CPT Flashcards
Which of the following is an important side effect of lithium use?
A. Decreased aldosterone secretion
B. Suicidal ideation
C. Nephrogenic diabetes insipidus
D. Atropine like effect
E. Hyperthyroidism
C
Other side effects include: tremor, ataxia, hypothyroidism (not hyperthyroidism).
Therapeutic drug monitoring is essential.
It also has drug interactions with diuretics.
A 75 year old man is being treated for Parkinson’s and develops a new onset heart murmur and is found to have fibrosis of his mitral cardiac valve. Which of the following drugs is most likely to be responsible?
A.Rasagiline
B. Levodopa
C. Donepezil
D. Pergolide
E. Amantadine
D
Pergolide is a ergot-derivative dopamine agonist.
This class of drugs is associated with fibrotic syndromes including cardiac valve fibrosis.
Carbamazepine is an anti-epileptic drug. Co-administration with which of the following drugs would not significantly increase the serum carbamazepine concentration?
A) Omeprazole B) Erythromycin C) Fluoxetine D) Ciprofloxacin E) Phenytoin
Phenytoin
Phenytoin is CYP450 inducer that will reduce serum carbamazepine concentration.
Others are CYP450 inhibitors that will increase serum carbamazepine concentration.
Which of the following anti-epileptic medications is associated with visual
field defects?
A) vigabatrin B) carbamazepine C) lamotrigine D) sodium valproate E) phenytoin
Vigabatrin
Toxic to retina and optic nerve.
Which of the following drugs can be used as a prophylactic agent in patients who frequently
develop migraines?
A. Sumatriptan B. Propranolol C. Phentolamine D. Paracetamol E. Codeine
Propranolol
Sumitriptan, paracetamol (and a lesser extent codeine) are used in the treatment of acute attacks.
A 7 year old girl is newly diagnosed with absence seizures. Which medication is the drug of choice
for this patient?
A. Ethosuximide B. Carbamazepine C. Gabapentin D. Phenytoin E. Clonazepam
Ethosuximide
2nd choice would be sodium valproate.
A 68-year-old woman has heart failure caused by ischaemic heart disease. She is currently treated with furosemide, enalapril, metoprolol and spironolactone. She complains of increased frequency of angina. Which change in her medication would be most appropriate?
A. add digoxin B. add isosorbide mononitrate C. add verapamil (controlled release) D. stop metoprolol E. stop spironolactone
Add isosorbide mononitrate
A 52-year-old man has been diagnosed with type 2 diabetes. He has normal renal function but has proteinuria and his blood pressure is 140/85 mm Hg. Which of these would be your first choice of antihypertensive drug?
A. thiazide B. beta-blocker C. angiotensin receptor blocker D. calcium channel blocker E. alpha-blocker
C
Which is the most accurate statement with regard to the treatment of hypertension?
A. ACE inhibitors are contra-indicated in type 1 diabetes
B. Alpha blockers are contra-indicated in benign prostatic hypertrophy
C. Beta-blockers are contra-indicated in hypertensive patients who develop congestive heart failure
D. Calcium channel blockers are contra-indicated in asthma
E. Thiazides are contra-indicated in patients with a history of gout
E
Contraindications:
- B blocker in asthma
- ACEi/ARBs in pregnancy
- Thiazides in gout
- non-dihydropyridine CCBs (verapamil) in CCF
A 22-year-old man is seen in A&E with a supraventricular tachycardia (at 170 beats/min) which is only transiently reversed by carotid sinus massage. Which of the following would be the drug of choice to induce sinus rhythm? A. adenosine B. atenolol C. digoxin D. flecainide E. verapamil
Adenosine
A 56-year-old man presents with a six month history of epigastric discomfort that is relieved by antacids. Over the past two months he has lost some weight. He smokes 20 cigarettes per day and drinks 32 units of alcohol per week. The most appropriate management plan is to:
A. give life-style advice, continue with antacid and review in six months
B. request a gastroscopy
C. request an ultrasound scan of abdomen
D. test for Helicobacter pylori and treat if positive
E. treat with a H2 receptor antagonist for six weeks and review
B
?Malignancy
A boy in his late teens is being treated with sodium valproate for absence seizures. Which of the following is the most serious toxicity that may be associated with this drug? A. cardiac dysrhythmias B. hepatic damage C. nephropathy D. neutropaenia E. thrombocytopaenia
Hepatic damage
A patient presents with acute cellulitis of the left leg. You should elect to treat him with an antibiotic which will cover: A. Bacteroides B. Clostridium tetani C. haemolytic streptococcus D. Proteus mirabilis E. Staphylococcus epidermidis
E
A 65-year-old woman on long-term therapy with warfarin is found to have an INR of 6 after starting an antibiotic for a urinary tract infection. Which of the following is most likely to be responsible? A. amoxicillin B. cefalexin C. ciprofloxacin D. nitrofurantoin E. trimethoprim
E
Ciprofloxacin also interacts with warfarin
Which of the following anticonvulsant drugs is currently considered to carry the least teratogenic risk? A. carbamazepine B. lamotrigine C. phenytoin D. sodium valproate E. vigabatrin
A
A patient is being treated for hypertension with verapamil. Which of the following is the most likely adverse affect at therapeutic dose? A. constipation B. erectile dysfunction C. hyperglycaemia D. myalgia E. nightmares
Constipation
A man in his 20s is being treated for chronic schizophrenia. Which of the following major tranquillisers is most likely to cause extrapyramidal adverse reactions? A. clozapine B. flupentixol C. olanzapine D. risperidone E. sulpiride
flupentixol
Typical anti-psychotic
Which is the most accurate of the following statements regarding the use of leukotriene antagonists in asthma?
A. they are effective in about two-thirds of asthmatic patients
B. they are given usually as part of step 3 as recommended by current guidelines
C. they are usually given 3-4 times a day
D. they have no serious adverse effects
E. they are often useful in exercise-induced asthma
E
Whilst they are used in Step 3 they are not part of usual management.
They do have a serious adverse effect: Churg-Strauss syndrome (an eosinophilic pneumonitis)
- A 21-year-old visitor to London attends your general practitioner surgery asking for a repeat prescription of a salbutamol metered-dose inhaler which has run out during his weekend visit. He has been using the salbutamol inhaler three or four times each day for symptomatic relief. Examination of the respiratory system is unremarkable and peak flow is 70% of predicted. The most appropriate immediate management is:
A. prescribe his salbutamol inhaler to use as before
B. prescribe his salbutamol inhaler to use as before and add a steroid inhaler to use twice a day
C. prescribe his salbutamol inhaler to use as before and add a 5 day course of oral
steroids
D. recommend that he consults his own general practitioner immediately he returns home
E. refer to hospital for observation and overnight peak flow recording
C
Mild according to PEFR
First line neuropathic analgesic agent vs trigeminal neuralgia
Carbamazepine
A 50 year old woman presents with a six hour history of palpitations. The ECG shows AF at a ventricular rate of 120bpm. Best management?
A) anticoagulation B) Carotid sinus massage C) IV adenosine D) IV lignocaine E) Perform DC cardioversion
E - perform DC cardioversion
Early cardioversion gives best opportunity to revert to sinus rhythm.
Must be within 48h of onset. No need to anticoagulate before this threshold.
A 95 year old man with cancer is given morphine. Which of these would be prescribed to minimise side effects?
A) aspirin B) co-danthramer C) dexamphetamine D) hyoscine E) Loperamide
Co-danthramer
A laxative to counteract the constipating effects of morphine.
A patient receiving chemotherapy develops severe hair loss and haemorrhagic cystitis
A) Chlorambucil B) Cisplatin C) Cyclophosphamide D) Doxorubicin E) Paclitaxel
Cyclophosphamide
MESNA is an antidote that will reverse the cystitis without affecting the chemotherapy affect,.
A 75 year old woman recovers from C.difficile infection after therapy but has a recurrence 3 weeks later. Best management
A) Metronidazole for 1 week B) Metronidazole for 2 weeks C) Vancomycin for 1 week D) Vancomycin for 2 weeks E) Both drugs for 2 weeks
Vancomycin for 2 weeks
Recent change in guidelines that after a recurrence you should switch to vancomycin to limit antibiotic resistance.
An 80 year old man drowsy and confused. Na 128 K 2.8 Urea 26.2 Creatinine 125. Cause?
A) Chronic renal failure B) chronically low dietary sodium intake C) diabetes insipidus D) excessive treatment with loop diuretics E) inappropriate use of ACEi
D - Excessive treatment with loop diuretics.
Low sodium and potassium with raised urea and creatinine. Implies losing circulating volume as well as electrolytes as done by loop diuretics.
Which of the following is the most accurate statement in relation to COPD:
A) inhaled steroids have no significant place in therapy
B) inhaled sodium cromoglycate is useful 3rd line therapy
C) LABA are rarely used
D) LTOT is indicated in the presence of pulmonary hypertension
E) there is no clinical advantage in using once-daily anti-cholinergic inhalers
D - LTOT is indicated in the presence of pulmonary hypertension
A 25 year old woman develops DVT during pregnancy and is given LMWH. After 3 weeks there is an abnormality…
A) lymphocytosis B) macrocytic anaemic C) neutropenia D) polycythemia E) thrombocytopenia
Thrombocytopenia
Other long term side effects of heparin include osteoporosis.
A man with T2DM has very high fasting serum triglyceride levels (>10 times upper limit of normal). Which drug should you give?
A) atorvastatin B) colestyramine C) Ezetimibe D) Fenofibrate E) Niacin
Fenofibrate
Most effective at reducing triglycerides.
At these levels important to do rapidly due to risk of acute pancreatitis rather than cardiovascular outcomes (on which fibrates have little effect)
Niacin is also effective but poorly tolerated due to SFx
Statins have a mild effect.
Diarrhoea is most likely as an adverse effect of which of the following at therapeutic doses?
A) Diclofenac B) Doxazosin C) Misoprostol D) Omeprazole E) Verapamil
Misoprostol
diclofenac and omeprazole also associated with diarrhoea.
Verapamil associated with constipation.
SSRIs, such as fluoxetine, are most likely to have a dangerous interaction with which of the following?
A) Diazepam B) Digoxin C) Diphenhydramine D) Phenelzine E) Phenytoin
Phenelzine
This is a MAO inhibitor.
Interaction results in a serotonin syndrome
Which of the following is most accurately described as a phase II metabolic reaction for a drug?
A) Deamination B) Glucoronidation C) Hydrolysis D) Reduction E) Sulfoxide synthesis
Glucoronidation.
Phase II reactions are usually conjugation reactions.
Which of the following statements is least accurate with respect to a 1 month old baby?
A) Absorption of drugs is significantly reduced compared to adults
B) hepatic drug metabolism is similar to that of adults
C) plasma protein binding of drugs is likely to be increase compared to adults
D) the glomerular filtration rate is close to adult levels
E) The half-life of diazepam is much shorter than in adults.
Hepatic drug metabolism is similar to that of adults
Which of the following is the most accurate statement concerning drug therapy in a 75 year old man?
A) GFR will be usually below its peak level
B) renal tubular function is likely to be normal
C) the absorption of most drugs will be impaired
D) the clearance of warfarin is almost always reduced
E) increased
A
An 18 year old woman has acute onset of generalised tonic-clonic seizures. Which is drug of 1st choice?
A) diazepam B) paraldehyde C) phenobarbitone D) phenytoin E) sodium valproate
Diazepam
Lorezepam is most preferable benzodiazepine.
Which of the following is most likely to be an adverse effect of carbimazole therapy?
A) cutaneous lupus B) gout C) hepatic necrosis D) neutropenia E) peptic ulceration
Neutropenia
A patient is known to have T1DM is found unconscious. In the absence of other information what would you do
A) Administration of 1mg rectal glucagon solution
B) Dextrose 5% 100ml via rapid infusion
C) IV fluids with infusion of soluble human insulin at 4 units
D) 40 units of soluble human insulin as bolus large peripheral veins
E) 50ml glucose 20% solution via rapid IV injection
E
Assume it’s hypoglycaemia.
Giving extra glucose to hyperglycaemia is unlikely to make any difference.
Which of the following is most likely to cause dangerous ventricular dysrhythmias in overdose?
Citalopram Fluoxetine Imipramine Lorazepam Phenelzine
Imipramine
TCAs are very dangerous in overdose mainly due to risk of ventricular dysrhythmias as well as CNS depressant.
Which of the following drugs is most likely to cause significant hypoglycaemia?
Acarbose Exanatide Gliclazide Metformin Pioglitazone
Gliclazide
Sulphonylureas are most likely to cause hypoglycaemia.
Which of these is likely to be used as a first line treatment in an immunocompromised patient with P.carinii
Amoxicillin Clarithromycin Co-trimoxazole Doxycycline Metronidazole
Co-trimaxazole (septrin)
Patient with alcoholic cirrhosis and ascites. Optimal first treatment?
A) Bendroflumethiazide B) Furosemide C) IV salt-free albumin D) Paracentesis E) Spironolactone
Spironolactone.
Secondary hyperaldosteronism
Hypokalemia increases the risk of hepatic encephalopathy so avoid non-K sparing diuretics.
Which of the following cytochrome P450 isozymes is responsible for oxidation of the largest range of xenobiotics?
CYP1A2 CYP2D6 CYP2C19 CYP3A4 CYP1A1
CYP3A4
