pharmacology

Question 1

trimethoprim/sulfamethoxazole formulations use what ratio of dose between trimethoprim and sulfamethoxazole

Answer 1

1:5 ratio, so trimethoprim is less than sulfamethoxazole
(just remember trimethoprim has less letters)
usually its 4+20

Question 2

denosumab - counselling points (5)

Answer 2

• 6 monthly dosing
• missing a dose by more than 4 weeks can lead to multiple spontaneous vertebral fractures
• if stopping, needs to be switched to a bisphosphonate
• can cause hypocalcaemia
• must maintain calcium and vit d status

Question 3

oral bisphosphonates - counselling points (3)

Answer 3

• oral formulations can cause GI upset
• absorption reduced by food, antacids, calcium, magnesium and iron
• can cause osteonecrosis of the jaw - see dentist beforehand)

Question 4

zoledronic acid - adverse effects (4)

Answer 4

transient influenza-like symptoms
uveitis (uncommon)
osteonecrosis of jaw
hypocalcaemia

Question 5

valaciclovir

- indications and dosage regimen (3)

Answer 5

genital herpes 
- initial infection - 500mg BD for 5-10 days
- recurrent infection - 500mg BD for 3 days
- prophylaxis - 500mg OD 
recurrent cold sores
- 2g every 12 hours, 2 doses
shingles
1g PO TDS for 7 days

Question 6

apixaban

- indications and dosage (3)

Answer 6

VTE prophlyaxis after hip/knee replacement
- 2.5mg BD, 10-14 days (knee) or 32-38 days (hip)
prophylaxis in AF
- 5mg BD
venous thromboembolism
- 10mg BD for 7 days, then 5mg BD for 3-6 months

Question 7

indomethacin - PR suppository dose

Answer 7

100mg BD

Question 8

pyridostigmine , neostigmine

• mode of action
• indications (2)

Answer 8

mode of action

• cholinergic
• inhibits cholinesterase enzymes -> more acetylcholine floating around to do neurotransmitting

indications

• myasthenia gravis
• reversing a neuromuscular blockade by neuromuscular blockers

Question 9

suxamethonium

• mode of action
• indications (1)

Answer 9

acts like acetylcholine, neuromuscular blockade by binding to acetylcholine receptors

relax muscles during anaesthesia

Question 10

atropine

• mode of action
• indications (2)

Answer 10

anticholinergic

bradycardia
blocks muscarinic side effects of neostigmine and pyridostigmine

Question 11

hyoscine

- which version crosses blood-brain barrier

Answer 11

hyoscine hydrobromide crosses blood brain barrier

Question 12

hyoscine

• which version is preferred in palliative care
• why

Answer 12

hyoscine butylbromide

less likely to cause CNS side effect

Question 13

hyoscine butylbromide

• mechanism of action
• indication in pall care

Answer 13

• anticholinergic

- reduce secretions

Question 14

lithium toxicity - presenting signs and symptoms

• GI (3)
• neuro (4 mild-mod, 3 severe)
• cardiac (2)

Answer 14

GI

• nausea
• vomiting
• diarrhea

neuro (mild to moderate)
- tremors
- hyperreflexia
- dysarthria
- ataxia
neuro (severe)
- confusion
- coma 
- seizures

Cardiac

• QT prolongation
• hypotension

Question 15

lithium toxicity - risk factors

• pmhx (3)
• pharm (1)
• personal (2)

Answer 15

pmhx

• nephrogenic diabetes insipidus
• hypothyroidism
• renal impairment

pharm
- new medications that affect renal fxn

personal

• age > 50
• poor hydration

Question 16

medications that can exacerbate or precipitate gout attacks (3)

Answer 16

• thiazide diuretics
• loop diuretics
• cyclosporin

Question 17

side effects of stimulants like dexamphetamine
GI (3) neuro (2) psych (2)
* rare x2

Answer 17

GI
* appetite suppression
* transient abdo pain
* nausea on commencement
neuro
* headache on commencement
* insomnia
psych
* emotional lability
* irritability

rare

• priapism
• cardiac events

Question 18

topical corticosteroids - low potency options

Answer 18

hydrocortisone 0.5%,
hydocortisone acetate 1%
desonide 0.05%

Question 19

topical corticosteroids - moderate potency options

Answer 19

betamethasone dipropionate 0.05% cream
betamethasone valerate 0.05%
triamcinolone acetonide 0.1
methylprednisolone aceponate 0.1%
clobetasone 0.05%

Question 20

topical corticosteroids - high potency options

Answer 20

betamethasone dipropionate 0.05% ointment
betamethasone valerate 0.1%
mometasone furoate 0.1%

Question 21

topical corticosteroids - superpotent

Answer 21

betamethasone dipropionate 0.05% in optimised vehicle

clobetasol propionate 0.05%

Question 22

liver enzyme inducing anti-epileptic medications

Answer 22

Phenytoin
oxcarbazepine
carbamazepine
topiramate

Question 23

common anti-epileptics that are not liver enzyme inducers

Answer 23

valproate
lamotrigine
gabapentin
pregabalin
levetiracetam

Question 24

topical olopatadine

• what is it
• indication
• dosage

Answer 24

antihistamine eye drop
allergic conjunctivitis
1 drop BD to affect eyes

Question 25

Hypertension Rx - ACE Inhibitor Rx -drug name, doses

Answer 25

ACE-I "prils"
once daily
- perindopril arginine 2.5-10mg od
- perindopril erbumine 2-8mg OD
- ramipril 2.5-10mg od
- lisinopril 5-40mg daily 
- fosinopril 5-40mg daily

once daily or twice daily divided
- enalapril 5-40mg daily (2.5-20mg bd)

twice daily
- captopril 12.5-50mg BD

Question 26

Hypertension Rx - ARB Rx -drug name, doses

Answer 26

ARB “sartans”

• candesartan 8-32mg od
• olmesartan 20-40mg od
• telmisartan 40-80mg od
• irbesartan 75-300mg od

Question 27

Hypertension Rx - CCB - drug name, doses

Answer 27

dihydropyridine CCB - “pines”

• amlodipine 2.5-10mg od
• felodipine CR 5-20mg od
• Lercanidipine 10-20mg od
• Nifedipine 20-120mg od

CCB “others”

• diltiazem CR 180-360mg od
• verapamil 80-160mg bd/tds
• verapamil CR 180-480mg od

Question 28

Hypertension Rx - Thiazide diuretics - drug name, doses

Answer 28

Thiazides

• hydrochlorothiazide 12.5-25mg od
• indapamide CR 1.5mg od

Question 29

medications associated with hypertriglyceridaemia

Answer 29

• spironolactone
• thiazides
• beta blockers
• glucocorticoids

Question 30

agranulocytosis in carbimazole

• when is it most likely to happen
• how to monitor for it

Answer 30

most likely in first 3 months
monitor for symptoms ie
- fever / sore throat / mouth ulcer / rash / fatigue / abdo pain / jaundice