OSPE

Question 1

young man
medication to prevent vomiting during his journey.

Answer 1

▪ Tab. Meclizine 25mg
▪ Dispense 5 tablets
▪ Take one tablet 30 minutes before the journey.
▪ It may cause drowsiness, avoid driving and alcohol

Question 2

27-year-old lady who is suffering from morning sickness

Answer 2

• Thalidomide, although possess antiemetic action, it is teratogenic and should not be given to pregnant women. It causes severe deformity of the fetus, known as phocomelia. The suitable antiemetic would be doxylamine or promethazine.

℞
Tab Doxylamine 10mg
Dispense 30 tablets
Take one tablet before breakfast and at bedtime.
Bed rest and reduce anxiety

Question 3

male,case of acute amoebic dysentery

Answer 3

Tab Metronidazole 500 mg
Tab diloxanide furoate 500 mg Dispense 21 tablets of each
Take one tablet thrice daily both.
Do not consume alcohol during and two days after completing the tablets as it may give unpleasant feeling.

Question 4

instructions for metronidazole

Answer 4

▪Greet the patient.
▪Take the drug as prescribed.
▪Avoid alcohol or products containing alcohol while taking metronidazole, and for three days after the course of metronidazole has finished. Explain the side effects if metronidazole taken together with alcohol( please add the adverse).
▪Inform the patient about the side effects of metronidazole (the patient might have metallic taste, nausea, abdominal cramps, loose stool, urine may appear dark brown, headache, glossitis, dryness of mouth and dizziness).
▪Some patients may have allergic reactions such as lesions (fixed drug eruption), itching, rashes, urticaria. Ask the patient to meet doctor if he experience the above side effects.

Question 5

femlae,prescription for vertigo.

Answer 5

Tab Cinnarizine 25mg Dispense 9 tablets
Take one tablet thrice daily.

Question 6

prescription for Mr. R typhoid

Answer 6

Tablet ciprofloxacin 500mg
Dispense 20 tablets
Take one tablet twice daily x 10 days.
Review after 10 days.

Question 7

A feeding mother consumed a purgative X continuously for 1 week on a self-medication basis. The breastfed infant started having diarrhea. The pediatrician asked her to stop the drug X as it was the culprit in this case. The infant’s diarrhea stopped spontaneously

Answer 7

a) Identify X
Senna glycoside

b) Describe the mechanism of purgative X
*Stimulates peristalsis by irritating intestinal mucosa
*Also stimulates colonic electrolyte & fluid secretion by altering absorptive & secretory activity of mucosal cells

c) List 2 other purgatives belonging to the same group
Aloe, cascara

d) List 2 laxatives which can be used to prevent constipation in general
bulk:wheat bran
osmotic:sorbitol

Question 8

Prescription for gastritis

Answer 8

Capsule omeprazole 20mg Dispense 7 tablets

Take one tablet in the morning in empty stomach 30 minutes before breakfast for 7 days.

Question 9

Prescription chronic constipation

Answer 9

Tablet bisacodyl 5mg
Dispense 3 tablet
Take 1 tab orally at bedtime, for 3 days
Consume plenty of water and increase intake fruits and vegetables.

Question 10

pantoprazole to a patient suffering from Gastroesophageal Reflux Disease.
What instructions?

Answer 10

Greet the patients
▪ Inform the patient to take the prescribed drug in the morning just
before breakfast.
▪ Inform the patient about the side effects of pantoprazole (the
patient might experience headache, abdominal pain, diarrhea and
vitamin B12 malabsorption).
▪ Avoid taking alcohol and tobacco.

Question 11

A 60-year-old chronic alcoholic patient developed hepatic encephalopathy.
Which drug is preferred to treat this condition?
Explain the basis for using the drug in this patient

Answer 11

Lactulose

• In hepatic encephalopathy, there is severe hepatocellular damage
• Portal blood shunted to systemic circulation
• Toxic metabolites(e.g.NH3) from colon accumulate in blood-CNS toxicity
• Lactulose is degraded to lactate-converts
  ammonia(NH3) to ionised NH4+salts

Question 12

Which drug would you prefer as an antidiarrheal agent and why? LOPERAMIDE VS CODEINE

Answer 12

Loperamide because it:
* Has longer duration of action
* Is more potent
* Does not cross BBB (negligible CNS side effects) * Has no abuse liability

Question 13

parkinsonian patient suffering from levodopa- induced vomiting.

Answer 13

-Metoclopramide should not be prescribed in Parkinson’s disease as it can cross blood-brain barrier and can block dopamine receptors in the brain causing extrapyramidal reaction and exacerbation of Parkinson’s disease symptoms.
It is C/I in Parkinson’s disease and therefore not prescribed in L-Dopa-induced vomiting.
Domperidone is preferred in L-Dopa-induced vomiting

Tab Domperidone 10mg Dispense 9 tabs
Take one tablet three times daily

Question 14

fixed dose combination for metronidazole and norfloxacin

Answer 14

NOTES

Question 15

Comment: fixed dose combination for metronidazole and norfloxacin

Answer 15

▪ Antibacterial + anti-amoebic combination.
▪ Antiamoebic drug is useless in bacterial infection and vice versa.
▪ Amoebiasis and bacterial diarrhea rarely coexist.
▪ The therapy should be based on diagnosis to reduce the cost of treatment
▪ Only one drug of the combination will be effective and the other one will be useless.

Question 16

68-year-old moderate hypertensive patient with history of diabetes.

Answer 16

R/
* Tab enalapril 2.5 mg
* Dispense 14 tablets
* Take 1 tab once daily for 2 weeks
* Review after 2 weeks

Question 17

prazosin to a patient with hypertension and benign hyperplasia of prostate.
What instructions will you give to this patient?

Answer 17

This drug can cause sudden fall of blood pressure
You should take the medication at bedtime and should not get up from bed for 2 to 3 hours as your blood pressure will fall and you may collapse due to change of posture i.e., from lying down position to sitting and standing position.
Justification: Prazosin is a selective alpha 1 blocker and there will be vasodilation and fall of blood pressure.
The patient should be started with a low dose and the dose should be increased gradually. The drug should be taken at bedtime.

Question 18

Prescription for a patient with mild HT & history of asthma

Answer 18

• Propranolol is a non-selective β blocker
• blocks β2 receptors on bronchial smooth muscles
• It can cause bronchoconstriction and can aggravate asthma.
• Amlodipine is suitable in this patient
• The prescription is not complete
• Tab amlodipine 2.5 mg
• Dispense 14 tablets
• Take 1 tab once daily for 2 weeks * Review after 2 weeks

Question 19

FDC Hydrochlorothiazide + Lisinopril for Hypertension

Answer 19

NOTES

Question 20

Describe the management of cyanide poisoning

Answer 20

A) Emergency and Supportive Measures
* Remove victim from exposure, taking care to avoid exposure to rescuers
* For cyanide ingestion, administer activated charcoal to prevent further
absorption
* Supportive care in the form of i.v fluids and high flow of O2

B) Specific treatment
Administer Amyl nitrite (inhalation) or Sodium nitrite (IV) ↓
Convert haemoglobin to methaemoglobin
↓
Methemoglobin has higher affinity for cyanide
↓
Forms unstable Cyanmethemoglobin
↓
Then administer I.V. Sodium Thiosulfate
↓
Forms Sodium Thiocyanate
↓
Excreted in urine

Question 21

Select a suitable drug for a hypertensive patient with history of arrhythmia
➢ Give justification for the selection
➢ Give justification for the rejection

Answer 21

Verapamil is suitable: It is more cardio selective.
It depresses pacemaker activity→slows sinus rate, slows AV conduction,
and controls arrhythmia.
Nifedipine is not suitable: It is more vessel selective. It can cause Vasodilation which leads to reflex tachycardia. Hence it cannot be used
in this case

Question 22

A 47-year-old man of normal body built visits the clinic for regular checkups. On one such regular visit, you find his BP is 130/86 mmHg. He has no other comorbidity, but he is a smoker and his father died of MI at the age of 65.
What advice and instructions

Answer 22

The patient has pre-hypertension with history of smoking. He will be advised for his lifestyle modification and to adhere to non-pharmacological management.
Non-pharmacologic treatment:
a) He should reduce salt intake (6 gm of table salt daily) and no extra salt
b) He should decrease carbohydrate intake and try to reduce weight
c) He should increase physical activity like brisk walking
d) He should consume more of fresh vegetables and fruits in the diet
e) Alcohol consumption should be reduced
f) He should qquit smoking
g) Should take measures to manage stress
h) The patient should be advised to visit the clinic after one month to monitor his BP

Question 23

Comment on the following drug combination, based on the criteria for identifying rational FDC.
Atenolol+ nifedipine SR for hypertension

Answer 23

NOTES

Question 24

Choose a suitable antihypertensive drug for a patient with mild hypertension and history of bronchial asthma.
Justify your answer.

Answer 24

Amlodipine is suitable. It is a dihydropyridine calcium channel blocker and does not block beta receptors and does not produce any adverse effect in patients with bronchial asthma.
In fact, it is drug of choice for hypertension in asthmatic individuals.
Propranolol is a non-selective beta-blocker and blocks both beta1 and beta2 receptors and can cause bronchoconstriction in asthmatic.
It is contra- indicated in patients with bronchial asthma.

Question 25

A patient who was on Digoxin accidentally received quinidine and developed complications like AV block and ventricular extrasystoles. On exam, his plasma digoxin level was elevated. a) Why did the patient develop the above complications? b) List 2 other positive inotropics which act by different mechanisms.

Answer 25

a) - quinidine is a class 1a antiarrhythmic drug - Concomitant use of quinidine with digoxin ↑ digoxin lvls ↑ toxicity - (quinidine interferes with renal tubular excretion of digoxin) - Quinidine prolongs repolarization & effective refractory period - When used with digoxin, leads to AV block & causes ventricular extrasystoles b) - Milrinone - Dopamine/ dobutamine

Question 26

A hypertensive patient develops a severe dry cough after taking an antihypertensive drug. Due to this complication, the therapy was discontinued, and he was switched to another drug.

Answer 26

a. Name the antihypertensive drug is responsible for the above symptom. Enalapril (ACE inhibitors) b. State another clinical indication and TWO (2) other adverse effects of the above class of drug. Clinical indication : Treatment of congestive heart failure Side effects: teratogenic effect , proteinuria

Question 27

68-year-old male with a history of diabetes,elevated BP

Answer 27

Tab enalapril 2.5 mg -Dispense 14 tablets -Take 1 tab once daily for 2 weeks. - Review after 2 weeks

Question 28

surgery,deep vein thrombosis

Answer 28

SC Enoxaparin 100mg OD Dispense for 10 days, or until oral anticoagulation is established. Inject subcutaneously once daily Tab Warfarin 10 mg OD for 2 days, maintenance dose 5mg OD until therapeutic INR is stable and ≥2.0 (range: 2.0-3.0) for 2 consecutive days - Review after 10 days or SC Fondaparinux 10mg OD Dispense for 10 days, or until oral anticoagulation is established. Inject subcutaneously once daily

Question 29

Explain to the patient how to administer sublingual nitroglycerine

Answer 29

1. GTN sublingual: a) Take 1 tablet at onset of chest pain b) Place it under your tongue until the pain is relieved c) Spit out (or swallow) the tablet as soon as the pain is relieved d) If pain is not relieved, 1 tablet can be repeated after 5 min. Do NOT take > 3 tablets e) If pain persists, report to the emergency unit immediately f) Take the tablet while sitting down, to avoid falling down (due to light-headedness/ dizziness)

Question 30

acute anginal attack. How would you manage the patient?

Answer 30

a) Place patient in comfortable position b) GTN sublingual tablet/ spray 0.5 mg (usually relief seen within 3 min) c) (Or) isosorbide dinitrate sublingual 5 – 10 mg d) Spit out tablet as soon as pain is relieved

Question 31

A 44-years-old male, chronic smoker for the past 20 years. He presents with central chest pain, shortness of breath and profuse sweating. He is a known Diabetes for the past 10 years on oral hypoglycaemic agent. ECG findings as STEMI and elevated cardiac biomarkers. List the steps in management for this patient.

Answer 31

notes

Question 32

List the steps involved in the management of cardiogenic shock with oliguria

Answer 32

a)Dopamine IV 5 μg/kg/min, ↑ gradually up to 10 μg/kg/min (according to BP) b) Correct 2° consequences (e.g. acidosis, hypoxia) c) Maintain vital organ functions (e.g. CO, BP, urine output) d) Plasma expanders

Question 33

65-years-old patient with mild HT and history of asthma:

Answer 33

Criticism: - Propranolol is a non-selective β blocker - It blocks β2 receptors on bronchial smooth muscles - Causes bronchoconstriction & thus aggravates bronchial asthma - CCB would be appropriate as it no affect bronchial smooth Tab amlodipine 2.5 mg - Dispense 14 tablets - Take 1 tab once daily for 2 weeks - Review after 2 weeks

Question 34

mixed worm infestation

Answer 34

Tablet Albendazole 400mg Dispense one tablet Take the tablet at bed time. or mebendazole 100mg. Dispense 9 tablets Take one tablet 2 times a day for 3 days.

Question 35

acute attack of malaria caused by plasmodium vivax.

Answer 35

Chloroquine tablet 500 mg Dispense chloroquine 5 tablets Take 1 g Bolus dose (immediately), THEN 500 mg after 6-8 hr THEN 500 mg at 24 hr and 48 hr after initial dose Total dose of 2500 mg in 3 days Review after 3 days

Question 36

prophylaxis of malaria

Answer 36

Tablet chloroquine 500 mg Tablet primaquine 30mg (0.5mg/kg) Dispense 9 tablets of chloroquine Dispense 14 tablets of primaquine 1 tablet of chloroquine per week, 2 weeks before travel and 1 tablet every week during travel and 1 tablet every week 4 weeks after return One tablet of primaquine daily for 14 days after chloroquine therapy

Question 37

Select a drug to treat MDR plasmodium falciparum malaria

Answer 37

Artesunate injection

Question 38

uses of primaquine

Answer 38

Gametocidal action, terminal prophylaxis and radical cure

Question 39

Select a drug that is used for terminal prophylaxis

Answer 39

primaquine tab

Question 40

Mention two non-malarial uses of chloroquine.

Answer 40

Rheumatoid arthritis and hepatic amebiasis