CR2 Drugs Flashcards

Question

How would you manange an acute TIA?

Answer 1

300mg aspirin

Answer 2

Treatment: **prostaglandin inhibitor,** such as **ibuprofen**; **surgery**

Answer 3

Always follow yourlocal area guidelines. These are developed by looking at the bacteria in the local area for theirantibiotic resistanceso are specific to that population. CRB Score 0: **Amoxicillin or Doxycycline or Clathromycin** CRB Score 1-2: **Amoxicillin** AND **Clathromycin** OR **Doxycycline** CRB Score 3-4: **Benzylpenicillin**

Answer 4

ACE inhibitors AT II receptor antagonists

Answer 5

A Offer ACE inhibitor or Angiotensin receptor blockers (ARBs) if have: type 2 diabetes under 55 but not black African / African-Caribbean OR Offer calcium-channel blocker (CCB) who: aged 55 or over AND no type 2 diabetes black African / African-Caribbean

Answer 6

If on ACE inhibitor: **- Add CCB or thiazide-like diuretic [2]** If on CCB: **- Add ACE inhibitor or ARB or thiazide-like diuretic**

Answer 7

**Dobutamine** Verapamil Diltiazem Amlodipine Clopidogrel

Answer 8

**Sympathomimetic β1 agonist** which is used in cardiac stress test and imaging **Increases contractility not rate**

Answer 9

**99m-technetium**

Answer 10

Isosorbide mono/dinitrate

Answer 11

Which of the following acts as a nitrate and also opens potassium channels which hyperpolarises the cell and prevents opening of voltage gated calcium channels so net effect is vasodilation. **Nicorandil** Amlodipine Nifedipine Verapamil Diltiazem

Answer 12

Aten**olol** Propran**olol**

Answer 13

Beta blocker **causes down regulation of RAAS** as well as acting as a anti-sympathomimetic

Answer 14

Which of the following calcium channel blockers are selective for voltage gated calcium channels in myocardium to reduce HR and O2 demand Dobutamine **Verapamil** Diltiazem Amlodipine Clopidogrel

Answer 15

Which of the following calcium channel blockers act on both myocardium and vessels for dual effect Dobutamine Verapamil **Diltiazem** Amlodipine Clopidogrel

Answer 16

Which of the following calcium channel blockers are selective for voltage gated calcium channels in **blood vessels** to cause vasodilation and decrease TPR. Dobutamine Verapamil Diltiazem **Amlodipine** **Nifedipine**

Answer 17

**Aspirin**

Answer 18

Clopidogrel

Answer 19

Fava beans, primaquine, cotrimoxazole, dapsone

Answer 20

**Anticoagulant** **Vit K** antagonist Acts agaisnt **factors II, VII, IX, X** AND **protein C &/ S**

Answer 21

Which of the following an heparin antagonist Fondaparinux Warfarin **Protamine** Folate *Binds heparin to inactivate it. Does not work as well on LMWH*

Answer 22

Which of the following is used in treatment of VTE / DVT and PE and is a has high selectivity for just anti-Xa activity and little antithrombin activity. **Fondaparinux** Warfarin Protamine Folate

Answer 23

LMWH Anti-Xa effect

Answer 24

Heparin induced thrombocytopaenia(HIT) 5-14 days after start(rare) bleeding

Answer 25

Which of the following blocks the Na/K/2Cl symporter in the ascending loop of Henle? Chlorthalidone Bendroflumethiazide **Furosemide** Spironolactone

Answer 26

Hypokalaemia

Answer 27

Which of the following blocks the Na/Cl symporter in the distal convoluted tubule to prevent sodium reabsorption? Chlorthalidone **Bendroflumethiazide** Furosemide Spironolactone

Answer 28

Capto**pril**, lisino**pril**

Answer 29

Whoch of the following blocks angiotensin II receptor preventing its vasoconstrictive effects? lisinopril Captopril Spironolactone **Losartan** Amiloride

Answer 30

Whoch of the following blocks aldosterone transporter? lisinopril Captopril **Spironolactone** Losartan Amiloride

Answer 31

Which of the following may you prescribe alongside spironlactone to normalise potassium levels? lisinopril Captopril **Furosemide** Losartan Amiloride

Answer 32

Which of the following pithelial sodium channels(ENaC) in the late DCT, collecting tubules and collecting ducts inhibiting sodium reabsorption there lisinopril Captopril Furosemide Losartan **Amiloride**

Answer 33

Which of the following blocks epithelial sodium channels(ENaC) in the late DCT, collecting tubules and collecting ducts inhibiting sodium reabsorption there lisinopril Captopril Furosemide Losartan **Amiloride**

Answer 34

Which of the following is an antihypertensive alpha 2 agonist that causes a decrease in CO and vascular tone? **Clonidine** Carvedilol Propranolol atenolol doxazosin

Answer 35

Which of the following is an alpha 1 antagonist that causes a decrease in CO and vascular tone? Clonidine Carvedilol Propranolol atenolol **doxazosin** **and prazosin**

Answer 36

Which of the following is a β2 agonist that causes short acting smooth muscle relaxation in the bronchioles Salmeterol Beclomethasone **Salbutamol** Prednisolone Indaceterol

Answer 37

Which of the following is a β2 agonist that causes long acting smooth muscle relaxation (LABA) in the bronchioles [2] **Salmeterol** Beclomethasone Salbutamol Prednisolone **Indaceterol**

Answer 38

Which of the following acts on steroid receptor to modify nuclear expression, in this case it prevents inflammatory expression for asthma / COPD treatment? Salmeterol Beclomethasone Salbutamol **Prednisolone** Indaceterol

Answer 39

Asthma treatments is a corticosteroid? Salmeterol **Beclomethasone** Salbutamol **Prednisolone** Indaceterol

Answer 40

Which of the following is associated with Cushings syndrome in long term use? Salmeterol Beclomethasone Salbutamol **Prednisolone** Indaceterol

Answer 41

Which of the following is associated with Cushings syndrome in long term use? Salmeterol Beclomethasone Salbutamol **Prednisolone** Indaceterol

Answer 42

Which of the following is a corticosteroid used to treat asthma but acts locally upon inhalation? Salmeterol **Beclomethasone** Salbutamol Prednisolone Indaceterol

Answer 43

Which of the following is a leukotriene antagonist? Tiotropium Ipratropium **Montelukast** Theophylline Beclomethasone

Answer 44

Which of the following is a SAMA used in asthma / COPD control? Tiotropium **Ipratropium** Montelukast Theophylline Beclomethasone

Answer 45

Which of the following treatments for TB blocks causes mycoloic acid synthesis Rifampicin **Isoniazid** Pyrazinamide **Ethambutol**

Answer 46

Which of the following stains bodily secretions orange **Rifampicin** Isoniazid Pyrazinamide Ethambutol

Answer 47

Which of the following blocks bacterial RNA polymerase for the treatment of TB **Rifampicin** Isoniazid Pyrazinamide Ethambutol

Answer 48

Which of the following is a prodrug which is converted to pyrazinoic acid and disrupts the membrane potential in TB causing death Rifampicin Isoniazid **Pyrazinamide** Ethambutol

Answer 49

You are attending a cardiology clinic one afternoon. A 56-year-old man presents for a medication review. He is currently taking a beta-blocker but is still frequently symptomatic. From his medication history, it is evident that he does not tolerate calcium channel blockers. The consultant considers the option of starting him on a new drug called nicorandil. Strangely enough, the patient feels that nicorandil is a calcium channel blocker and is not keen to try it out. You have been asked to explain the mechanism of the new drug to this patient. What is the mechanism through which the new drug exerts its effect? Causes vasoconstriction by activating guanylyl cyclase which causes an increase in cGMP Causes vasodilation by inactivating ATP-sensitive potassium channels Causes vasodilation by increasing intracellular calcium load **Causes vasodilation by activating guanylyl cyclase which causes an increase in cGMP** Causes vasodilation by inhibiting guanylyl cyclase which causes an increase in cGMP

Answer 50

A 65-year-old lady attends the GP surgery for a routine hypertension review. She has been taking amlodipine for a year and although her blood pressure is well controlled her ankles often become swollen. The ankle swelling is worse at the end of the day since starting amlodipine. The GP decides to prescribe a diuretic instead of amlodipine. Which of the following diuretics acts on the sodium-chloride transporter of the distal tubule? Acetazolamide (carbonic anhydrase inhibitor) **Bendroflumethiazide (thiazide diuretic)** Furosemide (loop diuretic) Spironolactone (potassium-sparing diuretic) Mannitol (osmotic diuretic)

Answer 51

A 71-year-old gentleman is admitted to the renal ward with acute kidney injury after having diarrhoea and vomiting for 4 days. Blood tests show that his potassium is below normal limits. You note that this is likely due to his gastrointestinal symptoms. You check his medications to ensure nothing is making the situation worse. You find that he is on diuretic therapy for the treatment of heart failure. Which of the following diuretics is associated with hypokalaemia? Triamterene **Bumetanide** Amiloride Spironolactone Eplerenone Loop diuretics may cause hypokalaemia

Answer 52

A 55-year-old man is admitted to the emergency department with sudden onset chest pain. His ECG shows ST depression in leads II, III, & aVF. His troponin is also found to be raised. He is treated for an NSTEMI (non-ST-elevation myocardial infarction), and as part of this treatment regime, he is given ticagrelor. What is the mechanism of action of this drug? Activates antithrombin III which mainly inhibits factors Xa and IIa **Inhibits ADP binding to platelet receptors** Inhibits prothrombinase complex-bound and clot-associated factor Xa Inhibits the production of prostaglandins Inhibits vitamin K epoxide reductase complex 1 Ticagrelor has a similar mechanism of action to clopidogrel - inhibits ADP binding to platelet receptors

Answer 53

A 45-year-old female is found to have a blood pressure of 185/102mmHg following ambulatory blood pressure monitoring. She is started on the ACE inhibitor Ramipril. What is the most common side effect of this drug? **A dry cough** Oedema Shortness of breath Excessive urine output Headaches

Answer 54

You are a medical student in general practice. A 67-year-old female attends for an annual checkup of her blood pressure. She has GTN spray at home. How does nitric oxide result in vasodilation? Directly opens K+ channels Directly opens Ca2+ channels **Activates guanylate cyclase** Inhibits the release of Bradykinin Activates cAMP

Answer 55

A baby is born at 36 weeks via an emergency cesarean section. His mother lives in a cottage up in the mountains. The baby looks healthy and is administered a dose of Vitamin K soon after birth. She is discharged the next day with a happy, healthy baby. Six weeks later, she presents to the hospital with the baby after she noticed increased work of breathing and difficulty while feeding. On auscultation of her heart, a continuous 'machinery' murmur is heard and is loudest at the left sternal edge. The cardiologist arrives at the scene and instructs that the child is given a dose of indomethacin. What is the mode of action of indomethacin? Endothelin receptor antagonist Phosphodiesterase inhibitor **Prostaglandin synthase inhibitor** Endothelin receptor agonist Adenosine receptor antagonist *Indomethacin inhibits prostaglandin synthesis in infants with patent ductus arteriosus*

Answer 56

A 74-year-old female was with urinary incontinence presents to the urogynaecology clinic. She was diagnosed with overactive bladder incontinence, and was started on pharmacological treatment which antagonises the parasympathetic pathway. Which of the following have a similar mechanism of action with the drug she was prescribed? Alfuzosin Meropenem Mirabegron **Atropine** Adenosine | Atropine is an antimuscarinic

Answer 57

Whilst in general practice, you review Susan a 48-year-old patient with hypertension. Despite taking ramipril, her blood pressure remains clinically elevated. Based on current guidelines you consider add-on therapy with a thiazide-like diuretic. Which of the following electrolyte disturbances may occur with this new treatment? Hypercalciuria Hyperkalaemia Hypermagnesemia **Hypokalaemia** Hypolipidaemia

Answer 58

A 65-year-old patient with chronic kidney disease is found to have a deficiency of antithrombin III after he presented to emergency department with left leg pain and swelling. A doppler-ultrasound scan of the leg confirms deep venous thrombosis (DVT). The patient is started on dabigatran. What is the mechanism of action of dabigatran? Activates anti-thrombin III P2Y12 inhibitor Glycoprotein IIb/IIIa inhibitor **Direct thrombin inhibitor** Direct factor X activator

Answer 59

Question 103 of 203 An 82-year-old lady with a history of heart failure presents to the general practice with a 5-day history of constipation. On further questioning, she tells you that she has been feeling weaker this week, and has been getting muscle cramps regularly On examination, there is reduced tone and hyporeflexia bilaterally in both the upper and lower limbs. You think this lady's presentation may be due to hypokalaemia. The patient takes a number of diuretics to control her heart failure. Which of the following diuretics is associated with hypokalaemia? Triamterene **Furosemide** Spironolactone Eplerenone Amiloride

Answer 60

A patient with a history of peripheral vascular disease presents to his GP with essential hypertension. Which of the following drugs may exacerbate his peripheral vascular symptoms? Ramipril **Atenolol** Spironolactone Hydrochlorothiazide Furosemide

Answer 61

A 60-year-old man presents to the emergency department complaining of sudden numbness of his right arm and right leg. On examination, he has decreased sensation and 3 out of 5 power throughout his right arm and right leg. A head CT reveals ischaemia along the area of the left middle cerebral artery. After initial management, he is deemed to be unfit to be prescribed clopidogrel and instead is prescribed aspirin and another antiplatelet that works by inhibiting phosphodiesterase. What medication was this patient likely prescribed in addition to the aspirin? **Dipyridamole** Heparin Ticagrelor Prasugrel Apixaban

Answer 62

A 63-year-old male presents to GP with mild chest pain and dyspnoea. The patient is normally fit and well with no significant medical history. He has a family history of heart disease with his dad passing away following a heart attack last year. The GP decides to do an ECG to confirm the diagnosis and suspects atrial flutter. Given the diagnosis, which of the following findings would you expect to see on an ECG? Broad complex tachycardia **Narrow complex tachycardia** Heart rate of 175/min Heart rate of 58/min Prolonged QT interval

Answer 63

A 53-year-old woman is reviewed in the hypertension clinic. Her past medical history includes depression and gout. Two months ago she was started on lisinopril for hypertension. The dose was gradually titrated up and her urea and electrolytes were monitored. Today she complains of a dry cough which has got gradually worse over the past four weeks. She describes it as being 'really annoying' and complains that it keeps her up at night. She is a non-smoker and a chest x-ray performed during an Emergency Department visit six weeks ago was normal. What is the most appropriate action with respect to her anti-hypertensive medications? Reassure her that the majority of ACE related coughs resolve within three months **Switch her to an angiotensin II receptor blocker** Switch her to bendroflumethiazide Switch her to amlodipine Explain that as the cough developed four weeks after starting treatment it is unlikely to be ACE related

Answer 64

A 53-year-old woman is reviewed in the hypertension clinic. Her past medical history includes depression and gout. Two months ago she was started on lisinopril for hypertension. The dose was gradually titrated up and her urea and electrolytes were monitored. Today she complains of a dry cough which has got gradually worse over the past four weeks. She describes it as being 'really annoying' and complains that it keeps her up at night. She is a non-smoker and a chest x-ray performed during an Emergency Department visit six weeks ago was normal. What is the most appropriate action with respect to her anti-hypertensive medications? Reassure her that the majority of ACE related coughs resolve within three months **Switch her to an angiotensin II receptor blocker** Switch her to bendroflumethiazide Switch her to amlodipine Explain that as the cough developed four weeks after starting treatment it is unlikely to be ACE related

Answer 65

A 68-year-old man has recently been discharged from hospital following a non-ST-elevation myocardial infarction (NSTEMI). He has a history of angina, hypertension and hypercholesterolaemia and was already taking aspirin, atorvastatin, bisoprolol and ramipril prior to his NSTEMI. Following his hospital discharge, he has been instructed to also take ticagrelor for the next 12 months. What is the mechanism of action of this newly-started drug? Activated factor X (Xa) inhibitor Cyclooxygenase inhibitor Direct thrombin inhibitor Glycoprotein IIb/IIIa receptor antagonist **P2Y12 receptor antagonist**

Answer 66

Immediately: Pharmalogical: **O2 & duiretic** Non Pharmalogical: **ventilation; ultrafiltration** After stabalisation: **ACE-I/ARB, beta-blocker, aldosterone inhibitor** Ongoing management: **Valve surgery; revasc; transplant**

Answer 67

Pirfenidone

Answer 68

Thalassaemia major (a+b) treatment: **Regular blood transfusion** BUT: can get Iron overload from constant blood transfusion: this happens because excess haemolysis can lead to excess free iron in blood (usually bound to ferritin in the spleen), which is oxidising

Answer 69

Medication to treat blood clots (**anti coagulants)** **Pacemaker**: control rhythm of heart **ICD**: shock heart if need to go into normal rhythm **Surgery**: remove areas of heart muscle / whole heart transport

Answer 70

Which of the following class of drug does indapamide fall into? ACE inhibitors: Angiotensin-II receptor antagonists Calcium-channel blocker **Diuretics** thiazide-like diuretic Beta-blockers

Answer 71

Which of the following class of drug does metoprolol fall into? ACE inhibitors: Angiotensin-II receptor antagonists Calcium-channel blocker Diuretics **Beta-blockers**

Answer 72

Which of the following class of drug does amlodipine fall into? ACE inhibitors: Angiotensin-II receptor antagonists **Calcium-channel blocker** Diuretics Beta-blockers

Answer 73

Which of the following class of drug does enalapril fall into? **ACE inhibitors**: Angiotensin-II receptor antagonists Calcium-channel blocker Diuretics Beta-blockers

Answer 74

Which of the following class of drug does losartan fall into? ACE inhibitors: **Angiotensin-II receptor antagonists** Calcium-channel blocker Diuretics Beta-blockers

Answer 75

Which of the following prevents the conversion of arachidonic acid to thromboxane A2 Heparin Warfarin **Aspirin** Dabigatran Edoxaban

Answer 76

Non-selective for **COX-1 and COX 2** enzymes (prevent aggregation) COX 2 inhibition **prevents arachidonic acid** conversion to **Thromboxane A2** Thus preventing Thromboxane A2 formation, **preventing platelet aggregation**.

Answer 77

Which of the following can cause thrombocytopenia **Heparin** Warfarin Aspirin Dabigatran Dipyridamole

Answer 78

Which of the following should not be used in pregnancy Heparin **Warfarin**: teratogenic Aspirin Dabigatran Dipyridamole

Answer 79

**Fondaprinux**

Answer 80

Which of the following is a non-specific phosphodiesterase inhibitor **Dipyridamole** Inhibits both adenosine deaminase and phosphodiesterase, preventing the degradation of cAMP, an inhibitor of platelet function

Answer 81

Dabigatran Rivaroxaban Apixaban Edoxaban

Answer 82

**Direct factor Xa inhibitor** (more modern version of heparin)

Answer 83

**Direct thrombin inhibitor**

Answer 84

Which of the following is not a direct factor Xa inhibitor Rivaroxaban Apixaban Edoxaban **Dabigatran**: direct thrombin inhibitor

Answer 85

Streptokinase Alteplase (tPA)

Answer 86

**Streptokinase**: Clot buster; Activates fibrinolytic pathway **Alteplase (tPA)**: Increase clot; breakdown by increasing Plasmin formation

Answer 87

Which of the following inhibits L type calcium channel **Amlodipine** Nicorandil Diatelzem Lisinopril **Verapamil**

Answer 88

Which of the following drug is for voltage gated calcium channels in myocardium to reduce HR and O2 demand? Amlodipine Nicorandil Diatelzem Lisinopril **Verapamil** - CCB

Answer 89

Which of the following is a CCB that acts on both myocardium and vessels for dual effect? Amlodipine Nicorandil **Diatelzem** Lisinopril Verapamil

Answer 90

Which of the following is a vasodilator that opens potassium channels which hyperpolarises the cell and prevents opening of voltage gated calcium channels and causes release of NO? Amlodipine **Nicorandil** Diatelzem Lisinopril Verapamil

Answer 91

Which of the following that particularly reduces peripheral vascular resistance / lowers peripheral BP? **Amlodipine** Bind to L-Type calcium channel Peripheral arterial vasodilator Reduce peripheral vascular resistance – lower BP Calcium channel antagonist (smooth + cardiac muscle)

Answer 92

**Verapamil** - CCB Inhibit L-Type calcium channel Reduce contractility and peripheral resistance Reduce heart rate by prolonging refractory period of AVN.

Answer 93

Which of the following can cause severe hypotension as an AE? **Amlodipine** Nicorandil Diatelzem Lisinopril Verapamil

Answer 94

Rosuvostatin

Answer 95

**Competitive inhibitor** of **HMG-CoA Reductase** Reduction of the **mevalonate** **pathway** **Inhibit cholesterol synthesis** **Inhibit LDL uptake, VLDL synthesis.**

Answer 96

rhabdomyolysis

Answer 97

Ramipril Lisinopril Captopril

Answer 98

Converted to **ramiprilat** **Inhibits ACE**, stop ACE-1 --> ACE-II conversion **Reduce sodium and H2O reabsorption** Reduces **peripheral vascular resistance.**

Answer 99

ACE breaks down **bradykinin**: causes **Dry COUGH**

Answer 100

**Hyperkalaemia** (Less Angiotensin II, NO aldosterone, less K secreted, less Na reabsorbed)

Answer 101

Valsartan Losartan

Answer 102

Which of the following would you prescribe if a patient has ACE-I intolerance? **Losartan** - ARB Captopril lisinopril Digoxin Ivabradine

Answer 103

Which of the following is an inotrope? Losartan Captopril lisinopril **Digoxin** increases the force of **myocardial contraction** and **reduces conductivity within the atrioventricular (AV) node.** Ivabradine

Answer 104

increases the **force of myocardial contraction** and **reduces conductivity** within the **atrioventricular (AV) node** **Stimulate Vagus Nerve**, **reduce** **circulating** **noradrenaline** = lower heart rate

Answer 105

Gynaecomastia

Answer 106

Which of the following has a risk of gynaecomastia? Losartan Captopril lisinopril **Digoxin** Ivabradine

Answer 107

Name the diuretic that works by blocking epithelial sodium channels in in the late DCT, collecting tubules and collecting ducts **Amiloride** Spironolactone Atenolol Propranolol Carvedilol

Answer 108

Both decrease HR and RAAS. Propranolol is **non-selective** Atenolol is **β1 selective**

Answer 109

Which of the following is an α2-agonist that causes a decrease in CO and vascular tone **Clonidine** Propranolol Atenolol Prazosin Doxazosin

Answer 110

Which of the following is an α2-agonist that causes a decrease in CO and vascular tone **Clonidine** Propranolol Atenolol Prazosin Doxazosin

Answer 111

Which of the following blocks α1 in vascular smooth muscle causing it to vasodilate Clonidine Propranolol Atenolol **Prazosin** **Doxazosin**

Answer 112

**Pirfenidone**: used to treat IPF

Answer 113

**Ivabradine** Hyperpolarization-activated cyclic nucleotide-gated (**HCN**) **channel blockers** **Slows heart rate**

Answer 114

What is the first line treatment for Asthma? **Salbutamol** Salmeterol Beclomethasone (Becotide) Montelukast Ipratropium

Answer 115

**trembling, particularly in the hands** nervous tension headaches suddenly noticeable heartbeats (palpitations) muscle cramps

Answer 116

Which of the following is a Long-Acting Beta-2 Agonist (LABA) Salbutamol **Salmeterol** Beclomethasone (Becotide) Montelukast Ipratropiuma

Answer 117

Which of the following is a maintenance therapy and combined with glucocorticoid for asthma treatment? Salbutamol **Salmeterol** Beclomethasone (Becotide) Montelukast Ipratropiuma

Answer 118

Which of the following is a maintenance therapy and combined with glucocorticoid for asthma treatment? Salbutamol **Salmeterol** Beclomethasone (Becotide) Montelukast Prednisolone

Answer 119

Which of the following is a corticosteroid used to treat asthma and acts more globally Salbutamol Salmeterol Beclomethasone (Becotide) Montelukast **Prednisolone**

Answer 120

Which of the following is a corticosteroid used to treat asthma and acts more locally Salbutamol Salmeterol **Beclomethasone (Becotide)** Montelukast Prednisolone

Answer 121

Which of the following is associated with Cushings disease if long term use occurs Salbutamol Salmeterol Beclomethasone (Becotide) Montelukast **Prednisolone**

Answer 122

Which of the following treatment for asthma can be associated with oral thrush? Salbutamol Salmeterol **Beclomethasone (Becotide)** Montelukast Prednisolone

Answer 123

Which of the following is a leukotriene antagonist to treat asthma? Salbutamol Salmeterol Beclomethasone (Becotide) **Montelukast** Prednisolone

Answer 124

What are the 4 drugs used to treat TB? [4] Rifampicin Isoniazid Pyrazinamide Ethambutol

Answer 125

Which of the following treats TB by blocking mycolic acid synthesis required for mycobacterial cell wall synthesis? Rifampicin **Isoniazid** Pyrazinamide Ethambutol

Answer 126

Which of the following is a prodrug which is converted to pyrazinoic acid and disrupts the membrane potential in TB causing death? Rifampicin Isoniazid **Pyrazinamide** Ethambutol

Answer 127

Which of the following blocks mycolic acid synthesis? Rifampicin Isoniazid Pyrazinamide **Ethambutol**

Answer 128

Which of the following blocks bacterial RNA polymerase to treat TB? **Rifampicin** Isoniazid Pyrazinamide Ethambutol

Answer 129

Alongside prescribing oxygen, which other drug would you give someone with acute heart failure? **diuretic** ACE-I/ARB beta-blocker aldosterone inhibitor

Answer 130

Nicorandil: **potassium channel agonist**, which inhibits voltage-gated calcium channels leading to muscle relaxation

Answer 131

Ivabradine: lowers heart rate through inhibition of cardiac ‘funny channels’

Answer 132

CCB: Blocks the action of **L-type calcium channels** - works at **cardiac and vascular tissue**

Answer 133

Apixaban is a type of medicine known as an anticoagulant is a direct inhibitor of activated factor X (factor Xa)

Answer 134

In patients with persistent AF the recommended management is rate control drugs (e.g. beta-blockers, calcium channel blockers) and anti-coagulation according to risk stratification.

Answer 135

**Stimulate presynaptic α2-adrenergic receptors in the CNS** → dilates peripheral blood vessels → lowers peripheral resistance → reduces blood pressure

Answer 136

**Dihydropyridine**: predominantly anti-hypertensive effects; block the action of **L-type calcium channels**, which are found in **vascular and cardiac tissue**; but primarily act on **vascualr tissue** **Non-dihydropyridine:** predominantly **anti-arrhythmic effects**

Answer 137

Which of the following medications is considered a type IV antiarrhythmic on the Vaughan-Williams classification? A Amiodarone B Propranolol C Flecainide **D Verapamil** E Lidocaine

Answer 138

**Class I** - block sodium channels **Class II** - beta-blockers **Class III** - block potassium channels **Class IV** - block calcium channels This can be remembered by the mnemonic ‘**Some Block Potassium Channels’.**

Answer 139

Which of the following is the antiarrhythmic of choice in patients with regular ventricular tachycardia? A Atenolol **B Amiodarone** C Flecainide D Verapamil E Adenosine

Answer 140

Which of the following is the antiarrhythmic of choice in patients with regular ventricular tachycardia? A Atenolol **B Amiodarone** C Flecainide D Verapamil E Adenosine

Answer 141

What are the appropriate target saturations in a patient not at risk of type 2 respiratory failure? A 90-100% **B 94-98%** C 88-92% D 96-100% E >94%

Answer 142

Question 8. What percentage of oxygen can venturi masks deliver? A 20-24% **B 24-60%** C 30-80% D 24-32% E 20-100%

Answer 143

Statins are generally considered contraindicated in which condition? **D Decompensated cirrhosis** Statins are contraindicated in patients with decompensated cirrhosis or acute liver failure (i.e. advanced liver disease).

Answer 144

Which of the following best describes the mechanism of action of a statin? A Inhibition of cholesterol absorption B Bile acid sequestrant C Stimulate beta-oxidation of fatty acids **D HMG-CoA reductase inhibitor** E Reduces breakdown of adipose tissue

Answer 145

Which of the following management options is the only effective way to halt the natural history of chronic obstructive pulmonary disease (COPD)? A Inhaled beta-2 agonists **B Smoking cessation** C Inhaled muscarinic antagonists D Exercise E Pulmonary rehabilitation

Answer 146

Which cells are important for the secretion of the incretin GLP-1? A K cells B M cells **C L cells** D D cells E S cells

Answer 147

Which cells are important for the secretion of gastric inhibitory peptide (GIP)? **A K cells** B M cells C L cells D D cells E S cells

Answer 148

Which cells are important for the secretion of secretin? A K cells B M cells C L cells D D cells **E S cells**

Answer 149

**C Reversible muscarinic acetylcholine receptor antagonist** Atropine transiently blocks the action of the vagus nerve (i.e. parasympathetic nervous system) leading to increased SAN electrical activity and increased conduction through the AVN. This results in an increase in heart rate.

Answer 150

On the Vaughan-Williams classification, amiodarone is which predominant class? **C Class III** Amiodarone is thought to have wide-ranging effects on cardiomyocytes. However, its predominant mechanism is on potassium channels. This means amiodarone is categorised as a class III antiarrhythmic agent. By blocking potassium channels, these drugs prolong the action potential.

Answer 151

Which of the following beta-blockers is the least cardioselective? **A Propranolol** B Nebivolol C Metoprolol D Bisoprolol E Atenolol

Answer 152

Afro-carribean patients and those **older than** 55 years old should be started on a calcium-channel blocker. (e.g. young afrocarribean would be on a ACE-i)

Answer 153

Which of the following medications should be used with caution in asthma? A Paracetamol **B Aspirin**: This is because of the risk of bronchospasm with these agents. I C Salbutamol D Prednisolone E Levothyroxine

Answer 154

What is the pharmacological mechanism for type II antiarrhythmic agents? A Inhibition of sodium channels B Inhibition of potassium channels **C Inhibition of adrenergic receptors** D Inhibition of calcium channels E Inhibition of chloride channels

Answer 155

Which of the following organs is the predominant site of cholesterol synthesis? A Cerebral cortex B Lungs C Spleen **D Liver** E Ovaries

Answer 156

Which of the following organs is the predominant site of cholesterol synthesis? A Cerebral cortex B Lungs C Spleen **D Liver** E Ovaries

Answer 157

Which of the following best describes the hepatic effects of metformin? A Enhances glycolysis **B Suppression of gluconeogenesis** C Increased utilisation of glucose D Enhances GLP-1 release E Increased tubular reabsorption of glucose

Answer 158

What type of drug is metformin A GLP-1 agonist B Sulphonylurea **C Biguanide** D Long-acting insulin E Sodium-glucose co-transporter 2 inhibitor

Answer 159

Aside from diabetes mellitus, metformin can be prescribed in which other condition? A Migraine B Chronic obstructive pulmonary disease C Hypertension **D Polycystic ovarian syndrome (PCOS)** E Alcoholic liver disease

Answer 160

Which muscarinic receptor subtype is thought to be most important in the treatment of chronic airway disease? A M1 B M2 **C M3** D M4 E M5

Answer 161

D Inhibit the conversion of angiotensin I into angiotensin II

Answer 162

Which of the following side-effects is commonly associated with metformin? A Headache B**Gastrointestinal upset** C Reduced vision D Hearing loss E Nail changes

Answer 163

Which of the following side-effects is commonly associated with metformin? A Headache B**Gastrointestinal upset** C Reduced vision D Hearing loss E Nail changes

Answer 164

Which of the following is not a recognised side-effect of thiazide diuretics? **A Hyperkalaemia** B Pancreatitis C Hypomagnesaemia D Hyperglycaemia E Hyperuricaemia

Answer 165

29-year-old is admitted with an acute exacerbation of asthma. Their saturations are currently 97% on 2L of oxygen via nasal cannulae. Approximately, what percentage of oxygen is being delivered to the patient? A 20% B 24% **C 28%** D 36% E 60% **As a general rule, each litre of oxygen via nasal cannulae provides an additional 4% of oxygen.**

Answer 166

Which electrolyte abnormality would you expect with the use of high doses of salbutamol? **B Hypokalaemia** This results from activation of beta-2 adrenoreceptors linked Na/K-ATPase channels leading to increased cellular uptake of potassium. Salbutamol may be used to help treat hyperkalaemia. At high doses salbutamol may also lead to tachycardia, hypomagnesaemia and hyperglycaemia.

Answer 167

Which statement best describes the cause of a dry cough with ACE-inhibitor use? **A Angiotensin converting enzyme blockade causes decreased degradation of bradykinin**

Answer 168

Which of the following is not a typical side-effect of ACE-inhibitors? A Angio-oedema B Hyperkalaemia **C Ankle swelling**: clasic AE of CCBs D Postural hypotension E Dry cough

Answer 169

Which of the following statements is not a recognised effect of corticosteroids in asthma? A Suppression of goblet cells B Decreased IgE synthesis C Reduced synthesis of inflammatory mediators **D Beta-2 adrenoreceptor downregulation** Corticosteroids lead to the **upregulation of beta-2 adrenoreceptors**, a synergistic activity that leads to increased bronchodilation in response to beta-2 agonists.

Answer 170

D Increases gastric emptying