GPhC Clinical Therapeutics & BNF Guidelines 4 — Questions and Answers
Question 1: Which anticoagulant does NOT require routine monitoring of anticoagulant effect?
- Apixaban (Correct answer)
- Warfarin
- Heparin (unfractionated)
- Low molecular weight heparin (therapeutic dose)
Correct answer: Apixaban
Direct oral anticoagulants (DOACs) like apixaban have predictable pharmacokinetics and do not require routine anticoagulation monitoring unlike warfarin (INR) or heparin (APTT).
Question 2: A patient on atorvastatin develops severe muscle pain and dark urine. What is the most likely diagnosis?
- Rhabdomyolysis (Correct answer)
- Peripheral neuropathy
- Acute hepatitis
- Deep vein thrombosis
Correct answer: Rhabdomyolysis
Severe myopathy progressing to rhabdomyolysis is a rare but serious statin side effect. Dark urine (myoglobinuria) with muscle pain should prompt urgent CK measurement and statin cessation.
Question 3: Which drug used in COPD exacerbations is a short-acting beta-2 agonist?
- Salbutamol (Correct answer)
- Tiotropium
- Salmeterol
- Beclometasone
Correct answer: Salbutamol
Salbutamol is a short-acting beta-2 agonist (SABA) used as rescue bronchodilator in COPD and asthma exacerbations due to rapid onset of action.
Question 4: What is the target INR range for a patient with atrial fibrillation on warfarin?
- 2.0–3.0 (Correct answer)
- 1.5–2.0
- 3.0–4.5
- 1.0–1.5
Correct answer: 2.0–3.0
The target INR for AF anticoagulation with warfarin is 2.0–3.0. Higher ranges (3.0–4.5) are used for mechanical heart valves.
Question 5: Which drug is used to reverse the effects of paracetamol overdose?
- N-acetylcysteine (Parvolex) (Correct answer)
- Naloxone
- Flumazenil
- Protamine sulfate
Correct answer: N-acetylcysteine (Parvolex)
N-acetylcysteine (NAC) replenishes glutathione, preventing accumulation of NAPQI (the toxic paracetamol metabolite) and treating hepatotoxicity in overdose.
Question 6: According to NICE, which drug is first-line for treating acute migraine attacks?
- Triptans (e.g., sumatriptan) or analgesics + antiemetic (Correct answer)
- Opioid analgesics
- Preventive beta-blockers
- Sodium valproate
Correct answer: Triptans (e.g., sumatriptan) or analgesics + antiemetic
NICE recommends a triptan combined with an NSAID or paracetamol plus an antiemetic for acute migraine. Opioids are not recommended due to risk of medication overuse headache.
GPhC Clinical Therapeutics & BNF Guidelines 4
Which anticoagulant does NOT require routine monitoring of anticoagulant effect?