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Question 1
Incorrect
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A 15-year-old girl arrives at the Emergency Department after ingesting a handful of her father's anxiety medication. He takes lorazepam 1 mg TID for generalized anxiety disorder which has not responded well to other treatments.
She has consumed 8 mg lorazepam and is now unresponsive, with a respiratory rate of eight per minute and oxygen saturation of 90% on room air.
The patient does not react to verbal stimuli, but responds to a painful sternal rub and attempts to push the examiner's hand away.
Given that the half-life of lorazepam is approximately 10-20 hours, how long will it take for the medication to be eliminated from her system?Your Answer: 80 hours
Correct Answer: 200 hours
Explanation:Clonazepam and Flumazenil in Benzodiazepine Overdose
Conventionally, a drug is considered to be eliminated from the system after four or five half-lives, leaving only a small fraction of the original amount. However, this does not necessarily mean that the drug’s clinical effects have disappeared. For instance, a person who has taken clonazepam, a potent benzodiazepine used to treat certain seizure disorders, may still feel relatively alert even after only one half-life has passed.
Clonazepam is a long-acting benzodiazepine that is approximately 20 times more potent than diazepam. In cases of benzodiazepine overdose, flumazenil may be a useful antidote. Flumazenil is particularly effective in uncomplicated cases of benzodiazepine overdose, and it works by reversing the effects of benzodiazepines on the central nervous system. Therefore, it may be considered as a treatment option for individuals who have taken an excessive amount of clonazepam or other benzodiazepines.
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This question is part of the following fields:
- Pharmacology
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Question 2
Correct
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How can this question be restated?
Your Answer: NMDA receptors are ligand gated ion channels
Explanation:Different Types of Receptors in the Body
There are various types of receptors in the body that play important roles in different physiological processes. One type of receptor is the 5HT3 receptor, which is a ligand gated ion channel. This means that it opens and closes in response to the binding of a specific ligand, allowing ions to flow in and out of the cell. Another type of receptor is the aldosterone receptor, which is a steroid receptor. This receptor binds to the hormone aldosterone and regulates the body’s electrolyte balance.
The β2 adrenoreceptor is another type of receptor, which is a g protein coupled receptor. This receptor is activated by the hormone adrenaline and plays a role in regulating heart rate and bronchodilation. Finally, the insulin receptor is a tyrosine receptor kinase. This receptor is activated by the hormone insulin and plays a crucial role in regulating glucose metabolism in the body. the different types of receptors in the body is important for how different physiological processes are regulated.
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This question is part of the following fields:
- Pharmacology
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Question 3
Incorrect
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The following result is obtained on a 48-year-old male who is admitted with acute onset chest pain:
Serum Cholesterol 7.3 mmol/L (<5.2)
He has a strong family history of ischaemic heart disease.
What abnormalities might be expected upon examination of this man?Your Answer: Ejection systolic murmur
Correct Answer: Tendon nodules
Explanation:Familial Hypercholesterolaemia and its Manifestations
Familial hypercholesterolaemia is a condition characterized by high levels of cholesterol in the blood. This condition is often indicated by the deposition of cholesterol in various parts of the body. The history of the patient suggests that they may be suffering from familial hypercholesterolaemia. The deposition of cholesterol can be observed around the corneal arcus, around the eye itself (xanthelasma), and in tendons such as achilles, knuckles or triceps tendons (tendon xanthomas).
While dietary and lifestyle modifications are recommended, they are usually not enough to manage the condition. High dose lifelong statin therapy is often necessary to control the levels of cholesterol in the blood. It is important to seek medical attention and follow the recommended treatment plan to prevent further complications associated with familial hypercholesterolaemia. The National Institute for Health and Care Excellence (NICE) recommends the use of statin therapy in conjunction with lifestyle modifications for the management of familial hypercholesterolaemia.
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This question is part of the following fields:
- Pharmacology
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Question 4
Correct
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A 40-year-old woman comes to the clinic with complaints of pain and swelling in her right calf. Upon further examination, it is confirmed that she has a deep vein thrombosis. Can any of the medications she is currently taking be a contributing factor to this condition?
Your Answer: Combined oral contraceptive pill
Explanation:Thromboembolic Risk and Oral Contraceptives
The use of combined oral contraceptives (OCP) is known to increase the risk of thromboembolism. This is due to the estrogen component of the pill, which promotes a pro-thrombotic environment. However, the risk of thromboembolism on the OCP is only about five times higher than normal, which is significantly lower than the risk during pregnancy, which is six to ten times higher. On the other hand, there is no clear evidence of an increased risk of thromboembolism associated with the use of progesterone-only contraceptive pills (mini pill). It is important for women to discuss their individual risk factors with their healthcare provider before starting any form of hormonal contraception.
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This question is part of the following fields:
- Pharmacology
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Question 5
Incorrect
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A teenage girl is given a prescription for an antibiotic by her doctor, but she comes back after two days, reporting that she is developing a rash on her face and arms that gets worse when exposed to sunlight. What drug reaction is likely causing this photosensitive rash?
Your Answer: Cephalexin
Correct Answer: Doxycycline
Explanation:Common Side Effects of Tetracyclines
Tetracyclines are a class of antibiotics that are commonly used to treat bacterial infections. However, they are also known to cause several side effects. Nausea and vomiting are among the most common side effects of tetracyclines. Additionally, patients may develop a photosensitive rash, which can be triggered by exposure to sunlight. Dental hypoplasia is another potential side effect of tetracyclines, which is why they are not recommended for use in children, pregnant or breastfeeding women. Finally, tetracyclines have been associated with idiopathic intracranial hypertension, a condition that causes increased pressure inside the skull.
It is important to note that photosensitivity can also be caused by other antibiotics, such as quinolones and sulphonamides. Patients who experience any of these side effects should contact their healthcare provider immediately. In some cases, the dosage or type of antibiotic may need to be adjusted to minimize these side effects. Overall, while tetracyclines can be effective in treating bacterial infections, patients should be aware of the potential side effects and discuss any concerns with their healthcare provider.
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This question is part of the following fields:
- Pharmacology
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Question 6
Correct
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A 65-year-old man is undergoing his yearly check-up for his type 2 diabetes. He is currently being evaluated for macroscopic haematuria.
Which medication for diabetes should be avoided in this case?Your Answer: Pioglitazone
Explanation:Safety Concerns Surrounding Glitazones
The glitazones, which include pioglitazone and rosiglitazone, have been associated with safety concerns. Rosiglitazone has been removed from use due to an increased risk of myocardial infarction in patients taking the drug. Pioglitazone is still in use, but there are concerns about an increased risk of cardiac failure, myocardial infarction, pneumonia, and fracture risk in patients taking the drug.
Additionally, the European Medicines Agency has advised that there is an increased risk of bladder cancer when taking pioglitazone. Although the risk is small, it should not be used in patients with a history of the disease, who have unexplained macroscopic haematuria, or are at a high risk of developing bladder cancer.
These safety concerns make glitazones less popular than some of the other new diabetes drugs. The European Medicines Agency advises that pioglitazone should only be used when other antidiabetes agents are not suitable. It is important for healthcare professionals to carefully consider the risks and benefits of glitazones before prescribing them to patients with diabetes.
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This question is part of the following fields:
- Pharmacology
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Question 7
Correct
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A 42-year-old woman with rheumatoid arthritis is currently taking methotrexate, folic acid, Adcal-D3, ibuprofen, and paracetamol. She visits the GP clinic complaining of a sore throat. Upon examination, her tonsils are enlarged with pus, she has tender cervical lymphadenopathy, and a fever of 38.5°C. She does not have a cough. What course of action would you suggest for her management plan?
Your Answer: Send an urgent venous blood sample for full blood count and commence benzylpenicillin 500 mg QDS for 10 days
Explanation:Methotrexate and Tonsillitis: Differential Diagnosis and Treatment
Methotrexate therapy can lead to a rare but serious complication known as marrow failure, which can manifest as fever and sore throat. However, in cases where there are clear signs of tonsillitis, such as in this patient, it is more likely to be the cause of the symptoms. To confirm the diagnosis, a full blood count is necessary to rule out marrow failure.
In this case, the patient meets the Centor criteria for antibiotic treatment of sore throat, which includes the presence of anterior cervical adenopathy, tonsillar exudates, fever, and absence of cough. A score of four or higher suggests that the tonsillitis is more likely to be bacterial in origin, making treatment with antibiotics reasonable.
While marrow failure is a serious complication, admitting the patient to the hospital as an emergency would not be a reasonable use of resources in this case. Instead, the focus should be on treating the tonsillitis and monitoring the patient for any signs of worsening symptoms or complications.
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This question is part of the following fields:
- Pharmacology
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Question 8
Correct
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A 20-year old woman arrives at the Emergency department after a night out with her friends. According to her friends, she has been talking to herself about nonsensical things and appears agitated and restless. During the examination, it is noted that her reflexes are heightened and an electrocardiogram (ECG) reveals ventricular ectopics. What type of substance abuse is suspected in this case?
Your Answer: Ecstasy
Explanation:Ecstasy Overdose
Ecstasy, also known as MDMA, is a drug that stimulates the central nervous system. It can cause increased alertness, euphoria, extroverted behavior, and rapid speech. People who take ecstasy may also experience a lack of desire to eat or sleep, tremors, dilated pupils, tachycardia, and hypertension. However, more severe intoxication can lead to excitability, agitation, paranoid delusions, hallucinations, hypertonia, and hyperreflexia. In some cases, convulsions, rhabdomyolysis, hyperthermia, and cardiac arrhythmias may also develop.
Severe cases of MDMA poisoning can result in hyperthermia, disseminated intravascular coagulation, rhabdomyolysis, acute renal failure, hyponatremia, and even hepatic damage. In rare cases, amphetamine poisoning may lead to intracerebral and subarachnoid hemorrhage and acute cardiomyopathy, which can be fatal. Chronic amphetamine users may also experience hyperthyroxinemia.
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This question is part of the following fields:
- Pharmacology
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Question 9
Incorrect
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Which statement regarding ligand gated ion channels (LGIC) is accurate?
Your Answer: Channel ion selectivity is dependent upon pore size
Correct Answer: Agonist recognition and ion channel are intrinsic to a single protein complex
Explanation:Ligand Gated Ion Channels: A Brief Overview
Ligand gated ion channels (LGICs) are protein complexes that have both agonist recognition and ion channel functions. These functions are intrinsic to a single protein complex, which is usually pentameric in nature. For example, the nicotinic acetylcholine receptor (nAChR) is composed of a2ßδγ subunits. Each monomer of the LGIC has four transmembrane domains (TMSD) labeled M1-M4. The M2 domain forms a putative alpha-helix within the membrane.
LGICs typically have a charged entrance that plays a role in ion selectivity. For instance, the nAChR has a negatively charged entrance that attracts Na and K ions. This selectivity is crucial for the proper functioning of the LGIC. the structure and function of LGICs is important for developing drugs that target these channels. By targeting LGICs, researchers can develop drugs that modulate the activity of these channels, which can have therapeutic benefits for a variety of diseases.
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This question is part of the following fields:
- Pharmacology
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Question 10
Correct
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What is a true characteristic of G protein coupled receptors and their involvement in biological processes?
Your Answer: GPCRs interact with G proteins through their third intracellular loop
Explanation:G Protein Coupled Receptors and Their Role in Signal Transduction
G protein coupled receptors are present in various systems of the body, including opioid and adrenaline binding. These receptors consist of seven transmembrane domains and are encoded by approximately 7% of the human genome. When an agonist binds to a G protein coupled receptor, it causes a change in the conformation of the linked G protein through the third intracellular loop and C tail. This change leads to the transmission of messages using second messengers like cAMP, ADP, and phosphokinase.
In summary, G protein coupled receptors play a crucial role in signal transduction in the body. They are involved in the binding of various substances and cause a conformational change in the linked G protein, leading to the transmission of messages through second messengers. the function of these receptors is essential in developing drugs that target them and can be used to treat various diseases.
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This question is part of the following fields:
- Pharmacology
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Question 11
Incorrect
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A young adult with a history of psychosis and mood disorder is experiencing frequent urination and is ultimately diagnosed with diabetes insipidus. Which medication is the probable culprit?
Your Answer: Propranolol
Correct Answer: Lithium
Explanation:Common Side Effects of Lithium
Lithium is a medication that is commonly used to treat bipolar disorder. However, it can also cause a number of side effects. One of the most common side effects is gastrointestinal disturbance, which can include nausea, vomiting, and diarrhea. Another common side effect is fine tremor, which can affect the hands and fingers. Weight gain and oedema (swelling) are also possible side effects of lithium.
In addition, lithium can cause goitre, which is an enlargement of the thyroid gland. If taken in excess, it can also lead to blurred vision, ataxia (loss of coordination), drowsiness, and coarse tremor. One of the more unique side effects of lithium is that it causes antidiuretic hormone (ADH) resistance, which can lead to the production of large volumes of dilute urine. Overall, while lithium can be an effective treatment for bipolar disorder, it is important to be aware of these potential side effects.
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This question is part of the following fields:
- Pharmacology
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Question 12
Incorrect
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Following the administration of lorazepam to a severely agitated senior patient, the nursing staff contacts you to report a decrease in respiratory rate and the patient's unresponsiveness. What medication would be suitable for reversing the adverse effects of this drug?
Your Answer: Naloxone
Correct Answer: Flumazenil
Explanation:Reversing the Effects of Benzodiazepines
Benzodiazepines work by binding to GABA receptors in the central nervous system, which enhances the calming and sleep-inducing effects of this neurotransmitter. However, these effects can be reversed by administering flumazenil. On the other hand, naloxone is used to counteract the effects of opiate overdose, while protamine is used to reverse the effects of excessive heparinization.
In the case of benzodiazepine overdose, it is important to ensure that the patient is receiving adequate ventilation. Additionally, administering flumazenil through a bag valve mask can help to reverse the effects of the drug. By doing so, the patient’s breathing and consciousness can be restored to normal levels. Proper management of benzodiazepine overdose is crucial in preventing serious complications and ensuring the patient’s safety.
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This question is part of the following fields:
- Pharmacology
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Question 13
Incorrect
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A 67-year-old man with a history of renal impairment and severe osteoporosis has come in with a worsening of his chronic lower back pain. Upon examination, an L4 wedge fracture was discovered on a lumbar spine x-ray. What medication is recommended for pain management?
Your Answer: Morphine
Correct Answer: Paracetamol
Explanation:Medications and Renal Impairment
When it comes to renal impairment, it is important to be cautious with certain medications. Nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided as they can worsen renal impairment. This is because renal prostaglandins, which control the rate of blood flow into the kidney, are impaired by NSAIDs. As a result, renal blood flow is reduced, exacerbating the impairment.
On the other hand, morphine can be used in renal impairment, but it should be used with caution. While it is an effective pain reliever, its excretion is reduced in individuals with renal impairment, which can lead to a buildup of the drug in the body. Therefore, paracetamol is typically the first line of treatment for pain relief in individuals with renal impairment, with morphine used only as necessary.
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This question is part of the following fields:
- Pharmacology
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Question 14
Correct
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A 30-year-old expectant mother complains of feeling tired. During the examination, her nail beds and conjunctiva appear pale, and her haemoglobin level is below 98 g/L, indicating significant anaemia. What is the recommended amount of dietary iron that pregnant women should consume?
Your Answer: 15 mg
Explanation:Anaemia in Pregnancy
During pregnancy, anaemia is a common occurrence due to various factors such as reduced absorption, fetal demand, and expansion of plasma volume. As the pregnancy progresses, maternal iron stores tend to become depleted. Although cessation of menstruation prevents iron loss, it is not enough to compensate for the additional fetal requirements. To address this, it is recommended that pregnant women consume 15 mg of dietary iron per day.
It is important to routinely assess haemoglobin levels throughout each pregnancy. If haemoglobin levels are found to be less than 110 g/L, investigations and management should begin promptly. By monitoring haemoglobin levels and ensuring adequate iron intake, the risk of anaemia during pregnancy can be reduced, promoting better health outcomes for both the mother and the developing fetus.
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This question is part of the following fields:
- Pharmacology
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Question 15
Incorrect
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A young adult female arrives at the Emergency Department after ingesting 18 paracetamol tablets in a moment of impulsivity during a disagreement with her partner. It has been six hours since she took the tablets and her paracetamol levels are measured, indicating the need for treatment. The patient is initiated on N-acetylcysteine. What is the mechanism of action of this medication?
Your Answer: Absorbs paracetamol from the bloodstream
Correct Answer: Replaces compounds used in paracetamol metabolism
Explanation:Paracetamol Metabolism and Toxicity
Paracetamol is metabolised in two ways. The first mechanism involves conjugation with glucuronic acid, resulting in a safe metabolite that can be excreted. However, there is a limit to how much paracetamol can be metabolised this way. The second mechanism is used when a large amount of paracetamol is taken. In this case, paracetamol is oxidised to a toxic metabolite called N-acetyl-p-benzoquinone. This metabolite can cause liver and kidney necrosis if glutathione supplies are exhausted.
Glutathione is responsible for making the toxic metabolite safe. However, when glutathione supplies are depleted, the toxic metabolite can cause damage to the liver and kidneys. N-acetylcysteine is a protective agent that increases the rate of glutathione synthesis. Therefore, it can help prevent liver and kidney damage caused by the toxic metabolite of paracetamol.
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This question is part of the following fields:
- Pharmacology
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Question 16
Incorrect
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A 67-year-old woman complains of muscle aches and pains. She has a medical history of ischaemic heart disease, which has been treated recently. What medication is the most probable cause of her symptoms?
Your Answer: ACE inhibitors
Correct Answer: Statins
Explanation:The Benefits and Risks of Statin Therapy
Statins are medications used to lower lipid levels in the body, which can significantly reduce the risk of cardiovascular disease. However, one common side effect of this treatment is myalgia, or muscle pain. This side effect can be worsened by certain medications, such as macrolides and fibrates, as well as by hypothyroidism. While myalgia is generally not life-threatening, it can be uncomfortable and may lead some patients to discontinue statin therapy.
In rare cases, statin therapy can lead to a potentially lethal condition called rhabdomyolysis. This occurs when there is severe muscle infiltration and destruction, which can cause renal failure. While this side effect is rare, it is important for patients to be aware of the potential risks associated with statin therapy and to report any unusual symptoms to their healthcare provider. Overall, the benefits of statin therapy in reducing cardiovascular risk generally outweigh the risks, but it is important for patients to work closely with their healthcare provider to monitor for any potential side effects.
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This question is part of the following fields:
- Pharmacology
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Question 17
Incorrect
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Which of the following drug/receptor interactions accurately describes steroid hormones?
Your Answer: Fludrocortisone - Mineralocorticoid antagonist
Correct Answer: Tamoxifen – Oestrogen antagonist
Explanation:Examples of Agonist and Antagonist Hormones
Agonist and antagonist hormones are two types of hormones that have opposite effects on the body. Agonist hormones bind to specific receptors in the body and activate them, while antagonist hormones bind to the same receptors but block their activation. This can have a variety of effects on the body, depending on the specific hormone and receptor involved.
Examples of agonist hormones include glucocorticoids like prednisolone, dexamethasone, and hydrocortisone, which are used to treat inflammation and autoimmune disorders. These hormones bind to glucocorticoid receptors and activate them, reducing inflammation and suppressing the immune system.
On the other hand, mifepristone is an antagonist hormone that blocks the effects of glucocorticoids. It is used to terminate pregnancies and to treat conditions like Cushing’s syndrome, which is caused by an excess of glucocorticoids in the body.
Another example of an agonist hormone is fludrocortisone, a mineralocorticoid that is used to treat conditions like Addison’s disease, which is caused by a deficiency of mineralocorticoids. Fludrocortisone binds to mineralocorticoid receptors and activates them, helping to regulate salt and water balance in the body.
In contrast, spironolactone is an antagonist hormone that blocks the effects of mineralocorticoids. It is used to treat conditions like high blood pressure and heart failure, which can be caused by excess mineralocorticoid activity.
Other examples of agonist and antagonist hormones include oestrogen and tamoxifen, which are used to treat breast cancer, and progesterone and danazol, which are used to treat menstrual disorders and endometriosis. the effects of these hormones and their receptors is important for developing effective treatments for a variety of conditions.
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This question is part of the following fields:
- Pharmacology
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Question 18
Incorrect
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Which statement about agonists and antagonists is accurate?
Your Answer: An antagonist has efficacy but no affinity
Correct Answer: A partial agonist has affinity but reduced efficacy
Explanation:Affinity and Efficacy in Pharmacology
In pharmacology, the terms affinity and efficacy are used to describe the relationship between a drug and its target receptor. Affinity refers to the strength of the binding between the drug and the receptor, while efficacy refers to the ability of the drug to activate the receptor and produce a response.
An agonist is a drug that binds to a receptor and activates it, producing a response. An agonist has both high affinity and high efficacy, meaning it binds strongly to the receptor and produces a strong response.
An antagonist, on the other hand, binds to the receptor but does not activate it, blocking the action of other agonists. An antagonist has high affinity but no efficacy, meaning it binds strongly to the receptor but does not produce a response.
A partial agonist is a drug that binds to the receptor and produces a response, but the response is weaker than that produced by a full agonist. A partial agonist has high affinity but reduced efficacy, meaning it binds strongly to the receptor but produces a weaker response.
the concepts of affinity and efficacy is important in drug development and in the effects of drugs on the body. By manipulating these properties, researchers can develop drugs that selectively target specific receptors and produce desired effects with minimal side effects.
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This question is part of the following fields:
- Pharmacology
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Question 19
Correct
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A 70-year-old male presents with two episodes of haemetemesis. He has a medical history of ischaemic heart disease (IHD) and is currently on medication. What is the probable reason for his condition?
Your Answer: Peptic ulceration
Explanation:The effects of different medications on renal tubular acidosis (RTA) are significant. RTA is a condition that affects the kidneys’ ability to regulate acid-base balance in the body. Various medications can cause RTA through different mechanisms.
Spironolactone, for instance, is a direct antagonist of aldosterone, a hormone that regulates sodium and potassium levels in the body. By blocking aldosterone, spironolactone can lead to hyperkalemia (high potassium levels) and a reduction in serum bicarbonate, which is a type of RTA known as type 4.
Type 4 RTA can also occur in people with diabetes mellitus due to scarring associated with diabetic nephropathy. Metformin, a medication commonly used to treat diabetes, can cause lactic acidosis, a condition where there is an excess of lactic acid in the blood. Pioglitazone, another diabetes medication, can cause salt and water retention and may also be associated with bladder tumors.
Ramipril, a medication used to treat high blood pressure and heart failure, can also cause hyperkalemia, but this is not related to direct aldosterone antagonism. Healthcare providers must be aware of the effects of different medications on RTA to ensure proper management and treatment of this condition.
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This question is part of the following fields:
- Pharmacology
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Question 20
Incorrect
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A 55-year-old man with uncontrolled type 2 diabetes is hospitalized and presents with elevated inflammatory markers, metabolic acidosis, leukocytosis, and an amylase level of 3480 U/L. Which medication is the probable cause?
Your Answer: Metformin
Correct Answer: Exenatide
Explanation:Exenatide and Pancreatitis: A Review of the Evidence
Exenatide is a medication that mimics the effects of the hormone GLP-1, which triggers insulin secretion in response to food intake. However, there is a rare but concerning association between exenatide and acute pancreatitis. A recent case-control study found that patients taking GLP-1 mimetics like exenatide had a higher risk of developing pancreatitis compared to those taking other diabetes drugs. As a result, patients starting on exenatide should be informed about the symptoms of pancreatitis and monitored closely for abdominal pain.
While there is some controversy surrounding the association between gliptins and pancreatitis, the British National Formulary recommends discontinuing sitagliptin if acute pancreatitis is suspected. It is important to note that lactic acidosis, a potential side effect of metformin, should not be confused with pancreatitis, which is characterized by elevated levels of amylase. Overall, healthcare providers should be aware of the potential risk of pancreatitis in patients taking exenatide and other GLP-1 mimetics, and take appropriate precautions to monitor and manage this condition.
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This question is part of the following fields:
- Pharmacology
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Question 21
Correct
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A 45-year-old male is undergoing treatment for ischaemic heart disease. He has recently reported experiencing cold peripheries. What medication could be causing this symptom?
Your Answer: Beta-blocker
Explanation:Causes of Cold Peripheries
Beta-blockers are known to cause cold peripheries due to their ability to constrict the superficial vessels. This constriction leads to a decrease in blood flow to the extremities, resulting in a feeling of coldness. In addition to beta-blockers, other factors can also contribute to cold peripheries. Bronchospasm, which is a narrowing of the airways in the lungs, can also cause coldness in the extremities. This is because the body redirects blood flow away from the extremities and towards the lungs to help with breathing. Finally, fatigue can also cause cold peripheries as the body’s energy levels decrease, leading to a decrease in blood flow to the extremities. Overall, there are several factors that can contribute to cold peripheries, and it is important to identify the underlying cause in order to provide appropriate treatment.
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This question is part of the following fields:
- Pharmacology
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Question 22
Incorrect
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A 24-year-old man with asthma is brought to the emergency department due to shortness of breath. He has been experiencing a worsening cough with thick yellow phlegm for the past three days. He regularly uses a beclomethasone inhaler and salbutamol inhaler as needed.
Upon assessment, the patient's heart rate is 166 bpm, blood pressure is 113/65 mmHg, oxygen saturation is 91%, and respiratory rate is 29. He is only able to speak in broken sentences.
Which of the following therapies is most likely to exacerbate his asthma?Your Answer: Salbutamol
Correct Answer: Bisoprolol
Explanation:Treatment for Acute Asthma Attack
When a person experiences an acute asthma attack, the first and most important treatment is to administer oxygen. This is followed by nebulised salbutamol to dilate the airways, oral steroids, and appropriate antibiotics if the productive cough is due to a chest infection. However, the use of the beta blocker bisoprolol to reduce the heart rate would be inappropriate.
Salbutamol works by targeting beta-2 adrenoceptors, which causes the bronchi to dilate. However, cardiac muscle also has beta adrenoceptors, which can cause an increased heart rate. In this case, the patient is likely tachycardic due to increased work of breathing and salbutamol administered on the way to the hospital. Bisoprolol, on the other hand, is a beta antagonist that counteracts these effects by causing a reduction in heart rate and smooth muscle constriction, which would constrict the bronchi. This is the opposite of the desired effect and can worsen the patient’s condition. Therefore, it is important to avoid using bisoprolol in the treatment of acute asthma attacks.
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This question is part of the following fields:
- Pharmacology
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Question 23
Incorrect
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Which diabetes medication is the least likely to cause weight gain?
Your Answer: Pioglitazone
Correct Answer: Exenatide
Explanation:Exenatide and its Benefits for Overweight Patients
Exenatide is a medication that mimics the effects of GLP-1, a hormone released by the gut in response to food intake. This hormone triggers insulin secretion in the pancreatic beta-cells, which makes GLP-1 mimetics like exenatide effective in stimulating insulin release. Additionally, exenatide is associated with weight loss, making it a good choice for patients who are significantly overweight.
According to NICE guidelines, exenatide should be used in patients with a BMI exceeding 35 kg/m2 or in those with significant weight-related comorbidity, even if their BMI is less than 35 kg/m2. After six months of therapy, exenatide should only be continued if the patient’s HbA1c has fallen by 11 mmol/mol and their weight has decreased by 3%.
However, exenatide does have some side effects, including nausea and vomiting. It should also be avoided in patients with renal failure, impaired liver function, and gastroparesis. On the other hand, other diabetes medications like gliptins, glitazones, and sulphonylureas are associated with significant weight gain, while repaglinide may result in minimal or no weight gain.
Overall, exenatide is a promising option for overweight patients with diabetes, as it not only stimulates insulin release but also promotes weight loss.
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This question is part of the following fields:
- Pharmacology
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Question 24
Correct
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A 50-year-old patient who had a kidney transplant two years ago is currently taking ciclosporin. However, due to a manufacturing issue, the patient cannot obtain their prescribed medication, Sandimmune, for the next five days. What should be done in this situation?
Your Answer: Switch him to another formulation and monitor his renal function, ciclosporin level and blood pressure whilst the changeover is being made
Explanation:Ciclosporin is an immunosuppressant used to prevent graft rejection and treat various conditions. Different formulations have varying pharmacokinetic properties, so it is important to prescribe by brand and monitor patients closely when switching formulations. Consultation with a renal unit is recommended before switching therapy.
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This question is part of the following fields:
- Pharmacology
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Question 25
Incorrect
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You are administering lidocaine to numb the skin of a young patient before a minor procedure. What is a true statement about this medication?
Your Answer: Can be safely administered with adrenaline in ring blocks
Correct Answer: Can be used to treat ventricular tachycardia
Explanation:Lidocaine: Characteristics and Uses
Lidocaine is a medication that is quickly broken down by the liver, making it unsuitable for oral administration. Its effects last for only 20 minutes, but this can be extended to approximately 90 minutes when combined with the vasoconstrictor adrenaline. However, this combination should not be used in areas where there is a risk of ischaemia.
Lidocaine is a potent antiarrhythmic drug that falls under class I, as it prolongs the action potential. It can be used to treat ventricular tachycardia, although it is not included in the ALS algorithm and should only be administered by a specialist.
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This question is part of the following fields:
- Pharmacology
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Question 26
Incorrect
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A previously healthy 95-year-old individual with a history of hypertension arrives at the Emergency department with dysphasia and right-sided hemiplegia. A CT scan is performed urgently 2 hours after the symptoms began, revealing a left hemisphere cerebral infarction. What is the time frame for administering alteplase in the treatment of this patient?
Your Answer: 6 hours
Correct Answer: 4.5 hours
Explanation:Guidelines for Thrombolysis in Stroke Patients
According to the guidelines set by The Royal College of Physicians, thrombolysis with alteplase can be administered within three hours from the onset of stroke symptoms, regardless of the patient’s age, as long as a haemorrhagic stroke is ruled out and there are no contraindications to thrombolysis. However, in patients under the age of 80 years, alteplase can be given up to 4.5 hours from the onset of stroke, and in some cases, up to 6 hours. It is important to note that the benefits of thrombolysis decrease over time.
The guidelines emphasize the importance of timely administration of thrombolysis to maximize its benefits. However, the decision to administer thrombolysis should be made after careful consideration of the patient’s medical history, contraindications, and the potential risks and benefits of the treatment. It is also important to rule out haemorrhagic stroke before administering thrombolysis, as it can worsen the condition and lead to complications. Overall, the guidelines provide a framework for the safe and effective use of thrombolysis in stroke patients.
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This question is part of the following fields:
- Pharmacology
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Question 27
Incorrect
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You are managing a pediatric patient with a multidrug resistant chest infection in the pediatric intensive care unit and are consulting with the pediatric infectious disease specialist regarding the antibiotics that have been administered. All of the following antibiotics inhibit protein synthesis in the bacterial ribosome except for which one?
Your Answer: Chloramphenicol
Correct Answer: Cefuroxime
Explanation:Mechanisms of Action of Antibiotics
Antibiotics are drugs that are used to treat bacterial infections. They work by targeting specific components of the bacterial cell, which can either kill the bacteria or stop them from multiplying. Cefuroxime is a second generation cephalosporin that inhibits cell wall synthesis, making it bactericidal. Chloramphenicol and clindamycin, on the other hand, bind to the 50S subunit of the bacterial ribosome, which prevents protein synthesis and is bacteriostatic. Aminoglycosides like gentamicin and tetracyclines such as doxycycline act on the 30S subunit, which disrupts protein synthesis and is bactericidal. the mechanisms of action of antibiotics is important in selecting the appropriate drug for a specific bacterial infection.
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This question is part of the following fields:
- Pharmacology
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Question 28
Incorrect
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A patient in his 50s with type 2 diabetes mellitus visits the clinic with an HbA1c of 68 mmol/mol. All recent blood tests are normal except for an eGFR of 54 mls/min/1.73 m2. The patient, who has a BMI of 29 kg/m2 and works as a heavy goods vehicle driver, is already taking the maximum tolerated doses of metformin and gliclazide and is trying to modify his diet and exercise habits. He has no other health conditions. What medication could be added to improve his glycemic control?
Your Answer: Insulin
Correct Answer: Sitagliptin
Explanation:Choosing the Right Medication for a Diabetic Patient
When selecting a medication for a diabetic patient, it is important to consider their occupation and any driving restrictions. Insulin may not be the best option in this case. Liraglutide is only recommended for overweight patients or those who would benefit from weight loss, and it is not suitable for patients with an eGFR less than 60 mls/min/1.73 m2. Nateglinide has not been approved by NICE, and pioglitazone has been associated with various health risks.
Therefore, sitagliptin is the most appropriate choice. While it may cause headaches and weight gain, it promotes insulin release and may require a reduction in the dose of gliclazide to avoid hypoglycemia. However, it should be used with caution in patients with renal failure. By considering the patient’s individual circumstances and medical history, healthcare professionals can make informed decisions about the most suitable medication for their diabetic patients.
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This question is part of the following fields:
- Pharmacology
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Question 29
Incorrect
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A patient is being treated for a pneumonia. She is given 200 mg of an antibiotic. The concentration of the drug in her bloodstream is measured at 5 mg/L.
What is the volume of distribution of this drug?Your Answer: 10,000 L
Correct Answer: 40 L
Explanation:Volume of Distribution
The volume of distribution is a measure of the volume required to achieve a specific concentration of a drug in the plasma. For instance, if 200 mg of a drug is administered and the concentration in the plasma is 5 mg/L, this is equivalent to dissolving the drug in 40 L of fluid. However, the volume of distribution varies depending on the drug’s properties, such as its affinity for proteins or fats. In general, a volume of distribution that is ten times greater than the average total plasma volume suggests that the drug is primarily bound to tissues or fat rather than being freely available in the plasma. This information is crucial when determining the appropriate loading doses for certain medications, particularly those used to treat epilepsy. To summarize, the volume of distribution is essential for optimizing drug dosing and ensuring effective treatment.
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This question is part of the following fields:
- Pharmacology
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Question 30
Incorrect
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A 25-year-old office worker arrives at the Emergency Department complaining of headaches due to work-related stress. She took two paracetamol earlier today, but when it didn't help, she took two aspirin. However, she developed an itchy rash on her face and is experiencing breathing difficulties. What type of drug reaction is this indicative of?
Your Answer: Induction of metabolism
Correct Answer: Idiosyncratic
Explanation:Idiosyncratic Reaction to Medication
A person’s idiosyncratic reaction to medication is a peculiar response that is not expected from the drug’s mode of action. In this case, a woman is experiencing an allergic reaction to either aspirin or paracetamol. The fact that she is having difficulty breathing is a serious symptom that requires urgent treatment. It is important to note that not all allergic reactions are the same, and some can be life-threatening. Therefore, it is crucial to seek medical attention immediately if any unusual symptoms occur after taking medication.
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This question is part of the following fields:
- Pharmacology
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