M1 Flashcards by Simon Evans

Mrs Patel, a 37-year-old patient, visits her GP and is
diagnosed with acute otitis media. She has a penicillin
allergy and develops a rash when she takes penicillin, she
is 25 weeks pregnant. What is the most appropriate
treatment for her acute otitis media?
A. Amoxicillin
B. Co-amoxiclav
C. Clarithromycin
D. Erythromycin
E. Vancomycin

Penicillin Allergy Consideration:
Since Mrs. Patel has a rash with penicillin, a macrolide (Erythromycin or Clarithromycin) is preferred.
Pregnancy Consideration (25 weeks):
Erythromycin is the preferred macrolide in pregnancy as it has the most safety data.
Clarithromycin is generally avoided unless no other options are available, as some studies suggest a potential risk in pregnancy.

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Mr Ivory has been prescribed doxycycline for the
treatment of cellulitis.
Which of the following is not a side effect of doxycycline?
A. Photosensitivity reaction
B. Nausea
C. Increased appetite
D. Benign intracranial hypertension
E. Oral disorders

Increased appetite

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Mr Manchester brings in a dental prescription to your
community pharmacy.
Which of the following medications can not be
prescribed by a dental practitioner on a FP10D
prescription?
A. Aciclovir cream
B. Amoxicillin capsules
C. Cefalexin tablets
D. Temazepam tablets
E. Vancomycin capsules

A. Aciclovir cream ✅ Yes Used for oral herpes simplex (cold sores).
B. Amoxicillin capsules ✅ Yes Used for dental infections.
C. Cefalexin tablets ✅ Yes Alternative antibiotic for penicillin-allergic patients.
D. Temazepam tablets ✅ Yes Can be prescribed for dental anxiety (but needs CD prescription requirements).
E. Vancomycin capsules ❌ No Not in the Dental Practitioners’ Formulary.

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Mr Allen, a 25-year-old patient, presents at the accident
and emergency department with a dog bite. He is
assessed and the decision has been made by the medical
team to prescribe him antibiotics, he has no medication
allergies. Which of the following would be the first-line
treatment for a dog bite?
A. Amoxicillin
B. Co-amoxiclav
C. Clarithromycin
D. Erythromycin
E. Doxycycline

Co-Amoxiclav

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Mrs London brings in a prescription for methadone
hydrochloride. In the 2001 regulations, drugs are divided
into five schedules.
Which schedule does methadone belong to?

A. Schedule 1
B. Schedule 2
C. Schedule 3
D. Schedule 4
E. Schedule 5

Schedule 2

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Mrs Williams is diagnosed with type 1 diabetes mellitus
and commenced on insulin.
She is counselled on the side effects of insulin, which of
the following is not a side effect of insulin?

A. Oedema
B. Lipodystrophy
C. Hypoglycaemia
D. Skin reactions
E. Weight loss

Insulin does NOT cause weight loss—in fact, it is associated with weight gain because it promotes glucose uptake and storage in fat and muscle cells.

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Mr Smith has been prescribed long-term steroids.
Which of the following is not a side effect of
corticosteroid use?
A. Diabetes mellitus
B. Osteoporosis
C. Weight gain
D. Addison’s disease
E. Muscle wastage

Addison disease

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A 56-year-old patient, Andrew Smith, presents to the
cardiorespiratory ward with chest pain that occurs on
exertion.
He is diagnosed with stable angina,
Which of the following would be the most suitable
treatment option to prevent further episodes of chest
pain?
A. Clopidogrel
B. Apixaban
C. Ranolazine
D. Bisoprolol
E. Glyceryl trinitrate

Bisoprolol

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A 47-year-old patient, Mark Wright, is admitted into
hospital following a paracetamol overdose.
Mr Wright presents with severe nausea and vomiting.
What is the most appropriate treatment for paracetamol
overdose?
A. Activated charcoal
B. Procyclidine hydrochloride
C. Acetylcysteine
D. Naloxone hydrochloride
E.Methylthioninium chloride

Acetylcysteine

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Mr Andews, a 67-year-old patient is admitted for the
acute admissions ward due to a fall, the medical team
believe it was due to one of his newly started
medications.
Which of the following medications is likely to have
caused his fall?

A. Adcal D3
B. Canagliflozin
C. Bisoprolol
D. Metformin
E. Prednisolone

Bisoprolol is a beta-blocker, and its main side effects include:

Bradycardia (slow heart rate) → can cause dizziness and fainting.
Hypotension (low blood pressure) → increases fall risk, especially in older adults.
Postural (orthostatic) hypotension → blood pressure drops when standing, leading to dizziness and falls.
Fatigue and weakness → can contribute to instability.
Given that Mr. Andrews is 67 years old, his body may not compensate as well for blood pressure drops, making him more prone to falls when taking a beta-blocker.

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Mrs Washingston, a 74-year old patient, calls your
community pharmacy.
She has noticed that she is extremely shaky and sweaty
since starting a new medication.
Which of her medication is likely to be responsible for her
symptoms?

A. Metformin
B. Glibenclamide
C. Bendroflumethiazide
D. Losartan
E. Adcal D3

Glibenclamide is a sulfonylurea, a class of medications used to treat type 2 diabetes by stimulating insulin release from the pancreas. A major side effect of sulfonylureas is hypoglycaemia (low blood sugar), which can cause:

Shakiness
Sweating
Dizziness
Palpitations
Confusion
Since Mrs. Washington is 74 years old, she is at higher risk of hypoglycaemia because:

Elderly patients have reduced kidney function, slowing the clearance of glibenclamide.
They may eat irregularly, increasing the risk of hypoglycaemia.

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Mr Adams walks into your pharmacy and complains his
new inhaler has led to him experiencing soreness in his
mouth and he has noticed white patches on his tongue.
Which of the following inhalers is likely to be responsible
for his symptoms?
A. Fostair ®
B. Ventolin Evohaler ®
C. Serevent Evohaler ®
D. Spiriva ®
E. Atrovent ®

Fostair

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A patient brings in a prescription for Temazepam 10mg
tablets. How long is the prescription valid for from the
date stated on the prescription?
A. 14 days
B. 28 days
C. 30 days
D. 6 months
E. 12 months

28 days

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Mrs Joshua has been started on digoxin for the
maintenance of atrial fibrillation.
Which of the following is not a side effect of digoxin?
A. Vision disorders
B. Arrhythmias
C. Diarrhoea
D. Increased appetite
E. Skin reactions

Increased appetite

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Mrs Doris brings in a prescription for pethidine
hydrochloride. In the 2001 regulations, drugs are divided
into five schedules.
Which schedule does pethidine belong to?

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Mr Patel has been started on a new medication for type 2
diabetes mellitus that mainly exerts its effect by
decreasing gluconeogenesis and by increasing peripheral
utilisation of glucose.
Which of the following medications is likely to have been
A. Acarbose
B. Metformin
C. Gliclazide
D. Glibenclamide
E. Canagliflozin

Metformin

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patient brings in a prescription for Zopiclone 7.5mg
tablets.
How long is the prescription valid for from the date
stated on the prescription?

A. 14 days
B. 28 days
C. 30 days
D. 6 months
E. 12 months

28 days

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Mrs Smith has been started on a new medication that
has to be prescribed by brand.
Which of the following medications should preferably
be prescribed by brand?

A. Metformin MR
B. Gliclazide
C. Nifedipine MR
D. Ramipiril
E. Losartan

Nifedipine MR

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Mrs Hand attends a Medicines Use Review (MUR) in your
community pharmacy.
She has noticed that her blood glucose is higher since
starting a new medication.
Which of her medication is likely to be responsible for her
hyperglycaemia?
QUESTION 19
A. Metformin
B. Gliclazide
C. Bendroflumethiazide
D. Losartan
E. Adcal D3

Bendroflumethiazide is a thiazide diuretic used to treat hypertension and fluid retention. It can cause hyperglycaemia by:

Reducing insulin sensitivity (making the body’s cells less responsive to insulin).
Increasing glucose production in the liver.
Depleting potassium levels, which is important for insulin secretion.
Thiazide diuretics, especially at higher doses, can worsen blood sugar control in diabetic patients.

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Mr Andrews has been started on a new antifungal
medication in hospital.
The doctor initially prescribed a test dose for Mr Andews
due to the risk of anaphylaxis.
Which of the following antifungals was likely prescribed
for Mr Andrews?
A. Voriconazole
B. Isavuconazole
C. Clotrimazole
D. Amphotericin B
E. Caspofungin

Amphotericin B is known for its high risk of hypersensitivity reactions, including anaphylaxis, fever, chills, and hypotension, especially when given intravenously. Because of this, a test dose is often given before administering the full dose to check for severe reactions.

It is a broad-spectrum antifungal used for serious systemic fungal infections like cryptococcal meningitis and invasive aspergillosis.
Common side effects include infusion-related reactions, nephrotoxicity, electrolyte imbalances (hypokalaemia & hypomagnesaemia), and anaemi

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Miss Obama has been started on an ultra-rapid-acting
insulin.
How long before a meal should an ultra-rapid-acting
insulin be given?
A. At the time of, or immediately after, eating
B. 15 minutes before
C. 30 minutes before
D. 40 minutes before
E. 60 minutes before

At the time of, or immediately after eating

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Mr Jenkinson has visited his diabetes specialist nurse and
has been started on a rapid-acting insulin.
Which of the following insulin preparations is rapid-
acting?
A. Insulatard®
B. Lyumjev®
C. Toujeo®
D. Tresiba®
E. Actrapid®

Lyumjev

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Miss Washington has been started on a new insulin and
has noticed it is cloudy in appearance.
Which of the following insulin preparations is cloudy in
appearance?
QUESTION 23
A. Insulatard®
B. Lantus®
C. Novorapid®
D. Fiasp®
E. Humalog®

Insulatard

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Mr Khan has been started on doxycycline for the
treatment of cellulitis.
Which of the following foods can likely reduce the
absorption of doxycycline?
A. Apple
B. Pomelo
C. Milk
D. Beef
E.Grapefruit

Doxycycline is a tetracycline antibiotic, and milk (and other dairy products) can reduce the absorption of doxycycline. This happens because calcium in milk binds to doxycycline, forming an insoluble complex that makes the drug less available for absorption into the bloodstream.

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Mr Smith has started a new medication and has noticed a blue-greyish discolouration of his skin. Which of his following medications is likely to be responsible for this side effect? A. Diazepam B. Amiodarone C. Bendroflumethiazide D. Bisoprolol E. Ramipril

Amiodarone

Which of the following is an example of a long acting benzodiazepine? A. Nitrazepam B. Loprazolam C. Temazepam D. Lormetazepam E. Midazolam

Nitrazepam

Mr James is complaining of severe pain from his heel after starting a new antibiotic, Which of the following antibiotics is likely to be responsible for his symptoms? A. Dalbavancin B. Vancomycin C. Linezolid D. Ciprofloxacin E. Ceftazidime

Ciprofloxacin

Which of the following is not a side effect of prednisolone? A. Diabetes mellitus B. Adrenal suppression C. Osteoporosis D. Psychotic disorder E. Weight loss

Weight loss

Which of the following foods can increase the blood concentration of tacrolimus? A. Milk B. Oats C. Pomelo D. Banana E. Orange

Pomelo (like grapefruit) contains compounds that inhibit the CYP3A4 enzyme in the liver and intestines. Tacrolimus is metabolized by this enzyme, so consuming pomelo can increase the blood concentration of tacrolimus, potentially leading to toxicity.

Prednisolone 40mg daily for 5 days then reduce the dose by one tablet every other day until all tablets are taken. How many prednisolone 5mg tablets would you supply? A. 28 B. 56 C. 84 D. 96 E. 112

You receive a prescription for prednisolone tablets, What time of the day would you recommend the patient to take the tablet? A. In the morning B. At lunchtime C. Mid afternoon D. With dinner E. At night

Prednisolone is a corticosteroid, and like the body's natural steroid production, it peaks in the morning. Taking prednisolone in the morning helps to mimic the body's natural rhythm and can reduce the likelihood of disrupting the body's circadian rhythm. It also minimizes the risk of side effects like insomnia.

What dose of temazepam is approximately equivalent to 5mg of diazepam? A. 1mg B. 2mg C. 5mg D. 10mg E. 20mg

10mg??

Which of the following can be used as treatment for benzodiazepine poisoning? A. Ondansetron B. Potassium chloride C. Dicobalt edetate D. Activated charcoal E. Sodium thiosulfate

Activated charcoal is commonly used to treat poisoning from various drugs, including benzodiazepines, as it can bind to the drug in the gastrointestinal tract and prevent further absorption into the bloodstream. For benzodiazepine poisoning, flumazenil (a benzodiazepine antagonist) is the most specific treatment, but activated charcoal is commonly used in the initial management of many poisonings, including benzodiazepines, especially if ingestion occurred within a few hours.

Which of the following antibiotics demonstrates activity against chlamydia pneumoniae? A. Doxycycline B. Dalbavancin C. Gentamicin D. Piperacillin/Tazobactam E. Amoxicillin

Doxy

Which of the following antibiotics demonstrates activity against mycoplasma pneumoniae? A. Co-amoxiclav B. Dalbavancin C. Ciprofloxacin D. Piperacillin/Tazobactam E. Amoxicillin

Ciprofloxacin is a fluoroquinolone antibiotic that is effective against a broad range of bacterial infections, including Mycoplasma pneumoniae, which causes atypical pneumonia. Fluoroquinolones, such as ciprofloxacin, work by inhibiting bacterial DNA gyrase, preventing the bacteria from replicating.

Which of the following is an example of a long-acting corticosteroid? A. Prednisolone B. Prednisone C. Fludrocortisone D. Hydrocortisone E. Dexamethasone

Dexamethasone

Which of the following antibiotics demonstrates activity against legionella pneumophila? A. Co-amoxiclav B. Vancomycin C. Clarithromycin D. Amoxicillin E. Temocillin

Clarithromycin is a macrolide antibiotic that is effective against Legionella pneumophila, the bacterium responsible for Legionnaires' disease. Macrolides, such as clarithromycin and azithromycin, are commonly used to treat infections caused by Legionella pneumophila due to their ability to penetrate host cells, where Legionella resides.

A patient is diagnosed with an animal bite and requires an antibiotic with activity against bacteroides fragilis. Which of the following antibiotics demonstrates activity against bacteroides fragilis? A. Co-amoxiclav B. Benzylpenicillin C. Temocillin D. Flucloxacillin E. Gentamicin

Co-amoxiclav is a combination of amoxicillin (a penicillin) and clavulanic acid (a beta-lactamase inhibitor). It has good activity against Bacteroides fragilis, which is an anaerobic bacterium commonly found in infections resulting from animal bites. The clavulanic acid component protects amoxicillin from degradation by beta-lactamase enzymes produced by some bacteria, including Bacteroides fragilis.

Which of the following antibiotics demonstrates activity against pseudomonas aeruginosa? A. Co-amoxiclav B. Benzylpenicillin C. Trimethoprim D. Cefalexin E. Piperacillin/Tazobactam

Piperacillin/Tazobactam is a broad-spectrum antibiotic that includes piperacillin (a penicillin) and tazobactam (a beta-lactamase inhibitor). It is highly effective against Pseudomonas aeruginosa, a common Gram-negative pathogen associated with infections in immunocompromised patients and those with chronic lung diseases, such as cystic fibrosis.

Which of the following antibiotics demonstrates activity against neisseria meningitidis? A. Co-amoxiclav B. Benzylpenicillin C. Temocillin D. Piperacillin/Tazobactam E. Nitrofurantoin

Benzylpenicillin (also known as penicillin G) is highly effective against Neisseria meningitidis, the bacterium responsible for meningococcal infections, including meningitis and septicemia.

A patient walks into your community pharmacy with a prescription for Zopiclone. Which controlled drug schedule does zopiclone belong to? A. Schedule 1 B. Schedule 2 C. Schedule 3 D. Schedule 4 E. Schedule 5

A patient is commenced on vancomycin for the treatment of a C. difficile infection. Which of the following side effects is not a side effect of vancomycin? A. Ototoxicity B. Red man syndrome C. Phototoxicity D. Phlebitis E. Nephrotoxicity

Phototoxicty

Which of the following cephalosporins is an example of a fifth generation cephalosporin? A .Cefalexin B. Cefaclor C. Ceftazidime D. Ceftaroline E. Cefuroxime

Ceftaroline

Which of the following diseases is not an example of a notifiable disease? A. Rubella B. Scarlet fever C. Endocarditis D. Meningitis E. COVID-19

Endocarditis

What is the recommended treatment of severe acute ulcerative colitis if corticosteroids are contraindicated? A. Intravenous hydrocortisone B. Intravenous infliximab C. Surgery D. Intravenous ciclosporin E. Oral methotrexate

n cases of severe acute ulcerative colitis (UC), corticosteroids are commonly used as first-line treatment. However, if corticosteroids are contraindicated, the next step is to consider intravenous ciclosporin. This medication is an immunosuppressant that can help control the inflammatory process in UC and is often used in patients who cannot tolerate corticosteroids or in those who do not respond to them

What is the first-line treatment of severe acute ulcerative colitis? A. Intravenous hydrocortisone B. Topical hydrocortisone C. Surgery D. Intravenous ciclosporin E. Oral methotrexate

For severe acute ulcerative colitis (UC), the first-line treatment is typically intravenous corticosteroids, such as intravenous hydrocortisone. This is used to rapidly reduce inflammation and control symptoms in patients who are hospitalized with severe disease

Miss London has been diagnosed with moderate proctitis. What is the first-line treatment of mild to moderate proctitis? A. Oral aminosalicylate B. Topical aminosalicylate C. Oral corticosteroid D. Topical corticosteroid E. Oral methotrexate

For mild to moderate proctitis, the first-line treatment is typically a topical aminosalicylate, such as mesalazine. This treatment is effective in reducing inflammation directly in the rectum, where proctitis occurs.

Which of the following medications is an example of an aldosterone antagonist? A. Digoxin B. Ranolazine C. Eplerenone D. Sacubitril/valsartan E. Sotalol

Eplerenone is an example of an aldosterone antagonist. It works by blocking the action of aldosterone, a hormone that increases sodium and water retention, which can contribute to high blood pressure and fluid buildup in conditions like heart failure. By antagonizing aldosterone, eplerenone helps to reduce blood pressure and prevent fluid retention.

Mr Smith has been prescribed a cardiac glycoside for atrial fibrillation. Which of the following medications is an example of a cardiac glycoside? A. Ranolazine B. Eplerenone C. Digoxin D. Bisoprolol E. Sotalol

Digoxin

Mr Andews is diagnosed with heart failure and is due to be prescribed medication. Which of the following medications is not licensed for heart failure? A. Bisoprolol B. Losartan C. Eplerenone D. Ramipril E. Ranolazine

Ranolazine - Anti angina

A patient, Mr Jones, is diagnosed with invasive aspergillosis. Which of the following antifungals is the first-line for aspergillosis? A. Amphotericin B B. Fluconazole C. Voriconazole D. Caspofungin E. Clotrimazole

Voriconazole is the first-line treatment for invasive aspergillosis. It is an antifungal medication that works by inhibiting the synthesis of ergosterol, a key component of the fungal cell membrane, thus preventing fungal growth.

Mrs Smith has been commenced on an antifungal and is counselled on the risk of phototoxicity. Which of the following antifungals is associated with phototoxicity? A. Amphotericin B B. Clotrimazole C. Voriconazole D. Caspofungin E. Ketoconazole

Voriconazole is known to be associated with phototoxicity, which can cause skin reactions such as redness, swelling, and blistering when exposed to sunlight or UV light. It is recommended that patients taking voriconazole avoid direct sunlight and wear protective clothing or sunscreen when outside.

Mr Daud is diagnosed with a severe diabetic foot infection and is due to be prescribed a glycopeptide antibiotic. Which of the following antibiotics is an example of a glycopeptide? A. Gentamicin B. Neomycin C. Dalbavancin D. Tobramycin E. Streptomycin

Dalbavancin

Mr Smith is experiencing constipation and you review his medication. Which of the following medications is most likely to be associated with constipation? A. Clindamycin B. Ferrous sulphate C. Piperacillin/tazobactam D. Metformin E. Empagliflozin

Ferrous Sulphate

Mr Joshua is started on a short-acting corticosteroid. Which of the following is an example of a short-acting corticosteroid? A. Prednisolone B. Prednisone C. Fludrocortisone D. Hydrocortisone E. Dexamethasone

Hydrocortisone

Mr Alexander, a 57-old-patient, is started on a new medication for type 2 diabetes mellitus. He was informed by his general practitioner to discontinue treatment and seek immediate medical assistance if he experiences persistent and severe abdominal pain as this may indicate pancreatitis. Which of the following medications has Mr Alexander likely been prescribed? A. Gliclazide B. Metformin C. Sitagliptin D. Canagliflozin E. Acarbose

Sitagliptin

Miss Smith, a 23-year-old patient, walks in with a prescription of Paroxetine 20mg daily for the treatment of major depression. What time of the day would you recommend Miss Smith to take the medication? A. In the morning B. At lunchtime C. Mid afternoon D. Early evening E. At night

Paroxetine, a selective serotonin reuptake inhibitor (SSRI), is typically recommended to be taken in the morning. This is because it can cause mild stimulation in some patients, which may affect sleep if taken later in the day. Taking it in the morning helps reduce the risk of insomnia or sleep disturbances. However, if the patient experiences drowsiness or sedation, it might be recommended to take it in the evening, but generally, morning is preferred.

Mr Andews, a 57-year-old gentleman, has been prescribed atorvastatin for the treatment of primary hypercholesterolaemia in patients who have not responded adequately to diet and other appropriate measures. What is the usual dose a patient would be initiated on? A. 5mg B. 10mg C. 20mg D. 40mg E. 80mg

10mg

Mr Callum, a 63-year-old gentleman, is diagnosed with an acute exacerbation of chronic obstructive pulmonary disease (COPD) and is due to be prescribed antibiotics, he has myasthenia gravis and no drug allergies. Which of the following is the most suitable antibiotic to prescribe for Mr Callum? A. Doxycycline B. Erythromycin C. Clarithromycin D. Amoxicillin E. Co-amoxiclav

Amoxicillin (D) is the most suitable antibiotic for Mr. Callum. In patients with myasthenia gravis, macrolides (erythromycin, clarithromycin) should generally be avoided due to their potential to worsen symptoms. However, amoxicillin is a first-line choice for treating bacterial exacerbations of chronic obstructive pulmonary disease (COPD) and is safe for patients with myasthenia gravis.

Mr London has been prescribed ciprofloxacin for a moderate diabetic foot infection, he is informed that ciprofloxacin may induce convulsions by the endocrinology consultant, he is also advised that certain medication classes alongside ciprofloxacin may also induce convulsions. Which medication class is the consultant likely referring to? A. Thiazide diuretics B. Loop diuretics C. Non-steroid anti-inflammatory drugs (NSAIDS) D. ACE inhibitors E. Beta blockers

Ciprofloxacin is a fluoroquinolone antibiotic, and one of its potential side effects is an increased risk of seizures or convulsions. Certain medications, such as NSAIDs, may further increase this risk when taken in combination with ciprofloxacin. This is because NSAIDs, particularly when combined with drugs like ciprofloxacin, can lower the seizure threshold and increase the likelihood of convulsions. Other classes, like thiazide diuretics, loop diuretics, ACE inhibitors, and beta blockers, are not typically associated with a similar risk when combined with ciprofloxacin.