Potential Qus

Question 1

How does epidoxorubicin cause cardiotoxicity

Answer 1

Produces oxidative stress (ROS) which damages DNA. Topoisomerase II also thought to be involves.
May result in myocyte death (irreversible)
systolic and diastolic heart failure
typically months to years after use.
Induces apoptosis through lipid peroxidation, impairs Ca handling
induced in 10% - irreversible Type 1 or reversible Type 2

Question 2

How do NSAIDS increase CV risk?

Answer 2

Inhibition of COX-2 in blood vessels REDUCES PROSTACYCLIN production. PC usually prevents platelet aggregation + vasoconstriction therefore reduction in this leads to excess clots and high BP

Question 3

QT prolongation

1. consequences
2. causes
3. common drugs

Answer 3

1. Arrhythmia - torsades de pointes
2. block of HERG impairing potassium current
   a) PD - 2 or more drugs
   b) PK - drugs affecting metabolism of QT drugs
   c) electrolytes - hypomagnasaemia and hypokalemia
3. citalopram, clarithromycin, methadone, amitriptyline,, dosulepin, ketoconazole, amiodarone

Question 4

Why are guidelines ABCD for HTN?

Answer 4

Afro-caribbeans and elderly have a low renin profile - ACE and ARBs are less likely to reduce BP as HTN not caused by RAAS

Question 5

What are the differences between supplementary and independent prescribers?

Answer 5

INDEPENDENT responsible for:
assessing your healthand diagnosis
making clinical decisions about how to manage your condition, including prescribing medication
SUPPLEMENTARY:
continuing care after independent prescriber has assessed health
work with IP to fulfil clinical management plan for medical care

Question 6

What are the difference between independent prescriber pharmacists and normal pharmacists?

Answer 6

Must only prescribe within their sphere of competence.
Can run clinics taking pressure of GPs
Can change prescriptions without consulting GP
Diagnose within competency
Enhance patient experience
IP pharmacists can play a role in GP surgeries e.g. med reviews

Question 7

9 GPhC Standards

Answer 7

1. Provide patient-centred care
2. Work in partnership with others
3. Communicate effectively
4. Develop and maintain professional knowledge and skills
5. Use professional judgement
6. Behave in a professional manner
7. Respect and maintain patient confidentiality
8. Speak up when things go wrong or you have concerns
9. Demonstrate leadership

Question 8

Describe Type I and Type II cardiotoxicity

Answer 8

I - IRREVERSIBLE - cell death, cardiomyopathy, HF, MI, thrombosis. Diagnosis - cardiac remodelling
II - Reversible - cell dysfunction. Temporary contractile dysfunction. Angina, HTN. No injury markers and reversible

Question 9

Describe Type I and Type II respiratory failure

Answer 9

1 - low O2 low CO2 - requires high O2 therapy

2 - low O2 high CO2 - requires low O2 therapy (with high flow causing fatal respiratory acidosis)

Question 10

Describe circle of heart failure

Answer 10

1. LVD, decreased CO —> reduced BP and renal perfusion —>Renin, Aldosterone and ADH release increasing sodium and water retention —>

Question 11

RAAS role in HF

Answer 11

reduced ejection fraction

Question 12

pathology of COPD

Answer 12

1. mechanical obstruction
2. loss of pulmonary elastic recoil
3. reduction of alveolar attachment around walls of small airways