GPhC Patient Safety & Clinical Pharmacy 4 — Questions and Answers
Question 1: According to NICE, what is the first-line pharmacological treatment for osteoporosis in post-menopausal women?
- Alendronic acid (bisphosphonate) plus vitamin D and calcium (Correct answer)
- Raloxifene alone
- HRT alone
- Strontium ranelate
Correct answer: Alendronic acid (bisphosphonate) plus vitamin D and calcium
NICE recommends alendronic acid as first-line bisphosphonate for post-menopausal osteoporosis, with calcium/vitamin D supplementation if dietary intake is inadequate.
Question 2: A patient on ciclosporin is started on clarithromycin. What is the clinical concern?
- Ciclosporin toxicity — clarithromycin inhibits CYP3A4, raising ciclosporin levels (Correct answer)
- Reduced immunosuppression
- Antibiotic resistance
- No clinically significant interaction
Correct answer: Ciclosporin toxicity — clarithromycin inhibits CYP3A4, raising ciclosporin levels
Clarithromycin is a potent CYP3A4 inhibitor. Ciclosporin is extensively metabolised by CYP3A4. Co-administration can lead to significantly elevated ciclosporin levels, risking nephrotoxicity.
Question 3: Which monitoring should be performed in a patient started on clozapine?
- Full blood count (FBC) — monitoring for agranulocytosis (Correct answer)
- Serum creatinine only
- Liver function tests only
- Blood glucose only
Correct answer: Full blood count (FBC) — monitoring for agranulocytosis
Clozapine monitoring requires regular FBC because the drug causes agranulocytosis in up to 1% of patients, which can be fatal if undetected. Monitoring frequency decreases as treatment duration increases.
Question 4: What is the mechanism by which NSAIDs can worsen heart failure?
- Sodium and water retention due to prostaglandin inhibition and reduced renal perfusion (Correct answer)
- Increased heart rate
- Direct myocardial toxicity
- Reduced platelet aggregation
Correct answer: Sodium and water retention due to prostaglandin inhibition and reduced renal perfusion
NSAIDs inhibit prostaglandins involved in renal sodium excretion and vascular regulation, leading to fluid retention, increased preload and afterload, potentially precipitating or worsening heart failure.
Question 5: A patient requires gentamicin therapy. Which monitoring is essential?
- Serum gentamicin levels, renal function, and signs of ototoxicity (Correct answer)
- Blood glucose only
- Full blood count only
- Liver enzymes
Correct answer: Serum gentamicin levels, renal function, and signs of ototoxicity
Gentamicin is an aminoglycoside with a narrow therapeutic index. Monitoring trough and peak levels, renal function, and symptoms of ototoxicity (hearing loss, tinnitus) is essential to prevent toxicity.
Question 6: What is the 'medication adherence' concept and why is it clinically important?
- Whether patients take medicines as prescribed; poor adherence reduces therapeutic efficacy and increases disease complications (Correct answer)
- How quickly patients refill prescriptions
- Whether medicines are stored correctly
- How often patients visit their pharmacy
Correct answer: Whether patients take medicines as prescribed; poor adherence reduces therapeutic efficacy and increases disease complications
Medication adherence refers to how consistently a patient takes medicines as prescribed. Poor adherence is a major cause of treatment failure, disease progression, and preventable hospital admissions.
GPhC Patient Safety & Clinical Pharmacy 4
According to NICE, what is the first-line pharmacological treatment for osteoporosis in post-menopausal women?