pharmacology

Question 1

ace inhbitors side effects

Answer 1

Side-effects:
* cough
occurs in around 15% of patients and may occur up to a year after starting treatment
thought to be due to increased bradykinin levels
* angioedema: may occur up to a year after starting treatment
* hyperkalaemia
* first-dose hypotension: more common in patients taking diuretics

Question 2

indapamide side effects

Answer 2

Thiazide diuretics can cause hypercalcaemia and hypocalciuria

Question 3

A 61-year-old man with peripheral arterial disease is prescribed simvastatin. What is the most appropriate blood test monitoring?

Answer 3

LFTs at baseline, 3 months and 12 months. might also do fasting lipid profile

Question 4

SSRI use during third trimester - risk of

Answer 4

SSRI use during third trimester - risk of persistent pulmonary hypertension of the newborn

Question 5

Cautions and contraindications ACE

Answer 5

Cautions and contraindications
* pregnancy and breastfeeding - avoid
* renovascular disease - may result in renal impairment
* * aortic stenosis - may result in hypotension
* hereditary of idiopathic angioedema
* specialist advice should be sought before starting ACE inhibitors in patients with a potassium >= 5.0 mmol/L

Question 6

ACE interactions

Answer 6

patients receiving high-dose diuretic therapy (more than 80 mg of furosemide a day)
* significantly increases the risk of hypotension

Question 7

Rivaroxaban and apixaban can be reversed by

Answer 7

Rivaroxaban and apixaban can be reversed by andexanet alfa

Question 8

which antibiotics should be avoided in in pregnant or breastfeeding women and in children younger than 12 years of age

Answer 8

Oral tetracyclines should be avoided in pregnant or breastfeeding women and in children younger than 12 years of age

Question 9

which TB drug affects vision?

Answer 9

Ethambutol is associated with optic neuropathy and development of colour blindness. It should be discontinued if these symptoms develop.

Question 10

are statins fine to take in pregnancy?

Answer 10

No
Pregnancy is a contraindication to statin therapy

Question 11

which treatment for UTIs should be avoided in the first trimester?

Answer 11

Trimethoprim is teratogenic in the first trimester and should be avoided during pregnancy

Question 12

the preferred antiplatelet for secondary prevention following stroke

Answer 12

Clopidogrel is the preferred antiplatelet for secondary prevention following stroke

Question 13

A 45-year-old female complains of lower back pain, constipation, headaches, low mood, and difficulty concentrating.

Her presentation is likely due to which of the following medications?

Answer 13

Long-term lithium use can result in hyperparathyroidism and resultant hypercalcaemia

Question 14

Patients with type I diabetes and a BMI > 25 should be considered for…in addition to insulin

Answer 14

Patients with type I diabetes and a BMI > 25 should be considered for metformin in addition to insulin

Question 15

he antibiotic of choice for cellulitis in pregnancy if the patient is penicillin allergic

Answer 15

Erythromycin is the antibiotic of choice for cellulitis in pregnancy if the patient is penicillin allergic

Question 16

features of lithium toxicity

Answer 16

coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma

additional:
blurred vision
episodes of syncope
intermittent palpitations and fleeting chest pain
very lightheaded

Question 17

regular monitoring with methotrexate:

Answer 17

Methotrexate may cause hepatotoxicity - monitor LFTs
as well as FBC and U and Es

Question 18

Aromatase inhibitors (e.g. anastrozole) may cause

Answer 18

Aromatase inhibitors (e.g. anastrozole) may cause osteoporosis

Question 19

Clindamycin treatment is associated with a high risk of

Answer 19

C. difficile so look out for watery diarrhea and cramping abdo pain

Question 20

Statins MOA

Answer 20

Statins inhibit HMG-CoA reductase, the rate-limiting enzyme in hepatic cholesterol synthesis
decreases intrinsic cholesterol synthesis

Question 21

statins interact with which common medication?

Answer 21

Statins + erythromycin/clarithromycin (macrolide) - an important and common interaction

Question 22

For a person < 80, with stage 1 hypertension, only treat medically if

Answer 22

For a person < 80, with stage 1 hypertension, only treat medically if: diabetic, renal disease, QRISK2 >10%, established coronary vascular disease, or end organ damage

Question 23

Bleeding on dabigatran? Can use… to reverse

Answer 23

Bleeding on dabigatran? Can use idarucizumab to reverse

Question 24

For type 2 diabetics requiring treatment, metformin is contraindicated in those with

Answer 24

For type 2 diabetics requiring treatment, metformin is contraindicated in those with eGFR < 30

Question 25

first line rate control in AF if asthmatic

Answer 25

diltiazem

Question 26

A 20-year-old female presents to the emergency department following overdose of a substance. She explains she has tinnitus and appears very anxious and sweaty. You are asked to perform an arterial blood gas (ABG). What are the most likely results on the ABG?

Answer 26

overdose of salicylates: symptoms of tinnitus, anxiety and (sweaty) diaphoresis.
typically presents with a respiratory alkalosis initially due to hyperventilation, followed by a metabolic acidosis due to lactic acid accumulation

Question 27

A 55-year-old woman with a history of rheumatoid arthritis (RA) presents with a urinary tract infection (UTI). Her RA is managed with methotrexate, for which she has a co-prescription of folic acid supplements. The doctor is considering a drug prescription to manage the patient’s UTI. She has no known drug allergies.

What medication should be avoided?

Answer 27

Co-trimoxazole contains trimethoprim and therefore should never be prescribed with methotrexate

Question 28

Which drugs has been associated with an increased risk of atypical stress fractures of the proximal femoral shaft?

Answer 28

Bisphosphonate so alendronate