GPhC Clinical Therapeutics & BNF Guidelines

Question 1

According to NICE guidelines, what is the first-line treatment for newly diagnosed type 2 diabetes alongside lifestyle advice?

Accepted Answer

Metformin

Answer

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?

Accepted Answer

Metformin

Answer

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?

Accepted Answer

Amlodipine (calcium channel blocker)

Answer

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?

Accepted Answer

Nitrofurantoin

Answer

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?

Accepted Answer

Increased INR and bleeding risk

Answer

Clarithromycin inhibits CYP3A4 and CYP2C9, reducing warfarin metabolism and increasing anticoagulant effect, raising INR and bleeding risk.

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GPhC Clinical Therapeutics & BNF Guidelines