HIGH RISK

Question 1

What is Azathioprine used for?

Answer 1

Used for transplant recipients and autoimmune conditions

It is metabolised to mercaptopurine.

Question 2

What should be done to Azathioprine doses when allopurinol is administered?

Answer 2

Doses should be reduced due to risk of bone marrow suppression.

Question 3

What are common side effects of Azathioprine?

Answer 3

-Nausea
-Hypersensitivity reactions
-Neutropenia
-Thrombocytopenia.

Question 4

What monitoring is required for Azathioprine?

Answer 4

FBC every 4 weeks then every 3 months

Question 5

What is the importance of Thiopurine methyltransferase (TPMT) testing before starting Azathioprine?

Answer 5

Patients with absent TPMT activity must not receive thiopurine drugs.

Question 6

What is Ciclosporin and its mechanism of action?

Answer 6

A calcineurin inhibitor

Question 7

What are the side effects of Ciclosporin?

Answer 7

Hepatic disorders
Renal impairment
Hyperkalaemia.

Question 8

What monitoring is required for patients on Ciclosporin?

Answer 8

FBC, liver function, serum potassium, renal function.

Question 9

What should be monitored when a patient is on Methotrexate?

Answer 9

Full blood count, renal and liver function tests every 1–2 weeks initially THEN every 3 months

Question 10

What are some side effects of Methotrexate?

Answer 10

Anaemia
GI discomfort
Liver toxicity
Pulmonary toxicity.

Question 11

What is the recommended action for a pregnant woman on Methotrexate?

Answer 11

Avoid use due to teratogenic effects.

Question 12

What is Tacrolimus and its function?

Answer 12

A calcineurin inhibitor

Question 13

What are some side effects of Tacrolimus?

Answer 13

Tremor
Alopecia
Hypertension
Renal insufficiency
Hyperlipidaemia.

Question 14

What is the importance of prescribing Tacrolimus by brand name?

Answer 14

To avoid blood level fluctuations.

Question 15

What types of insulin are classified as rapid-acting?

Answer 15

Insulin aspart, insulin glulisine, insulin lispro.

Question 16

What is the onset and duration of short-acting insulin?

Answer 16

Onset: 30–60 min; Duration: 5–8 hours.

Question 17

What is the mechanism of action of sulfonylureas?

Answer 17

Increase insulin secretion from pancreatic beta cells.

Question 18

What are common side effects of sulfonylureas?

Answer 18

Hypoglycaemia, abdominal pain, diarrhoea.

Question 19

What precautions should be taken for elderly patients on sulfonylureas?

Answer 19

Avoid in severe hepatic impairment and use the lowest effective dose in renal impairment.

Question 20

What are examples of bisphosphonates?

Answer 20

Alendronate, Risedronate

These are commonly used bisphosphonates for osteoporosis treatment.

Question 21

What is the mechanism of action of bisphosphonates?

Answer 21

Absorbed onto bone crystals, slowing bone turnover.

Question 22

What is a key risk associated with IV bisphosphonates?

Answer 22

Osteonecrosis of the jaw.

Question 23

What are the side effects of SGLT2 inhibitors?

Answer 23

Constipation
Thirst
Nausea
Lower UTI
Hypoglycaemia
Polyuria.

Question 24

Which SGLT2 inhibitor has a risk of lower-limb amputation?

Answer 24

Canagliflozin.

Question 25

What are common examples of aminosalicylates?

Answer 25

Sulfasalazine, Mesalazine, Balsalazide sodium, Olsalazine sodium.

Question 26

What are the indications for aminosalicylates?

Answer 26

Acute attacks of mild-moderate and severe ulcerative colitis Active Crohn's disease.

Question 27

What should patients report when taking aminosalicylates?

Answer 27

Unexplained bleeding Bruising Sore throat Fever Malaise

Question 28

What are the side effects of PPIs?

Answer 28

Abdominal pain, constipation, diarrhoea, dizziness, dry mouth, headache.

Question 29

What is a risk associated with long-term use of PPIs?

Answer 29

Increased fracture risk.

Question 30

What are examples of antimuscarinics?

Answer 30

Oxybutynin Darifenacin Solifenacin Tolterodine.

Question 31

What is the mechanism of antimuscarinics?

Answer 31

Inhibit muscarinic receptors on smooth muscle

Question 32

What are emergency reasons to stop CHC immediately?

Answer 32

Sudden chest pain, breathlessness, severe leg pain/swelling, severe abdominal pain.

Question 33

What is the mechanism of gentamicin?

Answer 33

Aminoglycoside antibiotic Active against many gram-negative and some gram-positive bacteria.

Question 34

What are the indications for gentamicin?

Answer 34

Bone infections Endocarditis PID Meningitis Pneumonia UTI Sepsis

Question 35

What are the side effects of gentamicin?

Answer 35

Nephrotoxicity, irreversible ototoxicity, neuromuscular blockade, nausea, vomiting.

Question 36

What is the mechanism of vancomycin?

Answer 36

Glycopeptide antibiotic Inhibits bacterial cell wall synthesis (gram-positive).

Question 37

What are the risks associated with vancomycin?

Answer 37

Increasing resistance Nephrotoxicity Ototoxicity Blood disorders

Question 38

What is the indication for teicoplanin?

Answer 38

Serious gram-positive infections

Question 39

What is the mechanism of co-amoxiclav?

Answer 39

Amoxicillin (penicillin) + clavulanic acid (beta-lactamase inhibitor).

Question 40

What are the indications for co-amoxiclav?

Answer 40

UTI Respiratory infections Skin infections

Question 41

What are the side effects of co-amoxiclav?

Answer 41

Nausea, vomiting, antibiotic-associated colitis (C. difficile risk), cholestatic jaundice.

Question 42

What is a warning associated with quinolones?

Answer 42

Contraindicated in history of tendon disorders.

Question 43

What should be monitored when using itraconazole?

Answer 43

Liver function (risk of hepatotoxicity).

Question 44

What is a common side effect of voriconazole?

Answer 44

Phototoxicity.

Question 45

What should be monitored weekly for the first month of voriconazole therapy?

Answer 45

Renal and hepatic function.