AKT Pharmacology and Prescribing 2 — Questions and Answers
Question 1: A patient taking an SSRI for depression is prescribed tramadol for pain. What potentially life-threatening interaction should be monitored?
- QT prolongation
- Serotonin syndrome (Correct answer)
- Neuroleptic malignant syndrome
- Malignant hyperthermia
Correct answer: Serotonin syndrome
Both SSRIs and tramadol (which inhibits serotonin reuptake) increase serotonergic activity; combined use markedly raises the risk of serotonin syndrome.
Question 2: Which drug is absolutely contraindicated in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency due to risk of hemolytic anemia?
- Amoxicillin
- Metformin
- Primaquine (Correct answer)
- Atenolol
Correct answer: Primaquine
Primaquine generates oxidative stress that G6PD-deficient red blood cells cannot neutralize, triggering acute hemolytic anemia.
Question 3: What is the primary mechanism of action of ACE inhibitors in treating hypertension?
- Blocking angiotensin II receptors directly
- Inhibiting the conversion of angiotensin I to angiotensin II (Correct answer)
- Increasing aldosterone secretion
- Blocking calcium channels in vascular smooth muscle
Correct answer: Inhibiting the conversion of angiotensin I to angiotensin II
ACE inhibitors block angiotensin-converting enzyme, preventing the formation of angiotensin II, which reduces vasoconstriction and aldosterone release.
Question 4: A patient with COPD requires antihypertensive therapy. If a beta-blocker is necessary, which agent is most appropriate?
- Propranolol
- Carvedilol
- Bisoprolol (Correct answer)
- Nadolol
Correct answer: Bisoprolol
Bisoprolol is a highly cardioselective beta-1 blocker with minimal beta-2 effects, making it the safest option in patients with obstructive airway disease.
Question 5: Which antibiotic class exerts its bactericidal action by inhibiting bacterial cell wall peptidoglycan synthesis?
- Fluoroquinolones
- Macrolides
- Aminoglycosides
- Beta-lactams (Correct answer)
Correct answer: Beta-lactams
Beta-lactam antibiotics (penicillins, cephalosporins, carbapenems) inhibit transpeptidases (penicillin-binding proteins) required for peptidoglycan cross-linking in the bacterial cell wall.
Question 6: A patient starting methotrexate therapy for rheumatoid arthritis should receive concurrent supplementation with which vitamin?
- Vitamin B12
- Vitamin D
- Folic acid (Correct answer)
- Vitamin C
Correct answer: Folic acid
Methotrexate is a folate antagonist; folic acid supplementation reduces the incidence of mucositis, hepatotoxicity, and bone marrow suppression without diminishing efficacy.
Question 7: What is the current recommended first-line triple therapy regimen for H. pylori eradication in the United States?
- Amoxicillin + metronidazole + ranitidine
- Clarithromycin + amoxicillin + PPI (Correct answer)
- Tetracycline + bismuth + H2 blocker
- Ciprofloxacin + metronidazole + PPI
Correct answer: Clarithromycin + amoxicillin + PPI
Standard triple therapy consists of clarithromycin, amoxicillin, and a proton pump inhibitor for 14 days, achieving eradication rates above 80%.
AKT Pharmacology and Prescribing 2
A patient taking an SSRI for depression is prescribed tramadol for pain.
What potentially life-threatening interaction should be monitored?