Background PK/PD pt2 Flashcards
Patient is on:
Bisoprolol 5 mg OD
Spironolactone 25 mg OD
Frusomide 50 mg
What condition do they most likely have….
a. Angina
b. Atrial fibrillation
c. Hypertension
d. Congestive heart failure
(d)
Mrs K is a 65 year old patient with type 2 diabetes. She usually takes Dapagliflozin 10mg daily to manager her condition but her doctor wants to switch her to a different anti-diabetic drug due to re-occurring urinary tract infection. Mrs K’s BMI is 33 kg/m2 and she has a history of heart failure and renal impairment. Her most recent eGFR measured at 25 ml/min. Choose the most suitable drug that you would recommend for Mrs K from the following options according to NICE guidelines?
A) Insulin glargine
B) Pioglitazone
C) Metformin
D) Linagliptin
E)Gliclazide
Answer is (D)
Insulin glargine (not used in initial stages of type 2 diabetes)
Pioglitazone (contraindicated in heart failure)
Metformin (eGFR is less than 30 so at increased risk of lactic acidosis)
Gliclazide (sulphonylureas cause weight gain and patient is already obese)
An 18 year old who suffers from chronic asthma is currently on Ventolin 100mcg inhaler QDS PRN and Clenil 100mcg inhaler BD. The doctor would like to step up her treatment as her symptoms are not well controlled. Which option is the correct next course of action to take according to BTS?
(A) Increase the dose of Ventolin inhaler
(B)Add a LABA
(C) Add a LTRA
(D) Increase the dose of her ICS
(E) Add modified release Theophylline
Answer: B
Increase the dose of Ventolin inhaler
Add a LABA (Preferred by BTS due to better breadth of patients whereas NICE prefers LTRA)
Add a LTRA (Good for patients with asthma only)
Increase the dose of her ICS (only after adding LABA)
Add modified release Theophylline
Grey baby syndrome is a side effect of which of the following drugs?
(A) Erythromycin
(B) Amoxicillin
(C) Chloramphenicol
(D) Methotrexate
(E)Phenytoin
C
Mr P has just recently received his blood results which show a low TSH and high T3 and T4 levels. Which medication below is most likely the cause of his abnormal results?
A. Losartan
B. Metformin
C. Tacrolimus
D. Carbamazepine
E. Amiodarone
E
(AmIODarone)
Mr Smith is a black African male who has been admitted to hospital recently for heart failure. He has also been diagnosed with type 2 diabetes and hypertension. The GP would like to start him on a stepwise management for his hypertension. Which medication below would be the most appropriate for this patient?
A. Ramipril
B. Diltiazem
C. Losartan
D. Bisoprolol
E. Spironolactone
(C)
Blood result:
Potassium: 2.5 [Range 3.5 – 5.1]
Sodium: 132 [Range 137 – 145]
Mr P has just had a blood test and he has received the blood results above. Which of his medications is the most likely cause of his results?
A. Salbutamol
B. Digoxin
C. Spironolactone
D. Prednisolone
E. Bumetanide
E
Mrs K’s daughter has been diagnosed with type 1 diabetes. She has forgotten how many times she needs to test her daughter’s blood glucose daily. She asks you how often does she need to test her daughter’s blood glucose levels?
A. At least once daily
B. At least twice daily
C. At least three times daily
D. At least four times daily
E. At least five times a week
D. At least four times daily [BEFORE each meal and before bedtime]
Which statement below about insulin is not correct?
A. Insulin should be injected in the area with most subcutaneous fat
B. Check insulin injection sites regularly for signs for infection, swelling or bruising
C. Injecting same area repeatedly may cause lipohypertrophy
D. Insulin is inactivated by liver enzymes and the subcutaneous route is the most ideal route
E. Patients should not inject into affected areas until the skin has recovered
D. [inactivated by GI enzymes]]
Which of the following is NOT associated with the use of SSRIs?
A. Anxiety
B. Arrhythmias
C. Drowsiness
D. Hypernatraemia
E. QT interval prolongation
D. Hypernatraemia [SSRIs are associated with hyponatraemia (BNF)]
Mr P is diabetic and has recently been diagnosed with schizophrenia, which antipsychotic below would be the most appropriate to prescribe in light of his diabetes?
A. Clozapine
B. Olanzapine
C. Quetiapine
D. Risperidone
E. Haloperidol
E)
Haloperidol [Hyperglycaemia or diabetes, 1st gen drugs (haloperidol and fluphenazine) least likely to cause diabetes compared to 2nd gen (risperidone, clozapine, olanzapine, quetiapine)]
Mr C has been prescribed Citalopram, he has been taking his medication for a few days but does not feel any improvement in his symptoms. Mr C would like to know how long he has to continue the medication before switching to a new drug due to lack of efficacy?
A. 2-3 weeks
B. 1-2 weeks
C. 4-8 weeks
D. 3-6 weeks
E. 4-6 weeks
4-6 weeks [6 weeks for elderly]
What is the general reason that the ultimate desired maintenance dose of Carbamazepine is much higher than the beginning dose?
A) Pharmacodynamic drug tolerance
B) Disease progression
C) Metabolic enzyme autoinduction
D) Renal function increased
E) Carbamazepine is a high hepatic extraction drug
C) Metabolic enzyme autoinduction
Autoinduction in drug metabolism is a known phenomenon observed when a drug induces the enzymes responsible for its own metabolism.
Patient R is a frail patient (75 years) who has been prescribed a Bendroflumethiazide. What side effect are you worried about for this patient.
Postural hypotension due to the reduction in total body volume which is more pronounced in elderly.
Patient X is starting to have pain in joints since they have been on Bendroflumethiazide. What is likely to be a cause.
(a) Hyperuricemia
(b) Hyperglycaemia
(c) Hypokalemia
(d) Hypercalcemia
(a) Hyper uricemia leading to secondary gout.
