webinars Flashcards by Simon Evans

Which of the following abx have the best activity against pseudomonas aerugonisa

Amox
Doxy
Clarith
Pip/Tazobact

Gram negative
can cause complicated UTI, pneumonia HAP

Pip/Tazo is the best

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A patient with penicillin allergy requires treatment for an MRSA bacterial infection, which is the most suitable alternative
vancomycin
cefalexin
amox
meropenem
doxycycline

Vancomycin has better MRSA coverage

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which of the following is macrolide and is effective against atypical (neither gram positive or negative) pathogens such as mycoplasma pneumoniae or chlamydia
Doxy
Ciprofloxacin
Azithromycin
Amikacin
Metronidazole

Azithromycin

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Primary mechanism of action of beta lactic abx
inhibition of protein synthesis
inhibition of DNA gyrase
disruption of cell membrane integrity
inhibition of cell wall synthesis
inhibition of folic acid synthesis

Cell wall synthesis

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which abx is known for its activity against anaerobic bacteria and is used in CDIFF
Amox
Fidaxomicin
Ciprofloxacin
Doxycyline
Gentamicin

Fidaxomicin

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A patient is prescribed an antibitoic that acts by inhibiting bacterial protein synthesis by binding to the 50s ribosomal subunit
Amox
Ciprofloxacin
Erythromycin
Co-Amoxiclav
Trimethoprim

Eryromycin - macrolide

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Which abx is effective against both gram positive and gram negative and is often used as broad spectrum empirical therapy for severe infections

Cefuroxime
Flucoxacillin
Linezolid
Vancomycin
Amikacin

Cefuroxime (amikacin works against alll gram negatives and only straphcolocs auerous )

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A 52 year old female patient is to imitate a protease inhibitor as part of her HIV treatment. Which of the following is a protease inhibitor

Atazanavir
Emtricitabine
Nevirapine
Riplivirine
Zidovudine

Atazanavir is a protease inhibitor (PI) used in the treatment of HIV. It works by inhibiting the HIV protease enzyme, preventing viral replication. Protease inhibitors are often used in combination with other antiretroviral drugs.
Why the other options are incorrect:

Emtricitabine – A nucleoside reverse transcriptase inhibitor (NRTI)
Nevirapine – A non-nucleoside reverse transcriptase inhibitor (NNRTI)
Rilpivirine – A non-nucleoside reverse transcriptase inhibitor (NNRTI)
Zidovudine – A nucleoside reverse transcriptase inhibitor (NRTI)

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A 33 year old patient with multi drug resistant HIF is being considered for a treatment regimen that includes an entry inhibitor. Which of the following is an entry inhibitor

Abacavir
DARUNAVIR
efavirenz
maraviroc
nevirapine

Maraviroc is an entry inhibitor (specifically a CCR5 antagonist) used in the treatment of HIV. It works by blocking the CCR5 co-receptor, preventing HIV from entering CD4+ T cells. It is particularly used in patients with CCR5-tropic HIV-1 and is part of salvage therapy for multi-drug-resistant HIV.
Why the other options are incorrect:

Abacavir – A nucleoside reverse transcriptase inhibitor (NRTI)
Darunavir – A protease inhibitor (PI)
Efavirenz – A non-nucleoside reverse transcriptase inhibitor (NNRTI)
Nevirapine – A non-nucleoside reverse transcriptase inhibitor (NNRTI)

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Type 2 diabetic is prescribed metformin as part of their treatment regimen, Which of the following adverse effects is most common and should be discussed with the patient during counselling

Hypoglycaemia
Weight Gain
GI upset
Hyperglycaemia
Lactic acidosis

Gi Upset usually transient

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A 45 year old man type 1 diabetic is experiencing frequent episodes of hypoglycaemia despite adhering to his insulin regimen. He takes his rapid acting insulin 45 mins before eating which of the following change sis most appropriate to help manage his condition and reduce the risk of episodes

Increase dose of long acting
Add metformin
Adjust time he takes his rapid acting insulin
Switch to different type of insulin

Adjust the time he takes his rapid acting insulin (15 mins before or immediately before)

Short acting 15-30 mins

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A 60 year old woman with hx of osteoporosis is being evaluated for pharmacological treatment to reduce fracture risk which of the following medications is classified as a bisphosphonate and is commonly prescribed for this purpose

Raloxifene
Alendronic acid
Denosumab
Teriparatide
Calcitonin

Alendronic acid

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Pt with Addison disease requires lifelong replacement therapy with corticosteroids which of the following is commonly used as part of the replacement regimen for managing Addison disease
Dexamethasone
pred
hydrocortisone
fludocortisone
betamethasone

Patients with Addison’s disease (primary adrenal insufficiency) require lifelong glucocorticoid and mineralocorticoid replacement therapy because their adrenal glands do not produce enough cortisol and aldosterone.

First-line treatment:

Hydrocortisone – A glucocorticoid used to replace cortisol. It is preferred because it has both glucocorticoid and mild mineralocorticoid activity, closely mimicking natural cortisol secretion. Short acting which is beneficial as condition can be life threatening

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Carbimazole MOA

Inhibition of thyroid hormone release
destruction of thyroid tissue
Inhibition of thyroid hormone syntheis
Blocking of thyroid hormone receptors
Stimulation of thyroid hormone metabolism

✅ Inhibition of thyroid hormone synthesis

Mechanism of Action (MOA) of Carbimazole:
Carbimazole is a prodrug that is converted into methimazole in the body. It works by:

Inhibiting the enzyme thyroid peroxidase (TPO), which is essential for the synthesis of thyroid hormones (T3 and T4).
This prevents iodine oxidation and organification, blocking the formation of thyroxine (T4) and triiodothyronine (T3) in the thyroid gland.

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Which of the following is an important counselling point for SGLT2 inhibitors

Monitor for signs of pancreatitis
Ensure adequate fluid intake to prevent dehydration
Report signs of liver dysfunction immediately
Avoid high potassium foods
monitor for signs of hyperglycaemia

✅ Ensure adequate fluid intake to prevent dehydration

Explanation:
SGLT2 inhibitors (e.g., dapagliflozin, empagliflozin, canagliflozin, ertugliflozin) lower blood glucose by blocking sodium-glucose co-transporter 2 (SGLT2) in the kidneys, promoting glucose excretion in urine. This leads to osmotic diuresis, increasing the risk of dehydration and hypotension, especially in elderly patients or those on diuretics.

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Patient with type 1 diabetes is transitioning from multiple daily injections to an insulin pump. Which of the following types of insulin is most commonly used in insulin pumps for continuous SC insulin infusion

Long acting insulin
Intermediate acting insulin
Short acting insulin
Rapid acting insulin
Premixed insulin

For continuous subcutaneous insulin infusion (CSII) using an insulin pump, rapid-acting insulin analogues are the preferred choice. These insulins provide a continuous basal rate and bolus doses for meals or corrections.

Common rapid-acting insulins used in insulin pumps:
Insulin aspart (NovoRapid, Fiasp)
Insulin lispro (Humalog)
Insulin glulisine (Apidra)

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Can antibiotics be given for covid-19

Only if there is a bacterial infection secondary to covid

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Which is the primary aim of type 2 diabetes management
Cure the condition
prevent the onset of diabetes
Minimise the risk of long term complications
Achieve blood glucose levels below 30mmol/l
Promote weight gain

Minimise risk of long term complications

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Patient has GI side effects with standard release metformin which is the next best steps
Stop metformin and switch to insulin
Switch to MR metfromin
Add a sulfonurea
Use pioglitazone instead
Discontinue and use no alternative

Switch to MR

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At what HbA1c level should drug treatment be intensified in patients on a single anti diabetic medication

48 mmol/mol
53 mmol/mol
58 mmol/mol
75 mmol/mol
100 mmol/mol

58 mmol/mol

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Which of the following antidiabetic drugs is associated with risk of diabetic ketoacidosis
Metformin
Sulfonureas
SGLT2
DPP4
Pioglitazone

✅ SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin, canagliflozin) are associated with an increased risk of diabetic ketoacidosis (DKA), even in patients with normal or mildly elevated blood glucose levels (euglycaemic DKA).

Why?
SGLT2 inhibitors increase glucose excretion via the kidneys, leading to:

Reduced insulin levels, which promotes fat metabolism → ketone production
Dehydration, which can exacerbate ketone accumulation
Delayed recognition due to lower-than-expected blood glucose levels

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What is the recommended hba1c target for a patient on metformin and no drugs associated with hypoglycaemia

42mmol/mol
48 mmol/mol
53 mmol/mol
58 mmol/mol

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Which of the following drugs is most suitable for type 2 diabetes and heart failure

DPP4 inhibitors
GLP-1 receptor agonists
SGLT2
Sulfonylureas
Insulin

✅ SGLT2 inhibitors (e.g., empagliflozin, dapagliflozin) are the most suitable choice for Type 2 Diabetes (T2DM) and Heart Failure (HF).

Why?
🔹 Cardiovascular benefits – Proven to reduce heart failure hospitalisation and mortality
🔹 Diuretic effect – Reduces fluid overload, beneficial in HF with reduced ejection fraction (HFrEF)
🔹 Renal protection – Slows CKD progression

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What is the primary defect in type 2 diabetes mellitus that leads to hyperglycaemia

Autoimmune destruction of beta cells
Absolute insulin deficiency
Insulin resistance
Ketone overproduction
Increased glucagon sensitivity

Insulin resistance

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Which medication reduces hepatic glucose production Insulin Metformin Sulfonylureas SGLT2 DPP-4 inhibitors

Metformin

Which medication class stimulates insulin secretion by pancreatic beta cells Sulfonylureas Metfomin SGLT2 DPP-4 inhbitors GLP-1 receptor agonists

Sulfonylureas

Which medication class reduces glucose reabsorption in the kidneys GLP-1 receptor agonIsts SGLT-2 inhibitors DPP-4 Inhibitors Insulin

SGLT-2 inhibitors

A 67 year old patient with type 2 diabetes is prescribed pioglitazone, Which of the following condition would be contraindicated in its use Osteoporosis Hypertension heart Failure CKD Peripheral Neuropathy

Heart Failure CKD is caution

Which of the following GLP-1 receptor agonists is licensed for weight loss Liraglutide (Saxenda) Dulaglutide (Trulicity) Lixisenatide (Lyxumia) Exenatide (Byetta) Sitagliptin (Januvia)

Liraglutide (Saxenda)

Which DPP-4 inhibitor does not require renal dose adjustment Sitagliptin Saxagliptin Vildagliptin Linagliptin Alogliptin

Linagliptin does not require dose adjustment in renal impairment because it is primarily eliminated via the biliary (hepatic) route, rather than the kidneys.

Which of the following is a contraindication for pioglitazone use Hx of bladder cancer Hx of Pancreatitis Stage 3 CKD Type 1 diabetes Peripheral neuropathy

Hx of bladder cancer

A patient on liraglutide presents with persistent, severe abdominal pain radiating to the back. What is the most likely complication? Diabetic ketoacidosis Acute pancreatitis Gallstones Gastroeophageal reflux disease Peptic ulcer disease

Acute pancreatitis

Which of the following antibiotics should be avoided in patients with a hx of QT prolongation Amox Ciprofloxacin Gentamicin Doxycycline Penicillin V

Ciprofloxacin

Which of the following is a common side effect of erythromycin due to its pro kinetic properties Constipation Hypertension N+V Tinnitus Drowsiness

Nausea and vomiting

Which antibiotic is associated with causing CDIFF Amoxicillin Vancomycin Metrondiazole Clarithromycin Ciprofloxacin

Ciprofloxacin 4C (Ciprofloxacin, Cephalosporins, co-amoxiclav and clindamycin)

Which antibiotic should be used cautiously in patient with hx of QT interval prolongation Clarithromycin Nitrofurantoin Trimethoprim Metrondiazole Flucloxacillin

Clarithromycin

Which is a notable adverse effect of gentamicin that requires patient monitoring Hepatotoxicity Ototoxicity Hyperkalaemia Photosensitivity Thrombocytopenia

Ototoxicity

A 37 year old male is diagnosed with acute exacerbation of COPD. He does not have any allergies. Which of the following would be the most suitable antibiotic to treat the patient? Co-Amoxiclav Meropenem Doxycycline Ciprofloxacin Fidaxomicin

According to NICE guidelines for managing acute exacerbations of COPD, first-line antibiotic choices include: Doxycycline Amoxicillin Clarithromycin Doxycycline is often preferred because it covers the common bacterial pathogens in COPD exacerbations, such as: Haemophilus influenzae Streptococcus pneumoniae Moraxella catarrhalis It also has good oral bioavailability and is well-tolerated. Co-Amoxiclav ⚠️ – Can be used in cases with suspected β-lactamase-producing bacteria, but it is not the first-line choice unless the patient is at higher risk (e.g., frequent exacerbations, antibiotic resistance, or severe disease).

A 45 year old male patient is diagnosed with low severity CAP. He has a penicillin allergy and develops a rash when taking penicillin, Which of the following would be the most suitable antibiotic to treat this patient? Co-Amoxiclav Meropenem Doxycycline Ciprofloxacin Amoxicillin

For a 45-year-old male with low-severity community-acquired pneumonia (CAP) and a penicillin allergy, NICE guidelines recommend: Doxycycline (First-line for penicillin-allergic patients) Clarithromycin (Alternative option, but avoid in patients at risk of QT prolongation) Doxycycline provides broad coverage against common CAP pathogens like: Streptococcus pneumoniae Haemophilus influenzae Mycoplasma pneumoniae (Atypical pathogen)

A 65 year old male patient is diagnosed with HAP and is acutely confused with a blood pressure of 88/70 mmHg. He has a penicillin allergy and the nature of the allergy is anaphylaxis. Which of the following would be the most suitable antibiotic to treat the patient with? Co-Amoxiclav Meropenem Doxycyline Levofloxacin Amoxicillin

Levofloxacin as due to sepsis Rationale: HAP Treatment – Guidelines recommend broad-spectrum antibiotics covering Gram-negative bacteria (including Pseudomonas aeruginosa) and Staphylococcus aureus, particularly in severe cases. Penicillin Allergy (Anaphylaxis) – Co-amoxiclav, amoxicillin, and meropenem are beta-lactam antibiotics, which should be avoided due to cross-reactivity. Carbapenems (e.g., meropenem) have some cross-reactivity with penicillins, so they are not suitable in anaphylactic reactions. Severe Infection (Hypotension, Acute Confusion) – Levofloxacin is a respiratory fluoroquinolone with good activity against Gram-negative organisms and atypical pathogens, making it suitable for severe HAP. Doxycycline is not suitable as monotherapy in severe HAP due to limited Gram-negative coverage and weak activity against Pseudomonas.

A 33 year old female patient is diagnosed with a Lower urinary tract by her GP, she does not have any allergies. She is not pregnant. Which of the following would be the most suitable antibiotic to treat the patient? Nitrofurantoin Trimethoprim Co-Amoxiclav Meropenem Amoxicillin

NITRO First-line treatment for uncomplicated UTI – According to NICE and local antimicrobial guidelines, nitrofurantoin is the preferred first-line antibiotic for lower UTIs in non-pregnant women, provided renal function is adequate (eGFR > 45 mL/min). Alternative (if nitrofurantoin is unsuitable) – Trimethoprim is an alternative but should be avoided if the patient has taken it in the last 12 months due to increasing resistance rates. Co-amoxiclav and amoxicillin – These are not first-line choices due to high resistance rates among E. coli, the most common uropathogen. Meropenem – A broad-spectrum carbapenem is not appropriate for uncomplicated UTIs and should be reserved for multidrug-resistant infections

A 37 year old female patient is diagnosed with a lower UTI by her gp, SHE DOES NOT HAVE ANY ALLERGIES BUT IS 22 WEEK PREG. Which of the following would be the most suitable antibiotic to treat the patient? Nitrofurantoin Trimethoprim Co-Amoxiclav Meropenem Amoxicillin

Nitrofurantoin - Should be avoided in third trimester but is only contraindicated at term

A 38 year old female patient is diagnosed with acute pyelonephritis by her Gp, She does not have any allergies and is not pregnant. Which of the following would be the most suitable to treat the patient Nitrofurantoin Meropenem Piperacillin./Tazobactam cefalexin Amoxicillin

Rationale: First-line treatment for acute pyelonephritis NICE and local guidelines recommend a cephalosporin (e.g., cefalexin), ciprofloxacin, or co-amoxiclav for uncomplicated pyelonephritis. Cefalexin is a good option due to its broad spectrum of activity against E. coli and other Gram-negative uropathogens. Why not the other options? Nitrofurantoin – Not suitable because it does not achieve therapeutic concentrations in renal tissue, making it ineffective for pyelonephritis. Meropenem – A broad-spectrum carbapenem, reserved for resistant infections (e.g., ESBL-producing E. coli), not first-line for uncomplicated cases. Piperacillin/Tazobactam – A broad-spectrum IV antibiotic, used for severe or hospital-acquired infections, not typically first-line for community-acquired pyelonephritis. Amoxicillin – E. coli resistance rates are high, so not reliable unless susceptibility is confirmed.

A 86 year old patient presents with a fever and has several watery bouts of diarrhoea. The lab discovers the CDIFF toxin in his stool. He was previously treated for c.difficile 7 weeks ago, which of the following should he receive Vancomycin IV Metronidazole IV Metrondiazole PO Fidaxomicin PO Vancomycin PO

Fidaxomicin PO Rationale: Recurrent CDI (within 12 weeks of a previous episode) According to NICE and local guidelines, fidaxomicin is preferred over vancomycin for recurrent CDI as it has a lower recurrence rate due to its narrower spectrum and preservation of gut microbiota.

A 45 year old patient presents with a red, swollen and tender area around their left eye and difficulty opening the eye due to swelling. The clinical team diagnosed it as perioribital cellulitis. The patient has no known allergies, Based on the guidelines which of the following is the appropriate first line option Flucloxacillin PO Co-Amoxiclav PO Doxycycline pO Clarithromycin IV Clarithromycin PO

Periorbital cellulitis (preseptal cellulitis) requires coverage for Gram-positive bacteria (e.g., Staphylococcus aureus and Streptococcus pyogenes) and anaerobes. Co-Amoxiclav provides: Broad-spectrum coverage, including S. aureus, S. pyogenes, and some anaerobes. Good penetration into soft tissues, making it effective for facial infections. Flucloxacillin PO – Covers S. aureus and Streptococcus, but lacks anaerobic coverage, making it less effective for periorbital cellulitis. Doxycycline PO – Not first-line for periorbital cellulitis; poor streptococcal coverage. Clarithromycin IV – IV treatment is not required unless the infection is severe or there are signs of systemic involvement. Clarithromycin PO – Less effective against S. aureus than co-amoxiclav, and does not cover anaerobes.

A patient with myasthenia graves is prescribed an antibiotic. Which of the following should be avoided due to the risk of neuromuscular blockade Amox ceftriaxone Gentamicin Clarithromycin Doxycycline

Gentamicin (Amino glycosides side effects include risk of neuromuscular blockade)

Which of the following abx is associated with red man syndrome when infused too quickly Erythromycin Teicoplanin Vancomycin Ciprfloxacin Co-Amox

Vancomycin

Which antibiotic requires therapeutic monitoring due to risks of nephrotoxicity and ototoxicity Amox Metrondiazole Vancomycin Flucloxacillin Azithromycin

Vancomycin

Which antifungal requires a test dose due to the risk of anaphylaxis Fluconazole Caspofungin Amphottericin B Itraconazole Voriconazole

Amphotercin B

Which of the following antifunagls is contraindicated in heart failure due to a risk of worsening symptoms Fluconazole Amphotericin B Itraconazole Caspofungin Voriconazole

Itraconazole

What is the first line treatment for aspergillosis Amphotercin B Posaconazole Voriconazole Caspofungin Itraconazole

Voriconazole

A 65 year old man with epilepsy is experiencing myoclonic seizures which of the following is first line treatment Sodium Valproate Levitracetam Topiramate Lamotrigine Gabapentin

Which abx should be avoided in pts taking statins due to risk of rhabdomyolysis cipro trimethoprim claritrhomycin vancomycin

Clarirthomycin (macrolide) - CYP3A4 inhbitor

Which abx can increase nephrotoxicity when co-administered with aminoglycosides Clarith Cipro Co-trimazole Vancomycin

Vancomycin

Which of the following meds is most associated with lactic acidosis Metformin SItagliptin Pioglitazone Acarbose Dapaglifozin

Metformin

Which of the following diabetic meds is associated with increased risk of UTI Pioglitazone Sitagliptin Semaglutide Glicazide Dapaglifozin

Dapaglifozin

Which class of diabetes medication is known for its ability to cause weight loss semaglutide pioglitazone acarbose metformin dapaglifozin

Semaglutide

Which of the following meds can cause grey skin discolouration as a side effect Digoxin Amiodarone Verampril Diltazem

Amiodarone

Which antidepressant is most safe in history of Myocardial infacrtion Amitrtpline Fluoxetine Paroxetine Venlafaxine Sertraline

Sertraline - low cardiotoxicity

What is the most appropriate management for life threatening c diff infection Fidaoximicin monotherapy Ciprofloxacin + metrondazole Oral vancomycin and IV metrondiazole IV gentamicin and clindamycin

Oral vanc and iV metronidazole

Which antidepressant is safest in pregnancy paroxetine sertraline fluoxetine amitrptyline venlafaxine

Sertraline - not fluoxetine as it has a long half life

Which of the following abx is a macrolide and is effective against atypical pathogens such as mycoplasma pneumonia doxy cipro azitrhomycin amikacin metronidazole

Azitrhomycin

a 65 year old man experiencing myoclonic seizures which of the following meds is first line SV Leviracetam Topiramte Lamotrigine Gabapentin

SV - Under 55