Pharm

Question 1

Which off licence drug can be used to treat gynaecomastia and what are its side effects?

Answer 1

Tamoxifen- selective oestrogen receptor modulator

Hot flushes
N&V
Fluid retention
Thromboembolism
Vaginal bleeding and discharge
Fatigue
Skin Rash

Question 2

Which antibiotic should not be co-prescribed with tacrolimus and what effect does it have?

Answer 2

Macrolides increase the effect of tacrolimus as they inhibit P450 which is the enzyme which metabolises tacrolimus in the body.

Question 3

Common side effect of first line treatment drugs for TB?

Answer 3

Ethambutol- optic neuritis, red green colour visual disturbance, peripheral neuropathy
Isoniazid- peripheral neuropathy, agranulocytosis, liver enzyme inhibitor, hepatitis
Rifampicin- orange secretions, hepatitis, potent enzyme inducer
Pyrazinamide- hyperuricaemia, hepatitis
Streptomycin- fever and rashes, vestibulocochlear nerve affected, nephrotoxicity.

Question 4

How do drugs affect pupil size?

Answer 4

Sympathomimetics cause pupil dilation- eg adrenaline. As well as antimuscarinics such as atropine, TCAs.
Muscarinic agonists, such as pilocarpine and also opiates cause pupil constriction.

Question 5

Common side effects of statins

Answer 5

Myositis- can progress to rhabdomyolysis
Altered LFTs
GI disturbances- pancreatitis
ILD- cough, dyspnoea and weight loss

Question 6

Common side effects of amiodarone

Answer 6

Pulmonary fibrosis
Corneal deposits
Skin pigmentation
Thyroid disturbance
Hepatotoxicity

Question 7

What extreme adverse effect can be due to canagliflozin use?

Answer 7

Lower limb amputations

Question 8

Which antiemetics should be given for functional bowel obstruction, mechanical bowel obstruction and metabolic causes of vomiting?

Answer 8

Metoclopramide
Cyclizine
Haloperidol

Question 9

Drug of choice for amoebic liver abscess?

Answer 9

Metronidazole

Question 10

Which antihypertensive can cause hyperuricaemia and hence cause a flare up of gout?

Answer 10

Loop and thiazide diuretics

Question 11

What is the conversion for rescue doses/breakthrough pain when taking regular morphine?

Answer 11

1/10-1/6th

Question 12

How do you calculate how much modified release morphine to give over 24hr period?

Answer 12

Establish pain control with regular morphine every 4 hours, calculate total dose and divide by 2 for once every 12 hourly preparations of MR morphine.

Question 13

Features of ecstasy poisoning

Answer 13

Hyperthermia
Agitation, anxiety, confusion, ataxia
Tachycardia, HTN
Hyponatraemia
Rhabdomyolysis

Supportive care
Dantrolene for hyperthermia if it does not resolve.

Question 14

Side effects of common antibiotics

Answer 14

Co-amox- cholestasis
Amoxicillin- rash with Infectious mononucleosis
Fluclox- Cholestasis
Erythromycin- GI upset, long QT
Cipro- lowers seizure threshold, tendonitis
Metro- reaction with alcohol
Doxy- photosensitivity
Trimethoprim- rashes, inc photosensitivity. Pruritus. Suppression of haematopoiesis.

Question 15

Features of salicylate overdose

Answer 15

Hyperventilation
Tinnitus
Sweating
Lethargy
N&V
Seizures
Coma
Hyper and hypoglycaemia.

Question 16

Side effects of common diabetic drugs

Answer 16

Metformin- GI upset, lactic acidosis
Sulfonylureas- hypoglycaemia, increased appetite and weight gain, SIADH, cholestasis
Glitazones- weight gain, fluid retention, liver dysfunction, fractures
Gliptins- pancreatitis