DPM Pharmacology & Therapeutics 3 — Questions and Answers
Question 1: Which class of medication used for diabetic peripheral neuropathy acts by inhibiting the reuptake of both serotonin and norepinephrine?
- Gabapentinoids
- SNRIs (Correct answer)
- TCAs
- Opioids
Correct answer: SNRIs
SNRIs such as duloxetine are FDA-approved for diabetic peripheral neuropathy and work by inhibiting serotonin-norepinephrine reuptake.
Question 2: A podiatrist performs a digital nerve block using lidocaine with epinephrine. What is the primary risk associated with epinephrine in this location?
- Systemic hypertensive crisis
- Digital ischemia and necrosis (Correct answer)
- Prolonged sensory block only
- Increased risk of infection
Correct answer: Digital ischemia and necrosis
Epinephrine causes vasoconstriction in digital end-arteries, risking ischemia and necrosis in toes, making it contraindicated for digital blocks.
Question 3: Colchicine is used to treat acute gout. At the cellular level, what is its primary mechanism?
- Inhibits COX-1 and COX-2
- Binds tubulin and inhibits microtubule polymerization (Correct answer)
- Blocks IL-1β receptor signaling
- Inhibits xanthine oxidase
Correct answer: Binds tubulin and inhibits microtubule polymerization
Colchicine binds tubulin dimers and prevents microtubule assembly, impairing neutrophil migration and phagocytosis of urate crystals.
Question 4: A patient with MRSA foot osteomyelitis requires IV antibiotic therapy. Which agent has excellent bone penetration and is active against MRSA?
- Vancomycin (Correct answer)
- Cefazolin
- Clindamycin
- Daptomycin
Correct answer: Vancomycin
Vancomycin remains a first-line agent for MRSA osteomyelitis with adequate bone penetration and proven efficacy.
Question 5: Which prostaglandin analogue is used topically to treat onychomycosis via a different mechanism than azoles or allylamines?
- Tavaborole
- Efinaconazole
- Ciclopirox (Correct answer)
- Amorolfine
Correct answer: Ciclopirox
Ciclopirox is a hydroxypyridinone antifungal that chelates polyvalent cations essential for fungal enzymes, unlike azoles or allylamines.
Question 6: A patient taking metformin for type 2 diabetes requires an IV contrast study for a vascular foot lesion. What is the primary concern regarding metformin?
- Contrast allergy cross-reactivity
- Lactic acidosis risk from contrast-induced nephropathy (Correct answer)
- Hyperglycemia from contrast media
- QT prolongation interaction
Correct answer: Lactic acidosis risk from contrast-induced nephropathy
Contrast-induced nephropathy can reduce metformin clearance, leading to accumulation and potentially fatal lactic acidosis.
Question 7: Which bisphosphonate is used in Charcot neuroarthropathy to inhibit osteoclast activity and potentially slow bone destruction?
- Etidronate
- Pamidronate
- Zoledronic acid (Correct answer)
- Alendronate
Correct answer: Zoledronic acid
Zoledronic acid (zoledronate) is the most potent bisphosphonate and has been studied for reducing bone turnover in acute Charcot neuroarthropathy.
DPM Pharmacology & Therapeutics 3
Which class of medication used for diabetic peripheral neuropathy acts by inhibiting the reuptake of both serotonin and norepinephrine?