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Question 1
Incorrect
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An 26 year old patient currently 9 weeks pregnant. This is her 1st pregnancy. She has been suffering with nausea and vomiting that has failed to respond to conservative measures including ginger, dietary changes and acupuncture. She wants to start medical therapy. Which of the following is 1st line drug treatment according to NICE guidance?
Your Answer: Domperidone
Correct Answer: Promethazine
Explanation:Promethazine or Cyclizine are 1st choice options for management of nausea and vomiting in pregnancy according to NICE. Prochlorperazine is also appropriate 1st line.
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This question is part of the following fields:
- Pharmacology
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Question 2
Correct
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Tamoxifen is associated with an increased risk of which of the following?
Your Answer: Endometrial cancer
Explanation:Tamoxifen is an oestrogen antagonist in breast tissue but it acts as a partial oestrogen agonist on the endometrium increasing the risk of hyperplasia and has been linked to endometrial cancer. Tamoxifen improves bone density in post-menopausal women. It is an off license treatment for gynaecomastia. Reduced lactation is a potential side effect of Tamoxifen.
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This question is part of the following fields:
- Pharmacology
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Question 3
Correct
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The following drugs cross the placenta to the foetus, EXCEPT:
Your Answer: Heparin
Explanation:Standard heparin, an effective treatment for antepartum thromboembolic disease, is thought to be safe for the foetus since it does not cross the placenta.
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This question is part of the following fields:
- Pharmacology
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Question 4
Correct
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In which part of the body does clomiphene trigger ovulation by antagonising oestrogen receptors?
Your Answer: Hypothalamus
Explanation:Clomiphene citrate is widely used in the induction of ovulation, especially in the treatment of anovulatory infertility and in conditions such as PCOS. The drug functions as a selective oestrogen receptor modulator, which acts in the hypothalamus to indicate low serum oestrogen levels. Reduced levels of negative feedback stimulate the secretion of GnRH from the hypothalamus, which in turn stimulate the production of gonadotropins (FSH and LH) from the anterior pituitary. These work to increase ovarian follicular activity.
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This question is part of the following fields:
- Pharmacology
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Question 5
Correct
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Hypoplasia & yellow discoloration of the primary teeth has occurred in infants whose pregnant mothers were treated with which drug:
Your Answer: Tetracycline
Explanation:Tetracycline is a broad-spectrum antibiotic that crosses placental barrier. Tetracycline was the first line of therapy in treating infections caused by Mycoplasma pneumoniae, chlamydia, rickettsia, and some spirochaetes. It has a wide range of adverse effects and is known for a unique property of being incorporated into skeletal and dental tissues at sites of active mineralization and staining of these tissues.
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This question is part of the following fields:
- Pharmacology
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Question 6
Correct
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What is the target INR in a patient who has just been started on warfarin therapy due to a pulmonary embolism?
Your Answer: 2.0-3.0
Explanation:Warfarin can be useful for management of thromboembolism. The target INR range for this medication is between 2.0-3.0 in patients with venous thromboembolism, pulmonary embolism etc. The INR range may increase to 3.0-4.0 in patients with mechanical valves. However, warfarin is not recommended in pregnancy, and Low Molecular Weight Heparin should be used for thromboprophylaxis instead.
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This question is part of the following fields:
- Pharmacology
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Question 7
Correct
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Tamoxifen is associated with an increased risk of which of the following?
Your Answer: Endometrial cancer
Explanation:Tamoxifen is a SERM that is effective in treating hormone-responsive breast cancer, it acts as an antagonist to prevent receptor activation by endogenous oestrogen. As agonist of the endometrial receptors it promotes endometrial hyperplasia and hence increases the risk of endometrial cancer.
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This question is part of the following fields:
- Pharmacology
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Question 8
Correct
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Which of the following best describes the mechanism of action of Promethazine?
Your Answer: Histamine H1-receptor antagonist
Explanation:Promethazine is type of antihistamine that acts on the H1 receptor. In pregnancy NICE guidelines advise oral promethazine or oral cyclizine should be used as 1st line drug management of nausea and vomiting. Both are H1 antagonists.
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This question is part of the following fields:
- Pharmacology
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Question 9
Incorrect
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A patient is on the ward with a mechanical mitral valve. There is no history of VTE. What is the target INR?
Your Answer: 2.5 - 3.0
Correct Answer: 2.5 - 3.5
Explanation:With the use of warfarin, strict control of the INR is compulsory. After mitral valve replacement the INR should ideally be kept between 2.5-3.5. If the Ball and Cage or the Tilting Disc is used as a prosthetic valve then the target INR is 3.5, for bi-leaflets the target INR is 3.0 and for biological valves the target INR is 2.5.
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This question is part of the following fields:
- Pharmacology
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Question 10
Incorrect
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You see a patient who gave birth earlier in the day. She was taken off warfarin during pregnancy and is currently on LMWH. She intends to breastfeed for the first 6-8 weeks and wants advice regarding restarting warfarin. Which of the following is appropriate?
Your Answer:
Correct Answer: Recommence warfarin in 5-7 days
Explanation:The use of anticoagulants during pregnancy is a complicated issue because warfarin is teratogenic if used in the first trimester, and is linked with fetal intracranial haemorrhage in the third trimester (mainly at doses 5 mg daily). Low molecular weight heparin may be insufficient at preventing thrombosis in women with mechanical prosthetic heart valves, where the risk of valve thrombus is 10 per cent. Anticoagulation is essential in patients with congenital heart disease who have pulmonary hypertension, or artificial valve replacements, and in those in or at risk of atrial fibrillation. The options are either to continue warfarin for the pregnancy, or replace it with heparin between 6 and 12 weeks gestation to avoid the teratogenic risk. Warfarin should be started a week after delivery.
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This question is part of the following fields:
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
