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MCQ Flashcards

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
Q

which one has more predictable anticoagulant effect? UFH, LMWH, Fondaparinux

A

LMWH and fondapariux have more predictable effect and doesnt need routine lab monitoring. UFH needs routine monitoring

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26
Q

which one has more predictable anticoagulant effect? UFH, LMWH, Fondaparinux

A

LMWH and fondapariux have more predictable effect and doesnt need routine lab monitoring. UFH needs routine monitoring

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27
Q

an example of rapid insulin (immediate onset, short duration)

A

NovoRapid

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28
Q

an example of short acting insulin (early onset, short duration)

A

Actrapid (soluble insulin)

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29
Q

an example of intermediate acting insulin (intermediate onset and duration)

A

Humulin I (isophane/ NPH insulin)

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30
Q

example of long acting insulin (flat profile with regular administration)

A

lantus (insulin glargine), Levemir (insulin detemir)

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31
Q

example of Biphasic insulin

A

Novomix 30

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32
Q

what drugs can increase requirement of insulin

A

systemic corticosteroids

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33
Q

what reduces the absorption of levothyroxine and bisphosphate?

A

oral iron salt

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34
Q

what drug is used for first line for focal seizures, generalised tonic-clonic seizures and absence seizures

A

lamotrigine

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35
Q

what epileptic drug is used for bipolar depression as well?

A

lamotrigine, it also doesnt increase risk of switching to mania episodes

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36
Q

does lamotrigine have cross-sensitivity with other antiepileptic drug?

A

yes

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37
Q

drugs that induce glucuronidation

A

carbamazepine, phenytoin, oestrogens, rifampicin, protease inhibitors

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38
Q

glucuronidation inhibitor

A

valproate

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39
Q

severe hypersensitive reaction is more common when lamotrigine is co-administered with what drugs?

A

valporate

- lamotrigine dose should be half

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40
Q

montelukast- what is its use

A

leukotriene receptor antagonists, third line treatment for asthma when LABA and inhaled corticosteroids are inadequate

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41
Q

levetiracetam

A

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

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42
Q

what is co-prescribed with lidocaine to prolong local anaesthetic effect

A

vasoconstrictor- adrenaline

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43
Q

Macrolides - clarithromycin, erythromycin, azithromycin

A

severe pneumonia (legionella pneumophila, mycoplasma pneumoniae), H pylori, broad spectrum: gram + and some gram -

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44
Q

treatment regime for H pylori

A

Clarithromycin + PPI + amoxicillin/ metronidazole

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45
Q

what is alternatives for penicillin allergies

A

macrolides (clarithromycin, erythromycin etc)

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46
Q

macrolides + warfarin

A

increase risk of bleeding

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47
Q

macrolides + statin

A

increase risk of myopathy

48
Q

macrolides should be prescribed with caution in pxt taking other drugs that prolong QT/ cause arrhythmias

A

amiodarone, antipsychotics, quinine, quinolone antibiotics, SSRIs

49
Q

which one has shorter half life? erythromycin/ clarithromycin

A

erythromycin

50
Q

what drugs increase blood glucose, hence reduce effect of metformin ?

A

prednisolone, thiazide, loop diuretics

51
Q

metformin needs to be stopped before what kind of procedure?

A

x-ray or operation

52
Q

target of HbA1c for T2DM, treating with metformin

A

<48 mmol/mol

53
Q

what diabetic drug increase weigh and which one doesnt

A

insulin and sulphonylureas increase weight gain, metformin doesnt.

54
Q

what problem may long term use of methrotrexate bring

A

hepatic cirrhosis and pulmonary fibrosis

55
Q

what is the overdose treatment for MTX

A

folinic acid, as well as hydration and urinary alkalinisation

56
Q

metronidazole spectrum

A

gram + c diff, gram - anaerobes, (bacteroides fragillis)

57
Q

metronidazole increase risk of bleeding with warfarin

A

metronidazole increase risk of toxicity with phenytoin

58
Q

can patient drink alcohol with metronidazole

A

no, pxt will feel very unwell if drink during or for up to 48 hrs after metronidazole treatment

59
Q

can patient drink alcohol with metronidazole

A

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
Q

what treats OD of opioids

A

Naloxone

61
Q

what happen to opioid dependent patient if taken naloxone

A

will experience opioid withdrawal reaction

62
Q

what happen to opioid dependent patient if taken naloxone

A

will experience opioid withdrawal reaction

63
Q

which one is short acting? GTN/ isosorbide mononitrate

A

GTN

64
Q

why should Nitrate be used with cautious with antihypertensive drug

A

nitrate may precipitate hypotension

65
Q

why shouldnt nitrate be used with phosphodiesterase inhibitor (eg. sildenafil)

A

because they enhance and prolong hypotensive effect of nitrates

66
Q

why shouldnt nitrate be used with phosphodiesterase inhibitor (eg. sildenafil)

A

because they enhance and prolong hypotensive effect of nitrates

67
Q

how to prevent nitrate tolerance?

A

ensure “nitrate free” period every day, usually overnight

68
Q

Nitrofurantoin is first choice for ?

A

acute, uncomplicated lower urinary tract infection. can also be used as a prophylaxis. alternatives are trimethoprim, amoxicillin, cefalexin.

69
Q

what is nitrofurantoin active against?

A

E.coli (gram negative) and staphylococcus (gram positive)

70
Q

what colour does nitrofurantoin turn urine into ?

A

dark yellow/ brown

71
Q

can nitrofurantoin be administered to pregnant women towards term?

A

no

72
Q

what are the main s/e of NSAIDS

A

GI toxicity, renal impairment, increase risk of CV events (stroke/ MI)

73
Q

which of NSAIDs has the lowest risk of GI

A

ibuprofen

74
Q

which of NSAIDs have the lowest risk of CV event

A

Naproxen and low dose of IBU

75
Q

COX-2 has lower risk of GI but higher risk of?

A

CV event

76
Q

which COXIB has highest risk of CV event? rofecoxib, etoricoxib, celecoxib?

A

Rofecoxib > etoricoxib > celecoxib

77
Q

what should be given with NSAIDs for gastric protection

A

lansoprazole 15mg daily

78
Q

what should be given with NSAIDs for gastric protection

A

lansoprazole 15mg daily

79
Q

what risk does combined hormonal contraception bring?

A

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
Q

hormonal contraception may cause?

A

irregular bleeding and mood changes but NOT weigh gain

81
Q

CYP 450 inducers ( carbamazepine and rifampicin) may reduce effectiveness of progestogen only contraceptive.

A

absorption of lamotrigine may be reduced by contraceptives, impairing seizure control

82
Q

what can be offered to patient for nausea after taking strong opioid like morphine

A

metlclopramide (anti emetic)

83
Q

which opioid should be avoided n epilepsy patient ?

A

tramadol as it lowers seizure threshold

84
Q

which opioid increase risk of serotonin syndrome?

A

tramadol, and should avoid taking with SSRI, MAOIs, TCA

85
Q

which opioid cause less constipation and respiratory depression

A

tramadol

86
Q

what toxic metabolite of paracetamol cause hepatic failure

A

NAPQI - n-acetyl-p-benzoquinone imine - accumulate and cause hepatocellular necrosis. can be prevented with treatment with the acetylcysteine

87
Q

what toxic metabolite of paracetamol cause hepatic failure

A

NAPQI - n-acetyl-p-benzoquinone imine - accumulate and cause hepatocellular necrosis. can be prevented with treatment with the acetylcysteine

88
Q

penicillin spectrum: streptococcal, meningococcal, clostridial

A

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
Q

which PPI reduce antiplatelet effect of clopidegrel ?

A

omeprazole

90
Q

which PPI reduce antiplatelet effect of clopidegrel ?

A

omeprazole

91
Q

which PPI have lowest chance to interact with clopidegrel ?

A

lansoprazole, pantoprazole

92
Q

should quinine be avoid in people with glucose-6-phosphate dehydrogenase deficiency?

A

yes, as it precipitate haemolysis

93
Q

which quinolones is preferred for LRTI? moxifloxacin or levofloxacin

A

moxifloxacin or levofloxacin

94
Q

which quinolones have preferred activity against gram + ? ciprofloxacin, moxifloxacin, levofloxacin

A

moxifloxacin or levofloxacin

95
Q

which quinolones have preferred activity against gram + ? ciprofloxacin, moxifloxacin, levofloxacin

A

moxifloxacin or levofloxacin

96
Q

which antibiotics is most likely to be associated with c.diff

A

quinolones and cephalosporins

97
Q

which quinolone are most likely to be associated with arrhythmia

A

moxifloxacin, prolong QT intervals

98
Q

triptans may increase risk of serotonin toxicity and syndrome when given with serotonergic drugs

A

serotonergic drugs: MAOi, tramadol, SSRIs, TCA

99
Q

can triptans be taken with anti-inflammatory

A

yes

100
Q

what is the main s/e of triptans

A

pain and discomfort in chest or throat, rarely MI

101
Q

what is the main s/e of triptans

A

pain and discomfort in chest or throat, rarely MI

102
Q

warfarin and tamoxifen should be avoided as increased risk of bleeding

A

if patient on cancer therapy requires anticoagulation, take low molecular weight heparin (enoxaparin) (than warfarin )

103
Q

warfarin and tamoxifen should be avoided as increased risk of bleeding

A

if patient on cancer therapy requires anticoagulation, take low molecular weight heparin (enoxaparin) (than warfarin )

104
Q

tetracycline (doxycycline) has a lower risk of c diff infection than other broad spectrum of antibiotics

A

tetracycline specific s/e: oesophageal irritation, ulceration, dysphagia, photosensitivity, discolouration of tooth in children, hepatotoxicity, and intracranial hypertension

105
Q

tetracycline (doxycycline) has a lower risk of c diff infection than other broad spectrum of antibiotics

A

tetracycline specific s/e: oesophageal irritation, ulceration, dysphagia, photosensitivity, discolouration of tooth in children, hepatotoxicity, and intracranial hypertension

106
Q

what is the first line for prophylaxis of generalised tonic-clonic seizures, absence seizures, focal seizures and myoclonic seizures?

A

valporate

107
Q

what is the first line for prophylaxis of generalised tonic-clonic seizures, absence seizures, focal seizures and myoclonic seizures?

A

valporate

108
Q

valporate increase risk of toxicity with lamotrigine

A

valporate is tetrarogenic

109
Q

vancomycin spectrum

A

only gram positive (staphy, strept, c diff) and inc MRSA

110
Q

what is red man syndrome and which antibiotic does it relate to

A

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
Q

what is red man syndrome and which antibiotic does it relate to

A

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
Q

vancomycin requires plasma drug monitoring to avoid toxicity

A

vancomycin when prescribed with aminoglycosides (gentamicin ), loop diuretics (furosemide) , ciclosporins, can increase risk of ototoxicity and nephrotoxicity

113
Q

vancomycin requires plasma drug monitoring to avoid toxicity

A

vancomycin when prescribed with aminoglycosides (gentamicin ), loop diuretics (furosemide) , ciclosporins (immunosuppressant), can increase risk of ototoxicity and nephrotoxicity

114
Q

what is used to reverse warfarin

A

phytomenadione

115
Q

what is used to reverse warfarin

A

phytomenadione

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