GPhC Clinical Therapeutics 2

Question 1

A patient with chronic heart failure is being managed with ramipril and bisoprolol.
Despite optimal doses, they remain symptomatic (NYHA class III).
According to NICE, which additional medication should be considered?

Accepted Answer

Spironolactone (or eplerenone)

Answer

Amlodipine

Answer

Digoxin as first add-on

Answer

Furosemide dose increase only

Question 2

Which of the following medicines requires therapeutic drug monitoring (TDM) due to its narrow therapeutic index?

Accepted Answer

Lithium

Answer

Amoxicillin

Answer

Omeprazole

Answer

Metformin

Question 3

A patient with COPD is prescribed a LAMA/LABA combination inhaler. They continue to have frequent exacerbations. According to NICE, what should be considered next if the patient has features suggesting asthmatic/eosinophilic disease?

Accepted Answer

Escalate to triple therapy by adding an inhaled corticosteroid (ICS)

Answer

Add oral theophylline

Answer

Switch to a short-acting bronchodilator only

Answer

Start prophylactic antibiotics

Question 4

A patient on warfarin presents with an INR of 8.5 with no active bleeding. According to NICE/BNF guidance, what is the most appropriate management?

Accepted Answer

Withhold warfarin and give oral vitamin K 1-5mg; recheck INR in 24 hours

Answer

Administer vitamin K 5mg intravenously immediately

Answer

Continue warfarin at a reduced dose

Answer

Administer fresh frozen plasma

Question 5

A newly diagnosed asthma patient is prescribed a salbutamol inhaler. They are using it four times per week. According to the BTS/SIGN stepwise approach, what should happen next?

Accepted Answer

Add a regular low-dose inhaled corticosteroid (ICS)

Answer

Continue with salbutamol alone as needed

Answer

Start a long-acting beta-agonist (LABA) without ICS

Answer

Prescribe oral montelukast as monotherapy

Question 6

Which of the following is a recognised serious interaction between clarithromycin and simvastatin?

Accepted Answer

Increased risk of rhabdomyolysis due to CYP3A4 inhibition

Answer

Reduced absorption of simvastatin

Answer

Decreased antibiotic efficacy

Answer

Hepatoprotective synergy