Clinical Therapeutics & BNF Guidelines Flashcards

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

Answer: Metformin

NICE recommends metformin as first-line pharmacotherapy for type 2 diabetes, provided renal function is adequate (eGFR ≥30 mL/min/1.73m²).

The BNF recommends stopping which drug at least 48 hours before iodine-containing contrast media in patients with eGFR <60?

Answer: Metformin

Metformin should be withheld before iodinated contrast to prevent contrast-induced nephropathy potentially leading to lactic acidosis due to reduced renal clearance.

Which antihypertensive is recommended as first-line for a 55-year-old Caucasian patient without diabetes?

Answer: Amlodipine (calcium channel blocker)

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.

Which antibiotic is first-line for uncomplicated lower urinary tract infection in women according to NICE?

Answer: Nitrofurantoin

NICE recommends nitrofurantoin as first-line for uncomplicated UTI in women (if eGFR ≥30). Trimethoprim is an alternative if local resistance rates are acceptable.

A patient taking warfarin is prescribed clarithromycin. What interaction should you counsel about?

Answer: Increased INR and bleeding risk

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

Which NSAID is associated with the lowest cardiovascular risk according to current evidence?

Answer: Naproxen

Naproxen is generally considered to have the lowest cardiovascular risk among NSAIDs due to its platelet inhibitory effects resembling aspirin, though GI risk remains.