AKT Pharmacology and Prescribing 1 — Questions and Answers
Question 1: A patient stabilized on warfarin begins taking ibuprofen regularly for joint pain. What is the primary prescribing concern?
- Ibuprofen reduces warfarin absorption
- Ibuprofen potentiates warfarin's anticoagulant effect, increasing bleeding risk (Correct answer)
- Ibuprofen causes warfarin metabolism to increase
- Ibuprofen displaces warfarin from plasma proteins, reducing its effect
Correct answer: Ibuprofen potentiates warfarin's anticoagulant effect, increasing bleeding risk
NSAIDs like ibuprofen inhibit platelet aggregation and can displace warfarin from protein-binding sites, synergistically increasing bleeding risk.
Question 2: Which of the following is the recommended first-line pharmacological treatment for Type 2 diabetes in a patient without contraindications?
- Glipizide
- Insulin glargine
- Metformin (Correct answer)
- Sitagliptin
Correct answer: Metformin
Metformin is universally recommended as first-line therapy for Type 2 diabetes due to its efficacy, safety profile, and low cost.
Question 3: A patient with a documented penicillin allergy needs antibiotic treatment. Which cephalosporin generation carries the greatest cross-reactivity risk?
- Fourth-generation cephalosporins
- Third-generation cephalosporins
- Second-generation cephalosporins
- First-generation cephalosporins (Correct answer)
Correct answer: First-generation cephalosporins
First-generation cephalosporins share the most structural similarity to penicillin via the R1 side chain, conferring the highest cross-reactivity risk.
Question 4: What is the maximum recommended daily dose of acetaminophen (paracetamol) for a healthy adult?
- 2,000 mg
- 3,000 mg
- 4,000 mg (Correct answer)
- 6,000 mg
Correct answer: 4,000 mg
The maximum safe daily dose of acetaminophen for healthy adults is 4,000 mg (4 g), though 3,000 mg/day is recommended for chronic use or in patients at hepatic risk.
Question 5: Which class of antihypertensive is contraindicated during pregnancy due to risk of fetal renal dysgenesis?
- Calcium channel blockers
- Beta-blockers
- Methyldopa
- ACE inhibitors (Correct answer)
Correct answer: ACE inhibitors
ACE inhibitors are teratogenic in the second and third trimesters, causing fetal renal tubular dysgenesis, oligohydramnios, and neonatal anuria.
Question 6: A patient on long-term lithium therapy presents with polydipsia, polyuria, and dilute urine. What is the most likely explanation?
- Lithium-induced hyperglycemia
- Lithium-induced nephrogenic diabetes insipidus (Correct answer)
- Lithium-induced central diabetes insipidus
- Lithium toxicity causing SIADH
Correct answer: Lithium-induced nephrogenic diabetes insipidus
Chronic lithium use blocks ADH action on the collecting duct, causing nephrogenic diabetes insipidus characterized by large volumes of dilute urine.
Question 7: Which of the following drugs requires routine therapeutic drug monitoring (TDM) of serum levels in clinical practice?
- Amoxicillin
- Digoxin (Correct answer)
- Lisinopril
- Atorvastatin
Correct answer: Digoxin
Digoxin has a narrow therapeutic index and requires serum level monitoring to ensure efficacy while avoiding toxicity.
AKT Pharmacology and Prescribing 1
A patient stabilized on warfarin begins taking ibuprofen regularly for joint pain.
What is the primary prescribing concern?