Pharmacology Exam Practice Questions - 5, Part 4

dermregperth's version from 2017-05-21 09:21



58. Progressive multifocal leukoencephalopathy - which of these drugs may cause PML?
Question Answer
PML caused by: RituximabTrue pg 712
PML caused by: CyclosporinTrue pg 712
PML caused by: MycophenolateTrue pg 712
PML caused by: DapsoneFalse


59. Agranulocytosis - which of these drugs may cause agranulocytosis?
Question Answer
Agranulocytosis: CimetidineFalse can be given to patient taking dapsone to reduce the risk of methemoglobin formation in human. Dapsone causes agranulocytosis.
Agranulocytosis: PenicillinTrue (Ticlopidine, calcium dobesilate, anti-thyroid drugs, dipyrone, & spironolactone were most strongly associated with agranulocytosis. Others include sulfonamides, phenytoin, β-lactam antibiotics, erythromycin, and diclofenac.) (p692)
Agranulocytosis: AllopurinolFalse but can cause DHS and aplastic anaemia pg 692
Agranulocytosis:SpironolactoneTrue pg 692 table 61-1
Agranulocytosis: ThalidomideFalse (Not in table or in thalidomide section in Chap 35 / p440).
Agranulocytosis: ThioguanineFalse can cause myelosuppression not in table on pg 440
Agranulocytosis: HydroxyureaFalse can cause myelosuppression not in table on pg 440


60. Haematological malignancy
Question Answer
Causes significant risk of haematological malignancy: ChlorambucilTrue table 62-6 on page 709 definite risk of malignancy established
Causes significant risk of haematological malignancy: CyclophosphamideTrue table 62-6 on page 709 definite risk of malignancy established
Causes significant risk of haematological malignancy: AzathioprineFalse possible or unlikely risk of malignancy table 62-6 on page 709
Causes significant risk of haematological malignancy: MethotrexateFalse possible or unlikely risk of malignancy table 62-6 on page 709


61. DRESS/Drug hypersensitivity syndrome - which of these drugs are associated with DRESS/DHS?
Question Answer
Causes DRESS: AllopurinolTrue see table 66-2 on pg 748
Causes DRESS: Traditional chinese medicineTrue see table 66-2 on pg 748
Causes DRESS: PenicillinFalse (Box 66-2, p748)
Causes DRESS: AcitretinFalse
Causes DRESS: Interferon False
Causes DRESS: DapsoneTrue see table 66-2 on pg 748
Causes DRESS: MinocyclineTrue see table 66-2 on pg 748


62. Question about drug interactions involving liver:
Question Answer
Extra questions: Penicillin and something elseUnsure Need to make up more questions
Extra questions: Dapsone + cimetidineUnsure Need to make up more questions


63. Gingival hyperplasia
Question Answer
Gingival hyperplasia: CyclosporinTrue pg 674 table 59-3
Gingival hyperplasia: NifedipineTrue pg 674 table 59-3


64. Pigmentation in oral mucosa - which of these drugs may cause it?
Question Answer
Pigmentation: FluoroquinolonesFalse
Pigmentation: MinocyclineTrue pg 674 table 59-3
Pigmentation: OestrogenFalse
Pigmentation: DiltiazemFalse
Pigmentation: MetronidazoleFalse
Pigmentation: PlaquenilTrue pg 674 table 59-3


65. Oral lidocaine:
Question Answer
Oral lidocaine: Maximum oral dose per day 50 mlFalse 15ml and 8 doses a day (120ml) pg 669
Oral lidocaine: Onset of effect is minutesTrue Unsure you apply it for 5 minutes and it recommends using every 3 hours.
Oral lidocaine: Contraindicated if patient has oral ulcersFalse
Oral lidocaine: Toxicity may occur if swallowedTrue pg 669
Oral lidocaine: Can it be used on tongue ulcersTrue


66. Tea tree oil:
Question Answer
Tea tree: Has antiandrogenic propertiesTrue found the reference pg 567 "tea tree oil has estrogenic and anti-androgenic properties also anti-inflammatory and antifungal" as does.....(Herbal products with antiandrogenic properties: Saw Palmetto, Green tea, Pygeum, Stinging Nettle, Spearmint - p374


67. DEET:
Question Answer
DEET: Higher concentrations of >35% increases its effectivenessFalse pg 622
DEET: Are older infants more at risk of side effects/toxic effects compared to older peopleFalse. Pg 624 children are not at greater risk of developing adverse effect from DEET than older individuals.
DEET: DEET can damage plastic spectacle framesTrue pg 622
DEET: Can children over 2 months safely use up to 30% DEETTrue pg 622
DEET: Is it safe to use on broken skin False should not be used on broken skin. See box 54-3 pg 623.


68. Dapsone:
Question Answer
Dapsone: Is lipid-soluble and water insoluble compoundTrue Pg 228
Dapsone: Does it undergo rapid metabolism by deacetylationTrue. But is also has another pathway of metabolism which is hydroxylation.
Dapsone: Half life is 10-50 hoursTrue see table 18-2 on pg 229
Dapsone: Dapsone can be inhibited by cimetidineTrue. Pg 235 It can reduce methemoglobin formation in humans. This effect is thought to be mediated by inhibition of the formation of hydroxylamine metabolites of dapsone, which cause haematological toxicity.


69. Clofazimine:
Question Answer
Clofazimine: Can be safely used with rifampicin and dapsoneFalse (Concomitant use with Dapsone is acceptable; however concomitant use with Rifampin or Isoniazid should be used with caution) (p428)
Clofazimine: Half life 70 daysTrue (It’s highly lipophilic & concentrates in lipid-rich tissues, especially the reticuloendothelial system, breasts, intestine & liver) (p427)
Clofazimine: It commonly takes 2-4 weeks to cause discoloration of the skin to orange-brownTrue (The cause is drug deposition & induced melanosis. Tears, sweat, hair, sputum, milk, urine & liver can also show discolouration) (p428)
Clofazimine: Large amounts of drug are excreted in urineFalse. (Only small amounts of the drug are found in the urine. Minimal, but significant elimination occurs in the sebum, sputum, tears & sweat. Formal studies of faecal / biliary elimination have not been undertaken) (p427)


70. Alpha hydroxyl acids
Question Answer
Alpha hydroxyl acids: Question on structure of AHAUnsure
Alpha hydroxyl acids: PHA is derived from cow's milkFalse (AHA are also called ‘fruit acids’ because they are commonly derived from various fruits, although they are also derived from sugar cane (glycolic acid) and milk (lactic acid), Chap 48 doesn't refer to Polyhydroxy acids (PHA) being derived from milk.) (p570)
Alpha hydroxyl acids: Larger size of molecules have an inverse relationship which results in slower rate of absorption into skinTrue (he higher molecular weight AHA (malic acid, citric acid, mandelic acid, tartaric acid) do not penetrate the stratum corneum as well.) (p570)
Alpha hydroxyl acids: Is pyruvic acid the keto form of glycolic acidFalse (Pyruvic acid is the keto form of lactic acid.) (Table 48-1, p571)
Alpha hydroxyl acids: Is AHA used in practice derived from natural sourcesFalse (Because they are extracted from organic products, patients often think this represents a natural form of treatment; however, the AHA used in practice are chemically synthesised.) (p570)
Alpha hydroxyl acids: Is salicylic acid more lipid soluble than AHATrue


71. Botox:
Question Answer
Botox: Does type A cleave synaptobrevin False (SNARE proteins are the target of the BoNT light chain, resulting in postsynaptic cellular paralysis. BoNT serotypes A, C & E catalyse the cleavage of SNARE protein synaptosomal-associated protein 25 (SNAP-25), whereas serotypes B, D, F and G catalyse the cleavage of synaptobrevin, also known as vesicle-associated membrane protein (VAMP)) (Q58-3, p659)
Botox: Is type C or D effective in humansFalse (p659)
Botox: Do all serotypes produce inhibition of acetylcholineTrue pg 658
Botox: Is type A the only serotype not degraded by the gutFalse (All BoNT serotypes have a generally conserved small neurotoxin protein (150 kDa), which is usually attached to larger, non-toxic proteins which provide protection against the acidic environment of the gut and the degradative effects of intestinal proteases) (p659)


72. Botox contraindications - are these absolute/relative contraindications to botox:
Question Answer
Contraindications to botox: Cervical dystoniaFalse. Botox is used to treat this.
Contraindications to botox: Concurrent beta blocker useFalse.It is calcium channel blockers not beta blockers table 58-1 pg 661
Contraindications to botox: Myasthenia gravisTrue. Relative contraindication pg 661.
Contraindications to botox: Body dysmorphic disorderTrue. Relative contraindication pg 661.


73. Local anaesthetic:
Question Answer
Local anaesthetics: Does the structural variation of the amine portion affect potencyTrue (Structural variations in the aromatic and amine portions affect protein binding, potency, duration of action, and other aspects of clinical use.) (p637)


74. Triclosan:
Question Answer
Triclosan: Is it safe on oral mucosa surfacesTrue. It is a broad spectrum antimicrobial agents. It is beneficial in minimising the formation of aphthous ulcers.


75. Chlorhexidine:
Question Answer
Chlorhexadine: Is it ototoxicTrue. Pg 458


76. Fluoroquinolone:
Question Answer
Fluoroquinolones: Does it provide anaerobic coverTrue. But has only minimal anaerobic acitivity.
Fluoroquinolones: Is it safe in childrenFalse. Found to impair cartilage formation and is not recommended for use in children. Pg 75
Fluoroquinolones: Is it bacteriostaticFalse Bacteriocidal. FQ exhibit a broader spectrum of concentration dependent bactriocidal activity than older quinolones. Pg 75
Fluoroquinolones: Potential cause of tendon ruptureTrue tendonitis and tendon rupture have been observed. Pg 76
Fluoroquinolones: Should it be taken with foodFalse. With the exception of norfloxacin, the oral bioavailability of FQ is excellent an minimally affected by food, except in the presence of metal ions co-administered in high concentrations, such as antacids and vitamin/mineral supplementation.


77. Azathioprine:
Question Answer
Azathioprine: Does it convert to 6-thioguanine in erythrocytesFalse. Azathioprine is rapidly converted to 6-MP in erythrocytes. Pg 182
Azathioprine: Can be degraded by xanthine oxidase to inactive metabolitesTrue. Degraded b xanthine oxidase into inactive metabolites. Pg 183
Azathioprine: Degraded by TPMT to active metabolitesFalse. Is degraded by TPMP to inactive metabolites. Pg 183


78. Mycophenolate:
Question Answer
Mycophenolate: Is it rapidly converted to inactive metabolites by serum esterasesFalse. MMF is rapidly absorbed and then converted by esterases in the plasma, liver and kidney to MPA, the active metabolite.
Mycophenolate: Bioavailability 100%True Nearly 100 pg 191
Mycophenolate: MPA is inactivated in the liver via glucuronidationTrue. MPA is inactivated in the liver by glucuronidation resulting in MPAG. Read this carefully as they sometimes add in something before the glucuronidation like 'beta' BUT beta-glucuronidase converts MPAG back to the active metabolite MPA and this is sometimes a question too.


79. Famiciclovir:
Question Answer
Famiciclovir: Bioavailability is 50%False Bioavailability is 77% compared to acyclovir 15-30% and 55% oral valaciclovir pg 127.
Famiciclovir: Is a prodrug of acyclovir False. Is a prodrug of penciclovir.
Famciclovir: Safe in pregnancyTrue is a category B but acyclovir is preferred pg 726
Famciclovir: Increases levels of DigoxinTrue (Uncertain mechanism – but Digoxin levels levels ↑ by 19%. However, Probenecid, Cimetidine & Theophylline decrease Famciclovir levels) (p126)


80. Aciclovir:
Question Answer
Aciclovir: Suppresses recurrent HSV in recurrent erythema multiformeTrue. Suppressive ACV therapy is a reasonable therapeutic option.
Aciclovir: Safe in pregnancyTrue
Acyclovir: Requires host cell kinases for phosphorylationTrue (Activation of ACV requires phosphorylation by herpes-specific thymidine kinase before bi and triphosphorylation by host cellular enzymes.)
Aciclovir: Is crystal nephropathy a potential side effectTrue. Can cause reversal renal impairment due to crystalline nephropathy. Pg 125.


81. Valaciclovir:
Question Answer
Valaciclovir: Is the prodrug of acyclovirTrue. Pg125
Valaciclovir: Lactated in breast milkUnsure ?? Me too ?? But considered compatible with breast feeding same recommendations as acyclovir. Category B in pregnancy. pg 726 table 64-13.


82. Finasteride and others:
Question Answer
Finasteride: Is an 5-alpha reductase inhibitorTrue. Is a 5-a reductase inhibitor along with dutasteride. Pg 361
Finasteride: Is absorped by hair folliclesFalse Is absorbed by GI tract, metabolised in the liver and excreted in the urine and faeces.
Drosperinone may have interactions with spironolactone drug interactionsTrue. Drospirenone may increase potassium levels, which should be checked during the first month of therapy. Pg 368
Cyproterone acetate is cyproterone a progestinTrue. It is a progestin with well-known anti-androgen properties pg 368
Regarding progestins Are most progestins antiandrogensTrue (Box 30-1, p362)


83. Finasteride:
Question Answer
Finasteride: There is an immediate reduction of DHT in 24 hoursTrue. Serum concentrations of DHT decrease by 65% in 24 hours.
Finasteride: Significantly reduces testosteroneFalse. Serum testosterone and estradiol increase by about 15% but remain in normal limits. Prostate testosterone increase about 6 fold. Pg 362
Finasteride: Safe in pregnancyFalse category X