GPhC Clinical Therapeutics & BNF Guidelines 1 — Questions and Answers
Question 1: According to NICE guidelines, what is the first-line treatment for newly diagnosed type 2 diabetes alongside lifestyle advice?
- Metformin (Correct answer)
- Gliclazide
- Sitagliptin
- Insulin glargine
Correct answer: Metformin
NICE recommends metformin as first-line pharmacotherapy for type 2 diabetes, provided renal function is adequate (eGFR ≥30 mL/min/1.73m²).
Question 2: The BNF recommends stopping which drug at least 48 hours before iodine-containing contrast media in patients with eGFR <60?
- Metformin (Correct answer)
- Atorvastatin
- Amlodipine
- Omeprazole
Correct answer: Metformin
Metformin should be withheld before iodinated contrast to prevent contrast-induced nephropathy potentially leading to lactic acidosis due to reduced renal clearance.
Question 3: Which antihypertensive is recommended as first-line for a 55-year-old Caucasian patient without diabetes?
- Amlodipine (calcium channel blocker) (Correct answer)
- Lisinopril (ACE inhibitor)
- Atenolol (beta-blocker)
- Spironolactone
Correct answer: Amlodipine (calcium channel blocker)
NICE step 1 for patients aged ≥55 or of black African/Caribbean origin: calcium channel blocker (e.g., amlodipine). ACE inhibitors are first-line for under 55s.
Question 4: Which antibiotic is first-line for uncomplicated lower urinary tract infection in women according to NICE?
- Nitrofurantoin (Correct answer)
- Co-amoxiclav
- Ciprofloxacin
- Trimethoprim (if local resistance low)
Correct answer: Nitrofurantoin
NICE recommends nitrofurantoin as first-line for uncomplicated UTI in women (if eGFR ≥30). Trimethoprim is an alternative if local resistance rates are acceptable.
Question 5: A patient taking warfarin is prescribed clarithromycin. What interaction should you counsel about?
- Increased INR and bleeding risk (Correct answer)
- Reduced warfarin absorption
- Decreased INR
- No clinically significant interaction
Correct answer: Increased INR and bleeding risk
Clarithromycin inhibits CYP3A4 and CYP2C9, reducing warfarin metabolism and increasing anticoagulant effect, raising INR and bleeding risk.
Question 6: Which NSAID is associated with the lowest cardiovascular risk according to current evidence?
- Naproxen (Correct answer)
- Diclofenac
- Ibuprofen high-dose
- Celecoxib
Correct answer: Naproxen
Naproxen is generally considered to have the lowest cardiovascular risk among NSAIDs due to its platelet inhibitory effects resembling aspirin, though GI risk remains.
GPhC Clinical Therapeutics & BNF Guidelines 1
According to NICE guidelines, what is the first-line treatment for newly diagnosed type 2 diabetes alongside lifestyle advice?