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Question 1
Correct
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Which statement about receptor tyrosine kinases is accurate?
Your Answer: Dimerisation of receptors is usually involved in activation
Explanation:Receptor Binding and Activation
Substances such as insulin, epidermal growth factor (EGF), and platelet-derived growth factor (PDGF) can bind to receptors in the body. These receptors have four domains: ligand binding, transmembrane, catalytic, and autophosphorylation domains. When an agonist binds to the receptor, it causes a change in shape, which leads to phosphorylation. This process activates the receptor and triggers a response in the body.
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This question is part of the following fields:
- Pharmacology
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Question 2
Incorrect
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A 32-year-old female patient complains of a disrupted menstrual cycle, decreased libido, and lactation despite never being pregnant. Upon blood testing, she is found to have elevated serum prolactin levels. Which medication is associated with causing hyperprolactinemia?
Your Answer: Atorvastatin
Correct Answer: Cimetidine
Explanation:Hyperprolactinaemia in Women
Hyperprolactinaemia is a condition that affects women and is characterized by an excess of prolactin hormone in the body. This condition can present with various symptoms, including anovulatory infertility, reduced menstruation, production of breast milk, reduced libido, and vaginal dryness. The condition is caused by either disinhibition of the anterior pituitary or excess production due to a pituitary tumor. A serum prolactin concentration greater than 5000 mIU/L suggests a pituitary adenoma.
Moreover, hyperprolactinaemia can also be caused by certain prescription medications, including antihistamines, butyrophenones, cimetidine, methyldopa, metoclopramide, and phenothiazines. These medications are strongly associated with the condition and can lead to an increase in prolactin levels in the body.
It is important to understand the symptoms and causes of hyperprolactinaemia in women to seek appropriate medical attention and treatment. With proper diagnosis and management, women can effectively manage this condition and improve their quality of life.
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This question is part of the following fields:
- Pharmacology
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Question 3
Incorrect
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Which patient with acute ischaemic stroke is a candidate for neurosurgical intervention?
Your Answer: A 59-year-old presenting with ataxia who has a small pontine infarction
Correct Answer: A 50-year-old with infarction of 60% of the middle cerebral artery (MCA) territory
Explanation:Guidelines for Decompressive Hemicraniectomy in Large Cerebral Infarctions
Current clinical guidelines recommend that patients under 60 years of age with large cerebral infarctions in the middle cerebral artery (MCA) territory should be considered for decompressive hemicraniectomy. This procedure involves removing part of the skull to reduce intracranial pressure and should be done within 48 hours of the stroke. Eligibility for the surgery is based on clinical and radiological evidence of a stroke affecting the MCA territory, radiological evidence that more than 50% or 145 cm3 of the MCA territory is involved, and being classified as having a moderate to severe stroke according to the National Institute of Health stroke scale.
In addition to large cerebral infarctions in the MCA territory, other indications for neurosurgical intervention in acute ischemic stroke include a massive cerebellar infarction or evidence of hydrocephalus or brainstem compression. It is important for healthcare professionals to be aware of these guidelines and indications for neurosurgical intervention in order to provide the best possible care for stroke patients. Proper and timely intervention can greatly improve outcomes and quality of life for stroke survivors.
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This question is part of the following fields:
- Pharmacology
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Question 4
Incorrect
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Which statement about voltage gated ion channels (VGIC) is accurate?
Your Answer: VGIC comprise five subunits
Correct Answer: Each subunit has six transmembrane spanning domains (S1-S6)
Explanation:Voltage Gated Ion Channels
Voltage gated ion channels (VGICs) are composed of four subunits, each containing six transmembrane domains (S1-S6). The S4 domain is believed to be the voltage sensor, as every other residue is charged. The channel of calcium and sodium VGICs is formed by a single peptide, while the potassium receptor channel is made up of four separate peptides, indicating that it is evolutionarily more primitive. The sodium VGIC is targeted by local anesthetics. In summary, VGICs are essential for the proper functioning of cells and play a crucial role in the transmission of electrical signals in the nervous system.
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This question is part of the following fields:
- Pharmacology
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Question 5
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 6
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: Heparin
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 7
Incorrect
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A 65-year-old male patient is started on azathioprine treatment by a gastroenterologist for Crohn's disease. After six months of treatment, you receive a request from the gastroenterology department to assist with monitoring his treatment.
What is the current recommended protocol for monitoring patients on long-term azathioprine therapy?
Note:
FBC - Full blood count
LFT - Liver function tests
U&E - Urea and electrolytes.Your Answer: FBC, LFT and U&E every 12 months
Correct Answer: FBC, LFT and U&E every three months
Explanation:Azathioprine: A Cytotoxic Agent for Severe Refractory Eczema and Other Conditions
Azathioprine is a cytotoxic drug that is converted to mercaptopurine, which acts as a purine analogue that inhibits DNA synthesis. It is used off-label for severe refractory eczema, post-transplant, and in patients with rheumatoid arthritis and inflammatory bowel disease. However, bone marrow suppression and hepatotoxicity are serious and well-known complications of azathioprine therapy. Other side effects include nausea, vomiting, and skin eruptions. Patients with low levels of the enzyme thiopurine methyltransferase (TPMT), which metabolizes azathioprine, are at increased risk of toxicity, and their enzyme activity is often measured before starting treatment.
To minimize the risk of complications, current guidelines from the British Association of Dermatologists and the British National Formulary recommend monitoring full blood count (FBC), liver function tests (LFT), and urea and electrolytes (U&E) every three months once patients are established on azathioprine treatment. By following these guidelines, healthcare providers can ensure that patients receive the benefits of azathioprine while minimizing the risk of adverse effects.
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This question is part of the following fields:
- Pharmacology
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Question 8
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: Naproxen
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 9
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 10
Correct
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A 55-year-old male patient complains of sudden chest pain and is being evaluated for acute coronary syndrome. Upon fasting, his serum cholesterol level was found to be 7.1 mmol/L (<5.2). What is the best initial course of action for managing this patient?
Your Answer: Statin therapy
Explanation:Statin Therapy for Hypercholesterolemia in Acute Coronary Syndrome
Hypercholesterolemia is a common condition in patients with acute coronary syndrome. The initial treatment approach for such patients is statin therapy, which includes drugs like simvastatin, atorvastatin, and rosuvastatin. Statins have been proven to reduce mortality in both primary and secondary prevention studies. The target cholesterol concentration for patients with hypercholesterolemia and acute coronary syndrome is less than 5 mmol/L.
According to NICE guidance, statins should be used more widely in conjunction with a QRISK2 score to stratify risk. This will help prevent cardiovascular disease and improve patient outcomes. The guidance recommends that statins be used in patients with a 10% or greater risk of developing cardiovascular disease within the next 10 years. By using statins in conjunction with risk stratification, healthcare professionals can provide more targeted and effective treatment for patients with hypercholesterolemia and acute coronary syndrome.
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This question is part of the following fields:
- Pharmacology
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Question 11
Incorrect
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You are creating a medication schedule for a patient with chronic renal failure who is elderly. Which medication may require a dosage modification due to the reduced renal clearance?
Your Answer: Warfarin
Correct Answer: Morphine sulphate
Explanation:Opioid Use in Patients with Abnormal Renal Function
Patients with abnormal renal function should have their opioid doses reduced due to the prolonged duration of action. However, it is important to note that the initial loading dose may need to be greater in these patients to achieve the desired drug effect. This is because patients with chronic renal failure have an increased volume of distribution, which can affect drug concentration in the plasma. Despite the need for a higher initial dose, subsequent doses should be reduced to account for poor drug clearance. It is important to monitor patients closely and adjust doses as needed to avoid adverse effects. None of the other agents typically require caution in patients with abnormal renal function.
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This question is part of the following fields:
- Pharmacology
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Question 12
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 13
Correct
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β-adrenergic receptor antagonists, like propranolol, are commonly prescribed in medical practice. In which of the following conditions are β-adrenergic receptor antagonists not recommended for use in elderly patients?
Your Answer: Asthma
Explanation:Beta Blockers and Asthma
Beta blockers are commonly used to treat various cardiovascular diseases due to their negative chronotropic and inotropic effects. However, they can be detrimental to individuals with asthma. This is because beta blockers antagonize beta-2 receptors, which can lead to bronchoconstriction and trigger asthma attacks. As a result, beta blockers are not recommended as a treatment for asthma. It is important for healthcare providers to be aware of this potential adverse effect and to consider alternative medications for patients with asthma who require cardiovascular treatment. Proper management of both conditions is crucial to ensure optimal health outcomes for patients.
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This question is part of the following fields:
- Pharmacology
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Question 14
Incorrect
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What is a true characteristic of G protein coupled receptors and their involvement in biological processes?
Your Answer: GPCRs comprise seven protein domains
Correct 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 15
Incorrect
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Which statement regarding ligand gated ion channels (LGIC) is accurate?
Your Answer: Muscarinic acetylcholinergic channels are ligand gated ion channels
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 16
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: Synergistic
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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Question 17
Incorrect
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A 57-year-old man arrives at the Emergency Department in a confused and unresponsive state. He had been given diazepam for his back spasms and had consumed half a bottle of wine during dinner. What type of drug reaction is this indicative of?
Your Answer: Inhibition of metabolism
Correct Answer: Synergistic
Explanation:Benzodiazepines and Ethanol Combination Leads to Excessive Sedation
The combination of benzodiazepines and ethanol can result in excessive sedation due to their shared action on GABA receptors, which leads to generalised neuroinhibitory effects. Both substances have a calming effect on the brain, and when taken together, they can intensify each other’s effects, leading to a dangerous level of sedation. This is likely the reason why the gentleman in question experienced excessive sedation. It is important to note that combining benzodiazepines and ethanol can be extremely dangerous and should be avoided.
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This question is part of the following fields:
- Pharmacology
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Question 18
Correct
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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: 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 19
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: Liraglutide
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 20
Incorrect
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A 50-year-old male is referred by his GP for an endoscopy due to recurrent indigestion. During the procedure, a small duodenal ulcer is discovered and Helicobacter pylori is found to be present. What is the recommended treatment for this patient?
Your Answer: Ranitidine, amoxicillin and metronidazole
Correct Answer: Omeprazole, metronidazole and clarithromycin
Explanation:Helicobacter pylori and Peptic Ulceration
The bacterium Helicobacter pylori, which is classified as a gram-negative curved rod, has been linked to the development of peptic ulceration by inhibiting the healing process. In fact, up to 90% of patients with duodenal ulceration and 70% of cases of peptic ulceration may be infected with Helicobacter. To treat this infection, therapy should focus on acid suppression and eradication of the bacterium. Triple therapy, which involves a proton pump inhibitor like omeprazole along with two antibiotics (amoxicillin/clarithromycin plus metronidazole), has been found to be the most effective treatment. This therapy should be administered for one week, with proton pump therapy continuing thereafter.
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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 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 22
Correct
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A disheveled woman is brought to the Emergency Department with constricted pupils, a respiratory rate of eight per minute and an oxygen saturation of 84% on room air. Her heart rate is 60 beats per minute and her blood pressure is 110/70. The medical team recognizes her as a frequent drug user in the area. She is placed in a supine position and given high-flow oxygen, but her respiratory rate remains at eight per minute and her oxygen saturation only improves to 86%.
What is the most appropriate medication to administer in this situation?Your Answer: Naloxone
Explanation:Treatment for Opiate-Induced Respiratory Depression
When a patient displays respiratory depression and mild bradycardia, it is likely due to opiate use. In such cases, the opiate antagonist naloxone is the most effective treatment. Naloxone has a rapid onset of action and can immediately reverse the effects of opiates. However, it is important to note that the half-life of naloxone is shorter than that of opiates, so patients must be monitored to prevent them from leaving prematurely.
Flumazenil is used to treat uncomplicated benzodiazepine overdose, while pralidoxime is used in organophosphate poisoning. However, in cases of opiate-induced respiratory depression, naloxone is the drug of choice. It is important to be aware that opiate abusers may become angry and aggressive when their high is suddenly reversed. Therefore, a slow infusion of naloxone may be necessary to ensure adequate oxygenation without completely reversing the effects of the opiates. Overall, naloxone is a highly effective treatment for opiate-induced respiratory depression.
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This question is part of the following fields:
- Pharmacology
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Question 23
Incorrect
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A patient in his 50s with heart failure is prescribed a diuretic by his GP and subsequently develops gynaecomastia. Which specific agent is most likely responsible for this adverse effect?
Your Answer: Bendroflumethiazide
Correct Answer: Spironolactone
Explanation:Drugs that may cause side effects and the role of Spironolactone
There are several drugs that may cause side effects, including cimetidine, oestrogens, digoxin, and ketoconazole. These drugs can affect the body in different ways, leading to various symptoms. For instance, cimetidine may cause confusion, while oestrogens may cause breast tenderness. Digoxin may cause nausea and vomiting, and ketoconazole may cause liver problems.
One drug that can help maintain plasma potassium levels is Spironolactone. It acts as an aldosterone antagonist, which means it blocks the effects of aldosterone, a hormone that regulates sodium and potassium levels in the body. By blocking aldosterone, Spironolactone helps to maintain a balance of potassium in the blood. This is important because too much or too little potassium can cause serious health problems, such as irregular heartbeats or muscle weakness. Therefore, Spironolactone is often prescribed to people with conditions such as heart failure, liver disease, or high blood pressure.
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This question is part of the following fields:
- Pharmacology
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Question 24
Incorrect
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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: 75 mg
Correct 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 25
Incorrect
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As a third year medical student in an outpatient department with a dermatology consultant, you are evaluating a 27-year-old patient who is unresponsive to current hyperhidrosis treatment. The consultant suggests starting botox injections to prevent sweating. Can you explain the mechanism of action of botulinum toxin at the neuromuscular junction?
Your Answer: Antagonist to acetylcholine
Correct Answer: Inhibits vesicles containing acetylcholine binding to presynaptic membrane
Explanation:Botulinum Toxin and its Mechanism of Action
Botulinum toxin is becoming increasingly popular in the medical field for treating various conditions such as cervical dystonia and achalasia. The toxin works by binding to the presynaptic cleft on the neurotransmitter and forming a complex with the attached receptor. This complex then invaginates the plasma membrane of the presynaptic cleft around the attached toxin. Once inside the cell, the toxin cleaves an important cytoplasmic protein that is required for efficient binding of the vesicles containing acetylcholine to the presynaptic membrane. This prevents the release of acetylcholine across the neurotransmitter.
It is important to note that the blockage of Ca2+ channels on the presynaptic membrane occurs in Lambert-Eaton syndrome, which is associated with small cell carcinoma of the lung and is a paraneoplastic syndrome. However, this is not related to the mechanism of action of botulinum toxin.
The effects of botox typically last for two to six months. Once complete denervation has occurred, the synapse produces new axonal terminals which bind to the motor end plate in a process called neurofibrillary sprouting. This allows for interrupted release of acetylcholine. Overall, botulinum toxin is a powerful tool in the medical field for treating various conditions by preventing the release of acetylcholine across the neurotransmitter.
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This question is part of the following fields:
- Pharmacology
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Question 26
Correct
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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: 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 27
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: Acarbose
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 28
Incorrect
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An 80-year-old man is brought to the Emergency Department by his physician due to sudden confusion. The patient had been treated for a chest infection with clarithromycin recently. He has a history of atrial fibrillation and is taking warfarin as an anticoagulant. Due to his confusion, it is challenging to obtain a detailed medical history from him. However, his blood tests reveal a significantly low haemoglobin level of 56 g/L (115-160). What type of drug reaction is this indicative of?
Your Answer: Antagonism
Correct Answer: Inhibition of metabolism
Explanation:Drug Interaction Causing Bleeding and Confusion
This patient’s symptoms are a classic example of a drug interaction between clarithromycin and warfarin. While there are many medications that can interact with warfarin, antibiotics are particularly known for affecting its effectiveness. In this case, clarithromycin has inhibited the metabolism of warfarin, causing it to become more potent. As a result, the patient has experienced bleeding, most likely in the gastrointestinal tract, which has led to confusion.
Further investigation is necessary to ensure that there is not an underlying issue, such as colon cancer, that has been unmasked by this drug interaction. It is important for healthcare providers to be aware of potential drug interactions and to monitor patients closely for any adverse effects. By doing so, they can help prevent complications and ensure that patients receive the best possible care.
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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 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: Give the patient advice about self-management of sore throat and advise to return if she does not improve in the next five days
Correct 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 30
Correct
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What is the term used to describe a drug that binds to the same receptor as an agonist but is unable to produce a comparable effect even with increasing doses?
Your Answer: Partial agonist
Explanation:Agonists, Antagonists, and Partial Agonists
Agonists, antagonists, and partial agonists are terms used to describe drugs that interact with receptors in the body. Competitive antagonists work by binding to the same receptor site as the agonist, preventing it from binding and producing its effect. However, increasing the concentration of the agonist can overcome this effect.
Allosteric drugs, on the other hand, act at a site separate from the receptor site of the agonist. This can either enhance or inhibit the effect of the agonist. Partial agonists, like buprenorphine, produce a weaker effect than a full agonist. When combined with a full agonist, like morphine, the overall effect is decreased, leading to poor pain control.
the differences between agonists, antagonists, and partial agonists is important in the development and use of drugs for various medical conditions. By targeting specific receptors in the body, these drugs can produce a desired effect or block unwanted effects. Proper dosing and combination of these drugs can lead to effective treatment and management of various conditions.
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This question is part of the following fields:
- Pharmacology
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