GPhC Clinical Therapeutics & BNF Guidelines 3

Question 1

What is the mechanism of action of selective serotonin reuptake inhibitors (SSRIs)?

Accepted Answer

Block serotonin reuptake at the presynaptic terminal

Answer

SSRIs inhibit the serotonin transporter (SERT), preventing reuptake of serotonin into the presynaptic neuron, increasing serotonin availability in the synapse.

Question 2

According to NICE, which antidepressant class should be avoided in patients with a recent MI?

Accepted Answer

Tricyclic antidepressants (TCAs)

Answer

TCAs have cardiotoxic effects including QT prolongation and arrhythmia risk, making them contraindicated post-MI. SSRIs are preferred for depression post-MI.

Question 3

Which proton pump inhibitor has the most significant interaction with clopidogrel?

Accepted Answer

Omeprazole

Answer

Omeprazole and esomeprazole are potent CYP2C19 inhibitors, reducing conversion of clopidogrel to its active metabolite. Pantoprazole has the least effect.

Question 4

What is serotonin syndrome and which combination most commonly causes it?

Accepted Answer

Dangerous serotonergic excess; SSRI + tramadol

Answer

Serotonin syndrome is life-threatening excess serotonin activity causing hyperthermia, clonus, and agitation. SSRI combined with tramadol (also serotonergic) is a common precipitant.

Question 5

A patient is prescribed lithium. Which monitoring parameter is most critical?

Accepted Answer

Serum lithium levels, renal function, and thyroid function

Answer

Lithium has a narrow therapeutic index. Regular monitoring of serum lithium (0.4–1.0 mmol/L), renal function (lithium is renally cleared), and thyroid function is essential.

GPhC Registration Practice Test

GPhC Registration Practice Test

GPhC Clinical Therapeutics & BNF Guidelines 3