Single Best Answer Set 4 Flashcards
An 11-year-old boy is admitted to hospital with an infective exacerbating of asthma. He has a past medical history of asthma, which has been well controlled until the development of infection. He is penicillin allergic. His current medication is as follow:
Salbutamol 100mcg MDI 2 puffs PRN
Seretide accuhaler 100 1 puff BD
Which of the following would be the most appropriate treatment option?
A. Amoxicillin B. Cefalexin C. Clindamycin D. Erythromycin E. Tetracycline
Erythromycin
Amoxicillin would be the MOST appropriate treatment however the patient is penicillin allergic and therefore erythromycin is a suitable alternative. Macrolides have a similar spectrum of activity and are commonly used when patients are penicillin allergic.
A patient comes into your pharmacy to speak to you. They have recently started taking theophylline a few weeks and think they are experiencing a side effect due to the drug.
Which of the following could be caused by theophylline?
A. Constipation B. Tremor C. Increased appetite D. Diarrhoea E. Dizziness
D. Diarrhoea
Theophylline side effects include: Arrhythmias; CNS stimulation; convulsions; diarrhoea; gastric irritation; headache; insomnia; nausea; palpitation; tachycardia; vomiting.
Mrs B comes into the pharmacy complaining of a sore mouth that she has developed over the past 24 hours. You notice on examination that she has red and raw cheeks and tongue. Upon questioning you find that she has newly started Clenil Modulite inhaler (beclomethasone dipropionate) 2 weeks ago. You send Mrs B to the GP. The GP contacts you and asks what would be the most appropriate initial treatment for Mrs B?
Which of the following would be the most appropriate initial treatment?
A. Co-amoxiclav 500/125ng TDS B. Strepsil lozenges C. Itraconazole 100mg BD D. Fluconazole 50mg OD E. Nystatin (100,000 units/mL) 1mL QDS
Nystatin
Mrs B has oral thrush due to her newly prescribed Clenil Modulite inhaler (beclomethasone). Initial treatment should be with nystatin or miconazole. Fluconazole is effective for unresponsive infections or if a topical anti-fungal cannot be used or if the patient has dry mouth.
A patient on your ward asks you to explain how to use his inhaler. You check his medication locker and find Symbicort® (Budesonide/Formoterol).
Which of the following instructions would you give regarding Symbicort® (Budesonide/Formoterol)?
A. Inhale slowly and gently B. Inhale slowly and deeply C. Inhale quickly and deeply D. Inhale quickly and shallowly E. Inhale slowly and shallowly
Symbicort® (budesonide/formoterol) is a dry powder inhaler and should be inhaled quickly and deeply to ensure adequate delivery to the lungs.
A patient comes with his 4 yo daughter with a prescription for Seretide 50 Evohaler (salmeterol and fluticasone). The dose states TWO puffs TWICE a day with a spacer. Which of the following actions would be the most appropriate;
A. Return prescription to prescriber for alternative brand
B. Contact prescriber to discuss supply of unlicensed medicines
C. Contact prescriber to reduce dose to ONE puff TWICE a day
D. Contact prescriber to reduce dose to TWO puffs ONCE a day
E. Return prescription to prescriber alternative inhalation device
B
Salmeterol unlicensed in <5 yo
Mr C is rushed to his local hospital emergency department as he is having a severe asthma attack. On arrival, the doctor tries to take a medication history but it is unable to gather much information as Mr C is unable to complete his sentences. You find from his previous admission notes for a recent operation that he regularly takes theophylline and smokes 20 a day.
Identify the most appropriate initial treatment:
A. Serevent Accuhaler (salmeterol) 50mcg per blister, 1 puff PRN
B. Ventolin Evohaler (salbutamol) 100mcg, 2-10 puffs via spacer immediately
C. Prednisolone 5mg tablets, 4 tablets immediately
D. Salamol Easi-breathe (salbutamol) 100mcg, 2-10 puffs immediately
E. Atrovent (ipratropium bromide) 250mcg/mL nebuliser solution, 500mcg nebuliser every 6 hours
Ventolin Evohaler (salbutamol) 100mcg, 2-10 puffs via spacer immediately Pmdi
Serevent Accuhaler = DPI
Salamol Easi-breathe = breath actuated MDI
Atrovent = pMDI
First-line treatment for acute asthma is a high-dose inhaled short-acting beta-2 agonist given as soon as possible. A pressurised metered dose inhaler with spacer device is preferred in patients with non-life-threatening acute asthma. Whereas, in patients with life-threatening acute asthma, a beta-2 agonist administered by an oxygen-driven nebuliser is recommended. If the response to an initial dose of short-acting beta-2 agonist is poor, consider continuous nebulisation with an appropriate nebuliser.
When using Peak Expiratory Flow (PEF) as one of the measures to categorise the severity of an acute asthma.
What PEF (best/predicted) would you expect to find for an adult who is defined as having a moderate asthma attack?
A. <33% B. 50-75% C. 33-50% D. >75% E. 25-33%
PEF;
Moderate; 50 - 75%
Severe; 33-55%
Life threatening; <33%
Moderate; normal speech, no features of severe/Life threatening asthma
Severe; resp rate at least 25bpm, >1 breath to complete sentences, pulse rate at least 110 bpm
Life threatening; o2 sat <92%, exhaustion, hypotension, silent chest, cardiac arrhythmia, cyanosis, poor resp effort
Which of the following statements is false regarding asthma?
A. Symptoms can be worse at night
B. Sometimes cause limitations on activities including exercise
C. Inflammation is mostly caused by eosinophils
D. Uncommon in over 40 year olds
D. Uncommon in over 40 year olds
Which of the following oral antihistamines is the most sedating?
A. Chlorphenamine
B. Alimemazine
C. Cetirizine
D. Acrivastine
Alimemazine
Sedating antihistamines: lipid soluble Cross BBB Alimemazine Chlorphenamine Clemastine Hydroxyzine Ketotifen Promethazine ⚠️used with caution in patients with prostatic hypertrophy, urinary retention and angle-closure glaucoma
Non sedating; Acrivastine Cetirizine Desloratadine Fexofenadine Loratadine Mizolastine Rupatadine
Preg/BF: loratadine and Cetirizine preferred
⚠️ Loratadine caution with liver impairment
⚠️ cetirizine caution with kidney impairment
Mrs B 52 years old, has just been prescribed her 4th course of Prednisolone, within a year, due to another asthma exacerbation. As this is her 4th course of steroid tablets additional monitoring should take place.
Which of the following is not something which would require monitoring due to the frequent courses of oral steroids?
A. Vision
B. Cholesterol
C. eGFR
D. HbA1c
Egfr
The severity of an acute exacerbation of asthma can be classed into ‘moderate acute asthma’, ‘severe acute asthma’ and ‘life-threatening acute asthma’. A child experiences confusion during an acute exacerbation.
What class does this fall into?
A. Moderate acute asthma
B. Severe acute asthma
C. Life-threatening acute asthma
Life-threatening acute asthma
Mr C Utee has visited the practice - ongoing widespread itch affecting sleep - nurse prescribes sedating antihistamine short term Mr C Utee’s list of medication is below: Aspirin 75mg 1 OD Atorvastatin 80mg 1 OD Ramipril 10mg 1 OD Bisoprolol 10mg 1 OD Amiodarone 200mg 1 OD
Which would be the least suitable sedating antihistamine to prescribe for Mr C Utee?
A. Clemastine
B. Chlorphenamine
C. Hydroxyzine
D. Promethazine
Hydroxyzine
BNF and MHRA alert
hydroxyzine is associated with a small risk of QT-interval prolongation and torsade de pointes; these events are most likely to occur in patients who have risk factors for QT prolongation, e.g. concomitant use of drugs that prolong the QT-interval, cardiovascular disease, family history of sudden cardiac death, significant electrolyte imbalance (low plasma-potassium or plasma-magnesium concentrations), or significant bradycardia.
Post-op, Mr C is returned to the ward with an epidural catheter in situ for his pain relief. In the evening, as Mr C is eating and drinking, he is prescribed all of his usual meds and post-op meds. Which ONE of the following drugs should be omitted in order to have the greatest reduction in risk of complications associated with the insertion of an epidural catheter?
A. Candesartan
B. Levothyroxine
C. Dabigatran
D. Gliclazide
E. Dalteparin
Dabigatran
NOACs carry a risk of causing epidural haematoma (collection of blood in between skull and dura matter). No evidence of a risk with LMWH.
Mr ARB is a 47-year-old, Afro-Caribbean man who has just had his blood pressure measured. The machine read 177/97 mmHg. He has no other medical conditions and takes no medication.
Which of the following lifestyle advice is the most appropriate to be given to Mr ARB to help reduce his blood pressure?
A . Stop smoking, as there is a direct link between smoking and hypertension
B. Restrict salt intake to no more than 9g per day
C. Partake in aerobic exercise every day for 50 mins
D. Alcohol consumption should be more than 4 units each day
E. Encourage a healthy diet consisting of an intake of at least five fruit or vegetables per day
Encourage a healthy diet consisting of an intake of at least five fruit or vegetables per day
The answer comes through the process of elimination. There is no direct link between smoking and hypertension. Salt intake should be restricted to 6g a day. It is recommended to partake in 30mins of moderate aerobic exercise 5 times a week. The recommended alcohol intake is 14 units a week for both men and women.
Mr ARB is a 47-year-old, Afro-Caribbean man who has had ambulatory blood pressure monitoring with an average of 155/95 mmHg.
Which of the following medicine should be initiated for the treatment of his hypertension.
A. Losartan 50mg daily
B. Nifedipine 60mg daily
C. Amlodipine 10mg daily
D. Perindopril 8mg daily
Losartan 50mg daily - ARB
Nifedipine 60mg daily - CCB
Amlodipine 10mg daily - CCB
Perindopril 8mg daily - ACEi
The CCB is the appropriate treatment for Mr ARB because he is of Afro-Caribbean origin and they are first line for this ethnic group. Nifedipine can be used but not at a dose of 60mg daily. There are multiple brands of Nifedipine indicated for hypertension. Amlodipine 10mg daily is indicated for hypertension at this dose
Mrs Jones has been prescribed a parenteral anti-coagulant for prevention of venous thromboembolism. The doctor has decided to prescribe the LMWH, tinzaparin.
What is the rationale for prescribing a low molecular weight heparin (LMWH) in preference to unfractionated heparin?
A. LMWH have a lower risk of heparin-induced thrombocytopenia
B. LMWH allow people to have regular INR monitoring to ensure safety
C. LMWH are more effective at preventing thromboembolism
D. LMWH have a higher risk of heparin-induced thrombocytopenia
A. LMWH have a lower risk of heparin-induced thrombocytopenia
To induce thrombocytopenia, a specific saccharide sequence needs to be present in the heparin formulation. This sequence is more commonly found in unfractionated heparin compared low molecular weight heparin.
Mrs D comes into the pharmacy asking about her sore leg. You ask her if you can take a look in the consultation room. You see that it is inflamed and red. Mrs D states that it is stiff and hot to touch she also states she has recently been to Malaysia for a holiday. She also takes the combined oral contraceptive pill.
Which of the following is the most appropriate advice to give?
A. Mrs D should take aspirin 300mg
B. Mrs D should take a regular anti-inflammatory such as ibuprofen 400mg to help with the inflammation
C. Mrs D should make a non-urgent GP appointment
D. Mrs D should rest and keep her leg elevated to help reduce the inflammation
Mrs D should seek immediate medical attention
Mrs D should seek immediate medical attention
These symptoms are indicative of a DVT. Taking the combined oral contraceptive pill increases the risk of VTE. For initial treatment of DVT, a low molecular weight heparin is used.
Mr S is a 71-year-old patient with hypertension and chronic heart failure. His current medication is as follows:
Digoxin 125mcg daily
Ramipril 5mg daily
Bisoprolol 2.5mg daily
Bumetanide 2mg daily
Atorvastatin 80mg at NIGHT
Vitamin D3 1000 units daily
Which of his medications listed above is most likely to predispose Mr S to digoxin toxicity?
A. Ramipril 10mg
B. Bumetanide 2mg
C. Bisoprolol 2.5mg
D. Atorvastatin 40mg
E. Vitamin D3 1000 units
Bumetanide is a loop diuretic, loop and thiazide diuretics can cause hypokalaemia which predisposes to digoxin toxicity.
Which class of drugs does cimetidine belong to?
A. H1 receptor agonist
B. H2 receptor agonist
C. H2 receptor antagonist
D. H1 receptor antagonist
H2 receptor antagonist
Antidepressant medication review with Mr PL who is 79 yo. Sertraline 50mg 1 OD a year and a half ago since the passing of his wife. Today Mr PL informs you he feels as though he does not need this medication anymore and is informing you, he is in a much better place. He has, over the last week or so started to wonder is he can come off this medication.
How long should antidepressant treatment be continued in Mr PL following remission?
A. At least 1 week
B. At least 4 weeks
C. At least 6 months
D. At least 12 months
D. At least 12 months
