer: A history of epilepsy
Correct Answer: A history of ischaemic heart disease
Explanation:Triptan use is contraindicated in individuals with cardiovascular disease.
Triptans for Migraine Treatment
Triptans are medications that act as agonists for 5-HT1B and 5-HT1D receptors and are commonly used in the acute treatment of migraines. They are often prescribed in combination with NSAIDs or paracetamol and are typically taken as soon as possible after the onset of a headache, rather than at the onset of an aura. Triptans are available in various forms, including oral tablets, orodispersible tablets, nasal sprays, and subcutaneous injections.
While triptans are generally well-tolerated, some patients may experience triptan sensations, such as tingling, heat, tightness in the throat and chest, heaviness, or pressure. It is important to note that triptans are contraindicated in patients with a history of or significant risk factors for ischaemic heart disease or cerebrovascular disease.
In summary, triptans are a commonly used medication for the acute treatment of migraines. They should be taken as soon as possible after the onset of a headache and are available in various forms. However, patients should be aware of potential adverse effects and contraindications before taking triptans.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 4
Incorrect
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A patient in her late 60s is hospitalized with digoxin toxicity. Which of her medications is the most probable cause of this condition?
Your Answer: Doxycycline
Correct Answer: Diltiazem
Explanation:The use of diltiazem can lead to the development of digoxin toxicity.
Understanding Digoxin and Its Toxicity
Digoxin is a medication used for rate control in atrial fibrillation and for improving symptoms in heart failure patients. It works by decreasing conduction through the atrioventricular node and increasing the force of cardiac muscle contraction. However, it has a narrow therapeutic index and requires monitoring for toxicity.
Toxicity may occur even when the digoxin concentration is within the therapeutic range. Symptoms of toxicity include lethargy, nausea, vomiting, anorexia, confusion, yellow-green vision, arrhythmias, and gynaecomastia. Hypokalaemia is a classic precipitating factor, as it allows digoxin to more easily bind to the ATPase pump and increase its inhibitory effects. Other factors that may contribute to toxicity include increasing age, renal failure, myocardial ischaemia, electrolyte imbalances, hypoalbuminaemia, hypothermia, hypothyroidism, and certain medications such as amiodarone, quinidine, and verapamil.
Management of digoxin toxicity involves the use of Digibind, correction of arrhythmias, and monitoring of potassium levels. It is important to recognize the potential for toxicity and monitor patients accordingly to prevent adverse outcomes.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 5
Correct
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A 68-year-old man presents to his GP with symptoms of urinary frequency, mild incontinence, and nocturia. Upon rectal examination, an enlarged and nontender prostate is noted, leading to a diagnosis of benign prostatic hyperplasia. The patient is prescribed finasteride. What is the mechanism of action of finasteride?
Your Answer: It is a 5-alpha reductase inhibitor
Explanation:Finasteride inhibits 5-alpha reductase, an enzyme that converts testosterone to DHT, and is prescribed for benign prostatic hyperplasia. This reduces the size of the prostate. Trimethoprim binds to dihydrofolate reductase, which interferes with bacterial DNA synthesis. Tamsulosin is an alpha blocker that selectively blocks alpha 1 receptors in the bladder neck and prostate, causing smooth muscle relaxation. Oxybutynin competitively antagonizes muscarinic receptors on the bladder, providing a direct spasmolytic effect on the bladder smooth muscle. Sildenafil inhibits cGMP specific phosphodiesterase type 5, improving blood flow to the penis and treating erectile dysfunction.
Understanding Finasteride: Its Uses and Side Effects
Finasteride is a medication that works by inhibiting the activity of 5 alpha-reductase, an enzyme responsible for converting testosterone into dihydrotestosterone. This drug is commonly used to treat benign prostatic hyperplasia and male-pattern baldness.
However, like any medication, finasteride has its own set of adverse effects. Some of the most common side effects include impotence, decreased libido, ejaculation disorders, gynaecomastia, and breast tenderness. It is important to note that finasteride can also cause decreased levels of serum prostate-specific antigen.
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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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A 25-year-old man presents to the emergency department with symptoms of nausea and vomiting. An F1 administers metoclopramide, but 20 minutes later the patient reports feeling as though his eyes are stuck in an abnormal position and he cannot move them. What is the likely cause of this man's symptoms?
Your Answer: Acute dystonia
Explanation:The administration of metoclopramide can result in extrapyramidal side effects, with acute dystonia being the earliest and most common. This can lead to oculogyric crises, particularly in young individuals. Long-term side effects may include akathisia, parkinsonism, and tardive dyskinesia. The patient’s history does not suggest an allergic reaction, as there were no symptoms such as facial or lip swelling, breathing or circulatory issues, or the presence of a rash.
Metoclopramide is a medication that is commonly used to manage nausea. It works by blocking D2 receptors in the chemoreceptor trigger zone, which helps to alleviate feelings of sickness. In addition to its antiemetic properties, metoclopramide also has other uses, such as treating gastro-oesophageal reflux disease and gastroparesis caused by diabetic neuropathy. It is often combined with analgesics to treat migraines, which can cause gastroparesis and slow the absorption of pain medication.
However, metoclopramide can have some adverse effects, such as extrapyramidal effects, acute dystonia, diarrhoea, hyperprolactinaemia, tardive dyskinesia, and parkinsonism. These side effects are particularly problematic in children and young adults. It is important to note that metoclopramide should not be used in cases of bowel obstruction, but it may be helpful in cases of paralytic ileus.
Although metoclopramide primarily works as a D2 receptor antagonist, its mechanism of action is quite complex. It also acts as a mixed 5-HT3 receptor antagonist and 5-HT4 receptor agonist. The antiemetic effects of metoclopramide are due to its D2 receptor antagonist activity in the chemoreceptor trigger zone, while its gastroprokinetic effects are mediated by both D2 receptor antagonist and 5-HT4 receptor agonist activity. At higher doses, the 5-HT3 receptor antagonist activity also comes into play.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 7
Incorrect
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A 65-year-old male is prescribed simvastatin for hyperlipidaemia. What is the most probable interaction with his medication?
Your Answer: Cranberry juice
Correct Answer: Grapefruit juice
Explanation:The enzyme CYP3A4, which belongs to the cytochrome P450 family, is strongly inhibited by grapefruit juice.
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 8
Correct
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A 32-year-old patient who is 30 weeks' pregnant with her first baby is urgently referred by her GP to the Obstetric/Endocrine Joint Clinic with newly diagnosed symptomatic hyperthyroidism.
Which of the following statements is true concerning the management of maternal thyrotoxicosis in pregnancy with carbimazole or propylthiouracil?Your Answer: Propylthiouracil crosses the placenta
Explanation:Thyroid Management During Pregnancy: Considerations and Recommendations
Pregnancy can have a significant impact on thyroid function, and thyroid dysfunction can occur in many pregnant women due to pathological processes. Anti-thyroid drugs such as propylthiouracil and carbimazole can cross the placenta, potentially causing fetal goitre and hypothyroidism. It is recommended to keep the dose of these drugs as low as possible to maintain euthyroidism during pregnancy. Neonatal goitre and hypothyroidism can occur even with low-dose anti-thyroid drugs, and the neonatal goitre is permanent if it occurs.
Block-and-replace therapy with carbimazole and thyroxine is appropriate maternal management only in the treatment of isolated fetal hyperthyroidism caused by maternal TSH receptor antibody production in a mother who previously received ablative therapy for Graves’ disease. The neonatal goitre and hypothyroidism normalise in a few days’ time, and the confirmatory tests will come back normal even if the TSH is high on screening.
Specialist assessment is needed to differentiate between Graves’ hyperthyroidism and gestational hyperthyroidism. Women treated with anti-thyroid drugs may need to have the drug or dose amended by a specialist at the diagnosis of pregnancy, because these drugs cross the placenta. Women with current or previous Graves’ disease should have their TSH receptor antibody levels measured by the specialist. Carbimazole and propylthiouracil are present in breast milk, but this does not preclude breastfeeding as long as neonatal development is closely monitored and the lowest effective dose is used.
In summary, thyroid management during pregnancy requires careful consideration and monitoring to ensure the health of both the mother and the fetus.
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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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Which of the following statements about saxagliptin is true?
Your Answer: It is a DPP-4 inhibitor
Explanation:Saxagliptin: A DPP-4 Inhibitor for Type 2 Diabetes Treatment
Saxagliptin is an oral hypoglycaemic drug that belongs to the dipeptidyl peptidase-4 (DPP-4) inhibitor class. Its mechanism of action involves slowing down the breakdown of incretin hormones, which stimulates insulin production and reduces gluconeogenesis in the liver. Compared to sitagliptin, saxagliptin has a shorter half-life. It is safe to use in patients with mild to moderate renal impairment, but should be avoided in severe cases. Saxagliptin is recommended as first-line therapy for type 2 diabetes in combination with other drugs or as initial monotherapy if metformin is contraindicated or not tolerated. However, its use during pregnancy and breastfeeding should be avoided due to potential toxicity. Regular monitoring of renal function is necessary before and during saxagliptin treatment.
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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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You are conducting a medication review for a 67-year-old man who has a history of cerebrovascular disease (having suffered a stroke 3 years ago), depression, and knee osteoarthritis. He is currently taking the following medications:
- Clopidogrel 75 mg once daily
- Simvastatin 20 mg once daily
- Amlodipine 5mg once daily
- Ramipril 10mg once daily
- Diclofenac 50mg as needed
- Sertraline 50mg once daily
What changes would you recommend to his medication regimen?Your Answer: Switch diclofenac for an alternative NSAID
Explanation:The use of diclofenac is now prohibited for individuals with any type of cardiovascular ailment.
MHRA Guidance on Diclofenac and Cardiovascular Safety
The MHRA has updated its guidance on diclofenac, a nonsteroidal anti-inflammatory drug (NSAID), after a Europe-wide review of cardiovascular safety. While it has been known for some time that NSAIDs may increase the risk of cardiovascular events, the evidence base has become clearer. Diclofenac is associated with a significantly higher risk of cardiovascular events compared to other NSAIDs. Therefore, it is contraindicated in patients with ischaemic heart disease, peripheral arterial disease, cerebrovascular disease, and congestive heart failure (New York Heart Association classification II-IV). Patients should switch from diclofenac to other NSAIDs such as naproxen or ibuprofen, except for topical diclofenac. Studies have shown that naproxen and low-dose ibuprofen have the best cardiovascular risk profiles of the NSAIDs.
The MHRA’s updated guidance on diclofenac and cardiovascular safety highlights the increased risk of cardiovascular events associated with this NSAID compared to other NSAIDs. Patients with certain conditions are advised to avoid diclofenac and switch to other NSAIDs. This guidance is important for healthcare professionals to consider when prescribing NSAIDs to patients with cardiovascular risk factors.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 11
Correct
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A 70-year-old hypertensive man with asthma, heart failure and peptic ulcer disease reports experiencing yellowish-green halos for the past week. He has also been feeling nauseous and has lost his appetite. Despite his conditions being well controlled, physical examination reveals no abnormalities. Which of the following medications that he is taking could potentially be responsible for his current symptoms?
Your Answer: Digoxin
Explanation:Common Side Effects and Risks of Medications
Digoxin Toxicity: Symptoms and Risk Factors
Digoxin toxicity can cause vague symptoms such as anorexia, nausea, confusion, and fatigue, as well as dysrhythmias. Risk factors for toxicity include imbalances in potassium, magnesium, and calcium levels.Salbutamol: Common Side Effects and Hypokalaemia
Salbutamol may cause fine tremors, anxiety, headaches, and muscle cramps. Prolonged use or high doses can lead to hypokalaemia, which is especially concerning in patients with renal failure.Enalapril: Common Side Effects and Serious Risks
Enalapril therapy may cause raised serum creatinine, dizziness, hypotension, syncope, and dry cough. The most serious risk is angio-oedema, which can obstruct airways.Ranitidine: Common Side Effects
H2-receptor antagonists like ranitidine may cause diarrhea, dizziness, and headaches.Aspirin: Contraindications
Aspirin should be avoided in patients with a history of hypersensitivity to NSAIDs or gastritis/peptic ulcer disease due to the increased risk of gastrointestinal bleeding. -
This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 12
Correct
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A 70-year-old man in the cardiology ward is experiencing muscle cramps, palpitations, and constipation. Upon conducting blood tests, the following results were obtained: Sodium 140 mmol/L, Potassium 3.1mmol/L, Calcium 2.2mmol/L, Phosphate 1.1mmol/L, and Magnesium 0.7mmol/L. Which medication is the most probable cause of this disturbance?
Your Answer: Bumetanide
Explanation:Hypokalaemia is a possible adverse effect of loop diuretics, such as bumetanide. Other potential side effects of bumetanide include hypocalcaemia, metabolic alkalosis, ototoxicity, and gout. Digoxin toxicity may lead to hyperkalaemia, but not hypokalaemia. Ace inhibitors like enalapril are more likely to cause hyperkalaemia than hypokalaemia, and may also result in dry cough, hypotension, and angioedema. Propranolol, a non-selective beta blocker, is not typically associated with hypokalaemia, but may cause bronchospasm, hypertriglyceridemia, and hypoglycaemia.
Loop Diuretics: Mechanism of Action and Indications
Loop diuretics, such as furosemide and bumetanide, are medications that inhibit the Na-K-Cl cotransporter (NKCC) in the thick ascending limb of the loop of Henle. This reduces the absorption of NaCl and increases the excretion of water and electrolytes, making them effective in treating conditions such as heart failure and resistant hypertension. Loop diuretics act on NKCC2, which is more prevalent in the kidneys.
As loop diuretics work on the apical membrane, they must first be filtered into the tubules by the glomerulus before they can have an effect. This means that patients with poor renal function may require higher doses to achieve a sufficient concentration within the tubules.
Loop diuretics are commonly used in the treatment of heart failure, both acutely (usually intravenously) and chronically (usually orally). They are also effective in treating resistant hypertension, particularly in patients with renal impairment.
However, loop diuretics can have adverse effects, including hypotension, hyponatremia, hypokalemia, hypomagnesemia, hypochloremic alkalosis, ototoxicity, hypocalcemia, renal impairment (from dehydration and direct toxic effect), hyperglycemia (less common than with thiazides), and gout.
In summary, loop diuretics are effective medications for treating heart failure and resistant hypertension, but their use should be carefully monitored due to potential adverse effects. Patients with poor renal function may require higher doses to achieve therapeutic effects.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 13
Incorrect
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A 72-year-old man with a history of atrial fibrillation and ischaemic heart disease is experiencing symptoms suggestive of a chest infection. He is currently taking amiodarone, warfarin, and simvastatin. Which antibiotic should be avoided, if possible?
Your Answer: Cefaclor
Correct Answer: Erythromycin
Explanation:Macrolides: Antibiotics that Inhibit Bacterial Protein Synthesis
Macrolides are a class of antibiotics that include erythromycin, clarithromycin, and azithromycin. They work by blocking translocation, which inhibits bacterial protein synthesis. While they are generally considered bacteriostatic, their effectiveness can vary depending on the dose and type of organism being treated.
Resistance to macrolides can occur through post-transcriptional methylation of the 23S bacterial ribosomal RNA. Adverse effects of macrolides include prolongation of the QT interval and gastrointestinal side-effects, with nausea being less common with clarithromycin than erythromycin. Cholestatic jaundice is also a potential risk, although using erythromycin stearate may reduce this risk. Additionally, macrolides are known to inhibit the cytochrome P450 isoenzyme CYP3A4, which can cause interactions with other medications. For example, taking macrolides concurrently with statins significantly increases the risk of myopathy and rhabdomyolysis. Azithromycin is also associated with hearing loss and tinnitus.
Overall, macrolides are a useful class of antibiotics that can effectively treat bacterial infections. However, it is important to be aware of their potential adverse effects and interactions with other medications.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 14
Incorrect
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A 30-year-old farmer with a history of depression arrives at the emergency department complaining of blurred vision, runny nose, watery eyes, diarrhoea, and vomiting. The patient admits to ingesting a pesticide in an attempt to commit suicide. What other clinical manifestations should be anticipated in this individual?
Your Answer: Dilated pupils
Correct Answer: Bradycardia
Explanation:This individual is displaying symptoms consistent with organophosphate poisoning, which is a type of pesticide. Organophosphate pesticides work by inhibiting acetylcholinesterase, which affects the nervous system. This causes an accumulation of acetylcholine at nerve synapses and neuromuscular junctions, resulting in excessive stimulation of muscarinic and nicotinic receptors. As a result, bradycardia is a common symptom. The recommended treatment for organophosphate poisoning is atropine, which should be administered every 10-20 minutes until secretions dry up and the heart rate increases to 80-90 beats per minute.
The options of dilated pupils, dry mouth, and hallucinations are incorrect. Organophosphate poisoning typically causes miosis (constricted pupils) due to overstimulation of the parasympathetic system, excessive secretions including salivation, bronchial secretions, diarrhea, and vomiting. While confusion, agitation, and coma may occur in severe cases, hallucinations are not a common symptom.
Understanding Organophosphate Insecticide Poisoning
Organophosphate insecticide poisoning is a condition that occurs when there is an accumulation of acetylcholine in the body, leading to the inhibition of acetylcholinesterase. This, in turn, causes an upregulation of nicotinic and muscarinic cholinergic neurotransmission. In warfare, sarin gas is a highly toxic synthetic organophosphorus compound that has similar effects. The symptoms of organophosphate poisoning can be remembered using the mnemonic SLUD, which stands for salivation, lacrimation, urination, and defecation/diarrhea. Other symptoms include hypotension, bradycardia, small pupils, and muscle fasciculation.
The management of organophosphate poisoning involves the use of atropine, which helps to counteract the effects of acetylcholine. However, the role of pralidoxime in the treatment of this condition is still unclear. Meta-analyses conducted to date have failed to show any clear benefit of pralidoxime in the management of organophosphate poisoning.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 15
Incorrect
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A 65-year-old woman comes to her doctor complaining of dysuria and increased urinary frequency. She is in good health otherwise and does not show any signs of sepsis. During a urine dip test at the doctor's office, blood, leukocytes, protein, and nitrites are detected. The patient has a medical history of asthma, which she manages with salbutamol and beclomethasone inhalers, hypertension, which she treats with amlodipine 10mg daily and ramipril 5mg daily, and stage 3 chronic kidney disease. Which antibiotic should be avoided when treating this patient's urinary tract infection?
Your Answer: Trimethoprim
Correct Answer: Nitrofurantoin
Explanation:When prescribing antibiotics for patients with chronic kidney disease (CKD), it is important to consider the patient’s level of renal function. Nitrofurantoin, an antibiotic commonly used to treat urinary tract infections, should be avoided in patients with CKD stage 3 or higher due to the risk of treatment failure and potential side effects caused by drug accumulation. Nitrofurantoin requires adequate glomerular filtration to be effective, and an eGFR of less than 40-60ml/min means the drug is unlikely to work. Additionally, nitrofurantoin can cause side effects such as peripheral neuropathy, hepatotoxicity, and pulmonary reactions and fibrosis, particularly in patients with impaired renal function. Amoxicillin and co-amoxiclav are safer options for patients with CKD, although dose reduction may be necessary in severe cases. Ciprofloxacin also requires dose reduction in CKD to avoid crystalluria. Patients taking nitrofurantoin should be aware that the drug may cause urine discoloration, and it is generally safe to use during pregnancy except at full term.
Prescribing for Patients with Renal Failure
When it comes to prescribing medication for patients with renal failure, it is important to be aware of which drugs to avoid and which ones require dose adjustment. Antibiotics such as tetracycline and nitrofurantoin should be avoided, as well as NSAIDs, lithium, and metformin. These drugs can potentially harm the kidneys or accumulate in the body, leading to toxicity.
On the other hand, some drugs can be used with dose adjustment. Antibiotics like penicillins, cephalosporins, vancomycin, gentamicin, and streptomycin, as well as medications like digoxin, atenolol, methotrexate, sulphonylureas, furosemide, and opioids, may require a lower dose in patients with chronic kidney disease. It is important to monitor these patients closely and adjust the dose as needed.
Finally, there are some drugs that are relatively safe to use in patients with renal failure. Antibiotics like erythromycin and rifampicin, as well as medications like diazepam and warfarin, can sometimes be used at normal doses depending on the degree of chronic kidney disease. However, it is still important to monitor these patients closely and adjust the dose if necessary.
In summary, prescribing medication for patients with renal failure requires careful consideration of the potential risks and benefits of each drug. By avoiding certain drugs, adjusting doses of others, and monitoring patients closely, healthcare providers can help ensure the safety and effectiveness of treatment.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 16
Correct
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A 61-year-old man with a known history of type 2 diabetes mellitus, atrial fibrillation and epilepsy presents with a complaint of feeling generally unwell. He reports a blue tinge to his vision. Which medication is most likely responsible for this symptom?
Your Answer: Sildenafil
Explanation:Drug-induced visual alterations
Viagra, also known as ‘the blue pill’, can cause blue-tinted vision. Digoxin, on the other hand, may result in yellow-green vision.Understanding Phosphodiesterase Type V Inhibitors
Phosphodiesterase type V (PDE5) inhibitors are medications used to treat erectile dysfunction and pulmonary hypertension. These drugs work by increasing the levels of cGMP, which leads to the relaxation of smooth muscles in the blood vessels supplying the corpus cavernosum. The most well-known PDE5 inhibitor is sildenafil, also known as Viagra, which was the first drug of its kind. It is a short-acting medication that is usually taken one hour before sexual activity.
Other PDE5 inhibitors include tadalafil (Cialis) and vardenafil (Levitra). Tadalafil is longer-acting than sildenafil and can be taken on a regular basis, while vardenafil has a similar duration of action to sildenafil. However, these drugs are not suitable for everyone. Patients taking nitrates or related drugs, those with hypotension, and those who have had a recent stroke or myocardial infarction should not take PDE5 inhibitors.
Like all medications, PDE5 inhibitors can cause side effects. These may include visual disturbances, blue discolouration, non-arteritic anterior ischaemic neuropathy, nasal congestion, flushing, gastrointestinal side-effects, headache, and priapism. It is important to speak to a healthcare professional before taking any medication to ensure that it is safe and appropriate for you.
Overall, PDE5 inhibitors are an effective treatment for erectile dysfunction and pulmonary hypertension. However, they should only be used under the guidance of a healthcare professional and with careful consideration of the potential risks and benefits.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 17
Correct
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A 35-year-old man presents with a 5-month history of cough, fever, and unexplained weight loss. Acid-fast bacilli are detected in his sputum culture. He is prescribed a drug regimen consisting of isoniazid and rifampicin for 6 months, along with ethambutol and pyrazinamide for the first 2 months. Additionally, he is advised to take pyridoxine to prevent which complication?
Your Answer: Peripheral neuropathy
Explanation:Prescribing pyridoxine can help lower the risk of peripheral neuropathy associated with isoniazid.
Side-Effects and Mechanism of Action of Tuberculosis Drugs
Rifampicin is a drug that inhibits bacterial DNA dependent RNA polymerase, which prevents the transcription of DNA into mRNA. However, it is a potent liver enzyme inducer and can cause hepatitis, orange secretions, and flu-like symptoms.
Isoniazid, on the other hand, inhibits mycolic acid synthesis. It can cause peripheral neuropathy, which can be prevented with pyridoxine (Vitamin B6). It can also cause hepatitis and agranulocytosis. Additionally, it is a liver enzyme inhibitor.
Pyrazinamide is converted by pyrazinamidase into pyrazinoic acid, which in turn inhibits fatty acid synthase (FAS) I. However, it can cause hyperuricaemia, leading to gout, as well as arthralgia, myalgia, and hepatitis.
Lastly, Ethambutol inhibits the enzyme arabinosyl transferase, which polymerizes arabinose into arabinan. It can cause optic neuritis, so it is important to check visual acuity before and during treatment. Additionally, the dose needs adjusting in patients with renal impairment.
In summary, these tuberculosis drugs have different mechanisms of action and can cause various side-effects. It is important to monitor patients closely and adjust treatment accordingly to ensure the best possible outcomes.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 18
Correct
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Which one of the following statements regarding metformin is true?
Your Answer: Should be stopped in a patient admitted with a myocardial infarction
Explanation:After a heart attack, Metformin usage should be discontinued as it can increase the risk of lactic acidosis. However, it can be reintroduced at a later time. To manage diabetes, an insulin/dextrose infusion such as the DIGAMI regimen can be used.
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 19
Correct
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Concurrent use of which one of the following would decrease the effectiveness of the combined oral contraceptive pill for a 25-year-old woman?
Your Answer: Carbamazepine
Explanation: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 20
Correct
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A 26-year-old female patient arrives with a sudden onset of pain at the back of her ankle while jogging, accompanied by a cracking sound. Which medication from the following list could have played a role in causing this injury?
Your Answer: Ciprofloxacin
Explanation:The patient is displaying typical symptoms of a ruptured Achilles tendon, which can be caused by ciprofloxacin. Tendon damage is a known potential side effect of quinolone antibiotics, and it seems to be a rare reaction that can occur after just 8 days of treatment.
Understanding Quinolones: Antibiotics that Inhibit DNA Synthesis
Quinolones are a type of antibiotics that are known for their bactericidal properties. They work by inhibiting DNA synthesis, which makes them effective in treating bacterial infections. Some examples of quinolones include ciprofloxacin and levofloxacin.
The mechanism of action of quinolones involves inhibiting topoisomerase II (DNA gyrase) and topoisomerase IV. However, bacteria can develop resistance to quinolones through mutations to DNA gyrase or by using efflux pumps that reduce the concentration of quinolones inside the cell.
While quinolones are generally safe, they can have adverse effects. For instance, they can lower the seizure threshold in patients with epilepsy and cause tendon damage, including rupture, especially in patients taking steroids. Additionally, animal models have shown that quinolones can damage cartilage, which is why they are generally avoided in children. Quinolones can also lengthen the QT interval, which can be dangerous for patients with heart conditions.
Quinolones should be avoided in pregnant or breastfeeding women and in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Overall, understanding the mechanism of action, mechanism of resistance, adverse effects, and contraindications of quinolones is important for their safe and effective use in treating bacterial infections.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 21
Correct
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A 32-year-old woman is diagnosed with breast cancer. After undergoing a wide local excision, it is discovered that the tumour is oestrogen-receptor positive. To lower the risk of recurrence, she is prescribed tamoxifen as adjuvant treatment. What is the most probable adverse effect she may encounter?
Your Answer: Hot flushes
Explanation:Hot flushes are a common side effect of tamoxifen, a medication used to treat oestrogen-receptor positive breast cancer by selectively blocking oestrogen receptors. Other side effects are similar to those experienced during menopause due to the systemic blockade of oestrogen receptors. Tamoxifen does not cause deep vein thrombosis (DVT) in itself, but patients taking it are at a higher risk of developing DVT during periods of immobility. Patients with a personal or family history of unprovoked thromboembolism should not start tamoxifen treatment. Tamoxifen increases the risk of developing endometrial cancer over time, but the risk is still lower than that of experiencing hot flushes. Hair thinning, rather than hair loss, is a possible side effect of tamoxifen. Tamoxifen may also cause headaches, including migraines, but this occurs less frequently than hot flushes.
Tamoxifen: A SERM for Breast Cancer Management
Tamoxifen is a medication that belongs to the class of Selective oEstrogen Receptor Modulators (SERMs). It works by acting as an antagonist to the oestrogen receptor while also partially agonizing it. This medication is commonly used in the management of breast cancer that is positive for oestrogen receptors. However, tamoxifen can cause some adverse effects such as menstrual disturbances like vaginal bleeding and amenorrhoea, hot flushes, venous thromboembolism, and endometrial cancer. Climacteric side-effects are also common, with 3% of patients stopping tamoxifen due to this reason. Typically, tamoxifen is used for five years after the removal of the tumour. For those who are at risk of endometrial cancer, raloxifene is a better option as it is a pure oestrogen receptor antagonist and carries a lower risk of endometrial cancer.
Overall, tamoxifen is a useful medication for the management of breast cancer that is positive for oestrogen receptors. However, it is important to be aware of the potential adverse effects that it can cause. Patients who experience any of these side-effects should consult their healthcare provider. Additionally, for those who are at risk of endometrial cancer, raloxifene may be a better option to consider.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 22
Correct
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A 68-year-old woman with chronic osteoarthritis to multiple joints has been managed on morphine modified-release for several months. She currently takes 30 mg morphine modified-release twice daily. She has also been using Oramorph 10 mg four times daily for the past week because the twice-daily, 30-mg morphine modified-release has not been helping. You decide to increase the total dose of modified-release morphine.
Which of the following is the most appropriate dose of morphine modified-release?
Select the SINGLE most appropriate dose from the list below. Select ONE option only.Your Answer: Morphine modified-release 50 mg twice daily
Explanation:Understanding Opioid Conversion and Dosage Adjustments
When managing pain in patients with advanced and progressive disease, strong opioids such as morphine are often used. However, as the patient’s condition changes, adjustments to the dosage and type of opioid may be necessary.
For example, if a patient is using a total of 100 mg of morphine in 24 hours and requires increased use of Oramorph PRN, it may be appropriate to increase the total daily dose of morphine modified-release. To calculate the new dose, simply add the total amount of morphine used in 24 hours and divide by 2, which gives a twice-daily dose for morphine modified-release.
It is important to note that transdermal patch formulations should not be routinely offered to patients for whom oral opioids are suitable. If a patient requires additional pain relief, other options such as adding a fentanyl patch may be considered.
When converting between different opioids, it is important to consult the BNF or local guidance for equi-analgesic potencies. For example, 10 mg of oral morphine is equivalent to 100 mg of codeine phosphate or dihydrocodeine, 1.3 mg of hydromorphone, 5 mg of oxycodone, 25 mg of tapentadol, or 67 mg of tramadol.
Dosage adjustments should always be undertaken with specialist advice, especially when converting to or from methadone. Transdermal opioids also require careful consideration, with buprenorphine and fentanyl patches available in various strengths and corresponding oral morphine equivalents.
In summary, understanding opioid conversion and dosage adjustments is crucial for effective pain management in patients with advanced and progressive disease.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 23
Incorrect
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A 65-year-old man presents to the emergency department with severe chest pain that started an hour ago and is radiating to his left arm. He has a history of type two diabetes and has smoked 50 packs of cigarettes in his lifetime. An ECG shows ST-elevation in leads V2-4, indicating a STEMI. As the healthcare provider, you decide to initiate treatment and give the patient 300mg of aspirin orally. What is the mechanism of action of this medication?
Your Answer: Selective COX 2 inhibitor
Correct Answer: Non-reversible COX 1 and 2 inhibitor
Explanation:Aspirin irreversibly inhibits both COX 1 and COX 2, preventing the conversion of arachidonic acid into prostaglandin, prostacyclin, and thromboxane. Thromboxane A2 is responsible for platelet aggregation and vasoconstriction. In cases of acute coronary syndrome, high doses of aspirin are administered to prevent the enlargement of the coronary thrombus.
The Mechanism and Guidelines for Aspirin Use in Cardiovascular Disease
Aspirin is a medication that works by blocking the action of cyclooxygenase-1 and 2, which are responsible for the synthesis of prostaglandin, prostacyclin, and thromboxane. By inhibiting the formation of thromboxane A2 in platelets, aspirin reduces their ability to aggregate, making it a widely used medication in cardiovascular disease. However, recent trials have cast doubt on the use of aspirin in primary prevention of cardiovascular disease, leading to changes in guidelines. Aspirin is now recommended as a first-line treatment for patients with ischaemic heart disease, but it should not be used in children under 16 due to the risk of Reye’s syndrome. The medication can also potentiate the effects of oral hypoglycaemics, warfarin, and steroids.
The Medicines and Healthcare products Regulatory Agency (MHRA) issued a drug safety update in January 2010, reminding prescribers that aspirin is not licensed for primary prevention. NICE now recommends clopidogrel as a first-line treatment following an ischaemic stroke and for peripheral arterial disease. However, the situation is more complex for TIAs, with recent Royal College of Physician (RCP) guidelines supporting the use of clopidogrel, while older NICE guidelines still recommend aspirin + dipyridamole – a position the RCP state is ‘illogical’. Despite these changes, aspirin remains an important medication in the treatment of cardiovascular disease, and its use should be carefully considered based on individual patient needs and risk factors.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 24
Incorrect
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You are reviewing an elderly patient's blood results:
K+ 6.2 mmol/l
Which medication is the most probable cause of this outcome?Your Answer: St John's Wort
Correct Answer: Spironolactone
Explanation:Understanding Hyperkalaemia: Causes and Symptoms
Hyperkalaemia is a condition characterized by high levels of potassium in the blood. The regulation of plasma potassium levels is influenced by various factors such as aldosterone, insulin levels, and acid-base balance. When metabolic acidosis occurs, hyperkalaemia may develop as hydrogen and potassium ions compete for exchange with sodium ions across cell membranes and in the distal tubule. ECG changes that may be observed in hyperkalaemia include tall-tented T waves, small P waves, widened QRS leading to a sinusoidal pattern, and asystole.
There are several causes of hyperkalaemia, including acute kidney injury, metabolic acidosis, Addison’s disease, rhabdomyolysis, and massive blood transfusion. Certain drugs such as potassium-sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, and heparin can also cause hyperkalaemia. It is important to note that beta-blockers can interfere with potassium transport into cells and potentially cause hyperkalaemia in renal failure patients. On the other hand, beta-agonists like Salbutamol are sometimes used as emergency treatment.
Foods that are high in potassium include salt substitutes, bananas, oranges, kiwi fruit, avocado, spinach, and tomatoes. It is essential to monitor potassium levels in the blood to prevent complications associated with hyperkalaemia. If left untreated, hyperkalaemia can lead to serious health problems such as cardiac arrhythmias and even death.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 25
Correct
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A 63-year-old man visits your clinic for his regular asthma inhaler prescription. During the consultation, he mentions experiencing difficulty in sustaining his erections and requests a prescription for sildenafil. What is the most prevalent side effect of sildenafil?
Your Answer: Headaches
Explanation:Sildenafil is frequently prescribed in primary care. Adverse effects of sildenafil consist of headaches, facial flushing, indigestion, and temporary visual disturbances with a blue-green tint.
Understanding Phosphodiesterase Type V Inhibitors
Phosphodiesterase type V (PDE5) inhibitors are medications used to treat erectile dysfunction and pulmonary hypertension. These drugs work by increasing the levels of cGMP, which leads to the relaxation of smooth muscles in the blood vessels supplying the corpus cavernosum. The most well-known PDE5 inhibitor is sildenafil, also known as Viagra, which was the first drug of its kind. It is a short-acting medication that is usually taken one hour before sexual activity.
Other PDE5 inhibitors include tadalafil (Cialis) and vardenafil (Levitra). Tadalafil is longer-acting than sildenafil and can be taken on a regular basis, while vardenafil has a similar duration of action to sildenafil. However, these drugs are not suitable for everyone. Patients taking nitrates or related drugs, those with hypotension, and those who have had a recent stroke or myocardial infarction should not take PDE5 inhibitors.
Like all medications, PDE5 inhibitors can cause side effects. These may include visual disturbances, blue discolouration, non-arteritic anterior ischaemic neuropathy, nasal congestion, flushing, gastrointestinal side-effects, headache, and priapism. It is important to speak to a healthcare professional before taking any medication to ensure that it is safe and appropriate for you.
Overall, PDE5 inhibitors are an effective treatment for erectile dysfunction and pulmonary hypertension. However, they should only be used under the guidance of a healthcare professional and with careful consideration of the potential risks and benefits.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 26
Incorrect
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A 65-year-old man visits his GP for a medication review. He has been diagnosed with stable congestive heart failure. As you review his repeat prescriptions, you consider his new diagnosis. The patient has type 2 diabetes mellitus, osteoarthritis, and erectile dysfunction. What is the most crucial medication to avoid in patients with chronic heart failure among his current medications?
Your Answer: Metformin
Correct Answer: Diclofenac
Explanation:Patients with heart failure should exercise caution when using NSAIDs as they have the potential to worsen the condition by causing fluid retention, particularly diclofenac.
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 27
Correct
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Which of the following drugs is most commonly associated with peripheral neuropathy in the treatment of tuberculosis, and how does it affect patients of different ages?
Your Answer: Isoniazid
Explanation:Side-Effects and Mechanism of Action of Tuberculosis Drugs
Rifampicin is a drug that inhibits bacterial DNA dependent RNA polymerase, which prevents the transcription of DNA into mRNA. However, it is a potent liver enzyme inducer and can cause hepatitis, orange secretions, and flu-like symptoms.
Isoniazid, on the other hand, inhibits mycolic acid synthesis. It can cause peripheral neuropathy, which can be prevented with pyridoxine (Vitamin B6). It can also cause hepatitis and agranulocytosis. Additionally, it is a liver enzyme inhibitor.
Pyrazinamide is converted by pyrazinamidase into pyrazinoic acid, which in turn inhibits fatty acid synthase (FAS) I. However, it can cause hyperuricaemia, leading to gout, as well as arthralgia, myalgia, and hepatitis.
Lastly, Ethambutol inhibits the enzyme arabinosyl transferase, which polymerizes arabinose into arabinan. It can cause optic neuritis, so it is important to check visual acuity before and during treatment. Additionally, the dose needs adjusting in patients with renal impairment.
In summary, these tuberculosis drugs have different mechanisms of action and can cause various side-effects. It is important to monitor patients closely and adjust treatment accordingly to ensure the best possible outcomes.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 28
Correct
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A 55-year-old man with type 2 diabetes of 8 years’ duration presents with poorly controlled blood glucose levels. He was initially started on metformin therapy and his diabetes was well controlled until the last 6 months. Despite strict adherence to diet, exercise and maximum daily doses of metformin and pioglitazone, satisfactory blood glucose control has proved difficult to achieve and the last HbA1c was at 85 mmol/mol. You consider adding the agent empagliflozin.
Managed either by lifestyle + diet
HbA1c target levels in adults with type 2 diabetes
Or
Lifestyle + diet + single drug not associated with hypoglycaemia
Managed with a drug associated with hypoglycaemia
48 mmol/mol
53 mmol/mol
Which of the following class of drugs does sitagliptin belong to?Your Answer: A dipeptidyl peptidase-4 (DPP-4) inhibitor
Explanation:Common Diabetes Medications and How They Work
Dipeptidyl peptidase-4 (DPP-4) inhibitors, such as sitagliptin, work by inhibiting the enzyme DPP-4, which breaks down hormones that stimulate insulin secretion and suppress glucagon secretion. This leads to increased insulin secretion and decreased glucagon release, helping to regulate blood glucose levels.
α-Glucosidase inhibitors, like acarbose, inhibit enzymes needed to digest carbohydrates, leading to decreased glucose absorption.
Sulfonylureas, such as tolbutamide and gliclazide, stimulate insulin release by inhibiting potassium channels in pancreatic cells.
Non-sulfonylurea insulin secretagogues, like repaglinide and nateglinide, also stimulate insulin release but act on a different binding site of the potassium channels.
Insulin sensitizers, including biguanides like metformin and thiazolidinediones (glitazones), increase glucose uptake by the cells and enhance insulin-dependent enzyme production, respectively.
Understanding the Mechanisms of Common Diabetes Medications
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 29
Correct
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A 42-year-old woman with epilepsy complains of hair loss and tremors. Her husband reports that she has become more irritable since starting her medication.
Which medication is the most likely culprit?Your Answer: Sodium valproate (Epilim®)
Explanation:Common Side Effects of Anticonvulsants and Analysis of Symptoms Associated with Different Medications
Anticonvulsants are commonly used to treat seizures, but they can also have side effects. One of the most common side effects of sodium valproate is hair loss, along with aggression and tremors. Levetiracetam is commonly associated with aggression and tremors, but rarely with alopecia. Carbamazepine is rarely associated with aggression or alopecia, and lamotrigine is commonly associated with aggression and tremors but not hair loss. Phenytoin is commonly associated with tremors but not the other symptoms mentioned. This analysis can help identify which medication may be causing certain symptoms. Other common side effects of anticonvulsants include fatigue, skin rashes, and gastrointestinal issues. It is important to consult with a healthcare provider about any concerns regarding medication side effects.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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Question 30
Incorrect
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A 38-year-old man visits his General Practitioner complaining of a sore throat. He has a Centor score of 4 due to the presence of a fever, cervical lymphadenopathy, absence of cough, and white exudate on his tonsils. He is allergic to penicillin and takes simvastatin as his only medication. What is the most suitable antibiotic to prescribe for his sore throat?
Your Answer: Phenoxymethylpenicillin
Correct Answer: Doxycycline
Explanation:A patient with a Centor score of 4 likely has acute group A streptococcal tonsillitis and requires antibiotics. However, the patient is allergic to penicillins and takes simvastatin, which is metabolized by the cytochrome P450 enzymes. Phenoxymethylpenicillin, the usual first-line treatment, cannot be used due to the allergy. Macrolides such as clarithromycin and erythromycin should also be avoided as they inhibit the cytochrome P450 enzymes and can increase the risk of statin-induced myopathy. Co-amoxiclav is not an option either. Therefore, doxycycline is the best choice as it is not a penicillin and does not affect the cytochrome P450 enzymes, allowing for concurrent use with simvastatin.
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This question is part of the following fields:
- Pharmacology/Therapeutics
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