pre-reg shortcuts

Question 1

what is the interaction between allopurinol + azathioprine
- Decreased uric acid levels
- Enhanced excretion of allopurinol
- Increased risk of hepatotoxicity.
- Increased risk of myelosuppression.
- Reduced efficacy of azathioprine.

Answer 1

increased risk of myelosuppression

Question 2

antidote for rivaroxaban
- andexanet alfa
- idarucizumab
- protamine sulfate
- tranexamic acid
- vit k

Answer 2

• andexanet alfa

Question 3

A 34-year old male with epilepsy has been prescribed phenytoin 100mg capsules at a dose of one capsule twice a day for the treatment of tonic-clonic seizures for the past 2 years. Due to an increase in frequency of seizures the consultant plans to add lamotrigine to the patient’s treatment regimen.

What is the most appropriate action regarding the interaction between phenytoin and lamotrigine?

• increase the dose of lamotrigine to achieve therapeutic levels.
• monitor for decreased efficacy of phenytoin due to potential decreased serum levels.
• monitor for signs of phenytoin toxicity due to potential increased serum levels.
• no action needed as there is no significant interaction between phenytoin and lamotrigine
• reduce the dose of phenytoin before starting lamotrigine to prevent toxicity

Answer 3

• increase the dose of lamotrigine to achieve therapeutic levels.
• phenytoin lowers lamotrigine levels

Question 4

pt has chronic alcoholism and Wernicke encephalopathy.

What is the initial treatment of choice for this condition?

• High-dose vitamin B12 injection
• Immediate psychiatric evaluation
• Intravenous glucose solution without thiamine
• Intravenous thiamine replacement
• Oral thiamine supplementation

Answer 4

• Intravenous thiamine replacement

Question 5

A 21-year-old female regularly has lamotrigine 100mg tablets prescribed for the treatment for focal epilepsy. She is now 4 weeks pregnant.

What is the most appropriate action for dose adjustments of lamotrigine during her pregnancy?
- Discontinue lamotrigine as it is contraindicated during pregnancy.
- Maintain the current dose of lamotrigine throughout the pregnancy.
- Monitor and increase the dose of lamotrigine throughout the pregnancy.
- Reduce the dose of lamotrigine due to increased sensitivity during pregnancy.
- Switch to an alternative antiepileptic drug during the pregnancy.

Answer 5

Monitor and increase the dose of lamotrigine throughout the pregnancy

Question 6

What is the youngest age at which miconazole oral gel can be recommended?
- newborn
- 1 month
- 4 month
- 6 month
- 12 months

Answer 6

4 months

Question 7

A 58-year-old patient presents to your clinic with a recent diagnosis of hypothyroidism and they are waiting for a prescription to initiate treatment.

They have a family history of stroke and their recent blood tests show a non-HDL cholesterol level of 5.6 mmol/L. You calculate the patient’s cardiovascular risk via QRISK3 and it has been calculated at 11.5%.

What is the most appropriate next step in managing this patient?

• Refer the patient to a dietitian for dietary advice.
• Start the patient on a high-intensity statin therapy.
• Advise the patient to increase physical activity.
• Prescribe a low-dose aspirin for stroke prevention.
• Initiate levothyroxine therapy for hypothyroidism.

Answer 7

• Start the patient on a high-intensity statin therapy.

to lower non-HDL + due to high risk of CVD in family

Question 8

A 62-year-old female patient has been experiencing symptoms of excessive sweating, insomnia, tachycardia, nausea, vomiting, tremor, muscle rigidity, and renal failure.

She has multiple co-morbidities and they take the following medication:

Tramadol 50mg capsules; one to two capsules every 4 to 6 hours as needed for pain.
Venlafaxine 75mg XL tablets; one tablet to be taken daily
Atorvastatin 80mg tablets; one tablet to be taken each evening
Ramipril 5mg capsules; one capsule to be taken each day
Furosemide 20mg tablets; one tablet to be taken each morning
Aspirin 75mg dispersible tablets; one to be taken each day

Which of the following is most likely contributing to the patient’s symptoms?

• Amlodipine and Tramadol interaction
• Naproxen and Amlodipine interaction
• Paracetamol and Naproxen interaction
• Tramadol and Venlafaxine interaction
• Venlafaxine and Naproxen interaction

Answer 8

• Tramadol and Venlafaxine interaction

venlafaxine+tramadol = GI bleed risk

Question 9

A 23-year old male with asthma is currently being treated with a short-acting beta-agonist (SABA) and inhaled corticosteroid (ICS). Despite this treatment, they are experiencing poor asthma control.

What is the next step in pharmacological management for this patient?

• Add a leukotriene receptor antagonist
• Add a long-acting beta-agonist (LABA)
• Add a long-acting muscarinic antagonist (LAMA)
• Add oral corticosteroids
• Increase the dose of ICS

Answer 9

• Add a leukotriene receptor antagonist

Question 10

A 78-year-old sedentary woman with permanent atrial fibrillation and heart failure is seen in the cardiology clinic. Her LVEF < 40% and she has pulmonary congestion secondary to her chronic heart failure. She also has a history of asthma and chronic obstructive pulmonary disease (COPD). Her pulse is irregular and 110 bpm. Her blood pressure is 150/90 mmHg. Her ECG shows atrial fibrillation with a ventricular rate of 110 bpm. She has no known drug allergies.

What is the most appropriate drug for rate control in her atrial fibrillation?

• Atenolol
• Bisoprolol
• Diltiazem
• Digoxin
• Verapamil

Answer 10

Digoxin
- not dilitiazem as CCBs are CI in LVEF

Question 11

what is a reversible cause of AF

Answer 11

• hyperthyroidism
• infection
• alcohol excess

Question 12

plasma digoxin level

Answer 12

0.8-2

Question 13

What is the most appropriate dose of rivaroxaban for the prevention of atherothrombotic events?

Select one of the following:
2.5 mg twice daily
10 mg once daily
15 mg twice daily
20 mg once daily

Answer 13

2.5 mg twice daily

Question 14

is tx necessary in molluscum contagiosum

Answer 14

no usually resolves on its own within 6-12 months but can use self-care measures

Question 15

common s/e of CCB

Answer 15

postural hypotension

Question 16

Which one of the following is the most appropriate advice for the use of atorvastatin?

• avoid grapefruit juice as it can increase the exposure to atorvastatin and increase the risk of adverse effects.
• take atorvastatin in the morning as it can cause insomnia if taken at night.
• monitor her liver function tests as atorvastatin can increase the levels of hepatic enzymes
• stop taking sertraline as it can decrease the efficacy of atorvastatin and increase the risk of cardiovascular events.
• take atorvastatin with food as it can cause gastrointestinal irritation and ulceration if taken on an empty stomach.

Answer 16

• monitor her liver function tests as atorvastatin can increase the levels of hepatic enzymes
• monitored @ 3month * 12 MT
• grapefruit can affect statins but not atorvastatin

Question 17

which AchI is given for lewy bodies
- donepezil
- galatamine
- memantine
- quietapine
- rivastigmine

Answer 17

rivastigmine

Question 18

Which of the following is the most important drug-drug interaction that you should warn the patient about when dispensing the new medicine?

• Tramadol and amlodipine may increase the risk of hypotension and bradycardia
• Tramadol and salbutamol may increase the risk of bronchospasm and tachycardia
• Tramadol and fluoxetine may increase the risk of serotonin syndrome and seizures
• Tramadol and paracetamol may increase the risk of hepatotoxicity and nephrotoxicity
• Tramadol and ibuprofen may increase the risk of gastrointestinal bleeding and ulceration

Answer 18

• Tramadol and fluoxetine may increase the risk of serotonin syndrome and seizures

Question 19

A 27-year-old woman wants to switch from a Yasmin film-coated tablets 0.03mg/3mg (ethinylestradiol, drospirenone) to Cerelle 75mcg (desogestrel). She has no medical conditions or allergies. She is currently on day 15 of her 21-day pack of Yasmin and reports she has not missed any pills.

Which of the following is the best advice for her?

• Finish the current Yasmin pack and start the desogestrel on the first day of the hormone-free interval (HFI). Use a barrier method for the next 7 days.
• Finish the current Yasmin pack and start the desogestrel on the first day of the hormone-free interval (HFI). No additional contraception needed
• Stop the current Yasmin pack and start desogestrel immediately. Use a barrier method for the next 7 days.
• Stop the current Yasmin pack and start desogestrel immediately. No additional contraception is needed.
• Start the desogestrel on the same day as the next Yasmin pill. Use a barrier method for the next 7 days.

Answer 19

Finish the current Yasmin pack and start the desogestrel on the first day of the hormone-free interval (HFI). No additional contraception needed

Question 20

A 50-year-old woman with ovarian cancer develops cardiomyopathy after receiving four cycles of chemotherapy. She has a history of coronary artery disease and previous myocardial infarction. Her left ventricular ejection fraction drops from 55% to 40% on echocardiography. She also has dyspnoea, fatigue, and oedema.

Which of the following cytotoxics is the cause of the patient’s symptoms?

Select one of the following:
Cisplatin
Doxorubicin
Methotrexate
Paclitaxel
Vincristine

Answer 20

Doxorubicin

Question 21

which is antidote for doxorubicin
- atropine
- amifostine
- dexrazoxane
- leucovorin
- mesna

Answer 21

• dexrazoxane

Question 22

A 55-year-old woman with COPD has been using a DuoResp Spiromax 160 micrograms / 4.5 micrograms inhalation powder (budesonide/formoterol fumarate dihydrate) for the past year, but she still has frequent exacerbations requiring oral corticosteroids. She also uses a short-acting beta 2 agonist (SABA) as needed for symptom relief, but she finds that she needs it more than four times a week. Her FEV1 is 50% of predicted and her CAT score is 20. She has no other medical conditions or allergies.

What is the most suitable treatment to prevent further exacerbations for this patient?

Select one of the following:
Add a leukotriene receptor antagonist (LTRA)
Add a long-acting muscarinic antagonist (LAMA)
Add a phosphodiesterase-4 inhibitor (PDE4 inhibitor)
Add Theophylline
Increase the dose of ICS

Answer 22

Add a long-acting muscarinic antagonist (LAMA)

Question 23

A 52-year-old woman with an intact uterus is experiencing symptoms of menopause, which include hot flushes, night sweats, mood changes such as anxiety and depression, and loss of memory and concentration.

Which of the following Hormone Replacement Therapy (HRT) preparations is most appropriate?

Select one of the following:
- BIJUVE 1mg/100mg Capsules (progesterone, estradiol hemihydrate), take one tablet daily continuously
- Estradot 25 micrograms/24 hours (estradiol hemihydrate) transdermal patches, apply one patch twice weekly
- Elleste-Solo 1mg (estradiol) with utrogestan (progestogen) 200 mg once daily on days 15–26 of each 28-day cycle
- Vagifem (estradiol) 10microgram pessaries, insert one pessary twice a week
- Sandrena 500microgram (estradiol) gel sachets, apply 1 mg once daily, to be applied over area 1–2 times size of hand

Answer 23

• Elleste-Solo 1mg (estradiol) with utrogestan (progestogen) 200 mg once daily on days 15–26 of each 28-day cycle
• intact uterus

Question 24

A 67-year-old male patient on palliative care is experiencing opioid-induced constipation. His current medication regimen includes morphine for pain, midazolam for anxiety, and levomepromazine for delirium or agitation.

Which of the following laxatives should be avoided for this patient?

Select one of the following:
Isphagula husk
Bisacodyl
Senna
Docusate sodium
Lactulose

Answer 24

Isphagula husk

Question 25

A 55-year-old female patient approaches the pharmacy counter requesting to purchase Gina OTC for symptoms of vaginal dryness. Upon reviewing the Gina checklist, you note that she is currently on medication for hypertension and had a hysterectomy 5 years ago. She mentions experiencing occasional spotting, which started a few months after beginning Gina treatment. What is the most appropriate action to take? Select one of the following: Advise the patient to continue using Gina and monitor the spotting. Recommend an alternative over-the-counter product for vaginal dryness. Refer the patient to her GP for further investigation of the spotting. Suggest increasing the dose of Gina to alleviate her symptoms. Counsel the patient that spotting is a common side effect and not to worry.

Answer 25

Refer the patient to her GP for further investigation of the spotting.

Question 26

A 68-year-old male patient with a history of depression and benign prostatic hyperplasia (BPH) is seeking treatment for his BPH symptoms. He is currently taking sertraline 50mg tablets for depression. Which of the following treatment options for BPH should be considered most appropriate in this patient? Select one of the following: Advise lifestyle modifications and watchful waiting. Initiate treatment with an anticholinergic. Prescribe a 5-alpha-reductase inhibitor. Recommend surgical intervention for BPH. Start treatment with an alpha-blocker.

Answer 26

Start treatment with an alpha-blocker.

Question 27

Mr. Thompson is a 68-year-old retired construction worker with a long-standing history of COPD. He has been a smoker for over 40 years, averaging 20 cigarettes a day. Despite being on triple inhaled therapy (ICS, LABA, and LAMA), Mr. Thompson has experienced 3 exacerbations in the past year, two of which required hospitalisation. His post-bronchodilator FEV1 is 45% of the predicted normal. He also has chronic bronchitis with a productive cough most days. Mr. Thompson's recent assessments show a CAT score of 20, indicating a significant impact on his health status, and an mMRC dyspnea scale of 3, reflecting a severe limitation in his activities due to breathlessness. When can roflumilast be prescribed for patients with COPD according to the GOLD guidelines? Select one of the following: As first-line therapy in all patients diagnosed with COPD. As an add-on to bronchodilator therapy in patients with a post-bronchodilator FEV1 <50% predicted normal and chronic bronchitis. In patients with COPD who have had 2 or more exacerbations in the previous 12 months despite triple inhaled therapy. As monotherapy in patients with severe COPD and a history of hospitalizations for exacerbations. For all patients with COPD who are current smokers.

Answer 27

As an add-on to bronchodilator therapy in patients with a post-bronchodilator FEV1 <50% predicted normal and chronic bronchitis.

Question 28

A 65-year-old female patient with a history of type 2 diabetes mellitus has been on a combination therapy of insulin and pioglitazone. She presents with new-onset symptoms including shortness of breath, rapid weight gain, and swelling in her legs. Which of the following adverse drug reactions (ADRs) is most likely associated with her current treatment? Select one of the following: Hypoglycaemia Pancreatitis Hemorrhagic cystitis Cardiac failure Hepatic dysfunction

Answer 28

Cardiac failure

Question 30

which antipsychotic has MOST risk of sexual dysyfunction

Answer 30

risperidone

Question 31

A 25-year-old woman presents to the clinic with a confirmed diagnosis of ectopic pregnancy. She is hemodynamically stable and wishes to avoid surgical intervention. Which of the following medications is most appropriate for the medical management of her ectopic pregnancy? Select one of the following: Dinoprostone Methotrexate Atosiban Ergometrine Misoprostol

Answer 31

Methotrexate

Question 32

A 50-year-old woman who has accidentally ingested a large amount of aspirin and is experiencing tinnitus and hyperventilation. Select one of the following: Acetylcysteine Deferoxamine mesilate Dicobalt edetate Flumazenil Glucagon Naloxone hydrochloride Protamine sulfate Sodium bicarbonate

Answer 32

Sodium bicarbonate to alkalinize urine

Question 33

A 68-year-old man who has taken too much heparin and has a high aPTT with signs of bruising. Select one of the following: Acetylcysteine Deferoxamine mesilate Dicobalt edetate Flumazenil Glucagon Naloxone hydrochloride Protamine sulfate Sodium bicarbonate

Answer 33

Protamine sulfate

Question 34

A 38-year-old woman who has overdosed on alprazolam and is drowsy and unresponsive. Select one of the following: Acetylcysteine Deferoxamine mesilate Dicobalt edetate Flumazenil Glucagon Naloxone hydrochloride Protamine sulfate Sodium bicarbonate

Answer 34

Flumazenil

Question 35

A 25-year-old woman who is pregnant has been advised to have a single dose of an immunisation to protect her and her baby. Select one of the following: Influenza vaccine Pneumococcal vaccine diphtheria with tetanus, pertussis and poliomyelitis vaccine Tetanus vaccine Hepatitis A vaccine Hepatitis B vaccine Rabies vaccine Yellow fever vaccine

Answer 35

diphtheria with tetanus, pertussis and poliomyelitis vaccine from 16th week (18-20wk)

Question 36

A 46-year-old female who is prescribed gentamicin for the treatment of sepsis and is also taking furosemide 20mg for heart failure Select one of the following: Increased risk of QT interval Increased risk of tendon rupture Increased risk of seizures Increased risk of photosensitivity Increased risk of hepatotoxicity Increased risk of resistance Increased risk of hypoglycemia Increased risk of nephrotoxicity

Answer 36

Increased risk of nephrotoxicity

Question 37

A 30-year-old male presents with an insect bite which is warm to touch and swollen. The patient has no known allergies. Select one of the following: Nitrofurantoin 100 mg twice a day for 3 days Chloramphenicol eye drops, 0.5% w/v, 1 drop every 2 hours for the first 48 hours Aciclovir 400 mg three times a day for 5 days Phenoxymethylpenicillin 500 mg four times a day for 5 days Flucloxacillin 500 mg four times a day for 5 days Hydrocortisone cream 1%, apply thinly twice a day for up to 7 days Cetirizine 10 mg once daily Amoxicillin 500 mg three times a day for 7 days

Answer 37

Flucloxacillin 500 mg four times a day for 5 days

Question 38

NSAID + CKD

Answer 38

NSAID wrosens kidney function esp in pt with CKD

Question 39

common s.e of phenytoin Hair loss Prolactinaemia Tremor Nystagmus Oligomenorrhea Rash Weight loss Hyponatraemia

Answer 39

Hyponatraemia