Pharm / Therapeutics

Question 1

Drugs that precipitate gout flare?

Answer 1

Diuretics
Salicylates e.g. aspirin
Pyrazinamide
Ethambutol
Nicotinic acid
Cytotoxic agents

Question 2

How to calculate plasma osmolality and anion gap?

Answer 2

PO: 2Na + Ur + Glucose
>290mOsm/kg in DKA, >320 in HHS (if no ketones)

AG: (Na + K) - (HCO3 + Cl)
Normal range 12-17 (>13 in DKA)

NOTE(osmolality is preferred term in medical context):
Osmolarity - conc particles per litre plasma
Osmolality - conc particles per kg plasma

Question 3

Combined oral contraceptive pill risks and containdications

Answer 3

Reduces risk of ovarian/endometrial cancer
Increases risk of breast/cervical cancer

C/I: imigraine with aura, breastfeeding (<6wks post-partum), smoking >35yrs (>15 cig/day), prev VTE/stroke/MI, BMI >35

Question 4

Diabetes oral medication options

Answer 4

Metformin (SEs: diarrhoea, LA - avoid if eGFR <30)
* Assoc w/ reduced B12 lvl

Sulphonylurea e.g. Gliclazide (SEs: hypoglycaemia, weight gain)

Pioglitazone (SEs: hypoglycaemia, weight gain, oedema, fractures in elderly)
* C/I in HF, bladder cancer

SGLT-2 inhibitor e.g. Empagliflozin (SEs: Hypoglycaemia, weight loss, UTI)
* Not recommended in impaired renal funct
* Canagliflozin associated with increased lower limb amputations

DPP-4 inhibitor e.g. Linagliptin (APPROVED FOR USE IN CKD, weight neutral)

GLP-1 analogues e.g. Exenatide/Liraglutide (SE: weight loss - useful if BMI >35; vomiting)
* Not recommended in impaired renal funct

Question 5

Different types of laxative

Answer 5

Bulk forming - fybrogel
Stimulant - senna, glycerin suppository
Softener - docusate
osmotic - movicol, lactulose, phosphate enema

Question 6

What HTN-med limits dose of simvastatin to 20mg OD?

Answer 6

Amlodipine - weak CYP450 inhibitor

Question 7

What does azathioprine and ACEi cause?

Answer 7

Anaemia and leukopenia