Clinical Therapeutics & BNF Guidelines Flashcards

Which anticoagulant does NOT require routine monitoring of anticoagulant effect?

Answer: Apixaban

Direct oral anticoagulants (DOACs) like apixaban have predictable pharmacokinetics and do not require routine anticoagulation monitoring unlike warfarin (INR) or heparin (APTT).

A patient on atorvastatin develops severe muscle pain and dark urine. What is the most likely diagnosis?

Answer: Rhabdomyolysis

Severe myopathy progressing to rhabdomyolysis is a rare but serious statin side effect. Dark urine (myoglobinuria) with muscle pain should prompt urgent CK measurement and statin cessation.

Which drug used in COPD exacerbations is a short-acting beta-2 agonist?

Answer: Salbutamol

Salbutamol is a short-acting beta-2 agonist (SABA) used as rescue bronchodilator in COPD and asthma exacerbations due to rapid onset of action.

What is the target INR range for a patient with atrial fibrillation on warfarin?

Answer: 2.0–3.0

The target INR for AF anticoagulation with warfarin is 2.0–3.0. Higher ranges (3.0–4.5) are used for mechanical heart valves.

Which drug is used to reverse the effects of paracetamol overdose?

Answer: N-acetylcysteine (Parvolex)

N-acetylcysteine (NAC) replenishes glutathione, preventing accumulation of NAPQI (the toxic paracetamol metabolite) and treating hepatotoxicity in overdose.

According to NICE, which drug is first-line for treating acute migraine attacks?

Answer: Triptans (e.g., sumatriptan) or analgesics + antiemetic

NICE recommends a triptan combined with an NSAID or paracetamol plus an antiemetic for acute migraine. Opioids are not recommended due to risk of medication overuse headache.