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MCQ Flashcards

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1
Q

what drug can mask hypoglycaemia (s/e caused by diabetic drugs)

A

beta blocker

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2
Q

what drug may increase blood glucose, list 3

A

prednisolone, thiazide, loop diuretics

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3
Q

which diabetic drug is the least likely to cause hypoglycaemia as a s/e

A

(DPPi ) sitagliptin,

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4
Q

why is prednisolone taken in the morning

A

to reduce chance of insomnia

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5
Q

which diabetic drug is the best with improving vascular complications as well as preventing hypoglycaemia?

A

SGLT-2

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6
Q

what is furosemide’s role in acute heart failure

A

direct effect on blood vessels: reduces preload and increase contractile function of the overstretched heart muscle

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7
Q

Can loop diuretic worsen gout

A

yes, for chronic use, as it inhibits excretion of uric acid

so does thiazide.

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8
Q

which diuretic increase toxicity of digoxin and why?

A

loop diuretic and its associated hypokalaemia

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9
Q

what diuretic increase blood glucose, LDL and triglycerides ?

A

Thiazides

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10
Q

which diuretic can cause impotence in men

A

thiazides

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11
Q

which diuretic’s effect may be reduced by anti-inflammotires

A

thiazides

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12
Q

what is the on/ off effect?

A

Levodopa- symptoms get worse towards end of dose interval. increase dose/ frequency to overcome but dyskinesia at beginning of the dosage interval. these happening tgt = on/ off effect

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13
Q

what is levodopa co-prescribed with and why?

A

carbidopa, a peripheral dopa-decarboxylase inhibitor to reduce dose required and reduce nausea

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14
Q

in acute ischaemic stroke, within ___hrs of the onset of stroke, should alteplase be administered to increase chance of living?

A

4.5 hrs

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15
Q

what kind of epilepsies/ seizures do gabapentin/ pregabalin treat? and in which kind should they be avoided?

A

they are used as add-on therapy for focal epilepsies where CBZ, lamotrigine, valporate are inadequate. They should be avoided in absence and myoclonic seizures

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16
Q

For gabapentin/ pregabalin- apart from focal epilepsies, what else are they indicated for

A
  • neuropathic pain (inc diabetic neuropathy)

- pregabalin is an option for generalised anxiety disorder

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17
Q

gabapentin/ pregabalin- bind to voltage sensitive Ca2+ channel to inhibit release of GABA- reduce neuronal excitability

A

better tolerated than older antiepileptic drugs

also less interactions than CBZ. valporate and lamotrigine

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18
Q

gabapentin can cause false positive in what kind of test

A

detection of protein on urine dipstick test

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19
Q

H2 antagonist- Ranitidine, cannot completely suppress gastric acid production (unlike PPIs), but it has faster onset of action

A

Ranitidine, like PPI can also mask symptoms of gastro-oesophageal cancer

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20
Q

Fondaparinux (heparin) is very specific for which factor

A

Fondaparinux, a synthetic pentasaccharide that mimics the sequence of the binding site of heparin to antithrombin, is very specific for factor Xa. it also less lower bleeding risk than with LMWH, UFH

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21
Q

which two clotting factors are important for antithrombin to target

A

Ila and Xa

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22
Q

Heparin-induced thrombocytopenia is less likely to happen to LMWH or UFH ?

A

LMWH
(and does not occur to fondaparinux)
HIT is an autoimmune reaction to heparin, result in low platelet counts and thrombosis

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23
Q

in renal impairment, which ones accumulate? - LMWH, UFH, fondaparinux?

A

LMWH and fondaparinux accumulate so lower dose or UFH should be used instead.

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24
Q

LMWH (enoxaparin) is co-prescribed with warfarin in VTE, why?

A

LMWH provides bridging anticoagulation, it can be stopped once warfarin has established its effect. usually use for about 5 days

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25
which one has more predictable anticoagulant effect? UFH, LMWH, Fondaparinux
LMWH and fondapariux have more predictable effect and doesnt need routine lab monitoring. UFH needs routine monitoring
26
which one has more predictable anticoagulant effect? UFH, LMWH, Fondaparinux
LMWH and fondapariux have more predictable effect and doesnt need routine lab monitoring. UFH needs routine monitoring
27
an example of rapid insulin (immediate onset, short duration)
NovoRapid
28
an example of short acting insulin (early onset, short duration)
Actrapid (soluble insulin)
29
an example of intermediate acting insulin (intermediate onset and duration)
Humulin I (isophane/ NPH insulin)
30
example of long acting insulin (flat profile with regular administration)
lantus (insulin glargine), Levemir (insulin detemir)
31
example of Biphasic insulin
Novomix 30
32
what drugs can increase requirement of insulin
systemic corticosteroids
33
what reduces the absorption of levothyroxine and bisphosphate?
oral iron salt
34
what drug is used for first line for focal seizures, generalised tonic-clonic seizures and absence seizures
lamotrigine
35
what epileptic drug is used for bipolar depression as well?
lamotrigine, it also doesnt increase risk of switching to mania episodes
36
does lamotrigine have cross-sensitivity with other antiepileptic drug?
yes
37
drugs that induce glucuronidation
carbamazepine, phenytoin, oestrogens, rifampicin, protease inhibitors
38
glucuronidation inhibitor
valproate
39
severe hypersensitive reaction is more common when lamotrigine is co-administered with what drugs?
valporate | - lamotrigine dose should be half
40
montelukast- what is its use
leukotriene receptor antagonists, third line treatment for asthma when LABA and inhaled corticosteroids are inadequate
41
levetiracetam
monotherapy/ add on therapy of focal seizures if CBZ/ lamotrigine unsuitable/ not tolerated. can also be add on for myoclonic seizures and generalised tonic-clonic seizures. it also has psychiatric s/e. if can switch from IV to oral then asap but iv is more expensive
42
what is co-prescribed with lidocaine to prolong local anaesthetic effect
vasoconstrictor- adrenaline
43
Macrolides - clarithromycin, erythromycin, azithromycin
severe pneumonia (legionella pneumophila, mycoplasma pneumoniae), H pylori, broad spectrum: gram + and some gram -
44
treatment regime for H pylori
Clarithromycin + PPI + amoxicillin/ metronidazole
45
what is alternatives for penicillin allergies
macrolides (clarithromycin, erythromycin etc)
46
macrolides + warfarin
increase risk of bleeding
47
macrolides + statin
increase risk of myopathy
48
macrolides should be prescribed with caution in pxt taking other drugs that prolong QT/ cause arrhythmias
amiodarone, antipsychotics, quinine, quinolone antibiotics, SSRIs
49
which one has shorter half life? erythromycin/ clarithromycin
erythromycin
50
what drugs increase blood glucose, hence reduce effect of metformin ?
prednisolone, thiazide, loop diuretics
51
metformin needs to be stopped before what kind of procedure?
x-ray or operation
52
target of HbA1c for T2DM, treating with metformin
<48 mmol/mol
53
what diabetic drug increase weigh and which one doesnt
insulin and sulphonylureas increase weight gain, metformin doesnt.
54
what problem may long term use of methrotrexate bring
hepatic cirrhosis and pulmonary fibrosis
55
what is the overdose treatment for MTX
folinic acid, as well as hydration and urinary alkalinisation
56
metronidazole spectrum
gram + c diff, gram - anaerobes, (bacteroides fragillis)
57
metronidazole increase risk of bleeding with warfarin
metronidazole increase risk of toxicity with phenytoin
58
can patient drink alcohol with metronidazole
no, pxt will feel very unwell if drink during or for up to 48 hrs after metronidazole treatment
59
can patient drink alcohol with metronidazole
no, pxt will feel very unwell if drink during or for up to 48 hrs after metronidazole treatment. (nausea, vomiting, flushing, headache) (co-trimoxazole will cause similar reaction to metronidazole)
60
what treats OD of opioids
Naloxone
61
what happen to opioid dependent patient if taken naloxone
will experience opioid withdrawal reaction
62
what happen to opioid dependent patient if taken naloxone
will experience opioid withdrawal reaction
63
which one is short acting? GTN/ isosorbide mononitrate
GTN
64
why should Nitrate be used with cautious with antihypertensive drug
nitrate may precipitate hypotension
65
why shouldnt nitrate be used with phosphodiesterase inhibitor (eg. sildenafil)
because they enhance and prolong hypotensive effect of nitrates
66
why shouldnt nitrate be used with phosphodiesterase inhibitor (eg. sildenafil)
because they enhance and prolong hypotensive effect of nitrates
67
how to prevent nitrate tolerance?
ensure "nitrate free" period every day, usually overnight
68
Nitrofurantoin is first choice for ?
acute, uncomplicated lower urinary tract infection. can also be used as a prophylaxis. alternatives are trimethoprim, amoxicillin, cefalexin.
69
what is nitrofurantoin active against?
E.coli (gram negative) and staphylococcus (gram positive)
70
what colour does nitrofurantoin turn urine into ?
dark yellow/ brown
71
can nitrofurantoin be administered to pregnant women towards term?
no
72
what are the main s/e of NSAIDS
GI toxicity, renal impairment, increase risk of CV events (stroke/ MI)
73
which of NSAIDs has the lowest risk of GI
ibuprofen
74
which of NSAIDs have the lowest risk of CV event
Naproxen and low dose of IBU
75
COX-2 has lower risk of GI but higher risk of?
CV event
76
which COXIB has highest risk of CV event? rofecoxib, etoricoxib, celecoxib?
Rofecoxib > etoricoxib > celecoxib
77
what should be given with NSAIDs for gastric protection
lansoprazole 15mg daily
78
what should be given with NSAIDs for gastric protection
lansoprazole 15mg daily
79
what risk does combined hormonal contraception bring?
double risk of VTE, increase risk of stroke and CV disease (also depends on other risk factors), increase risk of breast and cervical cancer
80
hormonal contraception may cause?
irregular bleeding and mood changes but NOT weigh gain
81
CYP 450 inducers ( carbamazepine and rifampicin) may reduce effectiveness of progestogen only contraceptive.
absorption of lamotrigine may be reduced by contraceptives, impairing seizure control
82
what can be offered to patient for nausea after taking strong opioid like morphine
metlclopramide (anti emetic)
83
which opioid should be avoided n epilepsy patient ?
tramadol as it lowers seizure threshold
84
which opioid increase risk of serotonin syndrome?
tramadol, and should avoid taking with SSRI, MAOIs, TCA
85
which opioid cause less constipation and respiratory depression
tramadol
86
what toxic metabolite of paracetamol cause hepatic failure
NAPQI - n-acetyl-p-benzoquinone imine - accumulate and cause hepatocellular necrosis. can be prevented with treatment with the acetylcysteine
87
what toxic metabolite of paracetamol cause hepatic failure
NAPQI - n-acetyl-p-benzoquinone imine - accumulate and cause hepatocellular necrosis. can be prevented with treatment with the acetylcysteine
88
penicillin spectrum: streptococcal, meningococcal, clostridial
benzylpenicillin and phenoxymethylpenicillin has relatively narrow spectrum: gram+ (streptococci, bacillus and some anaerobes) gram- cocci (neisseria meningitidis and N gonorrhoeae) not active against gram -ve bacilli
89
which PPI reduce antiplatelet effect of clopidegrel ?
omeprazole
90
which PPI reduce antiplatelet effect of clopidegrel ?
omeprazole
91
which PPI have lowest chance to interact with clopidegrel ?
lansoprazole, pantoprazole
92
should quinine be avoid in people with glucose-6-phosphate dehydrogenase deficiency?
yes, as it precipitate haemolysis
93
which quinolones is preferred for LRTI? moxifloxacin or levofloxacin
moxifloxacin or levofloxacin
94
which quinolones have preferred activity against gram + ? ciprofloxacin, moxifloxacin, levofloxacin
moxifloxacin or levofloxacin
95
which quinolones have preferred activity against gram + ? ciprofloxacin, moxifloxacin, levofloxacin
moxifloxacin or levofloxacin
96
which antibiotics is most likely to be associated with c.diff
quinolones and cephalosporins
97
which quinolone are most likely to be associated with arrhythmia
moxifloxacin, prolong QT intervals
98
triptans may increase risk of serotonin toxicity and syndrome when given with serotonergic drugs
serotonergic drugs: MAOi, tramadol, SSRIs, TCA
99
can triptans be taken with anti-inflammatory
yes
100
what is the main s/e of triptans
pain and discomfort in chest or throat, rarely MI
101
what is the main s/e of triptans
pain and discomfort in chest or throat, rarely MI
102
warfarin and tamoxifen should be avoided as increased risk of bleeding
if patient on cancer therapy requires anticoagulation, take low molecular weight heparin (enoxaparin) (than warfarin )
103
warfarin and tamoxifen should be avoided as increased risk of bleeding
if patient on cancer therapy requires anticoagulation, take low molecular weight heparin (enoxaparin) (than warfarin )
104
tetracycline (doxycycline) has a lower risk of c diff infection than other broad spectrum of antibiotics
tetracycline specific s/e: oesophageal irritation, ulceration, dysphagia, photosensitivity, discolouration of tooth in children, hepatotoxicity, and intracranial hypertension
105
tetracycline (doxycycline) has a lower risk of c diff infection than other broad spectrum of antibiotics
tetracycline specific s/e: oesophageal irritation, ulceration, dysphagia, photosensitivity, discolouration of tooth in children, hepatotoxicity, and intracranial hypertension
106
what is the first line for prophylaxis of generalised tonic-clonic seizures, absence seizures, focal seizures and myoclonic seizures?
valporate
107
what is the first line for prophylaxis of generalised tonic-clonic seizures, absence seizures, focal seizures and myoclonic seizures?
valporate
108
valporate increase risk of toxicity with lamotrigine
valporate is tetrarogenic
109
vancomycin spectrum
only gram positive (staphy, strept, c diff) and inc MRSA
110
what is red man syndrome and which antibiotic does it relate to
vancomycin - rate related s/e. atients may develop anaphylactoid reactions, including hypotension (see Animal Pharmacology), wheezing, dyspnea, urticaria, or pruritus. Rapid infusion may also cause flushing of the upper body (“red neck”) or pain and muscle spasm of the chest and back.
111
what is red man syndrome and which antibiotic does it relate to
vancomycin - rate related s/e. atients may develop anaphylactoid reactions, including hypotension (see Animal Pharmacology), wheezing, dyspnea, urticaria, or pruritus. Rapid infusion may also cause flushing of the upper body (“red neck”) or pain and muscle spasm of the chest and back.
112
vancomycin requires plasma drug monitoring to avoid toxicity
vancomycin when prescribed with aminoglycosides (gentamicin ), loop diuretics (furosemide) , ciclosporins, can increase risk of ototoxicity and nephrotoxicity
113
vancomycin requires plasma drug monitoring to avoid toxicity
vancomycin when prescribed with aminoglycosides (gentamicin ), loop diuretics (furosemide) , ciclosporins (immunosuppressant), can increase risk of ototoxicity and nephrotoxicity
114
what is used to reverse warfarin
phytomenadione
115
what is used to reverse warfarin
phytomenadione

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