PHARMACOLOGY:

Which of these drugs undergoes cytochrome p450-dependent hydroxylation?

Aspirin Lidocaine Methadone Procaine Warfarin

Incorrect:

The answer is Warfarin. Other important drugs that undergo hydroxylation include phenobarbital, propranolol, phenytoin and amphetamines.

Which local anaesthetic agent is an amide?

Tetracaine (also known as amethocaine) Benzocaine Cocaine Lidocaine Procaine

Incorrect:

The answer is Lidocaine. The other local anaesthetic agents are esters.

With regard to the neuromuscular junction, what causes a reduction in the release of acetylcholine?

Alcuronium Aminoglycoside Neostigmine Suxamethonium Tubocurarine

Incorrect:

The answer is Aminoglycoside. All the other agents actions are mediated on the postsynaptic membrane.

Which agent is a neurotransmitter used by the sympathetic preganglionic neuron?

-aminobutyric acid (GABA) Acetylcholine Adrenaline Isoprenaline Noradrenaline

Incorrect:

The answer is Acetylcholine. Both the parasympathetic and sympathetic preganglionic neurons use acetylcholine as a neurotransmitter.

Which agent is a selective alpha 2 agonist?

Cocaine Dobutamine Methyldopa Phenylephrine Salbutamol

Incorrect:

The answer is Methyldopa. This antihypertensive is a centrally acting alpha 2 receptor agonist. Phenylephrine is an alpha 1 agonist, and cocaine acts indirectly by inactivating the reuptake of noradrenaline.

In the treatment of hypertension which agent is a calcium antagonist?

Amlodipine Captopril Clonidine Minoxidil Prazosin

Incorrect:

The answer is Amlodipine. Calcium antagonists reduce the vascular tone by blocking the release of calcium from the sarcoplasmic reticulum and thus reducing cytosolic calcium ions. The most common side effects are hypotension, flushing and ankle oedema.

Warfarin disrupts the formation of vitamin K-dependent clotting factor. What are the vitamin K-dependent clotting factors?

Factors I, II, V, X Factors II, VII, IX, X

Factors II, IV, IX, XI Factors II, V, IV, X Factors III, IV, VI, X
Incorrect:

The answer is Factors II, VII, IX, X. Warfarins full effect is delayed for 3 days and has a half life of 40 hours.

How can the action of cyclizine be described?

5-HT3 antagonist H1 antagonist H2 antagonist H1 agonist H2 agonist

Incorrect:

The answer is H1 antagonist. Cyclizine is a antihistamine so it is a histamine receptor anagonist. H2 receptors are found mainly in gastric parietal cells and H2 antagonists include cimetidine and ranitidine.

A patient has developed a deep vein thrombosis postoperatively. What is the target international normalised ratio range for this patient?

12 1.52.5 23 2.53.5 34
Incorrect:

The answer is 23.

What is the most appropriate treatment for pelvic inflammatory disease?

Augmentin (co-amoxiclav) Ceftriaxone 250 mg and azithromycin 1 g for 7 days Doxycycline for 14 days Metronidazole and doxycycline for 7 days

Ofloxacin
Incorrect:

The answer is Ceftriaxone 250 mg and azithromycin 1 g for 7 days.

Broad-spectrum antibiotic therapy is generally required to cover Neisseria gonorrhoeae, Chlamydia trachomatis and anaerobic infection. Ofloxacin should be avoided in women who are at high risk of gonococcal pelvic inflammatory disease (PID) because of increasing quinolone resistance in the UK. Women at high risk of acquiring gonorrhoea include those whose partner has gonorrhoea, in clinically severe disease, or if there is a history of sexual contact abroad.

Although the combination of oral doxycycline and metronidazole (without ceftriaxone) has been used to treat PID in the UK, there are no clinical trials adequately assessing its effectiveness and its use in isolation is not recommended. Ceftriaxone should be added as single dose. Data supporting azithromycin monotherapy for PID is also limited at present. However the addition of ceftriaxone pre-treatment is essential.

A 23-year-old woman is newly diagnosed with thyrotoxicosis. She is 20 weeks pregnant. Which medication will be the most appropriate treatment?

Carbimazole Propranolol Propylthiouracil Radioactive iodine Thyroxine

Incorrect:

The answer is Propylthiouracil (PTU). Carbimazole and PTU are the most commonly used antithyroid drugs in the UK. Most patients are treated for 1218 weeks. Both drugs cross the placenta.

Very little PTU is excreted in breast milk and it is safer to breast feed with PTU. There is no need to change carbimazole dosage if the woman is already well maintained on it. However PTU is the drug of choice for all newly diagnosed cases. Propranolol may be used in the early management of thyrotoxicosis or during relapse to improve the symptoms of palpitations and tremors, but it is not the main treatment or drug of choice.

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A woman is admitted to the antenatal ward. You have been asked to prescribe thromboprophylaxis for her. Her body weight is 101 kg. What is the recommended prophylactic dose of enoxaparin?

20 mg 40 mg

60 mg 80 mg 100 mg
Incorrect:

The answer is 60 mg. Low-molecular-weight heparin is as effective as heparin and has a better side effect profile. The dose is recommended based on weight and not on body mass index. In obese patients, a higher dose is required to provide adequate thromboprophylaxis.

A 34-year-old woman attends her obstetrics ultrasound appointment. Her medical history noted mechanical prosthetic valves. The scan reveals the presence of depressed nasal bridge, stippling of non-calcified epiphyses and microcephaly. No other neural tube defect, cardiac problem or orofacial defect was noted. A history of taking which drug is likely to explain the aetiology?

Labetalol Metformin Propylthiouracil Sodium valproate Warfarin

Incorrect:

The answer is Warfarin. Both sodium valproate and warfarin can cause depressed nasal bridge and microcephaly. Sodium valproate is commonly associated with neural tube defects, cardiac defects and other dysmorphic features.

Stippling of non-calcified epiphyses is commonly associated with warfarin. Neurological abnormalities may be seen with warfarin usage in the second or third trimester. Teratogenic risk with warfarin is overestimated and should always be balanced with the risk versus the benefit profile. In women with a prosthetic heart valve replacement, there is are an undisputed indication for warfarin usage.

A 25-year-old woman with a history of type I diabetes attends the preconception clinic. What pharmacological advice should be offered?

Commence angiotensin-converting-enzyme (ACE) inhibitors Commence an oral hypoglycaemic agent Commence folic acid Commence statins Reduce the dose of insulin
Incorrect:

The answer is Commence folic acid. Folic acid is essential for the prevention of neural tube defects. Women with type I diabetes are at high risk of developing neural tube defects.

Folic acid should be prescribed at a dose of 5 mg per day in high-risk groups. Other high-risk group patients include women with previously affected children and women on antiepileptic drugs. Insulin is the drug of choice for the patient described above and in most cases, the dosage would not be required to be reduced.

You have been asked to prescribe a combined oral contraceptive pill to a woman with acne and hirsutism. She is known to have polycystic ovary syndrome (PCOS). What is the best available option?

Cerazette (desogestrel) Cilest (ethinylestradiol / norgestimate) Loestrin 30 (ethinylestradiol / norethisterone) Microgynon (ethinylestradiol / levonorgestrel) Yasmin (ethinylestradiol / drosperinone)
Incorrect:

The answer is Yasmin. From the options provided Yasmin is more beneficial in terms of management of acne and hirsuitism, along with PCOS. Women with PCOS may be further maintained on Marvelon (ethinylestradiol, desogestrel) or Mercilon (ethinylestradiol, desogestrel) for contraception.

Yasmin contains 3 mg of drosperinone, which has some antiandrogenic properties. Dianette (cyproterone acetate, ethinylestradiol) is also useful because it contains cyproterone acetate, which is also an antiandrogenic agent. Care must be taken for women with a high body mass index.

Mirena (levonorgestrel) is a good option for contraception in women with PCOS because it provides protection to the endometrium (by opposing the unopposed estrogen in PCOS).

Which medication may be used to reduce the symptom of stress incontinence?

Desmopressin Duloxetine Fluoxetine Imipramine Tolterodine

Incorrect:

The answer is Duloxetine. Duloxetine is a balanced serotonin and noradrenaline reuptake inhibitor. It increases urinary sphincter tone and has been shown to reduce incontinence by about 50%, with improvements in quality of life. Tolterodine and oxybutynin are muscarinic receptor antagonists and are used in urge incontinence.

How can the mechanism of action of ranitidine best be described?

It neutralises the acidic content of the stomach It hastens the gastric emptying It reduces the acid content and production by gastric parietal cells It mainly has an antiemetic action It delays gastric emptying
Incorrect:

The answer is It reduces the acid content and production by gastric parietal cells. It is used preoperatively to reduce the risk of aspiration pneumonia and Mendelsons syndrome.

Ciprofloxacin is a quinolone antibiotic. What is its mode of action?

Inhibits cross linkage of the peptidoglycan polymer chains Inhibits dihydrofolate reductase Inhibits dihydropteroate synthetase Inhibits DNA gyrase Inhibits transpeptidation
Incorrect:

The answer is it inhibits DNA gyrase. Although quinolones act on the same pathway as sulphonamides, they act on the final pathway that converts relaxed DNA to supercoiled DNA. DNA gyrase is an essential enzyme for this step.

Which drug prevents the peripheral deiodination of thyroxine?

Potassium perchlorate Carbimazole Labetalol Propylthiouracil Iodine

Incorrect:

The answer is Propylthiouracil. Although propylthiourcil, like carbimazole, prevents the peroxidase oxidation of iodide to iodine in the thyroid gland, it also has a peripheral action.

Which of the agents inhibit dihydrofolate reductase?

Bleomycin

Cisplatin Flurouracil Methotrexate Mechlorethamine

Incorrect:

The answer is Methotrexate. Fluorouracil inhibits thymidylate synthase.

What is the primary mechanism of tranexamic acid in the treatment of heavy menstrual bleeding?

Inhibits the activation of plasmin Inhibits the activation of fibrin Inhibits the activation of fibrinogen Inhibits the activation of plasminogen Inhibits the activation of thrombin
Incorrect:

The answer is Inhibits the activation of plasminogen. This is a common question because you are expected to know about the common drugs you prescribe.