Tophat Quiz Flashcards
You are called to a patient in A&E admitted with a mixed drug overdose. On examination the patient is unarousable, with pinpoint pupils and a respiratory rate of 4. After administration of 400 micrograms of IV naloxone the patient awakens suddenly and is clearly in distress. What is the mechanism of action of naloxone?
Competitive opioid receptor antagonist
A 72 year old man admitted with a Myocardial Infarction is approaching discharge. Which of these is NOT a drug to be started or continued in the community as part of Secondary prevention of CVD?
Digoxin
A 19 year old man presents to ED with a generalised tonic-clonic seizure. The paramedics report that he received buccal midazolam and IV lorazepam in the ambulance. The seizure is still ongoing. What is the most appropriate next stage in management?
Buccaneers midazolam
A 60 year old male with known hypertension has recently had to add an additional medication due to poor control with an ACEi and calcium channel blocker. He presents with an acute onset pain and swelling in his 1st metatarsophalangeal joint of the right foot. Which of his current medications is most likely to have caused this pain and swelling?
Bendroflumethiazide
A 75 year old woman has come to the GP with her partner, who is concerned about her having started gambling. Which of her medications may have precipitated this change in habits?
Co-careldopa (increases dopamine which is involved in reward system of behaviour)
What is the order of selectivity of COX inhibitors from least to most COX-2 selective?
Celecoxib diclofenac ibuprofen aspirin
Aspirin
Ibuprofen
Diclofenac
Celecoxib
70 year old gentleman presents with severe temporal headache, lethargy, jaw claudication and has difficulty combing his hair. Blood test results: CRP 40, PV 1.94 and ESR 64. No visual symptoms. He was diagnosed with Giant Cell Arteritis (GCA). PMH: Nil, No allergies. What is the recommended first line treatment?
Prednisolone (corticosteroid)
What is the mechanism of action of formoterol?
Long acting beta adrenoceptor agonist (LABA)
Mr Z has an annual Diabetic review which reveals a high HbA1c of 7.9%.
He is prescribed a new medication for his Diabetes to improve overall glycemic control. Drug X is highly lipophobic, taken intramuscularly, metabolised by the Kidneys and Liver, and cleared by the Kidneys.
PMH: Crohns, CKD3, alcoholic liver disease. In Mr Z, which 2 factors will most determine the amount of drug that remains in the body?
Metabolism and Elimination
Factors: CKD (elimination) and liver disease (metabolism)
Ms. Francis has had Rheumatoid Arthritis for 30 years and has been on many different anti-rheumatic medications during this time. At present, she and her Rheumatologist have settled on a regime with 2x DMARDs and Prednisolone 20mg OD.
She strongly wishes to come off the Prednisolone. What advice would you give her when coming off the Corticosteroid medication?
Titrate carefully with a clinician- need to gradually reduce to allow body to start producing steroid based hormones endogenously again.
For a drug which demonstrates 1st order kinetics, how long will it take to reach a state where the rate of administration is equal to the rate of elimination?
4-5 half lives
A 53 year old has just been to see their diabetologist. It is agreed that the patients TIIDM medication will be escalated and dapagliflozin will be added. What is the mechanism of action?
Competitive reversible inhibition of SGLT-2
Ben is a 24y/o man who has attended his annual asthma review with the specialist asthma nurse prescriber. He complains of disturbed sleep due to a nocturnal cough. He is otherwise well, completing sentences in one breath and with observations that are within normal range.
Ben’s asthma medication includes:
• Salbutamol inhaler 1-2 puffs as needed
• Beclomethasone inhaler 2 puffs BD.
According to NICE guidelines, which medication should be added to Ben’s regimen to improve his asthma control?
Montelukast (LRTA)
A 64 year old man presents to A&E with nausea and vomiting. A diagnosis of viral gastritis is made. His PMH includes Parkinson’s disease and hypertension. After receiving an anti-emetic, he becomes slow and stiff.
Which antiemetic is most likely responsible for his neurological deterioration?
Metoclopramide
A 64 year old man presents to A&E with nausea and vomiting. A diagnosis of viral gastritis is made. His PMH includes Parkinson’s disease and hypertension. The patient’s routine biochemistry shows a potassium of 2.4mmol/L (normal 3.5-5.0mmol/L).
Which of his current drugs (co-careldopa, selegiline, bisoprolol, bendroflumethiazide, lisinopril) is most likely to contribute to hypokalaemia?
Bendroflumethiazide