Family Practice Exam Family Practice Exam Pharmacology and Prescribing 1

Question 1

A patient stabilized on warfarin is started on fluconazole for a fungal infection. What effect will this have on the INR?

Accepted Answer

Increase INR

Answer

Fluconazole inhibits CYP2C9, reducing warfarin metabolism and raising plasma levels, which increases the INR and bleeding risk.

Question 2

Which antibiotic class should be avoided in children under 8 years old due to risk of permanent dental staining?

Accepted Answer

Tetracyclines

Answer

Tetracyclines chelate calcium in developing teeth and bone, causing permanent yellow-brown discoloration when given to children under 8.

Question 3

A patient on an SSRI for depression reports easy bruising. What is the most likely pharmacologic mechanism?

Accepted Answer

Platelet dysfunction

Answer

SSRIs inhibit serotonin reuptake in platelets, impairing serotonin-mediated platelet aggregation and increasing bruising risk.

Question 4

Which mood stabilizer requires regular serum level monitoring due to its narrow therapeutic index?

Accepted Answer

Lithium carbonate

Answer

Lithium has a narrow therapeutic index (0.6–1.2 mEq/L for maintenance) and requires routine serum monitoring to prevent neurotoxicity.

Question 5

What is the primary mechanism of action of metformin in type 2 diabetes?

Accepted Answer

Decreases hepatic glucose production

Answer

Metformin activates AMPK, primarily reducing hepatic gluconeogenesis and decreasing fasting plasma glucose levels.

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