Pharmacology

Question 1

What is the stepwise approach for asthma pharmacological management according to the Australian guidelines?

Answer 1

Step 1 - intermittent asthma (as-needed short-acting beta2 agonist (SABA))
Step 2 - mild persistent asthma (regular low-dose ICS)
Step 3 - moderate persistent asthma (low-dose ICS and additional therapy)
Step 4 - moderate to severe persistent asthma (medium-dose ICS and additional therapy)
Step 5 - severe persistent asthma (high-dose ICS and additional therapy).

Question 2

When is it appropriate to add a long-acting beta2 agonist (LABA) to inhaled corticosteroid (ICS) therapy for asthma?

Answer 2

According to the Australian guidelines, a LABA may be added to ICS therapy for asthma when the patient has persistent asthma symptoms despite treatment with low-dose ICS, or when the patient has moderate to severe asthma.

Question 3

What is the recommended treatment for acute asthma exacerbations?

Answer 3

The recommended treatment for acute asthma exacerbations includes a short-acting beta2 agonist (SABA) delivered via inhaler or nebulizer, along with oral or intravenous corticosteroids. Oxygen therapy may also be necessary for severe exacerbations.

Question 4

How often should asthma control be assessed in patients receiving pharmacological therapy?

Answer 4

According to the Australian guidelines, asthma control should be assessed at every visit for patients receiving pharmacological therapy for asthma. This includes monitoring symptoms, medication use, lung function, and exacerbation history.

Question 5

What are the potential side effects of inhaled corticosteroids (ICS) used for asthma management? How can they be minimized?

Answer 5

The potential side effects of ICS used for asthma management include hoarseness, oral thrush, and dysphonia. These side effects can be minimized by using a spacer and rinsing the mouth after inhalation.

Question 6

What are the potential side effects of beta2 agonists used for asthma?

Answer 6

The most common adverse effects of beta2 agonists used for asthma include tremors, tachycardia, palpitations, headache, hyperactivity, and hypokalemia.

Question 7

What is the first-line pharmacological treatment for primary hypertension?

Answer 7

Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin receptor blockers (ARBs)
Calcium channel blockers (CCBs)
Thiazide diuretics

Question 8

When would beta blockers be indicated for hypertension?

Answer 8

These medications may be preferred for patients with a history of myocardial infarction, heart failure with reduced ejection fraction, or atrial fibrillation. However, they should be avoided or used with caution in patients with asthma or chronic obstructive pulmonary disease.

Question 9

What considerations are there for the use of calcium channel blockers for hypertension?

Answer 9

These medications may be preferred for patients with coronary artery disease, angina, or peripheral artery disease. However, they should be avoided or used with caution in patients with heart failure.

Question 10

What considerations are there for the use of ACEi/ARBs for hypertension?

Answer 10

These medications may be preferred for patients with diabetes or chronic kidney disease, as they have shown to provide renal protection. However, caution should be taken in patients with bilateral renal artery stenosis or a history of angioedema

Question 11

Which antihypertensives are recommended for diabetic patients?

Answer 11

ACEIs or ARBs (protective against diabetic nephropathy)

Question 12

Difference between dihydropyridine and non-dihydropyridine CCBs. Mention examples of each.

Answer 12

Dihydropyridine CCBs primarily work by relaxing the smooth muscle cells in the walls of blood vessels, leading to vasodilation and a decrease in blood pressure. They have minimal effects on cardiac muscle cells and the electrical conduction system of the heart. Some examples of dihydropyridine CCBs include amlodipine, nifedipine, and felodipine.

Non-dihydropyridine CCBs have a greater effect on the heart and its electrical conduction system, and are therefore useful in treating certain arrhythmias such as atrial fibrillation. They also have some effect on blood vessels, but not as much as dihydropyridine CCBs. Some examples of non-dihydropyridine CCBs include verapamil and diltiazem.

Question 13

Indications for nitrates

Answer 13

Angina pectoris
- Short-acting nitrates such as sublingual nitroglycerin, isosorbide dinitrate, or nitroglycerin spray for treatment of acute attacks
- Long-acting nitrates such as isosorbide mononitrate can be taken regularly (2–3 times daily) for anginal prophylaxis: unlike some other nitrates, isosorbide mononitrate does not undergo first-pass metabolism by the liver and thus has ∼100% bioavailability.

Question 14

What are the effects of aspirin based on dosage?

Answer 14

Low dose (below 300 mg/day): inhibition of platelet aggregation, cardiovascular prevention
Intermediate dose (300-2400 mg/day): antipyretic and analgesic effect
High dose (2400-4000 mg/day): anti-inflammatory effect

Question 15

Adverse effects of aspirin

Answer 15

Gastrointestinal effects: Aspirin can irritate the lining of the stomach and cause ulcers and bleeding in the stomach and intestines.

Bleeding: Aspirin can interfere with blood clotting and increase the risk of bleeding, especially in people who are taking other medications that also affect blood clotting.

Allergic reactions: Some people may be allergic to aspirin and experience symptoms such as hives, swelling, and difficulty breathing.

Reye’s syndrome: Aspirin use in children and teenagers with viral illnesses such as the flu or chickenpox has been linked to Reye’s syndrome, a rare but serious condition that can cause liver and brain damage.

Kidney damage: Long-term use of high doses of aspirin can damage the kidneys.

Question 16

When would clopidogrel be indicated?

Answer 16

Clopidogrel is indicated for the prevention of blood clots, particularly in people with a history of heart attack, stroke, peripheral arterial disease, or acute coronary syndrome. It is also used in combination with aspirin to prevent blood clots in people with acute coronary syndrome or those undergoing percutaneous coronary intervention (PCI).

Question 17

Mention examples of parenteral and oral anticoagulants.

Answer 17

Examples of parenteral anticoagulants include:
- Heparin
- Enoxaparin

Examples of oral anticoagulants include:
- Warfarin
- Dabigatran
- Rivaroxaban
- Apixaban

Question 18

What is the therapeutic range for activated partial thromboplastin time (aPTT) when using unfractionated heparin (UFH)?

Answer 18

The therapeutic range for aPTT when using UFH is typically 1.5 to 2.5 times the control value. However, the exact target range may vary depending on the clinical situation and the patient’s individual characteristics.

Question 19

Which is the preferred agent for patients with severe renal impairment?

LMWH or UFH

Answer 19

While it is true that unfractionated heparin (UFH) is primarily cleared hepatically, both UFH and low molecular weight heparin (LMWH) can be used in patients with renal insufficiency. However, LMWH is generally preferred over UFH because it has a more predictable pharmacokinetic profile, a lower risk of bleeding complications, and does not require routine laboratory monitoring.

UFH may be preferred in certain situations such as patients with severe renal impairment or those requiring rapid anticoagulation reversal.

Question 20

When would LMWH be indicated over UFH?

Answer 20

• DVT prophylaxis, outpatient care (longer half-life → fewer injections)
• Generally preferred to UFH (fewer side effects, easier handling) as long as there are no contraindication (preferred in pregnancy)

Question 21

When would UFH be indicated over LMWH?

Answer 21

• Emergencies (more easily titrated, available as IV infusion)
• For patients with advanced renal failure (e.g., in patients with severe renal insufficiency (CrCl < 30mL/min) or the elderly)
• Pregnancies (does not cross placental barrier)

Question 22

Advantages and disadvantages of UFH.

Answer 22

Advantages:
Short half-life, allowing for rapid reversal if necessary
Can be used in patients with renal failure or in situations where renal function is uncertain, as it is not primarily cleared by the kidneys

Disadvantages:
Requires frequent monitoring of activated partial thromboplastin time (aPTT) to adjust dose
Can cause bleeding, heparin-induced thrombocytopenia (HIT), and osteoporosis with long-term use
Requires continuous IV infusion or frequent subcutaneous injections

Question 23

Advantages and disadvantages of LMWH.

Answer 23

Advantages:
More predictable anticoagulant effect, allowing for fixed dosing without routine monitoring
Lower risk of bleeding and HIT compared to UFH
Longer half-life, allowing for once or twice daily dosing
Does not require continuous IV infusion

Disadvantages:
Not easily reversible, with no specific antidote available
More expensive than UFH
May accumulate in patients with renal impairment and require dose adjustment

Question 24

Indications of UFH

Answer 24

Atrial fibrillation
DVT, acute arterial thrombosis, pulmonary embolism
Acute coronary syndrome, myocardial infarction
Mechanical heart valve replacement
VTE prophylaxis for patients with hemodialysis, heart-lung machine, etc.

Question 25

Commonly used oral anticoagulants

Answer 25

Warfarin (Coumadin) Direct oral anticoagulants (DOACs), also known as non-vitamin K oral anticoagulants (NOACs): Dabigatran (Pradaxa) Rivaroxaban (Xarelto) Apixaban (Eliquis) Edoxaban (Savaysa/Lixiana)

Question 26

Advantage and disadvantage of warfarin

Answer 26

Advantages: - low costs - reversible and can be easily managed in emergency situations (FFP or vitamin K) Regular blood tests can help monitor the effects of warfarin and adjust the dose if needed. Disadvantages: - narrow therapeutic window - dose needs to be closely monitored and adjusted - food and drug interactions - takes several days to reach its full effect, so patients may need riding anticoagulation - Regular blood tests are needed to monitor the international normalized ratio (INR) to ensure that the dose is appropriate, which can be inconvenient for patients.

Question 27

Advantages and disadvantages of NOACs

Answer 27

Advantages of NOACs include: - Predictable dosing with no need for regular monitoring of blood levels. - Lower risk of bleeding in the brain compared to warfarin. - Fewer drug interactions compared to warfarin. - Rapid onset of action, with some NOACs starting to work within hours of the first dose. Disadvantages of NOACs include: - Shorter half-life, which means that missed doses can increase the risk of clots. - Limited options for reversing the anticoagulant effect - Higher cost compared to warfarin. - Limited data on the use of NOACs in certain patient populations, such as those with severe kidney or liver disease, pregnant women, or patients with mechanical heart valves.

Question 28

What is the therapeutic range for warfarin?

Answer 28

For most indications, the target INR range is between 2.0 and 3.0, although in some cases (such as in patients with mechanical heart valves), a higher target range of 2.5 to 3.5 may be used.

Question 29

What are the main indication for warfarin and NOACs?

Answer 29

WARFARIN: Prophylaxis of thromboembolism (e.g., stroke) in patients with the following: - Valvular atrial fibrillation and nonvalvular atrial fibrillation - Heart valve replacement - Heart failure - DVT - PE NOACs: - Nonvalvular atrial fibrillation - DVT - PE

Question 30

Important drug interactions with warfarin.

Answer 30

Antibiotics: Antibiotics such as erythromycin, metronidazole, and fluconazole can increase warfarin levels and increase the risk of bleeding. Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen, naproxen, and aspirin can increase the risk of bleeding when taken with warfarin. Herbal supplements: Herbal supplements such as St. John's wort, ginseng, and garlic can interfere with warfarin metabolism and increase the risk of bleeding. Anticonvulsants: Anticonvulsants such as carbamazepine, phenytoin, and phenobarbital can increase warfarin metabolism and decrease its effectiveness. Statins: Statins such as atorvastatin and simvastatin can increase warfarin levels and increase the risk of bleeding.

Question 31

Side effects of loop diuretics

Answer 31

- Dehydration - Electrolyte disturbances (hypokalemia, hypomagnesemia, hyponatremia, hypocalcemia) - Metabolic alkalosis - Ototoxicity (especially with high doses and rapid IV administration) - Hyperuricemia and gout exacerbation - Impaired glucose tolerance - Hypotension - Skin rashes and photosensitivity.

Question 32

When would loop diuretics be preferred over thiazide or potassium-sparring diuretics?

Answer 32

When there is severe edema: Loop diuretics are more potent than other diuretics and can rapidly reduce fluid overload. When there is impaired renal function: Loop diuretics are effective in patients with impaired renal function as they act on the loop of Henle in the kidney, which is less dependent on renal blood flow. When there is a need for more rapid diuresis: Loop diuretics act more quickly than other diuretics and can produce a more rapid diuresis, which may be necessary in certain situations such as acute heart failure.

Question 33

When would thiazide diuretics be preferred over loop diuretics?

Answer 33

In patients with hypertension and normal kidney function or mild to moderate kidney impairment, as they are effective at lowering blood pressure and have a lower risk of electrolyte disturbances compared to loop diuretics. However, in patients with severe kidney impairment, thiazides may not be effective due to reduced renal excretion and loop diuretics may be preferred.

Question 34

When would potassium-sparing diuretics be preferred over loop or thiazide diuretics?

Answer 34

Potassium-sparing diuretics may be preferred over loop or thiazide diuretics in patients who are at risk of hypokalemia (low blood potassium levels) or have a history of cardiac arrhythmias (irregular heartbeat) because they help to conserve potassium. They may also be used in combination with other diuretics to counteract the potassium-wasting effects of those medications. Additionally, potassium-sparing diuretics may be used in patients with liver cirrhosis or ascites (accumulation of fluid in the abdomen) to help reduce fluid overload without causing electrolyte imbalances. However, they may not be as effective as other diuretics in reducing fluid volume.

Question 35

Important drug interactions with loop diuretics and their effects.

Answer 35

- NSAIDs - can decrease the effectiveness of loop diuretics and risk of kidney damage - Digoxin - can cause increased risk of digoxin toxicity due to hypokalemia - Lithium - can increase lithium levels and cause toxicity - Aminoglycoside antibiotics - can increase the risk of ototoxicity and nephrotoxicity - Corticosteroids - can decrease the effectiveness of loop diuretics and increase the risk of hypokalemia - ACE inhibitors and ARBs - can increase the risk of hyperkalemia when used with potassium-sparing diuretics.

Question 36

Important drug interactions with thiazide diuretics and their effects.

Answer 36

NSAIDs: Can decrease the effectiveness of thiazides and increase the risk of kidney damage. Lithium: Thiazides can increase the levels of lithium in the blood, leading to toxicity. Digoxin: Thiazides can cause low potassium levels, which can increase the risk of digoxin toxicity. Antidiabetic agents: Thiazides can increase blood sugar levels and reduce the effectiveness of antidiabetic medications. Calcium supplements and vitamin D: Thiazides can increase calcium levels in the blood, and taking calcium supplements or vitamin D with thiazides can increase the risk of high calcium levels.

Question 37

Examples of the different types of diuretics.

Answer 37

Loop diuretics: Examples include furosemide, bumetanide, and torsemide. Thiazide diuretics: Examples include hydrochlorothiazide, chlorthalidone, and indapamide. Potassium-sparing diuretics: Examples include spironolactone, eplerenone, and amiloride.

Question 38

What is the different use for H1 and H2 antihistamines?

Answer 38

H1 antihistamines are mainly used for allergic conditions, such as hay fever and hives, and they work by blocking histamine receptors in the body. On the other hand, H2 antihistamines are primarily used to treat conditions related to excess stomach acid production, such as gastroesophageal reflux disease (GERD), and they work by blocking histamine receptors in the stomach.

Question 39

Side effects of H1 antihistamines

Answer 39

- Sedation (less pronounced with second-generation antihistamines) - Anticholinergic effects (dry mouth and eyes, urinary retention, tachycardia, dizziness) - Headaches

Question 40

Indications for H2 antihistamines

Answer 40

Mainly for gastroesophageal reflux disease (GERD), peptic ulcers, and dyspepsia

Question 41

Side effects of a short-term course of corticosteroids.

Answer 41

- Increased appetite and weight gain - Insomnia or disrupted sleep - Mood changes, such as irritability or restlessness - Increased risk of infections, including fungal infections - Increased blood sugar levels, which may be a concern for people with diabetes

Question 42

Side effects of a long-term course of corticosteroids

Answer 42

- Osteoporosis and increased risk of fractures - Diabetes and impaired glucose tolerance - Hypertension and fluid retention - Cataracts and glaucoma - Increased risk of infections - Mood changes and psychiatric symptoms.

Question 43

Corticosteroids indications

Answer 43

- Inflammatory and autoimmune conditions such as asthma, chronic obstructive pulmonary disease (COPD), rheumatoid arthritis, lupus, and inflammatory bowel disease (IBD) - Allergic reactions and anaphylaxis - Skin conditions such as eczema, psoriasis, and dermatitis - Adrenal insufficiency - Transplant rejection prophylaxis - Cancer chemotherapy-induced nausea and vomiting.

Question 44

How would you stop corticosteroid use?

Answer 44

Short-term administration (≤ 3 weeks): usually no tapering is necessary Long-term administration (> 3 weeks): tapering regimen based on patient age and condition and on duration/dose of prior glucocorticoid administration → e.g., tapering over 2 months Sudden discontinuation after chronic use should be avoided because of the risk of adrenal insufficiency (adrenal crisis) secondary to long-term hypothalamic-pituitary-adrenal axis suppression.

Question 45

Adverse effects of PPIs

Answer 45

GI: nausea/diarrhea, abdominal pain, reduced absorption of iron and Vit B12, reduced absorption of calcium and magnesium (increased risk of osteoporosis) Neuro: lightheadedness, headaches

Question 46

Indications for PPI

Answer 46

Gastroesophageal reflux disease (GERD) Peptic ulcer disease Zollinger-Ellison syndrome Dyspepsia Barrett's esophagus Gastric prophylaxis in critically ill patients

Question 47

Side effects of statins

Answer 47

Muscle pain and weakness (continue if CK remains normal) Digestive problems such as nausea, constipation, or diarrhea Liver damage (increased LFTs 0 in up to 3% of patients)

Question 48

Indications for statin

Answer 48

- Primary prevention of cardiovascular events in individuals with elevated risk factors (such as high cholesterol, hypertension, diabetes, smoking, and family history of heart disease). - Secondary prevention of cardiovascular events in individuals who have already experienced a heart attack, stroke, or other cardiovascular event. - Familial hypercholesterolemia and other genetic lipid disorders. - Reduction of LDL cholesterol levels in individuals with hypercholesterolemia or dyslipidemia.

Question 49

Which lipid-lowering medication is most effective in treating high TG levels?

Answer 49

Fibrates

Question 50

Which antidiabetic drug has a higher risk of hypoglycaemia and why?

Answer 50

Sulfonylureas have a higher risk of hypoglycemia compared to other antidiabetic drugs. This is because they work by stimulating insulin secretion from the pancreas, and this release is glucose-independent (unlike GLP-1 agonists or DPP-4 inhibitors).

Question 51

Side effect profile of biguanides

Answer 51

Gastrointestinal upset (nausea, diarrhea, abdominal pain) Vitamin B12 deficiency (with long-term use) Lactic acidosis (rare but serious)

Question 52

Side effects of DPP-4 inhibitors

Answer 52

Upper respiratory tract infections Headache Gastrointestinal upset Pancreatitis (rare)

Question 53

Side effect profile of GLP-1 agonists

Answer 53

Nausea Vomiting Diarrhea Pancreatitis (rare)

Question 54

Side effects of SGLT-2 inhibitors

Answer 54

Genital yeast infections Urinary tract infections Hypotension (low blood pressure) Diabetic ketoacidosis (rare but serious)

Question 55

Which antidiabetic drug is indicated for pregnancy?

Answer 55

All antidiabetic agents are contraindicated. Antidiabetic drugs should be substituted with human insulin as early as possible (ideally prior to the pregnancy)

Question 56

Which antidiabetic drugs can be administered in moderate-severe CKD (eGFR<30)

Answer 56

Metformin: Metformin is renally cleared, and its use is contraindicated in patients with eGFR<30. However, it can be used with caution in patients with eGFR 30-45, with dose adjustments and close monitoring of renal function. Insulin: Insulin is not renally cleared, and its use is not affected by kidney function. GLP-1 receptor agonists: GLP-1 receptor agonists are not renally cleared, and their use is not affected by kidney function. DPP-4 inhibitors: Most DPP-4 inhibitors can be used in patients with eGFR<30, with dose adjustments and careful monitoring of renal function. However, linagliptin is the only DPP-4 inhibitor that does not require dose adjustments in patients with renal impairment. SGLT2 inhibitors: Most SGLT2 inhibitors are not recommended in patients with eGFR<30, due to the risk of renal impairment and euglycemic ketoacidosis. However, dapagliflozin is approved for use in patients with eGFR down to 30 mL/min/1.73m2, with dose adjustments and careful monitoring of renal function.

Question 57

Which antidiabetic drug has weight loss properties?

Answer 57

GLP-1 receptor agonists Metformin SGLT-2 inhibitors

Question 58

Which antidiabetic drug has weight gain properties?

Answer 58

The most common ones include insulin, sulfonylureas (such as glipizide and glyburide), and thiazolidinediones (such as pioglitazone and rosiglitazone).

Question 59

Which antidiabetic drugs have CV and/or renal protective factors?

Answer 59

Sodium-glucose cotransporter-2 (SGLT2) inhibitors: A newer class of medications that lower blood glucose levels by blocking glucose reabsorption in the kidneys, leading to increased urinary glucose excretion. They have been shown to have CV and renal protective effects. Glucagon-like peptide-1 (GLP-1) agonists: A class of medications that stimulate the release of insulin and inhibit the release of glucagon. They have shown to have CV protective effects and reduce the risk of diabetic nephropathy.

Question 60

How often does HbA1c has to be repeated when assessing glycaemic target?

Answer 60

Every 3 months

Question 61

At what levels of HbA1C would you consider adding a second hypoglycemic agent?

Answer 61

According to the Australian Diabetes Society (ADS) guidelines, a second hypoglycemic agent should be considered when HbA1C levels are persistently above 53 mmol/mol (7%) despite optimization of lifestyle interventions and metformin therapy.

Question 62

Which antidiabetic drug results in the greatest reduction in HbA1c?

Answer 62

insulin and GLP-1 receptor

Question 63

What is a basal-bolus insulin regimen?

Answer 63

In this regimen, a long-acting insulin (such as glargine or detemir) is administered once or twice daily to provide a basal insulin level. Short-acting insulin (such as lispro, aspart or glulisine) is then administered before meals to cover the rise in blood sugar levels after eating.

Question 64

When is insulin indicated for T2D?

Answer 64

Insulin therapy is indicated for patients with type 2 diabetes when glycemic targets are not achieved with lifestyle measures and oral hypoglycemic agents. Insulin therapy is also indicated for patients with symptomatic hyperglycemia or hyperglycemic crises, and for those who require insulin for other medical conditions (e.g. glucocorticoid-induced hyperglycemia).

Question 65

Indications of bisphosphonates (-dronates)

Answer 65

Treatment of osteoporosis Treatment of Paget's disease of bone Hypercalcemia of malignancy

Question 66

A simple summary of the underlying mechanism of bisphosphonates

Answer 66

Interferes with osteoclast activity and promotion of osteoclast apoptosis => reduced bone resorption

Question 67

Adverse effect of bisphosphonates

Answer 67

- Hypocalcemia - Aseptic osteonecrosis of the jaw - Atypical femoral fractures - Esophageal inflammation and cancer

Question 68

What should you tell patients before consuming oral bisphosphonates?

Answer 68

Patients should swallow medication with a sufficient amount of water and maintain an upright position for 30 minutes.

Question 69

When would POPs be preferred over OCPss?

Answer 69

OCPs are contraindicated in women with certain medical conditions, such as a history of blood clots, breast cancer, or uncontrolled high blood pressure. POPs may be a better option for women who cannot take estrogen, such as those who are breastfeeding or have a history of blood clots.

Question 70

What are the non-contraceptive benefits of OCPs?

Answer 70

improved menstrual cycle regulation and reduced risk of ovarian and endometrial cancer

Question 71

Adverse effects of the pill

Answer 71

Estrogen: VTE, hypertension, headaches, hepatic adenoma Progestin: breakthrough bleeding, follicular cyst

Question 72

What is the recommendation if you missed one day of OCP?

Answer 72

If you miss one day of the combined oral contraceptive pill (COC), the effectiveness of the pill may be reduced. It is recommended to take the missed pill as soon as possible, even if it means taking two pills in one day. Carry on taking the rest of the pack as normal. You do not need to use extra contraception.

Question 73

Most effective emergency contraception

Answer 73

The most effective emergency contraception is the copper intrauterine device (IUD). It is more than 99% effective in preventing pregnancy when inserted up to five days after unprotected sex. Other forms of emergency contraception, such as levonorgestrel (Plan B) or ulipristal acetate (Ella), can also be effective if taken within a certain time frame after unprotected sex (<3 days)

Question 74

Non-contraceptive indications of hormonal contraceptives

Answer 74

Menstrual irregularities: OCPs can be used to regulate menstrual cycles, reduce menstrual pain, and manage heavy menstrual bleeding. Acne: Some types of OCPs can improve acne by decreasing androgen production, which can reduce sebum production and inflammation. Polycystic ovary syndrome (PCOS): OCPs can be used to regulate menstrual cycles, reduce androgen production, and manage symptoms of PCOS, such as acne and hirsutism. Endometriosis: OCPs can help manage symptoms of endometriosis by suppressing ovulation and reducing menstrual flow and pain. .

Question 75

Compare heparin and warfarin

Answer 75

Heparin is a fast-acting anticoagulant that is typically used in acute settings, while warfarin is an oral anticoagulant used for long-term prevention of blood clots. Heparin is typically administered by injection, either subcutaneously or intravenously. It has a short half-life and is usually used in acute settings such as during hospitalization or for short-term prophylaxis. Warfarin, on the other hand, is an oral anticoagulant that works by inhibiting the vitamin K-dependent clotting factors. It takes several days to reach its full effect, so it is typically used for long-term prevention of blood clots.

Question 76

Antibiotic commonly used for UTI prophylaxis

Answer 76

Low dose trimethoprim (100mg daily)

Question 77

What is the usual first-line antibiotic for Gi infection?

Answer 77

Ciprofloxacin and metronidazole Ciprofloxacin is a fluoroquinolone antibiotic that has a broad spectrum of activity against many Gram-negative and Gram-positive bacteria, including Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Salmonella, Shigella, and Campylobacter jejuni. Metronidazole is an antibiotic and antiprotozoal medication that is particularly effective against anaerobic bacteria, including Bacteroides fragilis, Clostridium difficile, and Helicobacter pylori. Additionally, it is effective against protozoa such as Entamoeba histolytica and Giardia lamblia.

Question 78

Antibiotics for C. difficile infection

Answer 78

The first-line treatment is typically oral vancomycin or fidaxomicin. Metronidazole may be used as an alternative for mild-to-moderate infection.

Question 79

Antibiotic treatment for otitis media

Answer 79

According to Australian Therapeutic Guidelines, the recommended first-line antibiotics for uncomplicated acute otitis media in children are amoxicillin. For patients allergic to penicillin, cephalosporins such as cefuroxime may be used.

Question 80

Treatment of asymptomatic Chlamydia trachomatis infection.

Answer 80

Oral doxycycline or Oral azithromycin

Question 81

Treatment of asymptomatic gonorrhea infection.

Answer 81

Ceftriaxone + azithromycin Azithromycin is used to cover C. trachomatis, which often co-exists with N. gonorrhoeae

Question 82

Antibiotic choice for trichomonas infection

Answer 82

Metronidazole

Question 83

Antibiotic choice for treatment of early syphilis

Answer 83

Early latent syphilis is an asymptomatic infection of fewer than 2 years’ duration. Benzylpenicillin or doxycycline (if penicillin hypersensitive)

Question 84

Common etiology of cellulitis and antibiotic treatment choice.

Answer 84

Streptococcus pyogenes (GAS) or Staphylococcus aureus Benzylpenicillin (if GAS) or flucloxacillin (if S. aureus) If penicillin hypersensitive, use cefalexin

Question 85

When is antiviral therapy indicated for shingles?

Answer 85

immunocompetent adults and adolescents who present within 72 hours of onset of rash, and for all immunocompromised adults and adolescents (including those with HIV infection) regardless of duration of rash

Question 86

When is gentamicin indicated?

Answer 86

Gram-negative infections such as sepsis, urinary tract infections, respiratory tract infections, and meningitis caused by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Proteus species, and Acinetobacter species.

Question 87

Treatment for H. pylori infection.

Answer 87

Triple therapy - PPI + clarithromycin + amoxicillin/metronidazole

Question 88

Common etiology and antibiotic choice for bacterial meningitis

Answer 88

The most common pathogens in bacterial meningitis are Streptococcus pneumoniae, Neisseria meningitidis and, in young children who are not fully vaccinated, Haemophilus influenzae type b (Hib). Listeria monocytogenes is more common in adults older than 50 years, immunocompromised patients and neonates. Common regimen for bacterial meningitis in adults is intravenous ceftriaxone (good CNS penetrance) or cefotaxime plus dexamethasone. For patients who are older than 50 years, immunocompromised, pregnant or debilitated, or those with a history of hazardous alcohol consumption, to treat Listeria, add benzylpenicillin. Add vancomycin if S. pneumonia is suspected.

Question 89

Aetiology and empirical therapy for native valve IE

Answer 89

Staphylococcus aureus, viridans streptococci, coagulase-negative staphylococci, enterococci, and the HACEK group of oral Gram-negative bacilli Benzylpenicillin (or vancomycin if MRSA) + flucloxacillin + gentamicin

Question 90

Aetiology and empirical therapy for prosthetic valve IE

Answer 90

Staphylococci (Staphylococcus aureus and coagulase-negative staphylococci), Corynebacterium species, Streptococcus species, enterococci, Enterobacteriaceae, Pseudomonas aeruginosa Vancomycin + flucloxacillin + gentamicin

Question 91

Metoclopramide vs ondasteron

Answer 91

Metoclopramide works by blocking dopamine receptors in the brain and gastrointestinal tract, which increases the movement of food through the stomach and intestines and can prevent nausea and vomiting. It is often used for nausea and vomiting caused by gastrointestinal conditions such as gastroparesis or reflux, as well as for chemotherapy-induced nausea and vomiting. However, metoclopramide can have side effects such as restlessness, drowsiness, and tardive dyskinesia (a movement disorder). Ondansetron, on the other hand, works by blocking serotonin receptors in the brain and gastrointestinal tract. This can also prevent nausea and vomiting, and it is often used for chemotherapy-induced nausea and vomiting as well as postoperative nausea and vomiting. Ondansetron generally has fewer side effects than metoclopramide, but it can still cause headache, constipation, and dizziness.

Question 92

What are the different types of antipsychotics?

Answer 92

There are two main types of antipsychotics: typical and atypical. Typical antipsychotics include drugs such as chlorpromazine and haloperidol, while atypical antipsychotics include drugs such as risperidone and olanzapine.

Question 93

What are the side effects of antipsychotics?

Answer 93

- EPS symptoms: FGA>SGA - Hyperprolactinemia - Anticholinergic side effects (dry mouth, constipation, urinary retention, blurred vision) - Metabolic adverse effects: SGA>FGA

Question 94

What are important side effects to consider in clozapine?

Answer 94

Agranulocytosis Myocarditis Sialorrhea Metabolic syndrome

Question 95

What is tardive dyskinesia?

Answer 95

Tardive dyskinesia is a movement disorder that can occur as a side effect of long-term use of antipsychotics. It is characterized by involuntary movements such as lip smacking, tongue protrusion, and grimacing.

Question 96

What is the difference between typical and atypical antipsychotics?

Answer 96

Typical antipsychotics primarily block dopamine receptors in the brain, while atypical antipsychotics block both dopamine and serotonin receptors. Atypical antipsychotics are generally considered to have fewer side effects than typical antipsychotics.

Question 97

What are the possible options if a patient experiences EPS after antipsychotic use?

Answer 97

1. Reduce the dose of the antipsychotic medication 2. Switch to a different antipsychotic medication 3. Add an anticholinergic medication: Anticholinergic medications such as benztropine or diphenhydramine can be used to alleviate EPS symptoms. 4. Consider discontinuing the antipsychotic medication

Question 98

Preferred agent for acute psychosis

Answer 98

First-line: SGAs

Question 99

Preferred agent for refracctory agitations in acute delirium

Answer 99

- FGA: haloperidol - SGA: risperidone, olanzapine Benzodiazepines are deliriogenic. Do not treat delirious patients with benzodiazepines unless the delirium is due to alcohol or benzodiazepine withdrawal.

Question 100

Preferred agent for treatment-resistant schizophrenia

Answer 100

Clozapine

Question 101

Preferred agent for acute mania

Answer 101

Atypical antipsychotics are frequently used for the management of acute mania due to their rapid onset of action and various forms of administration. E.g. quetiapine, aripiprazole

Question 102

Preferred agent for psychosis during pregnancy

Answer 102

FGAs (e.g., haloperidol)

Question 103

Common side effects of antidepressants

Answer 103

Nausea Constipation Insomnia or sleep disturbances Sexual dysfunction Weight gain and increased appetite Increased risk of suicidal thoughts or behaviours, particularly in children and young adults.

Question 104

Preferred agent for depression with insomnia

Answer 104

Mirtazapine is a first-line antidepressant for depression with insomnia due to its sedative effects.

Question 105

Preferred agent for depression in pregnancy and breastfeeding

Answer 105

SSRIs such as sertraline and fluoxetine are the first-line antidepressants in pregnant and breastfeeding women.

Question 106

Preferred agent for depression in children

Answer 106

Fluoxetine - more safety data for fluoxetine in children, it is the preferred SSRI. Alternative include escitalopram or sertraline

Question 107

How long before antidepressants take effect?

Answer 107

up to 4-6 weeks

Question 108

Empirical therapy for low-severity CAP in adults

Answer 108

amoxycillin + doxycycline

Question 109

Empirical therapy for medium-severity CAP in adults

Answer 109

benzylpenicillin + doxycycline

Question 110

Empirical therapy for low-medium severity HAP in adults

Answer 110

oral or IV augmentin Alternative: IV ceftriaxone or cefotaxime

Question 111

Empirical therapy for high-severity HAP in adults

Answer 111

IV piperacillin + tazobactam

Question 112

Empirical therapy for high severity CAP in adults

Answer 112

azithromycin + ceftriaxone

Question 113

Common etiology of CAP

Answer 113

Typical - Streptococcus pneumoniae - Klebsiella - Haemophilus influenzae Atypical - Legionella pneumophila - Chlamydia - Mycoplasma pneumoniae

Question 114

Common etiology of HAP

Answer 114

Most common: S. pneumoniae Others: P. aeruginosa, MRSA, Enterobacteriae

Question 115

Etiology of acute cholecystitis and empirical antibiotics.

Answer 115

Enterobacteriaceae (eg Escherichia coli and Klebsiella species) - Empirical antibiotics: IV gentamicin + amoxicillin - Alternative: IV augmentin or ceftriaxone