GPhC Clinical Therapeutics & BNF Guidelines 4

Question 1

Which anticoagulant does NOT require routine monitoring of anticoagulant effect?

Accepted Answer

Apixaban

Answer

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?

Accepted Answer

Rhabdomyolysis

Answer

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?

Accepted Answer

Salbutamol

Answer

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?

Accepted Answer

2.0–3.0

Answer

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?

Accepted Answer

N-acetylcysteine (Parvolex)

Answer

N-acetylcysteine (NAC) replenishes glutathione, preventing accumulation of NAPQI (the toxic paracetamol metabolite) and treating hepatotoxicity in overdose.

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GPhC Clinical Therapeutics & BNF Guidelines 4