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
Which of the following medication is NOT administered orally as an inactive prodrug?
Carbimazole Azathioprine Enalapril Clozapine Codeine
Clozapine
Carbimazole -> methimazole
Azathioprine -> 6 mercatopurine
Enalapril -> enalaprilat
Codeine -> morphine
Which of the following does NOT induce CYP450?
Rifampicin St John's wort Erythromycin Phenytoin Phenobarbital
Erythromycin
What effect would you expect chronic alcoholism to have on the microsomal drug metabolising system?
Increased induction Reduced induction Increased inhibition Reduced inhibiton No effect
Increased induction
The activity of the microsomal drug metabolising system increases substantially after long term alcoholism, but this eventually reaches a plateau. Activation of this system after alcohol consumption can alter the breakdown of other drugs and this contributes to interactions between alcohol and these drugs.
Which of the following conditions would penicillamine NOT be used to treat
Wilson's Disease RA Lead poisoning SLE Cystinuria
D - SLE
Penicillamine is a chelating agent. It is used in the treatment of Wilson’s disease where it bids to accumulated copper and facilitates elimination in the urine. It can chelate heavy metals such as lead and mercury, eliminating them from circulation. It is also used as an immunosuppressant to treat RA - it inhibits macrophage function an reduces T cell numbers. It is used in cystinuria to promote the generation of an more soluble form of cysteine and prevent stone formation. An important complication from the use of penicillamine is the development of an SLE-like syndrome.
What percentage of patients treated with ACEi develop angioedema?
5% 10% 0.1% 1% 20%
0.1%
Angioedema is a painless, non-pruritic, non-pitting area of selling due to increased vascular permeability. It is often described as an anaphylactoid reaction. It is most apparent in the head and neck. Life threatening laryngeal oedema and airway obstruction are the major concerns
0.1-0.2% of patients treated with ACEi develop angioedema with an overall patient mortality of 11%.
Which of the following anti-obesity/anti-diabetic treatments influences noradrenaline reuptake and B3-receptor mediated thermogenesis in muscle?
Rimonabant Sibutramine Orlistat Metformin Pioglitazone
Sibutramine
Sibutramine is an orally administered appetite suppressant and centrallt acting serotonin-noradrenaline inhibitor. It has recently been withdrawn because it can increase heart rate and blood pressure.
Other appetite suppressors inculude: rimonabant, a CB1 antagonist of the cannabinoid CB1 receptor (withdrawn due to psychiatric problems); and orlistat.
Anti-diabetic drugs include metformin, which is an insulin sensitiser and pioglitazone which works through activation of PPARg
Which of the following drugs is NOT used in the treatment of T2DM?
Amylin Liraglutide Repaglinide Octreotide Metformin
Octreotide
Octreotide is a somatostatin analogue that inhibits that actions of insulin. IT is used in the treatment of acromegaly.
Pramlintide is an amylin analogue that, like insulin, is deficient in diabetes. IT aids glucose absorption by slowing gastric emptying and promotes hypothalamic satiety. Liraglutide is a GLP-1 analogue. Repaglinide is part of the meglitinide class of drugs that lower blood glucose by stimulating the release of insulin from the pancreas.
Which of the following drugs CANNOT be used to treat adrenal steroid excess
Ketoconazole Metyrapone Etomidate Esmolol Mifepristone
Esmolol
Esmolol is an IV B-blocker, used only in an ITU setting.
Metyrapone blocks the final step of cortisol synthesis. Ketoconazole is an anti-fungal, and etomidate is a short acting IV anaesthetic agents - both interfere with steroid biosynthesis.
Mifepristone is a glucocorticoid receptor antagonist and blocks the effects of excess cortisol.
A 37 year old man presents with suspected acromegaly, which is subsequently confirmed by the endocrine clinic. Which of these drugs might you prescribe for this patient?
Pegvisomant Levodopa Ghrelin analogues Somatrem Dexamethasone
Pegvisomant
Pegvisomant is a genetically modified analogue of GH that is a highly selective GH receptor antagonist. It is used when there is an inadequate response to tumour removal using surgery or radiotherapy.
Ghrelin analogues and levodopa would stimulate GH secretion from the anterior pituitary, where as sometime is a synthetic GH analogue. While dexamethasone would suppress GH secretion to a certain degree, it is not used as a treatment.
In which of the following conditions is the use of nitrates contraindicated?
Angina Erectile dysfunction Heart failure HOCM Open angle glaucoma
HOCM
Nitrates reducd the preload by venous dilation, and the after load by a lesser degree of arteridilation. They also have a marked dilating effect on coronary vessels, if these are not too atherosclerotic too respond.
In HOCM and other conditions, a large drop in preload has negative effects. These conditions include cardiac tamponade, pericardities, cor pulmonale and mitral stenosis.
Nitrate use with sildenafil can cause significant hypotension
Which of the following is NOT a contraindication for the use of dihydropyridine CCBs?
Sick sinus syndrome AV block Aortic stenosis Heart failure Cardiogenic shock
Heart failure
The dihydropyridines include amlodipine and nifedipine. These can be used as an adjunct in the treatment of hypertension in heart failure as it does not have the negative inotropic effects that are seen with verapamil and diltiazem.
At what level should diastolic BP be persistently greater than, in order for drug treatment for hypertension to be commenced, even in the absence of target organ damage and other risk factors?
85 mmHg 90 mmHg 95 mmHg 100 mmHg 110 mmHg
100mmHg
Drug therapy reduces the risk of cardiovascular disease and death. NICE guidelines suggest that drug therapy would be offered to patients with persistent BP >160/100 mmHg.
What type of laxative is lactulose?
Bulk Stimulant Osmotic Lubricant Stool softener
Osmotic laxative
Lactulose = osmotic laxative
Fybogel = Bulk laxative
Senna = Stimulant
Mineral oil = lubricant
A 38 year old woman is planning her first pregnancy. She suffers from Crohn’s disease and is well controlled on azathioprine. What advice would you give this patient?
Continue on azathioprine Switch to methotrexate Switch to sulfasalazine Switch to cyclosporin Switch to infliximab
Continue on azathioprine
It is advisable that Crohn’s be in remission prior to pregnancy. Active Crohn’s during pregnancy is associated with an increased risk in a number of undesirable outcomes, e.g. premature delivery. Limited data suggests that if a woman becomes pregnanct while taking azathioprine for IBD, continuing treatment does not increase the risks of pregnancy complications of congenital abnormalities.
If Crohn’s is well controlled on azathioprine, then treatment should continue. Although sulfasalazine is regarded as safe during pregnancy it is not advisable to switch drugs at this point due to the risk relapse.
Methotrexate and ciclosporin are contraindicated. There is insufficient evidence for infliximab during pregnancy.
A 31 year old man has been trying to conceive a child with his partner for the last 4 months. He suffers from IBD that is well controlled on azathioprine. His partner has no fertility problems. What advice would you give his patient?
Continue on azathioprine Switch to methotrexate Switch to sulfasalazine Switch to cyclosporin Switch to mesalazine
Switch to sulfasalazine
While azathioprine does not affect the sperm, there is evidence suggestive of an increased risk of congenital abnormality and spontaneous abortion if the father has received azathioprine treatment within 3 months of conception.
Sulfasalazine is not thought to be teratogenic, however, it does reduce the sperm count and alters sperm morphology so reducing male fertility. The effects are thought to be reversible when the medication is stopped or substituted with mesalazine.
Cyclosporin has negative effects on male fertility. There is no conclusive evidence that methotrexate influences male fertility but its negative effects on metal development make it an unlikely treatment option in this case.
Which of the following drugs is combined with diclofenac to form arthrotec?
Misoprostol Omeprazole Aspirin Paracetamol Codeine
Misoprostol
Misoprostol is a prostaglandin E analogue, used to minimise gastric ulceration when taking NSAIDs.
It is also used as an abortifacient, used in the medical termination of pregnancy, as it promotes uterine contractions.
Which of the following is an important and common side effect of misoprostol?
Churning effect Diarrhoea Vomiting Skin rash Hair Loss
Churning effect
D+V can occur when using misoprostol but are non-specific. The churning effect is a GI-upset characteristic to this medication. Some patients may also experience cramps. Misoprostol is used in medical terminations, so should not be prescribed to females looking to conceive.
An 18 year old with non-responsive asthma is started on a new medication. Two weeks later he is admitted to A&E with haemoptysis. Nasal polyps are also noted. Which medication is the most likely cause of these symptoms?
Ipratropium bromide Symbicort Sodium cromoglycate Theophylline Montelukast
Montelukast.
Churg-Strauss syndrome is a systemic vasculitis that also has features of asthma. The association of leukotriene receptor antagonists such as montelukast with Churg-Strauss syndrome has been recognised for several years. However, whether these drugs have a direct pathogenic role remains controversial.
Montelukast is used to control symptoms of asthma and sometimes allergic rhinitis. It works by blocking leukotriene receptors in the lungs and thus blocking their actions. This prevents excess mucus production, inflammation and narrowing of the airways. It is used for people whose asthma is not fully controlled by using regular inhaled steroids and SABA. Only about 30% responde.
Which of the following drugs can increase the pharmacological effect of warfarin?
Carbamazepine Rifampicin Cimetidine St John's Wort Phenytoin
Cimetidine
Warfarin is metabolised by CYP450 (2C8/9)
Inducers that decrease warfarin: carbamazepine, phenobarbital, phenytoin, rifampcin, rifapentine andSt John’s wort
Inhibitors that increase warfarin: cimetidine, delaviridine, fluconazole, gemfibrozil, nicardipine, NSAIDs, pioglitazone and sulfonamides.
Other CYP450 substrates include: amiodarone, fluoxetine, gliplizide, rosiglitazone and sertraline.
A patient is undergoing chemo and develops nausea, vomiting, tinnitus and high-tone hearing loss. Which anti-cancer drug is most likely to be responsible?
Cisplatin Bleomycin Doxorubicin Vincristine Methotrexate
Cisplatin
Nausea and vomiting are non-specific. However, cisplatin ototoxicity manifests itself with tints/high tone hearing loss and occasional deafness. The effects are more pronounced in children.
Bleomycin -> pulmonary fibrosis and pneumonitis
Doxorubicin -> myocardial toxicity and CCF
Which of the following classes of cytotoxic drugs bind to tubulin dimers, thus preventing microtubule assembly?
Vinca alkaloids Epipodophyllotoxins Taxanes Alkylating agents Bleomycins
Taxanes
Taxanes and Vinca alkaloids are derived from the Pacific Yew tree and periwinkle plant respectively. They are name spindle poisons as they both prevent microtubule assembly.
Vinca alkaloids binds to B-tubulin monomers, preventing them from being incorporated in growing microtubules.
Taxanes have the opposite effect, interacting with B-tubulin dimers that already have been incorporated, overloading the cell causing a mitotic crisis.
Epipodophyllotoxins are alkaloids, such as etoposide that inhibit topoisomerase II.
Bleomycin’s are metal-chelatin glycopeptides that degrade DNA.
Alkylating agents covalently bond with DNA.
A 53 year old man is newly diagnosed with Parkinson’s disease. He is concerned about ay psychotic side effects associated with drug treatment since his mother suffers from schizophrenia. Which of the following drugs would you prescribe as initial therapy?
Levodopa Pramipexole Selegiline Benzhexol Amantadine
Pramipexole
Dopamine agonists such as ropinirole and pramipexole are used in the treatment of early-onset Parkison’s, as they provide similar motor benefits with fewer dyskinesic effects seen with regimens including levodopa.
Which of the following psychiatric medications is described as a noradrenergic and specific serotonergic antidepressant (NaSSa)?
Isocarboxacid Moclobemide Venlafaxine Mirtazepine Fluoxetine
Mirtazepine
Isocarboxacid: irreversible, non-selective MAO
Moclobemide: reversible inhibitor of MAO
Venlafaxine: SNRI
Fluoxetine: SSRI
Which of the following antidepressatns drugs should be used with caution in hypertensive patients?
Citalopram Venlafaxine Reboxetine Clomipramine Mirtazepine
Venlafaxine
Venlafaxine is a 2nd line SNRI and evidence suggests that is increases heart rate and BP. Pre-existing HTN would need to be controlled before its use was considered.
A 36 year old woman is brought to A&E by ambulance. She is unconscious and thought to have taken an overdose of her amitriptyline medication several hours previously. ECG shows a significant QRS prolongation. Identify the most appropriate initial management.
Normal saline Haemodialysis O2 and charcoal Charcoal and phenytoin O2 and NaHCO3
O2 and NaHCO3
This will help to correct the hypoxia and acidosis and hopefully reverse the ECG abnormalities.
C. difficile prescribing
Moderate, first infection: 14 days metronidazole PO/IV
Severe or relapse: Vancomycin PO/NG
Cannot give vancomycin IV as does not reach bowel lumen.
Drug treatment vs Neuroleptic Malignant syndrome
Dantrolene + DA agonist (Bromocriptine)
Route of administration of buprenorphine
Sublingual
Which drug has been shown to improve survival in Amytrophic Lateral Sclerosis
Rituzole
Which anti-epileptic causes visual field defects?
Vigabatran
Affects GABA, nerve damage
Which anti-cholesterol agent is most effective at bringing triglycerides down?
Fibrates
First line agent for aspergillosis?
Voriconazole
First and second line treatment for PCP
Co-trimoxazole
Pentamidine
A gentleman is on 5mg of oxycodone TDS for pain. He is converted to IV morphine. What is the dose?
12.25mg IV morphine
Total oxycodone PO = 5mg x3 = 15mg
Equivalent to 1.5x PO morphine = 15mg x1.5 = 22.5mg
Divide by 2 for IV dose
22.5/2 = 12.25mg IV morphine
Which of the following possible side effects and complications should a Dr counsel a patient about for new thiazide diuretic?
A) Hyperuricaemia B) Hyperglycaemia C) Hypokalemia D) Postural hypotension E) All of the above
All of them
Remember that thiazides can trigger gout and worsen DM
Why can you not use penicillins vs Mycoplasma?
Mycoplasma is an atypical organism that lacks a cell wall. It is therefore not susceptible to penicillin that works by inhibiting peptidoglycan crosslinking for cell wall synthesis.
First choice antibiotics vs Legionella
Erythromycin (or other macrolide)
What is the rescue drug used in acute exacerbations of Parkinson’s disease
Apomorphine
Most common side effect of dilitiazem
Constipation.
Dilitiazem is non-dihydropyridine CCB
Which of the following are most likely to cause urinary retention?
Bendroflumethiazide Donepezil Doxazosin Enalapril Lofepramine
Lofepramine
Lofepramine is a TCA which has anti-cholinergic SFx such as urinary retention, this can be particularly acute if there is underlying prostate hypertrophy.
Which of the following drugs does NOT require dose adjustment on account of worsening renal function?
Allopurinol Cefuroxime Digoxin Metronidazole Morphine
Metronidazole
Metronidazole is affected by significant hepatic impairment
A 68 year old man diagosed with COPD is prescribed inhaled ipratropium bromide. Which concurrent disorder is most likely with this drug?
BPH Cataract Diverticular disease Peptic ulcer disease Stable angina
BPH
As an anti-muscarinic it can have anti-cholinergic effects including retention related to BPH.
A 23 year old lady with severe asthma is taking long term oral pred. She is then prescribed the cOCP. There is no rise in BP but what adverse interaction is likely to occur?
Addisonian crisis Contraceptive failure Increased incidence of breast cancer Worsening asthma Worsening of corticosteroid adverse effect
Worsening of corticosteroid adverse effects.
Plasma concentrations of steroids are increased by oral contraceptives containing oestrogen. This is probably a combination of factors including inhibition of metabolism and displacement from plasma proteins.
Which of the following is the most accurate statement concerning managment of UC?
Codeine and loperamide should not be used for the symptomatic treatment control of diarrhoea.
Infliximab is not effective in inducing remission.
Mesalazing causes more hypersensitivity reactions than sulfasalazine
Oral steroids are generally used to maintain remission
There is no systemic absorption from steroid enemas
Codeine and loperamide is absolutely contraindicated due the risk of inducing toxic megacolon.
CYP450 inhibitors
VIP comes in a cloud of FOG: Emilia Clarke (EC)
Valproate
Isoniazid
Protease inhibitors (ritonavir)
Fluconazole / Fluoxetine
Omeprazole
Grapefruit juice
Erythromycin
Ciprofloxacin + Cimetidine
Abx vs Legionella
Erythromycin
Drugs that cause prolonged QTc
Anti-arrhythmics - quinidine, sotalol, amiodarone
Anti-histamines
CYP450 inhibiting Abx
- fluoroquinolones - cipro
- macrolides - erythromycin
Anti-depressants
- TCAs
- Venlafaxine
Neuroleptics - phenothiazines
Prevention of variceal bleeding in 50-year-old man with alcoholic cirrhosis and portal hypertension
B-blockers and consider endoscopic variceal band ligation.
In how many half lives is steady state normally achieved?
5
What order kinetics dose phenytoin have?
Zero order kinetics
As do ethanol and salicylates
Why does isoniazid efficacy vary between patient populations?
Genetic polymorphisms in acetylation
Floppy Baby syndrome is associated with which class of drugs?
Benzodiazepines
Which anaesthetic agents is associated with hepatitis
Halothane
Which drug is associated with impotence, nightmares and T2DM?
Atenolol
Which drug is used in hypertensive emergencies?
Nitroprusside
MOA of: atropine
mAChR antagonist
MOA of: digoxin
Na/K ATPase inhibitor
MOA of: selegiline
MAOb inhibitor
MOA of: oxprenolol
partial B agonist
Clearance =
volume of plasma from which a drug is eliminated / unit time
= administration rate / steady state plasma concentration
Volume of distribution =
Apparent volume into which a drug appears to distribute
Can be greater than the total body volume.
Is influenced by a drug’s lipid solubility.
MOA of: acarbose
Competitive inhibitor of alpha-glucosidases in the intestines.
Grey baby syndrome is associated with which drug?
Chloramphenicol
