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  • Question 1 - A 62-year-old woman is brought to the Emergency Department as she is acutely...

    Correct

    • A 62-year-old woman is brought to the Emergency Department as she is acutely unwell. Her attendants inform you that she was recently started on lithium as a mood stabilizer.

      You instantly send a blood sample to check for lithium levels.

      What is the usual therapeutic range for lithium?

      Your Answer: 0.4-0.8 mmol/l

      Explanation:

      Lithium is the drug of choice for recurrent bipolar illness but should be carefully monitored as it has a very low therapeutic index. The normal therapeutic range is 0.4-0.8 mmol/l.

      The lower end of the range is usually the target for the elderly and as maintenance therapy. Toxicity is usually seen at levels >1.5 mmol/l. Samples should be taken 12 hours after the dose, and levels should be checked one week after starting therapy and one week after every change in dosage.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      6.7
      Seconds

  • Question 2 - The triage nurse asks if you will prescribe a dose of codeine phosphate...

    Incorrect

    • The triage nurse asks if you will prescribe a dose of codeine phosphate for a patient who is in a lot of pain. You discover that you are unable to prescribe it due to a contra-indication after evaluating the patient.

      The use of codeine phosphate is contraindicated in which of the following situations?

      Your Answer: Recent stroke

      Correct Answer: Age under 12 years

      Explanation:

      Codeine phosphate is a mild opiate that can be used to treat mild to moderate pain when other pain relievers like paracetamol or ibuprofen have failed. It can also be used to treat diarrhoea and coughs that are dry or painful.

      The use of all opioids is contraindicated for the following reasons:
      Respiratory depression (acute)
      Patients who are comatose
      Head injury (opioid analgesics impair pupillary responses, which are crucial for neurological evaluation)
      Intracranial pressure has risen (opioid analgesics interfere with pupillary responses vital for neurological assessment)
      There’s a chance you’ll get paralytic ileus.

      The use of codeine phosphate is contraindicated in the following situations:
      Because of the significant risk of respiratory side effects in children under the age of 12, it is not recommended for children under the age of 12.

      Patients of any age who have been identified as ultra-rapid codeine metabolizers (CYP2D6 ultra-rapid metabolizers)

      Because codeine can pass through breast milk to the baby and because mothers’ ability to metabolise codeine varies greatly, it is especially dangerous in breastfeeding mothers.

      If other painkillers, such as paracetamol or ibuprofen, fail to relieve acute moderate pain in children over the age of 12, codeine should be used. In children with obstructive sleep apnoea who received codeine after tonsillectomy or adenoidectomy, a significant risk of serious and life-threatening adverse reactions has been identified.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      30.8
      Seconds

  • Question 3 - A 5-year-old girl is brought into the Paediatric ER for acute seizures. She...

    Correct

    • A 5-year-old girl is brought into the Paediatric ER for acute seizures. She has been convulsing for the past 18 minutes now and was already two doses of lorazepam in the ambulance. Now, you prepare a phenytoin infusion to abolish the seizures.

      According to the APLS algorithm, what dose of phenytoin is advised for a convulsing child at this stage?

      Your Answer: 20 mg/kg over 20 minutes

      Explanation:

      Advanced paediatric life support (APLS) recommends phenytoin as the first choice for second-line anticonvulsant in a patient that continues to seize ten minutes after the second dose of the first-line anticonvulsant (benzodiazepine). (step 3 of the APLS algorithm)

      The recommended dose of phenytoin infusion is up at 20 mg/kg over 20 minutes. If the patient has already taken phenytoin as maintenance therapy or is allergic to phenytoin, then a phenobarbitone infusion should be set up at 20 mg/kg over 30-60 minutes.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      11.9
      Seconds

  • Question 4 - Despite taking the oral contraceptive pill, a 29-year-old woman becomes pregnant. During a...

    Correct

    • Despite taking the oral contraceptive pill, a 29-year-old woman becomes pregnant. During a medication review, you discover that she is epileptic and that her antiepileptic therapy has recently been changed.

      Which of the following antiepileptics is most likely to impair the oral contraceptive pill's effectiveness?

      Your Answer: Carbamazepine

      Explanation:

      The metabolism of ethinyl oestradiol and progestogens has been shown to be increased by enzyme-inducing antiepileptics. The oral contraceptive pill (OCP) is less effective in preventing pregnancy as a result of this increased breakdown.

      Antiepileptic drugs that induce enzymes include:
      Carbamazepine
      Phenytoin
      Phenobarbital
      Topiramate

      Antiepileptics that do not induce enzymes are unlikely to affect contraception. Non-enzyme-inducing anticonvulsants include the following:
      Clonazepam
      Gabapentin
      Levetiracetam
      Piracetam
      Sodium valproate is a type of valproate that is used to

      Lamotrigine is an antiepileptic drug that does not cause the production of enzymes. It does, however, require special consideration, unlike other non-enzyme-inducing antiepileptics. The OCP does not appear to affect epilepsy directly, but it does appear to lower lamotrigine levels in the blood. This could result in a loss of seizure control and the occurrence of seizures.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      10.9
      Seconds

  • Question 5 - A 32-old woman comes for a follow-up visit after being discharged on medications...

    Incorrect

    • A 32-old woman comes for a follow-up visit after being discharged on medications for her newly diagnosed epilepsy. She now complains of a tremor in her arm when she holds a tray in her hand. You examine the patient and notice she has developed postural tremors.

      Which of the following medications for epilepsy is most likely responsible for this tremor?

      Your Answer: Phenytoin

      Correct Answer: Sodium valproate

      Explanation:

      A postural tumour is observed when a person maintains a position against gravity, such as holding the arms outstretched. (The patient holding her tray against gravity)

      Sodium valproate is the most commonly prescribed medication for epilepsy. It is commonly associated with tremors as valproate-induced tremors occur in around 6-45% of patients. The tremors are commonly postural, but a resting tremor may also occur.

      Approximately 25% of patients taking sodium valproate are found to develop a tremor within 3-12 months of initiating therapy.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      21.8
      Seconds

  • Question 6 - A 78-year-old woman visits the emergency room with dizziness and nausea. She claims...

    Correct

    • A 78-year-old woman visits the emergency room with dizziness and nausea. She claims that her doctor gave her cinnarizine two days prior, but that it didn't seem to help.

      Cinnarizine's mechanism of action is which of the following?

      Your Answer: Antihistamine action

      Explanation:

      Cinnarizine is a piperazine derivative with an antihistamine effect that makes it anti-emetic. Motion sickness and vestibular disorders, such as Méniéres disease, are the most common conditions for which it is prescribed.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      36.3
      Seconds

  • Question 7 - A 32-year-old man is dehydrated as he presents with severe vomiting and diarrhoea....

    Correct

    • A 32-year-old man is dehydrated as he presents with severe vomiting and diarrhoea. He urgently requires resuscitation with intravenous fluid administration. He is also administered metoclopramide.

      Which of the following is the true mechanism of action of metoclopramide?

      Your Answer: Dopamine receptor antagonism

      Explanation:

      Metoclopramide is used to treat nausea and vomiting. It works by blocking the central and peripheral D2 (dopamine 2) receptors in the medullary chemoreceptor trigger zone in the vomiting centre (area postrema). It decreases the sensitivity of the visceral sensory nerves that transmit from the GI system to the vomiting centre. Blockade of inhibitory dopamine receptors in the GI tract may allow stimulatory actions of ACh at muscarinic synapses to predominate.

      At high doses, metoclopramide also blocks type-2 serotonin receptors though the effect is much weaker.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      16
      Seconds

  • Question 8 - A 34-year-old man arrives at the department befuddled. He has a history of...

    Incorrect

    • A 34-year-old man arrives at the department befuddled. He has a history of schizophrenia and is on an antipsychotic medication, but he can't recall what it's called.

      Which of the following statements about antipsychotic drug side effects is correct?

      Your Answer: Akathisia is an inability to initiate movement

      Correct Answer: Haloperidol is the most common causative antipsychotic drug

      Explanation:

      Extrapyramidal side effects are most common with piperazine phenothiazines (fluphenazine, prochlorperazine, and trifluoperazine) and butyrophenones (fluphenazine, prochlorperazine, and trifluoperazine) (benperidol and haloperidol). The most common causative antipsychotic drug is haloperidol.

      Tardive dyskinesia (rhythmic, involuntary movements of the tongue, face, and jaw) is most commonly associated with long-term or high-dose treatment. It is the most serious form of extrapyramidal symptoms because withdrawal of the causative drug may make it irreversible, and treatment is usually ineffective.

      Dystonia (abnormal facial and body movements) is more common in children and young adults, and it usually shows up after only a few doses. Procyclidine 5 mg IV or benzatropine 2 mg IV as a bolus can be used to treat acute dystonia.

      An unpleasant feeling of restlessness characterises akathisia. The inability to initiate movement is known as akinesia.

      Renal impairment causes increased cerebral sensitivity, so lower doses should be used.

      In elderly patients with dementia-related psychosis who are treated with haloperidol, there is an increased risk of death. This appears to be due to a higher risk of heart attacks and infections like pneumonia.

      The following are some of the antipsychotic drugs’ contraindications:
      Reduced level of consciousness/coma
      Depression of the central nervous system
      Phaeochromocytoma

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      28.4
      Seconds

  • Question 9 - Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and...

    Correct

    • Severe vomiting and diarrhoea were reported by a 25-year-old man. He's dehydrated and needs intravenous fluids to rehydrate. You give him cyclizine as part of his treatment.

      What is cyclizine's main mechanism of action?

      Your Answer: Antihistamine action

      Explanation:

      Cyclizine is a piperazine derivative that functions as an antihistamine (H1-receptor antagonist). To prevent nausea and vomiting, it is thought to act on the chemoreceptor trigger zone (CTZ) and the labyrinthine apparatus. It has a lower antimuscarinic effect as well.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      12.3
      Seconds

  • Question 10 - A 45-old woman is on several medications and being treated for epilepsy and...

    Incorrect

    • A 45-old woman is on several medications and being treated for epilepsy and bipolar disorder. In the ward rounds, you are asked to examine her in detail and discover she has a noticeable tremor. You believe that one of her medications may be responsible for this new onset tremor.

      Which of the following medications is least likely to be responsible for this tremor?

      Your Answer: Sodium valproate

      Correct Answer: Carbamazepine

      Explanation:

      The only medication that does not commonly cause tremors is carbamazepine.

      The other drugs present with the following types of tremors as a side effect to their usage:
      1. Sodium valproate – Postural tremor is most common, but a resting tremor can also occur. Approximately 25% of patients taking sodium valproate are found to develop a tremor within 12 months of starting therapy.
      2. Lithium – fine hand tremor is very commonly seen and reported in as many as 50% of patients during the first week of therapy. The tremor tends to reduce with time and is only present in around 5% of patients taking the medication two years or longer.
      3. Atypical antipsychotics, such as olanzapine and quetiapine – tremor and limb shakiness.

    • This question is part of the following fields:

      • CNS Pharmacology
      • Pharmacology
      12.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

CNS Pharmacology (6/10) 60%
Pharmacology (6/10) 60%
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