GPhC Clinical Therapeutics

Question 1

A 62-year-old patient with type 2 diabetes and an eGFR of 25 mL/min/1.73m² is currently taking metformin 1g twice daily. According to NICE guidelines, what action should be recommended?

Accepted Answer

Discontinue metformin as eGFR is below 30 mL/min/1.73m²

Answer

Continue metformin at the current dose as it remains effective

Answer

Increase the dose to improve glycaemic control

Answer

Switch to gliclazide only if HbA1c is above 58 mmol/mol

Question 2

A patient is started on ramipril for hypertension. After two weeks, blood tests show a rise in serum creatinine of 35% from baseline. What is the most appropriate action?

Accepted Answer

Stop ramipril immediately and investigate for renal artery stenosis

Answer

This is expected; continue ramipril and recheck in 3 months

Answer

Reduce the dose by half and recheck in 2 weeks

Answer

Add a calcium channel blocker to protect the kidneys

Question 3

Which antibiotic is recommended as first-line treatment for an uncomplicated lower urinary tract infection in a non-pregnant adult woman, according to NICE guidelines?

Accepted Answer

Nitrofurantoin 100mg modified-release twice daily for 3 days

Answer

Amoxicillin 500mg three times daily for 7 days

Answer

Ciprofloxacin 500mg twice daily for 3 days

Answer

Co-amoxiclav 625mg three times daily for 5 days

Question 4

A patient on long-term oral corticosteroids (prednisolone 15mg daily for 6 months) wants to stop the medication. What is the recommended approach?

Accepted Answer

Gradually taper the dose to avoid adrenal crisis

Answer

Stop immediately as corticosteroids can be discontinued at any time

Answer

Switch to inhaled corticosteroids before stopping

Answer

Halve the dose for one week then stop completely

Question 5

A 70-year-old patient with atrial fibrillation has a CHA₂DS₂-VASc score of 4. Which of the following is the most appropriate anticoagulation strategy according to NICE?

Accepted Answer

A direct oral anticoagulant (DOAC) such as apixaban or edoxaban

Answer

Aspirin 75mg daily

Answer

No anticoagulation needed at this score

Answer

Clopidogrel 75mg daily

Question 6

A patient taking simvastatin reports new-onset muscle pain and weakness. Their creatine kinase (CK) level is found to be 12 times the upper limit of normal. What is the most appropriate action?

Accepted Answer

Stop simvastatin immediately due to risk of rhabdomyolysis

Answer

Reassure the patient that mild myalgia is common with statins

Answer

Reduce the simvastatin dose and monitor symptoms

Answer

Add coenzyme Q10 to manage the side effects