Clinical Therapeutics & BNF Guidelines Flashcards

Which inhaler technique error is most common with a pressurised metered-dose inhaler (pMDI)?

Answer: Inhaling too fast

Inhaling too fast is the most common critical error with pMDIs. The aerosol requires a slow, steady inhalation to ensure deep lung deposition.

According to BNF, which medication should be avoided in patients with eGFR <30 mL/min/1.73m²?

Answer: Metformin

Metformin is contraindicated when eGFR <30 due to the risk of lactic acidosis from drug accumulation in renal impairment.

What is the recommended duration of dual antiplatelet therapy after a drug-eluting coronary stent?

Answer: 12 months

NICE and cardiology guidelines recommend 12 months of dual antiplatelet therapy (aspirin + P2Y12 inhibitor) following drug-eluting stent insertion to prevent stent thrombosis.

Which opioid analgesic has the highest oral bioavailability?

Answer: Methadone

Methadone has oral bioavailability of approximately 80–95%, significantly higher than morphine (~35%), making it effective orally. It also has a long half-life.

A patient with atrial fibrillation and a CHA₂DS₂-VASc score of 2 (male) should receive:

Answer: Anticoagulation with apixaban or warfarin

NICE recommends anticoagulation for males with CHA₂DS₂-VASc ≥2. A score of 2 warrants anticoagulation with a DOAC (e.g., apixaban) or warfarin.

Which drug class is first-line for preventing recurrent gout attacks?

Answer: Xanthine oxidase inhibitors (allopurinol)

Allopurinol (xanthine oxidase inhibitor) lowers uric acid production and is the mainstay of long-term urate-lowering therapy to prevent recurrent gout.