-
Question 1
Correct
-
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: 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.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 2
Correct
-
A 27 year old patient is maintained on warfarin during pregnancy due to a mechanical mitral valve. She has read about warfarin embryopathy. Which of the following is a typical feature?
Your Answer: Stippled epiphyses
Explanation:Warfarin is teratogenic if it is used in the first trimester. It causes bone defects and haemorrhages in the developing foetus. It causes the formation of multiple ossification centres in the long bones. Resulting in stippled epiphyses and hence deform long bones.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 3
Correct
-
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.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 4
Correct
-
Question 5
Correct
-
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.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 6
Correct
-
Which of the following medications, when given before & during pregnancy may help to protect neural tube defects?
Your Answer: Folic acid
Explanation:Maternal exposure to dietary factors during pregnancy can influence embryonic development and may modulate the phenotype of offspring through epigenetic programming. Folate is critical for nucleotide synthesis, and preconceptional intake of dietary folic acid (FA) is credited with reduced incidences of neural tube defects in infants.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 7
Incorrect
-
Lidocaine works by blocking which of the following ion channels?
Your Answer: fast voltage gated calcium channels
Correct Answer: fast voltage gated sodium channels
Explanation:It blocks the voltage gated sodium channels and reduce the influx of sodium ions preventing depolarization of the membrane and blocking the conduction of the action potential. The affinity of the receptor site in the sodium channels depends on whether it is resting, open or inactive.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 8
Incorrect
-
You are called to review a baby with cyanosis when feeding immediately after birth. Subsequent investigation and imaging reveals choanal atresia. Upon questioning the mother reveals she had been getting repeat prescriptions from her GP in Poland without her UK GPs' or your knowledge. Which of the following medication was most likely to cause this?
Your Answer: Warfarin
Correct Answer: Carbimazole
Explanation:This is one of the defects attributable to Carbimazole use.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 9
Correct
-
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.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 10
Correct
-
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.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 11
Incorrect
-
Question 12
Incorrect
-
In which part of the body does clomiphene trigger ovulation by antagonising oestrogen receptors?
Your Answer: Ovaries
Correct 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.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 13
Correct
-
A foetus is noted to be small for gestational age (SGA) on the 20 week scan. One of the mothers medications is stopped at this time. Follow up scans reveal renal dysgenesis. Which of the below medications was stopped?
Your Answer: Ramipril
Explanation:Use of angiotensin II receptors blocks and ACE inhibitors are known to result in renal dysgenesis. Due to renal dysgenesis oligohydramnios occurs that leads to IUGR.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 14
Correct
-
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.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 15
Incorrect
-
Which of the following best describes Clomiphene?
Your Answer: GnRH analogues
Correct Answer: Selective Oestrogen Receptor Modulator
Explanation:Clomiphene is a non-steroidal compound with tissue selective actions. It is used to induce ovulation in women who wish to become pregnant. It is a selective oestrogen receptor modulators.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 16
Correct
-
Which of the following is an appropriate treatment for Diazepam overdose?
Your Answer: Flumazenil
Explanation:Flumazenil is used for benzodiazepine overdose.
Naloxone is used for opioid overdose.
Parvolex (N-acetyl cysteine) is used for paracetamol overdose.
Protamine can be used for Heparin reversal.
Beriplex can be used for Warfarin reversal. -
This question is part of the following fields:
- Pharmacology
-
-
Question 17
Correct
-
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 - 3.5
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.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 18
Correct
-
Warfarin embryopathy is typically the result of the mother taking warfarin during which stage of pregnancy?
Your Answer: 6-12 weeks
Explanation:Warfarin is teratogenic if it is used in the first trimester. It causes bone defects and haemorrhages in the developing foetus.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 19
Incorrect
-
Which of the following best describes the mechanism of action of Promethazine?
Your Answer: Serotonin 5-HT3 receptor antagonist
Correct 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.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 20
Correct
-
You are asked to infiltrate a patients perineum with local anaesthetic prior to episiotomy. What is the maximum dose of lidocaine (without adrenaline)?
Your Answer: 3 mg/kg
Explanation:The half-life of lidocaine is approximately 1.5 hours. It is a local anaesthetic and the maximum dose that can be given is 3mg/kg.
-
This question is part of the following fields:
- Pharmacology
-
SESSION STATS - PERFORMANCE PER SPECIALTY
