AKT Pharmacology Quiz

1
AKT Pharmacology Quiz

• Dr. V.Krishnamoorthy

2
Contraceptive Advice

• 2 days of extra contraceptive precautions req
• 7 days of extra contraceptive precautions req
• 14 days of extra contraceptive precautions req
• Emergency contraception req
• No extra contraceptive precautions req
• Omit pill free week

3

• For each patient described, select the SINGLE
  MOST appropriate advice from the list above.
• Each option may be used once, more than once or
  not at all.

4

• 1. A 24 yr old woman is on the COC pill. She is
  on day 19 of the packet rings to say she forgot
  her pill yesterday morning and had intercourse
  last night. She has taken her pill this morning.
  He last period was normal and she has taken all
  her other pills correctly.

5

• 2. A 36 year old woman is taking the POP. She is
  on day 14 of the packet rings to say she forgot
  her pill yesterday had intercourse last night.
  She has taken her pill this morning. Her last
  period was normal she has taken all other pills
  accurately.

6

• 3. A 28 yr old woman had her first baby 8/52 ago.
  She is not breast feeding wishes to restart
  contraception straightaway. She has not started
  her periods yet and receives her first injection
  of Medroxy progesterone acetate that day.

7

• 4. A 26 yr old woman is taking the COC pill. She
  forgot to start her new packet of pills 3 days
  ago had intercourse last night. Her last period
  was normal and she had taken her previous pack
  of pills accurately.

8

• 5. A 24 yr old woman is taking the COC pill. She
  is on day 6 of the packet is treated with a 7
  day course of oral flucloxacillin for wound
  infection.

9
Answers

• 1 B
• 2 D
• 3 B
• 4 D
• 5 C

10
COCP

• Missed Pill take missed pill asap, then next
  pill at usual time
• Extra contraception for 7 days if
• vomiting/ severe diarrhoea
• missed pill gt 12 hrs
• antibiotics ( 7 days after completing course
  )
• Emergency contraception if
• gt/ 4 pills missed mid pack
• gt/ 2 pills missed at start or end of pack

11
POP

• Missed pill or delayed gt3 hrs ( 12 hrs for
  Cerazette )- continue taking pill at usual time
  use extra precautions for 2 days.
• If missed or delayed gt 3 hrs intercourse has
  occurred before 2 further tabs have been
  correctly taken emergency contraception.

12

• Which of the following drugs must never be used
  in subcutaneous infusions as they cause severe
  irritation at the site
•  
• Midazolam
• Dexamethasone
• Diazepam
• Chlorpromazine
• Prochlorperazine
• Cyclizine
• Levomepromazine
• Hyoscine hydrobromide
• Hyoscine butylbromide

13

• The answers are 3, 4, 5
•  
• Diazepam, prochlorperazine chlorpromazine cause
  severe irritation at the site. NEVER use them in
  a subcutaneous infusion
•  
•  
• Cyclizine and levomepromazine may also cause
  local irritation sometimes but are used in a
  subcutaneous infusion

14
Antibiotic Treatment

• Flucloxacillin
• Penicillin V
• Co-amoxiclav
• Benzylpenicillin
• Amoxicillin
• Methicillin
• Penicillin and flucloxacillin
• None of these

15

• Match the scenarios given below to the single
  most appropriate antibiotic treatment each
  response may be used once, more than once or not
  at all.
•  
• A hamster bit a plumber 24 hours ago. The bite is
  a small one on the back of her right hand and it
  looks inflamed. She is otherwise well.
• A one year old boy with headache, leg pains and
  preferring to be in a darkened room, has a stiff
  neck and a non blanching rash on his buttocks on
  examination.

16

• A 19 yr male has a 10 day history of fatigue, a
  sore throat and a temperature. On examination he
  has cervical and occipital lymphadenopathy. A
  monospot blood test done 24 hours ago has just
  been received back and is positive.
• A 26 yr nursery care worker has a fever, malaise,
  a cough productive of purulent sputum and left
  sided pleuritic chest pain . On examination there
  are coarse crackles heard at the left side of the
  chest
• A 4 yr girl presented to surgery with a red patch
  on the cheek covered in a golden crust. The child
  is otherwise well.

17
Answers

1. C
2. D
3. H
4. E
5. A

18

• Animal and human bites
• Co-amoxiclav alone (or doxycycline
  metronidazole if penicillin-allergic)
• Cleanse wound thoroughly. For tetanus-prone
  wound, give human tetanus immunoglobulin (with a
  tetanus-containing vaccine if necessary,
  according to immunisation history and risk of
  infection)

19

• Meningitis caused by meningococci
• Benzylpenicillin IM and transfer to hospital
• or cefotaxime
• Treat for at least 5 days
• Glandular fever
• Do not give Amoxicillin can cause a rash
• Symptomatic Rx only
• Community acquired pneumonia - - Amoxicillin

20

• Impetigo
• Topical fusidic acid (or mupirocin if
  meticillin-resistant Staphylococcus aureus) oral
  flucloxacillin or erythromycin(1) if widespread
• Topical treatment for 7 days usually
  adequate max. duration of topical treatment 10
  days
• Erysipelas
• Phenoxymethylpenicillin (or erythromycin(1)
  if penicillin-allergic)
• Treat for at least 7 days add flucloxacillin
  to phenoxymethylpenicillin if staphylococcus
  suspected

21

• Cellulitis
• Benzylpenicillin flucloxacillin (or
  erythromycin(1) alone if penicillin-allergic)
• Substitute phenoxymethylpenicillin for
  benzylpenicillin if oral treatment appropriate

22
Side effects of diabetic drugs

• Options
• Metformin
• Sulphonylureas
• Glitazones
•  
• For each of the side-effects below, select the
  most appropriate drug group from the list above.
  Each option can be used once, more than once or
  not at all. More than 2 options can also be used.

23

• Reduced Vit B absorption
• Weight gain and liver dysfunction
• Lactic acidosis
• Hypoglycaemic episodes
• Syndrome of inappropriate ADH secretion

24
Answers

• 1 A
• 2 B C
• 3 A
• 4 B
• 5 B

25
Side Effects

• Metformin
• Gastrointestinal side-effects Lactic
  acidosis Reduced vitamin B12 absorption -
  rarely a clinical problem
• Sulfonylureas
• Hypoglycaemic episodes Increased
  appetite and weight gain Syndrome of
  inappropriate ADH secretion Liver dysfunction
  (cholestatic)
• Glitazones
• Weight gain Fluid retention Liver
  dysfunction

26
Drug interactions

• Cranberry juice
• Grapefruit juice
• Marmite
• Vodka
•  
• Match the above food with the drug that it is
  most likely to interact with adversely

27
Drug interactions

• Cranberry juice
• Grapefruit juice
• Marmite
• Vodka
• Match the above food with the drug that it is
  most likely to interact with adversely

• Simvastatin
• Disulfiram
• Warfarin
• Moclobemide

28
Answers

1. B
2. D
3. A
4. C

29

• Simvastatin and Grapefruit juice - Grapefruit
  juice can increase the risk of rhabdomyolysis as
  a side effect of taking simvastatin
• Disulfiram and vodka Disulfiram is used in the
  Rx of alcohol dependence

30

• Warfarin and Cranberry juice cranberry juice
  can raise the INR of patients on warfarin.
• NOTE beware of high intake of tomatoes with
  warfarin there is excess Vit K in tomatoes.
  Warfarin is a Vit K antagonist. So excess Vit K
  in tomatoes reverses the effect of warfarin

31
Hay fever

• A 20 yr old student suffers from hay fever.
  She is about to take her final exams is worried
  that the meds may cause drowsiness. She is on
  Erythromycin for an ear infection.
• Which anti-histamine would be MOST suitable for
  treating her hay fever?

32

• A Promethazine
• B Desloratidine
• C Chlormethiazole
• D Chlorpheniramine maleate
• E Terfenadine

33

• Desloratidine long acting H1 antagonist
• poor CNS penetration
• no interaction with abx
• Cetrizine, desloratidine fexofenadine are all
  used to treat hay fever with equal efficacy.
• However, Cetrizine Fexofenadine interact with
  Erythromycin other macrolides.
• Chlorpheniramine Terfenadine cause drowsiness
  interact with Erythromycin.

34
Heart Failure

• A 76 yr old man who seldom attends the
  Surgery is finally brought in by his wife with
  several weeks Hx of orthopnoea, PND swollen
  ankles. O/E bibasal creps, HR110/min ECG- sinus
  rhythm. After treatment with ACEi frusemide, he
  is still symptomatic tachycardic. Which of the
  following is correct re further management?

35

• A He should be started on beta blocker.
• B He should be referred for a bi-ventricular
  pacemaker.
• C He should start Digoxin for rate control.
• D His dose of diuretic should be increased.
• E Spironolactone should be started.

36

• Patients with heart failure should be referred
  for consideration of a cardioselective BB-
  Carvedilol.
• Diuretics are an adjunct for initial Rx of
  oedema.
• Mainstay of Rx is ACEi BB.
• Digoxin Spironolactone both have a place but
  not as 1st/ 2nd line.
• Bi-ventricular pacing in severe heart failure.

37
Management of Chest pain

• A 55 yr old man has a 2 hour Hx of severe
  central chest pain radiating to his lt arm. He
  has no previous significant medical history. His
  BP is 150/85 mmHg, his chest is clear his pulse
  is regular at 90/min.
• In addition to Aspirin, which is the SINGLE
  MOST appropriate drug for this patient. Select
  one option only.

38

• A Amiodarone
• B Carvedilol
• C Diamorphine
• D Furosemide
• E Ramipril

39
Post MI

• A 58 yr old woman attends 2 months after a MI.
  She has made a good recovery but has developed
  features of low mood poor sleep pattern with
  early morning wakening.
• Which is the SINGLE MOST appropriate drug for
  this patient?

40

• A Amitryptiline
• B Fluoxetine
• C Lofepramine
• D Mirtazepam
• E Venlafaxine

41

• Answer Fluoxetine
• Sertraline is the most appropriate of SSRIs.
• TCA Can cause conduction defects arrythmias (
  amitryptiline, nortryptiline, lofepramine,
  imipramine, dothiepine )
• NARI Venlafaxine has similar cardiac profile.

42
Thank You

• And
• GOOD LUCK